Was listening to Coburn speak on the Senate Floor tonight, and as always he gave a very earnest and compelling speech, arguing that we need to fix the problems with health care and leave alone the parts that function better than anywhere else.  And it's hard to argue with that.  Then he delved into tort reform, and really, it's hard to argue with wanting doctors NOT to practice defensive medicine, where the fear of lawsuits leads to too many tests and specialist examinations.

But the problems with Senator (and Doctor) Coburn's speech is that he offered no solutions, and that's the root of the problem.  We have a system that doesn't work well, is very costly, and getting worse, not better, by the day.

What Democrats are proposing is a new system, and there's good reason to fear a new system: we have had it up to our ears with private health care; what if the Democrats plan ends up making healthcare worse?  What if the special interests have succeeded in drafting legislation that benefits them, doesn't fix the problem, and makes our lives worse, and charges more?  I understand why people might feel that way. 

That's why I really, really wish Republicans had made a different strategic decision regarding healthcare: the country WANTED them to be involved, and I mean that.  We needed to make healthcare operate efficiently   according to the principles of insurance: spread the risk and spread the cost - the maximum participants the larger the efficiency of scale the lower the costs.  I believe this is what we all want, regardless of party: reliable, efficient, universal  healthcare that's as affordable as possible without compromising the benefits of the existing system.

It's a shame that they failed to see the potential rewards of a sincere effort and a real accomplishment: the lifting of the burden that healthcare in america is today for individuals, corporations, and the overall emotional and financial health, ironically, of the entire country.  Even amoung the insured, how many people lose sleep arguing over coverage with their insurance company?  How many bills (that should be covered) are paid by a family's savings, rather than their insurance company?  The people who work a 2nd rate job just for the benefits because the cost for large businesses are smaller than for small businesses or entrepreneurs so they can't take the risk of starting their own business or working for a smaller company? And that doesn't count the uninsured who live in fear of getting hurt, or those who have already had to declare bankruptcy and/or lose their home.

Our capitalist system functions most smoothly when capacity exactly meets demand, but that's not the case now, and healthcare is one of the disruptive factors that makes our economy less efficient, and massively so. When thinking about a job, Americans have to take into account whether the employer can provide healthcare, and so long as that's a consideration healthcare is an eddy, a counterproductive force on our economy.  If the humanitarian arguments don't hit the mark the economic ones should.

So I'm sure Republicans see the need to fix the system, and maybe someone has thought about producing some legislation, REAL, CBO scored legislation as a counter-offer to the Democratic plan.  If Democrats tried to block this from being debated the Republicans could raise holy hell in the media and I'm 100% sure they would get heard. 

And what would that get us?  A debate between the 2 plans, with neither able to pass until it got the majority so with any luck at all there would be a meeting of the minds on some of the important issues and perhaps economists or healthcare experts or patients or doctors would be brought in to settle the debate.  Anyway, that's what we needed - for the Republicans to step up and offer a real, REAL plan to compliment or even fix the flaws of the Democratic plan, large or small. 

Instead all we get are the same non-arguments: intrastate regulation, tort reform (which would cap awards without considering the specifics of the case, which is why that's never passed), and really that's all I can think of.  The usual lies and distortions (hello death panels) and teapartiers, etc. 

For a while the Republicans claimed they had a plan: the Ryan plan.  However, as an example, it dealt with the uninsured by allowing states to pool together and decide what to do about the uninsured. That's not even a plan.  It can't be scored for cost so it's basically one question: if we allow states to pool insurance, how much would that lower healthcare costs?  Also, the Ryan plan includes this gem: "Integrating low‐income families with dependent children into higher‐quality private plans through direct assistance".  So one of the features of the REPUBLICAN plan would be to pay for PRIVATE insurance for medicare recipients.  Unbelievable.  So it's a little disingenuous for them to cry about how the Democrats are going to raise taxes when they were perfectly happy with yet another unfunded mandate.

So my take on this whole affair is this: I think many democrats have put down a good faith effort to fix the broken healthcare system.  Republicans have not offered any solutions, and they will try to convince every Republican and some Democrats that it's better to stay with what we know - endlessly - unaffordable as it is for everyone - than to start down the road of trying to legislate a solution to a problem the private sector refuses to acknowledge, never mind fix.  And we all know how well that works out; we are living through the financial services version of that same plan.

