Thanks Jane. How is it that the Dems gave away their majority by putting the Senate Finance Committee at 3 Repubs, 3 Dems? Why isn’t that committee properly reflecting majority rule – it should be comprised of 2 Repubs, 4 Dems. A quick reading of health reform material shows that all 3 House bills voted out of committee have the public option in various forms, as well as the 1 bill voted on in the Senate. So the SFC can give that all away b/c it’s set up 3 a side? With the Dem side pretty shaky? One thing I completely agree with you on is it would be outrageous to put through a mandate to have insurance without an immediately available public plan (some sort of Medicare plus 5% or so reimbursement rate is my favorite) available for purchase. It sounds like this 65% payout rate is pulled out of someone’s ass to relate it to the 65% of Cobra premiums the govt. is currently picking up for the unemployed. That’s disgusting.

The actual full Senate Finance Committee contains 13 Dems (Baucus, Rockefeller, Conrad, Bingaman, Kerry, Lincoln, Wyden, Schumer, Stabenow, Cantwell, Nelson (FL), Menendez, Carper) and 10 Republicans (Grassley, Hatch, Snowe, Kyl, Bunning, Crapo, Roberts, Ensign, Enzi, Cornyn)

But Baucus has determined that only the Gang of Six should be allowed to “help write” his version of the health care bill. Which probably means Baucus may not be wielding the gavel on this committee in the next Congress.

Thank you for the explanation and personally I think that gavel should be shoved right up his arse. It’s pretty depressing that the Dems have no idea how to be a majority party after only 12 years in minority.

Baucus didn’t decide to put the Gang of Six in charge, Obama did it by putting Baucus in charge. Give credit where credit is due.

It’s an insurance company bailout.
Not that they need one, but they’re getting a nice bailout.

As much as I dislike the path that Obama has been following with all this, he can’t be held responsible for Baucus being the chair as Baucus has been the chair of Senate Finance since the Dems re-took the Senate in ‘06. Baucus also chaired this committee from ‘01 – ‘03

It’s that senate seniority thing coming into play

if they pass an individual mandate with no public option .. i’ll sue the bastards .. there is no way in hell the gub’mint can make me buy BCBS ..

The Dems are doing exactly what they are being told to do. The notion that they are weak and unresponsive because they just cannot get it together is not so. They are paid to move through the world the way they do.

so this is how we should be planning on financing our healthcare under the Blue Dog plan: buy insuranceco stock!

In May, the Senate Finance Committee discussed requiring that insurers reimburse at least 76% of policyholders’ medical costs under their most affordable plans.

This may be off topic, but doesn’t the existence of less, more, and “most affordable plans” strongly suggest that health care rationing exists now and will continue under private plans, even for those who can afford insurance?

Christ, we’re fucked. Both parties are worthless now. I’m getting increasingly despondent about this whole thing.

On the flip side, I did get the joy of being called a “communist” for calling Mike Ross out on his campaign contributions at his town hall two weeks back.

Public Option or Start Over.

Seriously.

That’s what I’m saying. Be long or be wrong!

And Obama better realize he’s about to lose his hard working (for him) base if he cant deliver (@ the least a public option)!

Something to tell your conservative friends: Those who oppose meaningful reform will whine about the “lack of choice” under the public plan, yet they would force everyone in America to buy health insurance out of their own pocket — and that insurance wouldn’t cover diddly.

What about immigration legalization and cap and trade?

Exactly right, Jane.

No public plan, no mandate.

S

C

R

O

L

L

And let’s not forget enforcing trade laws, leveling the trade imbalance, so we can start getting manufacturing jobs back. Without strong paying manufacturing jobs, we will become the slaves of the elite in this country.

The Emmanuel brothers, Lieberman, and everybody in their ethnic tribe can always fly to Israel, get free health care, and then come back if they really needed to.

Is that a factor in this health care fight at all? Maybe not.

Why do you have to go racist?

Jane, two small corrections – “insurance” in the title is misspelled and your last line should read “no STRONG public plan, no mandate”.
Otherwise, thanks for an excellent post!

Ouch! Did you mean this to be as racist as it appears?

conrad and baucus arent dems in the way you mean it. SO, really, they put 6 republicans on it

Honestly, emmanuelle and leiberman dont need to fly anywhere, unless you mean through downtown with a police escort, to walk into the Dr.’s office and butt in front of everyone else waiting there. they have excellent “government run” health insurance right here in the U.S.A Inc.

*ding*

So Baucus proposes to increase the cost of our copays as well as tax employer paid benefits? Now that’s a vote getter.

I agree – start over. Time for an internet naming contest for the current mandate-without-public-option plan. A few suggestions: “Pay up or die plan” “HMO bailout plan” “No insurance company left behind plan” Someone can come up with a catchy slogan, because this proposed mandate to purchase for-profit insurance is so awful it’s laughable.

Maybe we should all seek medical asylum in Denmark

and designate our senate and congressional offices as the official taxpayer funded insane aslylum and then deny them coverage for their pre existing mental deficiency.

