great article hunt. Thanks

Yeah a 100 bucks to see a doctor is a shitload of money. Most spend way more than that on cell phones and eating out in a month. Besides, you ever had to call a plumber?

Or in a perfect world, you could go to the private practice doctor of your choice and pay him cash at the time of service. If he was too expensive you are free to shop around. In your perfect world dental, do you see resturants operating like police and fire stations where food will be provided to you as needed?

6/13/2009 6:16:04 PM

^^^ That makes FAR too much sense to ever influence policy.

6/14/2009 1:01:28 AM

Quote :

"however in a perfect world general practice doctor offices would be looked upon in the same way as police and fire stations. A place that all tax payers contribute to and then provided if and when needed."

Really? You want your doctor to have the same relative education as firefighters or policemen

6/14/2009 9:17:14 PM

I know I want volunteer doctors!

6/14/2009 9:31:27 PM

the number of doctors needed at a towns free clinic would be far fewer than the number of firefighters and police men need to operate in a similar sized town. This would allow for higher pay and an ability for them to be trained properly. Nurses carry the bulk of the work at your average doctors office anyways so only 2 or 3 doctors would be needed to carry a large patient load.

the military trains quite a few medics in state universities and a program to provide them jobs after service in state run free clinics would allow them to enter the medical field in a relativly painless way.

just a thought.

6/15/2009 10:36:29 AM

Quote :

"Really? You want your doctor to have the same relative education as firefighters or policemen"

I'm fairly certain that is what he is saying...if my house is on fire, my doctor neighbor next door best be able to put that shit out

6/15/2009 11:28:54 AM

^^ Where would the money come from in a free clinic?

6/15/2009 2:02:58 PM

Sweet!

I want to spend my time volunteering in a free health clinic. I learned CPR once, that should be enough for me to treat people, right?

6/15/2009 2:16:58 PM

^^where does money come from for the police and fire departments?

taxes!!!

I would use a free clinic more often than I would use the police and fire departments. Also increasing the general health of the public seems like a overall good way to save the governments money. We waste enough money fighting pot dealers and other dumb shit.

6/15/2009 3:58:16 PM

just because we fund one piece of dumb shit doesn't mean we should go out and fund something else, too.

and, again, I suppose you want your doctors to have the same relative level of education as your policemen and firemen, right?

6/15/2009 5:37:52 PM

I already explained this. The government already pays for medics to go to college to serve in the military. A similar system can be used for these clinics or we could use military medics and doctors to fill the roles.

we all help pay for people to go through naval acadamy so I dont see the dif if you trust our naval commanders

6/15/2009 8:20:26 PM

and yet, the same doesn't seem to happen with the police force and firemen. Why, then, would we expect different results from the same attempt?

Practically all navy personnel go through firemen's training. Why don't we use former sailors to run and man our fire stations? We have an MP force in the military. Why don't we use the MPs to run and man our police stations?

Why don't we go with a proven route: let the market dictate the prices and then people can afford it. The government has been dicking with the market via medicaid and medicare, and yet somehow prices have gotten worse.

Let's put it more simply: K-12 is "free." And yet many graduates can't find Iraq on a map. Is that really a program you want to emulate with our health care? I would like a doctor that can find my appendix, thank you very much. Or, more aptly, one that can at least tell me it aint there, since I have had mine removed.

6/15/2009 8:30:53 PM

I'm not talking about doctors fixing your organs here. Im talking doctors that can give general check ups and prevent certain illnesses and problems from getting worse. Im suggesting a free clinic not a free hospital.

I would go out on a limb and say many police and firefighters served in the military. Its a great training ground for people. How many swat guys do you think havent had military training?

About K-12. NC State is a state school and still filled with idiots who cant find Iraq on a map. AND its funded by taxes. whats your point? People are stupid.

6/15/2009 8:40:58 PM

Quote :

"I'm not talking about doctors fixing your organs here. Im talking doctors that can give general check ups and prevent certain illnesses and problems from getting worse."

Oh, you mean like a Nurse Practitioner? Too bad we can't use that kind of a thing more often in the current approach. But, the AMA won't allow that. Why should we allow such a thing in a gov't-run-system but not in the current approach? Seems kind of silly if you ask me...

Quote :

"I would go out on a limb and say many police and firefighters served in the military."

And you would be correct. But, not all of the police or firemen served in the military. That's my point.

Quote :

"NC State is a state school and still filled with idiots who cant find Iraq on a map. AND its funded by taxes. whats your point?"

My point is that the product of the K-12 system, which is funded by taxes, is far less than stellar. What makes you think a similar product put out by a gov't-run healthcare system would be any better?

6/15/2009 8:45:39 PM

it doesnt need to be perfect. We have plenty of shitty doctors that fuck stuff up. Thats why insurance for doctors is so high and makes life difficult for everyone. It seems you believe that every doctor in the private sector is amazing and is going to save everyones life and cure everything. well they dont

poor people cant even afford this and even middle class people cant afford this. I had some wart thing on my stomach when I was 15 and the doctor said they wernt dangerous and took them off and then charged my mom 200 bucks......

so the next one I got I just took it off with a needle.

people cant afford this shit.

[Edited on June 15, 2009 at 8:54 PM. Reason : run on sentance mo fucka]

6/15/2009 8:50:57 PM

Quote :

"Thats why insurance for doctors is so high and makes life difficult for everyone."

