Health care pt5

[nemein]

continued from http://forum.dvdtalk.com/politics-world-events/561284-health-care-pt-4-a.html

[classicman2]

'This may be our only chance to save our children.'

Taken from Morning Joe show, 10/27/09.

[classicman2]

Do you all believe the 'state opt-out' provision will be enough to get he 60 votes?

[orangecrush]

'This may be our only chance to save our children.'

Taken from Morning Joe show, 10/27/09.Who said that? Also, I am sure they will say the same thing about cap and trade.

[Venusian]

So if a state opts-out of the public option, do its citizens get to pay lower taxes?

[classicman2]

3 Democratic Senators (Landrieu, Lincoln, & Nelson (NE) are going to be watched closely in this debate.

They probably hold the key.

[Venusian]

Will Snowe go along with a public plan?

[Groucho]

So if a state opts-out of the public option, do its citizens get to pay lower taxes?:lol:

[JasonF]

Do you all believe the 'state opt-out' provision will be enough to get he 60 votes?

Harry Reid obviously does.

I don't know if it will get 60 votes for passage, but I assume Senator Reid has whipped the caucus and believes he will have enough votes for cloture. I hope he's right.

[JasonF]

Will Snowe go along with a public plan?

She would have gone along with a public-option-with-trigger plan. She's expressed disappointment that Senator Reid went this route instead, but hasn't categorically ruled out voting for cloture or voting for the plan.

[wishbone]

Will Snowe go along with a public plan?excerpt

Reid said he hoped to eventually win over Maine Sen. Olympia Snowe, the lone Republican to back the Finance Committee bill. Snowe has indicated her preference for a "trigger" provision that would mandate creation of a public health insurance option in the future if specific thresholds for expanded coverage and other changes were not met.

Snowe issued a statement Monday, saying she was "deeply disappointed" with Reid's decision on the public option. She argued that a decision in favor of a trigger "could have been the road toward achieving a broader bipartisan consensus in the Senate."

"It's unfortunate the Senate majority leader decided to take a different path, because he did say it was a pretty good doggone idea with respect to the trigger in September, so I don't what has happened to change his mind," she said later.

"It's regrettable, because I certainly have worked in good faith all of these months on a bipartisan basis and, as you know, have been standing alone at this point as a Republican to do so because I believe in good public policy," Snowe added.

Reid said he was "disappointed that the one issue, the public option, has been something that's frightened" Snowe.http://www.cnn.com/2009/POLITICS/10/26/health.care/index.html

As classicman mentioned there are a few senators waiting for specifics of how the "state opt-out" will work. It does not sound like Sen Snowe is on board at the moment.

[JasonF]

So if a state opts-out of the public option, do its citizens get to pay lower taxes?

Senator Dodd's version of the Public Option was entirely premium-funded beyond a loan from the general treasury to pay for the first three months of operation. We haven't seen the merged bill yet, but it likely will be the same.

[X]

Can someone explain exactly what it means under Ried's plan to "opt out" of the public option?It means Reid is afraid of being defeated for re-election in a state that doesn't want a public option.

[classicman2]

Harry Reid obviously does.

I don't know if it will get 60 votes for passage, but I assume Senator Reid has whipped the caucus and believes he will have enough votes for cloture. I hope he's right.

I believe Reid feels he is in a position where he has to call up the 'compromise.' Whether he really believes he has the 60 votes, I don't know. I do know he has called up measures in the past when he didn't have the votes; but, merely because of pressure from his caucus.

[rw2516]

So if a state opts-out of the public option, do its citizens get to pay lower taxes?

Sure, just like citizens of states where there are no hurricanes, earthquakes or a primary river flood plain get to pay less taxes because they don't use as much, if any FEMA money.

[kvrdave]

Sure, just like citizens of states where there are no hurricanes, earthquakes or a primary river flood plain get to pay less taxes because they don't use as much, if any FEMA money.

:lol:

[Ranger]

I hope they at least get the health benefits tax through. The unions not supporting it has made it incredibly easy for me to support it.

But I suppose loopholes will be made just for them.

[kvrdave]

I hope they at least get the health benefits tax through. The unions not supporting it has made it incredibly easy for me to support it.

But I suppose loopholes will be made just for them.

Agreed. It will severely piss me off if they give them a loophole. I want the unions to have to deal with the monster they helped create.

[X]

Agreed. It will severely piss me off if they give them a loophole. I want the unions to have to deal with the monster they helped create.Dreams never die, do they? And that's just what that is. Just like tort reform.

Not to mention that in a few years everyone's health benefits amount will rise to the point where they all are taxed.

[orangecrush]

Senator Dodd's version of the Public Option was entirely premium-funded beyond a loan from the general treasury to pay for the first three months of operation. We haven't seen the merged bill yet, but it likely will be the same.That didn't work out too well for Florida with homeowners insurance. They ended up taxing ALL insurance policies 1% to make up for their losses because they didn't want to raise rates.

[X]

Looks like the public option just lost Lieberman.

He, Snowe, and others are probably just positioning themselves for accepting a trigger which will inevitably just make the public option occur a couple years later while providing political cover.

[Venusian]

Connecticut Sen. Joseph Lieberman said Tuesday that while he won't vote to block Majority Leader Harry Reid's plan from going to the Senate floor for debate, he would ultimately oppose the measure because it includes a public option.

As long as he'll vote for cloture, Reid should be okay.

[kvrdave]

That's stupid of him. He knows that anything that gets to the floor will pass, so if you oppose it, the only time to do it which makes sense is the cloture vote.

[classicman2]

As long as he'll vote for cloture, Reid should be okay.

How do you reach that conclusion?

[Venusian]

How do you reach that conclusion?

I could be wrong but I thought he had well over 50 votes for the bill and the problem was getting 60 for cloture. Is that not the case?

[JasonF]

I see two possibilities (not counting stuff like "Senator Lieberman has gone insane").

Possibility one is that Senator Lieberman will wind up voting for cloture, but he's trying to extract something in return. I don't know what that something is, but I'd bet there is something.

If he doesn't vote for cloture, the caucus has no reason to allow him to keep his seniority and his chairmanships. They basically extended an olive branch to him in 2008; if he turns around and bites them on the first vote where they need him, there is no incentive not to punish him severely. He knows this.

Possibility two is he's getting ready to leave the Senate to go work for Fox News as a hihgly paid talking head, and he wants the credibility with the right he would get by blowing up the public option.

[X]

You forgot the most obvious reason that a person who appears to have come around in the last several years to putting belief before party would have said this -- he realizes the "public option" isn't good for the public.

[JasonF]

You forgot the most obvious reason that a person who appears to have come around in the last several years to putting belief before party would have said this -- he realizes the "public option" isn't good for the public.

Now who's being naive, Kay?

[hahn]

You forgot the most obvious reason that a person who appears to have come around in the last several years to putting belief before party would have said this -- he realizes the "public option" isn't good for the public.What? How is having a public option bad for anyone??

I honestly don't understand the position by the Republicans. They're against a public option, but they want private health care insurance to be required. In spite of estimates that private health care insurance companies' profits have increased over 400% from 2000 to 2007. Meanwhile, at the same time their profits have been soaring, coverage has decreased. Now they want to force the public to buy this? Why? Do they actually believe the health care insurance companies will lower their rates or improve their coverage???

For-profit health care insurance companies should be illegal. Period.

[classicman2]

I wasn't aware that the the Repubs want private health care insurance to be required.

For-profit health care insurance companies should be illegal. Period.

Do you really believe that?

[wmansir]

FACT CHECK: Health insurer profits not so fat (http://apnews.myway.com/article/20091025/D9BI4D6O1.html)

Edit: I know it's a repost.

I noticed after the WH pushed back in the press over Palin's "death panels" comment that for several weeks the press would routinely mention the charge with the preface like "debunked claims of death panels.....". I would be lying if I said I had any hope this would happen for claims of gross health insurance profiteering.

[BKenn01]

Harry Reid obviously does.

I don't know if it will get 60 votes for passage, but I assume Senator Reid has whipped the caucus and believes he will have enough votes for cloture. I hope he's right.


I pray he is wrong....

Its time for an all out blitz to destroy this thing. The Red State Dems have to feel their job is on the line, that is the only way to stop it.

[Sdallnct]

For-profit health care insurance companies should be illegal. Period.

1st...private health care doesn't make that much profit. Do a little research including Fortunes ratings of industry (be sure and look ONLY at health care, not Life Insurance lumped in with Health care).

2nd...I want a FOR profit company. Look at auto insurance. Highly competitive, many choices from many companies and a great value. The companies compete by keeping cost down (being most efficient) and offering the best customer service. Claims are claims...the "profit" comes from efficiency, and good customer service. Take the profit away and no incentive what so ever to be the best you can be.

3rd...take profit away and what do you have? Look at homeowners in Florida or the National Flood program.

