This can't be stressed enough: the mere fact that people get insurance through their companies (or even that they buy it on their own) does not mean that people have good insurance, that the costs are low enough or that the benefits are generous enough.

The question about people over and under 65 is a good one. But lets take it further: why do our congressional reps have more and better health care choices than the average citizen? If we can't have a national public option, then making the federal employee plan available to everyone at the same prices congressional reps pay is a good step.

Thanks for Dr. Dinosaur, which helped some family members.

Are you up for a primary challenge to Obama is he proves himself not up to the task of representing the 74% who want a public option?

What's that percentage among Democratic primary voters? 97%

Yes we can? If necessary?

They've got the guns, but we've got money bombs.

A heartfelt thank you Dr. Dean for your dogged efforts directed towards helping working Americans who need that help now more than ever.

Unless the President reverts to his original position that the competition of a strong public plan is essential to reining in costs and regulating fairness, I can't see congress, specifically the Senate, having the wherewithal to pass it (through the HELP committee plan or another). I'm not sure they necessarily have to use the reconciliation process if the Majority Leader shepherds a plan through and the President twists some arms, but if they have to, they should.

I would add that using any legislative means necessary (as someone has said) like reconciliation should be undertaken without any qualms considering how it has been used in the recent past, overwhelming public support for reform and the perhaps minor consideration that public health insurance is the right thing to do.

We need to let it be known that, between elections, elected office is not a fundraising job in an endless campaign but hard work serving the interests of their constituents, the people, not corporations.

"More than 14 million Americans receive their health coverage on the individual market, but although these patients pay hefty premiums, only a fraction of the dollars are spent on providing actual care. "

I'd also like to thank you for never forgetting that this is always about care in the end not the soulless, heartless, amoral, mantra of cutting costs. If care is delivered efficiently and appropriately, reductions in costs will follow. But without the focus on care, cost cuts may be nothing but cuts in the delivery of care to those too vulnerable to fight back.

Howard, as usual, you cut through the BS to the actual issues at play here.

What is galling about the current system is how great insurance is to have---unless you need to use it. Then it's a nightmarish game of pop goes the weasel.

Right now, the insurance company's goal is maximum profit, and that is all well and good in the public marketplace; but we need to put this "marketplace" on an actual level playing field by providing a public option.

Obama would have done well to appoint Mr. Dean as the point man on Health Insurance Reform

Error at end of Dr Dean's first sentence: politics should be policies.

Greetings, Dr. Dean! Welcome to TPM!

It seems to me that what we lack in our fight for a decent healthcare system is the right conduit through which we might consolidate and focus our energies against the corporate giants. I have avocated more then once in the TPM Cafe that Democracy For America would make an excellent vehicle for that purpose and I have found your determination praiseworthy and your consistency admirable. It seems there are no other individuals of wide repute who will step up and speak their truth as you have from Day 1.

We need a serious overhall of our healthcare system. I am disgusted at the way people are treated as commodities when it comes to their personal health and at the lack of compassion evident in the pursuit of profits by these mega- corporations. But to expect a private company to have any other agenda then profit is beyond naive.

Our politicians appear unable to recognize that the overwhelming majority of people expect them to develop a serious and effective overhaul of the healthcare system. I suspect they are mesmerized by the dollars pouring out of these mega-coporations. The enormity of the finaincial activity in lobbying against reform is impressive, but it pales in comparison to what people can do if we can work together. Obama's Presidential Campaign proved that, and now we need to do it again, in spite of the weak economy.

My suggestion has been that we, the people, focus our monetary contributions to your organization. If enough cash is raised, it might attract the attention of these politicians who may come to recognize that the people expect healthcare reform now and we are serious.

The only way to compete with the finances from the corporations is to make one entity our focus. I suggest that entity is DFA. From there funds might be disbursed to the Congress people who are doing the right thing, promoting universal healthcare, with at least a public option, since Single Payer has gained no advocates in Congress. If that means the private companies will diminish and vanish, AMEN to that. At least they will have the foresight to see their own demise and self-destruct in an orderly manner, or redirect their monies to other insurance markets. The future health of the people should not be for sale.

Thank you for your service. You have suffered much abuse at the hands of these bastards and I appreciate your work. Clearly in the remarks above you can see, I am not alone.

Theme : 6 Main Lies Have Nothing To Do With This Promising Reform.

1. The contents of savings (below) in this reform 'have nothing to do with' limit to medical access, rationing, tax raise, and deficit etc.

Rather, without wiping out these wastes and roots of bankruptcy for middle class, all fronts are sure to face larger financial ruin than this recession, which leads to more limit to medical access, more rationing, more tax raise, and more deficit etc than today.

$1.042trillion (cost of reform) + $245bn (cost to reflect annual pay raise of docs) = $1.287bn (actual cost of reform).

$583bn (the revenue package) + $80bn (so-called doughnut hole) + $155bn (savings from hospitals) + $167bn (ending the unnecessary subsidies for insurers) + 129bn(mandate-related fine based on shared responsibility) + $277bn (ending medical fraud, a minimum of 3% , the combined Medicare and Medicaid cost of $923.5bn per year, as of July,) = $1.391trillion + the reduced cost of ER visits (Medicare covers some 40% of the total) + the tax code on the wealthiest more reduced than originally proposed = why not ? (except for a magic pill, an outcome-based payment reform & IT effects and so forth).