Actually, insurance for doctors is incredibly high because of ambulance chasing lawyers like John Edwards.

Quote :

"It seems you believe that every doctor in the private sector is amazing and is going to save everyones life and cure everything. well they dont"

You are right. Every doctor isn't perfect. But i'm not talking about doctors alone. I'm talking about the health-care system. As in, the system itself will be very shitty.

Quote :

"poor people cant even afford this and even middle class people cant afford this. I had some wart thing on my stomach when I was 15 and the doctor said they wernt dangerous and took them off and then charged my mom 200 bucks...... so the next one I got I just took it off with a needle. people cant afford this shit."

So, the solution is to make it affordable. not free, but affordable. Why is it that even the "poor" used to be able to afford a doctor's visit but now they can't? It couldn't possibly be the massive amount of gov't interference, could it?

6/15/2009 10:04:54 PM

Quote :

"Actually, insurance for doctors is incredibly high because of ambulance chasing lawyers like John Edwards."

so doctors fucking up has nothing to do with this right?

Quote :

"You are right. Every doctor isn't perfect. But i'm not talking about doctors alone. I'm talking about the health-care system. As in, the system itself will be very shitty."

this is the problem. Im not talking about the health care system. Im speaking of free clinics along with regular doctor offices. Free clinics will be open for whoever wants them and will help the overall health of the nation. People can still go to pay clinics and use their health insurance if they want. Im not suggusting we overall the insurance industry right now.

Quote :

"So, the solution is to make it affordable. not free, but affordable. Why is it that even the "poor" used to be able to afford a doctor's visit but now they can't? It couldn't possibly be the massive amount of gov't interference, could it?"

when was the "used to" time period and who where these "poor". I remember watching some western movie where the doctor made house visits. Are you speaking of that?

6/15/2009 10:14:08 PM

Quote :

"so doctors fucking up has nothing to do with this right?"

only insomuch as malpractice insurance exists.

Quote :

"Free clinics will be open for whoever wants them and will help the overall health of the nation."

Many doctors have tried this. They have been shut down by the government at the behest of the insurance lobby.

Quote :

"when was the "used to" time period and who where these "poor"."

I'd wager within the past 50 years, frankly. Yes, western movies certainly come to mind, but I'm not inclined to take much from Hollywood. We can point to many gov't interferences in the market that have brought about the current problems we face in affordability.

6/15/2009 10:23:41 PM

Quote :

"Many doctors have tried this. They have been shut down by the government at the behest of the insurance lobby."

so is the problem excess goverment intervention or excess intervention by overly powerful entities dictating the actions of private individuals.

Quote :

"I'd wager within the past 50 years, frankly. Yes, western movies certainly come to mind, but I'm not inclined to take much from Hollywood. We can point to many gov't interferences in the market that have brought about the current problems we face in affordability."

The complex operations maybe people face that crush them with debt didnt exist 50 years ago. Im not talking about getting rid of someones cancer which costs thousands of dollars. Im talking going to the doctor to get a check up which costs upwards of $100 without insurance. Even with insurance its 25 dollars. Please point to the interference in the market that has caused these prices to reach this point? Also im not complaining about the prices are so high because the fact is that running a doctors office is expensive. That is why I suggested a free clinic to deal with these check ups. If we had to pay the fire department every time we had a fire it would be expensive as shit. Why cant we allow people free check up to prevent worse illnesses? This has nothing to do with surgery or complex medical procedures mearly general health check ups.

also im not even taking into account the costs of insuring an entire family. I worked with a guy who made a good amount of money and could afford it but insuring his wife and two kids cost him well over 1200 dollars a month.

6/15/2009 10:46:29 PM

Quote :

"so is the problem excess goverment intervention or excess intervention by overly powerful entities dictating the actions of private individuals."

It is neither, by itself. It is the effect of both, one at the behest of the other. you know, like I said.

Quote :

"Im not talking about getting rid of someones cancer which costs thousands of dollars. Im talking going to the doctor to get a check up which costs upwards of $100 without insurance."

Key words there being "without insurance." Insurance, in this case, is the problem. I shouldn't need insurance to be able afford a regular doctor's visit. I don't need car insurance to pay for an oil change. Likewise, I shouldn't need health-insurance to pay for a doctor's visit.

Market Interferences? Please, the obvious first two are Medicaid and Medicare. They pay less than the market rate. As such, they automatically raise the fucking price for every one else! Second would be laws that mandate what health-insurance must cover. These laws increase not only premiums, but also price at the doctor's office, because, again, insurance is NOT paying the full price.

Quote :

"Why cant we allow people free check up to prevent worse illnesses?"

Partly because those currently eligible for such services from the gov't don't use them, anyway. In fact, they make appointments and then never show up.

Quote :

"also im not even taking into account the costs of insuring an entire family. I worked with a guy who made a good amount of money and could afford it but insuring his wife and two kids cost him well over 1200 dollars a month."

You don't think that a lack of competition might have caused such a high price, do you? When your cheapest choice is your employer's insurance, then you really have no choice. People stick with their employer's coverage. Which reduces the demand for coverage not provided by an employer, which increases the premiums for such coverage. Wow. Simple economics at work! And what gave us the employer-coverage system? Gov't tax-breaks, of course!

Look at all that gov't interference!

