Republicans have unveiled their long-awaited alternative to the Democratic health reform proposal. It an amendment in the nature of a substitute with the short title: "Common Sense Health Care Reform and Affordability Act". The 219 page amendment is available here  (pdf).

The bill does all those republican things like Association Health Plans, high risk pools, bigger and better health savings accounts, medical liability reform, and my personal favorite - the "Enable Insurers to Ripoff Out-of-State Customers" provision they refer to as selling health insurance across state lines.

I have commented on the many problems that out of state sale of current health insurance products may engender. One of the most pernicious is that a company advertising cheap rates in their home state will be allowed to sell coverage where they have no provider network. Nothing in the Republican proposal even mandates the existence of a provider network. So, think about what happens when you get sick or injured and have to use your insurance.

Here's what is going to happen. Since there is no provider network, all of the providers are going to charge you their "usual and customary" fee rather than the much lower fees they accept under the terms of their network contracts. Moreover, uncontracted providers are under no obligation to write off differences between the insurer's allowable and their usual and customary fees. For example, last spring I was hospitalized for pneumonia. It was a lovely 10-day stay with a price tag of $63,846.38 based on the usual and customary rate schedule the hospital and doctors use. But since I was protected by a contract between the insurance company and my hospital and doctors, the negotiated fee schedule brought the whole cost down to $6,932.15.  If I had bought out-of-state insurance with no local provider network,  I would be on the hook for an extra $56,914.23. Of course, I could have gone to the insurers primary state where there is an established provider network, but I needed an Emergency Room and a few days in the ICU. It wasn't like I could go shopping, much less traveling.

There is probably much more to hate in the Republican bill, and it might be useful for TPM readers to pick it apart. Their new rhetoric is probably going to be all about their great plan that the Dems won't pay any attention to.  

Watching C-SPAN 2 and McCain comes out swing against Scalia as a judicial activist.

I have watched all of the town hall meetings on health care/insurance reforms available on C-SPAN. One of the issue that comes up, especially during Republican town hall meetings, is a proposal to allow sale of health insurance products across state lines. Proponents, like Michelle Bachman of MN, believe that such interstate sales, allowing the current stable of some 1800 health plans to sell their product nationwide, will significantly increase competition and thus lower costs according to free market principles. When I have heard this issue arise during town halls, it is soundly applauded by the conservative crowds. Why not?  It's so simple! This is an idea any idiot can understand.

And therein lies the problem.

This concept relies on some very significant, yet highly dubious assumptions. Paramount among these is the assumption that a substantial proportion of those 1800 insurance issuers will incur the considerable expense required to contract with physicians, hospitals and ancillary facilities nationwide. Will this will occur to any meaningful extent? Or will those who purchase coverage out-of-state find few if any practitioners to treat them? Proponents of this idea seem to disregard the unique function of health insurance as an intermediary, where contracts with providers are no less important than their contracts with subscribers.

I am comfortably retired, but if I were still in practice I would accept patients with Medicare, Tricare and four or five different private plans. However, each plan has its own requirements for submitting bills, coding nuances, and other varying restrictions such as the intrusive pre-approval processes unique among the private insurers. As more plans are added, more support personnel become necessary and administrative costs begin to skyrocket. Knowing this, I would not allow my practice to participate in any plan that did not have substantial market penetration in my local area.  

Of course, if insurers are willing to just pay the usual and customary fees, as dictated by physicians, hospitals, and ancillary service providers, rather than a negotiated rate schedule, that would work for the subscribers and provides, but it would be prohibitively expensive for the insurer. Such a system would most certainly be counter productive to the issue of cost containment. More likely, patients will be forced to act as intermediaries between the doctor and the insurer. Doctors will bill usual and customary fees that patients will be obligated to pay. Patients will make claims to their out of state insurance company, and they will receive a check for the insurance allowable minus deductible and co-insurance. I was recently hospitalized for pneumonia. My hospital bill at the usual and customary fees for services came out to $67,000. The negotiated rates brought the bill down to just over $6800. My cost was $500 - a $100 per day co-pay for the first 5 days in hospital. Under this proposal, I could be on the hook for more than $60,000! 

If this proposal were to pass, conscientious physicians would advise their patients to stay with their current plans or risk losing their current health care arrangements. Wise patients will understand that and eschew cheap insurance from remote companies operating in an unregulated environment beyond state control.

Under this proposal, the state insurance regulators will be handcuffed and there will be no regulatory framework to protect consumers. Without regulation there will be abuse (see AIG), and once the abuses become rampant, as surely they will, a massive new federal regulatory regimen will have to be enacted. By then it will be too late to undo the damage. This isn't just a bad idea, it's a profoundly stupid one, an idea only an idiot could love!

Remember all that missing Cash in Iraq? $12 Billion on innumerable pallets of crisp new $100 bills in nice shrink wrapped bundles weighing a whopping 363 Tons.

