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Obama's Big Question
President Obama is going to speak to Congress on Wednesday about Health Care Reform. He should start with this chart and simply ask, "Will everyone who thinks this system is working please stand up?"
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Jon - we know it's not working. The debate is over how do we fix it.
September 6, 2009 11:29 AM | Reply | Permalink
Except there's no debate going on. It's "They want to kill grandma and take over your lives." "You'll bankrupt the country." "The quality of health care will plummet!"
That's not debate. That's one side doing their damnedest to make sure nothing happens while the other is in such disarray they don't have a chance.
I would LOVE to see an honest, pragmatic, respected Republican explain to us why a Public Option is going to destroy the private health insurance market, and why that would be a bad thing. Without hyperbole. Without fear mongering. Without wild accusations regarding the 'true' motives of the current administration.
Then I'd like that same Republican to explain to us what the Republican plan is to lower health insurance and health care costs, assuming there is no Public Option.
I want numbers. I want realistic projections of what their plan will do to solve this problem. If it's so obvious we have a problem, and it's getting more and more out of control, why are they telling us to wait? To slow it down?
They want slow? FINE. Lay out a timetable, a plan, a list of problems to solve and when they will be solved, and when we will see legislation ready for a signature.
With the Democrats in such (apparent) retreat and disarray right now, the Republicans have a golden opportunity to prove to the country that they can govern responsibly. I would LOVE them to prove it to me. Instead they apparently want nothing more than the downfall of the current administration and the Democratic party.
Right now I'm disgusted with the whole lot of them.
September 7, 2009 12:54 AM | Reply | Permalink
Here's an even simpler approach (a letter to the editor of the SF Chronicle):
What functions do insurance companies perform? They don't do a single check-up. They don't do a single exam, they don't perform an operation. They only take billions of dollars that should otherwise be used for health care. The real question is why do we have a private plan?
LARRY MAAS, San Francisco
September 7, 2009 5:27 AM | Reply | Permalink
If all you've heard is the death panel garbage, then you have selective hearing. People are also pushing for tort reform and to open up the system such that I can buy insurance from any state I want to, not just the one I live in.
September 7, 2009 6:50 AM | Reply | Permalink
MiddleClass,
I have yet to see any research on how tort reform will make any dent of note in the cost of care.
As for buying insurance out of state, I guess you think insurance companies across state lines are somehow more altruistic, less concerned about return on investment than the state you live in.
September 7, 2009 6:55 AM | Reply | Permalink
MiddleClassBill: People are also pushing for tort reform and to open up the system....
Too bad 'those people' did not include your recent War President and his Republican Party.
Why didn't they listen to conservative supporters like you MiddleCalssbill when they had control of Congress and the Oval office for 6 years?
It seems while you wanted reform, they wanted to play politics. The GOP's concerns about health care did not go beyond George W. cogitating the partisan advantages of restricting stem cell research the month before 9/11, and playing politics with a brain dead female in Florida.
September 7, 2009 10:32 AM | Reply | Permalink
Don't forget his veto of SCHIP.
September 7, 2009 11:24 AM | Reply | Permalink
Why do we progressives always brush off tort reform with the weak "it just doesn't cost that much" argument? Particularly when there's a vastly better argument available: capping malpractice damages is not only completely contrary to our constitutional concept of jury trials, but it also results in unbelievable injustice.
Seriously, if a doctor completely blows a simple operation and leaves a 30 year-old patient a quadriplegic for the rest of his life, the victim's damages should be capped at $300k? He'll have millions in medical bills. The idea that a bunch of wealthy doctors can be that callous to the mistakes of their peers simply because they think they shouldn't have to pay for med-mal insurance is one of the best examples around of what passes for conservative thought these days. Madness...just simple greed.
Also, it's worth noting that "the mistakes of their peers" isn't some random distribution. A very small subset of doctors (the really bad ones) are responsible for the vast majority of med-mal suits, and they should be weeded out of the industry. Why good doctors would willingly protect bad ones with whom they compete is totally beyond me.
September 7, 2009 9:29 PM | Reply | Permalink
Hunter,
I agree with all you say, but one point; the reason progressives so often speak of how little malparactice adds to the cost is becasue more often than not they're replying to a rightie who is babbling about the cost.
September 8, 2009 1:35 PM | Reply | Permalink
Why do we progressives always brush off tort reform with the weak "it just doesn't cost that much" argument
Out of habit, from hearing Democratic party talking points, which over the years increasingly were written with the best interests of the trial lawyers lobby in mind, in order to maintain a symbiotic relationship:
September 8, 2009 11:22 PM | Reply | Permalink
Tort reform is like tax cuts. It means nothing, it does nothing. To paraphrase the mindless Republican, if you do nothing wrong there's nothing to sue about. What contributions to the health cost does tort reform address? How does tort reform solve the denial of coverage issue? How does tort reform resolve the preexisting condition issue? How does tort reform lower costs? The insurance companies don't reimburse 100% of costs anyway. Just because a doctor orders a test doesn't mean the insurance company pays for the test. HOW DOES TORT REFORM HELP THE PATIENT?
September 7, 2009 6:59 AM | Reply | Permalink
The GOP uses it to play to peoples' hatred and distrust of lawyers and reminds everyone that trial lawyers support Democrats. Nobody in the GOP ever asks about whether a patient should be able to sue when a doctor botches an operation.
September 7, 2009 11:27 AM | Reply | Permalink
From a Google search; Will tort reform lower health costs?
Q.A lot of people seem to have taken up the cause of tort reform. Why isn’t it included in the health care legislation pending on Capitol Hill?
A.Because it’s a red herring. It’s become a talking point for those who want to obstruct change. But [tort reform] doesn’t accomplish the goal of bringing down costs.
Q.Why not?
A.As the cost of health care goes up, the medical liability component of it has stayed fairly constant. That means it’s part of the medical price inflation system, but it’s not driving it. The number of claims is small relative to actual cases of medical malpractice.
Q.But critics of the current system say that 10 to 15 percent of medical costs are due to medical malpractice.
A.That’s wildly exaggerated. According to the actuarial consulting firm Towers Perrin, medical malpractice tort costs were $30.4 billion in 2007, the last year for which data are available. We have a more than a $2 trillion health care system. That puts litigation costs and malpractice insurance at 1 to 1.5 percent of total medical costs. That’s a rounding error. Liability isn’t even the tail on the cost dog. It’s the hair on the end of the tail.
September 7, 2009 2:42 PM | Reply | Permalink
I didn't say it was the savior to all problems. But it's one way to reduce costs and I haven't heard it being included in the bill. That's how it helps the patients. You don't think doctors authorize some tests just to reduce the chance of being sued?
September 7, 2009 9:42 PM | Reply | Permalink
Middle Class,
try to find an example of a doctor who ordered a test to avoid being sued.
September 8, 2009 1:38 PM | Reply | Permalink
Please read this article.
http://www.massmed.org/AM/Template.cfm?Section=Advocacy_and_Policy&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=23559
September 8, 2009 2:02 PM | Reply | Permalink
Middle CLass,
Put aside for a moment that what you have there are medical industry people polling doctors on malpractice, that's a stacked jury.
That study does not get to my request, it speaks in generalities; give me an example of a doctor practicing defensive medicine;
Doctor, when you sent that patient for a Cat Scan, what was it in particular that you wanted the CAT technician to zero in on? And why did you want the technician to zero in on that particular organ/area?
