Quote :

"Bull. Fucking. Shit. The projected cost is 1trillion for the gov't plan alone. Jesus, don't try and throw that bullshit in here."

its okay, they dont know any better

8/14/2009 4:33:13 PM

Quote :

"Bull. Fucking. Shit. The projected cost is 1trillion for the gov't plan alone. Jesus, don't try and throw that bullshit in here."

http://www.cbo.gov/ftpdocs/104xx/doc10431/07-02-HELPltr.pdf

Quote :

"According to that assessment, enacting those provisions would result in a net increase in federal budget deficits of $597 billion over the 2010-2019 period—reflecting net costs of $645 billion for the coverage provisions, which would be partially offset by net savings of $48 billion from other provisions of title I. (CBO has also estimated the budgetary impact of provisions in titles III and VI of an earlier draft of the legislation, which would add another $14 billion to the net cost of the proposal.)"

I mean, what more do you want? Go yell at the CBO and call them liars, I'm not the one making up these numbers. I know this is in addition to what we're already spending, but why does that matter? It just makes the price tag on this look like a relatively tiny addition for the benefits we would reap from it.

Quote :

"His point isn't that there isn't a problem. His point is that there are solutions other than this 1000 page monstrosity that simply perpetuates the problem. Contrary to your fucked-up logic, it is possible to do something and make the situation even worse. That is what he is saying."

How about you go read the fucking bill instead of assuming it will "make the situation even worse". How will insuring millions of uninsured make the situation worse? How will stopping insurance companies from denying claims and canceling policies for bullshit reasons make the situation worse? Those are problems with our system that the bill can fix. Just because it doesn't fix everything doesn't mean it's a bad plan.

[Edited on August 14, 2009 at 4:50 PM. Reason : :]

8/14/2009 4:46:08 PM

^ It depends on which bill you are talking about For "the America’s
Affordable Health Choices Act of 2009," HR 3200, 1 trillion is only for the first 10 years. There is a perpetual, ever-increasing difference between the plans projected expenses and revenue. The projected rate of growth in health-care expenses is greater than the projected growth in tax receipts on high earners and additional revenue from assumed Medicare cuts.



As per CBO's Director: “In the legislation that has been reported, we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount. And on the contrary, the legislation significantly expands the federal responsibility for health care costs.”

Considering we cannot pay for Medicare as is, it is incomprehensible that we would add a new, unsustainable layer to the mix.

[Edited on August 14, 2009 at 6:18 PM. Reason : .]

8/14/2009 6:04:20 PM

Quote :

"I mean, what more do you want? Go yell at the CBO and call them liars, I'm not the one making up these numbers. I know this is in addition to what we're already spending, but why does that matter? It just makes the price tag on this look like a relatively tiny addition for the benefits we would reap from it."

I'd say we're cherrypicking a little bit from the CBO scorings we're using, aren't we? From the same:

Quote :

"Once the legislation was fully implemented, CBO and JCT staff estimate, about 20 million fewer people would be uninsured compared with projections under current law. About 26 million individuals would obtain coverage through the new insurance exchanges, and about 6 million fewer people would purchase nongroup coverage outside the exchanges. In the aggregate, the number of people obtaining coverage through an employer would change very little. The draft legislation does not include a significant expansion of the Medicaid program or other options for subsidizing coverage for those with income below 150 percent of the federal poverty level (FPL); such provisions may be incorporated at a later date. By CBO’s estimate, about three-quarters of the people who would remain uninsured under this version of the legislation would have income below 150 percent of the FPL."

Half a trillion dollars, and all we get are less than half of the currently uninsured? Meanwhile, gimmicks like leaving out expansions of Medicaid bring the scoring down in the short-term, but are just that - gimmicks. Even the CBO identifies this for what it is, right there.

8/14/2009 6:11:06 PM

Economist, John Cochrane, on his health status-insurance idea as a way to protect against loss of coverage due to pre-existing conditions.

Quote :

