US Healthcare Policy

[Michael]

Well it sure looks like the 'kabuki' dance is in full swing in Washington. Seems like a majority of the efforts and energies invested into the issue of healthcare in Washington seem to be all focused upon how to pass a comprehensive healthcare policy that will look like a major reform policy, but essentially just maintain the status quo - thus fooling those who are in favor of such a policy and satisfying the healthcare industry's desire to maintian the status quo.

But critics argue that with low administrative costs and no need to produce profits, a public plan will start with an unfair pricing advantage. They say that if a public plan is allowed to pay doctors and hospitals at levels comparable to Medicare's, which are substantially below commercial insurance rates, it could set premiums so low it would quickly consume the market.

NYTimes (http://www.nytimes.com/2009/06/07/health/policy/07plan.html)

Indeed. Apparently any policy that actually seeks to address the fact that some 40 to 50 million Americans don't have any medical insurance is inherently "unfair" to the private healthcare marketing industry.

This reminds me of how the government's proposed changes to the administration of student loans is also "unfair" to the private companies who make millions in profits by administering the program on behalf of the government.

Seems that US healthcare industry considers their 'right' to make profits is more important than anyone's interest in healthcare services.

I'm wondering how much 'profit' the US healthcare industry could make if one removed all the tax subsidies, tax credits and monopoly enforcing rules that are apparently 'necessary' to support this 'free market' in healthcare that Americans like to brag about?

The 'tax-exempt' status of employer provided healthcare is the single largest tax subsidy provided annually by the US government. This is even bigger than the US government tax-subsidy for private mortgages, or the US government tax-subsidy for investing in the stock market.

This is of course beside the point of why the US government feels that tax-subsidies are so necessary for private markets to function.

[Americano]

Several individual US states are moving towards universal health care legislation, much to the chagrin of of private health care insurers, and I think due to political dissension at the federal level this is the only viable path to an eventual national program.

My state started the initial feasibility studies several years ago due to rising health care insurance costs in the public sector. It was estimated in initial projections that those costs would break the state by 2014 at their rate of expansion. Our state public coverage is similar to federal agencies, cradle to grave, no caps and either token or no co-pays. Oversight will be provided by a non-profit composed of members of the university system and private employers with state administration reporting to that body, not the legislature.

Until US tort laws are modified to keep the huge school of hungry shark lawyers from feeding on the current system, I don't see a viable national system ever containing costs or providing quality universal health care.

[Michael]

What really disturbs me about the healthcare debate in the US is that the US mass media doesn't seem to cover the issue at all. I generally follow this issue fairly closely and have been doing so for many years, yet most people don't have much of an idea what is in any of the dozen various healthcare proposals that are on the table - and probably won't.

The US media seems to be really only interested in the 'horserace' issue of which faction is most likely to influence the end result - and/or the internal politics of any proposed bill's passage. These seem to be the ONLY aspects of the healthcare issue that get regular and timely coverage.

In other words, if half as many words were spent on actually discussing the issue as are spent on predicting the probability of passage of any given plan, I think the quality of the debate would be improved.

That being said, the only thing more disfunctional than the media appears to be Congress itself. Knowledgable analysis of the failure of Bill Clinton's rather admirable healthcare initiative back in 1993 says that the bill died because it ruffled too many big egos in Congress. The Clinton White House created the plan and presented it to Congress for their consideration - but apparently this is NOT how things are done in Washington so Congress threw a hissy fit and the President's own party allies effectively killed the bill.

This time, the Obama Administration is trying the opposite tact. They have only made a broad statement of principle that they'd like to see a healthcare policy bill passed and suggested that Congress ought to do that. So that's what's happening now - various members of Congress, or Committees of Congress are engaged in creating various national healthcare policy proposals. There are literally more than a dozen of them out there flooding the market with various competing ideas to preserve the status quo.

If any rationaly coherent policy comes out of that corporate-lobby-funded meatgrinder that doesn't have enough loopholes to drive an HMO through, I'll eat my hat.

The US has two very large problems with healthcare as I see it:

1) US healthcare costs are roughly double the cost found anywhere else and the rate of US healthcare cost inflation is higher than anywhere else - or any other sector of the US economy.

2) A substantially large minority of US citizens cannot afford the cost of healthcare and cannot get healthcare insurance and thus, in many cases, are forced to go without healthcare.

The result of this is that the US population scores comparatively low in almost every comparison of public health with other western nations. This, at the very least, makes a mockery of the claim that the present US healthcare system is the best healthcare system in the world. It just isn't.

It is to be noted that no plan presently being considered by Congress actually addresses BOTH problems in any substantial way.

I respectfully submit that the key problem is NOT the unavailability of private healthcare insurance for poor people or the unavailablity of private healthcare insurance for unhealthy people. These are only symptoms of the actual issue that US private healthcare is really, really expensive and just about everything about the US healthcare system has the essential characteristic of driving the price up higher and higher over time, thus denying the services to more and more people over time.

Any proposed healthcare policy that is not entirely focused upon the skyrocketing costs of the US healthcare sector is thus doomed to fail. Of course, given the influence of the healthcare lobby in Congress, any proposed healthcare policy that aims to control or reduce the cost of healthcare is also doomed to fail.

And that's the present status of the US healthcare 'debate' in my assessment. Not very pretty. The White House seems entirely powerless to control the process. Congress insists on controlling the process, yet they are functionally incapable of doing anything about the problem since they are the ones who have worked the hardest to create the problem in the first place. US healthcare is expensive because of the historical policies enacted by the US Congress make it that way. The foxes rule the hen-house there.

So how does one get out of the deadlock? That's the tricky question. The Obama Administration seems to be trying the 'fingers crossed' technique. I'm not very confident of that approach.

[Lily]

I wish I had all the answers. I don't. But, I do see the problems every single day in the ER. An example: a 70-year old woman presented with a pinky finger that she had injured two weeks prior. She told the triage nurse that her primary care physician (PCP) had ordered xrays, they had been taken, had shown a small fracture and that she had been referred to an orthopaedic doctor. Her complaint? She couldn't see the ortho for another week, her finger hurt, so her PCP told her to come to the ER. That office had told her they would arrange to send her xrays to the ER. Of course, they never arrived.

Our ER doctor ordered another set of xrays. Yes, there was a very small fracture. We gave her a splint (one that someone could buy in Walgreens for a couple of dollars), gave her a script for Ibuprofen and a referral to another ortho and sent her on her way. In the best scenario, the ortho will do nothing but tell her to continue to wear the splint, take ibuprofen for pain, and that would be the end of it. But, this one ordeal had costs in the thousands.

In my opinion, here's what should have happened: the woman visits her PCP, the doctor examines the finger, tells her she may or may not have a small fracture, (may or may not order an xray, depending on the deformity -- there was none) gives her an aluminum splint (or directs her to Walgreens), tells her to take Ibuprofen and tells her it's going to hurt for a few weeks. Don't use the finger. End of story. But, because of the fear of lawsuits, the PCP orders an xray and refers her to an ortho. Because this woman was not educated on how these small digit fractures are truly treated or what to expect, she thinks "something is wrong" and calls the doctor again. The doctor sends her to the ER. Because the hospital is afraid of a lawsuit or wants to increase revenue (take your pick), she is xrayed again, and again sent to an ortho. Who knows what this ortho will do? He may actually put her in a cast for a few weeks. He will most likely xray her again, not trusting the hospital's xray since it is now a week old, or wanting to increase his own revenue or avoid a lawsuit.

The bottom line? Her outcome would most likely be no different had her PCP taken the correct action on the first visit, but since he or she did not, the cost of the women's care skyrocketed with little to show for it.

This is healthcare in America.

[Michael]

I wish I had all the answers. I don't. But, I do see the problems every single day in the ER.

...

The bottom line? Her outcome would most likely be no different had her PCP taken the correct action on the first visit, but since he or she did not, the cost of the women's care skyrocketed with little to show for it.

This is healthcare in America.

Yes this is exactly what I'm getting at regarding the cost of healthcare. Because of these types of situations, the overall cost of healthcare rises to horrific levels and it is the horrific costs of providing healthcare that causes private health insurance companies to charge high such rates that prevent poor people (and/or risky health people) from being able to get/afford healthcare insurance.

Thus, to me, the key issue that needs 'reform' in US healthcare is to address the overall cost issues (and the way they are climbing so fast).

I think the most efficient and effective way to deal with that problem is to adopt a 'single-payer' system, but unfortunately, that would require enormous changes to how the US does healthcare and that's not going to happen. The political barriers to this are enormous.

Since 'single-payer' is off the table completely, I'm curious what kind of ideas people here have to actually address the whole 'cost' issue with healthcare?

[Michael]

The only idea/recommendation I have for the discussion is twofold.

1. Some kind of public-option healthcare insurance needs to be established to address the failure of the private market to provide an essential service to certain segments of the population.

2. The model for this ought to be the already established Medicare and/or Veteran's Administration healthcare networks. Both of these institutions work remarkably well, with decades of experience, and both of them outperform the rest of the US healthcare sector in cost efficiency without sacrificing quality of care (measured by comparative statistical outcomes). It is particularly notable that both of these institutions are dealing with higher than average cost healthcare 'customers' (old people and veterans).

That is to say, I think the US has the infrastructure already existing to be able to 'ramp up' a robust public option that can or could compete in the private market - even though it would suffer 'dumping' from the private insurance companies.

The key to getting control of US healthcare costs is to get the big buyers to act like big buyers for mass purchases - and to combine those big buyers (Medicare and VA) for even more market power.

[The Drunk Guy]

The only idea/recommendation I have for the discussion is twofold.

1. Some kind of public-option healthcare insurance needs to be established to address the failure of the private market to provide an essential service to certain segments of the population.

2. The model for this ought to be the already established Medicare and/or Veteran's Administration healthcare networks. Both of these institutions work remarkably well, with decades of experience, and both of them outperform the rest of the US healthcare sector in cost efficiency without sacrificing quality of care (measured by comparative statistical outcomes). It is particularly notable that both of these institutions are dealing with higher than average cost healthcare 'customers' (old people and veterans).

That is to say, I think the US has the infrastructure already existing to be able to 'ramp up' a robust public option that can or could compete in the private market - even though it would suffer 'dumping' from the private insurance companies.

The key to getting control of US healthcare costs is to get the big buyers to act like big buyers for mass purchases - and to combine those big buyers (Medicare and VA) for even more market power.
Medicare pays the lowest. So low that some PCPs won't even except Medicare. In my industry, we love Medicare because, even at it's ridiculously low rate (nearly half of what it would cost the patient outright), we're still making a fortune. So, it is my argument that the private insurances are ridiculously expensive because medical procedures and treatments are ridiculously expensive.

I went to the ER last year to have my hand Xrayed. There was no fracture, but I got a tetnus shot and a pain pill and was sent packing. I saw one LPN who gave me the pill and shot, one Nurse Practioner to ordered the Xray, and the lab tech who gave me the Xray. Each person was in my presence for a maximum of ten minutes each. The bill I received afterward was nearly $3000. :eek: Luckily, I received my pre-dated insurance card just after my visit. Later, I was issued an EOB (explantion of benefits) letter from Humana detailing what they payed out on my behalf...less than $700.

The way I understand it, the system requires care providers to draw up contracts with insurance agencies. These contracts require price negotiation from the care provider in exchange for "network" status and referrals from the insurance. For the care provider to make the maximum profit, they shoot their "base rate" prices through the roof so that the insurance agencies feel that they are getting fantastic deals. Meanwhile, Medicare keeps coming along declaring what is a reasonable cost, sending care providers into uproar.

[Michael]

Yes, the US healthcare market is very complex and is full of all kinds of perverse 'incentives' for escalating prices.

One issue that tends to show this in stark relief is the price of pharmaceutical drugs. Medicare (for example) is legally banned from using its mass-market power when negotiating bulk purchase pricing with pharmaceutical companies.

Canada's 'government monopoly' healthcare insurance companies (one for each Province) of course routinely negotiate bulk purchase pricing with pharmaceutical companies. As a general rule, pharmaceutical products are thus about half the price in Canada as they are in the USA.

Surprisingly enough, Canada has a healthy pharmaceutical industry sector - and is a fairly big exporter of both branded name drugs and off-patent generics.

[Michael]

Wal-Mart Says It Backs a Mandate on Insurance

WASHINGTON — Wal-Mart, the nation’s largest private employer, joined hands with a major labor union Tuesday to endorse the idea of requiring large companies to provide health insurance to their workers, a move that gives a boost to President Obama as he is pushing for health legislation on Capitol Hill.

Source - NYTimes (http://www.nytimes.com/2009/07/01/health/policy/01health.html?_r=1)

Wow! This is HUGE news and a big boon for Obama's healthcare initiative that has been running an uphill behind the scenes battle in Congress.

[Lily]

That is huge news. We have four Wal-Mart stores in our hospital's range of service and we see so many of their workers who are not insured. Many of them work full-time hours but are still considered part-time workers, thus ineligible for health insurance. If Wal-Mart is willing to get on board, that will really help President Obama.

I don't know if anyone caught the President's town hall meeting on healthcare today, but one issue I found very interesting was "defensive medicine." I see this all the time in the ER. Physicians will order tests for even the simpliest complaint to avoid risking being caught on the bad end of a lawsuit. An example: we've had a run of nausea/vomiting/diarrhea lately. The great majority of the patients end up with a diagnosis of "gastroenteritis," basically a stomach virus. Antibiotics are useless and oral rehydration is recommended. The condition usually resolves within a few days without treatment. But here's what routinely happens: the patient gets an IV, blood tests, a CT scan with contrast of the abdomen and pelvis, IV fluids, medicine for pain, medicine for nausea and is usually sent home on some kind of anitibiotic. ER stay is generally 4-5 hours. Cost is in the thousands.

Why? Two reasons. First, the doctors want to cover all the bases to avoid anything coming back on them. Second, the patients want an instant cure. ERs are the drive-through MacDonalds of healthcare. The patients do not want to be sent away with nothing. They want the tests, they want the meds, they want the scripts.

We need to educate the public and we need to do something to protect doctors from unfounded lawsuits. That's my take on it.

[Michael]

That is huge news. We have four Wal-Mart stores in our hospital's range of service and we see so many of their workers who are not insured. Many of them work full-time hours but are still considered part-time workers, thus ineligible for health insurance. If Wal-Mart is willing to get on board, that will really help President Obama.

I don't know if anyone caught the President's town hall meeting on healthcare today, but one issue I found very interesting was "defensive medicine." I see this all the time in the ER. Physicians will order tests for even the simpliest complaint to avoid risking being caught on the bad end of a lawsuit. An example: we've had a run of nausea/vomiting/diarrhea lately. The great majority of the patients end up with a diagnosis of "gastroenteritis," basically a stomach virus. Antibiotics are useless and oral rehydration is recommended. The condition usually resolves within a few days without treatment. But here's what routinely happens: the patient gets an IV, blood tests, a CT scan with contrast of the abdomen and pelvis, IV fluids, medicine for pain, medicine for nausea and is usually sent home on some kind of anitibiotic. ER stay is generally 4-5 hours. Cost is in the thousands.

Why? Two reasons. First, the doctors want to cover all the bases to avoid anything coming back on them. Second, the patients want an instant cure. ERs are the drive-through MacDonalds of healthcare. The patients do not want to be sent away with nothing. They want the tests, they want the meds, they want the scripts.

We need to educate the public and we need to do something to protect doctors from unfounded lawsuits. That's my take on it.

From all the data I read, "defensive medicine" (doctors more concerned about lawsuits than patient care) costs the US healthcare system several times as much money as the malpractice lawsuits they seek to avoid.

And malpractice lawsuits are a really big red herring here. Statistically speaking, US has only a slightly higher rate of malpractice lawsuits compared with Canada or Australia and all three are well within the 'norm' for this in comparison with European countries (yes, they do have malpractice lawsuits too).

Last numbers I saw showed the cost of malpractice suits in the USA constituted about 0.6% of US healthcare costs (Canada is 0.45% for comparison).

In other words, the fear of malpractice lawsuits is being used to pump the system for extra profits from all the unnecessary procedures being ordered.

[Lily]

From all the data I read, "defensive medicine" (doctors more concerned about lawsuits than patient care) costs the US healthcare system several times as much money as the malpractice lawsuits they seek to avoid.

And malpractice lawsuits are a really big red herring here. Statistically speaking, US has only a slightly higher rate of malpractice lawsuits compared with Canada or Australia and all three are well within the 'norm' for this in comparison with European countries (yes, they do have malpractice lawsuits too).

Last numbers I saw showed the cost of malpractice suits in the USA constituted about 0.6% of US healthcare costs (Canada is 0.45% for comparison).

In other words, the fear of malpractice lawsuits is being used to pump the system for extra profits from all the unnecessary procedures being ordered.

That may be true, but I work day-to-day with these physicians, nurse practioners and physician assistants. I hear what they say. They are afraid of lawsuits and they do order tests as a result of those fears. Some of them have already been sued. For a young practioner looking to move up the ladder, a lawsuit on their record does not look good during the credentialing process at a new facility. And while the the numbers of lawsuits may be small statistically, the costs of malpractice insurance is large on top of student loans, especially when you do get sued.

[Michael]

As far as I understand the 'problem' with US healthcare is that it is twofold.

On the one hand, there is the 'problem' with some 40-50 million Americans not having or not being able to afford healthcare insurance.

The second big issue with US healthcare is the fact that healthcare in the USA tends to cost twice as much as anywhere else (with Americans scoring lower on most comparative health measures). Essentially, Americans are paying twice as much for healthcare as anyone else and getting less actual healthcare for the money spent.

I think the only solution to the first is a 'public option'. I don't think there's much to debate about that.

The real issue, and by far the more important one is the astronomical cost of healthcare in the USA (and the fact that healthcare costs have been rising at double-digit inflation rates for a couple of decades now).

In order to address this issue, I think it is important to explore the particular and specific reasons the US system is so massively expensive. Only then can one make a reasonable assessement of the utility of any given reform measure proposed by Congress.

And to that end, here's an exerpt from Erza Klein's healthcare policy blog...

The best way to drive down "medical-loss," explains Potter, is to stop insuring unhealthy people. You won't, after all, have to spend very much of a healthy person's dollar on medical care because he or she won't need much medical care. And the insurance industry accomplishes this through two main policies. "One is policy rescission," says Potter. "They look carefully to see if a sick policyholder may have omitted a minor illness, a pre-existing condition, when applying for coverage, and then they use that as justification to cancel the policy, even if the enrollee has never missed a premium payment."

And don't be fooled: rescission is important to the business model. Last week, at a hearing before the House Subcommittee on Oversight and Investigation, Rep. Bart Stupak, the committee chairman, asked three insurance industry executives if they would commit to ending rescission except in cases of intentional fraud. "No," they each said.

Potter also emphasized the practice known as "purging." This is where insurers rid themselves of unprofitable accounts by slapping them with "intentionally unrealistic rate increases." One famous example came when Cigna decided to drive the Entertainment Industry Group Insurance Trust in California and New Jersey off of its books. It hit them with a rate increase that would have left some family plans costing more than $44,000 a year, and it gave them three months to come up with the cash.

The issue isn't that insurance companies are evil. It's that they need to be profitable. They have a fiduciary responsibility to maximize profit for shareholders. And as Potter explains, he's watched an insurer's stock price fall by more than 20 percent in a single day because the first-quarter medical-loss ratio had increased from 77.9 percent to 79.4 percent.
Source (http://voices.washingtonpost.com/ezra-klein/2009/06/the_truth_about_the_insurance.html)

That suggests that 20% of the cost of US healthcare insurance is bureaucracy and profits for the private healthcare insurance sector.

That's a big chunk of change.

And here's another big factor influencing the high cost of healthcare...

oday many Americans have few choices when it comes to health insurance. This is because many insurance markets are dominated by only a handful of firms, even though there are over 1,000 private health insurance carriers in the United States. This concentration limits employers’ and families’ health insurance options as well as the care they receive.

In many states small insurers compete against one another in the individual market to insure only low-risk, healthy individuals. They refuse to insure Americans with pre-existing conditions such as high blood pressure, asthma, cancer, or diabetes and those who have ever taken certain prescription drugs—and they create barriers to needed care for those who are insured.

The map shows that in many states insurance markets are dominated by only one or two insurance carriers. In at least 21 states, one carrier controls more than half the market. More than half of the market is controlled by two carriers in at least 39 states. In 2007, a survey conducted by the American Medical Association found that in more than 95 percent of insurance markets, a single commercial carrier controlled at least 30 percent of the insurance market.[1]

The result of this market concentration is that health insurance interests come before Americans’ health care needs. Where markets are dominated by only a few firms, health insurers revenues are growing faster than health inflation as insurers maximize rates they charge employers and families and create barriers to care.[2] Employers are then unable to afford meaningful health insurance options for their employees or, in the case of small businesses, are unable to offer their employees insurance at all, while most Americans seeking health insurance in the individual market never purchase coverage.
Source (http://www.americanprogress.org/issues/2009/06/health_competition_map.html)

Check out the interactive map that shows which states have monopolies and which have some competition. Do you notice how the small states with the strongest 'monopoly' healthcare insurance industry are the same State Senators that are the most aggressive opponents of healthcare reform?

Suffice it to say that the glorious 'free market' in American healthcare doesn't actually exist outside of rightwing propaganda and healthcare lobbyists.

[Michael]

That may be true, but I work day-to-day with these physicians, nurse practioners and physician assistants. I hear what they say. They are afraid of lawsuits and they do order tests as a result of those fears. Some of them have already been sued. For a young practioner looking to move up the ladder, a lawsuit on their record does not look good during the credentialing process at a new facility. And while the the numbers of lawsuits may be small statistically, the costs of malpractice insurance is large on top of student loans, especially when you do get sued.

I don't doubt that doctors are genuinely afraid of malpractice lawsuits. I'm just pointing out that malpractice lawsuits, contrary to common beliefs, represent only a tiny fraction of the US healthcare sector and thus, this fear is disproportionate to its effect.

I'd suspect the malpractice insurance companies of fostering this belief in doctors since it is very profitable to them to do so.

And the point I'm making here is, lets look at the REAL actions that are causing US healthcare costs to skyrocket. Malpractice lawsuit settlements certainly isn't one of them. The super high cost of malpractice insurance is one of them though. ;)

[Lily]

I don't doubt that doctors are genuinely afraid of malpractice lawsuits. I'm just pointing out that malpractice lawsuits, contrary to common beliefs, represent only a tiny fraction of the US healthcare sector and thus, this fear is disproportionate to its effect.

I'd suspect the malpractice insurance companies of fostering this belief in doctors since it is very profitable to them to do so.

And the point I'm making here is, lets look at the REAL actions that are causing US healthcare costs to skyrocket. Malpractice lawsuit settlements certainly isn't one of them. The super high cost of malpractice insurance is one of them though. ;)

Exactly. The cost of malpractice insurance has driven some physicians out of practice, especially in the area of OB. Two metro hospitals shut down their OB units in the past five years here and that has put a huge strain on community resources. However, for physicians, even a lawsuit that goes nowhere relfects badly on a physician's record now that those records can be accessed on the internet by potential patients. Hospital credentialing boards shy away from any physician who has been sued for any reason, justified or not. It's a real problem and keeps good physicians out of good hospitals.

[Lily]

As far as I understand the 'problem' with US healthcare is that it is twofold.

On the one hand, there is the 'problem' with some 40-50 million Americans not having or not being able to afford healthcare insurance.

The second big issue with US healthcare is the fact that healthcare in the USA tends to cost twice as much as anywhere else (with Americans scoring lower on most comparative health measures). Essentially, Americans are paying twice as much for healthcare as anyone else and getting less actual healthcare for the money spent.

I think the only solution to the first is a 'public option'. I don't think there's much to debate about that.

The real issue, and by far the more important one is the astronomical cost of healthcare in the USA (and the fact that healthcare costs have been rising at double-digit inflation rates for a couple of decades now).

In order to address this issue, I think it is important to explore the particular and specific reasons the US system is so massively expensive. Only then can one make a reasonable assessement of the utility of any given reform measure proposed by Congress.

And to that end, here's an exerpt from Erza Klein's healthcare policy blog...


Source (http://voices.washingtonpost.com/ezra-klein/2009/06/the_truth_about_the_insurance.html)

That suggests that 20% of the cost of US healthcare insurance is bureaucracy and profits for the private healthcare insurance sector.

