Holy fundraisers, Batman!

Jane, this is fabulous. And you did it. You. Did. It.

Jane, spent part of the day dealing with Edwards’ office. They were unaware of The Hill quote it being “out of context.” Edwards was trying to say the Congress would not wait on the Senate. They were forceful in confirming her position of no public option, no bill.

Edwards will update her web site to clarify her statement, position. The office said they would follow up will me by email, one I could post.

Terry is a crazy son of gun but he is a proven fund raising powerhouse.

On a side note – this is staring to feel like the campaign again and I like it. We are working together fighting for something we believe in and doing it from the ground up.

Now let’s keep up the pressure and kick some ass!

Wow, talk about strange bedfellows. Well, I’ll take it.

Can I just say that nobody has been more helpful in this effort than Phoenix Woman? She has been indefatigable and her support has been unwavering, even when it felt like we were under attack from all sides.

That kind of support when you’re getting it from all directions is worth more than you can know, PW. You’re the best.

Good work Jane, and everyone! I like the argument that Glenn Greenwald made on his blog yesterday. He made the point that passing a good healthcare bill is a big deal, but an even bigger deal is changing the dynamics of our corrupt and constipated Congress. I have the feeling that we’re on the right track….

I’m glad McAuliffe’s doing this, but, seriously, are we going to have to bribe each and every on-the-fence-member into doing the right thing? Rahm should break away from doing the president’s back room deals for a spell and focus on beating some party loyalty into Congressional Dems. His penchant for party discipline is the only thing good about him, and he’s pretty good at enforcing it when he sets his mind to it. The stick, not the carrot, is what is needed here.

Janey! You’ll be in the history and civics books soon.

I wonder if Bill Clinton had a chat with Terry.

The battle is not won and there are many to fight to win the war – ie the nation back for the people from the corporations and special interests.

There is not logical reason NOT to have a single player plan and the public option may be the only way to get there. If the gov plan means the people get a real choice in their coverage and the price is reasonable and the profit is squeezed out by the government’s buying power, the insurance industry will leave for greener pastures where they can make their 30% profit perhaps by buying CDS to on eachother. last one standing wins all.

But do we have to listen to McAuliffe prattle?
Seriously, terrific work you guys.

The Pontiac salesman is more than happy to tweak the WH.

I am a Virginia Moderate / Progressive, and I took steps to contact my Congressional Rep and Senators after the whole shitstorm of “no public option?!” started swirling.

I received email replies from the offices of Senators Webb and Warner; Both Webb and Warner said they were committed to reform, neither said specifically that they supported a “public option”. In fact, Warner went out of his way to say he doesn’t support Single Payer. Warner did mention the public option as a compromise, but he mentioned this in the same sentence as “co ops” so Warner has, disappointingly, waffled on that.

My Congressman is Glenn Nye, and lo and behold, he is one of the Blue Dogs. His office has conveniently not responded to me on this matter. I didn’t have a problem electing him, because my last Rep was Extreme Bush Rubber Stamper Thelma Drake, but if he’s not going to play ball on health care, I may have to vote him out.

I didn’t support Terry for Governor, but I do support his efforts here.

Wow. unbelievable news. This is one of those paradigm-shifting moments. How unsurprising to find Jane Hamsher at the center of it!

There actually are a few reasons, at least in the interim (see my long series of comments on Jane’s “If Progressive Members of the House Think We’ll Accept Co-Ops as Public Plan, Think Again” thread earlier today for details). Basically, the system (not just the insurance end of it) as it is may be so broken that a lot of the dead-loss waste and inefficiency will just get carried directly into the Medicare-like system that replaces what we have now, and as a result, just as Medicare-costs are increasing, we’d continue to see systemwide costs escalate. The economic consequences of that would be devastating – instead of bankrupting consumers, we’d end up bankrupting the country.

Basically, the real problem is that the private sector has been so bad at self-discipline that the entire system is likely operating far below its efficient productivity frontier, which is the only conceivable explanation why it takes us 15-17% of our GDP to provide badly what, say, Singapore spends 6-7% of its GDP (the two countries have virtually the same GDP per capita) providing very very well. We get worse service (as measured in final outcomes – death rates, GDP, life expectancy, etc) for more money than virtually any other system in the developed OECD. Before a single payer system can be effectively implemented, we have to move the whole industry back toward the industry’s efficient productivity frontier, by ensuring affordable prices while increasing both labor and capital productivity and improving service at the same time.. at least until our service outcomes and cost structure approach that of the rest of the rich world. The public sector is better at setting prices and containing costs (i.e., what Medicare and the VA do well), but the private sector is almost certainly better at forcing greater efficiency (which Medicare has failed to do).

