“…near monopolies like insurers and providers…” with government support and enforcement power.

Guess I better put a bunch of emergency rooms on speed dial so I can negotiate the price to save my life from a heart attack, car accident, stroke, falling down the stairs, etc.

I think it was obvious that this was the plan. They want the onus on the individual not business, but aren’t willing to actually support that group. In point of fact the excise tax accelerates that, eventually every employer plan will hit it. Otherwise it would be based on what the plan contains NOT the cost of the premiums. And it will hit union jobs and employers in the states where the insurance companies are regulated the most first as insurance is generally more costly there.

If this shift to individuals were handled as it is in European countries such as Belgium, Switzerland, or France, it wouldn’t necessarily be a bad thing. But, of course, that won’t be the case and people will be further exploited by the medical/insurance complex until the vast majority of the country can’t afford healthcare. Then the hospitals, imaging centers, etc., will start to feel the pinch and all hell will start to break loose on both patient and provider sides.

“The goal of the Obama administration and many of its top defenders on health care seems to have always been to force everyone on to some form of private insurance exchanges.”

Obamacare was about cost-shifting to individuals and reducing their care. If Mitt Romney had tried to nationalize his Romneycare, the Democrats would have made a huge stink about it, but since a Democrat wanted to nationalize Romneycare, the natural opponents of corporatecare instead became its biggest cheerleaders.

Obama killed off everything that could have been useful in actually reducing costs (rather than just cost shifting), like with the Dorgan amendment, the public option, drug price negotiation, etc.

yep pretty obvious that the ACA is reaally the Unaffordable we don’t Care Act

Perhaps there is some hope in the way different states are developing their own plans. Vermont is a good example. I live in Oregon where a fast midnight train is running to develop Coordinated Care Organizations, whatever that means.. Medicare for all would be best, but faces too much opposition.
What a broke down mess..

This year the company I used to work for dropped their health insurance plan in favor of medical savings accounts.

I just got a note in my mail that my University is going to drop all medical coverage for retirees. No discussion. Just drop it. It was a great deal, and provided coverage when you visited the United States, which has become extremely risky for foreigners without insurance. I guess they believe they can hit the old people because they can’t strike anymore.

Until the profit is taken out of health care it will always suck… The VA system seems like a great model to me… But of course the Republicans have been chipping away at the system shifting more and more costs on the individual… again they think like Business people trying to make a profit on other people’s illnesses…

Occupy Medicare For All

Orszag thinks this is a good thing, because he believes in the free market economagic

the “free market” is not only “econmagic” it’s deliberate propaganda, the market RELIES on regulation, it can’t exist without regulation, what they really mean is “let us do what we want, regulations for us suck, regulations for the consumer are wonderful and they help us make TONS of money”

This afternoon I opted to pay for a full blood panel on my sick cat – $150. I didn’t take the time to shop around to find out if that was a good price or not. From what we can tell, it seems nothing too serious other than an infection which will hopefully respond to antibiotics.

He also got sub-cutaneous fluids, an antibiotic injection, and more oral antibiotics to be taken over 2 weeks.

The thing I was most impressed about was they could run a full blood panel right there in the office in less than 30 minutes. That’s something you can’t get as a human being in this world, unless you’re admitted to a hospital.

Single payor for all based on ability to pay.. Besides that would make American workers more competitive in the global market place… Every other country provides health care for all… Why can’t we?? Oh thats right the free market does a better job.. NOT!!

Believe it or not, it wasn’t all that long ago that the USA private sector used to provide pensions and retiree health care.

The first shoe to drop was that retirees got kicked off the health care plans with very little warning. Been down this road with my parents, who lost their corp-sponsored health insurance about a decade ago. My rightwing family, however, didn’t flinch and babbled out the usual Rush Limbaugh crap. It’s been costly, but fortunately Medicare still covers a certain amount, which defrays expenses.

I doubt that I’ll have *anything* remotely similar despite many long years paying into the system. Now we’re all supposed to “rugged individualists” including my 92 year old father who has Alzheimer’s. Believe me, my sibs and I have tried & tried to get the old geezer off his lazy butt and find a job but he just refuses. Can you imagine? What a lazy slacker… expecting that handout from the govt tittie… (yes snark, but in a way, not so much).

Best of luck to you. It’s certainly a challenge.

IMO, it’s better to just die.

The ‘private’ part of U.S. medical ind is the only part that’s almost completely malfunctional by now.

But that’s the plan.