Quote :

"That is why I suggested a free clinic to deal with these check ups."

So good. Let the doctors who want to run these free clinics do so! Tell the insurance lobby to shut the fuck up! Don't just institute free clinics at the cost of all.

6/15/2009 11:05:42 PM

ya I agree we shouldnt need insurance to go get a regular doctors visit.

I was suggesting free clinics as a nice middle ground and it seems we are just nit picking each others comments at this point.

Quote :

"You don't think that a lack of competition might have caused such a high price, do you? When your cheapest choice is your employer's insurance, then you really have no choice. People stick with their employer's coverage. Which reduces the demand for coverage not provided by an employer, which increases the premiums for such coverage. Wow. Simple economics at work! And what gave us the employer-coverage system? Gov't tax-breaks, of course!"

There are tons of insurance companies so the lack of competition has nothing to do with it. People pick their employers coverage because its cheaper and than just dig around and find the doctors that take it. There are well over 10 insurance providers in nyc which one might end up with. This doesnt seem like much of a lackof competition. Its just a competition we dont have an option for and instead are employers do. sucks regardless.

6/15/2009 11:23:16 PM

Quote :

"Actually, insurance for doctors is incredibly high because of ambulance chasing lawyers like John Edwards."

Unless it can be found that a doctor acted in gross negligence or maliciousness malpractice suits should be capped
at a 1:1 punitive to actual cost of accident.

Quote :

"So, the solution is to make it affordable. not free, but affordable. Why is it that even the "poor" used to be able to afford a doctor's visit but now they can't? It couldn't possibly be the massive amount of gov't interference, could it?"

feel like the situation has turned into a what came first the chicken or the egg. People can not afford healthcare without insurance..... Insurance is what pushes healthcare
costs up that make it unaffordable to receive without insurance adn teh cycle continues.

The cycle can only be broken and fixed with massive external involvement one option being the gov't. Unfortunately liberal interests on capital hill
want to use this chance to create a happy rainbow hippy peace and love health care for everyone fest. Someone has to pay for this. While
i do not shed a tear for the rich people who will unfortunately have to shoulder the cost. i do understand their plight but more
bothersome in my mind is that many of the people we will be covering with free health services would be able to afford their own
private insurance if they would budget and prioritize correctly.

Quote :

"insuring his wife and two kids cost him well over 1200 dollars a month."

Sounds like his employer has a crap insurance company.

6/15/2009 11:41:40 PM

Quote :

"Its just a competition we dont have an option for and instead are employers do."

which would mean, by definition, that there is no competition. thank you for agreeing with me.

^ you are correct that it is a bit of a cycle. But you are incorrect that the solution is massive gov't involvement. How, exactly, can the solution to a problem be to introduce more of the problem?

6/16/2009 7:16:43 AM

just because we dont have a say in the matter doesnt mean there isnt a competition.

there is cometition between companies that make brakes yet we have no say in what brakes our cars have.



also the guy paying $1200 is a private contractor and doesnt work for a company.

6/16/2009 12:36:21 PM

Quote :

"just because we dont have a say in the matter doesnt mean there isnt a competition."

how the fuck do you figure that? if we can't really choose, then how is there competition?

Quote :

"there is cometition between companies that make brakes yet we have no say in what brakes our cars have."

You are telling me you can't go down to Advance Auto Parts and pick out a set of brake pads and stick em in your car?

Quote :

"also the guy paying $1200 is a private contractor and doesnt work for a company."

That's all fine and dandy. And the reason he is paying 1200 is because he doesn't have employer-sponsored benefits. There's not as much demand for such plans, as I've already said. Thus, the price is higher in order to recoup fixed costs

6/16/2009 5:34:00 PM

Quote :

"You are telling me you can't go down to Advance Auto Parts and pick out a set of brake pads and stick em in your car?"

No, not if your car's manufacturer chose to go with brakes that are proprietary and do not appear at any auto parts stores. But, you chose to buy this car, just as you chose to take this job.

6/16/2009 5:38:48 PM

I've bought plenty of brakes there.

is this a common thing?

6/16/2009 5:42:01 PM

who gives a shit about brakes - you're getting distracted with bullshit examples

6/16/2009 5:43:17 PM

this may be true. and, let's be honest, I'm sure I can choose between different types of brakes as an option on the car, anyway, so the example given is already ridiculous

6/16/2009 5:45:25 PM

I just heard that some veterans hospital didnt clean their colon cleaning stuff and gave 10k people hiv or hep C.

so I give up with this free clinic thing.

6/16/2009 6:01:55 PM

thx for the troll

6/16/2009 6:06:50 PM

This could just as easily be placed in the Obama credibility thread...

