The Conrad-Grassley Coop Boondoggle
Senators Kent Conrad and Chuck Grassley want to set up a national system of health care cooperatives to compete with the likes of Aetna, United Health and other big campaign contributors. Does anyone want to bet that the federal money used to get these cooperatives off the ground will overwhelmingly be wasted?
It's a pretty safe call that most of these cooperatives will not prove successful and will at best be small actors in the market. (We have evidence on which to base this assessment.)
So, our great fiscal conservatives are apparently prepared to throw billions of taxpayer dollars in the toilet for the purpose of preventing the creation of a serious public plan that could compete with the insurance industry. There's nothing like a principled fiscal conservative.
It seems to me we need to separate out the different elements of what health care reform is supposed to be about when evaluating whether coops make sense.
Best I can tell, the point of health care reform is as follows:
1. Make insurance available to everyone, including those that can't pay.
2. Make sure that insurance companies don't discriminate against people who are high risk or have pre-existing conditions.
3. Reduce the overall cost of health care, whose current rates of growth are unsustainable.
My understanding is that goals #1 and 2 are largely addressed by the regulatory reforms that are largely agreed on by everyone. Any health reform bill will forbid insurance companies from refusing coverage and will contain subsidies for people who can't pay.
Goal #3 is where the issue is. The public option is designed to be competition for the private insurance companies. The issue, best I can tell, is that in many areas of the country, there is no competition at all as one insurance company dominates the market. The public option would make available competition everywhere. Such competition would force insurance companies to become more competitive, by charging lower prices or by offering better benefits.
The chief argument against the regional coop idea seems to be that they won't have the scale to affect the overall insurance market and do things like negotiate better prices for drugs and care. Logically that makes sense. But that only calls into question whether the reform will achieve goal #3 above, not #1 and 2.
It seems to me that in the health care debate progressives tend to care more about extending coverage and conservatives care more about reducing costs. But now it seems that progressives are going to the mat over a provision in the current proposals whose chief goals will be cost containment, not extending coverage which, as I said, will largely be accomplished by other elements of the plan.
I am no one's idea of a health care policy expert, so I'm sure I'm missing something. But why is the public option a line-in-the-sand issue for progressives when the chief progressive goals are already being met? And if one of the other goals is to provide competition for insurance companies where there is currently a local monopoly, why wouldn't coops accomplish that? For instance, if an insurance company gamed the system in some way and made obtaining insurance difficult despite the new regulation, wouldn't there be, under the coop plan, at least one other option for consumers, as there would be under the national public option plan?
These are not disingenuous questions. I am really curious why the public option has become such a do or die issue.
August 18, 2009 6:50 AM | Reply | Permalink
Lots of good questions Brad. Unfortunately those on the left who ferociously attack the insurance companies and blame them for all our health care problems are partly responsible for some of the misconceptions that are making health care reform so difficult.
Insurance companies are certainly part of the problem--their profits and high administrative overhead do add substantially to the cost of health care. But the real cost driver isn't insurance company overhead and profit-taking, it's the underlying cost of medical services. Vast sums of money flow toward health care for many reasons. Most important, when one is ill and the consequences of not getting treatment may be death or debility, people will spend anything to get care. Cost of treatment, no matter how high, is simply not an issue when the opportunity cost of refusing treatment is near infinite (death). Furthermore, most buyers of health care have no idea what they need (most of us aren't MDs after all), and therefore are completely dependent on the seller (doctors, hospitals) to tell them what care to purchase. In many cases, ill people are captives, confined to a hospital bed, often too weak to make decisions themselves. In these situations, the patient's keepers make all the decisions about the patient's care and are likely to err on the side of providing ever more care for many reasons, some good, some less good (desire to do everything possible to cure the patient, fear of lawsuits if the patient isn't cured, desire to make more money). And then, finally, the insurance companies (for all their failings) do tend to pay the majority of bills (at least for the majority of Americans with employer-sponsored coverage) no matter what is done.