Unlike high fuel price and mortgage rate in recent years as the roots of great recession and bankruptcy of middle class, the severity in the high cost of health premiums has come to light lately. Similarly, in an attempt to hide these deficit-driven corruptions and wastes, the greed allies struggle to turn the savings via removing these wastes into limit to medical access, rationing, tax raise, and deficit etc.

In contrast, not to mention a wide range of consumer protection, options across state lines, this promising reform takes initiatives in more primary care docs and improved long-term care. Unnecessarily, hope should not be replaced with all forms of malign lies, fear, just like people don't have to fear quitting drug.


2. Greedy insurers with no competitors by consolidation have nothing to do with the law of price, demand & supply.

Under the free market theory and the premise that the public health is also one of commodity like a house, if the demand decreases on a large scale, accordingly the price tends to reflect it, as in the case of house price, and it never happens for the price to spiral up. One step forward, in case the price is spiraling up, to be sure, the remaining clients should withdraw the contract or choose the other options. In practice, runaway premiums with no competitors by consolidation drive the enrollees out, and 4C + 2R (canceling, capping, cherry-picking, cash for special lobby, rationing, rapid premium hike) guarantee multiple times as much profit. Sadly, no way-out other than the prohibitive ER is allowed in America. Therefore, the victims today and tomorrow deserve long overdue protection from non-profit Government.

3. The plans to stem inflation in the House have nothing to do with crowd-out.
With the heartbreaking tears in mind (Nearly 11 Million Cancer Patients Without Health Insurance), private market also needs changes and should join together to complete this reform , as promised, otherwise, the runaway premium only has itself to blame while new firms are filling the void with competitive deals.
And It can be said that fair competition starts with a fair, sustainable market value.

However, the plan in the House is designed to keep people in an employer-based health insurance system, and the public option would be offered to those for whom employer-provided insurance is not available. And job-based coverage (indirect payment), some mandate code, ample capital, the reduced exorbitant ER costs, IT base to streamline the administrative processes and trim the costs might be favorable to the private market. Over time, supposedly, the public plan will concentrate more on basic, primary cares, and the private insurers will provide their clients with differentiated services. Focus should be on the uninsured, the underinsured.

In an attempt to avert innovation, moderation, and social responsibility, accusing essential affordability, citing take-over, will be a dirty play.

-- Except For The Underinsured, The Uninsured Alone Outnumber The Entire Population In Canada --

4. Profit-driven markets have nothing to do with affordable, sustainable public health.

When the public health is also one of commodity like a house, we come to a tragic and unthinkable conclusion : As to for-profit business, the more and longer ill patients get, the more profits they make, and it will debilitate the overall economy involving education for the future (roughly 40% of the uninsured, around 20million of young adults).

Under the most wasteful structure on the planet like no coordinated preventive care program waiting until people get ill, about 50% of idle world's best practices, a pay for each and every service reimbursement and frequent readmissions, no e-medical record and deaths, crushing litigations and the more profits via the unnecessary, risk-carrying procedures, and the most inefficient paper billing systems imaginable, overpriced pharmaceuticals, bloated insurance companies, incredible medial fraud, exorbitant costs by the tragic ER visits etc, it might be no wonder with the comprehensive, systematic reform in the pipeline, just one attitude of patient-oriented value in 10 regions has attained 16% of savings in Medicare while their quality scores are well above average.

Aside from the already allocated $583 billion and the savings of this reform package, 16% of $923.5bn (the combined Medicare and Medicaid cost per year, as of July) is around $147.76bn per year and 1.4776trillion over the next decade, and this patient-oriented value alone could be enough to meet the goal.

Please be 'sure' to visit http://www.nytimes.com/2009/08/13/opinion/13gawande.html?hp for credible evidences !

Today, another innovative, fundamental change in payment system, or patient's outcome based payment reform that is able to turn the profit-oriented malpractices and volume into the patient-oriented value and quality is waiting for a final decision.

5. Inflation-driven greedy allies backed by the insurers have nothing to do with deficit-neutral.

When some part of our body is ailing seriously, we are going to lose competitiveness, equally, when some part of a nation is ailing servery, it is going to loose competitiveness, too. In case somebody in the house gets ill, health will be put over house, in practice.

6. The analyses of CBO have nothing to do with common sense and practice.

Costs of Preventable Chronic Disease account for more than 75% of the nation’s $2.4 trillion medical care costs. U.S. health care spending is also expected to double in the next 10 years. and they are largely preventable -- 80 percent of the risk factors are behavior-related.

Unlike the analyses of CBO, world-wide outstanding public programs put heavier emphasis on preventive program equally, and preventable swine flu pandemic is expected to cost about $2trillion dollars world-wide for the lack of prepared vaccines. (Genes included in the new swine flu have been circulating undetected in pigs for at least a decade, according to a team led by Rebecca Garten of the federal Centers for Disease Control and Prevention who have sequenced the genomes of more than 50 samples of the virus).