" What to Do About Pre-existing Conditions: Most Americans worry about health coverage if they lose their job and get sick. There is a market solution. Even if you don't like the massive health-care package being considered in Congress, you have to admit that health insurance and health care in this country are not working well. There are two basic problems: First, if you get sick and then lose your job or get divorced, you lose your health insurance. With a pre-existing condition, new insurance will be ruinously expensive, if you can get it at all. This, the central defect of American health insurance, explains why most Americans are happy with their current coverage yet also support reform. Second, health care costs too much. Yes, we get better treatment, but the cost-cutting revolution that has swept through manufacturing, retail, telecommunications and airlines has not touched health care. The problems are real, but the proposed remedy—even more government intervention—is counterproductive. A market-based, deregulation-focused reform is possible, and it will work. Health care and insurance are service-oriented, retail businesses. There is only one way to reduce costs in such a business: intense competition for every customer. The idea that the federal government can reduce costs by negotiating harder or telling businesses what to do is a triumph of hope over centuries of experience. Take the claim that centralized record-keeping can cut costs. In his July 22 press conference, President Barack Obama noted that a new doctor today might run a test again rather than ask for records of a previous result. That seems silly. But maybe it isn't. Maybe the test is cheap, the condition changes, the test can fail, and the cost of setting up an integrated record system between these two doctors isn't worth two tests a year. The cost-cutting revolutions in other industries didn't settle questions like these with acts of Congress, expert commissions, armies of regulators, or via a "public option"—while leaving in place a system in which consumers have little choice, aren't spending their own money, and suppliers are protected from lower-cost competitors. That approach has never spurred efficiency, and for good reasons. Cost-cutting is painful. Even in Mr. Obama's trivial example, lab technicians and secretaries will lose their jobs to computer programs, and they will complain. Patients might have to get tests at inconvenient times and locations. They will do this when their money is at stake—what people will put up with from airlines for a few dollars is truly amazing—but they will never accept it from the government. But what about pre-existing conditions? A truly effective insurance policy would combine coverage for this year's expenses with the right to buy insurance in the future at a set price. Today, employer-based group coverage provides the former but, crucially, not the latter. A "guaranteed renewable" individual insurance contract is the simplest way to deliver both. Once you sign up, you can keep insurance for life, and your premiums do not rise if you get sicker. Term life insurance, for example, is fully guaranteed renewable. Individual health insurance is mostly so. And insurers are getting more creative. UnitedHealth now lets you buy the right to future insurance—insurance against developing a pre-existing condition. These market solutions can be refined. Insurance policies could separate current insurance and the right to buy future insurance. Then, if you are temporarily covered by an employer, you could keep the pre-existing-condition protection. Some insurers avoid their guaranteed-renewable obligations by assigning people to pools and raising rates as healthy people leave the pools. Health insurers, like life insurers, could write contracts that treat all of their customers equally. The right to future insurance could be transferrable to another company, for example, if you move. You could have the right that your company will pay a lump sum, so that a new insurer will take you, with no change in your premiums. Better, this sum could be occasionally placed in a custodial account. If you got sick but had something like a health-savings account to pay high premiums, you could always get new insurance. Insurers would then compete for sick people too. Innovations like these would catch on quickly in a vibrant, deregulated individual insurance market. How do we know insurers will honor such contracts? What about the stories of insurers who drop customers when they get sick? A competitive market is the best consumer protection. A car insurer that doesn't pay claims quickly loses customers and goes out of business. And courts do still enforce contracts. How do we get to a competitive market? The tax deduction for employer-provided group insurance, which has nearly destroyed the individual insurance market, is a central culprit. If we don't have the will to remove it, the deduction could be structured to enhance competition and the right to future insurance. We could restrict the tax deduction to individual, portable, long-term insurance and to the high-deductible plans that people choose with their own money. More importantly, health care and insurance are overly protected and regulated businesses. We need to allow the same innovation, entry, and competition that has slashed costs elsewhere in our economy. For example, we need to remove regulations such as the ban on cross-state insurance. Think about it. What else aren't we allowed to purchase in another state? The bills being considered in Congress address the pre-existing condition problem by forcing insurers to take everybody at the same price. It won't work. Insurers will still avoid sick people and treat them poorly once they come. Regulators will then detail exactly how every disease must be treated. Healthy people will pay too much, so we will need a stern mandate to keep them insured. And this step further reduces competition. Private, competitive insurance markets are a superior way to solve the pre-existing-conditions problem, and the only hope to lower costs. "

http://online.wsj.com/article/SB10001424052970203609204574316172512242220.html

[Edited on August 14, 2009 at 6:30 PM. Reason : ,]

8/14/2009 6:30:33 PM

Quote :

"I mean, what more do you want? Go yell at the CBO and call them liars, I'm not the one making up these numbers. I know this is in addition to what we're already spending, but why does that matter? It just makes the price tag on this look like a relatively tiny addition for the benefits we would reap from it."

I'm saying that the added trillion over ten years would be IN ADDITION to what we are already paying per year. You tried to imply that we would only be increasing spending by 400b, and that's just not fucking true.

Quote :

"How about you go read the fucking bill instead of assuming it will "make the situation even worse". How will insuring millions of uninsured make the situation worse?"

Because the bill does nothing to actually fix the problem. When insurance is the problem, adding more of it just perpetuates it. Durrrr

8/14/2009 7:47:05 PM

Oh no, we've angered the Brits!

http://www.cnn.com/2009/HEALTH/08/14/britain.america.nhs/index.html

Quote :

"Britons including Prime Minister Gordon Brown have leapt to the defense of their creaking healthcare service after President Barack Obama's plans for a similar system in the United States were branded "evil" by Republicans."

Quote :

" The comments caused a storm of protest in the United Kingdom, with Prime Minister Brown wading into the argument via micro-blogging site Twitter, where a conversation chain, "#welovetheNHS", is generating huge online traffic. A posting on the 10 Downing Street Twitter site on Wednesday read: "PM: NHS often makes the difference between pain and comfort, despair and hope, life and death. Thanks for always being there.""

Quote :

" Nevertheless, opposition Conservative Party leader David Cameron also added his voice to the defense campaign with a posting on his party's Web site. " Millions of people are grateful for the care they have received from the NHS -- including my own family. advertisement "One of the wonderful things about living in this country is that the moment you're injured or fall ill -- no matter who you are, where you are from, or how much money you've got -- you know that the NHS will look after you.""

And it looks like some in the Labour Party & Conservative Party are none to pleased!

Seems like we are attacking all our allies:





Some Canadians are none too happy either
(wont make sense if you haven't watched the short clip above - or more likely seen this earlier, I just haven't gone through the whole thread, I just wanted to make the point that we are angering some of our allies who we depend on for little things like the war on terror, when we demonize their way of doing things for our own gain).

Quote :

