The U.S. Health Care Debate

[Samurai Waki]

I don't understand this line of reasoning. At its most radical, the Dem proposal would put maybe five million people into a government sponsored insurance exchange. The much-dreaded "public option." And yet somehow this means we're going to become like Great Britain, where every medical professional is an employee of the state, where a truly socialist system of healthcare is entrenched?

I don't mean to say slippery slope, but man, that is a very friction-free incline you're standing on. The proposals, as they stand, are disappointingly modest, especially if we want to carve real cost efficiencies from the half-rabbit half-antelope system we currently have.

I really, truly wish the Repubs had been more involved in crafting the bill, rather than screaming "Socialism!" from the gallery. If both parties would just work together in good faith ... ah, who am I kidding?

Have the parties ever worked together in good faith? I always thought it was quid pro quo, which the Republicans could have done; they were practically getting handed the ball for shaping HCR, when the Dems didn't really need to, and they failed miserably. What happened to the days when the Republicans would have jumped all over the opportunity to make themselves look coherent?

[Crazed Rabbit]

I don't understand this line of reasoning. At its most radical, the Dem proposal would put maybe five million people into a government sponsored insurance exchange. The much-dreaded "public option."

Um, the House bill included the option to throw people in jail for not buying insurance - not buying insurance for yourself is to be a crime.
And complete government control over what insurance companies must offer and charge.
And forcing people through regulation into using the government option.
And control over what Doctors can prescribe in the way of treatments.
And forcing insurance companies to except everyone, including the people who waited until they got sick until buying insurance, and charging everyone the same price.

I think you are severely understating the scope.

If they had wanted to insure five million people, they could have put together some subsidy for people who can't afford insurance. And if they wanted competition and cost cutting, allow people to buy out of state insurance and allow companies to charge people doing unhealthy things more. And government price fixing always (@&$(s things up.

But they don't care about reform; it's about control, by having the government force itself into another huge facet of people's lives.

CR

[Xiahou]

I think you are severely understating the scope.

If they had wanted to insure five million people, they could have put together some subsidy for people who can't afford insurance. And if they wanted competition and cost cutting, allow people to buy out of state insurance and allow companies to charge people doing unhealthy things more. And government price fixing always (@&$(s things up.

But they don't care about reform; it's about control, by having the government force itself into another huge facet of people's lives.

CR

This public option will supposedly "compete" with private alternatives. As President Obama likes to put it, those who are happy with the insurance they have now can keep it -- and if they happen to prefer the government offering, well, gee whiz, that's the free market at work. The reality is far different. Not only will the new program become the default coverage for the uninsured, but Democrats intend to game the system to precipitate -- or if need be, coerce -- an exodus to government from private insurance. Soon enough, that will be the only "option" left.

link

To anyone who thinks that a public option wouldn't encourage people to abandon private insurance.... how many seniors turn down Medicare?

[Lemur]

To anyone who thinks that a public option wouldn't encourage people to abandon private insurance.... how many seniors turn down Medicare?

And how many seniors are agitating to get rid of Medicare? On the one hand, folks argue that the government is incapable of doing anything right. On the other hand, they argue that any public option will crush insurance companies. The two perspectives seem to be mutually exclusive.

Much more concerned about cost containment. What is healthcare now, 18% of GDP? Something obscene like that? If we accept that massive deregulation is a political non-starter ('cause it is), and that a radical experiment with all-private-sector medical care for all and sundry ain't gonna happen ('cause it ain't), then ... what? Yes, the Heritage Foundation and the Club for Growth would like to see an all-private healthcare system, but that is precisely as likely to happen as Fred Thompson becoming President. Maybe less likely.

Some sort of reform is necessary. And unfortunately, the Repubs blew their chance to influence it, by adopting the classical middle-eastern negotiating tactic of, "Give me everything I want or I won't talk to you." Which sucks, 'cause the Repubs could have bent this bill in a better direction. So now we have .. what? A choice between doing nothing, and nursing along our super-expensive gold-plated jackalope system, or the Dem bill? Why does neither option fill me with joy?

I hope every hardcore ideologue, both left and right, wakes up tomorrow with a massive fungal rash. Chasing ideological perfection is the enemy of practical problem-solving. And it's beyond absurd to insist that our healthcare system is not a problem.

[jabarto]

To anyone who thinks that a public option wouldn't encourage people to abandon private insurance.... how many seniors turn down Medicare?

Every time I see someone bring this up, I ask, "Why is this bad? The insurance companies aren't providing the services they're being paid for. They're less then worthless and need to have been thrown out a long time ago. Or are you seriously arguing for corporate welfare?"

I have yet to get anything resembling an answer.

And how many seniors are agitating to get rid of Medicare? On the one hand, folks argue that the government is incapable of doing anything right. On the other hand, they argue that any public option will crush insurance companies. The two perspectives seem to be mutually exclusive.