So money flows into the system in vast quantities because of the unusual market conditions. This stimulates a lot of innovation. There are vast profits to be made throughout the health care industry. Just look at the annual reports of pharmaceutical companies and medical equipment manufacturers. Health care professionals earn handsome salaries. And increasingly, for-profit hospitals and clinics (especially specialty clinics) generate good returns for their shareholders or private owners. The insurance companies profit, too--but it's not just them. The whole industry is highly profitable.
There are good things about this system. Our health care industry is incredibly innovative. It creates new treatments (necessary or not) at a tremendous rate. But those innovations don't necessarily translate into good health outcomes. And they certainly drive up the cost of care at astounding rates.
Successful reform will have to do several things. As you say, most important, it must ensure everyone has access to coverage (your points 1 and 2 really are both about this). And second it must drive down costs. Coops offer a different way of providing insurance, but how they actually reduce the underlying problem of rising costs for services mystifies me. And if they don't reduce underlying costs, I'm not sure how they help access. Even if they can provide insurance at 10% or 20% lower cost than the private companies can, the cost of insurance will still be too high for most people to afford. We'd need still need some kind of subsidy to help people afford their coop coverage.
I was long skeptical of so-called single payer. But the more you look at the health care market, which is inherently warped, the more I think government-provided care makes sense. Someone has to figure out how much money we pump into health care. The government--since it has the power to set rates in a way that no private insurer and certainly no coop has--can do that. Yes, there will be consequences. There will be a decline in innovation and there may be some rationing of care. But we've seen from the experience of other countries that governments can handle this responsibility reasonably well. And while the care in some countries may not be as high-tech and cutting edge as it is in the US, overall results are often better in countries with government-run health care than they are in the US. (There is an argument to be made that those other countries benefit for free from some of the innovation that happens here . . . but that's for another time).
Anyway, I'm not against coops or even a private-sector solution if someone can show me how the solution would actually help the solve the problems in our health care market. So far, though, no arguments for these non-government approaches have convinced me. I'm honestly wary of a government solution and it's costs--but so far no other solution seems better to me.
August 18, 2009 7:37 AM | Reply | Permalink
I think you hit the nail on the head when you say that the real cost driver isn't insurance company overhead and profit-taking, but the underlying cost of medical services.
I don't know much about the kind of coops Conrad has in mind, but seems fair to say that any reduction in premiums, whether via public option or coops, is going to be marginal in comparison with the underlying cost of medica services.
I also think there should be a bit of realism when people imagine how much rates could ever go down - for the same reason (cost of service).
Therefore, the real problem is not only not going to go away, but it could in fact get worse if everyone can suddenly squeeze more services under the same or lower insurance premiums.
August 18, 2009 8:23 AM | Reply | Permalink
The only way to lower costs permanently is to lower demand. The only way to lower demand permanently is to have healthier citizens. The only way to have healthier citizens permanently is to kill King Corn. I'll buy the pen.
August 18, 2009 2:17 PM | Reply | Permalink
Uh huh . . .
And while Mister Bluster's plan slowly comes to realization over the next two generations (think stop smoking), in the meantime we'll just let those that are in bad health simply die their ugly deaths from lack of affordable access to care. . .
~OGD~
ps: standby for the spittle and fire off the tongue of the Blustery One . . .
August 18, 2009 4:45 PM | Reply | Permalink
Actually that is the long-term goals of my ideas, with short-term wins to keep the process proceeding apace. Do you really not understand how lasting and sustainable change is designed and implemented?
I know old ducks aren't too good at new tricks, but unless democrats take a longer view on this issue, it is doomed to failure. Like just about everything else they have done since LBJ left the White House.
August 19, 2009 7:58 AM | Reply | Permalink
It's so Ironic ...