4th...for profit doesn't mean you deny claims to make money. Premiums are based on paying claims. Again, the profit comes from how efficient you can be. And if the incentive is profit, then you will do it. Besides, look at Medicare. They deny their fair share of claims.

[Nugent]

What? How is having a public option bad for anyone??

I honestly don't understand the position by the Republicans. They're against a public option, but they want private health care insurance to be required. In spite of estimates that private health care insurance companies' profits have increased over 400% from 2000 to 2007. Meanwhile, at the same time their profits have been soaring, coverage has decreased. Now they want to force the public to buy this? Why? Do they actually believe the health care insurance companies will lower their rates or improve their coverage???

For-profit health care insurance companies should be illegal. Period.

You have been guzzling too much of Mizz Pelosi's propaganda it would seem.
Where exactly to you get your "facts"? I just see some nonsense numbers being thrown around.

http://news.yahoo.com/s/ap/20091025/...alth_insurance


THE CLAIMS

_"I'm very pleased that (Democratic leaders) will be talking, too, about the immoral profits being made by the insurance industry and how those profits have increased in the Bush years." House Speaker Nancy Pelosi, D-Calif., who also welcomed the attention being drawn to insurers' "obscene profits."

_"Keeping the status quo may be what the insurance industry wants their premiums have more than doubled in the last decade and their profits have skyrocketed." Maryland Rep. Chris Van Hollen, member of the Democratic leadership.

_"Health insurance companies are willing to let the bodies pile up as long as their profits are safe." A MoveOn.org ad.

THE NUMBERS:

Health insurers posted a 2.2 percent profit margin last year, placing them 35th on the Fortune 500 list of top industries. As is typical, other health sectors did much better — drugs and medical products and services were both in the top 10

[BKenn01]

You guys are wasting your breath, the Left wants that 2% (plus the additional money it is going to take) feeding more bureaucrats. Profit is evil, remember........

[hahn]

You have been guzzling too much of Mizz Pelosi's propaganda it would seem.
Where exactly to you get your "facts"? I just see some nonsense numbers being thrown around.

http://news.yahoo.com/s/ap/20091025/...alth_insuranceI get my "facts" from the companies' own financial statements. 2.2% on $100 would not be a lot. 2.2% on $45 billion is $3.3 billion. That would be United Healthcare in 2006. Fortune 500 list of health care insurance companies and their revenue/profit from 2006 (http://money.cnn.com/magazines/fortune/fortune500/industries/Health_Care_Insurance_Managed_Care/1.html). And actually, if you look up the annual financials on Google or Yahoo Finance, they ended the full year of 2006 with a profit of $4.2 billion. In 2007, they made $4.6 billion.

Let's compare that to a company that most would recognize and consider to do quite well: Apple. In 2007, Apple had a net profit of $3.5 billion. In 2006, their net profit was $2 billion. So you're going to argue that United Healthcare's profits aren't very big?? You're being fooled by the percentage of profit margin. It might seem slim, but the revenues are so huge, it's a gigantic chunk of change. And unlike most other industries, they have very tight control over their costs through denials of claims. I don't believe that any of those for-profit companies listed have EVER had a loss in any fiscal quarter. EDIT: I just Googled and couldn't come up with ANY for-profit healthcare insurance company that has ever experienced a loss. If one had their head buried in the sand deep enough, one might believe that it's because they're ALL just that efficient and well-managed.

Yes, pharmaceutical and medical equipment companies make even more, but don't even get me started on how I feel about them. I'm not suggesting that healthcare insurance companies are the only problem in healthcare, but the idea of *healthcare* insurance companies operating on profit and growth is completely counter to the objective of providing quality healthcare to the maximum number of people.

And btw, for those who brought up other types of insurance, you cannot compare them to healthcare insurance. Not EVERYONE will get into a car accident. The vast majority of people will go through the hospital at some point in their lives and will use up far more than their contributed proportion of the pot.

Healthcare insurance is fatally flawed idea. It allows physicians to run many expensive tests without hesitation because they don't have to feel guilty about charging the patient (most physicians don't even know what the patients are charged), since the insurance companies are *supposed* to pay for it. They order *everything* even if it's unlikely because they want to cover their asses. Then when insurance companies who don't really have a good idea on a case to case basis of what's a justifiable charge and what isn't get the bill, they deny everything putting the impetus on either the hospital or patient to justify it.

Then you add in the notion of healthcare insurance for profit and everything just gets FUBAR'd.

BTW, here are some more interesting "facts" for you to chew on. Even as early as 2001 (way before the economic problems) medical bills were the leading cause of bankruptcy. AND, more than 3/4 of these had health insurance at the start of their illness. 38% were dropped by their health insurance company after they were diagnosed. LINK (http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.63/DC1)

Out of curiosity, to those of you who are arguing in support of private healthcare insurance - have any of you or your family members/close friends ever actually had a major illness that required expensive tests and/or treatments? I'm talking about needing tens or hundreds of thousands of dollars.

[hahn]

You guys are wasting your breath, the Left wants that 2% (plus the additional money it is going to take) feeding more bureaucrats. Profit is evil, remember........
By itself, profit is not evil. Profiting off ill people, however, is. You're entitled to your morals, as warped as I find them to be.

[DeputyDave]

What? How is having a public option bad for anyone??

I honestly don't understand the position by the Republicans. They're against a public option, but they want private health care insurance to be required. In spite of estimates that private health care insurance companies' profits have increased over 400% from 2000 to 2007. Meanwhile, at the same time their profits have been soaring, coverage has decreased. Now they want to force the public to buy this? Why? Do they actually believe the health care insurance companies will lower their rates or improve their coverage???

For-profit health care insurance companies should be illegal. Period.

I'm not a Republican but I haven't heard many claiming they want to make private health care insurance mandatory. Now, as a conservative I want nothing of the sort. Is that the newest statist talking point? Because you seem to be regurgitating all of the others.

[hahn]

I'm not a Republican but I haven't heard many claiming they want to make private health care insurance mandatory. Now, as a conservative I want nothing of the sort. Is that the newest statist talking point? Because you seem to be regurgitating all of the others.I worded that kind of poorly. The current (and as far as I know all of the previous ones) version of the healthcare overhaul bill has a mandatory healthcare insurance mandate. It is in there because it is popular with both parties. However, the Republicans are against the public option. Thus, what they want is everyone to be required to be insured, but without a public option, you are forced to buy from a private healthcare insurance company. The Republicans fear that if you have a cheaper public option, all the healthy people will go for that and private healthcare companies will suffer because people will then only go to them for insurance when they're actually sick. This is what the mandatory healthcare insurance is supposed to prevent.

IMHO, if no public option is available and healthcare insurance is mandatory, what will happen is a whole bunch of new healthcare insurance companies will then spring up that offer very very cheap healthcare insurance if you're young and not sick at all. Which then defeats the beneficial aim of mandatory healthcare insurance anyhow.

Neither scenario is ideal to me (I am against the idea of healthcare insurance in general), but I trust a public option more to provide a cheap alternative without trying to profit from it. And speaking as a physician, I would rather have a higher likelihood of a smaller payment each time, rather than have the possibility of no payment at all.

As a slight digression, I do believe that insurance reform is only the first step because healthcare insurance companies aren't the ONLY problem. Costs in medicine are ridiculous. Only problem is I don't even know where to begin. You look at some of the medical equipment around the hospital and if you ever bother to ask how much it costs (I have), you'd be shocked (I was). The healthcare system in general, has built a veritable fortress around itself and its profits. It's not going to be easy to take apart or fix. The more cynical side of me thinks that we should just let it implode kinda like the financial system has, so that we can start over from the wreckage. There's too many holes to patch and too many broken parts that just aren't fixable.

[hahn]

BTW, for those who keep arguing that this is just like auto insurance and mandatory auto insurance with for profit companies works there, you should read this: Mandatory Health Insurance Is Not Like Mandatory Auto Insurance (http://chronicle.com/blogPost/Mandatory-Health-Insurance-Is/7996/)

[Venusian]

Healthcare insurance is fatally flawed idea. It allows physicians to run many expensive tests without hesitation because they don't have to feel guilty about charging the patient (most physicians don't even know what the patients are charged), since the insurance companies are *supposed* to pay for it. They order *everything* even if it's unlikely because they want to cover their asses. Then when insurance companies who don't really have a good idea on a case to case basis of what's a justifiable charge and what isn't get the bill, they deny everything putting the impetus on either the hospital or patient to justify it.


So how would having a public option fix this? Or worse a single payer?

Why wouldn't the doctors still order every test since the govt is footing the bill now?

[Pharoh]

Could anybody give me some information on the health care bill possibly slated to go to the Senate floor, since I haven't read it yet? Will the public option be available to everyone, or only those under a certain economic threshold?

That was my original understanding while the bill was in committee, but I am not sure if it is still true.


By the way, the rationale given for this was because the proponents didn't want to destroy the private health insurance industry. But doesn't this type of system, if true, invalidate the competitive aspects?