Yes, I love this. The party that runs on the platform of "government is inefficient" is worried about government efficiency usurping private companies?

[Philippus Flavius Homovallumus]

I don't understand this line of reasoning. At its most radical, the Dem proposal would put maybe five million people into a government sponsored insurance exchange. The much-dreaded "public option." And yet somehow this means we're going to become like Great Britain, where every medical professional is an employee of the state, where a truly socialist system of healthcare is entrenched?

This is utter Rubbish, and the mind boggels as to how the American media continues to press this. My Dentist is private, for example. I go once a year, pay up front and even my parents (who have horrific teeth) consider it cheap and worthwile.

Your system is totally broken, but it isn't to do with the public/private issue.

[jabarto]

This is utter Rubbish, and the mind boggels as to how the American media continues to press this. My Dentist is private, for example. I go once a year, pay up front and even my parents (who have horrific teeth) consider it cheap and worthwile.

Your system is totally broken, but it isn't to do with the public/private issue.

In his defense, isn't the NHS somewhat unusual amongst UHC systems in the degree to which it's run by the government?

[Beskar]

In his defense, isn't the NHS somewhat unusual amongst UHC systems in the degree to which it's run by the government?

It isn't actually ran by the government, only its budget is pretty much ran by the government, and it has a minister incharge of looking at general figures.

The day to day running of healthcare is done regionally. It is pretty much configured as a federal state would be.

[rory_20_uk]

It isn't actually ran by the government, only its budget is pretty much ran by the government, and it has a minister incharge of looking at general figures.

The day to day running of healthcare is done regionally. It is pretty much configured as a federal state would be.

As a model it would work in the States:

The DOH - Central planning / bean counting
Strategic Health Authorities - in America probably at State level. Oversight and punishment
Primary Care Trusts - smaller areas. In charge of bean counting and job preservation
GPs / hospitals beneath the PCT, and the only ones who deal with patients.

[drone]

I hope every hardcore ideologue, both left and right, wakes up tomorrow with a massive fungal rash.

Would that be covered under the public option?

[Beskar]

Would that be covered under the public option?

I think thats the point. All the lefties would get treatment for free and without hassle while the Wrongies have to suffer it, or pay $10,000 for treatment.

[Crazed Rabbit]

Much more concerned about cost containment. What is healthcare now, 18% of GDP? Something obscene like that?

And how is a huge, over trillion dollar government entitlement program going to solve that? You see the abyss we're headed to with social security and medicare and your solution for healthcare costs is another huge government entitlement program?

If we accept that massive deregulation is a political non-starter ('cause it is)

Yeah, it is, but that doesn't mean we shouldn't even remind people that it's a lot more likely to help than the government (and some other reforms, like what I mentioned in the last post, and limits on insurance companies kicking people out). I'd prefer nothing to the creation of a hue program that would be nigh on impossible to get right.

CR

[Lemur]

And how is a huge, over trillion dollar government entitlement program going to solve that?

Could be worse, could be Medicare Part D, which is by far the most fiscally irresponsible abomination passed in my lifetime.

Here's a surprisingly clear-headed column on the subject today:

For anyone who cares about reducing medical costs and improving outcomes, there are probably six big issues to follow in the coming weeks. Let’s take them one at a time:

THE EASY STUFF Each year, about 100,000 people die from preventable infections they contract in a hospital. When 108 hospitals in Michigan instituted a simple process to prevent some of these infections, it nearly eliminated them.

If Medicare reduced payments for the treatment of such infections, it would give hospitals a huge financial incentive to prevent them. The Senate bill takes a small step in this direction by cutting payments to hospitals with high infection rates by 1 percent. The House bill merely requires hospitals to report their rates publicly. There are also other basic patient safety areas in which the bills can do much better.

WHAT WORKS? Earlier this year, I used prostate cancer as an example of how our fee-for-service medical system leads to higher costs and worse outcomes. There are a handful of possible treatments for early-stage prostate cancer, and the fastest-growing are the most expensive. But no one knows which ones work best.

Modern medicine is full of such uncertainty. Again, the federal government could make a big difference here by giving Medicare a moderate amount of money for research, which would pay for itself many times over. The stimulus bill began paying for such research, but the health reform bills fail to pick up where the stimulus leaves off.

A FED FOR HEALTH Twice a year, an outside advisory board sends Congress a list of suggestions for Medicare payment rates, based on the available evidence. Congress generally ignores them, in deference to the various industry groups that oppose any cuts to their payments.

We already have a wonderful model for how to avoid such interference. It’s called the Federal Reserve. The Fed is charged with setting interest rates based on economic conditions, not politics. The Senate bill would create such a commission for Medicare. Unfortunately, it initially applies to doctors and home health care providers but not hospitals, thanks to a deal between the hospitals and the White House. It expands to include everyone in 2019. The House bill has no such commission.