Mister Bluster mentioned LBJ. I wonder how many non-violent marches and decades long work Mister Bluster was part of so as to help bring to our country the current individual now residing at 1600 Pennsylvania Avenue? I've never stopped being active. It's a way of life and a life long crusade.
Him? I bet . . . none zip nada . . .
Same with the Peace Corps. I wonder if Bluster ever heard of the African Food Systems Initiative? I spent two years on that project. I bet hard cash that Bluster hasn't ever even heard of a federal volunteer agency called ACTION that Nixon started. But almost anyone you ask can pretty much tell you what the Peace Corps is. I still volunteer through Habitat for Humanity International. Oh and I was quite active domestically with the Crisis Corps during the Katrina and Rita hurricane disasters.
And I just so happened to have been active the past 40 years with the Special Olympics since my days of international competition in track field with the Council of International Sports Military (CISM) while serving in the Navy in the late 60s.
Does anyone think that Mister Bluster would ever see past his own little self-serving nose to actually put his money where his mouth is? I have serious doubts unless it's some local Chamber of Commerce or some such nonsense, or how to make buck off it.
Yup! Tell an ol' duck what it takes.
Failure? Kiss my tailfeathers... boy.
~OGD~
August 19, 2009 10:43 PM | Reply | Permalink
Failure, long and sustained, which is why you get so offended when someone bothers to point it out. That you talk about things done decades ago just goes to prove you and your generation have long rested firmly on their laurels, however modest they may.
Boy.
August 23, 2009 6:19 PM | Reply | Permalink
My lifetime of living . . .
. . . versus a panty-waist punk pounding a keyboard?
Bluster's just a fast talking bullshit artist that's done nothing more than sit on his ass and pound a keyboard for the past 20 years... It's all book l'arning . . .
For every Atta-boy the clown dumps 5,000 Ah-shits . . . Pretty piss poor percentage.
But understandable ... That's what you get for a progressive conservative. A true oxymoron.
~OGD~
August 25, 2009 9:11 AM | Reply | Permalink
the insurance companies (for all their failings) do tend to pay the majority of bills (at least for the majority of Americans with employer-sponsored coverage) no matter what is done
You have a good point here. I suggest that any healthcare reform that doesn't include a public option and does include mandates should also include a provision that the hospital can't bill the patient for anything the patient's insurance refuses to cover.
August 18, 2009 11:07 AM | Reply | Permalink
It's all about politics now. HR3200 is already a substantially watered-down concept from not only Medicare for All but also from the original conception of the public option.
It's now about Democrats, having won the election, still never getting to feel like winners, never being permitted to actually, you know, govern. It's about not being intimidated by Republicans bringing guns to Town Hall meetings.
The wonkish concerns you raise, which may in fact be valid in their own terms, are, for now, taking a back seat.
I don't know where this is going, but as long as there's a Block in Congress willing to fight this, I don't want to stand in their way. Even if they give way later, they may gain some further useful concessions.
August 18, 2009 8:33 AM | Reply | Permalink
Part of the issue is that you can't really uncouple those three points. You can't realistically achieve points #1 and #2 without addressing #3. Otherwise the cost escalation eventually derails the whole thing. You can't get universal coverage without making it affordable, and you can't make it affordable without universal coverage. You can't expect insurance companies to not deny coverage for pre-existing conditions without universal coverage. They're all linked.
August 18, 2009 10:49 AM | Reply | Permalink
Of course the coop proposal was never a serious one. It was thrown out only to create a distraction in the hopes of derailing the real health reform effort. Conrad and Grassley can't even explain what these coops are or how they will work, never mind making any kind of case that they will seriously lead to better, expanded, or less expensive health care coverage. Coop is a word that tests well in focus groups, I assume. It's another right-wing lie designed to dupe the easily confused and increasingly mush-brained American public. It's like the death councils or the British national health care system that killed Stephen Hawking. We don't have serious policy debates in this country anymore. We are constitutionally incapable of doing so. Sarah Palin should have been elected president. She represents our muddle-headed population far better than anyone else on the public scene. Bring her on. It's what we deserve. It's what we are.