"The Real Story On Canadian HealthCare Hater Shona Holmes You've probably seen her all over the TeeVee, both on the cable News and in all those shrill shill ads, proclaiming how she was denied speedy care for her brain tumor in Canada which forced her south for a $97,000 surgery at the Mayo Clinic. But here's the real thing, Ms. Holmes did not have a malignant brain tumor. Instead, she had a benign condition called 'Rathke's cleft' which is a self-contained cyst that does not spread. Therefore, speed is not of the essence, as it would be in, say, a case of malignant glioma that does rapidly spread. In fact, most of those cysts are embryological remmants (ie. they form while the baby is still developing in utero and hang around for the person's entire life). Thus, they are often treated conservatively unless secondary symptoms arise (ie. because of where they are they can push on the pituitary or the optic nerve). Therefore, in my best estimation at least, the fact that Ms. Holmes was not rushed into surgery in Ontario likely made both good medical AND good health care system sense. Regarding the latter, think of it this way....Ms. Holmes, who was not in imminent danger, was was asked to wait a bit so that the clinicians involved could get a handle on whether or not it was progressing (ie. the usual conservative treatment decision for this condition) AND so that the glioma patients who really, really needed it could get their treatment first. Now.... Ms. Holmes decided she couldn't wait....So, instead, she went south and had the relatively straightforward surgery to drain the cyst right away at a cost of $97,000. Which is fair enough. Just don't blame Canada for not letting her jump the queue. Why? Because the fact is that the folks in front of her in the line needed their immediate surgery much more than she did, which is something the great majority of Canadians agree is how things should be. There is, of course, something else that the great majority of Canadians also agree upon. Which is that nobody should have to pay $97,000 for any kind of medical treatment. And we don't. And because of that we don't lose our houses, or worse, when we get catastrophically ill. OK?"

8/14/2009 9:07:44 PM

Quote :

"Oh, Those Death Panels Posted by Amy Sullivan Thursday, August 13, 2009 at 10:14 pm 176 Comments • Trackback (30) You would think that if Republicans wanted to totally mischaracterize a health care provision and demagogue it like nobody's business, they would at least pick something that the vast majority of them hadn't already voted for just a few years earlier. Because that's not just shameless, it's stupid. Yes, that's right. Remember the 2003 Medicare prescription drug bill, the one that passed with the votes of 204 GOP House members and 42 GOP Senators? Anyone want to guess what it provided funding for? Did you say counseling for end-of-life issues and care? Ding ding ding!! Let's go to the bill text, shall we? "The covered services are: evaluating the beneficiary's need for pain and symptom management, including the individual's need for hospice care; counseling the beneficiary with respect to end-of-life issues and care options, and advising the beneficiary regarding advanced care planning." The only difference between the 2003 provision and the infamous Section 1233 that threatens the very future and moral sanctity of the Republic is that the first applied only to terminally ill patients. Section 1233 would expand funding so that people could voluntarily receive counseling before they become terminally ill. So either Republicans were for death panels in 2003 before turning against them now--or they're lying about end-of-life counseling in order to frighten the bejeezus out of their fellow citizens and defeat health reform by any means necessary. Which is it, Mr. Grassley ("Yea," 2003)?"

http://swampland.blogs.time.com/2009/08/13/oh-those-death-panels/

SHOCKING!

8/15/2009 12:33:20 AM

The democrats are not the only ones with a plan. Here are some ideas from the Cato Institute:

Quote :

"What Is the Free-Market Approach to Health Care Reform? President Obama is right when he says that the U.S. health care system needs reform. Although this country provides the finest care in the world, our health care system has serious problems. It costs too much. Too many people lack health insurance. And quality can be uneven. But a government takeover of the health care system, as proposed by the president and some in Congress, would be a step in the wrong direction. Instead, we should pursue a uniquely American solution, one that builds on free markets, competition and choice. 1.Let individuals control their health care dollars, and free them to choose from a wide variety of health plans and providers. 2.Move away from a health care system dominated by employer-provided health insurance. Health insurance should be personal and portable, controlled by individuals themselves rather than government or an employer. Employment-based insurance hides much of the true cost of health care to consumers, thereby encouraging over-consumption. It also limits consumer choice, since employers get final say over what type of insurance a worker will receive. It means people who don’t receive insurance through work are put at a significant and costly disadvantage. And, of course, it means that if you lose your job, you are likely to end up uninsured as well. 3.Changing from employer to individual insurance requires changing the tax treatment of health insurance. The current system excludes the value of employer-provided insurance from a worker’s taxable income. However, a worker purchasing health insurance on their own must do so with after-tax dollars. This provides a significant tilt towards employer-provided insurance, which should be reversed. Workers should receive a standard deduction, a tax credit, or, better still, large Health Savings Accounts (HSAs) for the purchase of health insurance, regardless of whether they receive it through their job or purchase it on their own. 4.We need to increase competition among both insurers and health providers. People should be allowed to purchase health insurance across state lines. One study estimated that that adjustment alone could cover 17 million uninsured Americans without costing taxpayers a dime. 5.We also need to rethink medical licensing laws to encourage greater competition among providers. Nurse practitioners, physician assistants, midwives, and other non-physician practitioners should have far greater ability to treat patients. Doctors and other health professionals should be able to take their licenses from state to state. We should also be encouraging innovations in delivery such as medical clinics in retail outlets. 6.Congress should give Medicare enrollees a voucher, let them choose any health plan on the market, and let them keep the savings if they choose an economical plan. Medicare could even give larger vouchers to the poor and sick to ensure they could afford coverage. 7.The expansion of “health status insurance” would protect many of those with preexisting conditions. States may also wish to experiment with high risk pools to ensure coverage for those with high cost medical conditions."

8/15/2009 10:54:13 AM

^ those are all good ideas except for number 2 and 5, and i'm not sure what 7 is saying.

8/15/2009 11:07:19 AM

If only the GOP would listen to a think-tank other than the Heritage Foundation, I'd almost believe that they were acting in good faith


Honest question: if we were to remove the employer-provided insurance tax benefit, how would the transition be managed?

I imagine insurance prices wouldn't move immediately, would they? It seems there'd be a significant amount of time between employers dropping coverage and coverage becoming cheap-enough for families to afford.

[Edited on August 15, 2009 at 11:13 AM. Reason : ]

8/15/2009 11:09:42 AM

Whole Foods CEO John Mackey wrote a piece for the Wall Street Journal saying stuff like this:

Quote :

"Instead, we should be trying to achieve reforms by moving in the opposite direction—toward less government control and more individual empowerment. :: Health care is a service that we all need, but just like food and shelter it is best provided through voluntary and mutually beneficial market exchanges. A careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter. That’s because there isn’t any. This “right” has never existed in America."

