Comments on: Getting Serious on Health Care

By: david

david — Fri, 26 Jun 2009 13:47:49 +0000

The Washington Times ran a good story on this issue. If you take away the illegals (10 million), people eligble for exisiting programs (10 million), people that could pay on their own (20 million), it makes this problem much easier to manage. We eliminate the Earned Income Credit, WIC, payments to farmers, payments to the World Bank (108 billion this year)..and get something going.

By: Maureen

Maureen — Fri, 26 Jun 2009 11:51:51 +0000

notes:

http://www.democracynow.org/2009/5/13/baucus_raucus_caucus_doctors_nurses_and

http://www.democracynow.org/2009/6/16/report_senator_max_baucus_received_more

Also, a 2008 survey found 83 percent of psychiatrists, 69 percent of emergency medicine specialists, 65 percent of pediatricians, 64 percent of internists, 60 percent of family physicians and 55 percent of general surgeons favor a national health insurance plan.

By: Ellen Dibble

Ellen Dibble — Thu, 25 Jun 2009 22:01:44 +0000

Are the insurance companies any more transparent than the “public option” would be? Where are the statements of the insurance industry arguing to the people (not to congressmen whom they have helped to put in office, senators they help to keep there)? The silence of that point of view is astonishing. Or maybe I hear it and it sounds so like an argument for the status quo that I completely dismiss it.
I was glad to hear Obama address the army of insurance specialists who are needed to negotiate with insurers and pay bills. Obama spoke of educating them to be healers rather than bean counters, sending them to be educated to care eventually for the 40-some million currently uninsured. Good that he focuses on it, but the insurance specialists at the doctors’ offices I deal with are preselected for keeping totally out of the way of the medical staff, not being even interested in that. They are very capable but they are not the nurse practitioners of the future.

By: jeffet

jeffet — Thu, 25 Jun 2009 21:35:41 +0000

Eric I could not agree more. Obama has missed his chance of a lifetime. The democrat’s are fro the most part the new conservative party. There is no progressive part in this country. The other issue is, lobbying needs to be reformed or abolished altogether in it’s current form.

Since when is doing out money free speech?
I think to call what goes on in Washington and K street free speech is an insult to what was the founders original intent in this area. Of course the Supreme Court disagrees with me.

By: Eric McNulty

Eric McNulty — Thu, 25 Jun 2009 20:01:40 +0000

Unfortunately, this debate has devolved into horse trading and other machinations of the political system. Obama missed an enormous opportunity by not laying out a big, challenging, results-driven goal akin to what JFK did with the space program. He should have started by asking the country to commit to being in the top ten in health outcomes for dollar spent within in a decade and in the top five within a generation (we are currently 37th, I believe).

It’s hard to oppose that goal and there is a way that everyone — individuals, doctors, hospitals, insurers, etc. — can contribute to its achievement. Then public vs. private and the other sub-issues become a debate less about ideology and more about how to achieve the goal. If private insurers think they can get us there, let’s hear how (they certainly haven’t so far) and so too would the supporters of a public plan have to make their case.

We’ve gotten too far down into the weeds and the result is not going to be pretty.

By: millard-fillmore

millard-fillmore — Thu, 25 Jun 2009 18:39:07 +0000

If Obama can’t reform the current health-care system and/or implement some kind of universal health-care when both houses of the Congress are solidly Democratic majority (including filibuster-proof one in the Senate, pending the challenge to Al Franken’s win), then shame on him and shame on the Democrats!! It will simply expose the truth – that the Democrats are beholden to special interests and are as corrupt as the Republicans. He doesn’t have the excuse that Clinton had – that the Republican majority torpedoed his proposal.

By: Health » Getting Serious on Health Care | WBUR and NPR - On Point with Tom …

Thu, 25 Jun 2009 16:25:33 +0000

[...] [...]

By: Putney Swope

Putney Swope — Thu, 25 Jun 2009 15:59:05 +0000

David at least the European countries have something to work with. They have breathing room and they will makes cuts. Germany is already doing this.

We on the other hand have a market based health care industry that is failing. Billions are wasted by the corporate for profit insurance companies for health care.

We are now regulated by some rube in an office making medical decisions that a doctor should. Doctors have to hire teams of people to wade through all the BS the insurance companies put up to keep all Americans from getting care. The model of the insurance industry is the antithesis to health care.