August 18, 2009 6:58 AM | Reply | Permalink
"It's another right-wing lie designed to dupe the easily confused and increasingly mush-brained American public"
- How can it be a right-wing lie while at the same time compell RNC to on record to oppose coops? That makes no sense.
August 18, 2009 8:13 AM | Reply | Permalink
You don't quite get it do you? All the right-wingers (democratic or republican) are doing is trying to derail reform. Coops were a nice distraction. When some people started sounding serious about them, though, they needed to be attacked. Confuse the issue. Muddy the waters. Scare people about any course of action. Then no action happens. This is the strategy. Just look at Grassley . . . he was for coops initially, now he has doubts. In reality he doesn't even understand what a coop is. Except, of course, as a political tactic. It's amazing to me that people are even debating coops--as if there was anything real or serious about the proposal to create them. They have never been anything more than a political ploy designed to confuse people. We're all so gullible. We're talking about coops as if they were a serious option to consider. We may as well talk about little green men from mars.
August 18, 2009 8:22 AM | Reply | Permalink
I'm not so sure.
First of all, everybody talks about coops not knowing what that means (and it includes you, me and the right and left wingers). NYT links point to things like national coops. Republicans say that a coop is a public option in eveything but the name because it could be easily set up as a national coop with the government seed money. Is that the reason Grassley changed his mind?
What does your crystall ball say?
August 18, 2009 8:27 AM | Reply | Permalink
I seriously believe that the coop idea was nothing but a political ploy. Until someone actually describes how they work and how they would alter the status quo, I can't think anything else. We've had various forms of health care coops (for purchasing care and/or for providing care) in this country. None have ever succeeded to any great extent (some work on a limited basis). Could they succeed with government funding? Maybe. But to what point? No one has explained what exactly they would do that private insurance doesn't already do. Bring down costs? Possibly by reducing profits, but if they remain small, they won't have the negotiating power that big insurance companies have (in-network care is cheaper because your insurance company has negotiated lower rates with the network providers). I just don't see any great benefits from coops. And none of the proponents seems able to describe any either. It's just a nice sounding word, I fear.
August 18, 2009 8:36 AM | Reply | Permalink
Of course it's a ploy, and a transparent one at that. And today they're saying what everyone already knew: the R's are going to vote against co-ops too. Think Lucy, Charlie Brown and the football. It's amazing to me the number of Charlie Browns out there.
August 18, 2009 1:29 PM | Reply | Permalink
Regardless of the merits of the Co-op plan (and I do agree with Dean), the political fact that the GOP has now come out against them as well as the public option (basically equating them) offers Democrats a chance to walk out of the bipartisan stranglehold and rebrand the GOP as the party of the status quo on Health Reform.
Let's roll the dice. Take coops off the table and ram HR3200 through with Democratic votes alone.
August 18, 2009 8:24 AM | Reply | Permalink
Not to be a dick but when you say:
it would be helpful to provide said evidence or links to same. Not only that but since the coop idea is not defined in anything other than generalities how can you say it won't work?
Maybe I just need to take a pill. I think single payer is the only real solution.
August 18, 2009 9:28 AM | Reply | Permalink
Well . . . Wish to repeat the stupidity?
It's been tried. Blue Cross/Blue Shield was originally a non-profit co-op. They were bought out by large for-profit interests like Anthem who bought up many and turned them into for-profit units.
My link? My memory. I was actually alive then.
Yeah ... Let's take that road again that led to nowhere.
~OGD~
August 18, 2009 4:29 PM | Reply | Permalink
Correction: It's not Grassley, it's Grasshole.
August 18, 2009 10:05 AM | Reply | Permalink
I see the apologists for insurance companies are out in droves today.