When you can answer those two questions, we'll speak again.
September 8, 2009 4:04 PM | Reply | Permalink
Sorry for the "generalities". I doubt you're going to get an interview with one particular doctor saying how he prescribes test that a patient doesn't really need. Not good press for that doctor.
I don't understand why you need a quote from a particular doctor. And just because the survey is done by doctors doesn't illegitimize its findings.
I am not a doctor and it doesn't sound like you are either. But I think the article makes a good case that there are excess costs that could be taken out if we don't cave to the trial lawyers.
September 8, 2009 4:53 PM | Reply | Permalink
MiddleClass,
it should be easy for any doctor to give an example of his practicing defensive medicine, especially any of those doctors in that survey.
I think the trouble with supplying an example is simply that they can't.
September 8, 2009 7:04 PM | Reply | Permalink
Unfortunately I don't know any of the doctors who took that survey. But many of them are saying that they over-prescribe treatments that aren't really necessary.
I'm not sure why you need more proof and I need to "produce" one of the participants.
September 8, 2009 8:34 PM | Reply | Permalink
MiddleClass,
that's the point, I have yet to see any proof.
I read some telling us they do certain things to avoid being sued, but they won't give us an example.
September 8, 2009 9:44 PM | Reply | Permalink
I don't understand why you don't believe the results of the study. It makes a lot of sense to me that doctors will have you do more tests than are really necessary in order to prevent a lawsuit.
September 8, 2009 10:06 PM | Reply | Permalink
He doesn't want to understand. Even if you do produce a doctor who stands right in front of you both and supports the study, he will argue with you, saying "who are you going to believe, me or your lying eyes?"
September 8, 2009 10:18 PM | Reply | Permalink
It isn't about whether doctors have NO reason to perform a test, but the current system provides no incentive for them to balance the cost of the test against the potential value. Fee for Service is just that -- fee paid for services performed. If there is a 1% (or 0.5% or 0.1%) chance of being sued if the test isn't performed and a 100% chance of being paid if the test is performed, rational doctors will order the test.
There isn't an easy answer to this -- if there was, I'm convinced it would have been done already. But the current proposals do almost nothing to address this fundamental problem which separates the cost of treatment from the decisions for treatment.
September 8, 2009 7:00 PM | Reply | Permalink
In the states where it's been tried, tort reform has made only a minimal difference to health care costs. Ideologically it's a wonderful magic wand, but in the real world it's not so much.
September 7, 2009 7:56 AM | Reply | Permalink
Problem is that the first thing insurance companies ask is 'Where do you live?' so they can phony up statistics to make sure you pay more.
September 7, 2009 8:54 AM | Reply | Permalink
Dear McBellow ... Tort Reform?
It's not major driving factor in high health care costs . . .
The tort reform issue is another empty solution that is an additional diversion from the true underlying factors on why we need reform.
Take the following snippet of information as an example:
Make sure you take the time to read the info at those links in the article.
I'm sure you won't though . . .
~OGD~
September 7, 2009 9:31 PM | Reply | Permalink
Thanks, I read them. Hopefully you'll read the article I am linking to here. http://www.massmed.org/AM/Template.cfm?Section=Advocacy_and_Policy&TEMPLATE=/CM/ContentDisplay
Tort reform won't fix the whole problem, but it certainly can't hurt.
September 8, 2009 3:30 PM | Reply | Permalink
Forrest,
excellent rejoinder.
September 7, 2009 6:51 AM | Reply | Permalink
For god's sake throw your Republican friends a bone! Give them tort reform and interstate insurance purchase and give us the public option and let's finish this thing before it finishes the Democratic party!
September 7, 2009 7:57 AM | Reply | Permalink
That would be a win-win thought. This is a win-lose debate today. Compromise isn't on the agenda for the President and Congressional leaders.
September 7, 2009 8:21 AM | Reply | Permalink
nutty,
you could give the Republicans tort and crossing state lines, it still wouldn't get you the public option.
September 7, 2009 9:25 AM | Reply | Permalink
"I would LOVE to see an honest, pragmatic, respected Republican"
Are you serious?
September 7, 2009 8:57 AM | Reply | Permalink
My grandmother was . . .
But she was born in 1888 and passed on about 35 years ago at the age of 86 ...
Talk about your different Republican from today's washed out bunch . . .
No comparison.
~OGD~
September 7, 2009 9:51 PM | Reply | Permalink
Forrest, all you write sounds very logical and, under different circumstances, would be the proper demands. However, everyone is focusing on the wrong point(s). What Obama supporters and voters need to look at is Obama's in office approach to everything he promised during his campaign. He has supported Wall Street and the banks with billions of dollars and left the American homeowners to be thrown into the streets; he has continued the Bush agenda regarding wiretapping, torture, wars in Iraq and Afghanistan,he dropped universal coverage before the healthcare debate even began and now he is turning his back on the public option insurance choice for the Snowe-trigger which means the insurance industry will make billions once the healthcare bill is passed (if congress does pass one--I hope it doesn't pass anything without a public insurance option). All this adds up to the fact that Obama is not the HOPE and CHANGE president we thought we were electing. He is a right leaning Blue Dog just as Rahm Emanuel, Max Baucus, Kent Conrad, et al, are. We can forget about any bills that favor the people and we can look forward only to bills that enrich PhRMA, the insurance industry, the banks, Wall Street, etc. I cannot tell you how heartbroken I am after two years of working, donating, crying and praying for this man to win the presidency. We have been betrayed by a Blue Dog who is laughing up his sleeve behind the closed doors of his Oval Office. There has not been any real debate because Obama-Rahm didn't want one (and still doesn't. Notice the "democratic" spinners on TV, not one has really presented the public option for what it is, a choice for real, affordable insurance, not a government run medical facility. Sorry, but I do not believe Obama cares one bit about the people and is looking forward to the big bucks from the Oligarchy for his 2012 run.
September 7, 2009 11:15 AM | Reply | Permalink
It's already framed as a concession speech. And with folks like Sell-out Sally, my dear Senator, whichever way the wind blows Amy, doing her best to make CNN know she stands for nothing and she'll stand for even less tomorrow, a few charts aren't going to do it.
We need a party that gives a damn. If they cared, you'd be able to tell.
We don't need charts. We need hearts.
September 6, 2009 11:49 AM | Reply | Permalink
It's already framed as a concession speech.
Yeah, this is what we're getting from Axelrod. I'm still going to hang onto the hope, against my better judgment, that Obama's consigliori has been put in charge of the Lowering Expectations department, and that there are surprises in store.
September 6, 2009 11:54 AM | Reply | Permalink
Dan K is getting all hopey and irrational? Jeezus, it is the end of the world...
Seriously, I'll eat my shorts if that happens. I can't think of a more insane PR policy than to splash all over the news that you're going to propose something moderate, and then do a 180 back to the so-called extreme left. When has this ever happened? And with success?
September 6, 2009 12:08 PM | Reply | Permalink
I didn't realize that 70%+ was extreme left.
September 7, 2009 7:02 AM | Reply | Permalink
It is to the extreme right.
September 7, 2009 7:53 AM | Reply | Permalink
Neither did I, but so says the MSM, with their talk of the 'radical lefty' public option. I'm talking about how this hypothetical strategy will get played. Don't get me wrong, I'm very much in favor of the public option, which is why the administration's wavering on it bugs me.