Whether one ends up in the final bill will be a good test of Mr. Obama’s endgame leadership.

THE MCALLEN PROBLEM Both bills would create some promising voluntary programs meant to reward doctors and hospitals that provide good care rather than more care. But the doctors and hospitals providing the most expensive, wasteful care — like those in McAllen, Tex., described by Dr. Atul Gawande in a recent New Yorker article — surely will not sign up for these programs.

And the language in the current bills suggests that Medicare officials cannot make the programs mandatory without new legislation from Congress, which is an invitation for lobbying from places like McAllen. Giving Medicare the authority to expand even a single successful program would be a big improvement.

CHOICE Last week, the Democratic leaders in Congress sent out another e-mail message bragging that for people who didn’t like their insurance, health reform would provide “affordable choices for you that can’t be taken away.” That isn’t true. The bills would do nothing to expand the choices of people with employer-provided insurance.

Senator Ron Wyden, an Oregon Democrat, has been obsessively trying to change this — to give even a small slice of people with the most expensive employer plans a chance to buy insurance on the exchange for small businesses and the uninsured. It’s not yet clear if he will succeed.

THE CADILLAC TAX Along with the Medicare commission, this tax is the biggest single difference between the Senate and House versions. Right now, health insurance — unlike income — is not taxed, effectively creating a subsidy for the costliest plans and health care providers. Labor leaders have helped persuade the House to keep the tax exclusion intact, largely because many of the most generous insurance plans are held by older unionized workers, who, in turn, have a lot of influence in their unions.

But the tax exclusion is terribly costly for the rest of us. If it were to disappear, employers would have an incentive to sign up for well-run insurance plans, leaving more money available for workers’ salaries. If the Senate’s tax on so-called Cadillac plans were enacted, the average household would be making an additional $1,000 every year (in today’s dollars) by 2019, according to an analysis of Congressional estimates by Mr. Gruber. In my house, $1,000 a year counts as real money.

Are Congress and the White House likely to succeed on all six of these issues? Of course not. But if the final bill were just moderately better than the Senate Finance version, it would be a major victory. Even that Senate bill, as it is, would be worth celebrating. It has the potential to reduce cost growth significantly and to improve health — in spite of all the recent criticism on those counts.

And if the final bill ends up looking like the House bill? Well, then the criticism will have been far too tame.

[Don Corleone]

So your article, interesting one, btw, expounds at length on what the House Bill did not do. Would you care to offer what, in 1992 pages of legislation (beyond what I've mentioned already) the House bill actually does?

Just curious, but not enough to start a separate thread, what everyone thinks the odds of the Stupack ammendment are in the Senate, and in the reconcilation bill? In Massachusetts, local chatter has it pegged as "worth voting against health-care reform", ala Martha Cokely (Ted Kennedy's most likely successor), believe it or not.

Will Democrats allow their dream of universal coverage to be tied to the dream of an elective abortion public funding provision? Would you personally vote for the bill, regardless of your thoughts on abortion (or public funding for it)? Even if you believe in public funding of elective abortion, would you let the perfect be the enemy of the good? Most of the people running for Ted Kennedy's seat say emphatically "YES!"

[Lemur]

Gah, getting some sort of healthcare reform is far more important than abortion. As I have said in previous threads, pro- and anti-abortion absolutists are going to be at loggerheads until technology renders the debate moot.

From what little I've read, the Stupak Amendment is a perfectly acceptable compromise if it gets reform moving.

[Ronin]

Jon Stewart busts Faux News trying to artificially inflate the anti-healthcare bill rallies..

And these people call them selfs journalists.

[Seamus Fermanagh]

Clinton's advice to the Dems in the Senate is tactically sound. They should simply put the House bill on the floor, unaltered, and vote it in. Then there would be no conference or further debate, just a signature by Obama and one very large camel's nose stuffed into the tent.

Fortunately, they'll never do it and the Senate might let it die.

[Xiahou]

And how many seniors are agitating to get rid of Medicare? On the one hand, folks argue that the government is incapable of doing anything right. On the other hand, they argue that any public option will crush insurance companies. The two perspectives seem to be mutually exclusive.

What's mutually exclusive? Do you consider Medicare "done right"? Of course seniors like it. If the federal government flew by your house every month and dropped a bushel of cash on your lawn would you agitate to get rid of it? If you liked it, would that make it successful program? Medicare is oppressively expensive and is going to grow to ruinous proportions of the budget.

Some sort of reform is necessary. And unfortunately, the Repubs blew their chance to influence it, by adopting the classical middle-eastern negotiating tactic of, "Give me everything I want or I won't talk to you." Which sucks, 'cause the Repubs could have bent this bill in a better direction. So now we have .. what? A choice between doing nothing, and nursing along our super-expensive gold-plated jackalope system, or the Dem bill? Why does neither option fill me with joy?