Here’s a specific and concrete public option: “Let people under 65 buy into Medicare.” Per Thom Hartmann:

[…] Medicare already exists. It works. Some people will like it, others won’t – just like the Post Office versus FedEx analogy you’re so comfortable with.

Just pass a simple bill – it could probably be just a few lines, like when Medicare was expanded to include disabled people – that says that any American citizen can buy into the program at a rate to be set by the Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) which reflects the actual cost for us to buy into it.

So it’s revenue neutral!

I prefer this the phraseology of “buying into Medicare” rathar than “Medicare for all,” because whenever I say Medicare for all people say, “But Medicare is already going broke…” When we say “buy in” that says where the money is coming from, going to, and getting there.

I don’t necessarily disagree but if that is true it begs the question, why go through the motions? Better (politically) never to have brought up the subject of health care reform than to campaign on the issue, begin a legislative process, and then appear to fail miserably in the effort.

Baucus bail out works for me.

This is a perfect example of why I believe in the nationwide movement to immediately call and cancel your health insurance policy. They are using your hard earned money to lobby against true health care reform. As it is now, you pay your premium and pray to God that the insurance company will agree to cover your medical care or not raise your rates again or drop you because you became ill. Dropping the policy seems like very small risk to me. Health care can change immediately if everyone who wants single payer will make one simple phone call to your health insurance carrier and drop your policy. Use your premium for yourself and your country to finance a trip to DC on Sept 8 to march for single payer. Ooops – guess you won’t need to spend it on a march to DC as a nationwide canceling of health insurance policies would bring the corrupt health insurance companies to their knees!

So your average worker would be paying medicare taxes AND paying for monthly Medicare coverage. Ok if you are 64 not if you are 24.

so the way i understand this, correct me if im wrong, that the “subsidies” to “help low income” people pay for the private insurance they are going to be forced by law to buy, are “tax credits”? and that these “tax credits” can be used for nothing else? so,tax revenue is going to be directly piped into insurance industry profits???OMG we have to kill this. i dont want to wind up on ron pauls mailing list but im really thinking we’re running out of options here.

Guess you missed the part about it being a choice. And for that 24 year old, the “old” Medicare would still be free when he reaches 65.

It’s not free! You pay taxes for the coverage.

You are right. I think that they will respond but only if a great deal of pressure is put on them. Election finance reform is the key to everything working again. We also need to take personhood away from the corporations.

So your average worker would be paying medicare taxes AND paying for monthly Medicare coverage.

Which, IIUC, is the status quo now and would remain so under all proposals currently on the table. The only difference is that the premiums would be paid to Medicare instead of a for-profit insurer and would presumably be significantly less than those charged by for-profit insurers.

Also on the table is discussion the matter of federal assistance paying health-insurance premiums, but presumably that assistance money could go toward Medicare premiums as well as those of for-profit insurers.

DING! DING! DING!

The insurance members of Congress have only covers 100% of their medical costs.

No, your “average worker” will still be getting her health insurance coverage through her employer. Or the VA. Or Tri-Care. And paying the very very small medicare tax to pay for coverage for her elderly relatives.

But anyone who does not get health care insurance through her employer would be able to pay a monthly premium to buy into Medicare.

It seems like a no-brainer to me.

You’re right Mary, but the Supreme Court is about to take up two cases that will push in exactly the opposite direction. I’ll see if I can find the link; I saw it yesterday.

I have considered leaving the country.Does Cuba take American defectors?

As federal workers, congress included us in Medicare around 1983 (I was 40). We started paying into Medicare at that time, while also paying a portion of the premiums for whatever health insurance coverage we selected under the Federal Employee Health Benefit |Plan (our part was about 33 percent of this employer supplied health benefit). I retired two years ago and came under Medicare last year. I pay about about $250 per month for the coverage under a selected FEHB plan and the government continues to pay its portion. Additionally, I pay about $100 per month for medicare, which essentially covers doctors and hospital (I don’t participate in part D, since the other insurance plan covers medication with a $20-co-pay). It is good coverage and it wasn’t unbearable to be paying into medicare at the same time as paying a portion of the health insurance before becoming elegible for medicare.

I’m 24 and have insurance through my company. My coverage rate is higher than what a 24 year should pay although my company picks up a great portion. My “group” is made up of many older than me and they pay a lower cost because my health care needs are not as great. I think everybody should drop their insurance coverage and yes the insurance companies will be drained of money. But the fun part is then we get to pay for all of our own medical expenses. The average medical costs per family is around $5000 per year right. Maybe we should all just get HSA’s and spend the $5000 a year and hopefully it will grow to have a positive balence in our later years. I would like to see costs of health care go down, not just find someone else to pay it for me. If everybody has the burden of having to pay then they should also be very engaged into having to put pressure on finding ways to bring the cost down.

FWIW, the Terry Gross’ Clean Air, on NPR, has this interesting interview with T.R. Reid in comparing U.S. health care with that in other wealthy nations. It sort of made me want to move to Britain, France, etc. He pointed out that all of the contries with universal health care, statistics indicate longer life spans that in the U.S., so “they don’t seem to be shoving the elderly over cliffs.”