That's a big chunk of change.

And here's another big factor influencing the high cost of healthcare...


Source (http://www.americanprogress.org/issues/2009/06/health_competition_map.html)

Check out the interactive map that shows which states have monopolies and which have some competition. Do you notice how the small states with the strongest 'monopoly' healthcare insurance industry are the same State Senators that are the most aggressive opponents of healthcare reform?

Suffice it to say that the glorious 'free market' in American healthcare doesn't actually exist outside of rightwing propaganda and healthcare lobbyists.

You've hit the nail on the head. One doesn't have to look too far to find a horror story about some woman who is denied life-saving cancer surgery because she "failed" to disclose some small detail on a health insurance application five years prior. Rescission is the insurance industry's dirty little secret and a practice that must change.

Free market healthcare is a joke in some places, as you've pointed out. Where there is no real competition, there is no real choice. No wonder some of these lawmakers and insurance companies are afraid of a little competition from a medicare-like plan.

[Michael]

Rescission is the insurance industry's dirty little secret and a practice that must change.
As far as I'm concerned, this is the entire argument in favor of single payer.

Peace of mind.

In my entire life, I've never given a single thought to the issue of medical expenses. And I know that no one can take that away from me. That issue just doesn't exist. That's the biggest advantage of a universal healthcare system.

[Lily]

I'd very much like to see Americans to be able to keep their health insurance if they lose their jobs. Yes, we do have COBRA, but it's very limited. First, the cost is prohibitive for many and, second, the benefits last only 18 months.

Personally, if I had a portable plan that didn't cost nearly $500 a month (that's the cost of COBRA; private insurance at my age would be higher), I would not be working full-time at my present job. In nursing, burn-out is a big problem; in the ER, that burn-out happens sooner than in any other type of nursing. If I had an affordable, portable plan, I would be working pool at a couple of different hospitals.

[Lily]

House Democrats have released details of their health care plan today. Here are some of those details:

• A Health Insurance Exchange providing individuals and small business with choices for coverage, including a government-funded public option.

• No more coverage exclusion for pre-existing conditions.

• Affordability credits for low- and moderate-income individuals and families, available to those with incomes up to 400 percent of the federal poverty level, or $43,000 for individuals or $88,000 for a family of four.

• Limits on annual out-of-pocket spending.

• Expanded Medicaid coverage to individuals and families with incomes at or below 133 percent of the federal poverty level.

• Required participation by individuals, with a penalty of 2.5 percent of adjusted gross income for non-compliance.

• Requirement that businesses with payrolls exceeding $250,000 provide their employees with health coverage or contribute up to 8 percent of their payroll on their behalf.

• A series of measures intended to reduce costs of Medicaid, Medicare and other existing systems.

Source (http://www.cnn.com/2009/POLITICS/07/14/house.health.care/index.html)

[Michael]

That's not bad. The devil is always in the details of course, and that still has to get through the Senate, but on the whole, that looks surprising robust. :thumbsup:

[Michael]

The Cato Institute, which is normally one of the few 'sane' think-tanks on the right has gone overboard with a new healthcare plan to solve all the problems.

Cato Plan (http://www.cato.org/pubs/pas/pa-633.pdf)

Apparently the folks at Cata think that all public and employer healthcare insurance plans ought to be eliminated and individuals should all be forced to buy private insurance (with no regulations).

To address the problem of insurance companies cancelling coverage when you get sick or old (precisely when you need the insurance coverage), Cato recommends you take out 'insurance' on your insurance to prevent that.

Simply brilliant. Because private healthcare insurance doesn't actually work, make people buy more insurance against the failure of their insurance!

Gotta wonder who pays these people to pump out this kind of shit. :ummm:

[The Drunk Girl]

In nursing, burn-out is a big problem; in the ER, that burn-out happens sooner than in any other type of nursing. If I had an affordable, portable plan, I would be working pool at a couple of different hospitals.

I have seen that quite a bit while working in nursing homes. Being at the bottom of the totem pole as a CNA you tend to get shit on a lot. We're expected to be the eyes and ears for these patients/residents, but what we say goes overlooked quite a bit, and it is usually due to the paperwork the nurses don't want to fill out. I don't know how many times, myself and others have said "such and such has a UTI" or report a behavior that goes "overlooked" until it is too late.

Where I work, a large majority of the residents are private-pay. There are a few cases where we will get someone that relies fully on Medicare and/or Medicaid, but they usually only stay 30 days or so, and the facility really doesn't "like" those who do. Evidently, the facility has to pay for doctor's appointments, surgeries, etc. for those who are on Medicare/Medicaid. They are reimbursed up to a certain amount and sometimes wind up actually losing money in the process.

I find it sad when looking at some of these old folks. They have worked hard their whole lives and are terribly worried about their care and how it is going to be paid for (well at least the ones that are still with it ;) ). One little man, who is as sweet as can be, had been in the home last fall with his wife. She was on a bi-pap and O2 and he ended up in there from wrecking his truck in the drive-way. In a month or so they both went home. A few weeks later, the wife died (I believe she fell and went into shock). Well, Mr. came back and his money started to run out. His lovely POA, a niece, decided to sell his house and all his property just so he could continue staying at the home. All he got was a few pictures and a chair...everything else was sold.

[Americano]

I have seen that quite a bit while working in nursing homes. Being at the bottom of the totem pole as a CNA you tend to get shit on a lot. We're expected to be the eyes and ears for these patients/residents, but what we say goes overlooked quite a bit, and it is usually due to the paperwork the nurses don't want to fill out. I don't know how many times, myself and others have said "such and such has a UTI" or report a behavior that goes "overlooked" until it is too late.

Where I work, a large majority of the residents are private-pay. There are a few cases where we will get someone that relies fully on Medicare and/or Medicaid, but they usually only stay 30 days or so, and the facility really doesn't "like" those who do. Evidently, the facility has to pay for doctor's appointments, surgeries, etc. for those who are on Medicare/Medicaid. They are reimbursed up to a certain amount and sometimes wind up actually losing money in the process.

I find it sad when looking at some of these old folks. They have worked hard their whole lives and are terribly worried about their care and how it is going to be paid for (well at least the ones that are still with it ;) ). One little man, who is as sweet as can be, had been in the home last fall with his wife. She was on a bi-pap and O2 and he ended up in there from wrecking his truck in the drive-way. In a month or so they both went home. A few weeks later, the wife died (I believe she fell and went into shock). Well, Mr. came back and his money started to run out. His lovely POA, a niece, decided to sell his house and all his property just so he could continue staying at the home. All he got was a few pictures and a chair...everything else was sold.

I'll end my life before becoming a veg in a nursing home.

[Americano]

The Cato Institute, which is normally one of the few 'sane' think-tanks on the right has gone overboard with a new healthcare plan to solve all the problems.

Cato Plan (http://www.cato.org/pubs/pas/pa-633.pdf)

Apparently the folks at Cata think that all public and employer healthcare insurance plans ought to be eliminated and individuals should all be forced to buy private insurance (with no regulations).

To address the problem of insurance companies cancelling coverage when you get sick or old (precisely when you need the insurance coverage), Cato recommends you take out 'insurance' on your insurance to prevent that.

Simply brilliant. Because private healthcare insurance doesn't actually work, make people buy more insurance against the failure of their insurance!

Gotta wonder who pays these people to pump out this kind of shit. :ummm:

AIG hoping for a new product?

[Michael]

AIG hoping for a new product?

Looks exactly like the kind of product they'd love. No one would ever expect private healthcare insurance in the US to be canceled when one gets old, sick or injured. That's a sure fire profit maker for AIG! :rolleyes:

That's even more brilliant than insuraning against the housing bubble popping! :rofl:

[partofme]

You guys may frown on me but the company I work for is owned by AIG. We don't offer major medical though. Cancer policies are the closest thing to health insurance we have. It's funny how the company is now issuing new paper work and supplies that no longer say AIG and if you bring it up managers say just to refer to the company as AGLA (American General Life and Accident) and leave out the parent company.

[Americano]

You guys may frown on me but the company I work for is owned by AIG. We don't offer major medical though. Cancer policies are the closest thing to health insurance we have. It's funny how the company is now issuing new paper work and supplies that no longer say AIG and if you bring it up managers say just to refer to the company as AGLA (American General Life and Accident) and leave out the parent company.

AIG's downfall was insuring financially engineered derivatives using assets targeted for inflation, not life or health insurance. I'd think all their many operating divisions are trying to avoid being associated with the corporate name. Many pension plans are in precarious positions due to AIG's blunders and I seriously doubt 'I'm from AIG' would open many doors for you. Actually, knocking on the wrong door with that announcement could endanger your health.

[Lily]

I'll end my life before becoming a veg in a nursing home.

You and me both. No kidding. While modern medicine is truly wonderful in many ways, it has also led to an artifically prolonged life, one that can be worse that death. Hospice is severely underused by the medical profession and that is a shame. They do great work.

[Michael]

Three Cheers for the Hemlock Society! :banana:

[Americano]

I live in the only US state that legally permits physician assisted suicide. The legislation is aptly named Death With Dignity.

[The Drunk Girl]

You and me both. No kidding. While modern medicine is truly wonderful in many ways, it has also led to an artifically prolonged life, one that can be worse that death. Hospice is severely underused by the medical profession and that is a shame. They do great work.

I have to agree with you and Americano on the the nursing home deal. After you see some of the stuff that goes on, it is sad. There are two, current particular cases where they should just let the person go where I am at. But because of the dollar signs they do everything in their power to keep them alive. I have vowed once I get my nursing degree that I would NEVER work in a nursing home.

What are your thoughts on Roxonal? From what I have been told, it's administered to help "aid" in the process of death...

[Americano]

I have to agree with you and Americano on the the nursing home deal. After you see some of the stuff that goes on, it is sad. There are two, current particular cases where they should just let the person go where I am at. But because of the dollar signs they do everything in their power to keep them alive. I have vowed once I get my nursing degree that I would NEVER work in a nursing home.

What are your thoughts on Roxonal? From what I have been told, it's administered to help "aid" in the process of death...

That's an industry brand name for morphine sulfate, one of many opiate derivatives used to relieve extreme pain. As addictive as heroin (same poppies), it's considered convenient and cost effective for people with terminal afflictions as it can be administered orally with almost instant results as versus the injection routine requiring higher paid help.

It doesn't aid in the process of death, it merely puts terminal patients in a semi-comatose state which requires far less staff attention. I've watched family members and a close personal friend in their final days begging for their 'medicine' to relieve the pain.

[The Drunk Guy]

That's an industry brand name for morphine sulfate, one of many opiate derivatives used to relieve extreme pain. As addictive as heroin (same poppies), it's considered convenient and cost effective for people with terminal afflictions as it can be administered orally with almost instant results as versus the injection routine requiring higher paid help.

It doesn't aid in the process of death, it merely puts terminal patients in a semi-comatose state which requires far less staff attention. I've watched family members and a close personal friend in their final days begging for their 'medicine' to relieve the pain.
My understanding is that the dosage is so massive and the coma so deep that the patient's systems begin to shut down once starting a regimen. Sort of a weeks-long "dying in your sleep" scenario.

[The Drunk Girl]

That's an industry brand name for morphine sulfate, one of many opiate derivatives used to relieve extreme pain. As addictive as heroin (same poppies), it's considered convenient and cost effective for people with terminal afflictions as it can be administered orally with almost instant results as versus the injection routine requiring higher paid help.

It doesn't aid in the process of death, it merely puts terminal patients in a semi-comatose state which requires far less staff attention. I've watched family members and a close personal friend in their final days begging for their 'medicine' to relieve the pain.

Well the reason why I was asking goes along with the two residents I was referring to. One has been taking it for a few years now and it's not done much good. She is "out" of it basically with numerous bed sores (I had never seen an artery until I helped a nurse clean and dress one of her wounds) She screams and cries but that is about it.

The other is a multi-millionaire who donated the money to build the library at the school I am attending. From the rumors, I have heard all her money goes to the school when she passes. The kicker is (and not a rumor) her POA is a banker. She has had 2-3 over the years and they get a nice little cut of her estate for every year she hangs on. Needless to say she is to get the best care and receives preferencial treatment over the others. The poor things suffers and all for the greed of others.

[Americano]

Well the reason why I was asking goes along with the two residents I was referring to. One has been taking it for a few years now and it's not done much good. She is "out" of it basically with numerous bed sores (I had never seen an artery until I helped a nurse clean and dress one of her wounds) She screams and cries but that is about it.

The other is a multi-millionaire who donated the money to build the library at the school I am attending. From the rumors, I have heard all her money goes to the school when she passes. The kicker is (and not a rumor) her POA is a banker. She has had 2-3 over the years and they get a nice little cut of her estate for every year she hangs on. Needless to say she is to get the best care and receives preferencial treatment over the others. The poor things suffers and all for the greed of others.

No different than justice being determined by the quality of one's retained legal counsel.

[Americano]

My understanding is that the dosage is so massive and the coma so deep that the patient's systems begin to shut down once starting a regimen. Sort of a weeks-long "dying in your sleep" scenario.

That can last a long time with reduced staff overhead and ongoing revenue. It is a business. I'd think a sharp bottom-line responsible administrator would have those circumstances factored in to operating spreadsheets.

[Lily]

I have to agree with you and Americano on the the nursing home deal. After you see some of the stuff that goes on, it is sad. There are two, current particular cases where they should just let the person go where I am at. But because of the dollar signs they do everything in their power to keep them alive. I have vowed once I get my nursing degree that I would NEVER work in a nursing home.

What are your thoughts on Roxonal? From what I have been told, it's administered to help "aid" in the process of death...

Roxinol? Well, it's an opiod. It depresses respiratory function. It's a pain killer. I don't know much about its use in nursing homes, but if it's used commonly, the patients (especially the frail elderly) would be pretty much gorked out the majority of the time. I can easily see that happening, as the use of such a drug would mean a whole lot of less demanding patients. And because it depresses the respiratory system, it could also mean a whole lot of patients would simply stop breathing in their sleep. Those patients with a DNR would likely not be resuscitated. However, medical restraint is not an appropriate measure in nursing homes, although meds are used, regardless.

I do know that Hospice uses opiods for their patients, with permission. Someone in the death throws of cancer, for instance, would be suffering intractable pain without such a drug. Yes, the opoid may hasten death, but the patient and family are aware of this. I think in these cases, opiods are appropriate.

[Michael]

Pardon my pedantry, but that would be "death throes". ;)

[The Drunk Guy]

Pardon my pedantry, but that would be "death throes". ;)
You know, I've noticed some typos in your work as of late, Mr. English. ;)

[Lily]

Pardon my pedantry, but that would be "death throes". ;)

You're right. I'm mortified. I shall say five Hail e.b. Whites and perform an act of pennants (heh heh).

Go 'Noles!

[Michael]

You know, I've noticed some typos in your work as of late, Mr. English. ;)
Sure and I've never suggested that there wouldn't be. I consider it petty to dwell upon simple spelling/typo mistakes.

I only pointed out that one because it looked like a 'word-error' rather than a simple typo.

You're right. I'm mortified. I shall say five Hail e.b. Whites and perform an act of pennants (heh heh).

Go 'Noles!
An act of pennants? That sounds like a flutteringly good idea! :lol:

[Lily]

Last week I wrote a letter to my Congresswoman stating I supported healthcare reform and suggested, very politely, that if she didn't get behind a bill this year, she might be looking for a new job next year.

Here, in part, was her response:


President Obama has rightly noted that our nation is in this current economic and fiscal crisis because of an inability to make the tough choices. I agree with our new President. However, As Congress debates the twelve annual appropriation bills this month, I find myself thinking about President Obama's words: I believe, so far they have been just that, words.

Talking about making tough choices and actually making them are two very different things. This Member of Congress understands that we can not spend our way out of these economically difficult times. I will continue to fight against out of control spending in Washington.


Talk about out of touch... does her staff even read her mail before sending the automated response?

[The Drunk Guy]

Talk about out of touch... does her staff even read her mail before sending the automated response?Time to get to work, making sure she is looking for a job next year. ;)

Sure and I've never suggested that there wouldn't be. I consider it petty to dwell upon simple spelling/typo mistakes.

I only pointed out that one because it looked like a 'word-error' rather than a simple typo.

You say tomato, I say tomato. Typos come in all shapes and sizes.

[Michael]

Anyone following the issue of how Republicans are trying to ensure that abortions are not covered by any public healthcare plan?

Or how many high-ranking Democrats (including Obama) have indicated that they are taking this very seriously and may go along with it?

This is mind-boggling.

And it takes some serious 'cognitive dissonance' from Republicans to argue that the problem with public healthcare insurance is that it somehow has the government taking healthcare choices away from patients and doctors (which it doesn't actually do), yet at the same time they are campaigning to do exactly that - using government political authority to interfere with private medical decisions between doctors and patients. :ummm:

And the media talking heads treat this kind of partisan duplicity as some kind of respectable principle? :shrug:

[Americano]

Anyone following the issue of how Republicans are trying to ensure that abortions are not covered by any public healthcare plan?

Or how many high-ranking Democrats (including Obama) have indicated that they are taking this very seriously and may go along with it?

This is mind-boggling.

And it takes some serious 'cognitive dissonance' from Republicans to argue that the problem with public healthcare insurance is that it somehow has the government taking healthcare choices away from patients and doctors (which it doesn't actually do), yet at the same time they are campaigning to do exactly that - using government political authority to interfere with private medical decisions between doctors and patients. :ummm:

And the media talking heads treat this kind of partisan duplicity as some kind of respectable principle? :shrug:

The amounts of lobbyist money being waved around and congressional votes up for trade (purchase) has to be beyond comprehension.

[Michael]

The amounts of lobbyist money being waved around and congressional votes up for trade (purchase) has to be beyond comprehension.

Since when has the anti-abortion set depended upon lobbyists and contribution bribery?

I'll admit there is huge amounts of corporate money pouring into anyone who will publicly oppose any healthcare reforms, but this is an entirely different thing. This is just the same old "cave-in to the anti-abortion minority" position that is always so much favored in Washington DC.

[Michael]

At a recent town hall meeting, a man stood up and told Representative Bob Inglis to "keep your government hands off my Medicare." The congressman, a Republican from South Carolina, tried to explain that Medicare is already a government program -- but the voter, Mr. Inglis said, "wasn't having any of it."

It's a funny story -- but it illustrates the extent to which health reform must climb a wall of misinformation. It's not just that many Americans don't understand what President Obama is proposing; many people don't understand the way American health care works right now. They don't understand, in particular, that getting the government involved in health care wouldn't be a radical step: the government is already deeply involved, even in private insurance. And that government involvement is the only reason our system works at all.
Source (http://www.nytimes.com/2009/07/31/opinion/31krugman.html?_r=1&scp=1&sq=Inglis&st=cse)

This is just so true. Medicare and the VA consistently show high level efficiencies in their operations and are generally very popular with their patients. Indeed - studies often show that VA and Medicare patients are the ONLY ones who are truly happy with their healthcare service. Apparently a majority of Americans are unable to comprehend that Medicare and VA are both entirely run by the government.

Healthcare reform is one thing, but fighting against this wall of ignorance, disinformation and outright lies is another thing entirely.

[Lily]

A recent Jon Stewart show aired a clip of a town hall meeting. A woman told Pres. Obama that she had heard that government workers would be sent to elderly folks' homes to ask how they would like to die. Dead serious (no pun intended.) Stewart remarked healthcare reform had a real perception problem when the President had to assure a citizen that the government wasn't going to kill her grandma.

Pres. Obama replied that he didn't believe the government had enough workers to send to all those homes. Maybe not the best time for his dry wit.

Funny, but true.

[partofme]

A recent Jon Stewart show aired a clip of a town hall meeting. A woman told Pres. Obama that she had heard that government workers would be sent to elderly folks' homes to ask how they would like to die. Dead serious (no pun intended.) Stewart remarked healthcare reform had a real perception problem when the President had to assure a citizen that the government wasn't going to kill her grandma.

Pres. Obama replied that he didn't believe the government had enough workers to send to all those homes. Maybe not the best time for his dry wit.

Funny, but true.

:rofl:

[Michael]

Governments are evil and inefficient and ruin everything.

So don't let the Government get anywhere near successful and popular programs like Medicare and/or Social Security.

Allowing government involvement in healthcare will only ruin these programs.

Apparently this is conventional wisdom amongst the US voting public. :ummm:

Scary isn't it?

[Americano]

Governments are evil and inefficient and ruin everything.

So don't let the Government get anywhere near successful and popular programs like Medicare and/or Social Security.

Allowing government involvement in healthcare will only ruin these programs.

Apparently this is conventional wisdom amongst the US voting public. :ummm:

Scary isn't it?

General public stupidity has long been an established fact.

"Nobody's ever gone broke underestimating the intelligence of the general public."

H.L. Mencken

[Michael]

General public stupidity has long been an established fact.
Yes, but there are degrees here.

In Canada for example EVERYONE knows that the government runs our healthcare system. No one pretends that it is magic. Likewise with Canada's Pension Plan (identical program to Social Security) - everyone knows that it is entirely funded by government taxes.

Indeed, voters have a tendency to hold the politicians directly responsible if the healthcare or pension plan system isn't satisfactory.

Seems odd that Americans have this weird notion that Medicare and Social Security are NOT government run programs paid for from tax revenues. That takes some serious cognitive dissonance (or a hell of a lot of propaganda!).

[Americano]

Yes, but there are degrees here.

In Canada for example EVERYONE knows that the government runs our healthcare system. No one pretends that it is magic. Likewise with Canada's Pension Plan (identical program to Social Security) - everyone knows that it is entirely funded by government taxes.

Indeed, voters have a tendency to hold the politicians directly responsible if the healthcare or pension plan system isn't satisfactory.

Seems odd that Americans have this weird notion that Medicare and Social Security are NOT government run programs paid for from tax revenues. That takes some serious cognitive dissonance (or a hell of a lot of propaganda!).

Canada didn't fall for US claims of weapons of mass destruction in Iraq (and was economically punished for same). I blame US general public apathy and ignorance created by propaganda.

[Michael]

Canada didn't fall for US claims of weapons of mass destruction in Iraq (and was economically punished for same). I blame US general public apathy and ignorance created by propaganda.

Actually, "weapons of mass distruction" were irrelevant. USA, China, Russia, France, UK, India, Pakistan and Israel all have lots of them already. Ergo the mere existence of these things isn't an issue at all unless one is playing political games of favortism.

Canada opposed the US invasion of Iraq because that violated the UN Charter. Period.

Canada's official position could not be otherwise.

[Americano]

Actually, "weapons of mass distruction" were irrelevant. USA, China, Russia, France, UK, India, Pakistan and Israel all have lots of them already. Ergo the mere existence of these things isn't an issue at all unless one is playing political games of favortism.

Canada opposed the US invasion of Iraq because that violated the UN Charter. Period.

Canada's official position could not be otherwise.

My point was the apathy and ignorance of US citizens making them susceptible to special interests driving political direction.

[Michael]

My point was the apathy and ignorance of US citizens making them susceptible to special interests driving political direction.

Yes, and that was the point of my reply. ;)

That old "apathy & ignorance" problem. It really does pose an almost impossible task upon rational governance. Clearly it must be considered a 'cultural' issue (or a conspiracy policy by the ruling elite).

[Lily]

Source (http://www.nytimes.com/2009/07/31/opinion/31krugman.html?_r=1&scp=1&sq=Inglis&st=cse)

This is just so true. Medicare and the VA consistently show high level efficiencies in their operations and are generally very popular with their patients. Indeed - studies often show that VA and Medicare patients are the ONLY ones who are truly happy with their healthcare service. Apparently a majority of Americans are unable to comprehend that Medicare and VA are both entirely run by the government.

Healthcare reform is one thing, but fighting against this wall of ignorance, disinformation and outright lies is another thing entirely.


True story. Last night in the ER I had a male patient, 66, telling me how nice my hospital was and how everything was going to be screwed up if "we let that Obama turn our healthcare into socialism."

"You're on medicare, right," I asked? "Medicare is paying for your visit here today. Paying for all your tests?"

"Yeah," he said.

"Medicare is a government-run, taxpayer-funded program. That is socialized medicine," I said.

His eyes just kind of glazed over and I swear I think he started drooling a little bit.