If CBO asks the profit-driven interests about why they have hindered the budget request for preventive program in Medicare and Medicaid, they will say, " just look at the health Catrina special lobbying has made, we are professional, and we are now obstructing this reform, too " .

7. Conclusion : The public health is a fundamental human right.

As I said previously, patient-oriented value alone could be enough to meet the goal, and another innovative, fundamental change in payment system, or patient's outcome based payment reform that is able to turn the profit-oriented malpractices and volume into the patient-oriented value and quality is waiting for a final decision.

If At least, some media pay attention to this flower of reform, people will feel empty as the past and current discussion has been time-consuming for sure.

Thank You !

Dr. Dean--To answer your question: Yes! We should offer Americans under the age of 65 the same kind of health care choices we give those over the age of 65. And just as critically: Yes, we can do it.

Isn't it interesting that the same Republicans who pushed through both a massive unfunded tax cut in 2001 and the costly Iraq war (also not included in the annual budget for 6 years) will not support health care reform that covers all Americans? If they don't value public health care plans, why don't they resign en masse from their Federal health plans, from Medicare, and from the VA benefits that some of them are participating in?

I think that arch-conservative Winston Churchill was right in his view of state-funded national health care in Great Britain:

"The discoveries of healing science must be the inheritance of all. That is clear. Disease must be attacked, whether it occurs in the poorest or the richest man or woman simply on the ground that it is the enemy; and it must be attacked just in the same way as the fire brigade will give its full assistance to the humblest cottage as readily as to the most important mansion. Our policy is to create a national health service in order to ensure that everybody in the country, irrespective of means, age, sex, or occupation, shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available."

Moving to the public option is likely to be a good half-step in the right direction. Let's all keep in mind, however, that the United States has already experimented with taking just such a half step in another arena, to arguably disastrous results.

Where? Campaign finance reform. Providing matching funds to Presidential candidates solved very little, yet it put an end to serious talk of reforming campaign finance for a generation. A strong, robust, accountable public health insurance option is crucial. That said, a weak one may be worse than nothing.

Thank you Dr. Dean. In all the babble going on right now,I never hear anyone talk about those of us with private insurance. It drives me nuts when the free market fanatics go on and on about how WE should have the choice of what kind of insurance we want. It's not our choice. It's the insurance companies choice as to whether or not we're worth covering. We pay almost $7,000 a year in premiums and get almost nothing in return. Free market my ass.

Let me know when the real debate begins. So far all that's been put forth is a plan, sans debate, to make insurers even richer and assure certain senators get reelected.

http://www.latimes.com/news/nationworld/nation/la-na-healthcare-insurers24-2009aug24,0,2392720.story

May I add my thanks, Dr Dean? You are a prince among men and, yes. we could give you the same grassroots we gave Obama.

I want Dr. Dean to have a more national role in this. We need to hear more from people like Dean, and less from the GOP/industry/BlueDog do-nothing camp.

Keep up the good fight, sir.

Without a not-for-profit option to stimulate and maintain competition in the health insurance industry, there will be no incentive for reducing health care costs and improving the quality of care. As long as insurance providers are driven by maximizing profits for their shareholders, and not by providing quality products and services to their customers, the quality of health care will continue to decline while the cost will continue to increase.

There is a clear conflict of interest between a health insurance company's commitment to high profit margins, and their commitment to provide affordable, quality health care to their customers. I think that ALL health insurance providers should be non-profit entities, or at the very least, there should be a cap on the amount of profit allowed.

The problem with healthcare isn't that so many people don't have it, the problem is that so many people still do.

Go back 6 months, 10s of thousands of people worked for GM Auto Dealerships and they were no doubt happy with their health care and they were probably ambivalent or vehemently against "reform". Fast forward 6 months and GM closes a number of dealerships and now all those people that were happy with their health care don't have it.

Everything they own is now at risk of a health problem. Their homes, cars, life savings, 401Ks; all at risk of an illness. Silent killers like uterine cancer, prostate cancer, or something as simple as pneumonia or a serious infection and you can be wiped out financially.

The problem with being happy with your health insurance is simply that you have no insurance against losing it.

heartfelt thank you Dr. Dean for your dogged efforts directed towards helping working Americans who need that help now more than ever.

Unless the President reverts to his original position that the competition of a strong public plan is essential to reining in costs and regulating fairness, I can't see congress, specifically the Senate, having the wherewithal to pass it (through the HELP committee plan or another). I'm not sure they necessarily have to use the reconciliation process if the Majority Leader shepherds a plan through and the President twists some arms, but if they have to, they should.

I would add that using any legislative means necessary (as someone has said) like reconciliation should be undertaken without any qualms considering how it has been used in the recent past, overwhelming public support for reform and the perhaps minor consideration that public health insurance is the right thing to do.

We need to let it be known that, between elections, elected office is not a fundraising job in an endless campaign but hard work serving the interests of their constituents, the people, not corporations.

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Are you up for a primary challenge to Obama is he proves himself not up to the task of representing the 74% who want a public option?

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