I believe in a strong public option as a viable competitor for the private sector, and I’ve really come to believe that the strong PO (SPO?) is actually the best short-term solution. Assuming that the SPO has a high standard of care and service, that people have the option to move freely between the public and private plans, and that regulation will prevent the SPO from becoming a dumping ground for those employed consumers (those with employer-bennies) that rapacious insurers don’t want (due to pre-existing conditions, etc.), the SPO will almost certainly emerge as the price setter, pushing private insurers into the position of being price-takers. This is exactly where we want them: where they will be forced by a competitively priced government plan to set affordable prices while simultaneously having to work hard to avoid margin compression (relative to how they do business today) by forcing pharmas and doctors into being more efficient and less wasteful. They will be forced to do so, because if they continue to charge ever-more-outrageous premiums for the same or worst service than the SPO, then they will just fail and the SPO will become a single-payer system by default. Government, if it’s smart, will then, as the private sector players reform the industry over time, continuously and repeatedly lower the price bar (the price of services provided by the SPO), basically whenever they see margin expansion at the surviving private insurers. This in turn will progressively force the private insurers to exert ever-increasing amounts of pressure on the care providers and the pharmacos, without, by the way, skimping on the service level, since the moment they cut service levels, they lose customers to the SPO. It puts them into a vise, which is precisely what will fix the system.

Eventually, this process will fix the system to the point that its real cost structure resembles that of European single-payer systems or Asian hybrid systems today. Only then, can a transition to a true American single-payer system occur. I’m not sure we can do this if we switched to a single-payer system on day one.

Well stated, as always, Teddy

I wonder if Bill Clinton should have a talk with Rahmbo.

Also: Jane is my hero!!!

I’m kinda with you until you start talking about not compressing insurance company margins. Is there some reason why we can’t mandate a 5% profit ceiling on health insurance companies? Make it just unattractive enough to discourage big money from going into the murder-by-spreadsheet racket? Shift profit motive over to the actual care providers and medical technology providers, not the insurers.

Huh. I’d rather have him doing this that spouting anti public option shit, but … don’t trust him. He’s got his angle. Can’t believe a corporate-loving DLC-er like him changes his stripes.

actually, what I said is that we have to brutally and ruthlessly compress their margins and the SPO is the best way to do this. The whole process I outlined will work automatically, the moment the SPO becomes a price-setter and the insurers become price-takers (which wil happen automatically if the SPO is worth its name).

Basically, if the Federal government (as the SPO’s lords and masters) is smart it will progressively and repeatedly cut prices for SPO services without compromising quality. This forces the price-takers – the private insurers – to do the same, therefore compressing their margins. In turn, they will then, in turn, beat cr*p out of the pharmacos and doctors to reduce waste and increase efficiency in order to maintain their margins or at least decrease the amount of compression they are suffering. It doesn’t end there: every time we see their margins go up (as a result of successful beatings), the government should lower the SPO’s prices yet again, forcing still more beatings to go on as the private margins get smaller and smaller. And the beauty of it is that while all this pummelling and torture of Big Medicine is going on, they can NEVER decrease the standard of care, since that’ll just cause consumers to jump to the SPO in its capacity as price-setter. It puts the insurers into a deadly vice.. the only way I can see to contain exploding costs we see the system. Once the national cost structure (doctors’ salaries, the price of medicine, the price of technology, etc.) comes down to European levels and once the waste and corruption is purged the systems (hospital administrators and healthcare execs making what their NHS counterparts do in England, for example), then we’ll be ready to administer the coup de grace against the private insurers and switch to true single-payer (if we even want to bother to do so at that point in time).

Yes, in theory, the government can do this on its own, through an instant-switch to single-payer on day one followed by brutal cost cutting, but in practice government has always been bad at forcing productivity enhancements in any industry. Just look at Medicare today or the Pentagon, ever. And service levels will likely suffer, as hard political decisions have to be made to either increase taxes or cut care, lending credence to rethug fear-mongering about bureaucracy and death panels, etc., etc.