[The Drunk Guy]

True story. Last night in the ER I had a male patient, 66, telling me how nice my hospital was and how everything was going to be screwed up if "we let that Obama turn our healthcare into socialism."

"You're on medicare, right," I asked? "Medicare is paying for your visit here today. Paying for all your tests?"

"Yeah," he said.

"Medicare is a government-run, taxpayer-funded program. That is socialized medicine," I said.

His eyes just kind of glazed over and I swear I think he started drooling a little bit.
I get that shit all the time. My favorite is hearing it from those fucks who have Medicaid as their secondary. Not one, but two forms of socialized medicine and they didn't even have to work for them!

[The Drunk Guy]

Yes, and that was the point of my reply. ;)

That old "apathy & ignorance" problem. It really does pose an almost impossible task upon rational governance. Clearly it must be considered a 'cultural' issue (or a conspiracy policy by the ruling elite).
That's an understatement. Apathy and ignorance have ended the Republic and replaced it with a smoke-and-mirrors styled oligarchy. And anyone who knows what's going on and is pissed off will eventually receive the label of "domestic terrorist," ending all hopes to make change.

This begs the question: how are Canada's immigration laws?

[Lily]

From the "shut the fuck up and sit the fuck down" files, there is this:


Palin: Obama's "Death Panel" Could Kill My Down Syndrome Baby
By Eric Kleefeld - August 7, 2009, 5:36PM

In a new posting on her Facebook account, former Gov. Sarah Palin (R-AK) made a dire statement about health care reform -- that it could result in an Obama-created "death panel" killing her infant son with Down Syndrome:

The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's "death panel" so his bureaucrats can decide, based on a subjective judgment of their "level of productivity in society," whether they are worthy of health care. Such a system is downright evil.

And she pointed Americans' attention to a recent speech by none other than Rep. Michele Bachmann (R-MN), warning of the dastardly involvement of Rahm Emanuel's brother, who is a doctor, in the health care debate:

Rep. Michele Bachmann highlighted the Orwellian thinking of the president's health care advisor, Dr. Ezekiel Emanuel, the brother of the White House chief of staff, in a floor speech to the House of Representatives. I commend her for being a voice for the most precious members of our society, our children and our seniors.

Could this be an early trial balloon for a Palin/Bachmann ticket in 2012?


Source (http://tpmdc.talkingpointsmemo.com/2009/08/palin-obamas-death-panel-could-kill-my-down-syndrome-baby.php?ref=fpa)

[Lily]

If anyone is interested in reading HR 3200, the health care bill, here is link.

http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.txt.pdf

[Michael]

If anyone is interested in reading HR 3200, the health care bill, here is link.

http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.txt.pdf

I would read it and sometimes do read legislation, but that's only the House bill and that one has been just sailing through. Its the Senate where the real horse-trading is going on and then the conference committee has to reconcile the two bills together.

HR 3200 will likely be unrecognizable if/when it were to be signed by Obama in the fall.

[dilettante]

If anyone is interested in reading HR 3200, the health care bill, here is link.

http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.txt.pdf

Wow. 1017 pages. And that's just this document. It doesn't count all the additional text(s) one would have to read to figure out what things like "Section 204 of division B of the Tax Relief and Health Care Act of 2006 (42 U.S.C. 1395b–1 note), as amended by section 133(a)(2) of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110–275), is repealed" actually mean.

These sorts of things make me glad I pay people to deal with legislation on my behalf (even if I'm not always pleased with their performance).

On another note, I have a suspicion that very, very few of all those town hall protesters chanting "read the bill" have slogged through these 1017 pages themselves...

EDIT: In fact, I'm really curious as to how many people have actually, personally, read the entirety of HR 3200. I'm guessing its a three digit number.

[Lily]

Wow. 1017 pages. And that's just this document. It doesn't count all the additional text(s) one would have to read to figure out what things like "Section 204 of division B of the Tax Relief and Health Care Act of 2006 (42 U.S.C. 1395b–1 note), as amended by section 133(a)(2) of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110–275), is repealed" actually mean.

These sorts of things make me glad I pay people to deal with legislation on my behalf (even if I'm not always pleased with their performance).

On another note, I have a suspicion that very, very few of all those town hall protesters chanting "read the bill" have slogged through these 1017 pages themselves...

EDIT: In fact, I'm really curious as to how many people have actually, personally, read the entirety of HR 3200. I'm guessing its a three digit number.

I'm curious as to how many members of the House actually, personally, read the entire bill. Michael's right, though, this bill will be torn to shreds in the Senate.

[Michael]

Leaked Email: CNBC Went To Tea Partiers Looking for Angry Protests

CNBC approached Tea Party activists, looking for angry protest events that would make good television, according to a leaked email from a Tea Party discussion group. And one Tea Bagger responded by flagging an upcoming event that, he said, "should be a riot ... literally."

Yesterday, Tea Party Patriots national coordinator Jenny Beth Martin sent an email, obtained by TPMmuckraker, to a Tea Party google group. Martin told the group: "We have a media request for an event this week that will have lots of energy and lots of anger. This is for CNBC."

She then asked: "So, where are the big events this week and where can TPP best be represented on the news?"

Source (http://tpmmuckraker.talkingpointsmemo.com/2009/08/email_tea_baggers_hoping_for_riot_at_rep_scotts_to .php?ref=fpb)

Gosh, the liberalism of the liberal media always amazes me...

[Michael]

MEET THE MEMBERS OF THE MOB....

The Wall Street Journal had an interesting item today on President Obama's town-hall event in New Hampshire. It noted, among other things, the gathering of protestors outside the event that "verged on a street brawl," with "opposing forces lined up like screaming armies on either side of the street."

One of the protestors, in particular, brought a unique perspective.

Diane Campbell of Kingston, N.H., held a sign with Mr. Obama's face superimposed on a Nazi storm trooper, a sign, she said, that was made by her chronically ill mother.

Her mother's hereditary autoimmune disease is treated with expensive transfusions of gamma globulin, paid for by Medicare. Her sister, Louise, was born with no arms and one leg, and is also covered by Medicare, the government-run, health-insurance program for the elderly and disabled.

"Adolf Hitler was for exterminating the weak, not just the Jews and stuff, and socialism -- that's what's going to happen."

Now, my goal is not to pick on Diane Campbell, whom I do not know. She's quite clearly confused, though, and has come to believe some ridiculous lies. Campbell has apparently been so enraged by the right-wing nonsense she's been told, she feels entirely comfortable going out in public with signs comparing the president to a Nazi, and telling a reporter, on the record, that health care reform is comparable to Hitler's Holocaust.

But let's not overlook the irony of Diane Campbell's situation. Government-run, taxpayer-financed health care has kept her mother alive. Government-run, taxpayer-financed health care provides treatment and care to her sister. Based on the descriptions, it's safe to assume the costs associated with treatments for Campbell's mother and sister are enormous, but taxpayers and a socialized health care system pick up the tab. What's wrong with that? Not a thing.

Except, of course, that Diane Campbell is now trying to convince people that health care reform is both radical and dangerous.

Source (http://www.washingtonmonthly.com/archives/individual/2009_08/019452.php)

This is the same phenomena I pointed out with the Teabagger Protest people.

The power of the rightwing noise machine really is amazing to watch in action. So many people saying that government social services are EVIL despite their own dependence on government social services. Weird.

[Lily]

And just who are these people, the Tea Party Patriots? Take a look, especially at the "Partners." FreedomWorks is run by Dick Armey. Remember him? The former House Majority Leader and current Senior Policy Advisor for DLA Piper, one of the largest lobbyist firms in the world. His clients include pharmaceuticals, hospital associations and the Cancer Centers of America.

http://teapartypatriots.org/

My guess is that if you follow the links for some of these other "Partners," you'd find a whole bunch of very powerful right-wing lobbyists who are working to perserve the status quo for the insurance, hospital and pharma industries. The people screaming at these town hall meetings are merely uniformed dupes.

[SMadsen]

Source (http://tpmmuckraker.talkingpointsmemo.com/2009/08/email_tea_baggers_hoping_for_riot_at_rep_scotts_to .php?ref=fpb)

Gosh, the liberalism of the liberal media always amazes me...
If rightwing media does the same does that mean you'll get a .. a .. neutral media?

[dilettante]

Source (http://tpmmuckraker.talkingpointsmemo.com/2009/08/email_tea_baggers_hoping_for_riot_at_rep_scotts_to .php?ref=fpb)

Gosh, the liberalism of the liberal media always amazes me...

I imagine those who oppose the administrations health care plans on more rational grounds might see it that way. Just yesterday I listened to an NPR report on the health care battle that purportedly showed the perspectives of "both sides". But what they did was put a particularly angry and frenzied protester interviewed outside a town hall meeting (against the plan) across from a prepared statement read by Sen. Arlen Specter (for the plan).

The choice to focus on the protesters doesn't paint the opposition to the administration in a particularly flattering light.

[SMadsen]

And just who are these people, the Tea Party Patriots? Take a look, especially at the "Partners." FreedomWorks is run by Dick Armey. Remember him? The former House Majority Leader and current Senior Policy Advisor for DLA Piper, one of the largest lobbyist firms in the world. His clients include pharmaceuticals, hospital associations and the Cancer Centers of America.

http://teapartypatriots.org/

My guess is that if you follow the links for some of these other "Partners," you'd find a whole bunch of very powerful right-wing lobbyists who are working to perserve the status quo for the insurance, hospital and pharma industries. The people screaming at these town hall meetings are merely uniformed dupes.
Did you mean uniformed or did you mean to say uninformed?


By the way, could this health care stuff turn into armed conflict in any way? It's just something I picked up in discussion forums here and there (and one never knows with Americans :) ).

[dilettante]

This seemed like an insightful story from NPR:

Why Obama Can't Brush Off Health Care Protests


A hint of the gathering storm came more than two weeks ago, when a polite older woman named Mary called into an AARP-sponsored health care "tele-town hall" with a question for President Obama.


"I have been told," Mary said, that under a new health care plan, Medicare recipients would "be visited and told to decide how they wish to die."
That prompted a grin from the president and, initially, a flip response. "I guarantee you, first of all," Obama said, "we just don't have enough government workers to send to talk to everybody to find out how they want to die."


That blithe treatment of Mary's fear, however baseless, suggested that the White House underestimated the level of anxiety its health care overhaul initiative has caused, and the opportunity it has presented for opponents to promote fear-mongering rumors.


The latest debunked rumors range from outrageous claims of government-sanctioned euthanasia to federally mandated abortions. But dismissing the protesters as isolated, non-representative collections of cranks and, perhaps, racists, would be a strategic blunder for the White House.


....


http://www.npr.org/templates/story/story.php?storyId=111812494 (http://www.npr.org/templates/story/story.php?storyId=111812494)



By the way, could this health care stuff turn into armed conflict in any way? It's just something I picked up in discussion forums here and there (and one never knows with Americans :) ).

Given the current state of things, I imagine it would take an epic blunder (on the scale of having the secret service open fire on the protests) for that to happen on a large scale. I haven't heard any reports of firearms or other weapons being brought to any of these riotous townhalls, and so far there isn't really a likely "target" for any kind of mass violence.

[Michael]

The choice to focus on the protesters doesn't paint the opposition to the administration in a particularly flattering light.

Support for Obama and support for healthcare reform in general has been dropping fast - particularly in the all important 'independent" demographic since these crazy 'death-panel' and euthanasia stories started being pumped by the rightwing media.

Another week or two of this pattern and the moderate Democrats are going to get cold feet fearing for their lives in November 2010.

[Michael]

I'm trying to withhold judgement on Obama's political skills (or apparent lack of them here) until the final bill is passed or failed.

But either way, I just can't help seeing all this opposition as bloody predictable and that a good political-strategy plan could have avoided or reduced or contained.

Obama and the Democrats seem to be totally blind-sided by this opposition and the rightwing smear machine pumping out lies. That's incompetence. They are on the defensive and they shouldn't be.

[The Drunk Guy]

Given the current state of things, I imagine it would take an epic blunder (on the scale of having the secret service open fire on the protests) for that to happen on a large scale. I haven't heard any reports of firearms or other weapons being brought to any of these riotous townhalls, and so far there isn't really a likely "target" for any kind of mass violence.
Ever hear of someone getting killed in a sheep stampede?

Yeah, me neither.

:shrug:

[The Drunk Guy]

I'm trying to withhold judgement on Obama's political skills (or apparent lack of them here) until the final bill is passed or failed.

But either way, I just can't help seeing all this opposition as bloody predictable and that a good political-strategy plan could have avoided or reduced or contained.

Obama and the Democrats seem to be totally blind-sided by this opposition and the rightwing smear machine pumping out lies. That's incompetence. They are on the defensive and they shouldn't be.
What's worse is that the same old people that bitch about all their copays are the ones fighting this legislation. What a nation of fucking boneheads we are.

[Michael]

What's worse is that the same old people that bitch about all their copays are the ones fighting this legislation. What a nation of fucking boneheads we are.

Yeah that's true. But it is the ones who are massively dependent on existing government social programs that seem to be the most ferociously against the idea that others might get the same benefits they depend upon.

Lots of 'begger thy neighbor' type attitudes on display.

And lots of people who get 'free' healthcare insurance seem to be very, very upset about the idea of other people getting 'free' healthcare insurance.

It is very disturbing to witness such a display of violent selfishness, mind-numbing stupidity and outrageous lies.

I can't help but to fault the Democratic leadership for acting like idiots and amateurs. Its not like the rightwing smear machine and their media enablers are something new. Some of us have been watching this technique of the right for decades. Nothing new here and anyone who didn't see this coming was an idiot or terribly naive.

[The Drunk Guy]

I can't help but to fault the Democratic leadership for acting like idiots and amateurs. Its not like the rightwing smear machine and their media enablers are something new. Some of us have been watching this technique of the right for decades. Nothing new here and anyone who didn't see this coming was an idiot or terribly naive.
Or, even worse, optimistic about the integrity of the voting population.

Not-so-coincidentally, I've heard more racist jokes about Obama this week than I have since he won the election. Even better are the people who say they hate him, oh, but not because he's black! Give me a fucking break. This neocon bullshit is getting to me.

[Lily]

Did you mean uniformed or did you mean to say uninformed?


By the way, could this health care stuff turn into armed conflict in any way? It's just something I picked up in discussion forums here and there (and one never knows with Americans :) ).


Funny you should mention that...


SPLC Report: Return of the Militias


The Militia Movement
The Second Wave
The return of the militias and the larger antigovernment 'Patriot' movement

The 1990s saw the rise and fall of the virulently antigovernment "Patriot" movement, made up of paramilitary militias, tax defiers and so-called "sovereign citizens." Sparked by a combination of anger at the federal government and the deaths of political dissenters at Ruby Ridge, Idaho, and Waco, Texas, the movement took off in the middle of the decade and continued to grow even after 168 people were left dead by the 1995 bombing of Oklahoma City's federal building — an attack, the deadliest ever by domestic U.S. terrorists, carried out by men steeped in the rhetoric and conspiracy theories of the militias. In the years that followed, a truly remarkable number of criminal plots came out of the movement. But by early this century, the Patriots had largely faded, weakened by systematic prosecutions, aversion to growing violence, and a new, highly conservative president.

They're back. Almost a decade after largely disappearing from public view, right-wing militias, ideologically driven tax defiers and sovereign citizens are appearing in large numbers around the country. "Paper terrorism" — the use of property liens and citizens' "courts" to harass enemies — is on the rise. And once-popular militia conspiracy theories are making the rounds again, this time accompanied by nativist theories about secret Mexican plans to "reconquer" the American Southwest. One law enforcement agency has found 50 new militia training groups — one of them made up of present and former police officers and soldiers. Authorities around the country are reporting a worrying uptick in Patriot activities and propaganda. "This is the most significant growth we've seen in 10 to 12 years," says one. "All it's lacking is a spark. I think it's only a matter of time before you see threats and violence."

A key difference this time is that the federal government — the entity that almost the entire radical right views as its primary enemy — is headed by a black man. That, coupled with high levels of non-white immigration and a decline in the percentage of whites overall in America, has helped to racialize the Patriot movement, which in the past was not primarily motivated by race hate. One result has been a remarkable rash of domestic terror incidents since the presidential campaign, most of them related to anger over the election of Barack Obama. At the same time, ostensibly mainstream politicians and media pundits have helped to spread Patriot and related propaganda, from conspiracy theories about a secret network of U.S. concentration camps to wholly unsubstantiated claims about the president's country of birth.


MoreHere (http://www.splcenter.org/news/item.jsp?aid=392)

[Lily]

Given the current state of things, I imagine it would take an epic blunder (on the scale of having the secret service open fire on the protests) for that to happen on a large scale. I haven't heard any reports of firearms or other weapons being brought to any of these riotous townhalls, and so far there isn't really a likely "target" for any kind of mass violence.

Someone did a bring a weapon, to Pres. Obama's town hall meeting in New Hampshire. The guy had a gun strapped to his hip and was carrying a sign that read, "The tree of liberty must be watered with the blood of tyrants." Strangly enough, that was the same message Timothy McVeigh had emblazoned on his t-shirt when he was arrested after the Murrah bombing.

[The Drunk Guy]

Someone did a bring a weapon, to Pres. Obama's town hall meeting in New Hampshire. The guy had a gun strapped to his hip and was carrying a sign that read, "The tree of liberty must be watered with the blood of tyrants." Strangly enough, that was the same message Timothy McVeigh had emblazoned on his t-shirt when he was arrested after the Murrah bombing.
I thought McVeigh's shirt read "Sic semper tyrannis."

[dilettante]

I thought McVeigh's shirt read "Sic semper tyrannis."

Actually, it had both, according to wikipeida. "Sic semper tyrannis" was on the front under an image of Lincoln (it was what Booth said after killing him) and the Jefferson quote about the tree of liberty was on the back.

[Americano]

The more debates I read on US health care reform the more my opinion of the general public drops. I didn't think that could get any lower.

[Michael]

The more debates I read on US health care reform the more my opinion of the general public drops. I didn't think that could get any lower.

Just to play Devil's Advocate here, but where may I ask are you encountering these "debates"?

I respectfully submit that neither internet discussion forums nor US mass media in general is any way representative of the general public.

That being said, I am myself constantly amazed at how incredibly close-minded and uneducated most people really seem to be on most political, religious or economic issues generally.

[Americano]

Just to play Devil's Advocate here, but where may I ask are you encountering these "debates"?

My small town newspaper (front page with an old man obviously over 65 screaming while shaking his fist that he doesn't want the government interfering in health care) and endless Internet reports of the same ignorant 'public' reactions.

I respectfully submit that neither internet discussion forums nor US mass media in general is any way representative of the general public.

That being said, I am myself constantly amazed at how incredibly close-minded and uneducated most people really seem to be on most political, religious or economic issues generally.

[partofme]

The more debates I read on US health care reform the more my opinion of the general public drops. I didn't think that could get any lower.

My opinion on that was at rock bottom long before the health reform bill came about.

[Americano]

Here's a little example of that mentality:

Different groups have been seeking to legalize medical marijuana in most states and inevitably run into block walls in the bible belt.

Georgia State Republican lawmaker Tommy Benton (31st House District) favors “caning” minor marijuana offenders and “executing” those who sell the drug, according to a recent correspondence sent by the representative to a constituent.

In a July 29, 2009 e-mail (which was voluntarily forwarded to the NORML office), Rep. Benton wrote: “Thanks for the email. We will have to agree to disagree on this and whether or not money is wasted (by mandating the state to prosecute minor marijuana offenders). I am opposed to the legalization of marijuana. I think we should go to caning for people caught using and maybe execute dealers. [emphasis NORML’s] That would solve the problem as well. That is what they do in Singapore and they don’t have a drug problem.

Caning is a form of corporal punishment consisting of up to 24 violent lashes with a long rattan cane that has been soaked in water. The procedure inflicts intense pain and deep, bloody lacerations that can take several months to heal.


Rep. Benton followed up his remarks in a separate e-mail on August 11 (also forwarded to NORML) in which he threatened to turn over the names of citizens who disagreed with his political viewpoints to local law enforcement.

[Lily]

Meet Rep. Benton, the very definition of a good ol' boy.

http://www.tommybenton.com/

[Americano]

From the masthead image to the video he turned into a real porker.

[Michael]

My small town newspaper (front page with an old man obviously over 65 screaming while shaking his fist that he doesn't want the government interfering in health care) and endless Internet reports of the same ignorant 'public' reactions.

Yes, they are out there. But I do believe that the corporate mass media is very much playing to the rightwing-Republican pro-corporate playbook here and doing everything possible to make opposition to healthcare reform appear massively larger than it is - by hand picking such idiots for your front page (for example).

The polls don't show any huge ideological opposition to healthcare policy reform at all. Policy polls show very strong public support for the public option and single-payer as well. The whole 'opposition' process here consists of a well financed and well organized corporate PR-political-spin campaign.

[Americano]

I think a decent analogy to the US health care crisis is the car industry. From the 1980s on Americans went through a media and government barrage of 'Buy American'. Even though American vehicles had in every respect advanced to compete rolling pieces of crap, Americans with little common sense or investigative desire kept buying them.

Studies have shown change of any type is at the top of the list as a least desired action for the general public. With regard to health care US companies are experiencing a tremendous earnings squeeze and responding accordingly. Outsource what one can and target remaining expenses with a sharp knife. Over the years I've been watching companies squeeze expenses such as health care, untaxed as supplementary income when it should be taxed, by raising deductibles, raising co-pays, lowering procedure caps and total annual coverage caps. That process is being rapidly accelerating during the economic decline.

When workers finally discover the bulk of those expense burdens have been slowly transferred directly to them, digging deeply into what remains of their already stagnated disposable income, they're going to begin looking at universal health care in the same light in which they finally compared a Toyota to a Chevy.

[partofme]

There goes the public option.

http://www.msnbc.msn.com/id/32437468/ns/politics-white_house/

[Lily]

And this is where it starts. Fast forward to 2012 with the Republicans picking up the socialism ball and running as fast as they can toward the goal, crowds of sheep baaa-ing them on, the likes of Rush and Hannity calling the play-by-play; insurance, banking and pharma executives ensconced in their sky boxes. What's the Super Bowl win? The elimination of Medicare. Next season, Social Security. Socialist programs, all.

Screw the people who can't afford tickets. Let them stand outside.

[Michael]

And this is where it starts. Fast forward to 2012 with the Republicans picking up the socialism ball and running as fast as they can toward the goal, crowds of sheep baaa-ing them on, the likes of Rush and Hannity calling the play-by-play; insurance, banking and pharma executives ensconced in their sky boxes. What's the Super Bowl win? The elimination of Medicare. Next season, Social Security. Socialist programs, all.

Screw the people who can't afford tickets. Let them stand outside.

Yes, I think you've called this one. I'll expect the Republicans to run 'full-on' crazy lies/bullshit/propaganda/denial mode in 2010 mid-terms and the 2012 presidential.

Can't say I blame them - this 'full-on crazy' mode is apparently taken seriously by the mass media and given a massive platform to spout unquestioned lies without any consequences. Poll numbers are starting to shift slightly.

[Michael]

There goes the public option.

http://www.msnbc.msn.com/id/32437468/ns/politics-white_house/

I've been expecting this for a while. They haven't officially dropped it, but I'd say that its about 90% dead.

As far as I'm concerned, if there is no public option, I'd just let the whole thing drop. I certainly couldn't support any healthcare reform policy that doesn't include that vital element.

Indeed, I'd say the Democrats in Congress would be better off to vote down Obama's watered-down Republican-pleasing bullshit comprimise and take the hit.

The long run politics on this issue says "now or never" for public option. As far as I'm concerned, healthcare reform in the US is dead in the water now - Bill and Hillary at least tried. I can't say even that much for Obama who seems only to be going through the motions here. This has turned out to be absolutely a trainwreck of a policy initiative from the Obama Administration and EVERY ERROR clearly originates from Obama personally and specifically.

(Btw, the "Co-op" suggestion is pure bullshit window-dressing - there is virtually no academic literature supports that nonsense - they just invented the concept because they needed some window-dressing for the giveaway to Pharma and the Healthcare Insurance industry they've just sold out to)

[partofme]

If it couldn't pass now I honestly don't think it will in the next ten years at least.

[Michael]

If it couldn't pass now I honestly don't think it will in the next ten years at least.