Quote :

"Democrats have spent years arguing that corporate tax rates don't matter to U.S. competitiveness. But all of a sudden one of their favorite arguments for government-run health care has become . . . U.S. corporate competitiveness. Political conversions on this scale could use a little scrutiny. "Businesses now recognize that if we don't get a handle on this stuff then they are going to continue to be operating at a competitive disadvantage with other countries," President Obama recently remarked. "And so they anxiously seek serious reform." Sure enough, many business leaders who should know better have picked up the White House theme. "You won't fundamentally solve the problems in business until you solve the problem of spiraling health-care costs, which is driving everybody crazy," said Google CEO Eric Schmidt the other day. Messrs. Obama and Schmidt need to brush up on their economics. Employers may write the checks to the insurance companies, but workers still pay for the coverage they get from those employers. The total cost of an employee is what matters to businesses, and fringe benefits are as much a part of compensation as cash wages. When health costs rise, firms don't become less competitive, as if insurance were lopped out of profits. Instead, nonhealth compensation drops. Or wages rise more slowly than they otherwise would. A recent study from none other than the White House Council of Economic Advisers notes exactly this point: If medical spending continues to accelerate, it expects take-home pay to stagnate. According to the New York Times, White House economic aide Larry Summers pressured CEA chairman Christine Romer to make the competitiveness argument, "adding that it was among the political advisers' favorite 'talking points.'" Ms. Romer pointedly retorted, "I'm not going to put schlocky arguments in there." How the schlock gets into Mr. Obama's speeches is a different question. It's certainly true that the U.S. employer-based insurance system can dampen entrepreneurial spirits. There's the "job lock" phenomenon, in which employees fear leaving a less productive job because they're afraid to lose their health benefits. Another problem is that insurance costs more for small groups than the large risk pools that big corporations assemble, meaning that it's harder to form new businesses that can offer policies. But all this is really an argument for developing the individual health insurance market, where policies would follow workers, not jobs. As for the competitiveness line, it's nonsense for most companies. The exceptions are heavily unionized businesses like auto makers that have locked themselves in to gold-plated coverage, especially for retirees. They have a harder time adjusting health costs and wages. Other companies might get a bit more running room in the short run if government assumed all health costs a la the single-payer systems of Western Europe. But over time the market would clear -- compensation being determined by the demand for and supply of labor -- and wages would rise. Or they might not rise at all if health-care costs are merely replaced by the tax increases necessary to finance Mr. Obama's new multi-trillion-dollar entitlement. This is where the real competitiveness argument is precisely the opposite of the one pitched by Messrs. Obama and Schmidt. Consider the European welfare states, where costly entitlements and regulations make it extremely expensive to hire new workers. The nearby table lays out the tax wedge, the share of labor costs that never reaches employees but instead goes straight to government. In Germany, France and Italy, the tax wedge hovers around 50%, in part to pay for state-provided health care. By contrast, the U.S. tax wedge was around 30% in 2008, according to the OECD. In other words, the costs of providing insurance would merely be converted into a larger wedge, which would itself eat into compensation. This is why Europe has tended to have higher unemployment and slower economic growth over the past 30 years. If Democrats really want to increase U.S. competitiveness, they could look at the corporate income tax, which is the second highest in the industrialized world and a major impediment to U.S. job creation when global capital is so fluid. Or drop their proposals to raise personal income-tax rates, which affect thousands of small- and medium-size businesses that have fled the corporate tax regime as limited liability companies or Subchapter S corporations. Or cut capital gains rates, which deter risk taking and investment. Or rethink their plans to rig the rules in favor of organized labor by doing away with secret ballots in union elections. On all these issues and more, Democrats want to increase, not reduce, the burdens on U.S. business. Their health-care line is, per Ms. Romer, "schlocky" political spin."

http://online.wsj.com/article/SB124520327436821723.html

6/17/2009 6:23:04 PM

Quote :

"In addition to the costs above, there are now costs to tax you, process the tax receipts, distribute the funds to insurance companies and subsidize users who can not or do not pay their full share of the costs."

You're referencing the proposal from the OP; however, that was merely a committee draft proposal, so I don't think anything you mentioned is happening now. Unless, of course, some other law has been passed, of which I am unaware.

Quote :

"In addition, now there must be tracking for multiple avenues of fraud, fraudulent billing by doctors, fraudulent billing by the insurance companies, fraudulent claims and internal fraud at the doctors, the insurance companies and at every level of the government that is involved (state and federal)."

I may have missed where this was mentioned in the draft proposal, but I don't see why government insurance would necessitate intervening with private insurance claims of fraud. Don't insurance companies already have internal auditing policies within their own organizations? I'd think that they would and that a government provider would only need to audit its own internal operations. However, someone may have some information that would clarify this for me.

[Edited on June 17, 2009 at 8:04 PM. Reason : ]

6/17/2009 8:02:11 PM

I was answering your question as to how a competitive system between private companies would generate lower costs than a government system, not directly talking about the original proposals, however, all of the points given would apply to the proposal. As for the government getting involved with fraud claims. If they're subsidizing it, I assure you they will be involved.

[Edited on June 17, 2009 at 9:54 PM. Reason : adsf]

6/17/2009 9:54:00 PM

[Edited on June 18, 2009 at 10:58 AM. Reason : img]

6/18/2009 10:56:49 AM

ObamaCare Sticker Shock
A $1.6 trillion deficit boost, and the uninsured will still be with us.

Quote :

"This was supposed to be a red-letter week for national health care, as Democrats started the process of hustling a quarter-baked bill through Congress to reorganize one-sixth of the economy on a partisan vote. Instead it was a fiasco. Most of the devastation was wreaked by the Congressional Budget Office, which on Tuesday reported that draft legislation from the Senate Finance Committee would increase the federal deficit by more than $1.6 trillion over the next decade while only partly denting the population of the uninsured. The details haven't been made public, but the short version seems to be that President Obama's health boondoggle prescribes vast new spending without a coherent plan to pay for it even while failing to meet its own standards for social equity. Finance Chairman Max Baucus postponed the health timeline, probably until after Congress's July 4 vacation. His team will try to scale down the middle-class insurance subsidies and make other cuts to hold the sticker shock under $1 trillion. (Oh, is that all?) Mr. Baucus also claims he's committed to a bipartisan consensus, yet most Republicans have been closed out of the negotiations, and industry lobbyists have been pre-emptively warned that even meeting with the GOP will invite retribution."