So let the insurers do it to their own bedfellows in Big Medicine. Meanwhile, all the SPO has to do is assure affordably priced, high quality services, and the invisible hand will then reform the industry.

bmaz is upstairs!
A Chebby In The National Driveway & Lesson In Healthcare Messaging

Really instantaneously? I would think the ability of SPO to affect other insurer’s rates would depend in large part on the numbers of subscribers in each pool. The more limited the SPO’s subscriber capacity, the less it will tend to pull down for-profit insurance premiums. I have a vague memory of hearing the PO would have a limited number of available seats at least at first — unless there’s some reason to believe SPO will have essentially unlimited capacity in terms if number of insureds?

Also I don’t see why single-payer is needed to mandate a 5% cap profit, by definition I was seeing that cap on the for-profit insurers.

Pontiac salesman. Ha! Or maybe a lawncare equipment salesman.

oh, and every time the private insurers secure concessions through their beating the cr*p out of the healthcare industry and the pharmas, the SPO will also reap the benefits, making the whole thing a virtuous cycle.

yes, that’s a concern, which is why I really want the PO to be an SPO, with the emphasis on the word “Strong” and truly universal. It has to have sufficient subscriber capacity and true portability on day one for all this to work – which is exactly what the insurers and Big Medicine want to prevent and why they’re pushing the insanity of localized co-ops.. precisely so that they won’t face a price-setter.

Trust me, this virtuous cycle and the boot of a price-setter on their necks, is precisely what Big Medicine is most terrified about. This is their real nightmare scenario – even more than single payer, which, if badly implemented, will only scr*w the insurers, leaving Big Medicine intact in its abject failure and greed. This is what they fear most: to be forced to really have to compete. They don’t have to compete today because the price elasticity of demand in healthcare is almost flat, with consumers willing to pay anything they can for healthcare. With this system, the elasticity curve steepens greatly, since the SPO becomes a viable competitive alternative. Then everything changes.

Jane you are the flame of the left. We are beggining to exert our muscle, and the events of the last few days prove it. Those town hall freak shows made me laugh. the right thinks the internet is merely a cheap way to advertise. Hopwever,at the end of the day, the right will never compete with us because they absolutely frigging despise “the people” those pathetic folks and corporate employees will never be “grass roots”. i estimate the netroots is equal to a corporate lobby or two already and they dont have the advantage we do. they have to pay shareholders, we do this because we HAVE to. we arent doing this for profit. we are the mujahidin they are the russians.

hiya npb!

because a 5% cap on profit in a system that now experiences 35-50% dead-loss from waste is nonsensical. It’s economically the equivalent of having an otter try to dam a tidal wave, or more accurately, trying to replace the nails on the wood columns in a house that’s well on its way to being devoured by termites. The first step is to get rid of the waste. You can cap the profit later.

Seconded.

Seems like all they have to do is make sure the PO remains a dwarf in terms of comparative subscriber numbers and they win.

Besides, the right is losing their womenfolk. So their tribe will dwindle over time…

yep. That’s why they want the co-ops. Hence, we only succeed in the PO is a STRONG one (SPO). National in scope, capable of picking up say a 70-100 million subscribers in a short while. But I think this is very possible, given the amount of people who are unhappy with their coverage today or who are either uninsured or, due to the recession, at risk of becoming uninsured.

Guess we’ll have to agree to disagree there. But here’s a last stab at explaining what I mean.

Even if the underlying medical provider industry has X amount of dead waste, and even if the insurer itself has Y amount of further dead waste, the insurer can still have Z% profit, and in fact the insurers are currently profitable. And that Z% is what the insurer’s shareholders and stock prices care about. Limit that Z% profit and either subscriber prices push down, or else costs (passed through to providers) push up. But because Z% is now not an attractive rate of return, further investment capital is not drawn into the health insurance sector; over time, private health insurance as a sector dwindles, increasing the space for non-profit systems such as the SPO to inhabit.

Once the PO becomes an integral piece of the health system, and of course every effort needs to be expended to assure this, then it will have an initial pool comprised of those people that are currently uninsured, ie close to 50 million people. This pool of people will be guranteed lower premiums than private insurers whose premiums they currently can’t afford.

There of course needs to be a mandate for everyone to have insurance since this allows for the maximum reduction of overall risk while allowing for the overall least cost.

Further, there are currently an enormous amount of federal dollars being directed for no good reason to subsidize private insurers and pharceutical companies, in no small part thanks to the acquiescence and complicity of Obama. So a PO is immediately viable and would be the preferred option as long as it is run efficiently.

It would appear that this issue has inspired a groundsell of willingness to act by a huge number of people and it is concievable that this same arousal of action can start to dicatate the way this country is run.