By: Putney Swope

Putney Swope — Thu, 25 Jun 2009 06:07:10 +0000

National health is dead in the water. Wait and see, this thing is going to be screwed up by congress and all the BS they get up to.

I fear that we will get something that is worse then we have now. A mess, a real cock up brought to you by our incompetent legislators.

“Suppose you were an idiot. And suppose you were a member of congress. But I repeat myself.”
–Mark Twain

“Wherefore being all of one mind, we do highly resolve that government of the grafted by the grafter for the grafter shall not perish from the earth.”
–Mark Twain

By: Ellen Dibble

Ellen Dibble — Wed, 24 Jun 2009 23:52:46 +0000

Maybe Obama will answer David Markowski’s question this evening at 10:00. The way I look at it, my income taxes (one unit in the US pot, so to speak) reflect a deduction each year of something under $10,000. Taxes on that, because I make a sort of average income, would be maybe $2,500, which is “in play” in various ways. Congress could reclaim that. It has been pointed out that the medical deduction is much more valuable to high-income earners because they would otherwise be paying higher taxes on those deducted dollars. So putatively, Congress could claim more from me if I were richer.
I don’t have a problem seeing this as a redistribution problem (not a casting of the piggy bank on the floor). If there are profits that have been jacked up (see Rick Evans’ post at 5:38 above) and administrative waste (duplication and so on), then that money as well is “on the table” so to speak.
There are possible reclaimed tax deductions, savings in costs, savings in emergency care, etc., etc., plus the monies so many of us fork over: Fleece me.
Whether or not it all balances out from day one does not matter hugely; people dedicated to making it work will have at it. Insurers will have to have a new role, one involved in holding down costs and enhancing/ complementing what a public plan has on offer. It would be hard not to improve on the status quo.

By: David Markowski

David Markowski — Wed, 24 Jun 2009 23:38:16 +0000

Question on the Health care “reform”. President Obama says the ‘Public option” will NOT drive private insurance out of business. My question is: Will NO taxpayer money be used for the public healthcare program?
If yes, how can anyone think that is a FAIR playing field against private for profit insurance which has to live within its income.
If NO, then where is the money going to come from?

By: David

David — Wed, 24 Jun 2009 23:12:32 +0000

Reports are coming out now that countries with state ran health care for their people are running out of money. Here is the problem that no one is talking about. Take a barrel and fill it up with all the uninsured people in America, great! you have now covered all the uninsured people at a price you think at this time will pay for it, near a trillion dollars over x amount of years. We have solved the problem. Then, good hearted politicians, looking to cement their voting base, gives amnesty with conditions to all the 20 million illegals. A sure way to get re-elected. Problem? they will need health care. Our barrel is stuffed to the rim. Where will this added burden go? Not to mention the millions more who are now lining up at the borders to come in. A barrel can only hold so much before it runs over and makes a big mess.
I will always remember the Carter days when he granted all the illegal Cubans a new place to live. Especially what one woman from Cuban said as she came on shore. The reporter ask her why she wanted to come to America? She replied, to retire on your countries social security.
Due to trying to change the world to our way of life, the world may rob us of our way of life.
The law of supply and demand. When demand for things excedes the ability to supply that need, the price will soar. Will you have enough money in your pocket to provide for this hungry plan? We need reform, but will it break the bank to get it?

By: Joe B.

Joe B. — Wed, 24 Jun 2009 23:11:41 +0000

Who in the world trusts Senator Chris Dodd?

By: Rick Evans

Rick Evans — Wed, 24 Jun 2009 22:38:16 +0000

David sadly you’re right about Medicare. Seniors are obsessed with their ailments which is why so many take half a dozen to a dozen pills hoping it will relieve their sedentary retiree lifestyles. Thus the Medicare part D gift to the drug companies. And Medicare does squander a lot of money on devices and treatments.

That said workers with generous private health plans that shield them from the cost of their medical services spend a lot too.

The talk of Massachusetts starting to get control of its spending is a joke. CommonwealthCare the plan for low wage workers is $115 million in the hole and is cutting the plan by this much. The Connector Board will stop automatically signing up low wage workers if they don’t ask. Well one way to save money is to cover fewer people. The state is also looking to cancel covering LEGAL immigrants.