Preface: The root of the problem is there is no real competition by insurance companies. Try to purchase insurance as an individual or small business - it's a nightmare. You can't see the rates, you can't understand the plans, and you never know for sure exactly what's covered. Also, mandatory straight off: no denial of coverage.

So I propose a few things: 


 a: the fed create standards by which all policies must conform. This could be done by the new consumer protection board that will also regulate credit cards and mortgages, or an independent entity. This would ensure consumers that they will be receiving high quality insurance. It would also require companies to hew to coverage guidelines (no exceptions). A complaint system, outside the courts, would deal with any charges of malfeasance. There should be no such thing as "underinsured" anymore. It would be as simple as accredited or not, and a not rating would mean you can't provide health insurance. 


 b: no more variable rates depending on your employer's negotiating power, etc. Companies would have to offer one rate, state-wide, regardless of whether the person is employed by a corporation or is purchasing the plan as an individual (I'm not suggesting one rate for all companies, just that each company decide on a rate, publish it, and allow consumers/employees to decide if that's a rate they want to pay or to purchase their insurance from someone else). 


 c: electronic, industry-wide standardized records. State to state, doctor to doctor, hospital to hospital, etc. This would accomplish not only better care, but a LOG of care, so any denial of care would be easy to reference, PLUS no more going to innumerable redundant xrays, blood tests, etc. 




 d: each state must set up (or pay the feds to set up for them if done improperly) a website listing the plans offered by insurance companies and the rates, along with clear explainations of deductibles. If you've seen a mortgage rate chart where they list the rates along with points, it could be done that easily. 


 e: create anti-trust provisions that determine what a competitive market is. If a state only has a few (or worse, a couple) of insurance companies the state MUST find a way to make the market more competitive or lose federal medicare dollars. 


 f: all health insurance payments (not including copayments) must be tax free. If employees get their health care tax free, everyone should, especially since as an individual you get no corporate benefits department to help or any other perks. OR, to prevent the overcharging of so-called "cadillac plans" make it tax free UP TO the average cost of health care in a state - if you want a plan that costs more, that portion of the cost is taxable to corporations and individuals. 


 g: I believe insurance companies should provide malpractice insurance. This would ensure the doctors in their networks are high quality, and the company would then have superior rate negotiating power with the malpractice insurance companies to lower rates, since they would have pools of doctors rather than each doctor paying individually. 


 h: coverage would be mandatory. For lower income people the fed could issue cards, similar to the cards used for food stamps, that carry a balance for what the lowest cost insurance available is, and that card could be used for payment. This would be better than a tax break since low income people may not have the capital available to sustain coverage until tax refunds are issued. 

 ---

I believe if insurance companies were truly competing for our business our capitalist model would work, but the current system is not competitive at all - it's a racket, and insurance companies have been gouging consumers and companies the same way the financial sector misbehaved and made immense profits at the expense of all of us. With real, meaningful oversight and competition the health sector could be vibrant as companies tried to lower costs by offering competing models for prevention, overall health, and better, more concerned care for consumers. 
I would say compare the cellphone industry to the cable tv providers. Where I live there are many cellular phone providers who compete vociferously with new products, new pricing, etc, while the cable companies have been raising prices (in NYC there are effectively 2 cable companies - time warner and cablevision - they even share a website and have identical pricing. The only other providers are dish network which is useless to most residents because building owners don't allow dishes on the roof. Comcast, Verizon, etc. aren't even in the market here). So the cellphone rates go down, service gets better, and people choose who they like best based on cost and services, while there is literally no choice for cable, and the costs go up and service gets worse (the notable exception is internet service which both companies offer - there is competition in that market and the service is great, but since it's tied to cable tv you get gouged on price anyway).


 The KEY though is to maintain standards - companies could lower rates by being more efficient, cutting administrative costs, reducing paper-pushers through electronic records, etc., but NOT through denial of service. Otherwise the patient, once again, will be the one paying the price.

Maybe the Republicans are right, and it will cost that much - but I doubt it.  The main problem I have with their approach is that they have no approach at all.  Gingrich said we need to create a bill with "incentives" rather than cap and trade.  In the context of legislation, what is an incentive?  It's a tax break.  And if you give a tax break to energy producers, who ends up paying the difference?  The taxpayers.  So it's the same thing, and it will add to the budget deficit which our new deficit hawks will cry about...