The result:
Boycott Whole Foods
6,658 members
http://www.new.facebook.com/group.php?gid=119099537379


It strikes me as a bit silly perhaps, but still a better way of venting your anger than shouting to keep constituents from being able to have conversations with their elected officials.

8/15/2009 11:12:36 AM

Quote :

"I imagine insurance prices wouldn't move immediately, would they?"

Boone, I believe they would. As more people are starting to shop thier individual plans, the pressure to earn your business is there. As opposed to just convincing the HR person what insurance that affects 1000 people, now they have to convince 1000 people.

8/15/2009 11:31:56 AM

Quote :

"Honest question: if we were to remove the employer-provided insurance tax benefit, how would the transition be managed? "

Right now, businesses get to deduct their portion of what they provide for employee coverage. Self-employed folks also get to deduct the cost of their health care as an expense.

Instead of this current set-up, you would let individuals purchase their own health care insurance and deduct the expense from their income. The tax deduction would shift from the employer to the individual. This creates much more competition among health insurers.

Instead of being geared for the employer, health insurance would market itself more to this new vast array of individual customers. And if we let Insurers compete across state lines, health shoppers would get even better deals.



Health Status Insurance

Quote :

"So how does health-status insurance work? As Cochrane explains, "Market-based lifetime health insurance has two components: medical insurance and health-status insurance. Medical insurance covers your medical expenses in the current year, minus deductibles and copayments. Health-status insurance covers the risk that your medical premiums will rise." Cochrane offers the example of a 25-year-old who will likely incur $2,000 in medical expenses in a year. His medical policy component would thus cost about $2,000 per year, plus administrative fees and profit. For purposes of illustration, Cochrane then assumes the 25-year-old has a 1 percent risk of developing a chronic medical condition that would increase his average medical expenses to $10,000 per year. In that case, he would be able to buy medical insurance for $10,000 per year—which is a big financial hit. That's where health-status insurance comes in: It insures that you can be insured in the future. Under Cochrane's proposal, if an insured person develops an expensive chronic condition, a lump-sum payment would be deposited into a health-status insurance account that would be available only to pay medical insurance premiums. "

More about Health Status Insurance here...

http://www.reason.com/news/show/132018.html

[Edited on August 15, 2009 at 11:44 AM. Reason : .]

[Edited on August 15, 2009 at 11:46 AM. Reason : ..]

8/15/2009 11:43:06 AM

Quote :

"those are all good ideas except for number 2 and 5"

Why exactly are #2 and 5 bad ideas? They seem pretty obviously good.

I mean, how is tying health insurance to employment a good idea? The minute you lose or change jobs, your health insurance coverage disappears. This does not seem to be a good thing, regardless of how you approach the healthcare issue. Fixing that issue seems to be what single-payer advocates are all about, and it seems to be ostensible purpose of the "public option", so why all of the sudden are you singling it out here?

Second, I fail to see why #5 is so objectionable. Nurse Practicioners are well-trained medical professionals - they basically are qualified to do most things one sees a GP for. From Wikipedia:

Quote :

"A nurse practitioner's job may include the following: Diagnosing, treating, evaluating and managing acute and chronic illness and disease (e.g. diabetes, high blood pressure) Obtaining medical histories and conducting physical examinations Ordering, performing, and interpreting diagnostic studies (e.g., routine lab tests, bone x-rays, EKGs) Prescribing physical therapy and other rehabilitation treatments Prescribing pharmacologic treatments and therapies for acute and chronic illness (extent of prescriptive authority varies by state regulations) Providing prenatal care and family planning services Providing well-child care, including screening and immunizations Providing primary and specialty care services, health-maintenance care for adults, including annual physicals Providing care for patients in acute and critical care settings Performing minor surgeries and procedures (with additional training and usually under supervision) (e.g., dermatological biopsies, suturing, casting) Counseling and educating patients on health behaviors, self-care skills, and treatment options"

http://en.wikipedia.org/wiki/Nurse_Practitioner

Then we have state reciprocity of medical licenses - again, how is this a bad thing? More providers means more competition and less costs with less waits. How is that a bad thing?

8/15/2009 12:05:53 PM

Quote :

"Whole Foods CEO John Mackey wrote a piece for the Wall Street Journal saying stuff like this:"

And then immediately follows up with an eight-point plan to make healthcare more available to everyone, based upon the successful model implemented at Whole Foods for his own employees.

The horrors!

I suppose anyone who opposes the orthodoxy must be quickly brought into line, however. There is but One Way.

8/15/2009 12:13:04 PM

^they are really getting into this too (for the record I am not among those boycotting)

8/15/2009 12:35:49 PM

Whole Foods employees are pretty damn happy every time I'm there. Mackey must be doing something right.

8/15/2009 12:45:06 PM

Yeah-- arguing against his advice is silly. The guy knows how to run things.

The problem is that Mackey and Obama's goals aren't quite the same. Mackey is pointing out great ways to reform healthcare, while Obama is seeking reform and universal coverage.

I really, really do wish that the Republicans were acting in good faith, so that they could push to integrate ideas like Mackey's (which sound an awful lot like McCain's better ideas) into the reform bill.

8/15/2009 12:53:15 PM

There are only two options: Fully support the current Healthcare bill, or you hate old people, everyone with a pre-existing condition or disease of any type, and anyone without health insurance.

8/15/2009 12:57:49 PM

^I thought if you fully support the current health care bill then that means you do hate old people & want to sentence them to death panels.

8/15/2009 1:06:25 PM

Quote :

"More about Health Status Insurance here..."

This seems to me to be needlessly complicated. Wouldn't it just be simpler to say that any medical costs you incur from an incident that occurred while insured by a particular provider are to be paid by that provider, regardless of when the expenses are incurred. It seems awful silly that if you pay for health insurance, and the day after you develop cancer, you also get fired, that all of a sudden the payouts from your insurance stop. If I had a coverable event while insured, it seems only reasonable to expect that payments for that event should continue until no further expenses are incurred.