And what happens when bad investment decisions and/or serious illness drains your HSA?

One thing that T.R. Reid has noted is that other developed countries do not allow for-profit insurers in their basic health-insurance market.

yeah, its pretty fucked up that after only 8 months of “change we need” Im working to get his big “health care reform” bumped off.

Your presentation pre-supposes that a 24 year old isn’t going to have any major health problems so why should you have to pay for those older?

$5k is not going to go very far in an HSA when presented with a catastrophic health crisis.

(Note: I speak from the fortunate experience of being in the AF when I developed a diseased gall bladder and had to have surgery to remove it. I was out of work for a month after the surgery. I was 30 years old. It happens and your way would not help folks)

How would that be different from paying medicare taxes and a health insurance premium?

I think you should be able to do whatever you want with your money ( to a point) and for a young proffesional with no children thats fine. most people without insurance (coverage) dont make enough money to put into HSA. When your company moves to taiwan, you might not either. or in couple years when you get married, and have kids…so..Anyone who wants to can start an HSA ANY time they want. we dont need government “reform” for that.

If you fly from Canada

What kind of public plan? Because the one they crafted in 3200 is not worth spit and won’t do anything to hold down the household costs of health care.

At #30, I recommended letting people under 65 buy into Medicare. Instead of paying premiums to a for-profit insurer, they’d pay into medicare, which should be a bargain given that their overhead is one tenth that of for-profit insurers.

Plan C.

Goddamn it I hate those fuckers. And yes, Medicare rates plus 5% sounds like the easiest public option available.

Excuse the profanity. The makeup of the Senate Finance Committee has me so pissed-off I can hardly type. Bribed-ass slimy fuckers with their excellent health care telling everyone else to piss off, we’re protecting the insurers.

No excuse necessary, they are “slimy fuckers”. Every last blug flea bitten dog of them

Olymipa snowe, max bauccus, kent conrad and evan bayh all live in states that have had over 100% increases in insurance costs in the last year.

76% reimbursement to 65% reimbursement cuts costs.
Insurer’s costs.
the consumer? YOYO.

I ranted about this and posted a copy in a diary on FDL, last week.

I can’t find past diaries on FDL.

And what’s up with the login system? I cannot save a password.

The very idea that these asshats can defend a racket where the basic math on costs does not even remotely add up. Hospital stays are much shorter, many illnesses can be handled with just drugs, no surgery. Even surgery has moved to outpatient over in-hospital for many minor procedures. Have insurance costs come down over the course of these massive improvements in health care? Fuck no! How come? Collusion, obv. I’ve learned a lot from lurking on this site. Actually I’ve learned a lot from ‘coming out’ and posting and eating the occasional insult when i’ve opined on something while uninformed. That’s great excepting the more I know the madder I am.

i agree with the “no public option, no mandate” line, but what worries me is, who says that the public option will be all that much better? is its reimbursement rate written into any of the bills? are there any caps on premiums or deductibles? from what i have been able to figure out so far they are designing it to be a “level playing field” – ie to make sure that the public option is *not* significantly cheaper or better than private insurance.

plus, the number of people who are even eligible to buy into the public option is pretty strictly limited, isn’t it? so will it really be all that helpful for most people?

A mandate will never work. It’s a stupid plan.

Wigwam – I agree with you completely. Pay your insurance premiums right into Medicare – a simple solution. And although your cuss words didn’t bother me … here is one of my favorites that won’t get “bleeped” …
“Egg sucking, snake bellied hound dogs”. Actually, I don’t think there’s a word in any language bad enough to adequately describe them.

If you go to The Seminal home page, scroll down to the Toolbox on the right that has the Registration/Login, Post a Diary, etc, there’s a link to “My Page.” click on “My Page, it should bring up all of your past diaries.

As far as logins, I have no idea. I tend to not log out of fdl so don’t have to login each day. But I think if you were not logged in, you would not be able to comment at any of the FDL sites.

Edit: if looking for a diary by someone else, click on the “Read More” button at the bottom of the list of most recent diaries. It will bring you to pages and pages of past diaries in the order in which they were posted. It takes brute force, but eventually you will get back to the diary you are looking for.

Any public option that is cheaper than private insurance will cause many small business owners to drop coverage and drive the employees to the public plan. So what you end up with is another hugh government program drowning in red ink. Kind of like the post office, eh?

As far as logins, I have no idea. I tend to not log out of fdl so don’t have to login each day. But I think if you were not logged in, you would not be able to comment at any of the FDL sites.

I suspect that remembering logins should be a function of the browser rather than the site.

That’s why at #30 I recommended letting people younger than 65 buy into Medicare, i.e., pay their premiums to Medicare and get standard Medicare coverage. That’s one possible public option, but it’s a concrete, realistic suggestion.

With 2 months remaining in the fiscal year 2009 the US Gov’t has spent 3.0 trillion, more than the nation has spent in any fiscal year ever. The 5 largest monthly deficits in history have occurred during the current 2009 fiscal year. There ain’t no money, son.