Jane, I heard about you for the first time last night via Rachel Maddow. You are an impressive individual and I’m thankful for your advocacy.

has my comment been moderated? It has disappeared

yes and yes and yes! ;-)

Keep the conversation civil, please, no matter what.

Yes.

good comments and wow i’m just still pleasantly* reeling from this post ..

*with a WO (wariness option)

I see what you mean, but bear in mind that what I’m asking for is a baseline scenario where Z% goes from where it is today (say 20%) to Z’%, which is actually massively negative, all other factors being equal. If they can’t then cut X to X’ such that Z’% goes back to being positive, then you’re right. Let them dwindle and die. I don’t care. Then we’ll have single payer.

But I’m betting that won’t happen. I don’t want to cap Z’% so much as I want X to fall much more than the dollar amount associated with pre-reform Z%, so if they can live with -Z% relative to the current baseline by beating the cr*p out of Big Medicine, then that’ll be the best possible outcome. I don’t want to cause disinvestment to occur so I don’t want to cap Z’%.

by the way, if you want to cap Z% (as opposed to Z’%) at 5% as a starter, then I’d be very supportive. In fact, I say let’s force them to roll premiums back to say 1990, by setting the SPO’s pricing accordingly AND let’s set Z% at 0% (not 5%). or, heck, -5%. We have up to 50% of total industry revenues to play with, so you can set Z% to any level you want and it’ll still work (although you probably don’t want them all to file Chapter 11 on day one). That’ll light a fire under their kabooshes.

Im as appreciative as anyone, of Janes valuable work on this. now mcaulife is in the act.???when did mcaulife get to be a progressive?? i think they are trying to steal some more of our money. Jonathan alter ( who i sadly, have NO respect left) has been shilling relentlessly to get the SPO killed. i know he’s sick, i know he wants to keep his insurance, but jonathan your trying to push 47 million people out the boat to save youself, and then tell them to “grow up”? its pretty nauseating. any way theres going to be a couple of kabuki votes in the house, so they can say they “kept” their promises, then they will go into committee and sell us out…..what then?

Thanks for summarizing. I think 0% profit would be a nonstarter as there is no motivation to do business in the first place, not to mention probably an unconstitutional taking of the existing business.

I know, i was just trying to the point that I really don’t think it matters where you set Z%.

By the way, in terms of enrollment potential for the SPO, even the pathetic MA Commonwealth Care caused statewide-insured to go by half a million in 3 years. Nationally, that’s the equivalent of 25,000,000 people, and Commonwealt Care is about as deficiently useless as you can imagine. Imagine what well-designed Public Option can do. Heck, I’d be happy to drop BC/BS if I could.

Welcome aboard, Dianne! You’ll be delighted that you checked in. Be sure to read emptywheel and attackerman too. (click on the links up top)

Im as appreciative of Janes valuable work on this. and now mcaulife is in the act.???when did mcaulife get to be a progressive?? i think they are trying to steal some more of our money. Jonathan alter ( who i sadly, have NO respect left) has been shilling relentlessly to get the SPO killed. i know he’s sick, i know he wants to keep jis insurance, but jonathan your trying to push 47 million people out the boat to save youself, and then tell them to “grow up” is pretty nauseating. any way theres going to be a couple of kabuki votes in the house, so they can say they “kept” their promises, then they will go into committee and sell us out…..what then?

Keith kicked Alter off his show for a long time, and he’s suddenly been back on lately. Hopefully after that comment he’ll be off again.

emptywheel is upstairs!
Scahill on the Blackwater Rent-an-Assassin Service

He feels it personally and it has bled into his work.
I haven’t lost respect for him so much as realigned my bias filter. I have some of them, too.

I wonder if Hillary had a chat with Bill who had a chat with Terry. Jane, my hero!

You are babbling and apparently suffering under the assumption that there is some inherent right for private insurers to exist as payers for the delivery of care by physicians.

The private insurers are completely superfluous, they don’t provide the service. Any entity can be the collective payer since each individual can not assume the entire cost of expensive care, especially when that entity can cover that risk better and cheaper by foregoing a profit.

Talk of how profits can be attained by private insurers when those profits are gotten only and necessarily by denying care can appeal only to an idealogue for markets. These profits that you seem enamored of are non payments to the ailing person which are then passed along to the genral public, and then further passed long by these very same insurers by raising their premiums.