The alleged success of the MA 2006 law is illusory. $600+ million ins federal uncompensated care funds were taken and gifted to insurance companies to create the subsidized plans.

Meanwhile the biggest and greediest beneficiaries Blue Cross/Blue Shield and for profit Partners Healthcare were colluding to drive up health care costs in the state. http://www.boston.com/news/specials/healthcare_spotlight/

By: Putney Swope

Putney Swope — Wed, 24 Jun 2009 22:28:26 +0000

I don’t like posting other peoples essays, but this one by Dr. Reich is right on the mark.

Why the Critics of a Public Option for Health Care Are Wrong.

By Dr. Robert Reich.

Without a public option, the other parties that comprise America’s non-system of health care — private insurers, doctors, hospitals, drug companies, and medical suppliers — have little or no incentive to supply high-quality care at a lower cost than they do now.

Which is precisely why the public option has become such a lightening rod. The American Medical Association is dead-set against it, Big Pharma rejects it out of hand, and the biggest insurance companies won’t consider it. No other issue in the current health-care debate is as fiercely opposed by the medical establishment and their lobbies now swarming over Capitol Hill. Of course, they don’t want it. A public option would squeeze their profits and force them to undertake major reforms. That’s the whole point.

Critics say the public option is really a Trojan horse for a government takeover of all of health insurance. But nothing could be further from the truth. It’s an option. No one has to choose it. Individuals and families will merely be invited to compare costs and outcomes. Presumably they will choose the public plan only if it offers them and their families the best deal — more and better health care for less.

Private insurers say a public option would have an unfair advantage in achieving this goal. Being the one public plan, it will have large economies of scale that will enable it to negotiate more favorable terms with pharmaceutical companies and other providers. But why, exactly, is this unfair? Isn’t the whole point of cost containment to provide the public with health care on more favorable terms? If the public plan negotiates better terms — thereby demonstrating that drug companies and other providers can meet them — private plans could seek similar deals.

But, say the critics, the public plan starts off with an unfair advantage because it’s likely to have lower administrative costs. That may be true — Medicare’s administrative costs per enrollee are a small fraction of typical private insurance costs — but here again, why exactly is this unfair? Isn’t one of the goals of health-care cost containment to lower administrative costs? If the public option pushes private plans to trim their bureaucracies and become more efficient, that’s fine.

Critics complain that a public plan has an inherent advantage over private plans because the public won’t have to show profits. But plenty of private plans are already not-for-profit. And if nonprofit plans can offer high-quality health care more cheaply than for-profit plans, why should for-profit plans be coddled? The public plan would merely force profit-making private plans to take whatever steps were necessary to become more competitive. Once again, that’s a plus.

Critics charge that the public plan will be subsidized by the government. Here they have their facts wrong. Under every plan that’s being discussed on Capitol Hill, subsidies go to individuals and families who need them in order to afford health care, not to a public plan. Individuals and families use the subsidies to shop for the best care they can find. They’re free to choose the public plan, but that’s only one option. They could take their subsidy and buy a private plan just as easily. Legislation should also make crystal clear that the public plan, for its part, may not dip into general revenues to cover its costs. It must pay for itself. And any government entity that oversees the health-insurance pool or acts as referee in setting ground rules for all plans must not favor the public plan.

Finally, critics say that because of its breadth and national reach, the public plan will be able to collect and analyze patient information on a large scale to discover the best ways to improve care. The public plan might even allow clinicians who form accountable-care organizations to keep a portion of the savings they generate. Those opposed to a public option ask how private plans can ever compete with all this. The answer is they can and should. It’s the only way we have a prayer of taming health-care costs. But here’s some good news for the private plans. The information gleaned by the public plan about best practices will be made available to the private plans as they try to achieve the same or better outputs.

As a practical matter, the choice people make between private plans and a public one is likely to function as a check on both. Such competition will encourage private plans to do better — offering more value at less cost. At the same time, it will encourage the public plan to be as flexible as possible. In this way, private and public plans will offer one other benchmarks of what’s possible and desirable.

Mr. Obama says he wants a public plan. But the strength of the opposition to it, along with his own commitment to making the emerging bill “bipartisan,” is leading toward some oddball compromises. One would substitute nonprofit health insurance cooperatives for a public plan. But such cooperatives would lack the scale and authority to negotiate lower rates with drug companies and other providers, collect wide data on outcomes, or effect major change in the system.