Remember all those adjectives? Astounding. Staggering. Incomprehensible. All that cash flushed down the Iraqi toilet.

Well the new toilet is Wall Street and the new amount is $700 Billion.

That's 21,175 Tons of $100 Bills!
That's 42,350,000 Pounds of $100 Bills!!
That's over 622 Truck and Trailer Loads of $100 Bills!!!

That's . . . . .

Words fail.

Nearly 9 years ago, on the eve of passing the Gramm-Leach-Bliley Act, the now infamous legislation that paved the way for today’s financial mess, Rep. John Dingell got it right.

“[This bill] fails to recognize that human nature has not changed.  It also fails to recognize something else. The technology that has changed has made it much easier to take money from the innocent and from the unsuspecting. It relaxes protection for investors, taxpayers, depositors, and consumers.

Let us talk about what is wrong with the legislation…Woe to the American people when they have to pick up the tag for one of the failures that is going to occur when competition disappears and prices shoot up and misbehavior or unwise behavior takes place…

I think we ought to look at what we are doing here tonight. We are passing a bill which is going to have very little consideration, written in the dark of night, without any real awareness on the part of most of what it contains.  I just want to remind my colleagues about what happened the last time the Committee on Banking brought a bill on the floor which deregulated the savings and loans. It wound up imposing upon the taxpayers of this Nation about a $500 billion liability. That is what it cost to clean up that mess. Now, at the same time, the banks by engaging in questionable practices wound up in a situation where the Fed and the Treasury Department had to bail them out also at the taxpayers’ expense.  But it did not show.  Having said that, what we are creating now is a group of institutions which are too big to fail.

Not only are they going to be big banks, but they are going to be big everything, because they are going to be in securities and insurance, in issuance of stocks and bonds and underwriting, and they are also going to be in banks.  And under this legislation, the whole of the regulatory structure is so obfuscated and so confused that liability in one area is going to fall over into liability in the next. Taxpayers are going to be called upon to cure the failures we are creating tonight, and it is going to cost a lot of money, and it is coming. Just be prepared for those events.

You are going to find that they are too big to fail, so the Fed is going to be in and other Federal agencies are going to be in to bail them out. Just expect that.”

 - Rep. John Dingell, 1999

From Jim Slattery's Blog for Kansas

Speaker Nancy Pelosi
United States House of Representatives
Washington, DC
Fax: 1 202 225-4188

Dear Speaker Pelosi:

I am a disabled physician. During the years I practiced medicine, I devoted myself to serving predominately low income working people, the elderly and the indigent who sought care at the University Medical Centers in Virginia and Kansas. I also served our veterans working with the Veterans Administration health system. I never pursued the financial rewards of private practice because I have always been relatively frugal and my want and need levels, with those of my family, have never been great. Service was always the paramount focus.

My disability arose from contracting a life-threatening, chronic infectious disease from one of my patients. After I was forced from practice by failing health, my family’s income was sustained only by virtue of the investments I had made in equities during my career. Now, many of those equities have been markedly deflated in value, and my family’s economic future is very uncertain. My son has just started college, and our savings for that have also been deflated.

This has all come about as a result of your failure in Congress to protect citizens from the machinations of Wall Street, even in the face of history and so many warnings from thoughtful economists and thoughtful members of the House and Senate. Now you ask me and every other American to absorb the cost of bailing out those whose malfeasance brought us to this disastrous moment.  But I have already paid my part in the form of market losses. Why should I have to pay twice?

I have 11,000 shares of virtually worthless Fannie Mae (FNM).  A year ago FNM was paying a quarterly dividend of $0.50 per share and had a share price that hovered around $60.00. The last dividend, in August, was $0.05 and there will probably be no more. I can’t sell the stock as there is no real market for it. It closed yesterday for $1.66 -- less than 2.8 cents on the dollar.

I think that if the Government of the United States is going to bail out anyone, I should be near the front of the line. I would like you to buy out my nearly worthless portfolio at 40 or 50 cents on the dollar against my cost basis. The cost to the government would only be $350,000, a mere one-half of one-millionth part of the $700 Billion in largess your are intending for the Wall Street moguls whom you allowed to screw the American people out of their retirement assets.  It is only fair, and I will not require any tax breaks to go along with the refund. Just give me my money back and I’ll pay my taxes as I always have -- without complaint.

Sincerely.

If Barack Obama has common ground with John McCain on a few details of their differing policy positions, what he should make clear to the audience is not that McCain is "absolutely right" about it, but rather that Obama himself believes and has said thus and so, and that he is "pleased that Senator McCain agrees with me on that point."

In the silly season, framing is everything.

This ad appears randomly on Yahoo! Finance's Market Overview. (I have a screen shot but I'm clueless how to post it here). The ad reads:

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Granted, I would invest differently depending on who is elected, but in my view it is McCain and his recklessness coupled with his economic stupidity and reliance on cronies that concerns me. I'm worried about McCain-proofing my portfolio.