September 7, 2009 10:48 AM | Reply | Permalink
bluebell,
the Democrats are as leaderless as the Republicans.
The only example of leadership from the Dems I've seen regarding this issue is Pelosi saying no bill will leave the House without the public option.
September 7, 2009 6:59 AM | Reply | Permalink
I think the Dems have 'Stockholm Syndrome' after the last eight years.
September 7, 2009 9:01 AM | Reply | Permalink
bubbal,
heh heh, truly. :-)
September 7, 2009 9:26 AM | Reply | Permalink
"Start with this chart." Right.
Good thing you are a professor and investor, Jon, and not a politician.
Maybe his second question could be, "Will everyone who can read this chart please stand up?"
September 6, 2009 11:50 AM | Reply | Permalink
Perot did it. Honest charts let people know you are taking them seriously even if they are not sure they understand all the charts.
September 7, 2009 10:32 AM | Reply | Permalink
I disagree with the above posts. Anyone remember Ross Perot? He got his point across beyond any other third party's wildest dreams with charts just like these. They are simple; even a dyslexic can tell what the lines going straight up, as apposed to the lines heading down mean.
Yes, we are a confederacy of dunces, but these charts are a visual aid that accomplishes quite a bit more than that other one -- you know, the one with Obama with a Hitler mustache.
This whole issue has been marked by very successful fear-mongering based on false gimmicks and talking points. Why not have a visual reminder of some simple truths? Why not remind all those who are oh, so comfy with their insurance just how tenuous their hold is on that guarantee?
It won't do anything to move people who have already made up their minds, but I'd like to think that some people really want facts.
September 6, 2009 12:07 PM | Reply | Permalink
They would have been a great tool to illustrate a message. The problem is he never sold the message and he's lost control of it. I'm listening to Democrats Klobuchar and Nelson sell conservatism on CNN. That's the trouble. Democrats have so internalized the Republican world view that they can't deliver a different message.
Now, if you want to cut costs for small business and make sure that no poor folks get any of your money -- Democrats can sell you that on Sunday morning. What they cannot do is make a case for universal healthcare.
September 6, 2009 12:17 PM | Reply | Permalink
But would you start the speech with charts? Yes, he needs to explain the problem. Maybe some visual aids will be useful along the way. Yes, a lot of people need more information. But I don't think a national college class is what is needed right now. The chief issue Obama is facing right now is a crisis of confidence in his leadership and commitment. He already has more than enough people in Congress and among the public who "get it", and can form a victorious legislative coalition. What they need to know right now is that if they through themselves into the breech to take on the status quo stakeholders and special interests, Obama has what it takes to see the fight through.
Anyway, this is an address to a joint session of Congress, not an Oval Office address or town meeting. Where is he going to put the charts? In front of Joe Biden's and Nancy Pelosi's faces?
He should have done the big national education thing early this summer, when people were ready and open to have the problem clarified and defined for them, and the solutions laid out in a way that made logical sense. But instead he stood back and decided to let Congress carry the ball. It's too late now.
September 6, 2009 12:24 PM | Reply | Permalink
Republicans already know the important facts:
1. Obama is a Democrat
2. Obama is a failure if Health Care Reform fails
3. Republicans are dead if Health Care Reform succeeds.
4. Obama is African American
5. Obama is African American
6. Repeat 1. and 5. ad nauseum
September 7, 2009 10:25 AM | Reply | Permalink
Like minds. I posted above before I read yours.
September 7, 2009 10:33 AM | Reply | Permalink
How ungenerous of you Dan! Have you forgotten how, over the past three decades, the Republicans went out of their way to bend over backwards to accommodate "Democrat" ideas and be bipartisan? Don't you understand that that's exactly how they maintained their hegemony for all that time--by reaching out and listening to the liberals and making compromises with them? Don't you understand that, as soon as the Republicans are back in power--which looks like it will be much sooner than anyone expected--they will again reach out in the same way to ensure Democrats feel included and listened to? Don't you remember Attwater and Rove and Luntz and all the others who worked so hard to seek Democratic support for everything they did? Well, even if you've forgotten, Axelrod and Obama haven't. In fact, they're clearly ready to go even further than the Republicans did and turn the whole government back over to the Republicans just as soon as they are comfortable that that's what the polls and FOX news tell them the American people want.
September 6, 2009 12:45 PM | Reply | Permalink
Right, and they would never get away with anything as terrible as calling the other side "assholes" in a conversation. Remind me who it was who said, "Go Fuck yourself!" to a Democratic Senator, ON THE FLOOR OF THE SENATE, and go absolutely no flak for it -- oh, yeah -- it was our very own republican Vice President -- the President of the Senate itself.
September 6, 2009 2:01 PM | Reply | Permalink
Purple State,
truly. Why who can forget how Tom 'the Hammer' DeLay reached across the aisle to the gay, liberal Congressman from TAXachusetts Barney Frank
and allowed Barney to insert into a bill a paragraph that forced banks to give mortgages to those who can't afford them.
Yep, old Tom, a leader of bipartisan government.
September 7, 2009 7:21 AM | Reply | Permalink
Ah, an oldie but a goodie. You're making me all nostalgic for the days when the right wing was only highly misleading, instead of blatantly dishonest.
September 7, 2009 7:59 AM | Reply | Permalink
True Bearpaw. Even the inspiration towards satire goes away once you realize your dealing with a pathology.
September 7, 2009 8:50 AM | Reply | Permalink
Dick Armey called him Barney Fag.
Good times.
September 7, 2009 11:34 AM | Reply | Permalink
There is a pretty easy way to solve the problem.
Any drug, medical device or procedure which was approved and covered by private insurance or Medicare as of 1/1/10 must continue to be covered, but any that are approved thereafter shall not be covered.
As patents expire and experience with procedures matures, costs will come down by themselves.
Since we already enjoy medical care that is "the best in the world", it will take a while for the rest of the world to catch up anyway.
September 6, 2009 1:42 PM | Reply | Permalink
Nice try Jon but you know all the republicans will stand up as well as the "Blue Dog" and a few other Dems.
C
September 6, 2009 2:11 PM | Reply | Permalink
Every Repub. will rise possibly even including Olympia Snowe. Steele will effusively congratulate them all for this betrayal of the citizenry.
September 7, 2009 7:01 AM | Reply | Permalink
Is there anything in the current legislation that will allow inter-state competition among the insurance companies? What about tort reform?
September 6, 2009 2:40 PM | Reply | Permalink
Did you even look at the charts, MCB? Did you notice the one about insurance company profits compared to worker's earnings (the third one); Oh, and the next one which shows the cost for coverage - tell me how the idiotic mantra of "tort reform" is going to fix that? Interstate competition? Give me a break! I'm all for that, but there is plenty of competition as it stands right now. How do the insurance companies cope with all this "competition?" WITH PRICE FIXING! Their premiums are all the same; they all have the same exclusions and coverage - well it varies just enough so that they can't actually be ACCUSED of price fixing,but that is what has happened.
What has prevented a good company from looking at that 3rd chart and saying, "I'll give you a comprehensive insurance policy with the same coverage as Aetna, Wellpoint, or BCBS, and the premiums will cost 1/2 -- how do we do it? We'll lower our overhead by having a lower profit, but also by cutting out reams of paper-work. What has prevented it? The effing insurance industry can get away with NOT doing it!