By failing to pass it now, that is what makes it impossible to pass next time and you are correct - 10 to 20 years at least.

The healthcare insurance industry and big Pharma know this. That's why they are fighting so hard now. They've got another decade or two of monopoly profits and 10% annual cost increases to defend.

[Michael]

I've been reading more about the proposed healthcare policy - minus the public option.

As I noted above, I think the Democrats would be better off to just drop the whole thing now and take the hit.

Passing a major healthcare legislation that does NOT include a public option is a recipe for a major political disaster! I'm referring to the "mandates" that are included in the policy. A mandate ORDERS individuals to buy health insurance or they are criminal. Sure the government might provide some tax-credits to offset the cost, but you will have to wait for your tax rebate to see that money.

But the bottom line is that the reason poor people don't have healthcare insurance is because they are poor. Ordering them by law to buy insurance from some corrupt private insurance company (with no real control on costs) is a powderkeg of bad publicity for the Democrats that would likely be more politically damaging than backing down now.

Healthcare reform that just makes the private healthcare insurance industry stronger and more profitable than ever is not good public policy and Democrats will suffer if this is what they deliver.

No public option means no meaningful healthcare reform. Just window-dressing and big bribes to big Pharma and giveaways to the insurance industry. Looks like a Republican policy now.

[dilettante]

This is somewhat amusing:

Health Care: Choose Your Own Adventure (http://politics.theatlantic.com/2009/08/democrats_choose_their_own_adventurestep.php)

[Michael]

The more I think about the 'legislative strategy' for dealing with the healthcare issue, the more I'm convinced that "public option or nothing" is the only way to proceed.

Single-payers is the only "real" solution to America's healthcare problems, and despite strong public support for this (above 60%), this option has never been on the table (no suprise to me).

The next best solution is the "public option".

As many (well informed) commentators have noted, Social Security and Medicare both were introduced as hideously small programs that would never be acceptable today. But once passed, these programs were modified and extended into the popular programs they are today.

I see the same dynamics in play with healthcare. A public option, even if it is a lame-ass shitty one, is better than nothing and can be modified or extended later on.

If the public option is dropped, its just GONE completely and according to political norms, it will probably be another twenty years before anyone has the guts to try again.

Every other feature of healthcare reform can be approached separately or incrementally legislated at anytime.

Bottom line is that a mandate without a public option is a 'boon' for private insurance companies and a political failure for the Democrats - which is why the private insurance companies support this policy - they know a good deal for themselves when they see one.

I'd say sacrifice everything for the public option to get that passed, even if it is a shitty policy. That's the best legislative strategy if your goal is genuine improvement in US healthcare policy.

The "bill of rights" for customers of insurance companies (no recision, no cancelling coverage, etc) is important, but this can be addressed separately or at another time.

Without a public option, forcing poor people by law to buy private insurance (i.e. "mandate") that they can't afford is just dumb policy. Given that the taxpayer is going to be paying subsidies here - and the fact that private insurance has an inflation rate of 11% per year for the last 10-20 years, this is a recipe for a massive tax subsidy going to support private profits (and that is always a bad public policy).

The only way to avoid (MORE) subsidizing of private profits is to create a 'public option'.

[dilettante]

I'm not a huge fan of Representative Barney Frank, but my hat's off to him here:

http://www.youtube.com/watch?v=hZsDhwZDwO8&feature=related

Longer version (including the full question from the women):
http://www.youtube.com/watch?v=ULtgIBKemlc&feature=related (http://www.youtube.com/watch?v=KxgLXDupHaI&eurl=http%3A%2F%2Fnews.google.com%2F&feature=player_embedded#t=26)

She's apparently a support of Lyndon LaRouche. I see these people every week or so during the semester handing out pamphlets and expressing concerns about the North American Union. I've never really been able to figure out what's going on there...

Anyway, hats off to Rep. Frank for simultaneously letting the women freely speak her piece and then delivering the rhetorical smack-down. :hatoff:

[partofme]

I'm not a huge fan of Representative Barney Frank, but my hat's off to him here:

http://www.youtube.com/watch?v=hZsDhwZDwO8&feature=related

Longer version (including the full question from the women):
http://www.youtube.com/watch?v=ULtgIBKemlc&feature=related (http://www.youtube.com/watch?v=KxgLXDupHaI&eurl=http%3A%2F%2Fnews.google.com%2F&feature=player_embedded#t=26)

She's apparently a support of Lyndon LaRouche. I see these people every week or so during the semester handing out pamphlets and expressing concerns about the North American Union. I've never really been able to figure out what's going on there...

Anyway, hats off to Rep. Frank for simultaneously letting the women freely speak her piece and then delivering the rhetorical smack-down. :hatoff:


I had never heard of Lyndon LaRouche until all this Obama/Hitler nonsense but apparently he has a big following and a private intelligence service. Does anybody know more about this guy and what his background is? I looked up some stuff on him but I can't seem to find any information about him other than from supporters.

[Michael]

I had never heard of Lyndon LaRouche until all this Obama/Hitler nonsense but apparently he has a big following and a private intelligence service. Does anybody know more about this guy and what his background is? I looked up some stuff on him but I can't seem to find any information about him other than from supporters.

The Wiki page on LaRouche Movement (http://en.wikipedia.org/wiki/LaRouche_movement) is decent enough and gives a good summary.

A political cult seems to be the most apt description of the movement. I consider them so far 'out there' that I couldn't even make a reasonable assessment of them as 'leftwing' or 'rightwing' - they just don't fit that kind of scale.

[Michael]

I think one of the other aspects of this is very fundamental to who we are as a people. There are a lot of sociologists and historians will tell you we as American people are just different. We're an outliers measured in many ways. Our value system is different. We don't think like Canadians. We don't accept government the way it is. We're not deferential to authority the way Canadians are or in Western Europe.

CNN Transcripts (http://transcripts.cnn.com/TRANSCRIPTS/0908/22/acd.01.html)

I'm thinking that Americans are never going to get good public policy until they stop lying to themselves about who they are. I see this particular piece of propaganda spouted fairly often - it is pure propaganda.

If you peruse actual opinion poll data, Americans routinely score significantly higher than Canadians or Brits on all measures of "deference to authority". Canadians apparently score amongst the lowest in the western world on this particular issue.

Fact is, Americans overwhelmingly accept US government the way it is, and are overwhelmingly deferential to authority. Americans support their own government to a degree that is unheard of outside in other western nations. Americans practically invented the concept of "my government, right or wrong". Pretending otherwise just leads to bad public policies.

For example, can you imagine the President getting massively booed in public? US media flips out if that happens (or tries to hide the evidence) acting as if such an act is tanamount to treason. Booing politicians is pretty routine everywhere else.

Or how about the art of 'pie-in-the-face'??? That's an artform in France and Canada to throw a cream pie in the face of some self-important politician. The practice is pretty much unheard of in the USA.

[wphelan]

CNN Transcripts (http://transcripts.cnn.com/TRANSCRIPTS/0908/22/acd.01.html)


Or how about the art of 'pie-in-the-face'??? That's an artform in France and Canada to throw a cream pie in the face of some self-important politician. The practice is pretty much unheard of in the USA.

I imagine anyone who attempted a pie-in-the-face of any US politician would immediately be labeled a terrorist and treated accordingly.

[Michael]

I imagine anyone who attempted a pie-in-the-face of any US politician would immediately be labeled a terrorist and treated accordingly.

Lets just say that the fellow who put a pie into PM Jean Chretien's face (and the PM's office tried to lay charges) got off scot-free. Public opinion in Canada ridiculed the PM's office for trying to get "assault" charges laid promised more cream pies for the PM if he did so. The PM's office subsequently backed down and didn't press charges.

Personally, I hated Chretien and this is a good example of why. I was also hoping that Chretien was going proceed with charges so that it was going to be 'open season' for pies on Chretien. That's my kind of civil disobedience.

[Michael]

What is the Pelosi Bill?

I keep hearing Republicans referencing the "Pelosi Bill" in reference to healthcare.

I know of at least five different Congressional healthcare proposals, all products of various Congressional Committees, none of which are actually bills yet, and none of them involve Pelosi.

But apparently, all of these bills are either the "Pelosi Bill" or "Obamacare". :ummm:

Methinks one needs a "Republican-code dictionary" to translate these codephrases they use to speak to their base (or seek to enflame them).

[Michael]

To paraphrase Kevin Drum...

The USA as a whole, spends twice as much as anyone else on healthcare, and just as much tax money as every one else, yet the USA has much lower quality of healthcare statistics than everyone else.

In other words, Americans pay twice as much to get much less healthcare than any other western nation.

So why is there even a debate about healthcare reform going on? How is that possible? The US healthcare system sucks bad.

[dilettante]

To paraphrase Kevin Drum...

The USA as a whole, spends twice as much as anyone else on healthcare, and just as much tax money as every one else, yet the USA has much lower quality of healthcare statistics than everyone else.

In other words, Americans pay twice as much to get much less healthcare than any other western nation.

So why is there even a debate about healthcare reform going on? How is that possible? The US healthcare system sucks bad.

I think the actual debate is over how to reform, not whether reform is needed. The media seems to think a binary battle of "for" vs "against" makes better news, so the debate seems to get cast that way, but I doubt there are two many people arguing that everything is just hunky-dory.

[Michael]

I think the actual debate is over how to reform, not whether reform is needed. The media seems to think a binary battle of "for" vs "against" makes better news, so the debate seems to get cast that way, but I doubt there are two many people arguing that everything is just hunky-dory.
That sounds exactly like the Republican spin on the issue.

A solid 68% of the public supports single payer or public option. There's no public debate here at all.

The debate is between the Republicans and their media allies who oppose any and all reforms here that don't reinforce the status quo and the Democrats who are proposing various reforms that may change the status quo.

Btw, the WaPo Ombudsman just released a report stating that over 75% of all WaPo news articles upon the topic focus entirely upon the 'process' (horse-race) and less than 20% of WaPo articles on the topic mention any policy issue at all.

If it wasn't for the institutional power of the US Senate for a small minority to veto majority legislation, there would be no issue here at all - healthcare reform (with the public option) would already be passed into law by majority rules. But the US Congress doesn't work that way at all.

Thus, the only issue here is the power of the Senate and how effectively the minority Republicans and their media allies are at pretending they are the majority and the majority Democrats are actually a tiny and radical minority.

[dilettante]

That sounds exactly like the Republican spin on the issue.

A solid 68% of the public supports single payer or public option. There's no public debate here at all.


That seems to depend sustantially on how the question is phrased. For example, asked if they favor giving "people a choice of both a public plan administered by the federal government and a private plan for their health insurance", 77% are in favor.
On the other hand, ask if they favor "creating a public health care plan administered by the federal government that would compete directly with private health insurance companies," only 41% are in favor.

http://www.huffingtonpost.com/2009/08/20/new-poll-77-percent-suppo_n_264375.html

[Michael]

That seems to depend sustantially on how the question is phrased. For example, asked if they favor giving "people a choice of both a public plan administered by the federal government and a private plan for their health insurance", 77% are in favor.
On the other hand, ask if they favor "creating a public health care plan administered by the federal government that would compete directly with private health insurance companies," only 41% are in favor.

http://www.huffingtonpost.com/2009/08/20/new-poll-77-percent-suppo_n_264375.html

Yes, public opinion polls on public policy issues are very easy to manipulate.

That's why I cited the 68% figure - it has been consistent for over a year if the question asked is not biased or loaded for political spin.

Once you spin the question, you can get any answer you like. Indeed, pollsters tend to spin the questions till they get the results their clients are most willing to pay for.

It is always important to cite who is paying for the poll. The results are always dependent upon that fact.

[Americano]

With the nationalized reporting rhetoric of death squads, rationed health care (which they already have) and long waiting periods I'm surprised any of the dumb as a rock general public would consider reform.

[Michael]

With the nationalized reporting rhetoric of death squads, rationed health care (which they already have) and long waiting periods I'm surprised any of the dumb as a rock general public would consider reform.

I doubt if the 40 million Americans that can't afford or can't get insurance are part of the political dialogue at all or even know it is taking place. Poor people's opinions just don't matter and they know it.

What we have instead is the comfortable majority deciding amongst themselves whether or not the lowly plebes deserve any healthcare or not. Apparently they don't.

[dilettante]

What we have instead is the comfortable majority deciding amongst themselves whether or not the lowly plebes deserve any healthcare or not. Apparently they don't.

That's a curious phrasing,
Do you believe the "lowly plebes" deserve healthcare?

[Americano]

I doubt if the 40 million Americans that can't afford or can't get insurance are part of the political dialogue at all or even know it is taking place. Poor people's opinions just don't matter and they know it.

What we have instead is the comfortable majority deciding amongst themselves whether or not the lowly plebes deserve any healthcare or not. Apparently they don't.

That comfortable majority is in fact providing partial health care for a majority of the plebes who want it through Medicare/Medicaid and ER facilities (I don't know cost breakdowns for an ER visit but would assume they're several times what a GP visit would cost). A major problem with that being there's no preventive medicine being practiced, leading to higher costs when the individual does require medical treatment.

[Michael]

That comfortable majority is in fact providing partial health care for a majority of the plebes who want it through Medicare/Medicaid and ER facilities (I don't know cost breakdowns for an ER visit but would assume they're several times what a GP visit would cost). A major problem with that being there's no preventive medicine being practiced, leading to higher costs when the individual does require medical treatment.

Perhaps Lily can shed more light on this, but my impression is that the healthcare insurance companies (and thus the consumer) are ultimately carrying the cost of these 'uninsured' visitors to hospitals, not particular government programs.

And yes, going to the emergency ward for a routine ailment does cost substantially more money than going to a GP for the same thing - totally independent of what prices might be charged for such services.

Diabetes is a classic example of a healthcare problem that can be addressed quite cheaply and easily if caught early by a GP - but can become a massively serious and expensive ailment if left too long without any treatment. Those without insurance tend to forego the early trips to the GP and end up facing massively expensive treatments down the road.

[Americano]

Perhaps Lily can shed more light on this, but my impression is that the healthcare insurance companies (and thus the consumer) are ultimately carrying the cost of these 'uninsured' visitors to hospitals, not particular government programs.

No, if government funding, primarily Medicaid, can't be justified to cover the costs they're written-off within 60-90 days and turned over to collection agencies. The write-offs obviously have to be recaptured through higher revenues and the cycle escalates health care costs.

And yes, going to the emergency ward for a routine ailment does cost substantially more money than going to a GP for the same thing - totally independent of what prices might be charged for such services.

Diabetes is a classic example of a healthcare problem that can be addressed quite cheaply and easily if caught early by a GP - but can become a massively serious and expensive ailment if left too long without any treatment. Those without insurance tend to forego the early trips to the GP and end up facing massively expensive treatments down the road.

[Michael]

No, if government funding, primarily Medicaid, can't be justified to cover the costs they're written-off within 60-90 days and turned over to collection agencies. The write-offs obviously have to be recaptured through higher revenues and the cycle escalates health care costs.

That's my point. These debts are uncollectable and therefore the cost goes into overhead and thus it is charged back to the insurance companies that way, thus contributing to the very high price of healthcare insurance in the USA.

[Americano]

That's my point. These debts are uncollectable and therefore the cost goes into overhead and thus it is charged back to the insurance companies that way, thus contributing to the very high price of healthcare insurance in the USA.

I'd think in most cases they've been there for quite some time as reserves for bad debt. The 'I've got mine' crowd who whine about other people getting a job and their own insurance have no clue that they're already paying for universal health care at rates far beyond what a large risk pool the size of the US could furnish.

[wphelan]

Do other countries subsidize employers for providing healthcare? And how does so-called insurance work elsewhere? Do all countries have insurance that 'insures' against known, predictable expenses? Having insurance to cover routine visits to the doctor has never made any sense to me, which is why for many years I never had insurance.

The two times I ever went to the doctor, I just payed out of my own pocket. I certainly saved money in the long run. I bought my first health insurance policy a little over a year ago and got one with a high deductible. The only time I should 'need' insurance is if something bad and severe unexpectedly happens. That seems to make more sense than the way most people view insurance, which is that they expect it to cover every single cost. If car insurance was anything like health insurance, oil changes and tire rotations would be covered under an insurance policy, and nobody would be able to afford it.

[Lily]

That's my point. These debts are uncollectable and therefore the cost goes into overhead and thus it is charged back to the insurance companies that way, thus contributing to the very high price of healthcare insurance in the USA.

From what I understand, and I am no expert on the billing practices of hospitals, there is a multi-tiered billing system in hospitals. Those with private insurance are billed at a higher rate than those on Medicare and Medicaid. The insurance companies are well aware of this practice and have in fact been subsidizing the lower rates paid by government programs (actually, the policy holders are subsidizing them); however, in the past years, that's been changing. Insurance companies more and more and paying the same rates or just a little above Medicare rates. The uncollectible debts from the uninsured are part of the overhead of the hospital, an expense. So, in a sense, Michael, you are correct in saying that the insured pay for the uninsured, as charges and reimbursements to the insurance companies are set using a complex forumla based at least partly on the cost of doing business.

In a very real sense, the government is setting the bar on all reimbursement for physicians and hospitals, as the private insurers are reluctant now to pay much higher than those goverment rates. Medicare will further cut those reimbursement rates, starting in 2010. I heard an interview on CSPAN last night with the CEO of a not-for-profit hospital who said those cuts will be 21%, growing to accumlated cuts of 40% by 2016. This man stated those cuts will effectively put some private practioners out of business. As it stands now, many physicians refuse to accept Medicare patients. I can only imagine this will get worse as these cuts in reimbursement rates take effect. Not a good scenario with so many baby boomers coming onto the Medicare roles in the next decade or so.

[Michael]

Yes, the US and Canadian systems are ultimately very similar. Canada just has a bunch of healthcare insurance companies that have no actual profit motive instead of a bunch of healthcare insurance companies with massive profit motives. That seems to be the key difference.

I suppose the other major difference is that hospitals are mostly owned/operated by non-profit charities, religious groups or the government itself - rather than being privately owned profit-making corporations.

And Canada has the same problem with idiots going to the emergency wards for routine ailments. Many don't understand that going to the doctor is free. Many don't understand that they ought to have a 'family doctor' and consult them first. This seems to be a particular problem with immigrants and children of immigrant families.

[Michael]

Is domestic violence a "pre-existing medical condition"? :eek:

According to nine states and the District of Columbia, the answer is a resounding YES! Those nine states are Arkansas, Idaho, Mississippi, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota, and Wyoming...

Source (http://www.demconwatchblog.com/diary/2360/is-domestic-violence-a-preexisting-medical-condition)

Wow. That's mind-boggling that such companies can get away with recission of insurance policies on this basis.

US needs healthcare insurance reform - real bad. Punishing victims of violence and/or poverty ought not to be the goal here.

[Americano]

Is domestic violence a "pre-existing medical condition"? :eek:



Source (http://www.demconwatchblog.com/diary/2360/is-domestic-violence-a-preexisting-medical-condition)

Wow. That's mind-boggling that such companies can get away with recission of insurance policies on this basis.

US needs healthcare insurance reform - real bad. Punishing victims of violence and/or poverty ought not to be the goal here.

Looking at the states I'm not surprised.

[mrhealthguy]

Several individual US states are moving towards universal health care legislation, much to the chagrin of of private health care insurers, and I think due to political dissension at the federal level this is the only viable path to an eventual national program.

My state started the initial feasibility studies several years ago due to rising health care insurance costs in the public sector. It was estimated in initial projections that those costs would break the state by 2014 at their rate of expansion. Our state public coverage is similar to federal agencies, cradle to grave, no caps and either token or no co-pays. Oversight will be provided by a non-profit composed of members of the university system and private employers with state administration reporting to that body, not the legislature.

Until US tort laws are modified to keep the huge school of hungry shark lawyers from feeding on the current system, I don't see a viable national system ever containing costs or providing quality universal health care.


What are your thoughts about In what is the first setback for US President Barack Obama in a centerpiece policy issue, the Senate Finance Committee overwhelmingly voted to throw out the government-run health insurance plan, dubbed the “public option.”

The proponents of the plan lost twice, first by 15 to 8 and next by 13 to 10, attempts at adopting the “public option” on September 29.

Three Democratic Party senators - Chairman Max Baucus of Montana, Kent Conrad of North Dakota, and Blanche Lincoln of Arkansas - voted against both proposals.

Under the proposed plan, the government can agree on rates with physicians, hospitals, and other health providers as an alternative to another proposal which would have linked the plan's rates to those paid by Medicare for two years.

Medicare is a US government social insurance program for providing medical care, especially to the aged and the disabled.

Despite the disappointment, the White House tried to put on a brave face on the defeat in the Senate. A White House spokesman, Reid Cherlin, said that while the president still believes in making a public option available to those without health insurance, Obama is “open to other constructive ideas of increasing choice and competition.”

The Democrats hold a majority in the Senate, with 60 out of the 100 seats.

[dilettante]

What are your thoughts about In what is the first setback for US President Barack Obama in a centerpiece policy issue, the Senate Finance Committee overwhelmingly voted to throw out the government-run health insurance plan, dubbed the “public option.”

The proponents of the plan lost twice, first by 15 to 8 and next by 13 to 10, attempts at adopting the “public option” on September 29.

Three Democratic Party senators - Chairman Max Baucus of Montana, Kent Conrad of North Dakota, and Blanche Lincoln of Arkansas - voted against both proposals.

Under the proposed plan, the government can agree on rates with physicians, hospitals, and other health providers as an alternative to another proposal which would have linked the plan's rates to those paid by Medicare for two years.

Medicare is a US government social insurance program for providing medical care, especially to the aged and the disabled.

Despite the disappointment, the White House tried to put on a brave face on the defeat in the Senate. A White House spokesman, Reid Cherlin, said that while the president still believes in making a public option available to those without health insurance, Obama is “open to other constructive ideas of increasing choice and competition.”

The Democrats hold a majority in the Senate, with 60 out of the 100 seats.

Source: http://presstv.com/detail.aspx?id=107453&sectionid=3510203

[Americano]

What are your thoughts about In what is the first setback for US President Barack Obama in a centerpiece policy issue, the Senate Finance Committee overwhelmingly voted to throw out the government-run health insurance plan, dubbed the “public option.”

The proponents of the plan lost twice, first by 15 to 8 and next by 13 to 10, attempts at adopting the “public option” on September 29.

Three Democratic Party senators - Chairman Max Baucus of Montana, Kent Conrad of North Dakota, and Blanche Lincoln of Arkansas - voted against both proposals.

Under the proposed plan, the government can agree on rates with physicians, hospitals, and other health providers as an alternative to another proposal which would have linked the plan's rates to those paid by Medicare for two years.

Medicare is a US government social insurance program for providing medical care, especially to the aged and the disabled.

Despite the disappointment, the White House tried to put on a brave face on the defeat in the Senate. A White House spokesman, Reid Cherlin, said that while the president still believes in making a public option available to those without health insurance, Obama is “open to other constructive ideas of increasing choice and competition.”

The Democrats hold a majority in the Senate, with 60 out of the 100 seats.

Anything that doesn't get out of committee is a dead issue. The lobbying success of private insurers is a glaring deficiency in all parts of our governing system.

[Michael]

Here's a nice news article that neatly sums up the problem with employer provided healthcare insurance in the USA...

WellPoint cuts workers health benefits

INDIANAPOLIS - WellPoint Inc., the largest U.S. insurer, dismissed a "small number" of workers last week and announced cuts to employee health benefits Friday, in its latest attempt to deal with the recession's toll on enrollment.

WellPoint eliminated the positions last week and expects to let more go before year's end, though the number will be "relatively small," Kristin Binns, a spokeswoman, said in a telephone interview. The company will also raise deductibles and premiums for some of its employee health benefits, the Indianapolis-based insurer told workers in a memo obtained by Bloomberg.

In the memo from Randy Brown, WellPoint's chief human resources officer, the company said it would lower its contribution toward worker premiums and raise deductibles in two of its three benefit plans. "Your cost per paycheck will probably increase," the memo said.

Source (http://news.cincinnati.com/article/20091003/BIZ/910030367/WellPoint+cuts+workers+health+benefits)

So the largest provider of private healthcare insurance in the USA likes to cut back on providing healthcare insurance benefits to even its own employees? Why am I not surprised.