Reform may be necessary, but that doesn't mean that any proposed reform is therefore necessary. Sometimes no reform is better than bad reform...

Could be worse, could be Medicare Part D, which is by far the most fiscally irresponsible abomination passed in my lifetime.

"It could be worse" isn't really much of an endorsement. I think anyone here would admit that Medicare Part D was a turd. In fact, I believe most every conservative here was opposed to it when it was passed. One interesting similarity between PartD and current reform though is how it's being sold. We were told PartD would actually save money, because thanks to all the wonderful pills seniors would be getting, they would need less expensive medical procedures. Of course, it's track record since and even the available data at the time showed that was false. With current reforms, we're being told that it will save money due to its emphasis on preventative care. Once again available data does not support this claim. Another similarity we'll see, if this passes, is that it's costs will wildly exceed the projected costs. Among it's arsenal of obfuscation, the current bill lists it's 10yr costs by beginning to charge us for the coverage before it's available. If you look at the costs starting when the plans are actually implemented, the costs balloon.


Did Medicare Part D stink? Yep. Are most Republicans playing politics with the current reform effort? Yep. But none of that adds up to us needing to pass the proposed reforms. The current deficit, and the deficits for the foreseeable future already blow away the worst Bush deficits several times over (I'm not assigning blame here, just stating the fact). It's hard to see how we can afford to be toying with a raft of expensive new government programs when we have no idea to pay for what we've got already.

Fortunately, they'll never do it and the Senate might let it die.

Let's hope.

[Louis VI the Fat]

Clinton's advice to the Dems in the Senate is tactically sound. They should simply put the House bill on the floor, unaltered, and vote it in. Then there would be no conference or further debate, just a signature by Obama and one very large camel's nose stuffed into the tent.

Fortunately, they'll never do it and the Senate might let it die.

https://www.youtube.com/watch?v=PSKH6Gw1TC8&NR=1

[jabarto]

Just a heads up, the Senate is going to vote on the healthcare plan after this weekend. Here's an overiview of what it will entail - http://www.pnhp.org/news/2009/novemb...d-bill-in-bold

As you probably gathered from the link, I'm hoping to god it will fail. My big issue of forcing people to buy crappy insurance with no controls on premiums is still unresolved.

[rory_20_uk]

The health system is utterly rubbish!
It's not worked for years! It costs a fortune with poor outcomes...



You spend as puch public money as some countries, then add twice again!



Oh, and the speed its getting worse is accelerating...

[jabarto]

It keeps getting worse...

http://www.politico.com/livepulse/12..._.html?showall

Moderate Sens. Landrieu, Olympia Snowe and Blanche Lincoln have an amendment to...remove states' ability to opt-out from a nationwide private insurance plan.

The next time I see someone clamoring for the ability to by insurance across state lines, I'm going to slap them. Not only will it acomplish absolutely nothing - if not make the situation worse - it's a big slap in the face to state's rights, somehting I thought the right was really big on.

[Seamus Fermanagh]

https://www.youtube.com/watch?v=PSKH6Gw1TC8&NR=1

Merci beaucoup! Tres drole! Je pense tres vrai aussi, mais je suis un "Grand Ancien Partie" person.

[jabarto]

Welp, the public option is officially dead.

http://hosted.ap.org/dynamic/stories...12-08-20-16-43

To be fair, it probably would have been absolute crap even had it made it.

[Louis VI the Fat]

Spin! Spin! Spin!


Meet the Republican Spinmeister:

Your new 28-page memo, “The Language of Health Care,” was sent to Republicans in Congress and recommends that they speak about health care reform in ominous phrases. For instance, you suggest that they refer to “a Washington takeover.”
“Takeover” is a word that grabs attention.




Is it a correct description of the president’s plans for reform?
We don’t know what he is proposing. We want to avoid “a Washington takeover.”


But that’s not at issue. What the Democrats want is for everyone to be able to choose between their old, private health-insurance plan and an all-new, public health-insurance option.

I’m not a policy person. I’m a language person.




http://www.nytimes.com/2009/05/24/ma...wwln-q4-t.html

[Beskar]

The thing is, it makes anyone looking towards America think Republicans are the slimiest -eating monkeys with a vested interested against the people of America.

In America, they don't know what politics is except from what they hear on Fox news.

All in all, it is a waste.

[Evil_Maniac From Mars]

The thing is, it makes anyone looking towards America think Republicans are the slimiest -eating monkeys with a vested interested against the people of America.

Not everyone, just the European equivalents of this:

In America, they don't know what politics is except from what they hear on Fox news.

The Democrats are easily just as useless in this whole debate.