[Pharoh]

I hope they at least get the health benefits tax through. The unions not supporting it has made it incredibly easy for me to support it.

But I suppose loopholes will be made just for them.

Do you want to pay such a tax?

[classicman2]

The first vote to watch is the procedural move by Reid - a Motion to Proceed. This will require 60 votes to proceed to the debate on the bill. If he doesn't get it - well, wait until next year.

Even if he does get the 60, he still will need 60 votes for cloture on the debate.

[CRM114]

Healthcare insurance is fatally flawed idea. It allows physicians to run many expensive tests without hesitation because they don't have to feel guilty about charging the patient (most physicians don't even know what the patients are charged), since the insurance companies are *supposed* to pay for it. They order *everything* even if it's unlikely because they want to cover their asses. Then when insurance companies who don't really have a good idea on a case to case basis of what's a justifiable charge and what isn't get the bill, they deny everything putting the impetus on either the hospital or patient to justify it.

I for one would not want my doctor to skip a test simply because of cost. If his professional opinion deems the test worthwhile, I don't want some guideline prohibiting that test.

[classicman2]

I for one would not want my doctor to skip a test simply because of cost. If his professional opinion deems the test worthwhile, I don't want some guideline prohibiting that test.

I agree.

When my surgeon ordered an ultrasound, fearing I might have a blood clot, I most certainly didn't object.

[kvrdave]

And with the government option, you won't have to object. Actually, you won't get the chance to.

[CRM114]

I agree.

When my surgeon ordered an ultrasound, fearing I might have a blood clot, I most certainly didn't object.

I think you need to have lived through a serious medical issue to get it.

[CRM114]

And with the government option, you won't have to object. Actually, you won't get the chance to.

Is this an assumption?

[wishbone]

Grayson apologizes for 'whore' remark
By JAKE SHERMAN & JONATHAN ALLEN | 10/27/09 12:21 PM EDT

Rep. Alan Grayson (D-Fla.) has apologized for calling a top adviser to Fed Chairman Ben Bernanke a “whore.”

“I offer my sincere apology to Linda Robertson, an adviser to Fed Chairman Ben Bernanke,” Grayson said in an emailed statement. “I did not intend to use a term that is often, and correctly, seen as disrespectful of women.”

In the emailed statement, Grayson gave further context to the comment, saying it was made “last month in the context of the debate over whether the Federal Reserve should be independently audited, was inappropriate, and I apologize.”

Grayson's apology is the latest in a string of incendiary statements by the Florida congressman, who in the past month has accused Republicans of wanting people to "die" rather than get better health care and has compared the health care crisis to a "holocaust."

Republicans circulated the audio Monday afternoon of Grayson calling Robertson a “K Street whore.” Todd Jurkowski, Grayson’s spokesperson, initially defended the remark by saying it was in reference to her time as the top lobbyist for Enron. He also pointed to an alternate definition in a dictionary.

“The attack was on her professional career, not her personal life,” Jurkowski wrote in an e-mail to POLITICO. “The second definition of ‘whore’ in the American Heritage Dictionary is 'A person considered as having compromised principles for personal gain.’”

Robertson lobbied for Enron, the Clinton Treasury Department and Johns Hopkins University before going to work for Bernanke. Jurkowski said his boss was simply making a point about Robertson’s prior work.

"She had the audacity to attack a congressman who used to be an economist. She's a career lobbyist who used to work for Enron and advocates for whatever she gets paid to promote," Jurkowski said.

It's the second time in recent weeks that a Grayson aide has cited a less-incendiary meaning for a word to try to put out a political fire Grayson lit by using strong language.

In a House floor speech earlier this month, Grayson blamed Republicans for the current state of the health care system, which he referred to as a "holocaust in America."

He was rebuked by the Anti-Defamation League and offered an apology for his remarks, but staff for Grayson, who is Jewish, insisted he was using the small-h "holocaust" rather than the capital-h "Holocaust" that refers to the Nazis’ murder of 6 million Jews.

Several of Grayson's colleagues, including House Majority Leader Steny H. Hoyer (D-Md.) have said his comments about Robertson were uncalled for.

Rep. Dina Titus (D-Nev.) called them "a bit extreme and rather sexist."

Rep. Anthony Weiner (D-N.Y.) said Monday night that Grayson is "one fry short of a Happy Meal," but changed his tune a bit after speaking to his Florida colleague about the matter.

"Alan Grayson is a friend and an extraordinary member of Congress. No obviously playful comment from me should distract from the important role Rep. Grayson has played in focusing on the true and tragic costs of our broken health care system," Weiner said in a statement e-mailed to POLITICO. "He is a leader and a patriot."http://www.politico.com/news/stories/1009/28786.html

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Nice attempt at spin Rep. Grayson and Mr. Jurkowski -- small-h holocaust, alternate whore definition...

[kvrdave]

Is this an assumption?

It's a joke about the catch-22 nature of it. If they don't limit things, prices will go up as the practice continues and will get worse as hospitals order more and more tests to make up for the amount the government in willing to reimburse for the tests. Or they can limit the tests and hold prices down while people revolt at the shit sandwich they were forced to eat.

But they will eventually be forced to ration, just like all the other healthcare systems.

[orangecrush]

I think you need to have lived through a serious medical issue to get it.I don't think the fears of over-testing are for those with serious medical issues.

[hahn]

So how would having a public option fix this? Or worse a single payer?

Why wouldn't the doctors still order every test since the govt is footing the bill now?I didn't say a public option would fix this. I'm saying that health insurance in general, whether private or public is a flawed idea. Health insurance is only part of the problem though. Doctors order a lot of tests that are unnecessary, but I'm not saying it's their fault. They cover their asses because of fear of lawsuits from a public that expects ZERO error from their physicians. And by zero error, I mean they expect that they shouldn't miss anything. Ever. That's not entirely the public's fault either though because they've been told that the U.S. healthcare system is the best in the world because it's doctors are the most knowledgeable and we have the most advanced technology. It's not true, but most people believe it. I would say most do it to cover their asses more than to make money, but I know of at least several cases through friends of mine (also physicians) from back East, where a certain department in a certain hospital orders a certain expensive test on EVERY SINGLE patient that gets referred to them just because they paid a lot of money for a cutting edge technology piece of machinery that does this test. Your eyeballs would pop out of your head if you knew how much was being charged.

And really, who's going to argue that it's unjustified? As physicians we can order pretty much whatever we want if we can come up with a reasonable suspicion. And it's really not that hard to come up with a reasonable suspicion for just about anything. But the question of how "reasonable" is defined is where the debate gets sticky. There are a lot of "unreasonable" tests or procedures done that out of sheer luck happen to be a good decision. So then it becomes hard to argue what was reasonable and what isn't. A lot of it is shaped by a physician's own experience. And unfortunately, yes, there are *some* highly immoral physicians out there who will use this to their advantage to maximize their charges. But how do you prove that? You can't.

But this is not a problem with a single factor. Many other things contribute to high costs and it's hard for me to say how much overtesting contributes compared to others (drugs, medical equipment, etc).

[Pharoh]

Could anybody give me some information on the health care bill possibly slated to go to the Senate floor, since I haven't read it yet? Will the public option be available to everyone, or only those under a certain economic threshold?

That was my original understanding while the bill was in committee, but I am not sure if it is still true.


By the way, the rationale given for this was because the proponents didn't want to destroy the private health insurance industry. But doesn't this type of system, if true, invalidate the competitive aspects?


I think I discovered the answer. Only those without access to employer provided insurance will be eligible for the public option, and even then those below an income threshold.

How in the world is this going to provide any competition, competition supposedly necessary to bring down costs?

[hahn]

BTW, as an aside, there was a recent NY Times article that talks about the American Cancer Society and how they're finally admitting that the benefits of cancer screening are overstated. LINK (http://www.nytimes.com/2009/10/22/health/22screen.html?scp=1&sq=cancer%20society%20screening&st=cse) This is something I've been arguing for years now and I'm glad it's finally put out there for discussion. It's one of those things that if you repeat often enough, everyone believes it's always true. Food for thought in this healthcare discussion.

[JasonF]

In terms of ordering too many tests, it's very easy to say in the abstract that doctors shouldn't perform a very expensive test to rule out a disease or condition that has a very small chance of being present. But if your doctor comes to you and says "It's 99.9% likely that you just have a simple headache, but 0.1% likely that you have a brain tumor that will kill you if we don't treat it. We need to conduct a CAT scan to know for sure," how many people will say "A 1 in a thousand chance of me dying from a treatable condition? Don't give me the test -- I'll play those odds!"