I propose a gas tax where the revenue is dedicated to reducing overall oil consumption.  Houses, industry, road construction (asphalt) all use a lot of oil, and if the income from the tax was dedicated to switching to alternative energy use, we would incite demand destruction two ways: the tax would discourage excessive driving, and the revenue would reduce demand.  This might help keep oil prices modest, starve the oil-producing dictators of their prized revenue, and clean the environment in one fell swoop... As of now I believe federal gas taxes are dedicated to maintaining the interstate highway system, and that's not exactly the incentive that helps...

Lastly, wasn't cap and trade preferred by republicans over government regulation just a few years ago?  I thought that was the "market answer".  Or maybe they only meant Enron...

I was struck watching Boehner (yeah, we're on a last name basis) on Lehrer news hour say that Obama wants to move the country in a different direction, and the american people will get a chance to decide if that's the right move.  The thing is, that already happened: it's what brought the admninstration to power, that's why he won the election!  The critics can say what they like about Obama's administration, but one would be hard-pressed to say he hasn't tried to accomplish EXACTLY what he said he would.  Earth to Boehner - America already voted for that direction; your duty to your constituents is to try to find a way to make his direction consistant with your principles.  It is not to recommend that the President try things your way - we've been doing that since '96, and it was THAT record that got Obama and the democratic congress (just as importantly) elected this year and 2 years ago.  He also said that's what he came to washington to fight - big government, higher taxes, etc.  But while he was fighiting for more deregulation and lower corporate taxes

Also after reading the MIT scientists letter today I found it interesting that he had the opportunity to float his spun numbers but didn't this time when the conversation moved to the "energy tax".

Lastly, he worries about the debt that's being left to future generations.  I agree totally that the administration and Pelosi et.al. are shovelling nonsense when they claim they will cut the deficit in half (first you expand it to twice as big as usual and then cut THAT in half - very different than cutting to 1/2 the average of say the last 8 years), but my question is this: how does cutting taxes solve the demand problem, especially when you cut them primarily for the wealthy?  How many businesses would be looking to expand in this market just because they have an extra 50-100k lying around?  Almost none.  I am an independent contractor (real estate) - if the government cut my taxes 15% would I use that money to invest in a storefront when rents are falling?  No.  Would I hire employees when I have no idea what economic landscape will be in the next 6 months?  No. 

Anyway, I could go on and on but I'll leave it there for now...

I'm just wondering where the giant pool of people who understand the complexities of the financial system but don't have ties to said same system are?

With all due respect to Mr. Krugman, for years the entire financial industry has been schooling itself on how to tilt the table so the ball always rolls into their pocket, and what we are fighting here is not an entitlement mentality but institutionalized corruption. Before the crash is was private industry corruption (the liar loans, the ratings game, the reductions in capital gains taxes and hedge fund fee system) and now it's been nationalized. Did you think the corruption would disappear because the government owns 80%?

For years the financial industry was the drug dealer and the government was the bodega owner who laundered the profits. Now it's both, and it has 80 years of systemization to undo and it won't happen overnight. This scandal will follow others until the system re-writes itself into an earnest business rather than a corrupt one.

I, for one, agree with Taleb that banks should only be allowed to operate as banks, and should not be permitted to play with other people's money, and there are any number of smaller banks around the country who can say that that model works fine, since there are many banks that operated using traditional guidelines that are still healthy. The problems always seem to arise when banks start trying to make ever-higher profits rather than making ever-better performing loans.

Never mind 165 million in bonuses, wait till the public finds out how much wall street tarp recipients have spent on lobbying congress NOT to change the rules so they can keep their defunct and debunked business model the way it is....

Best I can tell the Republican Congress of the last 8-12 years had a lot to do with the deregulation that led to this mess. 

And they ran the country into the ground with unwise spending sprees creating massive debt

Sounds a lot like the accusations against the big 3.

But of course the big 3 greased up republicans to fight the CAFE standards - and if they had embraced the CAFE standards and started building efficient cars 10 years ago they wouldn't have suffered such huge losses when americans stopped buying SUV's.

SUV'S  were too expensive due to gas prices which were run up because speculators knew the financial system was in danger and were looking for a new way to manipulate markets and make a huge profit.

So the wall street brokers who broke the credit markets, inflated and then destroyed the housing market, speculated wildly on oil (and other commodities) once the stock market started diving driving oil prices through the roof, THOSE wall street brokers got a bailout. 

But not the auto companies, becuase they need to take responsibilty for their poor choices while nobody else does.....