Given that those small businesses can use the money spent on helath care now to grow jobs, why is this a bad thing? It would make them more competitive with businesses in countries like England, Canada, Japan, Germany, France. It might even make the multi-national corporate behemoths respond to them and become more efficient.

Why do you hate small businesses and want to make it more difficult for them to succeed?

Logistically, I agree that this may be best way to implement the public option (basically, use the existing Medicare infrastructure for the new PO-based plan), but I still think that we need for this new Medicare-option to function as a real PO.. not a system that simply inherits the existing and highly problematic underlying Medicare cost-for-service structure. In other words, Medicare II has to focus on behaving like a competitive PO with respect to focus on lowering costs not only for the policy but on negotiating aggressively with end service providers (something Medicare has failed to do to date). Only then will the PO force private insurers that to “take” its price based on Medicare IIs rate to consumers and, in turn, be forced to push for price restructuring from the healthcare providers and from Big Pharma. But other than this caveat, I am all for letting Medicare be the basis for the design and implementation of an effective Strong PO.

In 2008, the world’s total gross domestic product (GDP) was 60 trillion dollars, a quarter of which ($14.25 trillion) was the U.S.’s GDP.

The US spends 17% of its GDP ($2.42 trillion per year) on healthcare compared to 10% for the other OECD nations, indicating that 41% of each U.S. health-care dollar (a trillion dollars per year) is unnecessary. Also, the U.S. spends an average of $7290 per capita per year on healthcare, roughly 2.5 times the OECD average of $2964, which indicates that 60% of each U.S. health-care dollar (1.45 trillion dollars per year) is unnecessary.

I don’t hate small businesses. “I am one” as they say. The problem is when you push all the previously covered private insured onto a po, it’s just a matter of time before Congress passes a “new tax” to cover the “unexpected” mass of people who went into the plan.

Which brings us to Tort reform.

Medicare gets the lowest rates of any insurer from the providers. Providers don’t like them because their rates are low, but love them because they pay right away and don’t fuck around like the private insurers do.

I agree with you that there is a lot of waste and inefficiency at the provider level, and what I’d like to see is a public health-service option along the lines of the Veterans Administration: http://www.washingtonmonthly.c…..ngman.html

yep. We pay 17% for the same quality of care other countries get for around 8-10%. And that 17% (20% of which are the insurers) grows at an average of 9% per year, versus about 3% for the rest of the OECD. When you pay 17% (or 14% after insurance premia) and get 8% in services, you have a fundamentally sick system. Unfortunately, Medicare cuts out the private premia but has done nothing to contain costs (the 9% per year and the difference between 14% and 8-10%). This problem is illustrated graphically here:
http://www.cbo.gov/ftpdocs/82xx/doc8255/825502.gif

The vertical access is % nominal growth rate in healthcare services (other than insurance premia). The blue line is Medicare. THe red is private insurance-funded care.

Torts account for less than 2% of our medical expenditures.

It’s not the actual tort but all the unnecessary tests that the drs. perform so they want get sued.

But isn’t a tax that gives everyone needed health coverage better than forcing businesses and individuals into bankruptcy for health care costs? Doesn’t it make sense from a public health standpoint?

Doesn’t it make sense to allow small businesses to be competitive against other countries that do have this coverage?

I’m sure any tax for this would be much less than current insurance costs

Doctors like to blame lawyers for unnecessary tests but often those test are additional revenue to the doctors themselves.

yeah.. but the problem is we NEED them to frack around, as you put it, with the sevice providers, to achieve cost containment. Costs need to come down radically for this to work. As it is, this system is doomed to failure.

Ultimately, my suspicion is that whatever PO we come up with will fail because the insurers will apply insufficient pressure on providers for costs to really come down enough (although we still need to try it this way first), and then VA-for-all becomes the only viable outcome (government takeover followed by massive, brutal cost-cutting – surgeons take that 97% pay cut I want for them).

This will happen in 2040 or whenever when the whole system goes belly-up.. if and when a strong PO fails. Without the PO, the status quo probably dictates bankruptcy and nationalization around 2017-2020, according to the studies I’ve seen. So ironicaly, the rethugs’ opposition to all change will lead to the People’s Republic all that much sooner (of course after hundreds of thousands suffer and die first).

Stop spreading the lie about “pushing” small busineses onto the PO, and frankly, youve got a lot of nerve complaining about some hypothetical problem, while govt is talking about ACTUALLY “pushing” the unisured onto PRIVATE insurace. jeezus, if the 47 million people could afford insurance they would have already done so.

I love math.

Eight months of change — a comprehensive progress report:

1) You can carry guns in national parks.

2) 17,000 more troops in Afghanistan.

3) Apparently, no more Pontiacs.