Quote :

"Capitol Hill's entitlement Democrats are determined too press ahead, despite this cost detour. Still, this week's lesson is that ObamaCare might not be inevitable once Americans figure out the astonishing price tag."

http://online.wsj.com/article/SB124536826475329427.html

6/19/2009 10:03:35 AM

The following, from economist, Greg Mankiw, should be kept in the minds of those who point to certain international stats to justify socialized health care...

Quote :

"With the debate over health reform heating up, you can expect a lot of specious arguments to be thrown around. In a previous post, I tried to debunk the idea that we need health reform for reasons of international competitiveness, and I have applauded CEA Chair Christy Romer for pushing back against that "schlocky" argument. There is another, flawed argument floating around that also needs debunking--that Americans pay more for healthcare but don't get anything for it, as measured by, for example, life expectancy. The problem with such international comparisons is that there are a lot of differences among nations beyond their health systems. To make comparisons in health outcomes, you need to control for other variables. Without such controls, the simple correlations have little meaning. I tried to make this point in a NY Times op-ed a while back. In a recent post on his blog, Nobelist Gary Becker makes a similar argument: "the American system has sometimes been found wanting simply because life expectancies in the United States are at best no better than those in France, Sweden, Japan, Germany, and other countries that spend considerably less on health care, both absolutely and relative to their GDPs.... [However], national differences in life expectancies are a highly imperfect indicator of the effectiveness of health delivery systems.for example, life styles are important contributors to health, and the US fares poorly on many life style indicators, such as incidence of overweight and obese men, women, and teenagers. To get around such problems, some analysts compare not life expectancies but survival rates from different diseases. The US health system tends to look pretty good on these comparisons. A study published in Lancet Oncology in 2007 calculates cancer survival rates for both men and women in the United States, the United Kingdom, and the European Union as a whole. The study claims that the most important determinants of cancer survival are early diagnosis, early treatment, and access to the best drugs, and that the United States does very well on all three criteria. Early diagnosis helps survival, but it may also distort the comparisons of five or even ten-year survival rates. In any case, the calculated five-year survival rates are much better in the US: they are about 65% for both men and women, while they are much lower in the other countries, especially for men. These apparent advantages in cancer survival rates are large enough to be worth a lot to persons having access to the American health system. Several measures of the quality of life also favor the US. For example, hip and knee replacements, and cataract surgery, are far more readily available in the US than in Europe." The next time you hear someone cavalierly point to international comparisons in life expectancy as evidence against the U.S. healthcare system, you should now be ready to point out how schlocky that argument really is."

[Edited on June 19, 2009 at 12:50 PM. Reason : .]

6/19/2009 12:48:54 PM

The Affordable Health Choices Act exempts members of congress...

Quote :

"Last September Sen. Barack Obama promised that under his health-care proposal "you'll be able to get the same kind of coverage that members of Congress give themselves." On Monday, President Obama repeated that promise in a speech to the American Medical Association. It's not true. The president is barnstorming the nation, urging swift approval of legislation that is taking shape in Congress. This legislation -- the Affordable Health Choices Act that's being drafted by Sen. Edward Kennedy's staff and the Health, Education, Labor and Pensions Committee -- will push Americans into stingy insurance plans with tight, HMO-style controls. It specifically exempts members of Congress (along with federal employees; the exemptions are in section 3116). Members of Congress "enjoy the widest selection of health plans in the country," according to the U.S. Office of Personnel Management. They "can choose from among consumer-driven and high deductible plans that offer catastrophic risk protection with higher deductibles, health saving/reimbursable accounts and lower premiums, or fee-for-service (FFS) plans, and their preferred provider organizations (PPO), or health maintenance organizations (HMO)." These choices would be nice for all of us, but they're not in the offing. Instead, if you don't enroll in a "qualified" health plan and submit proof of enrollment to the federal government, you'll be tracked down and fined (sections 3101 and 6055). For a health plan to count as "qualified," it has to meet all the restrictions listed in the legislation and whatever criteria the Secretary of Health and Human Services imposes after the bill becomes law. You may think you're in a "qualified" plan, but the language suggests that only plans with managed-care controls such as the "medical home" will meet the definition (sections 3101 and 2707). "Medical home" is this decade's version of HMO-style insurance, according to the Congressional Budget Office, with a primary-care provider to manage your access to costly services such as visits to specialists and diagnostic tests. Medical home providers in "qualified" plans, states the Kennedy bill, will have a "payment structure" based on "incentives" rather than payments for each doctor visit or procedure (section 3101). These requirements are reminiscent of the unpopular controls HMOs imposed two decades ago that caused public outrage and led to state laws reining in abuses. In December 2008, a Congressional Budget Office report evaluating early drafts of major federal health insurance proposals noted that "medical homes" were likely to resemble the HMO gatekeepers of 20 years ago if cost control is a priority. That report specifically referred to a payment incentive called the "withhold." When HMOs became dominant in the early 1990s, they would withhold 10% or more of physicians' fees until the end of the year and give it back only to the physicians who met targets for limiting how many referrals to specialists or diagnostic tests their patients used. The targets were so stringent that, if they were exceeded, what a doctor prescribed for you came out of your doctor's own pocket at the end of the year. This set up a conflict of interest between you and your doctor. Mr. Obama tried to put a positive spin on such cost controls in his June 13 weekly radio address. He said "if doctors have incentives to provide the best care, instead of more care, we can help Americans avoid unnecessary hospital stays, treatments and tests that drive up costs." Fair enough -- if you want your doctor paid to police your care and to be financially penalized for that extra test or referral you get. It is reasonable to require that people who accept a government subsidy for health insurance tolerate cost controls to protect taxpayers. But according to the terms of the Kennedy bill, you must enroll in a "qualified" plan or face a fine, even if you and your employer are paying the entire cost of the plan you already have (section 161). The president has promised that if you like your plan you can keep it. Mr. Kennedy's bill says that too. It's doubletalk, as the consequences of nonenrollment make clear. How big a fine will you face? The bill doesn't specify or set a limit. It says the fine will be enough to "accomplish the goal of enhancing participation in qualifying coverage" (section 161). If legislation similar to the Kennedy bill lands on Mr. Obama's desk, he has an obligation to keep his promises to the American people and veto it. And whatever health-insurance law is passed should apply to members of Congress. If it isn't good enough for them, it shouldn't be imposed on the rest of us. Ms. McCaughey is chairman of the Committee to Reduce Infection Deaths and a former lieutenant governor of New York state. "