[orangecrush]

In terms of ordering too many tests, it's very easy to say in the abstract that doctors shouldn't perform a very expensive test to rule out a disease or condition that has a very small chance of being present. But if your doctor comes to you and says "It's 99.9% likely that you just have a simple headache, but 0.1% likely that you have a brain tumor that will kill you if we don't treat it. We need to conduct a CAT scan to know for sure," how many people will say "A 1 in a thousand chance of me dying from a treatable condition? Don't give me the test -- I'll play those odds!"If you had told me it was 10,000 to 1, I would have taken it. Because, we all know if someone gives you 10,000 to 1 on anything, you take it. (Indecently, if John Mellencamp ever wins an Oscar, I am going to be a very rich dude)

[kvrdave]

It's one of those things that if you repeat often enough, everyone believes it's always true.

Just like there being a "health care crisis."

Hell, there is a budget crisis and a national debt drisis, but a health care crisis? Bah!

[CRM114]

I don't think the fears of over-testing are for those with serious medical issues.

Who is it for?

[CRM114]

I think I discovered the answer. Only those without access to employer provided insurance will be eligible for the public option, and even then those below an income threshold.

How in the world is this going to provide any competition, competition supposedly necessary to bring down costs?

I suppose that since healthcare coverage will be mandated, the public option will now have 30-40 million potential subscribers that the for-profits will want to snag as well. They will need to lower their rates to capture those customers.

But it's all nonsense. Single-payer, Medical for All is the only true solution but no one has the ability to communicate this without being called a Communist.

[hahn]

In terms of ordering too many tests, it's very easy to say in the abstract that doctors shouldn't perform a very expensive test to rule out a disease or condition that has a very small chance of being present. But if your doctor comes to you and says "It's 99.9% likely that you just have a simple headache, but 0.1% likely that you have a brain tumor that will kill you if we don't treat it. We need to conduct a CAT scan to know for sure," how many people will say "A 1 in a thousand chance of me dying from a treatable condition? Don't give me the test -- I'll play those odds!"
That's my point. People have zero tolerance for risk. Both patients and physicians. But then if you run a that CT scan on 1000 people just to catch that one person's brain tumor. Then you have to deal with the question of what % of the time is it treatable because what's the use of catching an untreatable brain tumor? So then is it worth it?

Before you say yes too quickly consider this hypothetical. What if there's a very expensive treatment that costs $100 billion dollars but will guarantee a cure for an otherwise fatal disease that only occurs in 10 people per year. Do we absorb $1 trillion dollars of cost (obviously these people can't pay it) in the healthcare system to cure these 10 people? Obviously I've exaggerated the circumstances here to make a point, but I hope you see it.

[CRM114]

In terms of ordering too many tests, it's very easy to say in the abstract that doctors shouldn't perform a very expensive test to rule out a disease or condition that has a very small chance of being present. But if your doctor comes to you and says "It's 99.9% likely that you just have a simple headache, but 0.1% likely that you have a brain tumor that will kill you if we don't treat it. We need to conduct a CAT scan to know for sure," how many people will say "A 1 in a thousand chance of me dying from a treatable condition? Don't give me the test -- I'll play those odds!"

I had (what was never officially diagnosed as) "viral meningitis." They had to do tons of tests including a spinal tap to rule out "spinal meningitis." I'm glad they did whatever tests necessary to make me well. By the way, they told me that to diagnose it as viral meningitis FOR SURE, they'd have to do a bunch of other tests which they didn't bother doing since VM just goes away on it's own.

[orangecrush]

Who is it for?People w/ runny noses and headaches. Let's face it, even 1000 to 1 is still pretty good ;)

[orangecrush]

But it's all nonsense. Single-payer, Medical for All is the only true solution but no one has the ability to communicate this without being called a Communist.It isn't the only solution for every country w/ a system different from our own.

[CRM114]

Before you say yes too quickly consider this hypothetical. What if there's a very expensive treatment that costs $100 billion dollars but will guarantee a cure for an otherwise fatal disease that only occurs in 10 people per year. Do we absorb $1 trillion dollars of cost (obviously these people can't pay it) in the healthcare system to cure these 10 people? Obviously I've exaggerated the circumstances here to make a point, but I hope you see it.

Yes since obviously nothing would cost billions of dollars. That is the point of insurance. What's the difference between that and us "absorbing" the cost of performing 5 open heart surgeries on some 500lb blowhard?

[CRM114]

People w/ runny noses and headaches. Let's face it, even 1000 to 1 is still pretty good ;)

I never was tested for anything with a runny nose and headache. Add vomiting though and yes.

[CRM114]

It isn't the only solution for every country w/ a system different from our own.

I thought all the other countries had socialized healthcare and therefore it was horribly substandard? (Except Singapore, apparently. :))

[Dr Mabuse]

It isn't the only solution for every country w/ a system different from our own.

Exactly.

It's no accident you never see an excellent example like the French model looked into in the propaganda war that is the 'health care debate'.

It's most always Canada or Britain, because the masters of information have put together 'why it's bad' arguments on those two.

[Pharoh]

I suppose that since healthcare coverage will be mandated, the public option will now have 30-40 million potential subscribers that the for-profits will want to snag as well. They will need to lower their rates to capture those customers.

But it's all nonsense. Single-payer, Medical for All is the only true solution but no one has the ability to communicate this without being called a Communist.

It likely is more 15 to 20 million, people who aren't going to be courted by the private insurers regardless. There simply isn't going to be any competitive aspects that will aid in the lowering of costs.

We are going to get a fully broken system that makes things worse, or a system that necessarily leads to a single payer system so favourable to yourself. I just wish the discussion was honest.

[hahn]

Yes since obviously nothing would cost billions of dollars. That is the point of insurance. What's the difference between that and us "absorbing" the cost of performing 5 open heart surgeries on some 500lb blowhard?The point is that there is a price point at which one would say this is no longer worth the cost to insurance pool of money. Everyone may have a different price threshold, but the point is that there IS one. We continue acting as if health is priceless and that we should do anything and everything to ensure that everyone is healthy all time and we should spend lots of money to make sure there isn't even the possibility that there could be something we're missing. It's the inconvenient truth of healthcare - health has a price tag.

Regarding your story, I wouldn't argue that you were overtested. And I would point out that I didn't say that everyone and every case is overtested. Just that many are. To be honest, I don't have a good idea of how bad the problem is. I don't have specific figures on how much overtesting is costing the system. No one does. Because overtesting is not an objective measurement and so it's difficult to get an accurate picture.

[orangecrush]

I thought all the other countries had socialized healthcare and therefore it was horribly substandard? (Except Singapore, apparently. :))It may shock you to know that I actually think that our system has more problems than this guy:
http://images.fanpop.com/images/image_uploads/Black-Knight-monty-python-380119_800_441.jpg

I just think our system would do better if people had more incentives to reduce costs than it would if it were Medicare+ But I can admit it when I am wrong. If we get Medicare+ and it turns out roses in the long run, I will buy you a beer. Just don't make me buy you a PBR.

[maxfisher]

get my "facts" from the companies' own financial statements. 2.2% on $100 would not be a lot. 2.2% on $45 billion is $3.3 billion. That would be United Healthcare in 2006. Fortune 500 list of health care insurance companies and their revenue/profit from 2006. And actually, if you look up the annual financials on Google or Yahoo Finance, they ended the full year of 2006 with a profit of $4.2 billion. In 2007, they made $4.6 billion.

Let's compare that to a company that most would recognize and consider to do quite well: Apple. In 2007, Apple had a net profit of $3.5 billion. In 2006, their net profit was $2 billion. So you're going to argue that United Healthcare's profits aren't very big?? You're being fooled by the percentage of profit margin. It might seem slim, but the revenues are so huge, it's a gigantic chunk of change. And unlike most other industries, they have very tight control over their costs through denials of claims.

So you think it's just totally irrelevant that United Health Group's revenues were over 350% of Apple's in 2006 and over 300% of Apple' in 2007?

Also, who do you think that 'gigantic chunk of change' goes to? Who do you think owns the health insurance companies? Do you really believe those owners don't deserve a return on their money?

I don't believe that any of those for-profit companies listed have EVER had a loss in any fiscal quarter. EDIT: I just Googled and couldn't come up with ANY for-profit healthcare insurance company that has ever experienced a loss. If one had their head buried in the sand deep enough, one might believe that it's because they're ALL just that efficient and well-managed.

This sounded ridiculous, so I looked into the last decade for ten big ones. Half them had posted losses at least once.

Aetna posted losses of $2.5 billion in 2002 and $279 million in 2001.

Humana posted a loss of $382 million in 1999.

Cigna posted a loss of $398 million in 2002.

Amerigroup posted a loss of $50 million in 2008.

Centene posted losses of $9 million in 1999 and $43 million in 2006.

[Dr Mabuse]

I just think our system would do better if people had more incentives to reduce costs than it would if it were Medicare+

You think?