Sadly you are so far removed from the way that private insurers carry out their rackets that your models have nothing to do with reality.

agreed, but I’m happy to let them keep whatever profits they can glean out of their soon to be diminished circumstances if they can prove themselves useful by wringing out the $500 billion to $800 billion in cost savings we all know is in the real health system…. call it a finders fee. If they can’t do that for us, then they can all go away and die the miserable death they so richly deserve… and a strong PO WILL finish them off. Basically, I’m utterly indifferent as to how many, if any, private insurers are left standing at the end of this. And many of them will fail regardless. But I do want to find and recover those billions in dead loss in the healthcare and pharma industries and the structural problems behind them or costs, even post-insurers, will continue to spiral out of control and endanger both consumers and the wider economy.

Careful. Terry McAuliffe has long been from the plutocrat, you scratch my back, I’ll scratch yours branch of the party. I would be very cautious about trusting him.

On the other hand, if a self-interested player like him thinks that there are points to be scored by siding with the good guys, I’ll take it.

On the third hand, it’s McAuliffe. Watch your wallet.

Jane, if Terry is good enough for you, he’s good enough for me. Rock on!

Aw, Jane. Now you’ve got me blushing. I only wish I could live up to your billing.

Hi Blub

I agree with a lot of this but this argument:

“The public sector is better at setting prices and containing costs (i.e., what Medicare and the VA do well), but the private sector is almost certainly better at forcing greater efficiency (which Medicare has failed to do).”

I don’t really buy. I’ll explain. When we’re talking about Medicare vs. private insurance, we’re not really talking about public sector vs. public sector health care. We’re talking instead about private sector vs. public sector insurance. We know, also that the overhead and profit costs in private insurance are about 30%, while Medicare overhead is 2.5% So, strictly as an insurance provider, the public sector is clearly far more efficient than the private sector.

Now let’s move to actual health care. In that area, the primary Government efforts are in VA care, and Tricare which is care for Veterans and their families. The proper comparison for Government care there, is care from private providers, Doctors, hospitals, and other institutions. I don’t have any numbers to provide the comparison, but I do know that there’s a huge variation in both the efficiency and effectiveness of private sector providers and institutions. I’d guess then, that many private sector providers are less efficient than Tricare or VA providers. Also, we know that costs are rising much faster in the private sector than in the public sector because Medicare inflation rates are quite a bit less than private sector rates. So, it’s quite likely that here, too, private sector efficiency is less than public sector efficiency.

Now in making these points, I certainly don’t intend to suggest any general rule. I am not saying that private sector is always more efficient than public sector or the reverse. What I am saying is that efficiency and effectiveness are functions of whole organizations both managers and workers, and that good organizations can be created in both the private and public sectors. That was something we knew in this country 40 or 50 years ago, but after the gutting of the Federal Government under Reagan, Bush 41, and Bush 43, it’s no wonder that people would assume that Government organizations are necessarily less efficient and effective than private organizations.

Blub and Hmmm:

Your discussion of Health Care Reform has been most educational.

The ideas, perspectives, and scenarios, which you have both put forth, deserve as broad a hearing as may be possible.

Rational, society-based discussion has been completely lacking in the calculations, manipulations (and gyrations) of the Political Class as they fall all over themselves protecting the “interests” of those entities whom they actually serve as opposed to the public whom they merely “represent” …

The utter lack of ANY apparent humane consciousness within the Political Class has not been lost upon that same public. Excepting, of course, the twenty-odd percent of the public whose selfish and arrogant sensibilities (if such we may term them) are completely aligned with the narcissistic and sociopathic tendencies of those who regard themselves as, “better than the rest of us” (as my neighbor, a very disgruntled conservative of the old school, puts it when describing politicians).

Politicians, as a class, have not been popular for some time, but their behavior during the Bush era and these early months of the Obama Presidency, has definitely not endeared them to the public.

It would behoove President Obama to realize this, knowing, as he must, that this disgust will engulf him as well if he does not begin to personally share a compelling and humane version of what his “reform” would “look” like with the rest of us.

If he is truly wise, then he will also address what it would “feel” like for our society to begin to seriously improve the quality of life for all Americans. Genuine Universal Health Care is the place to start.