You are so full of it, MCB - how do you even look at yourself in the mirror in the morning.
September 6, 2009 4:34 PM | Reply | Permalink
Why are you such a bitch? It was an innocent question to people that have read more of the legislation than I have.
I didn't say that the two things I asked about should be the ONLY pieces of reform. I simply asked about them because nobody on here is talking about them.
September 6, 2009 7:53 PM | Reply | Permalink
It wasn't an innocent question. You are being played the fool, or you are the fool. Do you even know what tort means? No human being uses the word tort, except in the mindless repetition of flash-cards for retards otherwise known as Republican Talking Points. Rather than "ask the innocent question", provide a fact based argument that strawberry tort reform will work and PRESENT IT.
September 7, 2009 7:07 AM | Reply | Permalink
If we are looking to cut costs, then one area where we could cut costs is all the unnecessary tests that doctors put patients through because they're so cared about getting sued.
September 7, 2009 9:38 PM | Reply | Permalink
MiddleCLass,
as I requested above, give me an example of a doctor who sent a patient for tests to avoid being sued.
September 8, 2009 2:00 PM | Reply | Permalink
I provided above a link to a Massachusetts Medical Society study which addresses your question.
September 8, 2009 3:03 PM | Reply | Permalink
MiddleClass,
I replied to your link above.
September 8, 2009 4:05 PM | Reply | Permalink
Because the tort 'reform' was tried in Texas and failed and most people know it. Because unnecessarily expensive drugs and procedures and insurance company profits are the basic causes of the increase in health care costs. Not tort recoveries against malpracticing doctors nor defensive medicine by fearful doctors. Because there is no reason to believe that enough people would shop across state lines for it to make any real difference even if the insurance companies on the other side of the fence were any better.
Research the idiotic slogans the Republicans feed you before you peddle them here.
September 7, 2009 10:40 AM | Reply | Permalink
CVille Dem,
The third graph doesn't show profits versus wages; it shows premiums versus wages.
The question is -- why are costs going up so fast? advances in medicine are part of the equation...MRI machines, ultrasound, laproscopic procedures, cancer treatments, etc... all cost big bucks
There is another problem. Doctors have two incentives to perform more tests: fee-for-service and the avoidance of lawsuits. Answer this hypothetical: Say you have a condition and the doctor is 99% sure it is diagnosis "A" with treatment "A" proscribed. The test to determine if it is diagnosis "B" costs $10,000. If you turn out to actually have "B" and the test wasn't performed, will you sue the doctor for malpractice? The doctor thinks you might...so he or she schedules the test and collects the fee for the "service."
Multiply this by millions of decisions every day, even if the test isn't $10,000 and you have a big cost problem due to the threat of malpractice suits and the fact that the doctor has no incentive to hold costs down if you are covered by insurance or a government plan.
Until this is addressed honestly by the administration, their talk of "reform" rings hollow, and instead sounds like just another government program for spending more money and going deeper in debt. This is a difficult problem with no easy solutions, but a problem the President (when a candidate) spoke eloquently about tackling in a bipartisan way and making hard decisions. He has done neither.
September 6, 2009 9:52 PM | Reply | Permalink
To be fair, you have to have a willing opposition to tackle things in a bipartisan way. I'm not seeing much willingness out of Republicans at the moment. They won't even let him talk to their kids for crying out loud!
That said, I do think this administration totally dropped the ball on this very important issue. I understand they wanted to let congress hash out the details, to avoid the appearance of the administration forcing a bill on the country.
I think the 'hard decisions' Obama is going to make will be shown this week in his address. The decisions will be to gut the current progressive wishlist in favor of any kind of victory, with the idea of going back for more later. I just hope later actually gets here in time.
September 7, 2009 1:04 AM | Reply | Permalink
John, Obama's problem is that he's being waaay too bipartisan in his approach. It was clear from the start that the Republicans weren't interested in helping the Dems pass health care. They knew a great health care program on the Democratic watch would seal their fate and put them in the political wilderness for decades. They were never going to help Obama and the Dems in Congress.
If that wasn't absolutely clear before the Town Hells, the way the GOP handled all of that should have removed all doubt. The GOP, the entire Right Wing Noise machine literally poured gasoline on wingnut fires and this country came close to major violence and real tragedy.
Obama doesn't owe the GOP shit. They've been pushing the buttons of some truly dangerous right wing fanatics and they've put Obama's life in danger.
Why anyone in their right mind would expect Obama to still try negotiate with the death panel lunatics is beyond me.
They should have come out strong for a Medicare for All package, explained it in a clear and concise manner, shown how it would benefit EVERYONE, and if the GOP didn't come aboard -- no way in hell that they would -- fuck 'em.
The main reason this got so out of hand is because Obama was being too damn nice. He brought his charm alone to a gun fight. He didn't even bring a knife. And the GOP escalated the gun fight to a nationwide lunatics parade. The Dems never should have let it get to that point.
September 7, 2009 1:41 AM | Reply | Permalink
I'm not sure how the President gets out of the mess he has made.
Blaming the Republicans is easy; but when the President handed the process over to Nancy Pelosi and Harry Reid, he guaranteed that Republicans wouldn't be part of the process. There is too much animosity against them.
The proposals don't address the COST side of the equation, and until they do, people will fear that government will need to either raise taxes broadly or ration care. All the yelling, stupid signs, death-panel talk comes down to this fear.
Until the administration puts a proposal together that deals with the increasing costs in a rational manner and addresses the fee-for-service and fear of lawsuits impact on costs, they are just proposing another big spending program, not reform.
September 7, 2009 8:17 AM | Reply | Permalink
If the Repubs had a rational reason for opposing health care reform your reasoning would hold water. But, by their own admission all they are doing now is trying to defeat Obama and the Democrats by preventing a solution to the health care problem. If the Repubs really wanted to discuss means of solving this problem, they would never have pushed the death panel idea as they did. And, the various meetings they disrupted and brought guns to would not have been treated that way. The evidence that Republicans are simply trying to defeat Obama is overwhelming.
September 7, 2009 10:35 AM | Reply | Permalink
And they do it by speaking to the reptilian brains of those fearful of any change. Death panels, pull the plug on granny, etc. Those are easy pictures to conjure. Sarah Palin put the image of herself "standing in front of Obama's death panels" with her Down Syndrome child and her elderly parents. That goes right to the gut. Telling people their insurance may not cover them in a serious illness is an abstraction that isn't realized until it happens. Then it's too late.
September 7, 2009 12:00 PM | Reply | Permalink
There aren't enough republicans in the population to stop smart reform. The Independents have turned against current reform proposals because they don't hold water -- increase coverage, provide subsidies, mandate insurance for all, have a new public insurance option, tell everyone that "if you like what you have, it will not change", then magic happens and costs come down. It isn't credible.
The President could get this back on track by demonstrating a way to have Medicare start to "bend the curve" before having all the other parts of reform. Let Medicare negotiate prices, institute cost controls, demonstrate success and the Independents will support a public option. Self-described republicans are less than 30% of the population; they can be ignored if the President can get Independents to go along with the Democrats
September 7, 2009 2:43 PM | Reply | Permalink
Ok, Mr. Wizard, tell my why in EVERY INDUSTRIALIZED NATION their cost is half our cost, but our outcome is 37th? If you really are a free-market capitalist, then why don't you want the BEST OUTCOME OUT THE LOWEST PRICE? Why do you argue for the WORST OUTCOME AT THE HIGHEST PRICE? You must be a frigg'n idiot capitalist.