Only problem is Obama and the Dems signed back room deals with the big three: Pharma, insurance, hospital corps, that guaranteed they wouldn't ask the three reasons why we have health care costs magnitudes greater than anyone on the planet to control, much less reduce costs in any way. Since insurance companies quite literally declared war on the sick and started dancing for Wall Street, their premiums have skyrocketed over the last 10 years. This bill does nothing about that because Obama and the Dems care FAR more about the lobbyists and re-election money than they care about the much-heralded 'change' bullshit they were spewing on the campaign trail. I mean every campaign, except for re-election, is about 'change', but the degree to which Obama in 2008(particularly) and the Dems in 2006 sold that bullshit was unprecedented IMO.

The normal bullshit trotted out like tort reform(amazing anyone would fall for it but they do, mostly along party lines), so-called 'defensive medicine', etc. are bullshit put out by the masters of information that do not even amount to a drop in the bucket combined. But they 'sell' to the ignorant and the ideologue alike.

Until we address those big three above, there will only be continued skyrocketing costs in the US. Costs skyrocketing for a health care system that already costs magnitudes more than anyone other on earth, and barely cracks the top 20 for actual results.

[kvrdave]

If the idea is just to extend our lifespan and quality of life (as the end result), it would be much simpler to simply require everyone to be either Mormon of Seventh Day Adventists. They live an average of 10 years longer than the rest of us. That's even better than all the other countries we tout as having such great lifespans.

[orangecrush]

The normal bullshit trotted out like tort reform(amazing anyone would fall for it but they do, mostly along party lines), so-called 'defensive medicine', etc. are bullshit put out by the masters of information that do not even amount to a drop in the bucket combined. But they 'sell' to the ignorant and the ideologue alike.
I don't know about others, but my true motivation for wanting some kind of tort reform is really just about sticking it to the lawyers. If I can sell it by claiming health cost benefits, so be it.

[BKenn01]

By itself, profit is not evil. Profiting off ill people, however, is. You're entitled to your morals, as warped as I find them to be.

It has nothing to do with my morals. Without profit in the system there is no incentive for innovation or advancement in new medical technology


I'm not a Republican but I haven't heard many claiming they want to make private health care insurance mandatory. Now, as a conservative I want nothing of the sort. Is that the newest statist talking point? Because you seem to be regurgitating all of the others.


I am a Conservative and I would argue that if the insurance companies are going to have to cover preexisting illness, you have to require it OR wave the requirment on people who have been uninsured for a period of time to eliminate people putting off getting insurance till they need it.

[hahn]

So you think it's just totally irrelevant that United Health Group's revenues were over 350% of Apple's in 2006 and over 300% of Apple' in 2007?

Also, who do you think that 'gigantic chunk of change' goes to? Who do you think owns the health insurance companies? Do you really believe those owners don't deserve a return on their money?
No, it's not irrelevant. That was the point. They have a smaller profit margin, but huge revenues. Thus, their profits are huge. The previous argument was their profits weren't very big. My argument is that they ARE. See what I wrote below in response to your claim that the owners "deserve a return on their money". It's fairly basic economics here. Healthcare costs. Quality healthcare costs more. Healthcare insurance companies that have shareholders are under pressure to grow profits. That is the whole point of being a for-profit healthcare insurance company. You can do that either by getting more people to sign on, OR you can cut costs. Or do both. Cutting costs leads to...you get the idea.

This sounded ridiculous, so I looked into the last decade for ten big ones. Half them had posted losses at least once.

Aetna posted losses of $2.5 billion in 2002 and $279 million in 2001.

Humana posted a loss of $382 million in 1999.

Cigna posted a loss of $398 million in 2002.

Amerigroup posted a loss of $50 million in 2008.

Centene posted losses of $9 million in 1999 and $43 million in 2006.
Guess I didn't look back far enough. Still, that doesn't change the fact that they can control their costs by simply denying more claims. Since the topic of justifiable claims is so complex and twisted, they get away with it pretty easily. There's not much an individual can do to force a healthcare company to pay up if they don't want to. Sure you could take them to court, but they've got deeper pockets and better lawyers than you. Most wouldn't take it that far.

For those who believe that healthcare insurance companies "deserve" to profit, I would ask, "based on what?" What are they contributing to healthcare that helps people? And how much profit do they deserve for whatever you think their contribution is to healthcare? While I'm against the idea of healthcare insurance, I'll admit I'm not sure what a better idea would be. But if we have to have healthcare insurance, there shouldn't be companies skimming profits just for being able to spread the money around. That's why I think that government should be at least partially involved. At the very least, these companies should be regulated a lot more than they are.

[Sdallnct]

Out of curiosity, to those of you who are arguing in support of private healthcare insurance - have any of you or your family members/close friends ever actually had a major illness that required expensive tests and/or treatments? I'm talking about needing tens or hundreds of thousands of dollars.

Yes.

As I have mentioned, I have had several different health insurance over the last 20 years. But in no way will health insurance ever make money on me, my kids or their kids.....

And when I did not like the service I got from one company during one issue, after it was all done, I left them and went to another.

I like choice. I like options. I like shopping around. The best insurance I ever had was a HMO. And YES we used it. I'm not using a HSA...I liked it for 2 years, but out of pocket more than I'd like this year. So I might switch.

[Sdallnct]

No, it's not irrelevant. That was the point. They have a smaller profit margin, but huge revenues. Thus, their profits are huge. The previous argument was their profits weren't very big. My argument is that they ARE. See what I wrote below in response to your claim that the owners "deserve a return on their money". It's fairly basic economics here. Healthcare costs. Quality healthcare costs more. Healthcare insurance companies that have shareholders are under pressure to grow profits. That is the whole point of being a for-profit healthcare insurance company. You can do that either by getting more people to sign on, OR you can cut costs. Or do both. Cutting costs leads to...you get the idea.


Guess I didn't look back far enough. Still, that doesn't change the fact that they can control their costs by simply denying more claims. Since the topic of justifiable claims is so complex and twisted, they get away with it pretty easily. There's not much an individual can do to force a healthcare company to pay up if they don't want to. Sure you could take them to court, but they've got deeper pockets and better lawyers than you. Most wouldn't take it that far.

For those who believe that healthcare insurance companies "deserve" to profit, I would ask, "based on what?" What are they contributing to healthcare that helps people? And how much profit do they deserve for whatever you think their contribution is to healthcare? While I'm against the idea of healthcare insurance, I'll admit I'm not sure what a better idea would be. But if we have to have healthcare insurance, there shouldn't be companies skimming profits just for being able to spread the money around. That's why I think that government should be at least partially involved. At the very least, these companies should be regulated a lot more than they are.

You simply have no concept of insurance. Your same argument could apply to home or auto insurance. Need to make more money? Just deny more claims. Insurance companies are in the business to pay claims. They set their premiums to be able to pay those claims. Most profits come from investments and how efficient they can pay claims and run their business. Insurance is arguable the most regulated industry.

And even if there was some truth to what you say, your automatically thinking the government would be better. So your saying the National Flood program has never denied a claim? Ok lets talk medical, you thing Medicare has never denied a claim? Of course they have.

[kvrdave]

Guess I didn't look back far enough. Still, that doesn't change the fact that they can control their costs by simply denying more claims.
[quote]
So can the government, and that is what governments with national health care do.

[quote]For those who believe that healthcare insurance companies "deserve" to profit, I would ask, "based on what?" What are they contributing to healthcare that helps people? And how much profit do they deserve for whatever you think their contribution is to healthcare? While I'm against the idea of healthcare insurance, I'll admit I'm not sure what a better idea would be. But if we have to have healthcare insurance, there shouldn't be companies skimming profits just for being able to spread the money around. That's why I think that government should be at least partially involved. At the very least, these companies should be regulated a lot more than they are.
Why do hospitals deserve profit? Why do doctors deserve to make as much money as they do? Simply make all hospitals non-profit and set wages for doctors just like they are trying to do for CEOs. What's wrong with that?

[Birrman54]

In 2007 Apple had an operating revenue of ~$24B, leading to $3.5B net income. United Healthcare made $3.5B on ~$45B in revenue. Google pulled in ~$17B in revenue and profited over $4B.

United Healthcare has 75,000 employees - 40K more than Apple, 55K more than Google.

So Apple is almost twice as profitable as this evil insurance company, Google is significantly more profitable. How can anyone actually make an argument that profit as a % of total revenue has no significance when determining what counts as 'excessive'?

[orangecrush]

In 2007 Apple had an operating revenue of ~$24B, leading to $3.5B net income. United Healthcare made $3.5B on ~$45B in revenue. Google pulled in ~$17B in revenue and profited over $4B.

United Healthcare has 75,000 employees - 40K more than Apple, 55K more than Google.

So Apple is almost twice as profitable as this evil insurance company, Google is significantly more profitable. How can anyone actually make an argument that profit as a % of total revenue has no significance when determining what counts as 'excessive'?Because it doesn't support their argument. Besides, large numbers scare people more than percentages.

[wildcatlh]

Just got a hold of HR 3962, the "Affordable Healthcare for America Act". It's the new leadership-sponsored bill.

