Came across my notes from a December 2001 conference I attended where various national health policy leaders spoke to members of the California Association of Public Hospitals. 

It was the darkly nervous days after 9/11. The conference's most pointed presenter was Dr. David Himmelstein, who is still professor of medicine at Harvard Medical School and backer of a single-payer universal coverage health system.

I wondered, were his insights accurate as I jotted them back then, and what about seven years later?

• Financial suffering is part of the dying process.
• We have de-facto health rationing. One-third of Americans are inadequately insured and die prematurely.
• The uninsured don't use more care than anyone else, they just use it in the ER because they can't access it elsewhere.
• The death risk for the poor is higher under managed care than under fee-for-service medicine.
• Managed care sends stroke patients to nursing homes for warehousing rather than more expensive rehab facilities.
• Large numbers of uninsured work for health providers.
• 80% of time spent at a doctor's office focuses on dismissing a medical problem while 20% is to ascertain the psychosocial problems a patient really has -- that last component is why you really need the physician.
• Unnecessary surgery is assault and battery -- going after someone with a knife for financial gain.

One other note caught my eye, coming from Dr. David Lawrence, now retired chair and CEO of Kaiser Foundation Health. 

There's still a deep-seated belief, he said, that when you're sick, it's your own damned fault. In reality, he said, it's an accident, genetics or where you walked. And this needs to hit home to the middle class.

Maybe I heard them wrong. Maybe they were accurate then or wrong then. What about now? What do you think?