The most successful healthcare insurance company is the one that can find new ways to deny paying out coverage. :shrug:

Private healthcare insurance is the problem. So long as US healthcare is predicated upon the employer-provided model, the problems with US healthcare are never going to go away.

So if profit margins drop just a bit, all of a sudden your operation isn't important any more. Strange way to run healthcare if you ask me.

[Non Sequitur]

Orignally posted by Michael
I'd be curious what kind of healthcare reform you'd specifically like to see? Perhaps we could continue that in the US Healthcare Policy thread?

Specifically, I want no part in the public option. I know many people are happy with it in other countries, but, quite frankly, I am very suspicious of any government power expansion (from government wire taps under Bush to this). Also, knowing the inemptitude of my government I don't believe they can do it (although I would love to be proved wrong on that count). My other major qualm is our ability to pay for it, but that hasn't been a concern of anyone in Washington on anything for decades.

[Americano]

Specifically, I want no part in the public option. I know many people are happy with it in other countries, but, quite frankly, I am very suspicious of any government power expansion (from government wire taps under Bush to this). Also, knowing the inemptitude of my government I don't believe they can do it (although I would love to be proved wrong on that count). My other major qualm is our ability to pay for it, but that hasn't been a concern of anyone in Washington on anything for decades.

A 35% excise tax on private entities who provide somewhat comprehensive health care to employees would be a good start at affording health care as a nation. It is supplemental income with no no associated tax. The pathetic back door used to collect that revenue comes with another blow to fiscal responsibility, tax revenue would go into the general fund rather than where it belongs, Medicare.

Medicare, through various funding obligations, is the primary health insurer for all Americans of all ages who for whatever reason are unable to secure private health care insurance. Depending on one's source, somewhere between 30 and 50 million Americans rely on Medicare funding to meet their health care needs.

The number of disadvantaged isn't a large enough political presence to motivate legislation on its own, but the soaring cost of caring for them on an emergency basis is far beyond private sector charity capability or just let them rot policy. Civil order demands attention to 10-20% of a population capable of violence if denied contemporary health care standards.

[Non Sequitur]

Medicare, through various funding obligations, is the primary health insurer for all Americans of all ages who for whatever reason are unable to secure private health care insurance. Depending on one's source, somewhere between 30 and 50 million Americans rely on Medicare funding to meet their health care needs.

The number of disadvantaged isn't a large enough political presence to motivate legislation on its own, but the soaring cost of caring for them on an emergency basis is far beyond private sector charity capability or just let them rot policy. Civil order demands attention to 10-20% of a population capable of violence if denied contemporary health care standards.

Medicare is also the standard by which all health care advance costs are judged by, further complicating the problem. New drugs, new devices, and etc... are all judged by how much it would cost Medicare. I agree that these people need to taken care of, if only on the basis that the are human beings.

[Lily]

A 35% excise tax on private entities who provide somewhat comprehensive health care to employees would be a good start at affording health care as a nation. It is supplemental income with no no associated tax. The pathetic back door used to collect that revenue comes with another blow to fiscal responsibility, tax revenue would go into the general fund rather than where it belongs, Medicare.

Medicare, through various funding obligations, is the primary health insurer for all Americans of all ages who for whatever reason are unable to secure private health care insurance. Depending on one's source, somewhere between 30 and 50 million Americans rely on Medicare funding to meet their health care needs.

The number of disadvantaged isn't a large enough political presence to motivate legislation on its own, but the soaring cost of caring for them on an emergency basis is far beyond private sector charity capability or just let them rot policy. Civil order demands attention to 10-20% of a population capable of violence if denied contemporary health care standards.

I think you may have meant Medicaid? Medicare insures those over 65.

[Americano]

I think you may have meant Medicaid? Medicare insures those over 65.

My error. 50% of Medicaid is funded by the feds, 50% by states. Medicare is 100% federally funded.

[Michael]

Here's a weird one... an op-ed from the WSJ that attacks the corporate predator state?

Has hell frozen over or something? :ummm:

This article even treats John Kenneth Gailbraith's economic theories with respect... that's really fucking weird for WSJ (the Fox News of newspapers).

Health Care and the 'Predator State'
It is corporate power, not the government, that we need to worry about.

"The 'predator state' describes what happens when chicken coops are given over to foxes," Mr. Galbraith continued. "When consumer protection, worker protection, environmental protection, and policing against fraud are handed over to lobbyists. And when health care is run for the benefit of private insurance companies, whose business model . . . is to target coverage on the healthy and delay payments to the sick."

That is predation. Public service is its opposite. And thus we come to the subtle part about Mr. Galbraith's theory, the catch that seems to have confused his potential admirers on the right: Government isn't simply "a predator" by definition, as Mr. Grassley would have it. Yes, it has been predatory in recent years, but for much of the last century it wasn't.

Source (http://online.wsj.com/article/SB10001424052748703298004574457392831216478.html)

[Michael]

Specifically, I want no part in the public option. I know many people are happy with it in other countries, but, quite frankly, I am very suspicious of any government power expansion (from government wire taps under Bush to this). Also, knowing the inemptitude of my government I don't believe they can do it (although I would love to be proved wrong on that count). My other major qualm is our ability to pay for it, but that hasn't been a concern of anyone in Washington on anything for decades.

That's a reasonable opinion, but it doesn't square with the facts.

Public surveys and studies consistently show that VA and Medicare are the best run and most popular healthcare enterprises in America.

As for the cost issue, that went out the window the day they banished the "single payer" solution from the debate. It may be counter-intuitive, but the reality is that universal healthcare would cost a whole lot less of the taxpayer's money than the present system. Do you have any idea how big the tax loophole is for the employer healthcare deduction? It is worth hundreds of billions annually - and it is one big fat private market subsidy.

[wphelan]

Is phasing out subsidized employer health insurance an unreasonable option? I don't understand why it makes any sense to keep it.

[Lily]

Is phasing out subsidized employer health insurance an unreasonable option? I don't understand why it makes any sense to keep it.

The general public would go apoplectic. Taking away what they perceive to be cheap work insurance and replacing it with who-knows-what would be akin to asking them to walk off the edge of a cliff.

[wphelan]

The general public would go apoplectic. Taking away what they perceive to be cheap work insurance and replacing it with who-knows-what would be akin to asking them to walk off the edge of a cliff.

But does anyone think it would be good policy?

[Michael]

But does anyone think it would be good policy?
Damn good policy.

I hold that the US employer-provided model is really bad public policy for several reasons.

1. It tends to reduce growth in 'real wages'.
2. It reduces labor mobility (aka "healthcare joblock").
3. It is a drag on entrepreneuralism (US has one of the lowest rates in the western world).
4. It costs just as much tax-expenditure as a universal single payer system without any of the benefits of a single-payer system.

I don't see any reason to keep it other than the political minefield of trying to get rid of it.

[wphelan]

Damn good policy.

I hold that the US employer-provided model is really bad public policy for several reasons.

1. It tends to reduce growth in 'real wages'.
2. It reduces labor mobility (aka "healthcare joblock").
3. It is a drag on entrepreneuralism (US has one of the lowest rates in the western world).
4. It costs just as much tax-expenditure as a universal single payer system without any of the benefits of a single-payer system.

I don't see any reason to keep it other than the political minefield of trying to get rid of it.

Ok, I'm glad to see I'm not the only one that thinks employer-based health insurance has no practical advantages. I understand it wouldn't be an easy policy to eliminate, but it makes no sense to me. It's terrible policy and a big hurdle to improving health insurance policy in the US.

[Lily]

But does anyone think it would be good policy?


I think it's horrible policy, for just the reasons Michael outlined above. Getting rid of it will be an uphill battle, though.

[Michael]

I think it's horrible policy, for just the reasons Michael outlined above. Getting rid of it will be an uphill battle, though.
"Uphill battle" doesn't quite describe it accurately.

Fucking impossible battle seems more realistic. :D

I don't think it is reasonable to even consider the possibility of removing a couple hundred billion dollars worth of tax-expenditure subsidies for private insurance profits. Those private insurance companies will fight like hell to keep that subsidy! Without it, they loose billions in profits.

[Non Sequitur]

That's a reasonable opinion, but it doesn't square with the facts.

Public surveys and studies consistently show that VA and Medicare are the best run and most popular healthcare enterprises in America.

Yeah I know the facts are lined up against me, I just still have reservations. What ever Congress passes, I wont complain much. Actually, I recently came to the conclusion that I just want Congress to pass something. If it doesn't work, we will work out the details later. I just want the debate to end.

As for the cost issue, that went out the window the day they banished the "single payer" solution from the debate. It may be counter-intuitive, but the reality is that universal healthcare would cost a whole lot less of the taxpayer's money than the present system. Do you have any idea how big the tax loophole is for the employer healthcare deduction? It is worth hundreds of billions annually - and it is one big fat private market subsidy.

Too true. When I said cost, my real point was trying to pay for this in a recession when we already had a massive stimulus and a government bail out.

On a side note, Insurance companies are one of the few companies exempt from anti-trust/monopoly charges. I would like to see this changed.

[Americano]

"Uphill battle" doesn't quite describe it accurately.

Fucking impossible battle seems more realistic. :D

I don't think it is reasonable to even consider the possibility of removing a couple hundred billion dollars worth of tax-expenditure subsidies for private insurance profits. Those private insurance companies will fight like hell to keep that subsidy! Without it, they loose billions in profits.

To say nothing of the employees who are realizing untaxed, supplementary income in the form of company provided health insurance.

[Michael]

On a side note, Insurance companies are one of the few companies exempt from anti-trust/monopoly charges. I would like to see this changed.
Yeah, well the Healthcare Insurance Lobby (AHIP) pissed the White House so much last week with their gamesmanship and lies that the WH immediately moved to get the anti-trust exemption lifted. :thumbsup:

It was all part of the secret deal Obama arranged with the Healthcare Insurance companies months ago. But the Insurance companies just couldn't keep to their side of the bargain so Obama is now using the big gun on them. Serves the fuckers right.

[dilettante]

Looks like 'public option' with some sort of 'opt out' plan is the way Reid is gonna try to play it.

http://www.latimes.com/news/nationworld/nation/la-na-healthcare-reid27-2009oct27,0,7425185.story

I'm uncertain how I feel about the 'public option', but I'm especially dubious about the notion of letting individual states 'opt out'. That just sounds like a recipe for trouble.

I'm also sad that Snowe's "trigger" plan isn't getting broader consideration, as I think (from my remarkably ignorant perspective) that it sounds the most promising of anything talked about so far.

[Michael]

Looks like 'public option' with some sort of 'opt out' plan is the way Reid is gonna try to play it.

http://www.latimes.com/news/nationworld/nation/la-na-healthcare-reid27-2009oct27,0,7425185.story

I'm uncertain how I feel about the 'public option', but I'm especially dubious about the notion of letting individual states 'opt out'. That just sounds like a recipe for trouble.
Actually, I think it is a reasonbly good comprimise. Blue states will get the public option and the Red states won't.

Since the Red states are where most of the socialist-mongering medicare-haters live, it seems appropriate.

Indeed, what could possibly be wrong with a policy that permits individual States to opt-out if their constituents don't support the policy? Let the voters 'reap what they have sown' and all that.

I'm also sad that Snowe's "trigger" plan isn't getting broader consideration, as I think (from my remarkably ignorant perspective) that it sounds the most promising of anything talked about so far.
Apparently you and Olympia Snowe are the only two people in the USA that supported this policy.

To most people who are seriously involved in the issue, "trigger" is a fancy word for 'punting' on it. That trigger was going to be set up so that it would never, ever activate. That's why some Republicans liked it - it allows them to be totally opposed yet pretend that they are in favor. Typical Washington bipartisan consensus stuff here - pretend to be some imaginary middle ground with a term no one understands and then make sure the fine print kills any possibility of it.

Besides, the "trigger" option is essentially identical to the "opt-out" option in reality. In both cases, it is up to each individual state to decide if they want to have public medicare available to the people. Trigger is a system where the mechanism of decision is hidden. Opt-out is a system where the mechanism of decision is the State Legislature.

The "trigger" option is thus doubly popular with anti-public option Republicans because if/when the "trigger" gets activated, we get to have this whole debate all over again! (which stirs up more of the same Obama=socialist stuff the rightwing lives for).

[dilettante]

Actually, I think it is a reasonbly good comprimise. Blue states will get the public option and the Red states won't.

Since the Red states are where most of the socialist-mongering medicare-haters live, it seems appropriate.

Indeed, what could possibly be wrong with a policy that permits individual States to opt-out if their constituents don't support the policy? Let the voters 'reap what they have sown' and all that.

It just looks to me like they're just asking for mass confusion and endless bickering. If public health insurance is going to be a federal program, let be a federal program; if its going to be a state-level program, let it be state-level. But the idea of something like this, which is neither fish nor fowl, raises a whole new world of questions and potential conflicts. What happens, for instance, when someone with public insurance moves across state lines?

And doesn't this just hurt everyone? I mean, if the public option is going to save us it will do so, in large part, through having very, very large risk pools. Letting states opt-out shrinks the pools and makes it less effective.
On the other hand, if the public option is going to unfairly compete with private companies, then companies operating in multiple states are in for a rough time and will have to raise rates in opt-out states to stay viable in public option states or else abandon the public option states altogether. It's a lose-lose compromise.

Then there's the question of how this works financially. This program is going to cost hundreds of billions of federal dollars; will the 'opt-out' states get to 'opt-out' of the costs? That sounds like an immense accounting headache.

And what about future reforms to health care? It seems entirely possible this would open the door to requiring two sets of legislation from now on, one to deal with public option states, another to deal with 'opt-out' states. And, doubtless, when supporters of the public option are in power they'll try to stick-it to the 'opt out' states to get them to switch over, and when opponents of the public option take over they'll shower favor on the opt-out states over the public plan.

Opting out just feels too close to "nullification" to me. I'd much prefer a national public option forced on every state to this bizarre worst-of-both-worlds compromise.

Of course, since no one seems to have any firm idea over exactly what "opting out" looks like, or how one could go about doing it, my thoughts are purely speculative. Hopefully we'll get some details soon.


Apparently you and Olympia Snowe are the only two people in the USA that supported this policy.

Maybe we should start a club. :)

Regardless, it's still the path I'd prefer. Let them hammer out the framework of a national, public plan, including new taxes to pay for it (because, honestly, if we're going to do this I'd really rather they no scrimp on it).
Then they can pass a set of reforms for the private sector, throw in whatever mandates and subsidies they need, and give the private industry measurable goals to achieve in X years.
If they reach their goals then huzzah for making things better without starting up a massive new government program! If not, we'll have a well-planned and carefully thought out public alternative that people will have had X years to get used to rather than some cheap option that was rammed through in a desperate attempt to get it passed before mid-terms.

I'm sure you entirely disagree, and apparently it is just me and Olympia here. Nonetheless, I'm undeterred. I think its the best idea.

[Michael]

It just looks to me like they're just asking for mass confusion and endless bickering. If public health insurance is going to be a federal program, let be a federal program; if its going to be a state-level program, let it be state-level. But the idea of something like this, which is neither fish nor fowl, raises a whole new world of questions and potential conflicts. What happens, for instance, when someone with public insurance moves across state lines?
I don't accept your "neither fish nor fowl" argument here.

US Education, medicare and welfare policies all fit that description right now. All are state administered agencies, with substantial funding provided by the federal government. Do you lose your public education or medicare if you cross state lines?

Btw, this is precisely how most countries actually do government sponsored healthcare insurance. Canada specifically follows this model (we have 10 separate provincial healthcare insurance companies, each with a monopoly in their respective province).

I see nothing wrong (and lots that is admirable) about having 50 separate government sponsored state-level healthcare insurance companies.

It makes no real difference if there are 10, 20, 30 or 50 of them.

And doesn't this just hurt everyone? I mean, if the public option is going to save us it will do so, in large part, through having very, very large risk pools. Letting states opt-out shrinks the pools and makes it less effective.
Not really. The vast majority of US states each make sufficient risk pools themselves. One doesn't need 300 million population for a functional and diverse risk-pool.

The key to risk pooling is diversity, not geography. Most private healthcare insurance operations have non-diverse risk pools (and want to keep it that way as a matter of profit maximizing).

On the other hand, if the public option is going to unfairly compete with private companies, then companies operating in multiple states are in for a rough time and will have to raise rates in opt-out states to stay viable in public option states or else abandon the public option states altogether. It's a lose-lose compromise.
Unfairly compete?

The private healthcare insurance industry is the prime beneficiary of a tax exemption subsidy that is worth several hundred billion dollars per year.

If you want "real" market competition, get rid of that private market subsidy.

So long as the private market is dependent upon that massive public tax subsidy, don't talk to me about 'unfair' competition. That's just rightwing propaganda that ignores the basic facts of the matter.

Then there's the question of how this works financially. This program is going to cost hundreds of billions of federal dollars; will the 'opt-out' states get to 'opt-out' of the costs? That sounds like an immense accounting headache.
What's complicated about the State of Pennsylvania deciding whether they want to participate in the program or not?

And yes, as a general rule, "opt-out" usually means opt out of the cost too.

I don't see your point here - or you are missing the fact that public option healthcare tends to reduce healthcare costs overall. That's always been the big problem with US healthcare - everyone avoids simple cheap procedures because they cost money - and end up only getting treated down the road when the problem reaches critical stage (and costs a fortune to treat). A robust public healthcare program tends to eliminate this.

Thus, the primary way to cut the cost-growth curve for Medicare is to bring in public option healthcare.

This is particulary significant with poor people who tend to have poor health. If/when they make it to 65, they cost the taxpayer a fortune at that point. With pubic healthcare, poor people generally have much better health and thus don't cost the taxpayer a fortune the day they turn 65.

And what about future reforms to health care? It seems entirely possible this would open the door to requiring two sets of legislation from now on, one to deal with public option states, another to deal with 'opt-out' states. And, doubtless, when supporters of the public option are in power they'll try to stick-it to the 'opt out' states to get them to switch over, and when opponents of the public option take over they'll shower favor on the opt-out states over the public plan.
Suffice it to say that there is no known example of any government healthcare plan being rejected by the voters at any time, once it is enacted. Generally speaking, such plans are amongst the most popular of all government programs and any politician that dares attack them is dead-meat.

In other words, if an "opt-in" public option is on the table, the conversion process is entirely one way. State voters will never permit an "opt-out" once "opt-in" has been established. There is no credibility for asserting otherwise.

Opting out just feels too close to "nullification" to me. I'd much prefer a national public option forced on every state to this bizarre worst-of-both-worlds compromise.
I really don't see the basis for your objection.

For those of us who understand public healthcare insurance, we know that "opt-in" is only a matter of time for all 50 states.

If bringing in a national program state-by-state is the only way that is politically acceptable to the small minority of Senators who have the power to block this, then I accept that this is the way to go. The end result is still the same.

I'd prefer a full roll-out across the country, but if Oklahoma and Texas want to piss on their citizenry, that's their business, not mine.

Of course, since no one seems to have any firm idea over exactly what "opting out" looks like, or how one could go about doing it, my thoughts are purely speculative. Hopefully we'll get some details soon.
Opting out looks just like the present status quo (except worse, since there will be a mandate). The political pressure for opt-in will be very strong.

Nothing but a full public healthcare system for all will solve US healthcare problems. Most US healthcare problems come from the fact that it is rationed so strictly according to wealth.

Regardless, it's still the path I'd prefer. Let them hammer out the framework of a national, public plan, including new taxes to pay for it (because, honestly, if we're going to do this I'd really rather they no scrimp on it). Then they can pass a set of reforms for the private sector, throw in whatever mandates and subsidies they need, and give the private industry measurable goals to achieve in X years.
If they reach their goals then huzzah for making things better without starting up a massive new government program! If not, we'll have a well-planned and carefully thought out public alternative that people will have had X years to get used to rather than some cheap option that was rammed through in a desperate attempt to get it passed before mid-terms.
The problem with your model is that the Republican party is adamantly opposed as is the private healthcare industry. They will both fight you tooth and nail no matter what you propose - they want the status quo and that's all.

As for your "speed" argument, suffice it to say that US healthcare insurance reform (and the public option) has been on the table since President Truman first tabled the idea some half a century ago.

And the vast majority of the present healthcare plan is almost identical to the plan put forward by the Clinton WH fifteen years ago.

Nothing new here at all. These are all old ideas that have been around for decades. Similarly, most of these programs have been running in other western countries for many decades. This is not some new fad.

I'm sure you entirely disagree, and apparently it is just me and Olympia here. Nonetheless, I'm undeterred. I think its the best idea.
Like the "co-op" option, the "trigger" was always a code-phrase that served the short term political posturing interests of certain and particular Republican Senators (and pretty much no one else).

No sympathy for Snowe either. Let her vote against it and let her explain that to the strong majority in Maine that supports the public option. It would be nice to see her get taken down for this gamesmanship she's been playing.

[Non Sequitur]

Don't know if this is being talked about somewhere else already, but it looks like a bill has been unveiled

House Health Bill Has Compromise on Public Option

WASHINGTON – House legislation to overhaul the health-care system, unveiled Thursday, includes a compromise version of a public insurance option and carries an overall cost of $894 billion over 10 years, House aides said.

The cost figure is just under the $900 billion upper limit set by President Barack Obama for a health-care bill he will sign.

The bill includes a mix of cuts to existing programs and new taxes, including a surtax on high earners, to fully offset its impact on the federal budget. The bill will actually produce a net savings of $30 billion over the first 10 years, according to a summary from House Democrats

this looks ok to me (here is the rest of the article (http://online.wsj.com/article/SB125682351602615905.html?mod=WSJ_hpp_LEFTTopStori es)). Specifically, I approve the repeal of the exemption insurance companies have from Antitrust laws and the expansion of Medicaid. If this is passed, I could tolerate it.

[dilettante]

Does anyone have any thoughts on how the proposed plans handle payment rates? As I understand it, both the House and Senate bills call for the public option plans to negotiate rates with service providers just as private insurers do, and that this is a compromise for Pelosi and House liberals who would have preferred payments to be tied to medicare rates.

[Michael]

Btw, with regard to an earlier point about the "opt-in/opt-out" format, this is identical to the existing structure for Medicaid. It is to be noted that every state has opted-in and no State has ever opted out.

Likewise with federal highway funding - that is also "opt-in" only and has about 99.999999% opt-in rate.

In both cases individual states can at the will of the State Legislature, vote to "opt-out" of the programs (and forgo available federal funding for same).

It is also relevent to remember the example of the stimulus funding package - quite a few Republican Governors from southern states loudly proclaimed their opposition to the program but have been quite enthusiastic about getting the
funds and spending them.

I suspect the same would happen with any public option health insurance - Republicans will rant and rave about it to partisan audiences, but will be forced by public opinion to enact it.

[Michael]

For those of you who may still have some doubts about just how insanely overpriced US healthcare services are, here is some comprehensive evidence. Just looking at the pretty colored graphs tells the whole tale without even reading the report!

US price for each service listed is on average ten times as expensive as the average cost in other western countries (who all have socialized healthcare systems).

Even taking the US 'lowend' prices are still massively inflated above the international average. US 'highend' prices are just silly.

Report (http://voices.washingtonpost.com/ezra-klein/IFHP%20Comparative%20Price%20Report%20with%20AHA%2 0data%20addition.pdf)

[Greendruid]

For those of you who may still have some doubts about just how insanely overpriced US healthcare services are, here is some comprehensive evidence. Just looking at the pretty colored graphs tells the whole tale without even reading the report!

US price for each service listed is on average ten times as expensive as the average cost in other western countries (who all have socialized healthcare systems).

Even taking the US 'lowend' prices are still massively inflated above the international average. US 'highend' prices are just silly.

Report (http://voices.washingtonpost.com/ezra-klein/IFHP%20Comparative%20Price%20Report%20with%20AHA%2 0data%20addition.pdf)

That's amazing! Their economy can't afford to shift to socialised medicine! Think of all the chauffeurs, maids and butlers that will be put out of work once the doctors stop making so much money on their routine practices. I don't even want to know what specialists make for their special practices. I can see the headlines now:

"Canadian border flooded with ex-pat nurses and doctors returning home to look for work!"

[Lily]

That's amazing! Their economy can't afford to shift to socialised medicine! Think of all the chauffeurs, maids and butlers that will be put out of work once the doctors stop making so much money on their routine practices. I don't even want to know what specialists make for their special practices. I can see the headlines now:

"Canadian border flooded with ex-pat nurses and doctors returning home to look for work!"