It's 1,990 pages long.

Not only is there a requirement that you buy health insurance, but there's also a "voluntary" new health insurance entitled the CLASS program, for long-term care for individuals requiring community living assitance services. I use "voluntary" in quotations because it's an opt-out program, not an opt-in program (Title XXXII, Section 3204, page 1575)

[taa455]

By itself, profit is not evil. Profiting off ill people, however, is. You're entitled to your morals, as warped as I find them to be.

I guess hospitals and doctors shouldn't be making a profit either. Let's just put them all on the government payroll!

[shifrbv]

Here's a summary of the bill:

http://edlabor.house.gov/blog/2009/10/affordable-health-care.shtml

I still don't understand why changes are taking 5 years to kick in. And small business doesn't need to comply until 2018.

Does congress believe companies can survive 30% increases every year for the next 5 years?

This bill looks weak to me. It looks like it's trying to please everybody. Even raising Medicaid reimbursements to Medicare levels (which Medicare is broke right now).

Kvrdave is right on, why do doctors need to make so much money? Everybody else in this country has seen a decrease in pay or wage stagnation. Why should they be immune from the pain?

[X]

I still don't understand why changes are taking 5 years to kick in. And small business doesn't need to comply until 2018.That's how you get the 10 year cost estimate down. Notice they don't say what it costs the 2nd 10 years?

[X]

Kvrdave is right on, why do doctors need to make so much money? Everybody else in this country has seen a decrease in pay or wage stagnation. Why should they be immune from the pain?How about athletes and movie stars? I suppose we need to go after their obscene salaries. It's only "fair".

[JasonF]

And administrators for DVD websites. Those guys are totally overpaid.

[shifrbv]

How about athletes and movie stars? I suppose we need to go after their obscene salaries. It's only "fair".


If taxpayers were footing the bill for those guys, like they are for Medicare, Medicaid, and now a new "Exchange", then they should be allowed a say.

[shifrbv]

That's how you get the 10 year cost estimate down. Notice they don't say what it costs the 2nd 10 years?

This is bothersome to me. You can't give everybody subsidized care at today's prices (and the guaranteed increases that healthcare professionals demand) and not expect it to lead to some serious financial issues down the road.

I saw a quote online from Obama's healthcare expert Peter Orzsag talking about deficit costs in the "out years" and everybody was making jokes about what that meant. Most said it would be the years they were all out of office.

I still contend this bill looks like it kicks the can down the road.

[wildcatlh]

I'm still wondering why they're not being required by the CBO to use the same 75-year amortization schedule that Medicaid and Social Security use.

[kvrdave]

I still don't understand why changes are taking 5 years to kick in. And small business doesn't need to comply until 2018.


Because Obama wants it to be budget neutral, and the only way to do that is to collect taxes for 10 years and have the system go for 5 years. Then they declare victory. It's a shell game.

edit -X already got it.

[Birrman54]

If taxpayers were footing the bill for those guys, like they are for Medicare, Medicaid, and now a new "Exchange", then they should be allowed a say.

Taxpayers most certainly foot the bill for various stadium constructions through the country.

Speaking of athletics and obscene salaries.

http://www.americasbestonline.net/index.php/pages/collegehighestpaidcoaches.html

A lot of state schools on that list. How much should these coaches be profiting from a game! ;)

[DeputyDave]

Well, I guess this proves the Democratic party is still in the pocket of the trial lawyers. Any hope of real reform goes out the window.

[Superboy]

This sounded ridiculous, so I looked into the last decade for ten big ones. Half them had posted losses at least once.

Aetna posted losses of $2.5 billion in 2002 and $279 million in 2001.

Humana posted a loss of $382 million in 1999.

Cigna posted a loss of $398 million in 2002.

Amerigroup posted a loss of $50 million in 2008.

Centene posted losses of $9 million in 1999 and $43 million in 2006.

Those are accounting losses, not economic losses. Those are two very different concepts. Those losses aren't generated by expenditures that aren't met by profit; they're met by expenditures that are given tax benefits.

For that matter, what do you think their "losses" were from? the health insurance and pharm industries are incredibly profitable for two reasons:

1. Their goods/services are inelastic

2. Their costs are mostly variable costs.

These two factors put together cook up the perfect recipe for a monopoly, or its slightly less attractive but still massively profitable sister, the oligopoly.

[wildcatlh]

Those are accounting losses, not economic losses. Those are two very different concepts. Those losses aren't generated by expenditures that aren't met by profit; they're met by expenditures that are given tax benefits.

For that matter, what do you think their "losses" were from? the health insurance and pharm industries are incredibly profitable for two reasons:

1. Their goods/services are inelastic

2. Their costs are mostly variable costs.

These two factors put together cook up the perfect recipe for a monopoly, or its slightly less attractive but still massively profitable sister, the oligopoly.

But it's a government-sponsored monopoly (as a result of restrictive laws on entering the market and the anti-trust exemption that prevents a national insurance market from forming). So this becomes another case where government intervention creates a large problem, and the government is able to convince people that the only way to solve that problem is with more government intervention.

[wildcatlh]

via Reason, an interesting caveat on the end of the CBO's score of HR3962 (in which they stated it would reduce the deficit)


Those longer-term projections assume that the provisions of H.R. 3962 are enacted and remain unchanged throughout the next two decades, which is often not the case for major legislation. For example, the “sustainable growth rate” mechanism governing Medicare’s payments to physicians has frequently been modified to avoid reductions in those payments, and legislation to do so again is currently under consideration in the Congress. The bill would put into effect (or leave in effect) a number of procedures that might be difficult to maintain over a long period of time. It would leave in place the 21 percent reduction in the payment rates for physicians currently scheduled for 2010. At the same time, the bill includes a number of provisions that would constrain payment rates for other providers of Medicare services. In particular, increases in payment rates for many providers would be held below the rate of inflation (in expectation of ongoing productivity improvements in the delivery of health care).

[X]

It would leave in place the 21 percent reduction in the payment rates for physicians currently scheduled for 2010.That's how Congress is keeping the cost under $1 trillion and making it appear "budget-neutral" so Obama can keep his promise of not increasing the deficit with this bill.

They will introduce a separate $250 billion bill to restore the payments after the health care bill is signed. Your government at work. And people go for this?

[Birrman54]

So physicians are just supposed to absorb a 21% reduction in payment?

I'm sure that won't affect supply at all.

[maxfisher]

Those are accounting losses, not economic losses. Those are two very different concepts. Those losses aren't generated by expenditures that aren't met by profit; they're met by expenditures that are given tax benefits.

For that matter, what do you think their "losses" were from? the health insurance and pharm industries are incredibly profitable for two reasons:

1. Their goods/services are inelastic

2. Their costs are mostly variable costs.

These two factors put together cook up the perfect recipe for a monopoly, or its slightly less attractive but still massively profitable sister, the oligopoly.

Let's ignore the fact that you're apparently smarter than the market, seeing as how most of these companies' stocks took hits in the years they posted losses. Are you claiming that the profit margins for health care companies are far in excess of what they actually state? Looking at the Fortune 500 list of the 43 industries that were profitable in 2009, health insurance ranked 35th. If that's incredibly profitable, I'm curious what kinds of adjectives would get pulled out for industries in the top 10.

[wildcatlh]

So physicians are just supposed to absorb a 21% reduction in payment?

I'm sure that won't affect supply at all.

I think the point is that while the CBO's proclimation that the deficit will fall assumes that the 21% payment reduction will actually happen, the chances that it will actually happen are pretty doubtful. So the payment reduction is in there to make the budget numbers look better, but that's not going to be reality.

[Sdallnct]

Those are accounting losses, not economic losses. Those are two very different concepts. Those losses aren't generated by expenditures that aren't met by profit; they're met by expenditures that are given tax benefits.

For that matter, what do you think their "losses" were from? the health insurance and pharm industries are incredibly profitable for two reasons:

1. Their goods/services are inelastic

2. Their costs are mostly variable costs.

These two factors put together cook up the perfect recipe for a monopoly, or its slightly less attractive but still massively profitable sister, the oligopoly.

Please, at least do a little looking,

Insurance companies have two essential way to determine profit/loss. 1) Underwriting 2)Net.

Underwriting = the business of insurance. Basically is the total of premiums coming in minus claims going out + the expenses associated with those.

Net = Underwriting profit or loss + taxes (paid or credits) + Investments.

The investments is an interesting one. Most insurance companies are willing to break even or have a small underwriting profit and make much of their money on investments (which hasn't worked so well recently - some companies have lost 1/3, 1/2 or more of their net worth, but it has worked over the long haul). So will the government be investing premiums? Part of the reason insurance companies try to make money on investments is to keep premiums down and be more competitive. Will the government do that? How will that work?