Motley Fool's editors IMHO are casting unwarranted aspersions on Obama. For average investors, I think markets have generally performed better under Democratic administrations. Motley Fool's whole thesis here is bogus. Pisses me off.

Their e-mail: member help@fool.com

NEDRA PICKLER, Associated Press Writer, reports:

Both McCain and Obama had returned to Washington on Thursday at the urging of President Bush, who invited them to a meeting with congressional leaders at the White House. But a session aimed at showing unity in resolving the financial crisis broke up with conflicts in plain view. McCain would not commit to supporting a plan worked out by congressional negotiators, said people from both parties who were briefed on the exchange.

Would it be that hard to say that it was McCain who requested the president to hold the White House meeting? It's the truth and it certainly adds a whole other dimension to the story.

Lies of omission are still lies where I come from.

Palin to Katie: "When you consider national security issues with Russia, as Putin rears his head and comes into the airspace of the United States of America, where do they go? It's Alaska. It's right over the border."

This is true as long as the earth is flat.

But in the real world the earth is an oblate spheroid and, except for flights from Vladivostok to the US west coast, which may cross a part of the Aleutian Island chain, Flights from Russia to the US follow west-bound great circles that take them over the North Atlantic, this is even true for flights from Moscow to Anchorage Alaska.

Here's a fun toy: http://gc.kls2.com/ 

Republican Navraj Singh, who is running against Brad Sherman for the CA 27th District seems to be conducting a stealth campaign of posts on TPM today attacking his opponent. Singh doesn't mention in his posts that he is the candidate opposing Sherman. I guess he's too cheap to buy real attack ads and put them on the teevee, when he can post them here for free.  

If the Republican challengers can't take time out from their emergency work on the economy, how about getting Bob Barr to stand in and debate the Libertarian party position? I am sure Mr. Barr could appeal to a great many Republican voters, and the nation could have a substantive debate of the issues.

"I want oversight," the snake oil salesman says. "I welcome oversight."

That's why he proposed:

"Decisions by the Secretary pursuant to the authority of this Act are non-reviewable and committed to agency discretion, and may not be reviewed by any court of law or any administrative agency." 

What a lying a$$hole!

Ascaris lumbricoides (intestinal roundworms of humans and pigs) is an interesting animal model of Republican parasitism.

Ascaris lumbricoides [...] is one of the largest and most common parasites found in humans. The adult females of this species can measure up to 18 inches long (males are generally shorter), and it is estimated that 25% of the world's population is infected with this nematode.

The Republican parasite is similar, but that malady seems to infect a slightly larger fraction of society - about 30-35%. The males of this species of parasite are also often on the short side.

The adult worms live in the small intestine and eggs are passed in the feces. A single female can produce up to 200,000 eggs each day! About two weeks after passage in the feces the eggs contain an infective larval or juvenile stage, and humans are infected when they ingest such infective eggs.

Adult Republicans also spew out about 200,000 lies each day, and those who swallow them are at extreme risk of infection.

The eggs hatch in the small intestine, the juvenile penetrates the small intestine and enters the circulatory system, and eventually the juvenile worm enters the lungs. In the lungs the juvenile worm leaves the circulatory system and enters the air passages of the lungs. The juvenile worm then migrates up the air passages into the pharynx where it is swallowed, and once in the small intestine the juvenile grows into an adult worm.

Yuk! Why do we keep swallowing it. Spit it out!

Why Ascaris undergoes such a migration through the body to only end up where it started is unknown.

Republican parasites also make circuitous journeys through policy causing a great deal of pain and harm as they do.

Ascaris infections in humans can cause significant pathology. The migration of the larvae through the lungs causes the blood vessels of the lungs to hemorrhage, and there is an inflammatory response accompanied by edema. The resulting accumulation of fluids in the lungs results in "ascaris pneumonia," and this can be fatal.

Republican parasites migrate into the halls of power inflaming the economy with swelling debt and causing widespread hemorrhage of our resources. This, too, can be fatal.

The large size of the adult worms also presents problems, especially if the worms physically block the gastrointestinal tract. Ascaris is notorious for its reputation to migrate within the small intestine, and when a large worm begins to migrate there is not much that can stop it. Instances have been reported in which Ascaris have migrated into and blocked the bile or pancreatic duct or in which the worms have penetrated the small intestine resulting in acute (and fatal) peritonitis.

Republican worms (especially the larger ones) are always obstructing something which is why the body politic has become so ill.

Ascaris seems to be especially sensitive to anesthetics, and numerous cases have been documented where patients in surgical recovery rooms have had worms migrate from the small intestine, through the stomach, and out the patient's nose or mouth.

As we now witness in Republican John McCainworm and Republican Sarah Palinworm.

When I heard Barbie of the North guess that the Bush Doctrine was "his worldview" I thought she was just dumb.

I had no idea that "worldview" was one of those christofascist code words that the wingnuts so enjoy using, until I stumbled upon this.

Scary!

http://slacktivist.typepad.com/slacktivist/