Absolutely true. Small business has been nearly as abused as individuals in this health insurance scam run over the last decade. Big Biz gets group coverage at lower prices while smalls can’t even hire new workers w/o sweating the cost of the health insurance, whether that person has dependents that will drive up the cost, how much of the cost they can shift to employees. It’s all bullshit – and worthy of RICO charges, actually. Big biz eats the smalls and then lays off their staff and moves the HQ. Thanks insurers! That works out great for the country. Fuckers.

Medicare cuts out the private premia but has done nothing to contain costs (the 9% per year and the difference between 14% and 8-10%). This problem is illustrated graphically here: http://www.cbo.gov/ftpdocs/82xx/doc8255/825502.gif

The vertical access is % nominal growth rate in healthcare services (other than insurance premia). The blue line is Medicare. THe red is private insurance-funded care.

Those healthcare services consist mainly of suppliers, hospitals, physicians, and testing facilities. Medicare has been prohibited by Congress from squeezing the major supplier, the pharmaceutical industry. A lot of the rest of the waste could be cut out by reducing the paperwork, which accounts for 31% of our healthcare expenditure — cutting it out would reduce our healthcare expenses to 11.7% of GDP. But obviously we can cut much of it out unless we went to single payer.

Since physicians are paid for treatment and only for treatment, there is a lot of unnecessary treatment in the U.S.: http://www.newamerica.net/publ…..d_american

But cutting down on treatment would require putting physicans on salary by instituting something like the Veterans Health Administration for everyone: http://www.washingtonmonthly.c…..ngman.html

Also S-chip expanded, air quality a bit improved (goodbye clunkers), some global respect restored, troops (slowly) moving out of Iraq, IG for the torturers, Lilly Ledbetter Act, US aid organizations can now counsel on birth control – it’s not all bad, really.

Yes it does make sense. Let’s not forget that health care for the uninsured is being paid for now, by everyone, and that’s a hidden cost that the insurers and everybody else ramps up and gets paid for at top dollar. It’s foolish to talk about how high the deficit is and as a result we can’t reform the system that makes our small US companies uncompetitive. Repubs run up deficits with unfunded tax cuts and war(s). Then complain that we can’t possibly afford social spending b/c of deficits. It’s an old game. When Dems get the whip hand, they cut defense spending (bye Iraq, and sorry) and raise taxes (except for the tax cut for the middle class coming right out of the pocket of the wealthier citizens this time). Naturally, Repubs hate this. But I know a lot of Repubs who are so ashamed of BushCo they voted for Obama as the biggest fuck you they could come up with to that whole regime. All they wanted was to pay less tax, not to totally slime the country. And real small business owners are all about the health care exchange, they need access to it including the public option for their people as well. This is not kicking anyone off private ins. at all. This is letting companies at last hire w/o thinking about cost, discriminating against employees w/family b/c of insurance cost, all that crap.

Very true. Obama has totally changed the tenor of our gov’t, in a good way, and has made lots of tiny changes for the good at the margin of things. Thing is, this is a historic opportunity for the kind of fundamental change we desperately need, in things like not having by far (far, far, far in most cases) the developed world’s highest incarceration rate, most violent crime, most children in poverty, worst health care, most exvessive executive salaries, and most reactionary policies towards gays and drugs, while being involved in at least two wars at all times, spending more on war than the rest of the world combined, and enabling/paying for Israel’s endless occupation of Palestine. With one-sixth of the first term gone, I’m not encouraged by the direction.

yep. which is why I’m convinced that this will eventually (at some point in the next two to four decades) move to VA-for-all, regardless of what we put together now. You’re not going to make this work unless the underlying cost structures start to resemble those of other OECD countries and that means physicians on government salary.

So with 5/6ths of his 4 years ahead of him, you are so unhappy with Obama’s effort? Obama worked v. hard in Illinois when he was a State Senator to force the Chicago police department to videotape interviews, in particular for capital crimes. People laughed at him for this, they thought it was so impossible. Standard practice now. People laughed at him for pushing to equalize the 10 years for crack, 1 year for powder cocaine sentencing rule – claimed it would ruin his career and make him look soft on crime. The law passed and he’s the President now. None of these people who ‘knew’ this standard knowledge knew jackshit. Didn’t mean to hijack this from health care, just want to offer up that he doesn’t give up easily and most things take longer than he or anybody else would like. None of those problems on your list took just 7 months to develop.

Medicare is going broke because of the Bush tax cuts. Raise marginal tax rates back to what they were under Reagan. Establish three new tax brackets at 500K, 1 mill, and 5 mill, and the problem’s taken care of. Then in the next few years make health care organizations high velocity organizations, and we’ll cut down costs by 50%. When all is said and done we can end up at 7% of GDP. It’s not really rocket science. It just requires Medicare for All and regulation, and not letting everyone do exactly what they want at the expense of taxpayers.

Right and none of their citizens are going broke due to the taxes they pay to fund their national health insurance, in those cases where they have it.

Right, thats all great.So now if the crack dealers get caught BEFORE they “cook up” the powder they get the mandatory 10years too. thats what we need. more drug offenders in prison on mandatory sentences. its very hard for most of us who have heard the president talk about how imporatant the PO is to “keep costs down”, and how we wont “get another bite at the apple”, to be “fired up and ready to go” over the insurance industry bailout, to be paid for with govt money and our enforced payments to insurance industries.