These LAME DUCK republicans should realize the reason voters chose to vote them out was because of votes like this, and their complicity in the the creation of the un and under regulated shadow banking system that destroyed the economy...

Ach, seems a little hypocritical to me - your state receives over 100 billion in reconstruction aid from the gov't but you can't spring 14 billion to save 250k-1 million jobs for the automakers?

With the big 3 we MIGHT be pouring money down the drain, with Louisiana we spent the money to REBUILD WHAT WAS THERE BEFORE more or less, so that's definitely money down the drain.

On a related note, how on earth did Louisiana vote republican in this election?  Didn't they learn their lesson?  Wow...

I hope big business has noticed that the republican party, which it worked so hard to elect, is letting it bleed to death through a combination of gross incompetence and blind adherence to the philosophy of "free markets" that are free of "government interference".

Big business is unfortunately reaping what it sowed.  It has sponsored the ascension of a philosophy that dictates the government do nothing to interfere with business, thinking it would help them avoid regulation and taxation, but what it also got is a philosophy that denies the government itself bears any responsibility for the collapse of the economy, and does not have a responsibility to help fix the problem it helped create. 

It seems to be pretty well accepted that keeping interest rates too low led to a flood of cheap and easy credit, and that the SEC and others didn't keep companies leveraged at a reasonable level.  Greenspan refused to regulate CDS's, and congress deregulated investment banks (see Gramm; Phil). These seem to be the fundamental sources of all that followed: the failure of credit ratings companies, the insane asset bubble fueled by mortgages with virtually no underwriting standards in the pursuit of ever higher returns, balance sheets that were levered 30:1 rather than 12:1.  If indeed the root of the problem was federal inaction or irresponsibility, should the government not share in the costs of fixing it? 

The final perversity is that as the economy weakens and citizens become more vulnerable to severe problems, the government will be less able to help, because it will not have the revenue to do so, especially considering the debt we racked up under republican leadership.  And the less the government is able to help, the worse it will get, etc.  So it's impossible to say you are acting on behalf of your constituents when your inaction guarantees that you will do less for them, and the business community (through jobs, charity, etc.) will be unable to help either.

State and city governments are now being criticized for spending beyond their means, and many of them did.  But when people lose jobs, they stop paying state, local and federal taxes, so the local governments will have to raise taxes or cut services, and the state and federal governments will have to cut spending  - unless they use more deficit spending to finance the programs they needs to help their citizens deal with the sudden loss of income from their jobs. 

So if you loan the automakers 25 billion dollars, you know you have loaned them that amount.  If the industries collapse, and the government needs to finance itself through increased deficit spending, are you willing to bet, to even state publicly anywhere, that you think we will borrow only $25 billion?

So republicans have a message for big business, and Americans everywhere: Drop Dead

I don't see how congress can let the big 3 fail and go into chapter 11 when a: chapter 11 has been resulting in chapter 7 for a lot of firms because they don't have access to the credit they need to get back on their feet and end up getting liquidated and b: all automakers are suffering from huge reductions in sales.  It's just that the import companies are healthier because they aren't burdened by legacy costs so they can absorb the losses better.  If the US had nationalized health care, for example, none of these guys would have to beg for a loan, so the gov't is in a sense implicit in their problems.  c: the banks, which created the credit crisis would have failed without government intervention - the automakers, who are victims of the credit crisis, get nothing?  Not even a loan?  Sheesh.  We bailed out Chrysler in 79 and got paid back at a profit and the company lasted another 29 years.

I think the automakers should demand that they DON'T have to pay back the money if congress fails to enact national health care legislation by March or whenever the loan would be due...

p.s. - don't ever fly in your corporate jet to the BAILOUT LOAN HEARINGS.  Obviously these guys aren't used to having to consider public opinion....

From the NY Times:

"Mr. Barry said that, without any notice, American Express had reduced the credit limit on his business and personal credit card at least four times in the last year, which he said had lowered his credit score." (emphasis added}

We have to have legislation to keep this from happening RIGHT NOW.  As banks and credit card issuers watch their balance sheets, they cannot be allowed to (unintentionally) bring down the credit scores of customers who, possibly through no fault of their own, are having their credit limits lowered (ok) and their credit scores lowered as a result (not ok).

"Lenders are shunning consumers already in debt and cutting credit limits for existing cardholders, especially those who live in areas ravaged by the housing crisis or who work in troubled industries. In some cases, lenders are even reining in credit lines after monitoring cardholders who shop at the same stores as other risky borrowers or who have mortgages from certain companies."