http://online.wsj.com/article/SB124536864955329439.html

[Edited on June 19, 2009 at 5:06 PM. Reason : link]

6/19/2009 5:06:10 PM

man. talk about double-talk. way to go, Obama. CHANGE WE CAN BELIEVE IN!

not only will we get big-gubment healthcare, we'll get HMOs again! Hot damn! That worked out so well last time!

I think this should serve as a big "I told you so" to everyone who claimed that gov't healthcare wouldn't lead to rationing. This legislation fucking states it in all but name.

6/19/2009 5:15:52 PM

Quote :

"Last September Sen. Barack Obama promised that under his health-care proposal "you'll be able to get the same kind of coverage that members of Congress give themselves." On Monday, President Obama repeated that promise in a speech to the American Medical Association. It's not true. The president is barnstorming the nation, urging swift approval of legislation that is taking shape in Congress. This legislation -- the Affordable Health Choices Act that's being drafted by Sen. Edward Kennedy's staff and the Health, Education, Labor and Pensions Committee -- will push Americans into stingy insurance plans with tight, HMO-style controls. It specifically exempts members of Congress (along with federal employees; the exemptions are in section 3116)."

http://online.wsj.com/article/SB124536864955329439.html

6/20/2009 5:08:30 PM

^ thanks for posting the same article that was just posted.

6/21/2009 8:39:50 PM

Well, don't I feel sheepish

6/21/2009 10:20:29 PM

http://www.boston.com/news/local/massachusetts/articles/2009/06/24/state_cuts_its_health_coverage_by_115m/

Quote :

"Overseers of Massachusetts’ trailblazing healthcare program made their first cuts yesterday, trimming $115 million, or 12 percent, from Commonwealth Care, which subsidizes premiums for needy residents and is the centerpiece of the 2006 law. The board of the Connector Authority made the cuts as officials confronted two side effects of the recession: the state budget crisis and a surge in enrollment by the recently unemployed. The largest share of the savings will come from slowing enrollment. An estimated 18,000 poor residents who qualify for full subsidies, but who forget to designate a health plan, will no longer be automatically assigned a plan and enrolled and thus could face delays in getting care. Savings will also come from eliminating dental coverage for the poorest residents enrolled in Commonwealth Care, roughly 92,000 people who currently are the only ones in the program who receive that care. This $10 million cut was included in Governor Deval Patrick's revised budget proposal, but then was restored in the budget lawmakers approved last week. It now falls to the governor to decide the program's fate. ... Patrick Holland, the Connector Authority’s chief financial officer, said enrollment spiked during the last three months, from 165,000 to nearly 177,000 members, because so many workers are losing their jobs and, with that, employer-provided health insurance. ... Much of the rest of the $115 million in savings, $32 million, comes from slowing payments to the managed-care health insurance companies that won bids to offer insurance through the Commonwealth Care program. Regulators said that by slowing enrollment growth, the companies would receive less money than they had banked on when they submitted their bids earlier this year."

http://www.boston.com/news/health/articles/2009/06/24/state_treasurer_cahill_opposes_tax_hike_would_trim_healthcare_costs_instead/

Quote :

" State Treasurer Timothy P. Cahill has come out strongly against the $1 billion in tax increases approved by the Legislature, proposing instead deep cuts in the state’s landmark effort at universal healthcare, calling it a luxury taxpayers can no longer afford. ... “Everyone wanted it to pass, to get it on their resume,’’ Cahill said of the state’s 2006 healthcare law. “Nobody asked the tough questions. It was expensive, even in good times. In tough times . . . it just doesn’t seem doable.’’ ... At the same time, the healthcare initiative is expensive and getting more so, as more residents enroll, even though at some point, according to the law’s original intent, it is supposed to help pay for itself by shifting more people into managed care. The budget crisis forced state regulators yesterday to slow enrollment. “We’re all still waiting for the savings,’’ Cahill said. “Universal healthcare was supposed to eventually save us money.’’ “It’s a warning for the federal government as it looks to do something similar,’’ he added. “I’m not saying we can’t afford any of it, but it certainly doesn’t appear that we can afford all of it.’’"