I prefer this the phraseology of “buying into Medicare” rathar than “Medicare for all,” because whenever I say Medicare for all people say, “But Medicare is already going broke…” When we say “buy in” that says where the money is coming from, going to, and getting there.

Your point is absolutely correct. But I don’t carry with me documentation sufficient to convince the average person of it. I find it ever so much more convenient and convincing to simply say “They’d simply pay their premiums to Medicare instead of their current insurer.” For me, it’s a matter of framing.

Medicare’s going to go broke because the unit cost for service (before insurance) is around 14% of GDP and increasing by 9% per year. In the long term taxes have nothing to do with the underlying problem. It is simply not possible to sustain an industry cost growth rate 6% higher than inflation per year, when the baseline today is already 6% higher than the rest of the world today. The math doesn’t work. Unless the cost-growth and production-possiblity-curve issue is addressed today, than we might as well start planning for the inevitable – system nationalization a la Canada or the UK.

One of the best docs. I had left a group private practice to go to the VA….not for money, but for a better schedule/more able to manage him time. Quality doc with quality values.

No, not the PO in HR 3200. We shouldn’t be demonstrating for that bill; we should be supporting HR 676, Medicare for All. Check this one, and check this also

no we shouldn’t. Unless y’all explain to me how you plan to get the math to work. ’cause it really doesn’t.

I’ll be pushing for the strong public option. Now, I don’t care if the strong PO leverages off of Medicare’s infrastructure and processing capability, but I want the strong PO as the only viable choice. Y’all can even call it Medicare II if you want to. But it must function as a competitive PO and not as universal single payer. Either that, or I want VA-for-all, full system nationalization, which I’m convinced is the only other workable solution. HR 676 will only work if you can roll back unit service prices to 1990 levels to begin with.

The average U.S. physician has horrible life expectancy. The are doing what’s in a factory is called “piece work.” It’s high pressure and the paperwork is extremely frustrating for them. They’d be personally better off working for less money and on a salary. And by the way, there is plenty of incentive for salary workers to do excellent work. For example, the doctors at the Mayo Clinic are on salaries.

No. You’s end up with a great burden off small business that would be a great boon to American small business and make it much more competitive with small businesses in nations that already have government-funded or subsidized health care.

Also it would free many from “job lock”, which would create a much more fluid and vibrant job market, and create competition for the best workers, which is probably yet another reason why large corporations and some small businesses dont want the PO also.

I think insurers like the “affordable” plans because they pick up young, healthy customers who think they are not going to get sick, i.e. customers they might not ordinarily have. Often those people don’t get very sick, and the insurance makes some profit from their premiums. Then when the customer does develop a major illness, they get necessary expensive hospital care, which the cheapo insurance doesn’t cover much of, and someone else has to pick up the tab or take it as a loss, which is fine with the insurer.

unlikely, because above all private insurance doesn’t want to lose good paying customers, and their margins are the highest right now for these small business types. “Bad” customers are the ones they dump based on existing conditions or who actually do get sick a lot, not small business employees. This is the beauty of the strong PO. Private insurers will become price-takers who will be forced to lower their premiums considerably AND simultaneouly those insurers will be incentivized to place pressure on pharma and providers to contain their own costs, in order to prevent themselves from suffering from margin compression. All the strong PO will have to do is set premium prices competitively, hopefully on a means-adjusted basis (which I’d like to see). I really think there should be means-adjusted pricing (but for equal service) at the PO, which will apply even more pressure to the private insurers and hence to the service providers.

National health ala GB or the VA would be great.

Medicare is going broke because there are several issues such as no centralization of tests,treatments, etc. Computerization and clear guidelines that would provide primary physician approve tests to avoid duplication and/or unnecessaey tests. Also there is considerable fraud on all levels, but one I have observed is in durable goods, equipment, medical supplies such as bandages. When the wrong items are sent and you advise your medicare supplier that you were sent the wrong items [24 in all] they say, “we’ll send you the correct items, but forget about our picking up the wrong items.” So I keep throwing away incorrectly sent bandages, packing, etc. constantly. Can you imagine how this and other outright frauds raise the costs? Accountability has not been establhed.
Finally the beginning of the sledge hammer to Medicare was Bush’s 2 tax cuts for the wealthy while we were [and are] conducting 2 wars.

Medicare needs to be controlled, but Baccus and Co are out to sabotage it and Obama has shown no leadership. In fact he has never given us a clear and detailed account of what his plan for reform actually is. His message has been muddled and he’s allowed the party out of favor to frame and control the debate. Democrats look weak, and Rahm seems to have a hand in this screwed up idea of strategy

Asking us to give up benefits in order to lower premiums is a joke. Another outrageous bait and switch as in the Medicare RX Plan D drug program with its doughnut hole.

Obama should know that it’s 3 AM and the phone is ringing. He should pick it up.