I’m with you…

FAS 106, in 1992 was the turning point.

Financial Accounting Standard 106 required corps to account for medical benefits promised to retirees. I had identified medical inflation as a problem a year earlier, but not high enough macro priority for me to follow. So I sent my RA to NYSSA meeting on subject. She reported back that employers (biggies like Citi) were outraged that they should have to account for such promises. I should have recognized that outrage as an indication that they had no intention of honoring their promises, but I was much too naive to see that in 1992.

Right after that came ‘managed care’ and right after that came elimination of med benies altogether, not just for retirees.

Of course unlike Orszag, I consider this a terrible trend, because my health care theories are based on decades of historic international data instead of fantasy thinking.

That’s just sums it up–Austrian school fantasy, masquerading as economics. The reality-avoidance of neoliberal economists is just incredible.

Echoing Marvin Harris, about mistaken ideas in the social sciences in general, it’s really too bad that mistaken ideas in the social sciences don’t have to deal with the same immediate consequences as mistaken ideas in hard sciences like chemistry or physics do. For there the problem solves itself–practice reality-avoidance in the lab and in no time at all the bodies of people like Orszag get swept out along with the rubble they created.

-stewartm

Surely you jest about consequences of mistaken ideas in hard science.

Exhibit I: global warming.

Exhibit II (predicted by me): life possible planet discovery.

On edit: Among other impt diffs is a major one: whenever a political agenda is involved, no evidence, no science is sufficient to block crazies.

I just got a note in my mail that my University is going to drop all medical coverage for retirees

Of course, coupled with the news that they’re going to lower tuition for students…NOT.

Education and health-care in the are both badly overpriced and badly need reform.

I guess they believe they can hit the old people because they can’t strike anymore.

Anyone ever considered that, to be politically active, it helps more than a tad to be financially independent? To not to be beholden to anyone to live? (Jefferson certainly saw that as a key element of maintaining liberty).

Is then any wonder why the PTB are arranging things so that the groups that used to be traditionally active in the New Deal era (both college students and the elderly) are now being driven quite deliberately into dependency?

-stewartm

Corps, as detailed in 20, were 2 decades ahead of universities.

Exhibit I: global warming.

There too, the same consequences of reality-avoidance will come to fruition. Sad to say, in that case we don’t have a separate lab from the deniers.

-stewartm

As I typed earlier today, extinction of humans can’t come soon enough for me.

Yes, sad to say that the global climate change deniers consequences will come to roost on all of us. Hence, that’s why, I think, that eCAHN posits:

Exhibit II (predicted by me): life possible planet discovery.

Others here (not just eCAHN) have made this suggestion, which seems ever less far-fetched considering how effed up everything is. Does the Bush Crime syndicate actually have investments in off-world expansion, rather than just over the Paraguayan aquifer???

Beginning to feel the same way and making plans according (not kidding). It’s a really good time to start a meditation practice, if one is so inclined (again: not kidding).

Interesting. Well even working in the public sector, I have to say that – in reality – the health care benefits can really start to get costly.

I worked for a different agency previously. Long story short: bc of the way that retirement benefits had been set up (a very short time of work netted on a LOT of benefits), the agency was *supporting* more retirees than workers. Hence the service provided was severely impacted.

My solution, however, would not be just to turf the retirees off the system. Rather, the health care system should be massively overhauled so that retirees are not a huge drain for anyone, public or private.

Yeah, I know: being too rational again. can’t have that.

Yeah, but some of them are cute. (Sorry, thinking of red pandas with that remark).

-stewartm

Humans just practicing on pandas.

Servitude…………. Americans are in servitude to banks, oil whores and now, health insurance corporations? Under fear of tax penalty Americans are compelled, to enter into contracts with corporations who have historically, fucked us? To bad the government can’t control corporate scum, the way they try to control, people! Americans need access to health services, not modern fugitive slave laws, protecting “”health insurance corporations”" and the profits extracted from, and at the expense of life!

So how much fucking money did America waste out out collective fucking tailpipes today sitting in traffic going nowhere fast?????????????????

There was a story, not too long ago, where a high school forced a cheerleader to perform at a game where her rapist was playing. Seems like an appropriate metaphor for the times.

I believe the judge ruled against the cheerleader as well

My experience in the past couple of years with having to enter the individual health insurance market for the first time – EVER – was a real eye opener. It requires a lot of personal time and effort to acquire that kind of insurance and the insurance companies have really random and stupidly flawed processes for deciding who they will or will not insure. I’m feeling sick just thinking about it!