Another emerging compromise is to hold off on a public option altogether unless or until private insurers fail to meet some targets for expanding coverage and lowering health-care costs years from now. But without a public option from the start, private insurers won’t have the incentives or system-wide model they need to reach these targets. And in politics, years from now usually means never.

To get health care moving again in Congress, the president will have to be clear about how to deal with its costs and whether and how a public plan is to be included as an option. The two are intimately related. Enough talk. He should come out swinging for the public option.

By: LinP

LinP — Wed, 24 Jun 2009 21:39:31 +0000

***I keep hearing those opposed to a public healthcare option use the term “government run” and state that the “government will determine your care.”***

So true. But these same people conveniently omit that it’s now “insurance run” and “insurance will determine your care.”

I sometimes wonder about these Republicans. Have they never had a necessary medical request turned down in their whole lives? They’ve never bumped into insurers as the obstructionist middlemen that they are? Has not one person in their families ever been sick, and had to deal with insurance red tape? They have no touchstone, or direct experience with what the sick have to deal with? Are they that insulated? What kind of perfect world, completely devoid of reality do these people live in? If in fact they do inhabit such a perfect world, they are luckiest sons-of-you-know-what around. I don’t get it.

By: david

david — Wed, 24 Jun 2009 21:04:16 +0000

Medicare spends too much money on it’s patients. The customers they serve abuse office visits, free electric scooters, beds etc..etc..etc…it needs to be scaled back and just pay for major medical problems. There are alot of seniors that use Medicare with the idea of “get some” rather than they really need help.

By: Fred W. Bracy

Fred W. Bracy — Wed, 24 Jun 2009 19:21:22 +0000

Ms. Wilensky thinks there’s something wrong with Medicare and Medicaid. What a sad thing it is to have youth wasted on the young (or younger than I, anyway). When Ms. Wilensky the “senior citizen” comes along, she’ll look back and wonder, “What in the world was I thinking?”

There’s nothing wrong with Medicare. Some folks are simply listening to people like John McCain (who don’t need Medicare–they’re billionaires) and who also don’t know what they’re talking about. I could not and cannot to this day tell the difference between Medicare and the employer-provided system I was in more than 7 years ago. I still have the same doctor. I get prescription filled exactly as I always have. There is virtually no difference … except for the fact that it’s cheaper.

Listen to these people … people like Ms. Wilensky … and try to remember that they’ve got “skin in the game” of making sure that the rich get richer and the poor get poorer. It’s not clear in every case what “skin” it is they’re protecting, but it sure isn’t that of their children and grandchildren. They’re ready to sell this country down the river on any silly premise that comes into their heads … put there by the greedy oligarchs who truly run this country.

By: Ralph Mason

Ralph Mason — Wed, 24 Jun 2009 17:13:48 +0000

Once again the simplest of facts about healthcare reform gets lost in the complicated weeds of the beltway politics of the issue. Look, we do not have measurably better care, perhaps not even as good care, as countries who cover all or nearly all of their people at 50 – 60 precent the cost per capita. This should be the first fact discussed when talking about reforming our system: The facts that John Boehner and Lindsay Graham and for that matter, NPR, needs to recognize:

Total health expenditures per capita, 2003
United States $5711
Australia $2886
Austria $2958
Belgium $3044
Canada $2998
Denmark $2743
Finland $2104
France $3048
Germany $2983
Iceland $3159
Ireland $2466
Italy $2314
Japan $2249
Luxembourg $4611
Netherlands $2909
Norway $3769
Sweden $2745
Switzerland $3847
United Kingdom $2317

By: Marc Hymovitz

Marc Hymovitz — Wed, 24 Jun 2009 16:43:19 +0000

So much of the health reform discussion focuses on the supposed “high cost” of passing a health care reform law… you hear numbers like $1 trillion being thrown around. In the Boston Globe today, key Beacon Hill leaders are saying Massachusetts health reform is too expensive and we can’t continue it.

At the American Cancer Society we have focused our advocacy efforts on the question of what is the cost of doing nothing? What’s the cost of treating late stage cancer diagnosis because someone was un- or even under-insured and couldn’t get a screening? What’s the cost of treating patients with minor illnesses in an emergency room because they had no insurance? Can businesses continue to compete in a global market with the same system of insuring their employees that we have now, a system that leaves almost 50 million people out?