September 7, 2009 7:15 AM | Reply | Permalink
I will refrain from the ALL CAPS, but I do want better outcomes at lower costs.
My frustration is that Candidate Obama promised to make hard decisions and act in a bipartisan way to solve difficult issues. President Obama, however, turned over the process to Nancy Pelosi and Harry Reid, guaranteeing no bi-partisan support and no hard decisions would be made. Let's list the ideas/claims currently being proposed:
Mandate insurance for all
Require businesses to provide insurance, or pay into a system that does
Expand subsidies for those who can't afford insurance
Provide a Public Option for insurance coverage
Don't allow insurance to be dropped or restricted due to pre-existing conditions
If you like your insurance, you get to keep it
Where are the hard decisions? All upside, no downside. Where is the adult reasoning (as opposed to the childish reasoning from the previous administration) that we have a problem and need solutions? The Congress has done what they do when left to their own devices -- increase spending, provide new entitlements and have proposed NOTHING to address the COST problem that is in ALL our health care system. It is a problem with all current health care providers -- Medicaid, Medicare, Private Insurance, Business Insurance. Costs are going up too fast.
I am frustrated that the proposals aren't solutions at all, but just more of the same. Either we have Republicans that promise tax cuts and more spending or Democrats that promise tax increases and even more spending than Republicans. Neither side is willing to approach the problem with a solution, instead of a campaign slogan.
September 8, 2009 7:24 PM | Reply | Permalink
One source of high costs: Doctors' salaries in the United States are far higher than those among our industrialized peers.
In most areas, competition doesn't work to drive down costs, because there are few hospitals and few options. And the individual insurance policy holder is offered little incentive to shop for the lowest cost. There are expensive redundancies in the system.
September 7, 2009 10:20 AM | Reply | Permalink
True, and a good point. Perhaps the government could offer free medical school tuition in exchange for working in the new healthcare system, at a lower-than-today salary level. Of course, this isn't contemplated in any of the bills currently under consideration.
September 7, 2009 3:25 PM | Reply | Permalink
Are you serious?
No training nor assistance for health professionals and primary care doctors?
What the hell is this all about?
____________start paste______________
H.R.3200
America's Affordable Health Choices Act of 2009 (Introduced in House)
`Subpart XI--Health Professional Needs Areas `SEC. 340H. IN GENERAL.
`(a) Program- The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall establish a program, to be known as the Frontline Health Providers Loan Repayment Program, to address unmet health care needs in health professional needs areas through loan repayments under section 340I.
`(b) Designation of Health Professional Needs Areas-
`(1) IN GENERAL- In this subpart, the term `health professional needs area' means an area, population, or facility that is designated by the Secretary in accordance with paragraph (2).
`(2) DESIGNATION- To be designated by the Secretary as a health professional needs area under this subpart:
`(A) In the case of an area, the area must be a rational area for the delivery of health services.
`(B) The area, population, or facility must have, in one or more health disciplines, specialties, or subspecialties for the population served, as determined by the Secretary--
`(i) insufficient capacity of health professionals; or
`(ii) high needs for health services.
`(C) With respect to the delivery of primary health services, the area, population, or facility must not include a health professional shortage area (as designated under section 332), except that the area, population, or facility may include such a health professional shortage area to which no member of the National Health Service Corps is currently assigned.
`(c) Eligibility- To be eligible to participate in the Program, an individual shall--
`(1) hold a degree in a course of study or program (approved by the Secretary) from a school defined in section 799B(1)(A) (other than a school of public health);
`(2) hold a degree in a course of study or program (approved by the Secretary) from a school or program defined in subparagraph (C), (D), or (E)(4) of section 799B(1), as designated by the Secretary;
`(3) be enrolled as a full-time student--
`(A) in a school or program defined in subparagraph (C), (D), or (E)(4) of section 799B(1), as designated by the Secretary, or a school described in paragraph (1); and
`(B) in the final year of a course of study or program, offered by such school or program and approved by the Secretary, leading to a degree in a discipline referred to in subparagraph (A) (other than a graduate degree in public health), (C), (D), or (E)(4) of section 799B(1);
`(4) be a practitioner described in section 1842(b)(18)(C) or 1848(k)(3)(B)(iii) or (iv) of the Social Security Act; or
`(5) be a practitioner in the field of respiratory therapy, medical technology, or radiologic technology.
`(d) Definition- In this subpart, the term `primary health services' has the meaning given to such term in section 331(a)(3)(D).
`SEC. 340I. LOAN REPAYMENTS.`(a) Loan Repayments- The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall enter into contracts with individuals under which--
`(1) the individual agrees--
`(A) to serve as a full-time primary health services provider or as a full-time or part-time provider of other health services for a period of time equal to 2 years or such longer period as the individual may agree to;
`(B) to serve in a health professional needs area in a health discipline, specialty, or a subspecialty for which the area, population, or facility is designated as a health professional needs area under section 340H; and
`(C) in the case of an individual described in subsection 340H(c)(3) who is in the final year of study and who has accepted employment as primary health services provider or provider of other health services in accordance with subparagraphs (A) and (B), to complete the education or training and maintain an acceptable level of academic standing (as determined by the educational institution offering the course of study or training); and
`(2) the Secretary agrees to pay, for each year of such service, an amount on the principal and interest of the undergraduate or graduate educational loans (or both) of the individual that is not more than 50 percent of the average award made under the National Health Service Corps Loan Repayment Program under subpart III in that year.
`(b) Practice Setting- A contract entered into under this section shall allow the individual receiving the loan repayment to satisfy the service requirement described in subsection (a)(1) through employment in a solo or group practice, a clinic, an accredited public or private nonprofit hospital, or any other health care entity, as deemed appropriate by the Secretary.
`(c) Application of Certain Provisions- The provisions of subpart III of part D shall, except as inconsistent with this section, apply to the loan repayment program under this subpart in the same manner and to the same extent as such provisions apply to the National Health Service Corps Loan Repayment Program established under section 338B.
`(d) Insufficient Number of Applicants- If there are an insufficient number of applicants for loan repayments under this section to obligate all appropriated funds, the Secretary shall transfer the unobligated funds to the National Health Service Corps for the purpose of--
`(1) recruitment of sufficient applicants for the National Health Service Corps for the following year; or
`SEC. 340J. REPORT.`(2) making additional loan repayments under section 338B if there is an excess number of qualified applicants for loan repayments under such section.
`The Secretary shall submit to the Congress an annual report on the program carried out under this subpart.
`SEC. 340K. ALLOCATION.`Of the amount of funds obligated under this subpart each fiscal year for loan repayments--
`(1) 90 percent shall be for physicians and other health professionals providing primary health services; and
SEC. 2212. PRIMARY CARE STUDENT LOAN FUNDS.`(2) 10 percent shall be for health professionals not described in paragraph (1).'.
(a) Loan Provisions- Section 722 (42 U.S.C. 292r) is amended by striking subsection (e) and inserting the following:
`(e) Rate of Interest- Such loans shall bear interest, on the unpaid balance of the loan, computed only for periods for which the loan is repayable, at the rate of 2 percentage points less than the applicable rate of interest described in section 427A(l)(1) of the Higher Education Act of 1965 per year.'.