8/15/2009 1:20:56 PM

Quote :

"^I thought if you fully support the current health care bill then that means you do hate old people & want to sentence them to death panels."

So, to summarize:

You either want to sentence old people to death by death panels, or you want them to die out in the streets.

It's like a win-win!

8/15/2009 1:49:30 PM

I have a question for all you dems who support this bill and are ready to get it passes ASAP. Do you trust the republican party (which clearly many of you despise) to run this program as much as you trust the democratic party? In the future, eventually the congress and president WILL be controlled again by the republican party. I'm not prodding necessarily, but just wondering if this has even crossed your minds.

8/15/2009 2:16:47 PM

^ Republicans might campaign as a unified block, but they run the gamut between people like GrumpGOP to Sarah Palin.

I definitely trust someone like GrumpyGOP, or any number of republicans, to do what is best for the country when the time comes.

8/15/2009 2:30:42 PM

I'd be fine with the Republicans running it. It needs some cost-cutting measures, and by the time the GOP get's its crap straight (2016, 2020?), the plan will be too popular with people to kill it outright.

8/15/2009 2:31:56 PM

Quote :

"The problem is that Mackey and Obama's goals aren't quite the same. Mackey is pointing out great ways to reform healthcare, while Obama is seeking reform and universal coverage."

These goals are not mutually exclusive. Obama can reform the system as prescribed by Mackey and also provide vouchers for the few who actually need them – in the same way that we provide food stamps to feed the poor instead of constructing a separate, government-run grocery chain to compete with Harris Teeter, Trader Joes, Wal-Mart, Target, among a thousand others.

Quote :

"I really, really do wish that the Republicans were acting in good faith, so that they could push to integrate ideas like Mackey's (which sound an awful lot like McCain's better ideas) into the reform bill."

Many of them have, but have not been given the time of day:

Quote :

"Four Republicans in Congress -- Sens. Tom Coburn (Oklahoma) and Richard Burr (North Carolina) and Reps. Paul Ryan (Wisconsin) and Devin Nunes (California) -- will today introduce a bill that moves away from federal centralization. Aptly called the Patients' Choice Act, it provides a path to universal coverage by redirecting current subsidies for health insurance to individuals. It also provides a new safety net that guarantees access to insurance for those with pre-existing conditions. The nexus of their plan is redirecting the $300 billion annual tax subsidy for employment-based health insurance to individuals in the form of refundable, advanceable tax credits. Families would get $5,700 a year and individuals $2,300 to buy insurance and invest in Health Savings Accounts. Low-income Americans would get a supplemental debit card of up to $5,000 to help them purchase insurance and pay out-of-pocket costs. They would have an incentive to spend wisely since up to one-fourth of any unspent money in the accounts could be rolled over to the next year. The combination of the refundable tax credit and debit card gives lower-income Americans a way out of the Medicaid ghetto so they can have the dignity of private insurance."

Ironically, the above is very similar to a plan proposed by Obama’s National Economic Council Deputy Director, Jason Furman: http://www.taxpolicycenter.org/tpccontent/healthconference_furman.pdf

[Edited on August 15, 2009 at 4:15 PM. Reason : .]

8/15/2009 4:13:49 PM

John Mackey provides the full, unedited version of his op-ed on his blog:

Quote :