The answer to, why public option?, has nothing to do with costs. Health insurance ceased to be anything but a mirage years ago. The demand for a public option is a demand for actual insurance. Perhaps when that happens the insurance companies will decide to compete by offering insurance, too. Perhaps not.
August 18, 2009 10:19 AM | Reply | Permalink
"At the broadest possible level, the public option is necessary simply because it's impossible to identify a successful health system anywhere in the world based on a for-profit insurance model. If profit-driven health insurance could be made to work, then surely somebody would have figured it out by now. Paul Krugman, in an Aug. 17 New York Times column, likens health reform to the reforms Switzerland instituted in 1994: "[E]veryone is required to buy insurance, insurers can't discriminate based on medical history or pre-existing conditions, and lower-income citizens get government help in paying for their policies." But there's a significant difference. In Switzerland, private insurers are required to provide basic health coverage on a nonprofit basis. Under Obamacare, private insurers will continue to seek profits, and it's quite possible that the new regulatory restraints imposed on them (take all comers, don't punish the sick with higher premiums, don't seek out fine-print reasons to cancel policies after policyholders get sick, etc.) will inspire them to find ever-more-ingenious ways to avoid payouts. President Obama often says that a public option will help keep the private insurers honest. What he doesn't say, but surely knows, is that private insurers' duties to their shareholders may be irreconcilable with their duties to their customers. Should that prove true, a public option would provide a necessary refuge."
- Timothy Noah in Slate
August 18, 2009 10:47 AM | Reply | Permalink
I support getting our reps in the house to pass or support in big numbers HR676 the Single Payer legislation in the house. If there is a strong vote on this bill it will give leverage in the House to move the Senate toward a public option in conference and put some perspective on those 'few' who are resisting a public option.
August 18, 2009 11:06 AM | Reply | Permalink
Who wants to make a bet that if the co-op deal goes through, Grassley and Conrad will have friends and relatives already in place to open co-ops and rake in all those government subsidies.
Who cares if they work or not? The whole point is getting government contracts and paying the board members.
August 18, 2009 11:12 AM | Reply | Permalink
And when the co-ops fail, as they will, critics of public health care will be able to say that they "already tried" a public option and it doesn't work.
August 18, 2009 11:15 AM | Reply | Permalink
Wild guess:
- coops will fail if forced to "compete" as equals with private insurance.
What does that say about the state of competition in health insurance?
I'm talking about McCarran-Ferguson Act, which exempts insurance business from federal anti-trust laws, which limits lawsuits against redlining by insurance companies, permits price fixing in states where its allowed, etc, etc.
Or the "Stark Law" that tried to ban kick-backs in the form of self-referrals and ended up banning lower-cost forms of payment, such as pay-for-performance, shared savings, etc.
And still, even despite these past gifts from Democrats, Uni of Pittsburg says that we have on average 12% lower premiums in markets that have more and diverse health insurance players and less consolidation.
Why are liberals so fucking obsessed with their dogma?
Why can't they start by fixing the mess we have today instead of creating a brand new one on top of it??
August 18, 2009 11:37 AM | Reply | Permalink
You make the very good point that we could level the playing field by removing the subsidies of law that benefit private insurers. Those guys don't exist in anything even resembling a free market system.
August 18, 2009 11:44 AM | Reply | Permalink
We have such an amazing regulation in place for private insurance (not just health) today that we actually ALLOW them to share contract data, do not impose any reporting requirements on annual contracts, permit state-level monopolies, etc, etc.
So - we LET them do all this, year after year, then we turn around, accuse them of doing what we either expressly permit or do not expressly ban.
And that's the whole reason d'etre for the public option - the evil evil insurance companies we ourselves created.
I'm actually starting to wish for the coops to be enacted and to fail so spectacularly that it will force the lawmakers to fix the mess they created.
August 18, 2009 11:52 AM | Reply | Permalink
I agree. The only way to fix it is to get rid of insurance altogether and provide healthcare for everyone.