It's the specialists and their non-routine testing who are bringing down the big bucks. Family practioners are struggling. Fewer and fewer doctors are choosing to go into family practice and some practioners are closing down altogether. The specialists are buying into the CT/MRI imaging centers, the rehabs, the sleep centers, the outpatient surgery centers -- all of the high-end money makers, and of course, referring their patients to these businesses.

On the other hand, in my county there is one free clinic and it's run by these same doctors. They put up the money, volunteer their time and treat people who would otherwise end up in our ERs. Right now, the clinic is open one day a week, but these doctors hope to have it open three days a week next year.

[Americano]

It's the specialists and their non-routine testing who are bringing down the big bucks. Family practioners are struggling. Fewer and fewer doctors are choosing to go into family practice and some practioners are closing down altogether. The specialists are buying into the CT/MRI imaging centers, the rehabs, the sleep centers, the outpatient surgery centers -- all of the high-end money makers, and of course, referring their patients to these businesses.

On the other hand, in my county there is one free clinic and it's run by these same doctors. They put up the money, volunteer their time and treat people who would otherwise end up in our ERs. Right now, the clinic is open one day a week, but these doctors hope to have it open three days a week next year.

Physician family practitioners in my area are rapidly being replaced by nurse practitioner offices as regular health care providers.

[dilettante]

It's the specialists and their non-routine testing who are bringing down the big bucks. Family practioners are struggling. Fewer and fewer doctors are choosing to go into family practice and some practioners are closing down altogether. The specialists are buying into the CT/MRI imaging centers, the rehabs, the sleep centers, the outpatient surgery centers -- all of the high-end money makers, and of course, referring their patients to these businesses.


That's the impression I've gotten from the family practitioners I know as well. People complain about health care costs, but they're struggling to make ends meet (which really sucks if you consider how long they were in school and training for this). It's not like the average health care provide in America is raking in the moola and living in luxury.

[dilettante]

Looks like the bill squeaked by in the House with just 2 votes to spare, and that only after some contentious language on abortion.

On to the Senate for round 2!

[Americano]

Looks like the bill squeaked by in the House with just 2 votes to spare, and that only after some contentious language on abortion.

On to the Senate for round 2!

I don't think it stands a chance of passing the senate. It would take 60 votes to avoid a filibuster. At this point private sector insurance lobbyists have to be promising to pay for reelection costs and vacation villas for the entire senate.

Special interests have always governed the US.

[Michael]

That's the impression I've gotten from the family practitioners I know as well. People complain about health care costs, but they're struggling to make ends meet (which really sucks if you consider how long they were in school and training for this). It's not like the average health care provide in America is raking in the moola and living in luxury.
I don't have much sympathy for the income levels of doctors, even the lowly GP averages 2-3 times the average industrial wage, or 4 to 5 times the poverty line.

They are envious of the incomes of specialists who tend to make double the average GP income. And lets not forget that doctors are all self-employed professionals with all the tax advantages that comes with (meaning they are able to pay a lower effective tax rate than most other American taxpayers on incomes many times higher than the average American taxpayer). Sure it is a tough job that requires lots of education. But the bottom line is that this profession is very well paid by any measure.

[Michael]

Anyway, the House has passed Healthcare legislation. I've not read any summary of what is passed and I won't bother until the Senate passes a bill. That "reconcilliation" stage always boggles my mind - since they can and will ignore actually passed legislation and insert whole new line items then. What comes out doesn't necessarily bare resemblance to what went in.

Got to be the most weird (and corrupt) aspect of this oddly unique insitutional form of government used in the USA. No wonder no other nation has ever copied the US institutional system!

[dilettante]

I don't have much sympathy for the income levels of doctors, even the lowly GP averages 2-3 times the average industrial wage, or 4 to 5 times the poverty line.

They are envious of the incomes of specialists who tend to make double the average GP income. And lets not forget that doctors are all self-employed professionals with all the tax advantages that comes with (meaning they are able to pay a lower effective tax rate than most other American taxpayers on incomes many times higher than the average American taxpayer). Sure it is a tough job that requires lots of education. But the bottom line is that this profession is very well paid by any measure.

Frankly, I have no problem with that. Given the immense amount of effort, the percentage of one's live, and the absurd levels of stress involved in becoming a doctor, I would say that earning 2-3 times an industrial wage is perfectly fair, though again, none of the GPs I've known have lived lives of luxury.
There are all sorts of people who, IMO, have unjustifiable incomes (CEOs and sports professionals, to name a few), but I don't include doctors on that list.

The idea of a low-paid physician just sounds like trouble; it also sounds like a recipe for a shortage of physicians, long lines in offices and long waits for common procedures.

[Michael]

Frankly, I have no problem with that. Given the immense amount of effort, the percentage of one's live, and the absurd levels of stress involved in becoming a doctor, I would say that earning 2-3 times an industrial wage is perfectly fair, though again, none of the GPs I've known have lived lives of luxury.
There are all sorts of people who, IMO, have unjustifiable incomes (CEOs and sports professionals, to name a few), but I don't include doctors on that list.

The idea of a low-paid physician just sounds like trouble; it also sounds like a recipe for a shortage of physicians, long lines in offices and long waits for common procedures.
I wasn't bitching about it or criticizing doctors for being paid well. As a general rule, they are hardworking and valuable contributors to society. I was just pointing out that doctors receive zero sympathy from me when they complain of being underpaid. Doctors are in every respect, paid more than than 98% of the patients they treat.

And as I noted above, with the tax advantages of being self-employed, you can be sure that your doctor pays less income tax than you do.

[Lily]

I wasn't bitching about it or criticizing doctors for being paid well. As a general rule, they are hardworking and valuable contributors to society. I was just pointing out that doctors receive zero sympathy from me when they complain of being underpaid. Doctors are in every respect, paid more than than 98% of the patients they treat.

And as I noted above, with the tax advantages of being self-employed, you can be sure that your doctor pays less income tax than you do.



True. But I don't pay an average $56,000 a year in malpractice insurance either. That's what a GP pays in Florida, according to the GAO's 2009 survey.

[Michael]

True. But I don't pay an average $56,000 a year in malpractice insurance either. That's what a GP pays in Florida, according to the GAO's 2009 survey.
Now you are talking about the gross income of a doctor's practice. They probably pay that same amount for assistants too - plus office rent and other expenses. All of these are tax deductable expenses.

[Michael]

The Stupak Amendment makes it illegal for any government healthcare subsidies to go towards a healthcare insurance that covers abortion services.

This is of course not just a run of the mill anti-abortion law. This is a particular anti-abortion law that targets poor people. Prosperous middle class people apparently can keep their massive government subsidies ($250 billion per year) for their abortion providing healthcare insurance.

Funny how that works...

I wonder why Stupak doesn't push for a similar anti-abortion amendment to the tax subsidy that goes to pay for private healthcare insurance? That could cost many middle class people several thousand dollars per year! Better to make one's anti-abortion crusade only affect poor people because when it comes to anti-abortion politics, principles mean nothing and it is always easier to make examples out of poor people. Middle class tax subsidies and/or private market subsidies are a special kind of entitlement that doesn't count. :shrug:

[Michael]

Here's some more fun facts about US healthcare - the kind of facts that the US media and politicians don't talk about...

Fact is, US has the highest priced healthcare insurance in the western world. Everyone already knows this. However, are you aware that the US already spends more tax dollars per capita on healthcare than any other western nation? This is before any reform policy in Congress right now.

If you add up the cost of Medicare, Medicaid, VA and the $250 billion private healthcare subsidy, that price tag is way over $1 trillion per year.

In other words, theUS already has a highly socialized healthcare system where taxpayer money covers about half of all US healthcare expenditure. This is called a "private system" because that's where all the profits go.

[dilettante]

The Stupak Amendment makes it illegal for any government healthcare subsidies to go towards a healthcare insurance that covers abortion services.

This is of course not just a run of the mill anti-abortion law. This is a particular anti-abortion law that targets poor people. Prosperous middle class people apparently can keep their massive government subsidies ($250 billion per year) for their abortion providing healthcare insurance.

Funny how that works...

I wonder why Stupak doesn't push for a similar anti-abortion amendment to the tax subsidy that goes to pay for private healthcare insurance? That could cost many middle class people several thousand dollars per year! Better to make one's anti-abortion crusade only affect poor people because when it comes to anti-abortion politics, principles mean nothing and it is always easier to make examples out of poor people. Middle class tax subsidies and/or private market subsidies are a special kind of entitlement that doesn't count. :shrug:

That seems like an unjustifiably cynical assessment. I would think the most likely reason for not pushing for the additional restrictions you suggest is that it would be an unwinnable fight and he knows it.

Now I know nothing about Stupak as an individual, but in general settling for what you can get instead of vainly demanding the impossible isn't necessarily a sign of hypocrisy or proof that one's "principles mean nothing". All-or-nothing is just a good way to get nothing; someone truly devoted to changing things will be willing to do it one step at a time.

[Michael]

That seems like an unjustifiably cynical assessment. I would think the most likely reason for not pushing for the additional restrictions you suggest is that it would be an unwinnable fight and he knows it.

Now I know nothing about Stupak as an individual, but in general settling for what you can get instead of vainly demanding the impossible isn't necessarily a sign of hypocrisy or proof that one's "principles mean nothing". All-or-nothing is just a good way to get nothing; someone truly devoted to changing things will be willing to do it one step at a time.
Why would it be impossible? Anti-abortion is a principle. Refusing to use taxpayer subsidies for abortion services is a principle. And these principles were STRONGLY supported in Congress this week. Ergo, eliminating the tax subsidy for abortions by private healthcare providers looks like a no brainer.

Since Congress hasn't done this, it is thus entirely reasonable to assert that taxpayer subsidies for poor people abortions is against the law, but taxpayer subsidies for middle class and rich people's abortions is just fine with Congress.

That is hypocrisy (or poor-bashing) no matter how you want to spin it. Just because the Congressional pigs at the trough don't like having their trough feeding interrupted doesn't make trough-feeding an entitlement or a right that can't be interrupted. Indeed, it just makes the hypocrisy that much more obvious.

[dilettante]

Why would it be impossible? Anti-abortion is a principle. Refusing to use taxpayer subsidies for abortion services is a principle. And these principles were STRONGLY supported in Congress this week. Ergo, eliminating the tax subsidy for abortions by private healthcare providers looks like a no brainer.

Since Congress hasn't done this, it is thus entirely reasonable to assert that taxpayer subsidies for poor people abortions is against the law, but taxpayer subsidies for middle class and rich people's abortions is just fine with Congress.

That is hypocrisy (or poor-bashing) no matter how you want to spin it. Just because the Congressional pigs at the trough don't like having their trough feeding interrupted doesn't make trough-feeding an entitlement or a right that can't be interrupted. Indeed, it just makes the hypocrisy that much more obvious.

So you think that if Stupak had proposed an amendment that cancel tax deductions for any insurance that allowed abortions, it would have passed the House? I find that to be extremely unlikely, and I expect Stupak did as well.

Even as it stands the amendment is causing uproar. I don't see anything unrealistic about someone seeing a chance to change the law to decrease (round-about) public funding for abortions, but recognizing that completely eliminating it is 'a bridge too far'.

Anyway, short of being able to read the man's mind and know that he secretly thought he could have gotten even great restrictions but (out of his bizarre personal loathing for the poor) chose not to bother, I'm not willing to dismiss the man's principles or call him a hypocrite.

[Lily]

Stupak did nothing to further the language in the Hyde Amendment of 1977, an amendment that has been argued and argued every single time Medicaid funding has come up in the Congress. So, honestly, this was just another dog and pony show. It meant nothing.

The Senate, however, wants to do want Stupak was unwilling to do; that is, eliminate abortion for all federally subsidized health insurance, including those policies privately purchased. We'll see how far that gets. My guess is though, just about as far as the Stupak amendment got.

[Lily]

Regarding the above post, apparently I was wrong. The Stupak Amendment did include restrictions on abortions for all government subsidized policies under the the so-called "insurance exchange." This amendment would provide federal subsidies for a single woman making up to $43,000 and a family of four making up to $88,000 a year. That's a lot of lower middle class and working poor people. These woman would be allowed to purchase a supplemental policy to cover elective abortions.

[Zarquon]

Democrats Clinch Votes Needed to Bring Health Bill to Senate Floor

Senate Democrats said that they had clinched the votes needed
on Saturday to propel major health care legislation to the
floor for weeks of full debate and amendments, as the
majority party's two last hold-outs, Senators Mary L.
Landrieu of Louisiana and Blanche Lincoln of Arkansas, said
that they would not block consideration of President Obama's
top domestic initiative.
Source (http://www.nytimes.com/2009/11/22/health/policy/22health.html?emc=na)

[Zarquon]

Senate Votes to Open Health Care Debate

The Senate voted on Saturday to begin full debate on major health care legislation, propelling President Obama (http://topics.nytimes.com/top/reference/timestopics/people/o/barack_obama/index.html?inline=nyt-per)’s top domestic initiative over a crucial, preliminary hurdle in a formidable display of muscle-flexing by the Democratic majority.
The 60-to-39 vote (http://politics.nytimes.com/congress/votes/111/senate/1/353), along party lines, clears the way for weeks of rowdy floor proceedings that will begin after Thanksgiving and last through much of December.
The Senate bill seeks to extend health benefits to roughly 31 million Americans who are now uninsured, at a cost of $848 billion over 10 years.

Source (http://www.nytimes.com/2009/11/22/health/policy/22health.html?th&emc=th)
So, now their will be 'debate' in the senate for a few weeks, before the dems rally behind one of their bills, and get it passed. Once (and If) that happens, the Senate and house bills have to be reconciled and that version(if reconciliation is successful) will be sent to the President for approval.

[Michael]

Source (http://www.nytimes.com/2009/11/22/health/policy/22health.html?th&emc=th)
So, now their will be 'debate' in the senate for a few weeks, before the dems rally behind one of their bills, and get it passed. Once (and If) that happens, the Senate and house bills have to be reconciled and that version(if reconciliation is successful) will be sent to the President for approval.

And what are the odds a 'robust' public option will survive that hornet's nest of corporate lobbyists?

I'm thinking longshot.

[Non Sequitur]

And what are the odds a 'robust' public option will survive that hornet's nest of corporate lobbyists?

I'm thinking longshot.

I think it actually has about 50/50 odds. The current congress has a lot of legitimacy resting on this bill.

[Americano]

And what are the odds a 'robust' public option will survive that hornet's nest of corporate lobbyists?

I'm thinking longshot.

If congressional opponents and proponents can rationalize a deal excluding abortion in favor of the public raising unwanted children for 18+ years the public is, as usual, screwed.

[Michael]

Seems that the Public Option is totally dead now. No surprise since Obama fucked up the negotiations from day one. This is the logical result of Obama's opening stance.

By taking the 'single-payer' option off the table before the debate began, Obama essentially defined the 'public-option' as the most leftwing extreme form of healthcare reform - and all the pseudo-centerists always reject whatever is the most leftwing extreme by definition - hence 'public option' is now rejected by consensus.

If the debate began with 'single payer' as the properly defined leftwing extreme position, then the pseudo-centerists would all be defending the 'public option' as the centerist choice to avoid doing what the hated lefties want.

I hold Obama specifically responsible for this negotiating dynamic. If the public option fails in the Senate, Obama is the one to blame.

All that being said, I do approve of the new policy idea to just expand the enrollment into Medicare. That was my initial policy proposal on this issue - just expand Medicare to cover everyone since that program is remarkably popular and surprisingly efficient. Of course, that's a "single-payer" system, but as long as it is called "Medicare" (which everyone loves) instead of calling it "single-payer" (which is evil) that's enough to confuse the idiots. :shrug:

[Michael]

Btw, I used to hold the example of various Chairs of the Foreign Intelligence Committee (House) not being able to say whether Saudi Arabia was majority Shia or Sunni to have been the hallmark of moronic and ill-educated Congress-critters.

All that has been trumped by the mind-numbing ignorance on display in Congress regarding healthcare. I'll never again have any respect for any member of Congress after this - they are all fucking morons.

[Michael]

By the time the Senate gets done slicing and dicing the Healthcare bill, I wonder what will be left?

As I've said all along, I think the idea of the "individual mandate" combined with a lack of a public option is political suicide for the Democrats.

The reason some 40 million Americans don't have healthcare insurance is because they can't afford it. Passing a law that requires them to buy private market insurance that they can't afford isn't my idea of a good plan.

[Zarquon]

By the time the Senate gets done slicing and dicing the Healthcare bill, I wonder what will be left?

As I've said all along, I think the idea of the "individual mandate" combined with a lack of a public option is political suicide for the Democrats.

The reason some 40 million Americans don't have healthcare insurance is because they can't afford it. Passing a law that requires them to buy private market insurance that they can't afford isn't my idea of a good plan.
read this and tell me what you think:
http://www.fivethirtyeight.com/2009/12/why-progressives-are-batshit-crazy-to.html

[Michael]

read this and tell me what you think:
http://www.fivethirtyeight.com/2009/12/why-progressives-are-batshit-crazy-to.html

The left blogosphere is one big echo chamber with that argument and it is getting very repetitive (it is presently posted at a dozen by my count).

Lets just say that the people who keep making that argument are not the ones without healthcare insurance. They are in fact a particular group of people with a massive vested interest in passing healthcare legislation (any legislation at all!) to whom the details don't affect them. I've always discounted the analysis of such vested interests.

Besides, where in that little chart is the explanation for where the average family that can't afford healthcare insurance is going to magically find $9,000 to pay for healthcare insurance?

If they had $9,000 lying around to spend, they'd probably already have healthcare insurance. But they don't - so they don't.

And all the Senate bills in the world aren't going to put that magic $9000 in their pockets. And if those poor people can't scrounge up $9000, they will be considered criminals.

And you are asking me why I think it is a silly plan? The only people cheering for this plan are the insurance companies (and progressive activists who desperately need a victory on this issue more than anything else).

Postscript: That last "caveat" in the Five-Thirty-Eight post just shows how out to lunch these progressive activists are. The average family of four in USA with a gross income of $54,000 probably doesn't actually pay any income tax at all and therefore, talking about claiming tax credits is just pie-in-the-sky. This is a very common error. The bottom 50% of the US population doesn't actually pay any net federal income tax. But somehow, the poor people who can't afford healthcare insurance are going to claim their "co-pays" and deduct that from their taxes! :lol:

[drgoodtrips]

It could be a refundable tax credit (I didn't read the bill, so I don't know). This is a bizarre little piece of the US tax code where one can actually claim a negative tax burden. That is, if I make 20 thousand per year and I subtract all of my credits and deductions and wind up paying no federal income tax, I can actually get a check from the IRS at tax time that is larger than all of my annual withholdings.

It's convoluted shit like this in the tax code that often makes semantical US partisan arguing over taxes rather amusing. That is, the tax code can be used to get right-wingers to support welfare ("No, no, no, this isn't welfare - it's a tax break where low income people get more from the government in tax refunds than they pay in taxes!" "Oh, taxes are bad - sign me up!") or to get left-wingers to support regressive taxation policy ("No, no, no, this isn't a tax break that disproportionately favors the wealthy - we're reducing anyone's gross tax burden by fifty percent if they buy CFL bulbs!" "Oh, that seems like a good idea - it's good for the environment and applies equally to all!")

In my cynical view, I think that's why you don't see any serious effort to reform and simplify the tax code in the US from its current state of being so incredibly convoluted that the IRS itself probably wouldn't get the same figure twice on the same tax return. Politicians can easily obfuscate the true nature of whatever it is they're trying to do and how they're trying to finance it to maximize its political appeal.

[Michael]

It could be a refundable tax credit (I didn't read the bill, so I don't know).
Yes, it could, if refundable tax credits for this were in the bill - but they are not (or atleast, there has been no mention of them in any of the dozen versions of the bill that have existed in the last six weeks).

The example I referred to was some blogger assuming that average people (who can't afford healthcare insurance) could just claim the cost of their 'co-pays' on their income tax to get a tax credit - which is supposed to reduce the overall cost - which is why I pointed out that one has to owe substantial taxes in order to get the value of a tax credit (and the average US family doesn't actually owe substantial federal income taxes in the first place).

As for the overall structure of US federal tax law, I agree completely. The complexity of it appears to be a 'feature, not a bug' much favored by duplicitous politicians.

One of the worst is the US corporate income tax. On paper, the official rate is one of the highest in the western world and rightwingers never miss an opportunity of pointing this out. In reality, the net rate of US corporate income taxes paid is one of the lowest in the western world (by a large margin in fact). Thus, US corporate income taxes are both the highest and the lowest in the world - depending upon your particular outlook. No doubt the politicians like it this way.

[bug]

Hear, hear!!!! (To individual mandate being unwise)

[wphelan]

That the majority of the debate and focus of health 'care' reform seems focused on insurance seems totally disconnected from reality. The biggest issue with healthcare in this country is its ever increasing cost. Yet, the current focus on insurance isn't going to solve the cost issue. If anything, it will make it worse.

Most people want to ignore basic economic principles in this case, but like everything else the price of healthcare is subject to market forces. The further an individual is removed from knowing anything about the cost of healthcare, the worse the problem is going to be. This is easily verified by the fact that when a person goes to visit and doctor and doesn't have insurance, they are nearly always charged less than a person covered by insurance.

[Michael]

That the majority of the debate and focus of health 'care' reform seems focused on insurance seems totally disconnected from reality. The biggest issue with healthcare in this country is its ever increasing cost. Yet, the current focus on insurance isn't going to solve the cost issue. If anything, it will make it worse.

Most people want to ignore basic economic principles in this case, but like everything else the price of healthcare is subject to market forces. The further an individual is removed from knowing anything about the cost of healthcare, the worse the problem is going to be. This is easily verified by the fact that when a person goes to visit and doctor and doesn't have insurance, they are nearly always charged less than a person covered by insurance.

That is the essential reason that I'm opposed to the individual mandate without a public option. As you quite rightly pointed out, the number one problem with healthcare in the USA is the fact that it costs double (or triple) the price compared with other western nations - and has a sector inflation rate that has been running in double-digits now for several decades.

There is NOTHING in the bill that will address this. Indeed, all of the key factors that have been identified as 'causing' these over-inflated healthcare costs are still there. Thus, there is no reason to beleive that the double-digit rate of healthcare insurance price increases is going to change.

And yes, 90% of what's left in the healthcare bill is all about reforming the rules that govern healthcare insurance. There is some subsidies built-in to 'top-up' the cost for poor people - but as I pointed out above, that's after the poor people cough up $9000 in cash up front (or go to jail).

(Yes, I'm being facetious about going to jail, but that's only a semantic game to pretend that illegal is not criminal).

[Michael]

Poll: Loss Of Public Option Causes Big Increase In Opposition To Health Care Bill

The NBC/Wall Street Journal poll coming out later today will show opposition to the health care bill growing -- mainly from disappointed liberals, who are very much disappointed to see the public option getting thrown out.

The poll has 47% saying the Obama health care plan is a bad idea, to only 32% who say it's a good idea.

Chuck Todd writes on Twitter: "Most of the movement on the 'bad idea' comes from some of the president's core support groups, folks upset about lost public option." He also writes: "Still, large majorities of the president's core support groups believe his plan is a 'good idea,' but the margins have shrunk."

Source (http://tpmdc.talkingpointsmemo.com/2009/12/poll-loss-of-public-option-causes-big-increase-in-opposition-to-health-care-bill.php)

Good to see that the public isn't entirely stupid. They can tell when they've been sold down the river in favor of corporate profit.

[Michael]

As for the argument to pass the bill, suffice it to say that argument boils down to one thing... "its better than nothing". Indeed that is true.

But the political cost on this one is going to be very high. You can't go around pissing on your base and selling out to the opposition and expect there to be no political repercussions from that.

And as I've said before, I lay the blame for this debacle squarely on Obama's shoulders. It was he who 'quarterbacked' the plan in the first place. Obama was wrong at every step of the way on this healthcare issue.

I expect the Democrats are going to lose big in the 2010 midterms because of this.

[drgoodtrips]

Cynically, I think the problem might be that the weird combination of employer subsidized health insurance, and increasingly complicated health insurance practices has created a situation where the average citizen is too stupid to understand the logistics or consequences of the reform being posed. Note, my complaint is that they are not informed enough. I mean, it's literally been made so complex, that I believe it requires a fairly sophisticated intellect to understand it.