"As you are probably aware, I wrote an Op/Ed piece that was published in the Wall Street Journal earlier this week on health care reform, one of the biggest and most emotional issues facing our country. I was asked to write an Op/Ed piece and I gave my personal opinions. While I am in favor of health care reform, Whole Foods Market as a company has no official position on the issue. In answer to President Obama’s invitation to all Americans to put forward constructive ideas for reforming our health care system, I wrote this Op/Ed piece called simply “Health Care Reform.” An editor at the Journal rewrote the headline to call it “Whole Foods Alternative to Obamacare,” which led to antagonistic feelings by many. That was not my intention - in fact, I do not mention the President at all in this piece. I fully realize that there are many opinions on the healthcare debate, including inside my own company. As we, as a nation, continue to discuss this, I am hopeful that both sides can do so in a civil manner that will lead to positive change for all concerned. You are welcome to share your thoughts in the comments section below. (Just remember our comment guidelines prohibit vulgarity and personal attacks.) Here is the original unedited version that I submitted. Health Care Reform “The problem with socialism is that eventually you run out of other people’s money”-Margaret Thatcher. With a projected $1.8 trillion deficit for 2009, several trillions more in deficits projected over the next decade, and with both Medicare and Social Security entitlement spending about to ratchet up several notches over the next 15 years as Baby Boomers become eligible for both, we are rapidly running out of other people’s money. These deficits are simply not sustainable and they are either going to result in unprecedented new taxes and inflation or they will bankrupt us. While we clearly need health care reform, the last thing our country needs is a massive new health care entitlement that will create hundreds of billions of dollars of new unfunded deficits and moves us much closer to a complete governmental takeover of our health care system. Instead, we should be trying to achieve reforms by moving in the exact opposite direction-toward less governmental control and more individual empowerment. Here are eight reforms that would greatly lower the cost of health care for everyone: 1. Remove the legal obstacles which slow the creation of high deductible health insurance plans and Health Savings Accounts. The combination of high deductible health insurance and Health Savings Accounts is one solution that could solve many of our health care problems. For example, Whole Foods Market pays 100% of the premiums for all our team members who work 30 hours or more per week (about 89% of all team members) for our high deductible health insurance plan, and provides up to $1,800 per year in additional health care dollars through deposits into their own Personal Wellness Accounts to spend as they choose on their own health and wellness. Money not spent in one year rolls over to the next and grows over time. Our team members therefore spend their own health care dollars until the annual deductible is covered (about $2,500) and the insurance plan kicks in. This creates incentives to spend the first $2,500 more carefully. Our plan’s costs are much lower than typical health insurance, while providing a very high degree of team member satisfaction. 2. Change the tax laws so that that employer-provided health insurance and individually owned health insurance have exactly the same tax benefits. Right now employer health insurance benefits are fully tax deductible for employers but private health insurance is not. This is unfair. 3. Repeal all state laws which prevent insurance companies from competing across state lines. We should all have the legal right to purchase health insurance from any insurance company in any state and we should be able use that health insurance wherever we live. Health insurance should be portable everywhere. 4. Repeal all government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance many billions of dollars. What is insured and what is not insured should be determined by individual health insurance customer preferences and not through special interest lobbying. 5. Enact tort reform to end the ruinous lawsuits that force doctors into paying insurance costs of hundreds of thousands of dollars per year. These costs are ultimately being passed back to us through much higher prices for health care. 6. Make health care costs transparent so that consumers will understand what health care treatments cost. How many people know what their last doctor’s visit cost? What other goods or services do we as consumers buy without knowing how much they will cost us? We need a system where people can compare and contrast costs and services. 7. Enact Medicare reform: we need to face up to the actuarial fact that Medicare is heading towards bankruptcy and move towards greater patient empowerment and responsibility. 8. Permit individuals to make voluntary tax deductible donations on their IRS tax forms to help the millions of people who have no insurance and aren’t covered by Medicare, Medicaid, SCHIP or any other government program. Many promoters of health care reform believe that people have an intrinsic ethical right to health care-to universal and equal access to doctors, medicines, and hospitals. While all of us can empathize with those who are sick, how can we say that all people have any more of an intrinsic right to health care than they have an intrinsic right to food, clothing, owning their own homes, a car or a personal computer? Health care is a service which we all need at some point in our lives, but just like food, clothing, and shelter it is best provided through voluntary and mutually-beneficial market exchanges rather than through government mandates. A careful reading of both The Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter, because there isn’t any. This “right” has never existed in America. Even in countries such as Canada and the U.K., there is no intrinsic right to health care. Rather, citizens in these countries are told by governmental bureaucrats what health care treatments and medicines they are eligible to receive and when they can receive them. All countries with socialized medicine ration health care by forcing their citizens to wait in lines to receive scarce and expensive treatments. Although Canada has a population smaller than California, 830,000 Canadians are waiting to be admitted to a hospital or to get treatment. In England, the waiting list is 1.8 million citizens. At Whole Foods we allow our team members to vote on what benefits they most want the company to fund on their behalf. Our Canadian and British team members express their benefit preferences very clearly-they want supplemental health care more than additional paid time off, larger donations to their retirement plans, or greater food discounts; they want health care dollars that they can control and spend themselves without permission from their governments. Why would they want such additional health care benefit dollars to spend if they already have an “intrinsic right to health care”? The answer is clear-no such right truly exists in either Canada or the U.K.-or in any other country. Rather than increase governmental spending and control, what we need to do is address the root causes of disease and poor health. This begins with the realization that every American adult is responsible for their own health. Unfortunately many of our health care problems are self-inflicted with over 2/3 of Americans now overweight and 1/3 obese. Most of the diseases which are both killing us and making health care so expensive-heart disease, cancer, stroke, diabetes, and obesity, which account for about 70% of all health care spending, are mostly preventable through proper diet, exercise, not smoking, minimal or no alcohol consumption, and other healthy lifestyle choices. Over the past two decades, breakthrough scientific research by Colin Campbell, as documented in his book The China Study, and clinical medical experiences by many doctors including Dean Ornish, Caldwell Esselstyn, John McDougall, Joel Fuhrman, and Neal Barnard have shown that a diet consisting of whole foods which are plant-based, nutrient dense, and low-fat will help prevent and often reverse most of the degenerative diseases that are killing us, and becoming more and more expensive to treat through drugs and surgery. We should be able to live healthy and largely disease free lives until we are well into our 90’s and even past 100 years of age. Health care reform in America is very important. Whatever reforms are enacted it is essential that they be financially responsible and that we have the freedom to choose our own doctors and the health care services that best suit our own unique set of lifestyle choices. We are responsible for our own lives and our own health. We should take that responsibility very seriously and use our freedom to make wise lifestyle choices that will protect our health. Doing so will enrich our personal lives and will help create a vibrant and sustainable American society."

http://www2.wholefoodsmarket.com/blogs/jmackey/2009/08/14/health-care-reform-full-article/#comments

8/15/2009 4:46:43 PM

Boone,

Quote :

"The problem is that Mackey and Obama's goals aren't quite the same. Mackey is pointing out great ways to reform healthcare, while Obama is seeking reform and universal coverage."

Obama's plan achieves universal coverage because it simply requires everyone to have insurance. THAT'S IT! The public option and everything else about the plan is about either making health care more affordable (which would not achieve universal coverage on its own) or cutting the growth in future health care spending.

Rising costs is probably the biggest problem to fix, but universal coverage is what tugs at lefty heart strings.

If Republicans were smart, they would neutralize the emotional argument by adopting the health insurance requirement that the Dems are proposing along with the reforms McCain was proposing last year--e.g. removing restrictions from buying health care across statelines to introduce more competiiton into the insurance market to bring down premiums (to bring down premiums) and encouraging the wealthy to take on more of their own health care expenses through HSAs, which would help slow the growth in health care spending.

BADABOOM! A Republican Plan that Achieves Universal Health Care, Cheaper Health Insurance, and Reduces Growth in Health Care Expenditures!! ALL AT A CHEAPER COST THAN THE DEM PLAN!