August 18, 2009 11:57 AM | Reply | Permalink
So you've actually run across a principled fiscal conservative?
I thought I had heard or read where they had gone extinct. Can't say as I've seen one near thirty years or better. Wonder if the breed will ever make a comeback? Nah! Gone the way of the dinosaurs.
August 18, 2009 12:04 PM | Reply | Permalink
I thought the first three comments were particularly interesting, because they each focused on the driver of costs that is far greater than excesses charged by insurers. It is the cost of medical care itself - replete with duplicated or unnecessary facilities, tests, and procedures encouraged by a fee for service payment paradigm that rewards excess. Insurance reform can make access to healthcare more equitable, but its effect on costs will be marginal unless the system itself is fixed.
Interestingly, the proposed bills (HR 3200 and I believe the Senate HELP bill also) begin to address this through programs to use comparative effectiveness to distinguish valuable from unnecessary interventions, through Medicare reimbursement shifts to incentivize primary care, and through pilot programs that evaluate the substitution of payment mechanisms based on fee for value rather than fee for service. These will be an essential part of reform.
Once a reform package is passed that mandates (as the current proposals do) insurance for all (with a few exceptions), a minimum set of essential services in all plans, no denial of insurance to any applicant, no discriminatory rates based on health status, and no annual or lifetime limit on coverage, the stage will be set to determine whether these additional reform targeted to health care itself can make a difference. Here, a public option or possibly very large co-ops with strong competitive leverage could make a difference by offering reduced premiums they achieve via contracts with the medical providers who are part of the reform movement within medical care. In that sense, they could facilitate reform faster than private insurers who might have less incentive to take the long term view, and would rather pay providers excessive rates as long as they can pass them on to the consumer. Of course, visionary private insurance corporations might also choose to place their bets on a medical care structure for the future, but examples of those are not frequent in an area that demands short term returns to investors.
August 18, 2009 12:24 PM | Reply | Permalink
Blue Cross, Blue Shield started out as a Co-op....this is about the health care insurance companies greed and the hatred coming from the right..Health Insurance is about profits..they don't want to lose, they want more...the right hate a Democratic President..some because he is a black Democratic President...others because they just hate America and want a Authoritarian type GOP Dictatorship...the Republicans hate the fact they lost the election..hate that they lost the House, the Senate and the White House..they had them selves a nice little dictatorship going for awhile until they got a hard slap of reality..woke up one morning and were out of power..(damn democracy and voting..not fair, not fair!!)...and they will do anything, even watch thousands of people die every day (for lack of Health Care) to get that power back...!
August 18, 2009 12:50 PM | Reply | Permalink
Look around, the left has already tired of multilateralism, compromise, negotiation -- they want action, with or without the help of potential allies. The Huffington Post has a banner headline "Ignore This Man," a reference to this piece in the Hill about liberal activists pressuring Senate Democrats to move forward without Iowa Republican Chuck Grassley. “We are encouraging Finance Committee members and Senate Democrats to do their own bill and not compromise with a bunch of Republicans who are not going to vote with them anyway," Roger Hickey, co-director of the Campaign for America’s Future, tells the paper. There was some talk like that on the right about a second security council resolution on Iraq prior to the invasion.
Washington Monthly blogger Steve Benen asks, "shouldn't this tell Democrats something about the utility of negotiations, and the futility of finding a bipartisan compromise?" Benen and other "progressives" support negotiation and compromise with Iran and North Korea, but Republicans? Forget about it.
Left-wing blogger "Digby" quotes Charlie Cook saying that the Blue Dogs may lose seats in 2010 over health care and says, "If Cook is right and the Dems maintain their majority while losing a bunch of these reactionary wingnuts, I couldn't be happier." This is the same kind of ideological purity demanded by the Club for Growth and mocked by liberals everywhere. Purge the moderates who get elected in tough districts!