I would say that this is a problem. Imagine if something else basic (like the purchasing of food) were this complex. It would be a nightmare:

Here's the way this works. If you want to buy food, you don't go to the grocery store anymore. You go to your local food regulatory agency. It sounds like something the government would run, but it isn't. What that agency does is pool the risks associated with buying food over the collective populace and then it subsidizes your food purchases. At the food regulatory agency, you show them the food card issued by your employer, and they give you a series of food plans from which to choose.

There are some food plans, called FMO's that are reasonably priced, but only allow you to shop at one grocery store. If you want ethnic, vegan or specialty food, you need to obtain a note from your primary grocery store to go visit a specialty grocery store. Then we have PPO's, which are more expensive in terms of the withholding from your paycheck, but they allow you to go to any grocery store in the network of preferred grocery stores without visiting your primary grocery store. If you're travelling, you can go to out of network grocery stores, but instead of subsidizing 70% of your grocery bill, they only subsidize 50% for out of network visits.

To help offset the cost to employers and thus employees, we're now rolling out a FMA. What this does is give you a stipend to help you fill your yearly food deductible. So, all of your food purchases up to $2000 are covered for the year. You pay for any food that costs between $2000 and $5000, and then the FMA pays for 80% of the cost of any food over $5000 up to $10,000, at which point it pays for everything. Of course, all of these purchases are subject to your food co-pay, per individual grocery visit provision in your PPO or FMO.

Now, this is where it gets tricky. The plans do not necessarily cover all articles of food, so before you buy food, it's important to contact your local food regulatory agency to receive a list of approved foods available for purchase. If you buy the wrong kinds of food, too much food, or you have pre-existing food that you're not eating, you are subject to lose your food coverage.

For those who can't afford food coverage, you're SOL for the most part. However, when you get really hungry, you can show up at the grocery store and eat whatever. Nobody will stop you, but this will hurt your credit. While it's true that allowing you to purchase and prepare your own food would actually be cheaper than letting you wolf down expensive pastries right in the store, you have to understand that there really is no viable alternative for those who can't afford a food plan. We can't let them starve.

There are also those without employment to consider. Generally, employers allow spouses and children to be added to food plans, but for someone without a job, it's difficult to get a food plan. There are some available, but they tend to be extremely expensive and only cover the purchase of Lays potato chips. We realize that eating only Lays potato chips is likely to cause problems, but it's really the best thing for someone. At least they get something to subsist on until they get another job and thus a food plan.

Now, we get to the important matter. Fixing this thing! I think we can do it by tweaking the food plan rates. And, this can best be accomplished by a non-refundable tax credit for those in certain tax demographics. Basically, this will serve to create a situation where everybody can afford a food plan. And, if you don't purchase a food plan, you're guilty of a crime. But don't worry about that because whether or not you have a job, you will technically qualify for this tax credit which is basically the same thing as your employer subsidizing your food plan, except that it's payable retroactively instead of deductible from a paycheck that you don't have. We'll still let people show up at the grocery store and eat for free if they're hungry, but we'll tell them that we-are-super-serial when we say that they should really buy a food regulatory plan.

Whew. That was easy. Why won't anyone vote for this?!?

[Michael]

I think that sums it up rather well! :lol:

Contrast this with what us poor Canadians have to go through....

If I get sick (or even if I'm not sick and just want a checkup) I just call up my doctor and make an appointment.

That's it, that's all. My doctor has my OHIP number on file. No paperwork, no forms, no bills, nothing.

If I get referred to a specialist or go to the hospital for an operation, everything is exactly the same - no sign of any paperwork anywhere, though I might have to show my OHIP card to the hospital or the specialist doctor since they don't have me on file.

Everyone in the country is automatically enrolled in the program. No application form necessary.

[Americano]

Cynically, I think the problem might be that the weird combination of employer subsidized health insurance, and increasingly complicated health insurance practices has created a situation where the average citizen is too stupid to understand the logistics or consequences of the reform being posed. Note, my complaint is that they are not informed enough. I mean, it's literally been made so complex, that I believe it requires a fairly sophisticated intellect to understand it.

I would say that this is a problem. Imagine if something else basic (like the purchasing of food) were this complex. It would be a nightmare:

Here's the way this works. If you want to buy food, you don't go to the grocery store anymore. You go to your local food regulatory agency. It sounds like something the government would run, but it isn't. What that agency does is pool the risks associated with buying food over the collective populace and then it subsidizes your food purchases. At the food regulatory agency, you show them the food card issued by your employer, and they give you a series of food plans from which to choose.

There are some food plans, called FMO's that are reasonably priced, but only allow you to shop at one grocery store. If you want ethnic, vegan or specialty food, you need to obtain a note from your primary grocery store to go visit a specialty grocery store. Then we have PPO's, which are more expensive in terms of the withholding from your paycheck, but they allow you to go to any grocery store in the network of preferred grocery stores without visiting your primary grocery store. If you're travelling, you can go to out of network grocery stores, but instead of subsidizing 70% of your grocery bill, they only subsidize 50% for out of network visits.

To help offset the cost to employers and thus employees, we're now rolling out a FMA. What this does is give you a stipend to help you fill your yearly food deductible. So, all of your food purchases up to $2000 are covered for the year. You pay for any food that costs between $2000 and $5000, and then the FMA pays for 80% of the cost of any food over $5000 up to $10,000, at which point it pays for everything. Of course, all of these purchases are subject to your food co-pay, per individual grocery visit provision in your PPO or FMO.

Now, this is where it gets tricky. The plans do not necessarily cover all articles of food, so before you buy food, it's important to contact your local food regulatory agency to receive a list of approved foods available for purchase. If you buy the wrong kinds of food, too much food, or you have pre-existing food that you're not eating, you are subject to lose your food coverage.

For those who can't afford food coverage, you're SOL for the most part. However, when you get really hungry, you can show up at the grocery store and eat whatever. Nobody will stop you, but this will hurt your credit. While it's true that allowing you to purchase and prepare your own food would actually be cheaper than letting you wolf down expensive pastries right in the store, you have to understand that there really is no viable alternative for those who can't afford a food plan. We can't let them starve.

There are also those without employment to consider. Generally, employers allow spouses and children to be added to food plans, but for someone without a job, it's difficult to get a food plan. There are some available, but they tend to be extremely expensive and only cover the purchase of Lays potato chips. We realize that eating only Lays potato chips is likely to cause problems, but it's really the best thing for someone. At least they get something to subsist on until they get another job and thus a food plan.

Now, we get to the important matter. Fixing this thing! I think we can do it by tweaking the food plan rates. And, this can best be accomplished by a non-refundable tax credit for those in certain tax demographics. Basically, this will serve to create a situation where everybody can afford a food plan. And, if you don't purchase a food plan, you're guilty of a crime. But don't worry about that because whether or not you have a job, you will technically qualify for this tax credit which is basically the same thing as your employer subsidizing your food plan, except that it's payable retroactively instead of deductible from a paycheck that you don't have. We'll still let people show up at the grocery store and eat for free if they're hungry, but we'll tell them that we-are-super-serial when we say that they should really buy a food regulatory plan.

Whew. That was easy. Why won't anyone vote for this?!?

I predict long lines of show up and eat at pastry/deli/chips/soda sections off all grocery stores other than those surrounded by armed troops and reserved for politicians, government employees and their cronies. The ruling elite will of course have their food supplies delivered by military convoy in refrigerated vans.

[drgoodtrips]

I think that sums it up rather well! :lol:

Contrast this with what us poor Canadians have to go through....

If I get sick (or even if I'm not sick and just want a checkup) I just call up my doctor and make an appointment.

That's it, that's all. My doctor has my OHIP number on file. No paperwork, no forms, no bills, nothing.

If I get referred to a specialist or go to the hospital for an operation, everything is exactly the same - no sign of any paperwork anywhere, though I might have to show my OHIP card to the hospital or the specialist doctor since they don't have me on file.

Everyone in the country is automatically enrolled in the program. No application form necessary.

The simplicity of that appeals to me. All of the shouting around this subject domestically has made me somewhat apathetic. I think this is an original quote of mine (apologies if it turns out I co-opted it from somewhere): "People's volume level when talking about a contentious subject tends to be inversely proportional to their knowledge of the subject."

As an engineer/programmer, when you look at something that is convoluted and difficult to understand, the solution is almost never to introduce an additional complexity. I constantly see people make that mistake because the thinking goes "This works 90% of the time and if we start all over, it will work 0% of the time at first. Better to fiddle with it to get it working 95% of the time and hope for the best."

I can understand the rationale with say manufacturing or mechanical engineering. However, my experience is that in matters of software/electrical or meta-engineering (engineering process) this is almost invariably a poor decision. The reasoning makes sense, but the results don't back it up. Generally, that fiddling creates the outcome you want for the 5% you're addressing, but breaks another 10% somewhere else. Or, your changes don't break anything but have unintended and unforeseen consequences.

The heart of the matter is that it's a bad idea to make changes to something when you don't fully understand how/why it works in the first place. Better to scrap the bad design and start all over. I've found, from experience, that your second run through takes a fraction of the time of the first run and produces a simple and elegant result (because you avoid all of the mistakes you made and realized in the first run). A popular author in the field of software engineering once said something like "Build one that you plan to throw out. You're going to wind up doing it anyway."

As it relates to the US healthcare debate, this is how I see it. Politically, it's probably infeasible, but I think the best thing here is a complete reboot. I don't know how much I favor the Canadian/European style of healthcare (I will concede that it is far superior to what we have logistically), but if that's the outcome, c'est la vie. I think throwing out all previous assumptions and brainstorming from there is the idea solution.

[drgoodtrips]

I also say this in part because of anecdotal observation. That is, I see a lot of people who really don't understand at all how the current system actually works, so it is easy for them to interpret any sort of change as a threat to them. The status quo is really in almost nobody's best interest, but the system is so convoluted that everyone has every reason to view every change as a possible threat.

Think of it this way: I have a magical black box. If you shake it, sometimes nothing happens, sometimes it spits out a few bucks, and sometimes a sword comes out of it and stabs you. Most reasonable people who aren't junkies would opt not to shake the box.

This is how a substantial cross section of the US public views our healthcare system. So every time politicians go to "shake the box", it isn't hard to convince them that "here comes the sword!" This makes actual progress incredibly difficult, from a political capital perspective.

[Michael]

As for the Canadian system, as I've said before, the chief benefit of this system is not just the simplicity. It is the security issue.

I've never in my life given any thought to the consequences of ill health. The thought that I might loose my insurance coverage or go bankrupt if I get cancer has never even crossed my mind.

I know absolutely that if I get sick, I'm covered. If I quit my job or move across the country, nothing changes. That's it, that's all.

That's the real benefit of the Canadian system - it is stress free.

[Michael]

read this and tell me what you think:
http://www.fivethirtyeight.com/2009/12/why-progressives-are-batshit-crazy-to.html

One question. Where in this graph is the promise that these subsidies for poor people are going to keep up with double-digit healthcare inflation?

Is Congress going to pass a bill every year (like the Alternative Minimum Tax) to make sure that the poor people get their subsidies indexed to a rate of inflation that is 5 to 6 times as high as the core rate of inflation?

Indeed, by the time 2016 rolls around, that price of healthcare insurance will probably be up about 50% given present rates of healthcare inflation. Do you think the subsidies are going to be raised by that same amount by that time?

[Lily]

I'm so fed up with this health care bill. I don't even know what it contains anymore, who it's supposed to cover, how it covers people, what it will cost... I think I'm like a lot of people these days who'd rather stick a fork in my eye than try to unravel this mess. And I work in health care.

[Michael]

I'm so fed up with this health care bill. I don't even know what it contains anymore, who it's supposed to cover, how it covers people, what it will cost... I think I'm like a lot of people these days who'd rather stick a fork in my eye than try to unravel this mess. And I work in health care.
Yes, I can well understand this. I've followed it all along, but I'm a bit of a policy wonk - I'm interested in the details.

To put it simply, the present bill retains all of the 'middle-class' regulatory benefits (ban on rescission, ban against bias on pre-existing conditions, bans against cancellation for frivolous reasons, elimination of the Medicare drug benefit 'donut hole' etc.). I call these benefits 'middle class' because these issues are primarily of interest of those people who already have healthcare insurance. Anything that even remotely smells of "cost control" is totally out.

All of the controversy and negotiations for the last few weeks is all about the efforts to get coverage for the 40 million plus Americans who don't have healthcare insurance - or rather, efforts to put as many limits on this as possible (if not eliminate any solution outright). As it stands, I don't think the bill that gets passed will do much for this group at all (except turn them into criminals under law for failing to have healthcare insurance that they can't afford) due to the nature/structure of the subsidies.

That's about it. I can predict with confidence that come 2016, the USA will still have tens of millions for whom healthcare is a distant dream. Those that already have healthcare insurance, will benefit from this bill (as it presently stands).

As far as I can see, there is nothing here that is going to remove the USA from the odious position of "last place" for healthcare in competitive rankings of western nations. That policy is safe - you can thank your Senators for that since they are the one's who have killed off most of the good stuff (but anything the insurance industry or pharma wants in the bill is still in the bill).

[dilettante]

Looking doubtful that the Senate will get anything done by Christmas now that Nelson's turned down the abortion compromise.

Saw this quote today in an article:

"Slowly, slowly, the Democratic health agenda is turning into a political suicide pact."

[Michael]

Looking doubtful that the Senate will get anything done by Christmas now that Nelson's turned down the abortion compromise.

Saw this quote today in an article:

"Slowly, slowly, the Democratic health agenda is turning into a political suicide pact."

Yes, that's been my fear all along. The abortion games are going to really hurt. The ardent healthcare reform base of the Democratic party might - might - tolerate some anti-abortion nonsense if the bill was going to deliver some actual progressiveness. But as I've pointed out above, this bill isn't looking very progressive at all - it is looking like a routine and moderate reform bill aimed at establishing a few new regulations for healthcare insurance companies and some new subsidies for some poor people to help them buy healthcare insurance. The bill is a major boon for industry and pharma though - no doubt about that. Heck, I surprised they are keeping up the opposition given that the present bill is a damn good one for them - they are big winners so far.

Just take a look at the stock prices on the healthcare insurance companies over the last six months - that tells the story there. (hint: stocks are up - Wall Street smells increasing profits for healthcare insurance companies in the future!)

So the bill isn't very thrilling to people like me who see the bill as something that is turning into an entrenchment of the status quo - the exact opposite of what I'd hope to see in this bill. I didn't expect a single-payer system to get created - I'm not unrealistic. But I must say I'm deeply disappointed to see the Democrats fall so far short of the most basic goals when they just won control of both Houses and the White House with healthcare reform as a primary policy platform. That's a huge political failure. And that's why the pressure is on from the Democratic Party officials and most of the leftwing activist set to spin this as a victory (since they both need the victory very badly).

[Americano]

Yes, I can well understand this. I've followed it all along, but I'm a bit of a policy wonk - I'm interested in the details.

To put it simply, the present bill retains all of the 'middle-class' regulatory benefits (ban on rescission, ban against bias on pre-existing conditions, bans against cancellation for frivolous reasons, elimination of the Medicare drug benefit 'donut hole' etc.). I call these benefits 'middle class' because these issues are primarily of interest of those people who already have healthcare insurance. Anything that even remotely smells of "cost control" is totally out.

Which means rates will be taking a hike upward, justified by actuary inclusion of new yet identified costs from civil service experience. That'll force US employers providing health insurance for a domestic work force to either maintain annual cost per employee (currently $12k) by increasing co-pays/raising cap payouts or take an operating profit hit.

All of the controversy and negotiations for the last few weeks is all about the efforts to get coverage for the 40 million plus Americans who don't have healthcare insurance - or rather, efforts to put as many limits on this as possible (if not eliminate any solution outright). As it stands, I don't think the bill that gets passed will do much for this group at all (except turn them into criminals under law for failing to have health care insurance that they can't afford) due to the nature/structure of the subsidies.

That's about it. I can predict with confidence that come 2016, the USA will still have tens of millions for whom healthcare is a distant dream. Those that already have healthcare insurance, will benefit from this bill (as it presently stands).

As far as I can see, there is nothing here that is going to remove the USA from the odious position of "last place" for healthcare in competitive rankings of western nations. That policy is safe - you can thank your Senators for that since they are the one's who have killed off most of the good stuff (but anything the insurance industry or pharma wants in the bill is still in the bill).

Congress has potentially expanded insurer markets by turning people who don't subscribe to their products into criminals. From there it's not much of a jump for revenue starved municipalities to begin issuing pricey compliance citations at emergency rooms to uninsured patients.

[dilettante]

Think of it this way: I have a magical black box. If you shake it, sometimes nothing happens, sometimes it spits out a few bucks, and sometimes a sword comes out of it and stabs you. Most reasonable people who aren't junkies would opt not to shake the box.

Heck, half the time that's how I feel about Congress no matter what they're debating!

[dilettante]

Yes, that's been my fear all along. The abortion games are going to really hurt. The ardent healthcare reform base of the Democratic party might - might - tolerate some anti-abortion nonsense if the bill was going to deliver some actual progressiveness. But as I've pointed out above, this bill isn't looking very progressive at all - it is looking like a routine and moderate reform bill aimed at establishing a few new regulations for healthcare insurance companies and some new subsidies for some poor people to help them buy healthcare insurance. The bill is a major boon for industry and pharma though - no doubt about that. Heck, I surprised they are keeping up the opposition given that the present bill is a damn good one for them - they are big winners so far.

Just take a look at the stock prices on the healthcare insurance companies over the last six months - that tells the story there. (hint: stocks are up - Wall Street smells increasing profits for healthcare insurance companies in the future!)

So the bill isn't very thrilling to people like me who see the bill as something that is turning into an entrenchment of the status quo - the exact opposite of what I'd hope to see in this bill. I didn't expect a single-payer system to get created - I'm not unrealistic. But I must say I'm deeply disappointed to see the Democrats fall so far short of the most basic goals when they just won control of both Houses and the White House with healthcare reform as a primary policy platform. That's a huge political failure. And that's why the pressure is on from the Democratic Party officials and most of the leftwing activist set to spin this as a victory (since they both need the victory very badly).

I wonder if they'd be better off just scrapping the whole thing and vowing to hit it again in 2011 and try for a strong public option or single-payer system; maybe that would rally their base enough to get them through the mid-terms and, if the public really wants that kind of plan, let them pick up enough seats to make it happen.

[Michael]

Here's my take on the 'meta-politics' of the healthcare issue and why this issue is so important for the Democrats.

Four basic facts:

1. Some 40 million plus Americans don't have (or can't get) healthcare insurance and thus don't have (or can't afford) access to adequate healthcare services.

2. USA, despite being one of the richest nations in the world, ranks virtually last in almost every ranking, and by almost every measure, in comparative healthcare statistics when compared with other advanced western nations.

3. Overall US healthcare costs are roughly double or triple of healthcare costs in other advanced western nations (as a % of GDP).

4. US Government already spends more (as a % of GDP) than any other western nation on healthcare - despite points #1 and #2. This includes funding for Medicare, VA, Medicaid and SCHIP. This same level of government funding is sufficient to cover the cost of a universal healthcare system on par with Canada or France.

Add those four points together and that adds up to a big problem in need of a solution. And it is a problem that is well studied with lots of good solutions avialable and on the table. This is not a 'pie-in-the-sky' problem with no good solutions. Canada, France, Switzerland and Germany, to name just four examples, have good public healthcare systems that are very popular in those countries. All four systems are very different, but all add up to a publicly sponsored universal healthcare system. And all of them do it with pretty much the same amount of tax money as the US presently already spends.

That's the policy side. On the political side, the primary beneficiaries of this original policy goal is the poor. That 40 million number just keeps staring you in the face. The people who suffer most from the status quo are mostly the working poor. The hopelessly poor are mostly hopeless - even providing them free healthcare doesn't seem to do much good. But the working poor, they suffer and they need the help here - they need it bad.

So that's the driving "do-gooder-liberal" principle in play here. And this key policy goal has been one of the main driving forces in enabling the Democratic party to re-capture control of Congress and also played a very large part in mobilizing for White House victory in 2008. It has been the major policy principle that has united the big-tent factions of the Democratic electoral vote - and has attracted a large portion of the 'independent' voters too.

So that's why this HCR thing is so massively disappointing. What began as a noble venture to actually 'reform healthcare' and help the poor and make America a better place for everyone, seems to have turned into a process to reform healthcare insurance practices that middle class people find troublesome or infuriating. That's nice for middle class voters, but it isn't going to actually change any of the four 'facts' I outlined above.

And if those four 'facts' don't change, the clamour for healthcare reform isn't going to stop - its just been punted down the road - again. Yes, a few hundred billion will now go towards subsidies for the 'working poor' to help them buy private market insurance, but none of the problems with the American healthcare system that make that insurance so massively expensive are being addressed here. That's the core of the problem. If one could somehow reduce the overall cost of healthcare, that would reduce the cost of insurance so more people could afford it and less people would die without it and everybody wins (except the insurance companies).

So that's why so many people are going to be seriously disappointed with this HCR bill (as it appears to stand right now). Yes, it has some nice fat goodies for pharma and the insurance industry, but it does have some nice goodies for middle class voters (and old people) who all have nice healthcare insurance coverage already. It has some help for working poor, but not much. And it makes poverty a crime if one can't afford to buy healthcare insurance (that individual mandate thing). The individual mandate is only acceptable policy if it is counter-balanced with the 'public option'. As soon as that half is removed, the individual mandate becomes anti-progressive and just a big fat gift to the insurance industry.

[Michael]

Congress has potentially expanded insurer markets by turning people who don't subscribe to their products into criminals. From there it's not much of a jump for revenue starved municipalities to begin issuing pricey compliance citations at emergency rooms to uninsured patients.
Yikes! I hadn't thought of that - but yes, that's a possibility in some counties certainly!

Like I said, the 'individual mandate' without the counter-balancing public option is nasty business. There is no "out" for problem people - they will be caught in a trap here. Don't the poor get punished enough without this added misery?

I wonder if they'd be better off just scrapping the whole thing and vowing to hit it again in 2011 and try for a strong public option or single-payer system; maybe that would rally their base enough to get them through the mid-terms and, if the public really wants that kind of plan, let them pick up enough seats to make it happen.
That's a tough call.

In the short run, that would be hell since US politics works on "momentum" and "symbolic leadership". Admitting a massive defeat on Obama's signature issue in the first year of his Administration and control of both Houses would kill momentum and the appearance of competence. Many would believe that there is no way to recover from that. US voters are quite likely to 'punish' the Democrats for such an epic failure.

And if the Democrats lose a few seats in either House in November 2010 midterms, then they are less able to deliver the policy than now.

As for your suggestion of appealing to the voters to resolve their failure in Congress, I think that's not viable. US Congress isn't actually democratic. If you count popular vote in the Senate, the Democrats have an overwhelming popular majority there but it just isn't enough because of the nature of the US political system. And with gerrymandering, a majority of Congressional House seats are just not competitive at all.

As we discussed in a previous thread, it is quite possible to lockdown the US Senate with the votes of less than 20% of the country (by population).

[Americano]

I also say this in part because of anecdotal observation. That is, I see a lot of people who really don't understand at all how the current system actually works, so it is easy for them to interpret any sort of change as a threat to them. The status quo is really in almost nobody's best interest, but the system is so convoluted that everyone has every reason to view every change as a possible threat.

Think of it this way: I have a magical black box. If you shake it, sometimes nothing happens, sometimes it spits out a few bucks, and sometimes a sword comes out of it and stabs you. Most reasonable people who aren't junkies would opt not to shake the box.

This is how a substantial cross section of the US public views our healthcare system. So every time politicians go to "shake the box", it isn't hard to convince them that "here comes the sword!" This makes actual progress incredibly difficult, from a political capital perspective.

Basic Pavlovian training and conditioned learning. US politicians have perfected the carrot/stick behavioral technique with the US general public, much to the satisfaction of their masters.

[Greendruid]

As for the Canadian system, as I've said before, the chief benefit of this system is not just the simplicity. It is the security issue.

I've never in my life given any thought to the consequences of ill health. The thought that I might loose my insurance coverage or go bankrupt if I get cancer has never even crossed my mind.