(b) Medical Schools and Primary Health Care- Subsection (a) of section 723 (42 U.S.C. 292s) is amended--
(1) in paragraph (1), by striking subparagraph (B) and inserting the following:
`(B) to practice in such care for 10 years (including residency training in primary health care) or through the date on which the loan is repaid in full, whichever occurs first.'; and
(2) by striking paragraph (3) and inserting the following:
`(3) NONCOMPLIANCE BY STUDENT- If an individual fails to comply with an agreement entered into pursuant to paragraph (1), such agreement shall provide that the total interest to be paid on the loan, over the course of the loan period, shall equal the total amount of interest that would have been incurred by the individual if, from the outset of the loan, the loan was repayable at the rate of interest described in section 427A(l)(1) of the Higher Education Act of 1965 per year instead of the rate of interest described in section 722(e).'.
(c) Student Loan Guidelines-
(1) IN GENERAL- Section 735 (42 U.S.C. 292y) is amended--
(A) by redesignating subsection (f) as subsection (g); and
(B) by inserting after subsection (e) the following:
`(f) Determination of Financial Need- The Secretary--
`(1) may require, or authorize a school or other entity to require, the submission of financial information to determine the financial resources available to any individual seeking assistance under this subpart; and
`(2) shall take into account the extent to which such individual is financially independent in determining whether to require or authorize the submission of such information regarding such individual's family members.'.
(2) REVISED GUIDELINES- The Secretary of Health and Human Services shall--
(A) strike the second sentence of section 57.206(b) of title 42, Code of Federal Regulations; and
SEC. 2213. TRAINING IN FAMILY MEDICINE, GENERAL INTERNAL MEDICINE, GENERAL PEDIATRICS, GERIATRICS, AND PHYSICIAN ASSISTANTSHIP.(B) make such other revisions to guidelines and regulations in effect as of the date of the enactment of this Act as may be necessary for consistency with the amendments made by paragraph (1).
Section 747 (42 U.S.C. 293k) is amended--
(1) by amending the section heading to read as follows: `primary care training and enhancement';
(2) by redesignating subsection (e) as subsection (f); and
(3) by striking subsections (a) through (d) and inserting the following:
`(a) Program- The Secretary shall establish a primary care training and capacity building program consisting of awarding grants and contracts under subsections (b) and (c).
`(b) Support and Development of Primary Care Training Programs-
`(1) IN GENERAL- The Secretary shall make grants to, or enter into contracts with, eligible entities--
`(A) to plan, develop, operate, or participate in an accredited professional training program, including an accredited residency or internship program, in the field of family medicine, general internal medicine, general pediatrics, or geriatrics for medical students, interns, residents, or practicing physicians;
`(B) to provide financial assistance in the form of traineeships and fellowships to medical students, interns, residents, or practicing physicians, who are participants in any such program, and who plan to specialize or work in family medicine, general internal medicine, general pediatrics, or geriatrics;
`(C) to plan, develop, operate, or participate in an accredited program for the training of physicians who plan to teach in family medicine, general internal medicine, general pediatrics, or geriatrics training programs including in community-based settings;
`(D) to provide financial assistance in the form of traineeships and fellowships to practicing physicians who are participants in any such programs and who plan to teach in a family medicine, general internal medicine, general pediatrics, or geriatrics training program; and
`(E) to plan, develop, operate, or participate in an accredited program for physician assistant education, and for the training of individuals who plan to teach in programs to provide such training.
`(2) ELIGIBILITY- To be eligible for a grant or contract under paragraph (1), an entity shall be--
`(A) an accredited school of medicine or osteopathic medicine, public or nonprofit private hospital, or physician assistant training program;
`(B) a public or private nonprofit entity; or
`(C) a consortium of 2 or more entities described in subparagraphs (A) and (B).
`(c) Capacity Building in Primary Care-
`(1) IN GENERAL- The Secretary shall make grants to or enter into contracts with eligible entities to establish, maintain, or improve--
`(A) academic administrative units (including departments, divisions, or other appropriate units) in the specialties of family medicine, general internal medicine, general pediatrics, or geriatrics; or
`(B) programs that improve clinical teaching in such specialties.
`(2) ELIGIBILITY- To be eligible for a grant or contract under paragraph (1), an entity shall be an accredited school of medicine or osteopathic medicine.
`(d) Preference- In awarding grants or contracts under this section, the Secretary shall give preference to entities that have a demonstrated record of the following:
`(1) Training the greatest percentage, or significantly improving the percentage, of health care professionals who provide primary care.
`(2) Training individuals who are from underrepresented minority groups or disadvantaged backgrounds.
`(3) A high rate of placing graduates in practice settings having the principal focus of serving in underserved areas or populations experiencing health disparities (including serving patients eligible for medical assistance under title XIX of the Social Security Act or for child health assistance under title XXI of such Act or those with special health care needs).
`(4) Supporting teaching programs that address the health care needs of vulnerable populations.
`(e) Report- The Secretary shall submit to the Congress an annual report on the program carried out under this section.
`(f) Definition- In this section, the term `health disparities' has the meaning given the term in section 3171.'.
SEC. 2214. TRAINING OF MEDICAL RESIDENTS IN COMMUNITY-BASED SETTINGS.Title VII (42 U.S.C. 292 et seq.) is amended--
(1) by redesignating section 748 as 749A; and
`SEC. 748. TRAINING OF MEDICAL RESIDENTS IN COMMUNITY-BASED SETTINGS.(2) by inserting after section 747 the following:
`(a) Program- The Secretary shall establish a program for the training of medical residents in community-based settings consisting of awarding grants or contracts under this section.
`(b) Development and Operation of Community-Based Programs- The Secretary shall make grants to, or enter into contracts with, eligible entities--
`(1) to plan and develop a new primary care residency training program, which may include--
`(A) planning and developing curricula;
`(B) recruiting and training residents and faculty; and
`(C) other activities designated to result in accreditation of such a program; or
`(2) to operate or participate in an established primary care residency training program, which may include--
`(A) planning and developing curricula;
`(B) recruitment and training of residents; and
`(C) retention of faculty.
`(c) Eligible Entity- To be eligible to receive a grant or contract under subsection (b), an entity shall--
`(1) be designated as a recipient of payment for the direct costs of medical education under section 1886(k) of the Social Security Act;
`(2) be designated as an approved teaching health center under section 1502(d) of the America's Affordable Health Choices Act of 2009 and continuing to participate in the demonstration project under such section; or
`(3) be an applicant for designation described in paragraph (1) or (2) and have demonstrated to the Secretary appropriate involvement of an accredited teaching hospital to carry out the inpatient responsibilities associated with a primary care residency training program.
`(d) Preferences- In awarding grants and contracts under paragraph (1) or (2) of subsection (b), the Secretary shall give preference to entities that--
`(1) support teaching programs that address the health care needs of vulnerable populations; or
`(2) are a Federally qualified health center (as defined in section 1861(aa)(4) of the Social Security Act) or a rural health clinic (as defined in section 1861(aa)(2) of such Act).