DW

You misunderstand me, so I guess I apologize for being insufficiently clear. (Though frankly I don’t understand what was unclear in that paragraph you quoted, and I do write for a living, and so forth.) I have no love for the insurance companies, quite the opposite. I want them dead and gone. But because that is not available in the context current reform push, I am looking for practical ways to set in motion mechanisms to force their sunset over time. And I hope you understand that paragraph was a reply to an argument in Blub’s comment.

good thoughts. I guess I’m not saying that private is automatically better at cost containment. In fact I think I said the opposite. But cost control is not the same improving efficiency – removing the structural problems that make us pay 17% of GDP for about 8% of GDP in actual services. This is the core of the problem. And Medicare, as an insurer, hasn’t really helped the country even begin to address it, even if it has admirably kept it’s own overhead down.

If you simply killed off all the insurers and assuming the rest of the system still functioned in it’s current form, you’d wipe out maybe 20% of that 17% – or now 13.5% of GDP, growing at a phenomenal rate of 9% a year. In four more years, you’d be right where you started. Somehow, someone has to fix the underlying structural crisis of American healthcare. Basically, the total revenue pie has to shrink by up to one half AND stay there. I think a hybrid system is the best way to address this problem, and there is simply no choice about solving it. It’s that or the whole untenable system eventually implodes. This rot is foundational and goes far beyond the corruption of the insurers. Eventually, the house will fall irrespective of whether or not you have today’s private system or Medicare-for-all.

continuing, letsgetitdone, if we all know that pie has to shrink and drastically, and stay that way, it is politically and economically more palletable for the private sector to do the violence. Let the private insurers figure out the messy details of how best to make $5,000,000 a year surgeons take 97% pay cuts. If we or Medicare did it, they’d say we were organizing death panels. So let Aetna do it, and then, through the hybrid system’s new pricing mechanism, let the public sector reap the benefits.

RE: the VA –

That’s actually the best care in the US, thanks to Bill Clinton.

Meanwhile, check this out: http://seminal.firedoglake.com/diary/7220

New town hall event:

Rob Andrews NJ-01
Date: Monday, August 24, 2009
Time: 6:00 p.m. – 8:00 p.m.
Location: Rowan University – Wilson Hall, Glassboro, New Jersey 08028

While we’re waiting to see if McAwfully’s latest is for real, here’s an interesting article:

http://pnhp.org/blog/2009/07/2…..h-how-the-“public-option”-was-sold/

Not sure if that link will work. Here’s another attempt.

second that Phoenix Woman, Blue Texan and Teddy Partridge !!!

and wow Jane Hamsher – this is stunning and goodness knows where it may lead – did you see what Madame Speaker said today ? and looks like you even got Move On to exhale – ya got the ‘mo now – you’ve more than earned it.

Blub, I agree with this. But I think we need to do health insurance reform first, since it could save a bunch of money quickly, and give us more time for the more important underlying reform. There’s also a moral question here, and that is the past behavior of the insurance companies and the compensation for that behavior they owe the American people. There’s even the question of whether they deserve to exist anymore considering that their behavior leads to 20,000 needless deaths each year and 1 million needless bankruptcies. The colorful phrase “murder by spreadsheet” is often used to describe their behavior, and itself raises these moral questions.

The issue of better functioning and higher quality really has to do with the provider organizations and helping them to literally seek out, face, solve problems with their functioning, and integrate the solutions into their organizations in a systematic way. Organizations that can do that have been called high-velocity organizations, FAST organizations, and open enterprises. The form of management that creates such organizations has been called “knowledge management,” and also “Problem Solving Pattern Management.” You can find out more about PSP management here, and more about high-velocity organizations, including high-velocity health care organizations here.

Legislation can help address the problem of facilitating the development of high-velocity health care organizations in both the private and public sectors. Such legislation wouldn’t involve massive government expenditures, but would be more along lines of setting up a national center for encouraging developing high-velocity health care organizations. The center could be cited within HHS, and it would have research, evaluation, information dissemination and coordination, and training functions. It would also provide grants to university medical centers to develop local PSP Management centers to spread the discipline of PSP to health care organizations.

Blub, They won’t do it. Their business model is just to extract more and more from clients. Government, through Medicare for All, is much better suited to changing the fee for procedures system and implementing a more rational compensation model, and it’s also much more suited to freezing prices and preventing further inflation. Of course, we need to develop a stronger political movement to get this done, and we need to treat the insurance companies like the villains they are. But I think it can be done if we have the will to do it.

I called Moran’s office two days ago and the aide, Maria, told me unambiguously that Moran would not vote for a bill that does not contain the public option — and I made my question very clear and repeated it. I don’t know if she knew what she was talking about, but there you have it.