…and will likely be the only realistic option if these idiots keep on dithering, stalling and obfuscating. The rethugs don’t seem to realize that by preventing us from dealing with the problem today, they are simply advancing the date of the inevitable: full system nationalization. The only question is, how much misery and death will be required before we as a country realize that nationalization will be the ultimate cost of their disloyalty and their resistance to change.

Maybe you’ll enjoy this.

At our local healthcare meeting, a wingnut crazy was holding up a sign that claimed that anyone supporting a public option was a “red”. A polite, 20-something gentleman sidled over to me and asked what it meant! The old red-baiting is lost on this younger generation.

I thought “red” meant Republican ;-)

In response to Blub @ 98

Medicare’s going to go broke because the unit cost for service (before insurance) is around 14% of GDP and increasing by 9% per year. In the long term taxes have nothing to do with the underlying problem.

.
There’s a fundamental law of the universe that what can’t go on forever won’t. (I used to say that about the upward march of housing prices, but didn’t know how or when to cash in on that knowledge.)

The AMA early on endorsed Obama’s healthcare reform before any of the details had been publicly announced, sufficient evidence to convince me that the fix was in so far as providers were concerned. Nor have I heard any nay-saying from the Hospitals, so I’m sure they are being taken care of too. We’ve heard a lot about the deal that was cut for the prime medical supplier, PhRMA, so it’s clear that their status will remain quo. And there’s nobody else for the White House to squeeze.

The insurers’ medical loss ratio is roughly 80% and we’re spending 17% of our GDP on healthcare, so the non-insurer portion is roughly 14% of our GDP. (Specifically, 80% of 17% is 13.6% but that’s a lower bound; a lot of medical expenses go through Medicare from which the insurers don’t get a 20% cut.)

Do you have any breakdown of where the money goes for the non-insurance medical services?

Doctors at non-profit Kaiser Permanente are also on salary and don’t have to bill an insurance company for every procedure. For example, they can take time to teach prevention even when there is no insurance code for that. They don’t profit by doing procedures or lose money by not doing them. They’re still under time pressure in primary care, but there is no outside insurance company to get permission from and no claim forms.

I’m told by a friend whom I trust that Oszag is a very good and competent guy. If he is given sufficient authority he should be able to straighten out the Social Security and Medicare stuff. But I don’t know if that’ll happen.

Medicare is also suffering hugely from the deal that Repubs cut with Pharma when they added coverage for prescription drugs and at the same time prohibited Medicare from bargaining with Pharma for prices as the health plans of other countries do. Pharma is planning on including the same prohibition in whatever comes out of Congress now.

Good point. Any idea how they’re doing financially?

It’s an article of faith from the Gospel according to Saint Ronald that the government can’t/won’t run anything competently, and that certainly seems to be true whenever the disciples of Saint Ronald are in charge.

I think we’re just using different language. What I call the cost of service before insurance sounds like the same thing as what you’re calling the non-insurer portion (14%, which assumes that the cost of insurance is about 20% averaged system-wide). I’m on a PDA now, so I can’t link, but my understanding (from CBO, 2007) is that the breakdown is as follows: 32%-40% in-patient, 28-36% physican and hospital out-patient services, 9% drugs, 15% nursing/homehealth/hospice. The ranges are due to amounts under Medicare competitive bidding programs, so use the top end of the range for comparative purposes.

With respect to your point about things not growing forever, that’s good advice. The difference here is that there is no reliable self-correction built in, given the near-zero price elasticity of demand in healthcare services. All it means that in the end, when 50% of the country is uninsured and costs are at 30% of GDP, the system just stops working and we have to nationalize the whole system.

There’s as much money as we want to print. Also, if you don’t want to print it, we can always get more by getting out of Iraq and Afghanistan, ending those boondoggles, and raising marginal tax rates to where they were under Reagan. Frankly, if average Americans are asked whether they want guaranteed health care invulnerable to insurance company decisions, or whether they’d rather continue these foreign wars, I think I know what the majority would choose.

Blub, both extending Medicare and what you want can be legislated under reconciliation. It only takes 50 votes plus the VP.

I was talking about managerial logistics, not legislative logistics. As far as I’m concerned, any PO can be admistered by the existing Medicare programs’ administrative apparatus. They do a good job of it, even if they haven’t done anything to contain underlying costs.

Could be. But that tax won’t be nearly as much as you’re for insurance now, assuming your business provides it for your employees.

What about percent growth rate in private insurance prices?

What tort reform have to do with these costs. Try excessive administrative costs and excessive profits. Do you know what overhead costs are in Japanese private insurance companies? 1.5% Know why? Because they’re regulated, and if they charged anymore the public would fry them for waste.

But wigwam, that would mean that those in the public plan wouldn’t have any choice of providers. Don’t you think that would make the public plan uncompetitive relative to private insurance? -:)

I know. But I’d rather frame it the other way so I could remind them that our financial problems are due to wealthy people not paying their fair share and also to the incompetence of the previous Republican Administration which created the current financial crisis and the huge Federal deficits. Framing is one thing, but it should never stop us from facing up to major issues and not trying to walk away from them. Democrats have been doing that for too long. If we want to win we have to educate people; and that means shaking up their preconceptions as well as putting things into an attractive frame.