`(e) Additional Preferences for Established Programs- In awarding grants and contracts under subsection (b)(2), the Secretary shall give preference to entities that have a demonstrated record of training--
`(1) a high or significantly improved percentage of health care professionals who provide primary care;
`(2) individuals who are from underrepresented minority groups or disadvantaged backgrounds; or
`(3) individuals who practice in settings having the principal focus of serving underserved areas or populations experiencing health disparities (including serving patients eligible for medical assistance under title XIX of the Social Security Act or for child health assistance under title XXI of such Act or those with special health care needs).
`(f) Period of Awards-
`(1) IN GENERAL- The period of a grant or contract under this section--
`(A) shall not exceed 2 years for awards under subsection (b)(1); and
`(B) shall not exceed 5 years for awards under subsection (b)(2).
`(2) SPECIAL RULES-
`(A) An award of a grant or contract under subsection (b)(1) shall not be renewed.
`(B) The period of a grant or contract awarded to an entity under subsection (b)(2) shall not overlap with the period of any grant or contact awarded to the same entity under subsection (b)(1).
`(g) Report- The Secretary shall submit to the Congress an annual report on the program carried out under this section.
`(h) Definitions- In this section:
`(1) PRIMARY CARE RESIDENCY TRAINING PROGRAM- The term `primary care residency training program' means an approved medical residency training program described in section 1886(h)(5)(A) of the Social Security Act that is--
`(A) in the case of entities seeking awards under subsection (b)(1), actively applying to be accredited by the Accreditation Council for Graduate Medical Education; or
`(B) in the case of entities seeking awards under subsection (b)(2), so accredited.
SEC. 2215. TRAINING FOR GENERAL, PEDIATRIC, AND PUBLIC HEALTH DENTISTS AND DENTAL HYGIENISTS.`(2) HEALTH DISPARITIES- The term `health disparities' has the meaning given the term in section 3171.'.
Title VII (42 U.S.C. 292 et seq.) is amended--
(1) in section 791(a)(1), by striking `747 and 750' and inserting `747, 749, and 750'; and
(2) by inserting after section 748, as added, the following:
____________ end paste______________
Just wondering if some folks' heads are buried up there asses . . .
~OGD~
September 7, 2009 10:26 PM | Reply | Permalink
2 years service for loan repayment doesn't address the original post that doctors in the US make so much more money than in other industrialized countries.
September 7, 2009 11:09 PM | Reply | Permalink
Spoken . . .
. . . like a true dyed in the wool socialist.
Whatever happened to the ol' principle of:
It appears that John wants a type of "wage cap" policy to be applied to doctors. That would be in lieu of providing incentives to individuals to enter the health care provider system and thereby increase the numbers of doctors and health care professionals in those targeted areas that most need to be increased, primary care physicians be the most glaring prime example.
John should apply the principles of K.I.S.S
~OGD~
September 8, 2009 8:52 AM | Reply | Permalink
I didn't mean to say that I want a wage cap; if it was interpreted that way, I was careless with my posting.
I tried to say that IF one believes high doctor earnings are part of the problem, a solution could be to have government-run hospitals where doctors are on salary where their education had been provided for by the government. A model similar to the Cleveland Clinic or the Mayo Clinic, in terms of salaried staff. Although these two health care providers have been praised by the administration, the current proposals don't advance this idea.
September 8, 2009 7:06 PM | Reply | Permalink
Cutting costs is easy. Neither party is willing to do it. But it's easy.
Private insurance adds 480 billion dollars a year extra. Extend Medicare to everyone and we save 30% right off the top. With the power of Medicare for everyone, we could also force down the exorbitant price of drugs. America pays more for drugs than any other country on earth. Medicare for all would be like the mother of all Walmarts and could negotiate prices down.
It's truly crazy that Americans can't see the snake in front of their noses. Private insurance is the most important variable here. It's the one most easily gotten rid of. It's like paying a company $30 bucks a month to support your router when you have just one computer. Get rid of the router and hook your computer directly to the modem and save the $30.
Private insurance does nothing whatsoever to improve health care. It doesn't fix your broken bones or make advances in cancer treatments. All it does is skim its huge profits off the top, pay its execs tens of millions (the top ten make 12 million a year on average), pay lobbyists and advertisers and shareholders tens of millions, along with covering roughly just 85% of your claims.
Americans are flat out stupid to actually want to pay the gatekeepers for the privilege of seeing doctors and paying them too, even with insurance.
Direct from the government Medicare for all would save this country hundreds of billions each and every year.
And for people screaming about "socialism". Think about the Military. Think about our spending on Defense. We spend more on Defense than the rest of the world combined and most of that goes down the drain. We pay billionaires to make missile systems that we'll never use, jets we'll never use. In Iraq, we're paying as many private contractors as soldiers over there now, and those private contractors make ten times as much.
Does anyone scream "socialism" or Taxed Enough Already when it comes to the DOD?
What is more beneficial for the American people? Universal health care as a part of being citizens in this country, or a trillion dollars a year on Defense we'll never use?
Again, Americans are beyond stupid.
September 7, 2009 1:32 AM | Reply | Permalink
The way I see it, and admittedly I'm a novist, if I were Obama I would announce that, the next day, I would be signing a temporary emergency executive order allowing Medicare to sell insurance to people who have none at cost.
The order will last until health reform legislation ends up on his desk.
I call this "medicare-for-sale."
There's lots of issues behind this. Like, can he do that?
Well, according to the constitution, probably not.
But according to the doctrine of the Unitary executive, you can do whatever you can get away with and that no one can stop.
It's revenue neutral, so it doesn't need legislative action.
There's a democratic legislature that's not going to pass legislation that stops him.
The supreme court won't hear what it calls 'political questions."
The day after he signs this, millions of people will be lining up for medicare-for-sale.
Let Republicans stand up and attempt to deny people something that they already have.
Actually, if I were Obama I would have done this the day after I signed the recovery bill (which would have been four times larger if I had signed it.)
Instead of dragging their feet, the Republicans would be pushing hard to get a bill passed.
September 7, 2009 2:52 AM | Reply | Permalink
An easier way of dealing with the socialism question is to point out that all forms of insurance are a form of socialism.
In fact, insurance is the argument that, in some cases, socialism is a good idea. Not all, but some.
I pay my car insurance. You have an accident. Some of my money goes into paying for your car getting fixed: or as Marx said, "from each according to their surpluss to each according to their need."
Insurance is just socialism using another term.
September 7, 2009 2:56 AM | Reply | Permalink
This. Exactly this. If by "socialism" they mean "distributing risk amongst member/subscribers" then yes. The real issue is that the insurance companies, the ones who are supposed to be assuming this risk, instead spread it out to the few cherry-picked insurees they select. If they don't assume any risk, what purpose to they serve? And if they serve no real purpose, why prop them up?
September 7, 2009 6:55 AM | Reply | Permalink
Thank you! Thank you! Thank you! I make that same argument to my friends and co-workers all the time. Hey, you love free market capitalism, 100% of the time, PAY YOUR OWN FRIGG'N BILL. ALL OF IT!
September 7, 2009 7:10 AM | Reply | Permalink
But if you have a history of getting into accidents and drive recklessly, your car insurance rates will be higher. Would you support higher medical insurance rates for risky behavior like smoking, obesity, skydiving, sedentary lifestyles, etc.?
September 7, 2009 2:49 PM | Reply | Permalink
Yes . . .
If those higher insurance rates only apply to you.