If companies do not provide insurance to employees, I think they will pay a cost in productivity because of the time and aggravation it takes employees to find it on their own. And, if the employee does a sucky job at choosing, they may be less healthy and thus less productive. Maybe some companies might just still care about productivity, but I don’t know.

Against her parents, but same difference, really.

With you on that.

x2000 but leave the kitties and doggies alone.

Corporate Sodomy enabled under the color of law. Congress and the corporate elite rape America the way “Sandusky” raped little boys?

http://www.cbsnews.com/8301-201_162-57338657/sandusky-jailed-on-new-child-sex-abuse-charges/

Voltaire comes to mind!

“He may personally detach himself (Abba Lerner) from that, but it’s not possible for the politicians to accept his advice, to detach themselves from the kind of government, and the kind of procedures, which enable those abstractions to become reality. And, that has to be grasped; because, now, no longer is economics merely a plaything of an obscure corner of the academic priesthood. Now economic policy is that which determines the lives, and daily lives and conditions of people. The form of economic policy, determines the kind of government, which is necessary to carry it out. And, the only kind of government which can carry out the kind of policy which Professor Lerner recommends … would have to be a Bonapartist or fascist government.” –1971 Queens College debate between Abba Lerner and Lyndon LaRouche.

http://www.youtube.com/watch?v=kLG66ER0UUM

Yes protecting, a “legitimate business/government interest,” football?

The standard, not full, blood panel should be available at every doctor’s office. But like everything else in America, it’s a business decision, so many places don’t even have the standard panel available.
Everything is sent out because it’s cheaper.
Every dollar they save, they can keep. They call it good business.
Doctors have businessmen like all other professionals (and the exceptions are a minority that only prove the rule).

When the “reformers” cut the baloney and find the WHY for how come the cost of medical services, NOT insurance, we might get somewhere. As long as the cost of medical services keeps skyrocketing, it does not matter what you do with insurance, it will continue to raise.

also, I recently has a friend from Canada who is an artist, and not conservative, write me an email which said “my husband recently had a quadruple bypass, so I’ve been quite busy. He had to wait so long to get it that he was very beaten down. It’s made the after care and attention more difficult.”

there must be a better solution than total free market or total single payer or total maze of bureaucratic pages of law.

None of those solutions works well. Everyone of them compromises something big.

Even when Doctors have the ability to do something in their office pretty easily, they still charge you/the ins co up the yin-yang for it. Bringing BigIns in as the middle man is what has really effed everything up, but I know I’m preaching to the choir.

Used to be that you just paid the Doc for what you needed, and the prices weren’t out of control. Having Ins for extreme conditions makes some sense, but having Ins for every effing hang nail is just stupid. But that’s how it’s developed, and the BigIns CEOs tap dance their way delightedly all the way to their off-shore accounts.

It’s all a RACKET, esp what BigHosp charges… insane.

compared to near monopolies like insurers

Reminder:

near monopolies like health insurers who also happen to have an anti-trust exemption. Thanks to the huge Democratic majorities and taking over of the White House, they used that opportunity to ensure that this anti-trust exemption continued.

What could possibly go wrong with a near monopoly with an anti-trust exemption??

The future of health care in American is that only rich people will have it. I would like to see occupy setting up clinics and bringing in Cuban doctors. As the resistance matures it will begin governing and providing assistance. The rich have their government. We need to be building ours.

Spot on – Vermont is the key – if allowed in 2014, its single payer financed by a payroll tax (plus the Federal subsidy that would otherwise be wasted on the “EXCHANGE” premiums for lower income folks) will lead the way.

Meanwhile God save us from folks like Peter Orszag who are not actuaries and know little of what they speak.

What Peter is aying is that the payout for health care – at least basic health care – must be limited – hence his “defined contribution” wording.

But Defined Contribution replacing Defined Benefit in pensions was a transfer of investment risk from the employer to the worker, while at the same time drastically cutting pensions because workers had no unions – all wrapped up in a way to increase financial institution wealth by charging for holding and advising on those “wealth accumulations”.

In health there is no “wealth accumulation” – at least not for any long period of time since the Medical Savings account always gets eaten up by medical costs every few years – it was a way for Casualty Insurance companies in Indiana to get their hands on a few dollars for a few years, so that the Casualty Insurance companies would not feel like second class companies compared to the life/annuity companies that were building a custodial/advisor fee income from holding all that defined benefit pension money and then the added money of the 401k/IRA accounts.