Good to know that when people would most need a government health plan, the first thing that will happen is that the government will cut funding, payments and services for the people that need it most. I so look forward to a similar federal system which will force you to pay for a service that won't be there when the chips are down and you really need it the most.

6/26/2009 8:05:33 AM

I do not see what the problem is with a system in which if you have a "reasonable" income and you CHOOSE to not receive health insurance even if its "affordable" than u simply do not get service. Of course we will provide the medicaid or HMO plans like that status quo for underpriviledged people many with legitimate needs. For the former group though if you are leasing a lexus, have a 60" TV, and get your clothes new from the mall; yet do not have health insurance. Sucks but too bad when u get denied for medical treatment shoulda had your priorities straight

6/26/2009 8:28:07 AM

Quote :

"I so look forward to a similar federal system which will force you to pay for a service that won't be there when the chips are down and you really need it the most."

Kinda sounds like Social Security, doesn't it?

6/28/2009 12:29:39 AM

here's a discussion of the "healthcare rationing" scare tactic that opponents of any gov't run program uses
http://economix.blogs.nytimes.com/2009/07/03/rationing-health-care-what-does-it-mean/

Quote :

"In short, free markets are not an alternative to rationing. They are just one particular form of rationing. Ever since the Fall from Grace, human beings have had to ration everything not available in unlimited quantities, and market forces do most of the rationing. Many critics of the current health reform efforts would have us believe that only governments ration things. When a government insurance program refuses to pay for procedures that the managers of those insurance pools do not consider worth the taxpayer’s money, these critics immediately trot out the R-word. It is the core of their argument against cost-effectiveness analysis and a public health plan for the nonelderly. On the other hand, these same people believe that when, for similar reasons, a private health insurer refuses to pay for a particular procedure or has a price-tiered formulary for drugs – e.g., asking the insured to pay a 35 percent coinsurance rate on highly expensive biologic specialty drugs that effectively put that drug out of the patient’s reach — the insurer is not rationing health care. Instead, the insurer is merely allowing “consumers” (formerly “patients”) to use their discretion on how to use their own money. The insurers are said to be managing prudently and efficiently, forcing patients to trade off the benefits of health care against their other budget priorities."

on a related note, it strikes me that pretty much all of the arguments against a gov't run alternative (or a single-payer system) are not really unique at all to public plan are are already happening in some form or another. For example -
- rationing - discussed in the link

- "long wait times" - try to get an appt with a specialist now under your current plan and see how many weeks it takes

- "access to only gov't approved doctors" - IIRC, when my employer changed insurance providers a couple years ago (from Cigna to Aetna), the first thing we all had to do was look at Aetna's list of "in-network" doctors to see if they overlapped with the same doctors we were visiting under Cigna's plans

- "a gov't bureaucrat will be between you and your doctor" or "a gov't official will be making decisions for what care you can or can't get" or something to that effect - well, we already have bureaucrats standing between us and our doctors, deciding what care we can receive, only they work for the insurance companies, not the gov't. The difference I see in this one is that at least a gov't official is, theoretically, at least working on the same side as the patients, because his employers (tax-payers) and his customers (tax-paying patients) are the same people. On the other hand, insurance companies and employees are legally obligated to to answerable to their shareholders, first and foremost, and to drive profit. Any decision an insurance adjuster makes has the priority first to profitability, and only later to the health of the customer/patient.

7/5/2009 5:11:04 PM

^ i havent read your link yet, but people are suggesting that an alternate reform to fix some of those issues is to allow interstate competition for healthcare. One criticism of this is that the expenditures are related to regional factors, and it doesn't make sense for a provider of healthcare to someone in the desolate, cold, isolated North Dakota wilderness to have to compete with providers of someone in the populated, temperate, urban areas of California.

7/5/2009 5:30:18 PM

^^ I don't think I've ever seen anyone arguing against government health care claim that there isn't rationing under the current system. Rather the claim is that under a government run system, rationing will occur based on political whims, arbitrary governmental fiat and nonsensical government nannying, and all of that in addition to the natural rationing that with have to occur simply due to the fact that medical knowledge and care is not unlimited, nor is the tax payer's pocketbook (despite our politicians thoughts to the contrary). And further, as we can see above, when the tax funds start dwindling, your healthcare "right" suddenly gets less important.

As to long wait times, under the current system, those waits are due to natural limits. There are only so many neurologists, brain surgeons and cancer specialists, and your wait time is directly tied to how many of these resources are available. By comparison, under government systems, in addition to natural limits and waits, you will also see waits due to such things as some law maker deciding that in order to make things fair, only so many specialists will be allowed to practice in a certain area. And they will only be able to take so many patients. In addition, such idiotic moves like tying compensation to medicare rates won't accurately reflect the costs of specialists, and so you will see less specialists and more general practitioners as the benefits of being a specialist just won't be there.