The left doesn't want a public option -- they are demanding one, and threatening war with anyone who stands in their way, Democrats in the House, Republicans in the Senate, constituents, trade groups, anyone. The left has embraced unilateralism at the first hint of resistance to their hyper-ambitious plans to remake the world. And yet these same people believe that we can talk the Iranians out of a nuclear program, talk Hamas into recognizing Israel, talk the North Koreans into sanity. But they can't even talk their own majority into passing a health care bill.
Posted by Michael Goldfarb
http://www.weeklystandard.com/weblogs/TWSFP/2009/08/liberal_unilateralism_1.asp
August 18, 2009 1:12 PM | Reply | Permalink
Imagine you purchase an island in the Pacific. You then invite people from around the world to immigrate to your island as you're building a new country. Imagine that after a time your new country has 300 million people.
Now imagine you go to your first assistant and tell him/her to create a health delivery system for the public.
Now imagine three months passes and he/she comes into your office with the plan and its as follows;
Create 1300 to 1500 for profit middlemen called Insurance Companies who will offer the public 10 plans each. Each of the 10 plans will have different coverage, different co-pay, different deductibles. Each different insurance company will also have their own list of "approved" Physicians and pharmaceuticals.
Many, if not all, will have a little known lifetime limit on the amount of money they pay out to each subscriber, and in many, if not all circumstances, will continue to collect premiums well after the lifetime limit has been reached, in effect, having the subscriber pay for coverage he won't get.
These for profit middlemen will also be able to engage in "rescission", the act of dropping a person covered if the person gets sick.
Anyhow, what would your reaction be to this plan?
August 18, 2009 3:51 PM | Reply | Permalink
Imagine you purchase an island in the Pacific. You then invite people from around the world to immigrate to your island as you're building a new country. Imagine that after a time your new country has 300 million people.
Now imagine you go to your first assistant and tell him/her to create a food delivery system for the public.
Now imagine three months passes and he/she comes into your office with the plan and its as follows;
Create 1300 to 1500 for profit middlemen called Supermarkets, who will offer the public all kind of food with very strange confusing pricing systems including sales, coupons and so on.
Anyhow, what would your reaction be to this plan?
Now imagine you go to your second assistant and tell him/her to create a food delivery system for the public.
Now imagine three months passes and he/she comes into your office with the plan and its as follows;
Universal single payer food delivery system for the public.
Anyhow, what would your reaction be to this plan?
August 18, 2009 4:19 PM | Reply | Permalink
Geez ... Life's a bitch . . .
. . . and then you die.
Now imagine that . . .
Tool!
~OGD~
August 18, 2009 4:36 PM | Reply | Permalink
I doubt the assistant would come back with a plan for a food insurance industry - and that is precisely the point. If you really examine your analogy, you see that john's point remains unchallenged and is in fact enhanced.
Or shall we all sustain ourselves on insurance? Pretty thin gruel, I'm afraid.
August 19, 2009 11:27 PM | Reply | Permalink
"health care cooperatives to compete with the likes of Aetna, United Health and other big campaign contributors."
1908 Competition was natural enough at one time, but do you think you are competing today?.... Against whom? Against Rockefeller? About as I would if I had a wheelbarrow and competed with the Santa Fe (Railroad) from here to Kansas City. Eugene V. Debs, Socialist Party candidate for president in 1908.
1905 When I say I believe in a square deal I do not mean, and nobody who speaks the truth can mean, that he believes it possible to give every man the best hand. If the cards to not come to any man, or if they do come, and he has not got the power to play them, that is his affair. All I mean is that there shall not be any crookedness in the dealing. President Theodore Roosevelt, speech on April 5.
Do we need the middleman making millions? Is that crooked?
August 18, 2009 7:08 PM | Reply | Permalink
No, we need the middleman making billions. Only when somebody makes billions in health care, will have health care as good and as affordable as browsers, Ipods, computers and furniture.
August 18, 2009 8:30 PM | Reply | Permalink