Several pages ago or even in part 3 or 4 it was noted that a government option would save the typical person 10% to 20% of what they are currently paying. Wow...with all those zillions that health insurance companies make and all the quadbillions that the CEO's make, you would think eliminating those (because I'm assuming the government will get people to work for them for free), would do better than 10% to 20% savings over what we have now. And that was from a PROPONENT of the plan! So in reality...I doubt there would be any savings.

[Save Ferris]

Will this affect the idea of private hospitals? When I lived in England and had to have my wisdom teeth removed I didnt want to go to a national dentist. Instead I went to a private hospital to have the procedure done.

I dont know about all the new legislation here these days but a friend mentioned to me that her worry was private hospitals:

Whats to keep all the BEST doctors from joining a private practice that accepts no insurance or government aid and just charges rich patients for the best service?

The idea being that the worst doctors that accept the lowest pay will be what national people get.

[Birrman54]

I think the point is that while the CBO's proclimation that the deficit will fall assumes that the 21% payment reduction will actually happen, the chances that it will actually happen are pretty doubtful. So the payment reduction is in there to make the budget numbers look better, but that's not going to be reality.

Oh I get that point, but I'm wondering how anyone can think financing this expansion of care by cutting the payments of the care-providers by 1/5 is a good plan.

[DeputyDave]

Has anyone been discussing how the plan will force states to remove the caps they placed on malpractice payouts? Gee, I wonder what special interest group got that slipped in?

[wildcatlh]

Has anyone been discussing how the plan will force states to remove the caps they placed on malpractice payouts? Gee, I wonder what special interest group got that slipped in?

What section is that? Couldn't find it in my quick search of the 1990 page tome.

The section I'm curious about is Section 2572 of Title V, on page 1510 of the legislation. That clause would require a nationwide imposition of the same costly menu labeling requirements that have been shown to be completely ineffective since they were first introduced in New York City.

[Venusian]

Is there a site that has the bill up in an easy to search/read format like someone did for the stimulus bill?

[orangecrush]

What section is that? Couldn't find it in my quick search of the 1990 page tome.

The section I'm curious about is Section 2572 of Title V, on page 1510 of the legislation. That clause would require the same costly menu labeling requirements that have been shown to be completely ineffective since they were first introduced in New York City.Has it been in effect long enough in New York to show its effectiveness either way?

[DeputyDave]

What section is that? Couldn't find it in my quick search of the 1990 page tome.

The section I'm curious about is Section 2572 of Title V, on page 1510 of the legislation. That clause would require a nationwide imposition of the same costly menu labeling requirements that have been shown to be completely ineffective since they were first introduced in New York City.

Not sure (I actually think I heard it said it was in the 1600's). Just something I heard on the radio late last night when I couldn't sleep. They were saying it requires all caps to be removed if states want to receive funding.

[Venusian]

I'd guess it's in this section:

SEC. 208. OPTIONAL OPERATION OF STATE-BASED HEALTH INSURANCE EXCHANGES.


wildcat, i couldn't find what you're talking about.

I'm looking here: http://www.opencongress.org/bill/111-h3200/text

SEC. 2572. ONLINE HEALTH WORKFORCE TRAINING PROGRAMS. That doesn't seem to be what you're addressing

[wildcatlh]

Not sure (I actually think I heard it said it was in the 1600's). Just something I heard on the radio late last night when I couldn't sleep. They were saying it requires all caps to be removed if states want to receive funding.

I did a global search using the word "malpractice". This is what was found...

Section 261, page 149: States that the implementation of guideline or standards under the bill doesn't establish a standard of care for malpractice actions

Section 262, page 151: Talking about antitrust issues

Section 1125(a)(6)(A)(ii), page 411 -- A California-specific clause related to fee schedules

Section 3400(d)(1)(D)(iv), page 1452 -- Talks about the non-expansion of medical malpractice liability protection under the Federal Torts Claims Act for federally dunded qualified health centers under that section

Section 2537(c), page 1465 -- Establishes medical-legal partnerships "to assist patients and their familites to navigate health-related programs and activities". The specific section prohibits those funds from being used "for any medical malpractice or other civil action or proceeding"

Not saying you're incorrect, but that's all I could find.

[wildcatlh]

I'd guess it's in this section:

SEC. 208. OPTIONAL OPERATION OF STATE-BASED HEALTH INSURANCE EXCHANGES.


wildcat, i couldn't find what you're talking about.

I'm looking here: http://www.opencongress.org/bill/111-h3200/text

SEC. 2572. ONLINE HEALTH WORKFORCE TRAINING PROGRAMS. That doesn't seem to be what you're addressing

You're not lookng at the correct bill. The new bill is HR3962.

[Venusian]

d'oh!

here is a pdf of the real bill: http://docs.house.gov/rules/health/111_ahcaa.pdf

[Birrman54]

Has it been in effect long enough in New York to show its effectiveness either way?

Calorie postings don't change habits, Study finds (http://www.nytimes.com/2009/10/06/nyregion/06calories.html)

[JasonF]

There's something ironic about someone with a Milton Friedman quote in his signature posting a link that says that giving people more data won't affect their consumption choices. So much for information economics!

Switching subjects completely ... over the weekend, I learned about the way hospital reimbursements are handled in Maryland. Basically, for the last 30 years, Maryland has had price controls.

In most states, every insurer will bargain with every hospital to set those rates. So Blue Cross will go to a hospital and they'll agree that Blue Cross will pay $5,000 per appendectomy. Cigna may wind up paying $12,000 per appendectomy. It has a lot to do with how many patients are in the hospital's area -- if Blue Cross has 10,000 subscribers in the area and Cigna has 500, the hospital will cut Blue Cross a huge discount to get those 10,000 subscribers in the door and make up for it by charging Cigna a lot. As a result, a lot of insurance companies have pulled out of markets where they are not the top one or two insurers.

Maryland does it completely differently. In Maryland, there's an administrative agency that tells every hospital what to charge for every test, pill, or procedure. It's done on a hospital by hospital basis and varies to account for the different overhead costs (rural hospitals vs. urban, teaching hospitals vs. non-teaching, etc.), but basically, if the commission decides that Johns Hopkins will charge $6,000 for an appendectomy, then that's what Blue Cross pays and that's what Cigna pays, and that's what everyone else pays. They've had this system since 1977.

Here's the bottom line from the article I found on this

The system has largely reined in hospital costs. In 1976, Maryland hospital costs were 25% more per case than the national average; by 2007, the latest year for which data are available, Maryland’s costs were 2% less than the national average. Maryland also saw the nation’s second-slowest increase in hospital costs during the same period, said Robert Murray, the commission’s executive director.

On average, Maryland hospitals charged patients 20% above the cost to treat them in 2007, compared with a national average of 182%, according to the American Hospital Association.


The article also notes that this system winds up costing Medicare more than it would otherwise pay (which makes sense, since Medicare has a lot of bargaining power in other states, so can get lower rates than the average insurance company).

http://www.passionforsubro.com/health-care-legislation/thoughts-on-maryland-reins-in-hospital-costs-by-setting-rates/

The other thing this made me wonder is whether this system had any effect on the quality of care in Maryland. So I found this link:

http://www.statehealthfacts.org/comparemaptable.jsp?ind=689&cat=8

This is a list of doctors per capita by state. Maryland ranks number three -- behind DC and Massachusetts, and tied with New York and Vermont. Note that these are all liberal states (or districts, as the case may be). Price controls (and, in the case of Massachusetts, universal coverage), don't seem to have caused an exodus from the state.

So ... what would people think of a federal agency charged with setting prices? A federal mandate for states to establish their own Maryland-style rate-setting agencies?

[Ranger]

Well, that is interesting, but I don't think it's something the feds would be able to do well. But the feds telling other states to be more like Maryland to help insurance competition seems feasible.

[DeputyDave]

What section is that? Couldn't find it in my quick search of the 1990 page tome.



Section 2531, entitled “Medical Liability Alternatives,” establishes an incentive program for states to adopt and implement alternatives to medical liability litigation. [But]…… a state is not eligible for the incentive payments if that state puts a law on the books that limits attorneys’ fees or imposes caps on damages.

http://biggovernment.com/2009/10/30/pelosi-health-care-bill-blows-a-kiss-to-trial-lawyers/#more-23042

Like I said last night:

Well, I guess this proves the Democratic party is still in the pocket of the trial lawyers. Any hope of real reform goes out the window.

[wildcatlh]

There's something ironic about someone with a Milton Friedman quote in his signature posting a link that says that giving people more data won't affect their consumption choices. So much for information economics!

Score one for... completely misstating facts? Or are you purposefully being obtuse here? I can't really tell.

[wildcatlh]

Section 2531, entitled “Medical Liability Alternatives,” establishes an incentive program for states to adopt and implement alternatives to medical liability litigation. [But]…… a state is not eligible for the incentive payments if that state puts a law on the books that limits attorneys’ fees or imposes caps on damages.

http://biggovernment.com/2009/10/30/pelosi-health-care-bill-blows-a-kiss-to-trial-lawyers/#more-23042

Like I said last night:

There's a very large leap from "the states won't get money for this one incentive program" to "it's forcing states to do this", isn't there? If the program is to adopt alternatives to litigation, a state with caps really wouldn't need that, now would they?