Of course, you will NEVER see that Republican Health Care Plan. Why? Because the Party Actually *IS* run by a bunch of obstructionist diddle-fucks that don't realize that Sarah-Palin-style Red-Meat Aw-Schucks Politics is actually what lost them the election in 2008!!

[Edited on August 15, 2009 at 5:26 PM. Reason : ``]

8/15/2009 5:21:59 PM

Quote :

" So, to summarize: You either want to sentence old people to death by death panels, or you want them to die out in the streets. It's like a win-win!"

I think this is probably the best & most reflective description of the actual health care reform debate I've seen.




On a side note, Whole Foods is helping to fund the 14th annual Gay & Lesbian Film Festival in Durham right now.

[Edited on August 15, 2009 at 6:45 PM. Reason : .]

8/15/2009 6:44:39 PM

^ Dude, I don't mean any harm, but is everything about "gay" with you?

8/15/2009 6:46:44 PM

^I was point out that it would be unfair to judge Whole Foods are being right wing based on this one action when they do other left wing things too, dude.

8/15/2009 7:02:54 PM

Quote :

"I was point out that it would be unfair to judge Whole Foods are being right wing based on this one action when they do other left wing things too, dude."

Which makes sense, given that Mackay's self-described politics are libertarian, not conservative.

8/15/2009 7:52:20 PM

^^ Fair enough--and I swear I'm not trying to give you shit. It just seems that you're a bit of a Johnny One Note--I'm just being honest.

8/15/2009 9:17:04 PM

In the past month or two I have participated in threads about topics ranging from the Healthcare Thread, a couple of environmental threads, the birther movement thread, the cash for clunkers thread, a few threads about David Price, 2 or 3 threads on the issue of race, threads about affairs of government officials, one on the topic of the NC Senate race, one about the Raleigh City Council race… if you look outside of the soapbox my one note starts to look like pet & vet related threads especially in the lounge & in a story on the front page of TWW, if you look in chit chat then it’s mostly random stuff.

Here is a list of threads I've started this & last month:

Quote :

" Chit Chat Perpetual Energy Thread Supplanter 8/15/2009 2:13:17 AM Chit Chat WCHL 1360AM Radio... How far can it be heard? Supplanter 8/14/2009 12:52:57 PM The Soap Box Oil Lobby funds Astroturf Campaign heading to NC Supplanter 8/14/2009 11:52:08 AM The Soap Box David Price attends face to face town hall meeting Supplanter 8/13/2009 11:21:09 PM Chit Chat Turns out Obama is a Cylon Supplanter 8/12/2009 11:21:38 PM The Lounge Pet Food Drive this Friday Supplanter 8/3/2009 4:34:18 PM Chit Chat Fool Me Once... Supplanter 7/23/2009 2:01:02 PM The Soap Box Unjamming your front door while black? (Page 2 3 ... 6 7) Supplanter 7/20/2009 8:46:03 PM The Soap Box Ensign Supplanter 7/10/2009 2:17:18 PM The Soap Box NCSU Alumnus running for Raleigh City Council Supplanter 7/5/2009 11:49:12 AM"

I will grant that I probably mention gay stuff more often in the soap box than anyone else, because frankly there aren’t a lot of gay people who regularly participate in the soap box (although I’m too much of a NCSU fan, & the soapbox will probably be stuck with me for quite some time ), so I while I understand how the impression could arise, I think I have more than one note. Although, if I recall correctly it was you that drew me into the DADT thread after PMing me, wherein I agreed with you & disagreed with Obama on the issue of DADT.

But that is a part of what is so cool about NCSU, its large & diverse enough to have about every opinion & every issue there is up for discussion, even if I am bringing this particular issue to the table more than most. So again I guess I understand how the impression would arise, but I do hope that upon reflection one can see that I’m more than a one issue guy.

[Edited on August 15, 2009 at 10:54 PM. Reason : .]

8/15/2009 10:47:47 PM

^ Fair enough, sir.

8/15/2009 11:47:13 PM

Per Keith Hennessey, some reasons to believe the public option will not always operate on a level playing field.

Quote :

" THE PRESIDENT: Now, I recognize, though, you make a legitimate — you raise a legitimate concern. People say, well, how can a private company compete against the government? And my answer is that if the private insurance companies are providing a good bargain, and if the public option has to be self-sustaining — meaning taxpayers aren’t subsidizing it, but it has to run on charging premiums and providing good services and a good network of doctors, just like any other private insurer would do — then I think private insurers should be able to compete. They do it all the time. Follow-up question: Mr. President, are you confident that current and future policymakers won’t try to give the public option advantages over private plans? Look at all the cases where that has happened: * Fannie Mae and Freddie Mac crowded out private firms in the mortgage securitization business because they had government-provided advantages. * Only the government offers flood insurance, because private firms cannot compete. * Only the government offers terrorism reinsurance above a certain amount, because private firms cannot compete. * The Tennessee Valley Authority has no competitors, because the government has granted TVA market protections and advantages. * You are proposing cutting Medicare payments to private plans that compete with the Medicare “public option.” * Congressional Democrats argue that the government should save money by directly negotiating drug prices with pharmaceutical companies, a negotiation in which the government has most of the power. * The Federal Housing Authority is crowding out private forms that offer mortgage insurance. * The government is about to start crowding out private lenders who offer guaranteed student loans, in favor of direct student loans offered by the government"

[Edited on August 16, 2009 at 10:57 AM. Reason : .]

8/16/2009 10:56:00 AM

I'm not sure those examples are going to win anyone over, though. They're pushing out the private market because they're darn good services.

Thank heaven for my FHA home loan.

8/16/2009 12:38:51 PM

^ I'm pretty sure the point KH is making is that they are pushing our private competitors because are subsided in such a way that they can compete bellow cost. The fact that you don't see that as a problem probably goes to your apparent criteria for what constitutes a good government "service": one that benefits him.