~OGD~
September 8, 2009 9:04 AM | Reply | Permalink
We are watching the media takeing a look at the President for the first time. Van Jones is a professional racist, as is a lot of the Washington DC elite, we look past what they say and do and hope for the best. Why does Larry King continue the Jackson funeral when Van Jones is being exposed for being what is common in todays Whitehouse and most other liberal news outlets.
September 7, 2009 1:42 AM | Reply | Permalink
Van Jones isn't a racist. But you are. Your signature picture is of a black man in white face. Think about it.
September 7, 2009 2:16 AM | Reply | Permalink
hawaiian,
come on, fess up, you're really Glenn Beck, right?
September 7, 2009 7:25 AM | Reply | Permalink
Which "liberal news outlets" are you talking about, exactly?
September 7, 2009 2:16 AM | Reply | Permalink
Better question: Anybody here who thinks Obama isn't selling us down the river, please stand up.
Anybody?
Hello?
~crickets...~
September 7, 2009 5:50 AM | Reply | Permalink
I'll stand up in a second. The idea that Obama is "selling us down the river" is the worst kind of defeatism and exactly what is going to result in power reverting to the Repubs so they can trash the country for another eight years or so.
Obama could easily have put the whole health care thing on hold, claiming he has to deal with the economic crisis first. Instead, he has moved this issue farther than it has ever gotten under seveal past presidents (most of whom weren't dealing with an economic crisis of anywhere close to the same magnitude).
You're attitude assumes that Obama could just pull a switch and give us a highly progressive new health care system if he wanted to, but has decided to "sell us down the river" instead. Horseshit! He is dealing with a broken political system in which it is much easier to block change than to make change happen. He is trying to get something meaningful to build on, which would be a huge leap forward over anything that has happened before.
Naysayers like you are the ones who are going to trash it all and turn the country back over to the dark side.
September 7, 2009 7:39 AM | Reply | Permalink
If he didn't have the time and if he wasn't willing to risk the political capital to push for a good bill, he should have put it on hold.
A bad bill is worse than no bill. This issue is not about Obama and I don't care if it costs him reelection. This issue is something people have been working on for decades. He doesn't have the right to screw it up.
September 7, 2009 11:31 AM | Reply | Permalink
Capitalism, baby, Capitalism.
September 7, 2009 8:07 AM | Reply | Permalink
ISRAEL has 100% HEALTHCARE, free at the point of demand for everyone. Hospitals, drugs, consultants, everything.
The Israeli economy can afford this universal healthcare for all its citizens because it receives $3billion dollars every year under an aid plan signed by Bush before he disappeared.
How come that country can afford healthcare for every one of its citizens and 40 million Americans have nothing!
PROPOSAL: STOP ALL AID TO BOTH ISRAEL (and EGYPT for keeping the Rafah Crossing closed) AND GIVE THOSE ESTIMATED 5 BILLION DOLLARS SAVED EACH YEAR TO THOSE 15% OF AMERICANS WHO HAVE NO HEALTHCARE.
September 7, 2009 8:58 AM | Reply | Permalink
I love the idea of opening up Medicare (or the Government workers health plan or the VA) to every citizen at cost. Revenue neutral and instant coverage at cheaper than the private market rates. Why can't a politician come forward with such an elegantly simple solution?
September 7, 2009 9:43 AM | Reply | Permalink
By far the simplest and easiest method for getting the health care for all program underway is to start with Medicare and expand it. An act as simple as making those 60 and older, or 16 and under eligible for Medicare would do it. Then, move the upper age bracket down by 5 years every 2 years and soon we have universal health care.
The cost side would still need work, but with everyone under Medicare, that would be relatively easy, with many routes to follow.
In fact, that, in my opinion, is exactly what Obama should propose tomorrow.
Don't be put off by the fact that it would take several years before everyone would be covered. All of the proposed bills require several years to fully take effect.
September 7, 2009 10:44 AM | Reply | Permalink
Expanding Medicare isn't the solution to the escalating cost problem. It can be a solution for those currently uninsured, but that is only part of the stated goalsof the President. In fact, cost control has been the most commonly cited reason for proposing health care reform. Medicare costs are also increasing at an unsustainable rate. See: http://prescriptions.blogs.nytimes.com/2009/08/30/looking-ahead-runaway-health-costs/
The administration needs to address the sources for cost increases, even if that means difficult and unpopular decisions, if they are to be taken seriously by the large number of people who are concerned about an increase in government programs without any mechanism for reducing costs.
September 7, 2009 2:30 PM | Reply | Permalink
Big Bill Haywood, leader of the Western Federation of Miners,
In December 1911, Haywood told a Lower East Side audience at New York's Cooper Union that parliamentary Socialists were "step-at-a-time people whose every step is just a little shorter than the preceding step”
A contract without, a time period for performance, is useless.
Of course TORT reform was and has always been the objective.
Remember the Europeans’ TRADE with the Native Americans? Trading worthless trinkets, for the acquisition of Manhattan. Somebody got ripped off.
Seems the trait of taking advantage of others, is still prevalent today.
Only I'm not interested in trading away something of value; the right to recover damages for injury, for worthless trinkets of watered down Healthcare reform.
Tort reform for Healthcare reform is a bad deal for the Natives.
September 7, 2009 10:48 AM | Reply | Permalink
The solution is so simple: Either (a) run time backwards; or (b) turn the charts upside down.
September 7, 2009 12:16 PM | Reply | Permalink
In addition to asking who feels our system is working, it would be extremely helpful to pose the question: what actual goods or services are the insurers providing? I regularly pass a Blue Cross / Blue Shield campus in Minnesota that is one of the largest and best kept facilities in the entire state---with many buildings and thousands of employees. As a self employed businessman, BC/BS is my carrier, and I am often prompted to wonder how much of my insurance dollar goes to the people and facilities in that beautiful campus, and how much goes to my actual medical care. On the other side of town is the headquarters of United Health care, who cover's my wife. Again, beautiful huge campus, with many hundreds of employees and a CEO who reportedly cleared over $6million in compensation last year. What do these (and the other many similar insurance providers) actually contribute to our national health care system?
September 7, 2009 7:09 PM | Reply | Permalink
You (or your wife's employer) could always go self-insured and handle the paperwork, compliance reporting, claims administration, in-network doctor and rate negotiations and pay the bills directly on behalf of you and your employees. Also, you will want to make sure you have sufficient capital to pay claims if they exceed your short term cash flows. If you have employees, you will probably want to hire a lawyer or two to deal with disputes between what procedures you think you cover and what procedures your employees think you cover. Or, you could just source these activities to United Healthcare or Blue Cross.
September 7, 2009 7:21 PM | Reply | Permalink
Well spoken . . .
That is, well spoken for a corporate insurance industry shill...
~OGD~
September 8, 2009 9:31 AM | Reply | Permalink
I'm no advocate for the insurance companies. A question was asked and I attempted to answer. I don't claim any of the activities they perform add any value to our health care system.
September 8, 2009 6:55 PM | Reply | Permalink
You left out the middleman CEO for injecting himself into the process.
It's one thing to have have expenses incurred for the time involved, but come on GET REAL! Do we really need a CEO to get paid millions?
Because I can assure you the cost of CEO's are driving up the cost of healthcare needlessly.
How do we reign in these costs, when even the stockholders can't?
http://www.companypay.com/
September 8, 2009 1:43 PM | Reply | Permalink