Blub, if we get a breathing space for a few years, we can bend the cost curve the other way. No question, we will have to regulate. Some people will have to make less. Our attitude towards tests will have to change. But things are done differently in other nations and they have better outcomes than we have. The time to start is now and the first thing to do is Medicare for All and forget about the public option, which won’t bend the cost curve. Once everyone’s in Medicare, we’ll be able to regulate much more easily and help people in the system to cut costs. I don’t mean to minimize how difficult this is going to be, but nonetheless this is the big picture, and if we continue catering to the private companies who have been extracting excessive compensation and excessive profits from their customers.

Medicare is the answer to UNIVERSAL Health care. This was proposed by Rep Pete Stark (D) Ca when the Clintons tried to reform Health Care. The bureaucracy is in place; just add everyone that wants to join Medicare. If you prefer private insurance; great! stay with your private carrier.

Blub, I plan to get the math to work by introducing process reforms that create declining costs. The waste in our medical system right now is incredible. We spend more than twice per person what the second most profligate nation spends. But enough work has been done to show that reforms that can costs radically can be introduced. See Steven Spear’s Chasing the Rabbit for examples of the kinds of things that can be done.

As for the PO, there is no PO that is a possibility in Congress right now that will work to introduce any meaningful competition. That is quite clear. HR 676 would immediately reduce costs by cutting out the administrative and profit costs of the insurance companies. That’s a great start. Additional cost reductions can be made by introducing the process reforms I referred to.

At this present time it appears that the insurance companies have managed to turn health care reform to their advantage, believing that the present chaos will give them unlimited license to do whatever they want to, charge whatever they want to, deny whatever coverage they want to, increase deductibles, and generally do whatever they feel is necessary to rake up even greater profits at the expense of the suffering citizens of this country. Worse, they have somehow managed to draft the most vulnerable elements of our society, such as senior citizens afraid of losing Medicare, in their service. If we continue on our present course, only the insurance companies are going to profit, and for the first time I am afraid that this country, which I love, may cease to exist, swallowed up by corporations.

Ha, I already have that idea. But not for health care reasons…

I’m ready to become an expat if were going to continue to give my tax dollars to wealthy corporations without any accountability, continue to not care about the least of us even when a good portion of the country demands it, fired the Republicans and put Dems in power.

We elected Dems to get things done, this is only ONE in a series of heavy duty social issues we need solved and solved correctly.

As somebody once said, “America tends to do things two or three times before it does the right thing and then asked, how come it took so long?”

How is this for a plan?n All of us who have a private health insurance policy drop it. I am speaking of those of us who have not been making claims, and will practice healthy measures to keep out of hospitals. One month of them not receiving premiums from us who simply pay for nothing will bring the vampire “health” insurance companies to their knees. Then they will be begging for a public option just to stay in business. That is the only message these bloodsuckers understand…when it cuts into their ill-gottten gains, maybe have to sell a mansion or two. Now that is how to negotiate.?

The content of this alarmist post is much ado about nothing. The Senate Finance bill isn’t going anywhere. The Senate bill to be voted on will be coming from Chuck Schumer’s Rules committee, and the final Conference bill will have public option and none of this content.

By Zane F Pollard, MD

I have been sitting quietly on the sidelines watching all of this
national debate on healthcare. It is time for me to bring some clarity
to the table by explaining many of the problems from the perspective of
a doctor.

First off the government has involved very few of us physicians in
the healthcare debate. While the American Medical Association has come
out in favor of the plan, it is vital to remember that the AMA only
represents 17% of the American physician workforce.

I have taken care of Medicaid patients for 35 years while representing
the only pediatric ophthalmology group left in Atlanta, Georgia that
accepts Medicaid. For example, in the past 6 months I have cared for
three young children on Medicaid who had corneal ulcers. This is a
potentially blinding situation because if the cornea perforates from
the infection, almost surely blindness will occur. In all three cases
the antibiotic needed for the eradication of the infection was not on
the approved Medicaid list.

Each time I was told to fax Medicaid for the approval forms, which I
did. Within 48 hours the form, (which was sent in immediately via fax),
came back to me , and I was told that I would have my answer in 10 days.
Of course by then each child would have been blind in the eye.

Each time the request came back denied. All three times I personally
provided the antibiotic for each patient which was not on the Medicaid
approved list. Get the point — rationing of care.
EDITED FOR LENGTH HERE

~~~ModNote: Material from outside sources needs to comply with Fair Use guidelines – limited to 200 words. Also, a link would be great. Thanks.~~~

The stock analysts on Wall Street would beg to differ.

I pray that the House progressive caucus holds the line & sinks this atrocity if it’s not REAL reform.

Dr. Pollard, I would bet there are a far greater number of horror stories that can be tied to the for-profit private insurance companies denying vital services. Seems there is no big outcry from people on Medicaid or those on a civilized system ,such as exists in France , for example.