If credit card issuers are profiling rather than reducing lines on an individual basis, than the individual client will be paying (literally) for the crimes of others...as if the bailout wasn't enough.

I'm not positive that a reduction in your credit line will reduce your credit score, but it seems likely (and I spend a decent amount of time looking at credit reports as a broker in NYC).  If anyone reading this can reach out to Dodd, Franks, Shelby, etc... and try to get this rectified immediately you would be doing a great service to a lot of people who will otherwise get screwed.  Also important to note that this will not affect banks or credit card issuers at all - they can do what they like, but credit scoring agencies should not be using whether a credit line was reduced in their algorithms to determine and score credit worthyness.

Here is a link to the article:  http://www.nytimes.com/2008/10/29/business/29credit.html?pagewanted=2&hp   

..because Barack Obama and the Democrats have jeopardized our Medicare and Social Security with their proposed massive government takeover of health care, and will be reducing access to doctors and slowing development of life-saving drugs. Don't let the inexperience and poor judgement of Barack Obama and his Democrat allies put our livelihood at risk. This call was paid for by the Republican National Committee and McCain-Palin 2008 at 866 558-5591.

Wierd - I can't find a reason listed in their smear that would put their livelihood at risk - and why the assumption that americans make their living running political campaigns.  Maybe saying Obama would put their LIVES at risk was too insane an accusation to make, so they chose to accuse him of something that sounds like lives but doesn't mean that?

So as CSPAN McCain is railing against Obama for not supporting McCain's oversight bill from 2005, as if Fannie and Freddie are the biggest problem, and the root cause of the 30% drop in the dow....

Nevermind that one of the reasons foreign gov'ts and investors poured money into the GSE's was the assumption they were backed by the gov't.  Compared to Bear Stearns, Lehman, AIG and the bailout they are relatively minor; the gov't simply nationalized what investors had assumed was a nationalized company all along...(they found out a little late, but whatever).

Doesn't erase 26 years of being a constant voice for deregulation and more deregulation by a longshot....

Unions can be the solution to the health care crisis.

I recently read my wife's benefits folio, (she works for a large employer - maybe 10,000 people worldwide), and found that the company paid 2x what my wife paid in, which amounted to 20,000 a year.  My wife's health care contributions, however, were roughly $250 a month, so collectively she and her company paid $750 a month for her health insurance, which is very good - not top shelf, but very good.

When she was unemployed, I was shopping around for health care, and a similar policy would have cost us $1200 or more, as far as I can tell.  I attribute the difference to the power of her employer to get a discounted rate, in exchange for delivering the health care provider their 10,000 employees business (which is paid for by the company, so it's a huge assurance of income, as compared to the individual employment situations of a similar number of individual policy holders).

I suggest unions use the same bargaining power they use for their members for the greater public, which will in turn give them even more bargaining power, which could (should) result in lower costs for their members and the general public as well.  The unions would make their current plans available to the general public, plus the cost of added administrative costs for coordinators, claims submissions, etc..  By adding members, of course, the unions could get better rates, which they could pass on to their members, lowering the cost of health care for union members. 

If unions did this across the country, they could add members nationwide, becoming the default middleman between the public and the insurance companies, which would even out the rates everyone pays - corporate, individual, unions, etc would all, eventually, end up paying the lowest cost possible for the care they are receiving.

I believe once it all settled out, health care could still be run and managed by private companies, but be delivered at a much lower cost.

He must be confusing "fundamentals" with "fundamentalist" because he seems to define it as a measure of the character of the American worker.  If the fundamentals of the economy meant that, however, there would only be 2 explanations for the current state of affairs: a: the american worker has always been a person of character, so the fundamentals are therefor ALWAYS strong, or b: the american worker recently went really bad - started rotting from the core.

Now I don't think that either of those scenarios define the problems with the economy these days, so I will argue that when people say the phrase :the fundamentals of the economy are strong", they are using the word "fundamentals" to mean something more along the lines of transparent, solvent, and trustworthy.  I personally feel it is dangerous for a president of the united states to believe otherwise.

i don't think this is relevant

hard to knock to the mainstream media for ignoring the important issues while TPM posts stories about Palin having a tanning bed.  After all, there is a reason white people are white, and a lot of it has to do with living in places like alaska....