As to approved doctors, you can still go to your old doctor, in fact, chances are good even under your current plan your insurance will pay benefits, just not as much. By comparison under a government run system, you could very well find that even if you want to pay out of pocket for a service, you can't because of some moronic decision to limit the number of procedures a doctor can do or claim in a given time period. Of course like all such things, the artificial constraints put in place by the government will generate a black market, and just like now, only more so, the absolute best care will be reserved for those with the money and the connections to get it. Everyone else will go without.

As to the bureaucrat, you have a fundamental misunderstanding as to who employs these bureaucrats. They will be employed by politicians, who in turn are not employed by the people, but by the lobbyists, who incidentally in this horrible cock up of a system that we would end up with will be the medical industry. Aetna, UHC, and BCBS will be their employers because they will be the ones making the political contributions, and any mid level bureaucrat who doesn't toe the line will soon find themselves having their .gov care subsidized.

Further, his customers aren't the tax payers either, it will be the insurance companies and the doctors. Once again, the care of individuals just like now, will be between bean counters, pencil pushers and lawyers. The only difference will be under .gov care, not only will you not have the option to just go ahead and buy your own care and the hell with the insurance company, but you will also have no recourse because the people who make the decisions about your care are the same people who will decide if such decisions are legal in the first place.

The public is not served by having their health insurance, their health provider and their legal recourse against the failings of both to be the same entity. When the .gov care politicians decide that the only care they will pay for is the cheaper politically favored treatment and fine any doctor who dares to provide the other one, what recourse will you have? Yes, you can sue the government, but when it comes to battling a massive entity in court, I would rather be fighting a private company than the government.

Lastly, no one has claimed that our system is ideal. Multiple times I and other have expressed a very real need for change to our system, however, the proposed government plans will not make the system better. Instead, they will cary almost all of the existing problems, plus a host of new ones. But don't take our word for it, ask a few military folks, ask them how much they love Tri-Care. Or even better, ask our veterans how wonderful working with the VA hospitals is. Or even better than that, why don't we ask Obama why, if he is so certain that government healthcare and government provided insurance is the way to go, does he favor taking the care of our veterans off of the government pocketbook and onto the private supplemental insurances our vets carry (http://www.cnn.com/2009/POLITICS/03/17/obama.veterans/). Surely, if government healthcare is the cure for what ails our health system, the government wouldn't be looking for ways to reduce the care it already provides? Surely we could point to the VA care system and Tri-Care as shinning examples of how healthcare should be run.

But we can't.

7/5/2009 7:55:27 PM

Quote :

"I don't think I've ever seen anyone arguing against government health care claim that there isn't rationing under the current system."

i've never heard public-option opponents claim there is rationing in the current system, at least not in those words. I've never really heard any of the opponents say anything other than something like "sure, our current system isn't perfect, but do you really want government to take over?", without ever giving any specifics.

As for the rest of your post...... i could have saved you a lot of typing - "yeah, but, but, but - government will just make it worse!!!"

7/5/2009 8:26:59 PM

Quote :

"On the other hand, these same people believe that when, for similar reasons, a private health insurer refuses to pay for a particular procedure or has a price-tiered formulary for drugs – e.g., asking the insured to pay a 35 percent coinsurance rate on highly expensive biologic specialty drugs that effectively put that drug out of the patient’s reach — the insurer is not rationing health care. Instead, the insurer is merely allowing “consumers” (formerly “patients”) to use their discretion on how to use their own money. The insurers are said to be managing prudently and efficiently, forcing patients to trade off the benefits of health care against their other budget priorities.""

No, that is NOT rationing. You know why? Because it's spelled out from the get-go. Moreover, there is always another option. The government plan isn't billed as such. It's a "every one gets healthcare!!!" mantra that will NEVER come true. Moreover, the private company doesn't run out of money, in general, so true rationing doesn't occur. Pre-set tiers are not "rationing," no matter how much your little liberal heart wants it to be.

Quote :

"- "long wait times" - try to get an appt with a specialist now under your current plan and see how many weeks it takes"

That couldn't possibly be because the gov't has limited the number of doctors, could it?

Quote :

"- "access to only gov't approved doctors" - IIRC, when my employer changed insurance providers a couple years ago (from Cigna to Aetna), the first thing we all had to do was look at Aetna's list of "in-network" doctors to see if they overlapped with the same doctors we were visiting under Cigna's plans"

You know, you could always have paid cash elsewhere. Sounds like you weren't restricted to only one set of doctors.

Quote :

"The difference I see in this one is that at least a gov't official is, theoretically, at least working on the same side as the patients, because his employers (tax-payers) and his customers (tax-paying patients) are the same people."

Keep telling yourself that.

Quote :

"On the other hand, insurance companies and employees are legally obligated to to answerable to their shareholders, first and foremost, and to drive profit. Any decision an insurance adjuster makes has the priority first to profitability, and only later to the health of the customer/patient."

False. There's this nasty thing called a "contract" that the insurer has to follow. While some will be bastards and not follow the contract, if you fight hard enough, you will get that contract followed. In the gov't's case, they'll tell you to fuck off. Then who are you gonna complain to? The gov't that just told you to fuck off? Right...

Quote :

"Further, his customers aren't the tax payers either, it will be the insurance companies and the doctors."

You are correct. We saw this very thing recently exposed with the FAA calling the airlines its "customers."

7/5/2009 9:53:18 PM