[Edited on August 16, 2009 at 1:35 PM. Reason : ``]

8/16/2009 1:25:30 PM

Quote :

"More than 20 percent of all Medicare spending occurs in the last two months of life. Gundersen Lutheran Health System in La Crosse, Wisconsin has developed a successful end-of-life, best practice that combines: 1) community-wide advance care planning, where 90 percent of patients have advance directives; 2) hospice and palliative care; and 3) coordination of services through an electronic medical record. The Gundersen approach empowers patients and families to control and direct their care. The Dartmouth Health Atlas has documented that Gundersen delivers care at a 30 percent lower rate than the national average ($18,359 versus $25,860). If Gundersen's approach was used to care for the approximately 4.5 million Medicare beneficiaries who die every year, Medicare could save more than $33 billion a year."

- Newt Gingrich, July 2nd, 2009
http://views.washingtonpost.com/healthcarerx/panelists/2009/07/right-gingrich.html

Quote :

"I think people are very concerned when you start talking about cost-controls… you’re asking us to trust the government. Now I’m not talking about the Obama administration, I’m talking about the government. You’re asking us to believe that the government is to be trusted. We know people who’ve said routinely, well, you’re going to have to make decisions. You’re going to have to decide. Communal stadards, historically, is a very dangerous concept."

- Newt Gingrich, August 9th, 2009
http://blogs.abcnews.com/george/2009/08/gingrich-defends-palins-death-panels-.html

8/16/2009 2:29:18 PM

Wouldn't you pretty much need to have something similar to a "death panel"? You could spend a million bucks on a 95 year old cancer patient to keep them alive for another month, and if it's all on the government's dime, someone would need to make the call. Spending whatever is necessary to keep everyone alive for the maximum amount of time is not a viable option under universal coverage, is it?

8/16/2009 2:35:54 PM

^^ I think the difference in the above is the voluntary nature of the setting. Notice that it is pointed out that 90% of patients have an advance directive, for instance.

Hospice and palliative care are not bad things. They're not euthanasia. The fear, which I think has been blown up into "death panels", has been that patients will be shoved into hospice care against their will. The model pointed out above sidesteps this by having end-of-life decisions planned out by patients and their families (and not the government) well in advance.

But this kind discussion about end-of-life care decisions is necessary, and would only become more so under a more government-funded system. The problem is that we've come to a perverse debate over "death panels" instead (although frankly, one has to wonder what the alternative is when the plan meets with the hard, inevitable reality of needing to control costs without a more voluntary, patient-directed plan in place).

8/16/2009 2:57:18 PM

Quote :

"White House appears ready to drop 'public option' Health and Human Services Secretary Kathleen Sebelius said that government alternative to private health insurance is "not the essential element" of the administration's health care overhaul. http://news.yahoo.com/s/ap/us_health_care_overhaul "

Looks like the public option and most of what people have been arguing about is out.

[Edited on August 16, 2009 at 4:14 PM. Reason : ]

8/16/2009 4:11:41 PM

Quote :

" "not the essential element" "

haha, that made me dizzy.

I think medicare and anything funded with taxpayer money needs to have restrictions on end of life care. People in thier 90s are getting chemo. Or a spouse or family tells the doctors to do all they can to keep someone alive.(a natural response) While I dont have a problem with people getting the treatment, but their needs to be a point where the subsidies stop, or reduce, and they pay for it themselves. imo

8/16/2009 6:12:24 PM

Isn't the whole public option the intended meat of the bill? Or does this just mean that rather than having there be a public option, now the bill will focus on forcing insurance companies to accept everyone regardless of how much they earn etc?

I mean the whole idea of making the system better run is good....I don't think there was ever a debate over doing things like giving some sort of incentive to encourage different doctors/hospitals to send along test results to keep from duplicating the same one right? I know that's not it, but what were some other sticking points in the bill that were holding anyone up?

8/16/2009 6:40:49 PM

^I have no idea what the other sticking points were. What else was even in the bills? I think most people have heard "public option" and were "Hooray, public option, heath care for all, this is awesome" or "Public option? No, I have enough government and do not want anymore. I hate this and will now try to find things in it that might get others to hate it too." (Gross oversimplification)

Now, with "public option" off the table, whats the plan? I think most people who were against the government plan, myself included, believe that reform is needed, and there are many ideas thrown around in various editorials that I can see myself supporting. I guess now its time to see what congress comes up with when the recess is over.

Or, the White House is just trying to give the antigovernment plan group nothing to bitch about during the rest of the recess. Last I checked, Congress, not the White House writes the bills.

8/16/2009 7:22:14 PM

Quote :

"Isn't the whole public option the intended meat of the bill?"

I heard someone on NPR yesterday I think ranting about anyone who says the bill, saying there are like 5 different versions out there, and they'd still change once reconciliation between house & senate versions had to happen, and that she was angry at people who both support & oppose health care reform for saying anything is in "the bill."


Also, this was kind of amusing.

8/16/2009 11:35:06 PM

^ he repeats the same old story about adverse selection leading to an "implosion" of the insurance market, yet he doesn't realize that the statistics that woman provides actually poke holes in that argument. If adverse selection was actually the problem, we would see a large number of chronically uninsured sick people. Yet, as she stated, only a small portion of U.S. citizens are chronically uninsured. And recent research from the Kaiser foundation (google it to see its a pretty well respected institution in these matters) shows that the uninsured are not unhealthy. All of this suggests that adverse selection is NOT the problem, no matter what Paul Krugman tells you.

The guy may have delivered a one-liner that will get Rachel Maddow all wet, but he apparently has no clue about what he's saying.

8/17/2009 12:29:51 AM

8/17/2009 11:51:09 AM

Quote :

"The guy may have delivered a one-liner that will get Rachel Maddow all wet"

The only flaw I could find in your arguement.

8/17/2009 11:52:49 AM