In health there is not that much potential fee income from custodial/advisor fee income.

So Orszak is not an actuary – and doesn’t know what the hell he is saying.

All that is true is that the US must join the other 157 countries that have single payer health for basic care with a annual budget as to its cost set by the gov – and medical care givers ordered to accept patients and to accept the gov’s payment as total or near total payment in full.

God – “defined contribution health” – God save us from economists that want to pretend to be actuaries.

Four times as expensive as the next most expensive country of the civilized world.
With worse measurable healthcare outcomes.
Ranked 37th in the most recent WHO ratings (the year 2000, and it’s only gotten worse since then.)

Hey, I know how to fix it – FORCE EVERYONE to buy it.

What a fucking JOKE.

Fas 106 – and the later two revisions – had zero effect on medical inflation. They also had zero effect on retiree health promises.

Obtaining workers overseas, lack of unions, no gov protection for unions, bottom line chasing by Wall Street all affected the adoption of retiree health. Indeed up until the Bush years I was still doing installs of retiree health in companies.

To be clear, the effect of Fas 106 was to set up what was in effect a one time liability for the run off of claims whose payment was promised for injury in the current year. Changes in that liability were minimal after the initial set up. There is no liability set up for the life of the retiree.

Peter Orszag is a bit of an enigma. He worked for a time with one of my friends wo says that he was a very liberal, good-hearted, and bright expert on pension systems. His brother, Michael, is also a world-recognized expert on pensions. (His late father, Stephen Orszag, was a brilliant mathematician who was a professor at MIT, Princeton, and then Yale.)

That said, after the time when he worked with my friend, it appears that he went over to the dark side. In 2006, he co-founded the Hamilton Project with Robert Rubin, and then-senator Barack Obama was the keynote speaker at their opening. (At one time, Rubin’s Muckety Map entry listed Orszag among his “personal relations” alongside Rubin’s wife and sons — he has since been edited out.)

Rubin was economic adviser to the Obama campaign and handled the economic side of Obama’s staffing. The Hamilton project was essentially a government-in-waiting and had to all but shut down as they all moved to the White House, with Orszag as Budget Director and the economics team staffed with other Rubinites.

Rubin and his buddy Pete Peterson are charter members of the .01%. Rubin, for example, is a director of Peterson’s Concord Foundation.

Meanwhile, Orszag has left the Obama Administration and gone on to collect his reward as Vice Chairman of Global Banking at Citigroup, a columnist at Bloomberg View, and an adjunct senior fellow at the Council on Foreign Relations. And that is the position from which he recommends defined contributions over defined benefits.

P.S.: I strongly recommend this 12/07/09 diary by fflambeau, which links to an even earlier diary by Dr. James Kirk Murphy. Here’s a sample:

I. Background: Why the Hamilton Project is Important.

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Obama’s Hamilton Project speech is vital to understanding the man since:

1) it shows the real Obama before his p.r./propaganda team repackaged him;

2) it shows his links, at an early age, to Bob Rubin and Goldman Sachs; he’s been owned by Goldman ever since;

3) it shows Obama has long been a free trader and lied to get votes when he promised to renegotiate NAFTA. He had no such intention and is philosophically opposed to such a renegotiation. He made that promise (and flip-flopped on it) to pander for union votes in Ohio while fighting Hillary for the nomination;

4) it shows Obama is in the bag for what Goldman really wants: free trade AND cuts to entitlements (including social security and medicare).

Before we examine Obama’s Hamilton Project speech, let’s pay tribute to a much earlier diary right here at Firedoglake which exposed this years ago. Hats off to Kirk James Murphy, M.D., whose diary, “The Hamilton Project: Same Corporatist Whine in New DLC Vessels” spelled this out back in February 13th, 2008. Dr. Murphy wrote in his diary this about the opening of the Hamilton Project:

Oh – the Senator who made time for the christening of the new corporatist think tank… the love child of the Clintons’ BFF Robert Rubin?
Sen Barack Obama.

Unfortunately, they continue to oppose assisted suicide.

Pretty soon this most powerful country on earth will have something in common with India: Elderly/sick/poor people dying in the gutter, and nobody gives a shit.

OH NOES! You mean in the future we won’t be held hostage by our jobs and will be able to freely leave or start our own business without having to fear losing our health care! The horror! The horror!

Really? This is all you’ve got left?