I know absolutely that if I get sick, I'm covered. If I quit my job or move across the country, nothing changes. That's it, that's all.

That's the real benefit of the Canadian system - it is stress free.

Michael, I have to call bullshit on this. There are plenty of cancer drugs and treatments that are not covered and each province is different. You are speaking from a particular demographic and it is misrepresenting the Canadian health system as flawless, which it is not.

My brother-in-law, deserving asshole that he is, had a stage 3/4 brain tumour. He had to wait 7 months for his first MRI. That was in Ottawa. Then there are families who have to move out of province to get treatment for many different types of cancers. They live at a hotel and hope that the province they came from will be generous and cover their costs. Often times they won't. I know that the large cities have idyllic conditions for medicine but the population that lives outside of that lives across a pretty wide chasm. Sure, I can go to a doctor when I want to, if I can find one. We lived for four years without a family doctor because there were none in our area taking new patients. The capital region has no less than 25 at anyone time. Disgusting.

Then there's the huge shortage on blood because we don't operate blood donation on a pay basis. I watched my father's body lose all of it's blood when he was dying because a transfusion was 2 hours away - then the synthetic started to come out too. There's lots of paperwork in a hospital setting - just have a family member end up in ICU and you'll get all kinds of procedural jargon thrown at you, surgeons having disagreements about what to do - it's no different here than anywhere else once a truly serious illness befalls you. And its not about who's paying for what necessarily.

Ah, my favourite is the foreign use of our hospitals. I watched a Texan waste 30 minutes on an admissions nurse - the only emergency admissions nurse mind you - while my wife turned pale from a uterine infection and I held our 10 day old son in line behind this dipshit. He wanted some assurance that he wouldn't be sent a bill for treatment and he wanted it in writing. Furthermore, he wanted to make sure that Mexicans had to pay the same as Americans in Canada. Politeness all around while the taxpaying citizens get sicker in the ER.

Don't get me started on the nursing staff in a backwater either. They're just peaches :thumbsup: Yes, I moved here, somewhat by choice, with the same expectations Michael expressed above. Unfortunately, they're only true in the largest of Canadian cities. The north is far, far worse than this. The aboriginal north is far, far, far worse than that.

[Lily]

Here's my take on the 'meta-politics' of the healthcare issue and why this issue is so important for the Democrats.

Four basic facts:

1. Some 40 million plus Americans don't have (or can't get) healthcare insurance and thus don't have (or can't afford) access to adequate healthcare services.

2. USA, despite being one of the richest nations in the world, ranks virtually last in almost every ranking, and by almost every measure, in comparative healthcare statistics when compared with other advanced western nations.

3. Overall US healthcare costs are roughly double or triple of healthcare costs in other advanced western nations (as a % of GDP).

4. US Government already spends more (as a % of GDP) than any other western nation on healthcare - despite points #1 and #2. This includes funding for Medicare, VA, Medicaid and SCHIP. This same level of government funding is sufficient to cover the cost of a universal healthcare system on par with Canada or France.

Add those four points together and that adds up to a big problem in need of a solution. And it is a problem that is well studied with lots of good solutions avialable and on the table. This is not a 'pie-in-the-sky' problem with no good solutions. Canada, France, Switzerland and Germany, to name just four examples, have good public healthcare systems that are very popular in those countries. All four systems are very different, but all add up to a publicly sponsored universal healthcare system. And all of them do it with pretty much the same amount of tax money as the US presently already spends.

That's the policy side. On the political side, the primary beneficiaries of this original policy goal is the poor. That 40 million number just keeps staring you in the face. The people who suffer most from the status quo are mostly the working poor. The hopelessly poor are mostly hopeless - even providing them free healthcare doesn't seem to do much good. But the working poor, they suffer and they need the help here - they need it bad.

So that's the driving "do-gooder-liberal" principle in play here. And this key policy goal has been one of the main driving forces in enabling the Democratic party to re-capture control of Congress and also played a very large part in mobilizing for White House victory in 2008. It has been the major policy principle that has united the big-tent factions of the Democratic electoral vote - and has attracted a large portion of the 'independent' voters too.

So that's why this HCR thing is so massively disappointing. What began as a noble venture to actually 'reform healthcare' and help the poor and make America a better place for everyone, seems to have turned into a process to reform healthcare insurance practices that middle class people find troublesome or infuriating. That's nice for middle class voters, but it isn't going to actually change any of the four 'facts' I outlined above.

And if those four 'facts' don't change, the clamour for healthcare reform isn't going to stop - its just been punted down the road - again. Yes, a few hundred billion will now go towards subsidies for the 'working poor' to help them buy private market insurance, but none of the problems with the American healthcare system that make that insurance so massively expensive are being addressed here. That's the core of the problem. If one could somehow reduce the overall cost of healthcare, that would reduce the cost of insurance so more people could afford it and less people would die without it and everybody wins (except the insurance companies).

So that's why so many people are going to be seriously disappointed with this HCR bill (as it appears to stand right now). Yes, it has some nice fat goodies for pharma and the insurance industry, but it does have some nice goodies for middle class voters (and old people) who all have nice healthcare insurance coverage already. It has some help for working poor, but not much. And it makes poverty a crime if one can't afford to buy healthcare insurance (that individual mandate thing). The individual mandate is only acceptable policy if it is counter-balanced with the 'public option'. As soon as that half is removed, the individual mandate becomes anti-progressive and just a big fat gift to the insurance industry.

Here's what that version of the HCR bill will do in reality, Michael. More of the poor and the working poor will not get care until it's too late. They will die. Plain and simple, they will die. The ones who don't will end up in our ICUs and our ORs, so sick that it will cost tens of thousands of dollars to try to fix them. We won't fix most of them, we'll just prolong their very expensive chronic illnesses. The ones who come to the ER now for minor stuff, who never pay their ER bills and have no intention of paying their ER bills, will continue to come to the ER for minor stuff. They'll be fined for not having insurance, and they won't pay that fine, either.

I think this bill is going to leave power in the hands of those who've always had the power, the insurance and pharmaceutical industries. The working people, as always, will get screwed.

[Michael]

Btw, for those who are curious about how these proposed new insurance industry regulations (banning recission, banning bias against pre-existing conditions, etc) will be monitored and enforced, well, that's a darn good question - because there is NOTHING in the bill to establish anything or any way to enforce these regulations (which is why I'd expect the insurance industry will find ways around all of them and keep going on with business as usual).

[Michael]

Here's what that version of the HCR bill will do in reality, Michael. More of the poor and the working poor will not get care until it's too late. They will die. Plain and simple, they will die. The ones who don't will end up in our ICUs and our ORs, so sick that it will cost tens of thousands of dollars to try to fix them. We won't fix most of them, we'll just prolong their very expensive chronic illnesses. The ones who come to the ER now for minor stuff, who never pay their ER bills and have no intention of paying their ER bills, will continue to come to the ER for minor stuff. They'll be fined for not having insurance, and they won't pay that fine, either.

I think this bill is going to leave power in the hands of those who've always had the power, the insurance and pharmaceutical industries. The working people, as always, will get screwed.
Yes, that's pretty much my take on it.

But middle class people who already have healthcare insurance, they will get some goodies here, along with the insurance industry and big pharma. That's what Congress is all about. No one cares about the riff-raff. Let them eat cake.

[Michael]

The rot starts at the top! Let the spin war begin!

The Democratic leadership MUST spin this HCR comprimise crap as a major progressive victory or die trying. Opening salvos all started firing yesterday. Howard Dean fired the first shot across the bow. I'm sure this battle will be rolling for months.

Plouffe Counters Obama's Healthcare Critics

"We're going to reduce costs for government, for families, for businesses," Plouffe declared. "I have a great deal of confidence," he continued, that "the principles the president laid out in the campaign" will be in the final package. A mounting number of progressives disagree, of course, upending the coalition for healthcare reform that had held together for months.

From Howard Dean to Sen. Russ Feingold, progressives now openly criticize Obama's health care leadership, since each week's concession for centrists seems to undo last week's liberal fig leaf. Daily Kos blogger Markos Moulitsas recently drew a line against the Senate compromises, arguing that "corporatist Democrats" watered down the bill so much it was "potentially worse than the status quo." Then, pointing to a fresh fundraising email from President Obama keyed off healthcare, Moulitsas suggested that the DNC's grassroots antennae are broken. Trying to fundraise off the compromise, he wrote, reveals "a lack of understanding of just how pissed the base is at this so-called reform." Plouffe, who advises and consults for the DNC, has very little tolerance for that argument.

Source (http://www.thenation.com/doc/20091221/melber)

Indeed. Just getting HCR passed through the Senate is only half the battle.

Because this policy is going to be rocky and encounter lots of pushback every step of the way. And a very large group of people who have been very strongly pushing this policy for many long years are tuning out and likely will not be 'ready or willing' to defend this policy when push comes to shove (I count myself in that group).

Don't forget how important (and effective) the 101st Fighting Keyboarders were to the Bush Admin during the darkest days of the Iraqi debacle. That cadre was willing to go to bat to defend Bush's policies in public, on discussion forums, in coffee houses, in blog comment rolls, etc. That's a very valuable political asset. The Democrats are dangerously close to losing the support of their own 'loud-mouthed' activists with this sellout bill on such a critical issue.

[Zarquon]

Col.Krugman reporting for duty:
http://www.nytimes.com/2009/12/18/opinion/18krugman.html?hp
David Brooks making sense!:
http://www.nytimes.com/2009/12/18/opinion/18brooks.html

[Michael]

Col.Krugman reporting for duty:
http://www.nytimes.com/2009/12/18/opinion/18krugman.html?hp

Krugman has been very consistent on this issue for quite a while.

I accept Krugman's argument - passing the bill is less damaging to the Democrats than not passing the bill.

But I can't agree that this bill is even a quarter as good as these cheerleaders are making it out to be.

There is no mechanism to enforce regulatory reform on these insurance companies and all the measures to control cost are a joke. And those subsidies are NOT going to be indexed to double-digit healthcare inflation rates.

So Krugman is right. Pass the bill. But don't expect me to praise it because there's little there worthy of praise (and a whole lot that is very ugly).

David Brooks making sense!:
http://www.nytimes.com/2009/12/18/opinion/18brooks.html
Yes, Brooks and Tom Friedman are two of a kind. Both are complete idiots and notably mendacious 90% of the time, but occasionally do make good columns. This is one of those rare good ones from Brooks.

I do find it interesting that Brooks has zeroed in on the my principle critique of the bill - that it entrenches and reinforces the status quo. And it is the institutional structure of the status quo that is the main driving force behind the double-digit cost inflation in healthcare in the USA.

Essentially, the only method of effectively controlling the cost spiral was taken off the table before the debate even began - so don't be fooled by the silly little 'pilot projects' and hogwash about 'bending the curve'. The bottom line is that private insurance companies have a very strong vested interest in denying coverage as much as they can get away with. That principle is still the ruling principle of US healthcare system and defines the character of US healthcare. As long as that doesn't change, the nature of the US healthcare marketplace likely won't change any time soon.

[Donkey]

The Democrats should kill this bill, then spend the next ten months reminding everyone who is responsible for it dying.

[Michael]

The Democrats should kill this bill, then spend the next ten months reminding everyone who is responsible for it dying.

In a purely theoretical sense, that makes perfect sense. Unfortunately, in the realm of actual US electoral politics, the Democrats control Congress and the White House. Failure to deliver the policy is clearly a failure of the Democrats.

That's who will be blamed regardless of actual facts. The media will make sure of it.

[dilettante]

The Democrats should kill this bill, then spend the next ten months reminding everyone who is responsible for it dying.

I wonder if they could break it up. Pass something small and relatively popular (rules to end rescission or some such) and call it Health Care Reform, Part 1. That might earn them a victory for passing something, and let them try again later for the more difficult stuff.

[partofme]

The Democrats should kill this bill, then spend the next ten months reminding everyone who is responsible for it dying.

To be honest when it comes to getting things done it's sad the democrats lose even with a supermajority.

[Michael]

I wonder if they could break it up. Pass something small and relatively popular (rules to end rescission or some such) and call it Health Care Reform, Part 1. That might earn them a victory for passing something, and let them try again later for the more difficult stuff.
That sounds good on paper, but in reality, it was Obama's chosen strategy to bundle the whole thing up and buy off the insurance industry and pharma with sweetheart deals even before the bills hit Congress.

In other words, the insurance industry 'agreed' to accept a ban on recission and similar such regulations in return for the individual mandate. That deal was cut about nine months ago (back in March I believe).

So while I agree that would have been a better strategy to start with, it is way too late to switch over. That would involve stepping back from the present initiative and the media will declare that the Democrats failed (and will repeat this endlessly no matter what). Remember, the Democrats are up against the media as well as the Republicans here. The US media and the Republicans do work closely together on most issues and speak with common talking points.

Don't forget all those silly outbursts about "death panels" were amplified and endlessly repeated by the media - seeking to drown out any actual factual discussion of the topic. For the media, they wanted to know why the Democrats supported these "death panels". With that kind of media environment, anything but 100% Democratic success will be spun by the media as total failure.

[Michael]

To be honest when it comes to getting things done it's sad the democrats lose even with a supermajority.
Precisely.

This healthcare debacle has turned into a massive and categorical failure of the Democratic leadership and there is no way to spin this otherwise - though they certainly will try very hard to do exactly that.

They will point at the few small goodies in the bill and pronounce this the greatest piece of progressive legislation since the advent of Medicare. That the bill amounts to about 5% of what the Democrats promised and campaigned on is hoped to be forgotten.

[Donkey]

To be honest when it comes to getting things done it's sad the democrats lose even with a supermajority.

Precisely.

This healthcare debacle has turned into a massive and categorical failure of the Democratic leadership and there is no way to spin this otherwise - though they certainly will try very hard to do exactly that.

They will point at the few small goodies in the bill and pronounce this the greatest piece of progressive legislation since the advent of Medicare. That the bill amounts to about 5% of what the Democrats promised and campaigned on is hoped to be forgotten.

The supermajority is tenuous at best. Fucking Joe Lieberman on Anderson Cooper the other night wouldn't even rule out running as a Republican next time. After the dust settles and the Democrats are licking their collective wounds, Lieberman should be uninvited from every position that he holds. If he wants to turn his back on everything he has said re: healthcare in the past (not to mention what he has campaigned on) then he can take his toys and go home. I don't think Reid has the testicular fortitude to stand up to him, sadly enough.

[Zarquon]

I don't think Reid has the testicular fortitude to stand up to him, sadly enough.
fortitude ain't exclusively testicular, and Reid might not be around after the Midterms given his current ratings(low 40's).
And on balance, I'm with Krugman; the bill can be improved later, but if they balk now, HRC ain't gonna happen until another decade or so; America's just too fucking conservative. and so is its legislative system.

[Zarquon]

Democrats Say They Clinch Deal on Health Care Overhaul

Senate Democrats said they had neared agreement Saturday on a
major overhaul of the nation's health care system, putting
them within reach of approving legislation by Christmas.

As the Senate convened in a driving snowstorm, Democratic
lawmakers and senior officials said a breakthrough came when
Senator Ben Nelson, Democrat of Nebraska, agreed after hours
of negotiation Friday to back the legislation, making him the
pivotal 60th vote.

Source (http://prescriptions.blogs.nytimes.com/2009/12/19/democrats-say-they-clinch-deal-on-health-care-overhauls/?hp)
meh, if they can't pass this version, they might as well resign.

[Michael]

Source (http://prescriptions.blogs.nytimes.com/2009/12/19/democrats-say-they-clinch-deal-on-health-care-overhauls/?hp)
meh, if they can't pass this version, they might as well resign.

The devil is always in the details. I'll wait till Monday when I can get a sense of what's in and what's out. That's been bouncing around pretty wildly in the last few weeks.

Besides which, even after passing through the Senate with 60, then there is the 'conference' stage - the magic/secret black box stage that really blows my mind away since it is mysteriously arbitrary and doesn't seem to have substantial legal limits.

I am referring here to several cases that occured (in the previous Congress during the Bush Administration) when new ammendments were introduced at that final 'conference' stage, were never voted on in Congress, but were inserted into the final copy signed into law by the President.

That 'reconcilliation' stage between Senate and House bills is just mysteriously weird shit that is not democratic or transparent - a huge flaw in the US Constitutional system.

[Americano]

Details of the payoff deal to Nebraska 's Sen. Ben Nelson for securing his vote would be interesting. That a state with a population of 1,783,432 can put a gun to the head of health care for 300-million citizens for extortion purposes doesn't speak highly of our system.

[partofme]

I wonder if when the two bills are combined if they will be able to hold enough votes after the changes.

[Donkey]

Details of the payoff deal to Nebraska 's Sen. Ben Nelson for securing his vote would be interesting. That a state with a population of 1,783,432 can put a gun to the head of health care for 300-million citizens for extortion purposes doesn't speak highly of our system.
Or that two individuals (Nelson and Lieberman) can fuck the entire country, including the majority in Senate.

[Americano]

Or that two individuals (Nelson and Lieberman) can fuck the entire country, including the majority in Senate.

Politics being what they are I'd think Lieberman would have long ago been stripped of his committee responsibilities if he didn't know where some bodies are buried.

Nelson's just a successful thug.

[dilettante]

Details of the payoff deal to Nebraska 's Sen. Ben Nelson for securing his vote would be interesting. That a state with a population of 1,783,432 can put a gun to the head of health care for 300-million citizens for extortion purposes doesn't speak highly of our system.

Or that two individuals (Nelson and Lieberman) can fuck the entire country, including the majority in Senate.

Well, Nelson, Lieberman and 40 Republican senators...
Nelson might be the tipping point, but his "no" isn't any more decisive than McCain's; he's just the last to speak up.

[dilettante]

...
I am referring here to several cases that occured (in the previous Congress during the Bush Administration) when new ammendments were introduced at that final 'conference' stage, were never voted on in Congress, but were inserted into the final copy signed into law by the President.

That 'reconcilliation' stage between Senate and House bills is just mysteriously weird shit that is not democratic or transparent - a huge flaw in the US Constitutional system.

The bill still has to be approved by both Houses of Congress after the reconciliation stage. They might not vote on each individual item the committee adds or subtracts to reconcile the bills, but they do have to vote on the whole package before it goes to the President.

[partofme]

The bill still has to be approved by both Houses of Congress after the reconciliation stage. They might not vote on each individual item the committee adds or subtracts to reconcile the bills, but they do have to vote on the whole package before it goes to the President.

Does that still require the 60 votes in the senate?

[Donkey]

Well, Nelson, Lieberman and 40 Republican senators...
Nelson might be the tipping point, but his "no" isn't any more decisive than McCain's; he's just the last to speak up.
True, which Republicans elsewhere don't seem to understand. Basically they say "We can keep our party in lockstep, it's not our fault."

Yeah it is, you douchebags.

But I resent Lieberman even more for being a pos turncoat.

[dilettante]

Does that still require the 60 votes in the senate?

I believe so, but I'm not positive.
The report of the conference committee cannot be amended by either house, but as far as I know it's subject to filibuster like any other bill in the Senate and it would take 60 votes to end debate if the Republicans were being obstinate.

[Zarquon]

The founding fathers were a bit too concerned with avoiding tyranny, and too unconcerned with governing:|
Can't the Democrats change Senate procedures?

[dilettante]

The founding fathers were a bit too concerned with avoiding tyranny, and too unconcerned with governing:|
Can't the Democrats change Senate procedures?

What part would you want them to change?

Technically, changing the rules of the senate requires the support of 67 Senators (two thirds); if the Democrats can't get 60 votes there's no way they'll get 67, especially for something that would look very much like recklessness.
The only alternative would be the so-called "nuclear option" which the Republicans threatened in order to pass judicial nominees under Bush, which involves a rather underhanded means of changing the Senate rules via loophole. God willing, we won't go down that "change-the-rules-until-you-win" road.

[Zarquon]

What part would you want them to change?

The filibuster, which every other democracy has limited or abrogated.

[Zarquon]

Krugman on this issue:
http://www.nytimes.com/2009/12/21/opinion/21krugman.html

[dilettante]

The filibuster, which every other democracy has limited or abrogated.

Krugman on this issue:
http://www.nytimes.com/2009/12/21/opinion/21krugman.html

I kinda like the Harkin-Lieberman proposal he mentions there ("Sixty votes would still be needed to end a filibuster the beginning of debate, but if that vote failed, another vote could be held a couple of days later requiring only 57 senators, then another, and eventually a simple majority could end debate.")
However, getting it passed would still require at least 67 votes or nuclear-option-esque machinations. I hope they don't take the latter road.

[partofme]

All the coverage I've read is about how it will likely pass by Christmas but does anybody know the time line as to when they will try to get the final version passed?

[Michael]

All the coverage I've read is about how it will likely pass by Christmas but does anybody know the time line as to when they will try to get the final version passed?

Not to be snarky, but what difference does it make? Most of the bills provisions don't take effect until at least 2014 anyway.

The only 'rush' or 'timeline' on this bill is just Democratic party strategy, nothing more, nothing less.

[partofme]

Not to be snarky, but what difference does it make? Most of the bills provisions don't take effect until at least 2014 anyway.

The only 'rush' or 'timeline' on this bill is just Democratic party strategy, nothing more, nothing less.

I'm just curious. It's possible a senator could become sick or die.

[Michael]

I'm just curious. It's possible a senator could become sick or die.
If the inopportune death or sickness of a single individual can derail one of the most important and hard-fought legislative initiatives before Congress, that just points out how silly/stupid/corrupt/gerry-rigged the US legislative system is.

[Donkey]

Not to be snarky, but what difference does it make? Most of the bills provisions don't take effect until at least 2014 anyway.

The only 'rush' or 'timeline' on this bill is just Democratic party strategy, nothing more, nothing less.
It's massively important for those of us working on other legislative issues. :)

[Michael]

It's massively important for those of us working on other legislative issues. :)

Apparently Congress can only handle one at a time! :lol:

That's pathetic.

[dilettante]

If the inopportune death or sickness of a single individual can derail one of the most important and hard-fought legislative initiatives before Congress, that just points out how silly/stupid/corrupt/gerry-rigged the US legislative system is.

I think it just points out how close the vote is.
Not that the system isn't corrupt and broken; but even without any corruption there would still be the possibility of one person making the difference if the votes were close enough.

[Michael]

I think it just points out how close the vote is.
Not that the system isn't corrupt and broken; but even without any corruption there would still be the possibility of one person making the difference if the votes were close enough.
No, that's the US system.

Up here, if things are down to one vote and one person dies/sickness, we'd have a byelection to replace that person next week.

Heck, we can run a whole election (and swear in a new Parliament and government) while your Congress takes Christmas vacation.

The problem is institutional.

[Americano]

It's massively important for those of us working on other legislative issues. :)

Funding attached to that bill?

[Michael]

Funding attached to that bill?

I think he's referring to the "no air" issue. Congress is obsessed with the Healthcare bill right now so no one is interested in discussing any other issue. Once that bill is gone, then other issues can be discussed.

I'm just speculating of course.

(obviously our favorite young lobbyist doesn't have a fat budget to bribe people with!!!) :D

[Americano]

I think it just points out how close the vote is.
Not that the system isn't corrupt and broken; but even without any corruption there would still be the possibility of one person making the difference if the votes were close enough.

Especially if that one person had control of a major piece of the political trades and pay-offs that dominate all US legislation. The legislation would again be up for grabs until the lengthy process of new backroom deals being cut to the satisfaction of power brokers was finalized.

[Americano]

I think he's referring to the "no air" issue. Congress is obsessed with the Healthcare bill right now so no one is interested in discussing any other issue. Once that bill is gone, then other issues can be discussed.

I'm just speculating of course.

(obviously our favorite young lobbyist doesn't have a fat budget to bribe people with!!!) :D

True. With the right amount of spice applied in the proper places anything is possible. I haven't looked at legislation attached (or to be attached) to the health care bill but I'm sure its no different than anything else with a shitload of favored deals riding on the vote coattails.

[Zarquon]

Lets see, there is:


Financial Reform
Climate Change Law/Green Energy Development Initiative
Infrastructure Renewal/Upgrade
Education Reform
Balancing the Budget
Sorting out 'Af-Pak' after the surge is done with

Quite a lot for one term, and while Obama is deliberative/slow and shrewd/manipulative and also a consensus-seeker/timid, one hopes the bastard gets things done in his sneaky way after all.