[JasonF]

Score one for... completely misstating facts? Or are you purposefully being obtuse here? I can't really tell.

I'm being unitentionally obtuse, I guess.

Information economics holds that people make "better" choices -- in the sense that they increase their utility -- when they have more information.

The data from New York is that when people have more information about nutrition, they make the same choices.

This suggests that information economics is wrong, at least when applied to this specific scenario.

Milton Friedman is a famous economist and proponent of information economics (I assume he is, anyway -- pretty much every economist I'm aware of is a proponent of information economics).

Therefore, there's an irony (however slight) in the juxtaposition of the Friedman quote with the counter-example to the postulates of information economics.

What am I missing?

[DeputyDave]

There's a very large leap from "the states won't get money for this one incentive program" to "it's forcing states to do this", isn't there? If the program is to adopt alternatives to litigation, a state with caps really wouldn't need that, now would they?

I don't see it saying that at all. Also, in my opinion, threatening to withhold money in order to get a state to follow along (like speed limits) is in the same ball park as "force

[orangecrush]

Calorie postings don't change habits, Study finds (http://www.nytimes.com/2009/10/06/nyregion/06calories.html)I especially like
It found that about half the customers noticed the calorie counts, which were prominently posted on menu boards. About 28 percent of those who noticed them said the information had influenced their ordering, and 9 out of 10 of those said they had made healthier choices as a result.

But when the researchers checked receipts afterward, they found that people had, in fact, ordered slightly more calories than the typical customer had before the labeling law went into effect, in July 2008.

[orangecrush]

So ... what would people think of a federal agency charged with setting prices? A federal mandate for states to establish their own Maryland-style rate-setting agencies?I agree with Ranger that if this sort of thing were to be implemented, it would be better to have each state set prices in lieu of a federal level control. It seems like direct control over prices has been implemented w/ some success. May as well look at it as an option.

[Sdallnct]

I agree with Ranger that if this sort of thing were to be implemented, it would be better to have each state set prices in lieu of a federal level control. It seems like direct control over prices has been implemented w/ some success. May as well look at it as an option.

But I thought one of the ways the government was going to be less than private is thru efficiency? If each state is doing its own thing, isn't that rather inefficient?

[kvrdave]

So ... what would people think of a federal agency charged with setting prices? A federal mandate for states to establish their own Maryland-style rate-setting agencies?


I think it would end up being 1200 pages and in the end not do what it is suppose to. I would rather see states do this on their own because I believe the feds will fuck it up.

[kvrdave]

There's a very large leap from "the states won't get money for this one incentive program" to "it's forcing states to do this", isn't there? If the program is to adopt alternatives to litigation, a state with caps really wouldn't need that, now would they?

Sure they would, depending on their alternative. They could set up a system of mediation, or a number of things that could still lead to big payouts. But if they dared to cap those, they don't get money.

It isn't any different that the feds saying you don't get any highway money if you don't have a 55 mile an hour speed limit. They aren't forcing any state to have a 55 mph speed limit....they can do whatever they want, right?

[brayzie]

You're not lookng at the correct bill. The new bill is HR3962.


The "America's Affordable Health Choices Act" Bill is now HR 3962?

Does anyone know when the vote on this will be? Does this mean that both the Senate and House of Reps will both be voting on it?

[classicman2]

The House will vote on their version.

If passed, the Senate will vote on their version.

If passed, the bills will go to conference.

[Birrman54]

I'm being unitentionally obtuse, I guess.

Information economics holds that people make "better" choices -- in the sense that they increase their utility -- when they have more information.

The data from New York is that when people have more information about nutrition, they make the same choices.

This suggests that information economics is wrong, at least when applied to this specific scenario.

Milton Friedman is a famous economist and proponent of information economics (I assume he is, anyway -- pretty much every economist I'm aware of is a proponent of information economics).

Therefore, there's an irony (however slight) in the juxtaposition of the Friedman quote with the counter-example to the postulates of information economics.

What am I missing?

You're assuming that calorie postings on menu items are accurate and people are interested in making purchasing decisions based on calorie counts.

At a sit down restaurant I doubt that's true for most, it's sort of resting on the assumption that Americans are being tricked into eating fatty foods. I disagree.

[Birrman54]

I especially like

Were the receipts checked for the 90% of the 28% of the 50%? Or all the people?

I'd be interested to see whether the 11% who noticed the information and said it affected their decisions actually made better choices.

[Birrman54]

In most states, every insurer will bargain with every hospital to set those rates. So Blue Cross will go to a hospital and they'll agree that Blue Cross will pay $5,000 per appendectomy. Cigna may wind up paying $12,000 per appendectomy. It has a lot to do with how many patients are in the hospital's area -- if Blue Cross has 10,000 subscribers in the area and Cigna has 500, the hospital will cut Blue Cross a huge discount to get those 10,000 subscribers in the door and make up for it by charging Cigna a lot. As a result, a lot of insurance companies have pulled out of markets where they are not the top one or two insurers.

Maryland does it completely differently. In Maryland, there's an administrative agency that tells every hospital what to charge for every test, pill, or procedure. It's done on a hospital by hospital basis and varies to account for the different overhead costs (rural hospitals vs. urban, teaching hospitals vs. non-teaching, etc.), but basically, if the commission decides that Johns Hopkins will charge $6,000 for an appendectomy, then that's what Blue Cross pays and that's what Cigna pays, and that's what everyone else pays. They've had this system since 1977.

Here's the bottom line from the article I found on this



The article also notes that this system winds up costing Medicare more than it would otherwise pay (which makes sense, since Medicare has a lot of bargaining power in other states, so can get lower rates than the average insurance company).

http://www.passionforsubro.com/health-care-legislation/thoughts-on-maryland-reins-in-hospital-costs-by-setting-rates/

The other thing this made me wonder is whether this system had any effect on the quality of care in Maryland. So I found this link:

http://www.statehealthfacts.org/comparemaptable.jsp?ind=689&cat=8

This is a list of doctors per capita by state. Maryland ranks number three -- behind DC and Massachusetts, and tied with New York and Vermont. Note that these are all liberal states (or districts, as the case may be). Price controls (and, in the case of Massachusetts, universal coverage), don't seem to have caused an exodus from the state.

So ... what would people think of a federal agency charged with setting prices? A federal mandate for states to establish their own Maryland-style rate-setting agencies?

I can look into the Maryland situation some more; my father is a surgeon in Baltimore and on the board at one of the hospitals. I worked in his office when I was younger and I worked IT at one of the hospitals briefly while in college.

I was under the impression they were facing shortages of certain specialties (Obstetrics & General Surgery come to mind). I think these were mostly due to pressures of hours required and changes in insurance costs.

I think the board controlled costs have to do with acute, emergency care only. The pay is pretty small comparatively, but it does allow the hospitals some predictability in their budgeting. I think it's similar to the states with uninsured driver funds.

For the majority of care; scheduled surgeries, office visits, etc - most of the insurance companies took their pay rate cues from Medicare (some % above Medicare rates). So I think that's pretty similar to how most states operate.

I recall the "all patients, insured or uninsured, are charged the same" being an issue. We would have preferred offering discounts to the uninsured, but that was illegal according to state law.

[JasonF]

Birrman, I'd love to see your father's take on this. All I know is what I learned during a passing reference on NPR and the article I linked to, so I'm relatively ignorant on this topic. I was under the impression that all hospital services were covered (not just emergency), but like I said -- I could very easily be wrong.

[Birrman54]

I'll give him a call tomorrow, I remember doing billing for him and the CPT codes had different payment amounts depending on BCBS vs Cigna vs Aetna, etc. This was several years ago, so my memory is imprecise.

[kvrdave]

I was reading an article on Ford and their contract negotiation with the union here http://online.wsj.com/article/SB10001424052748703294004574509942431423158.html?mod=googlenews_wsj and the last line contained this...
On Sunday afternoon, the Canadian Auto Workers announced its workers at Ford had overwhelmingly ratified a separate labor deal to cut benefits, reduce vacation compensation and add co-pays on health care insurance, all of which were pattern items from earlier agreements with Chrysler and GM.


Can someone explain that? Doesn't Canada have a national health care system, so why would health insurance be part of the benefits?

Also stumbled across this. It makes me laugh at the public option that Obama wants so badly....
http://www.northjersey.com/news/health/Public_option_worth_all_the_debate.html

The latest look at the public option comes from the Congressional Budget Office, the nonpartisan economic analysts for lawmakers. It found that the scaled back government plan in the House bill would not overtake private health insurance and might help a little.

The CBO estimated that about 6 million people would sign up for the public option in 2019, when the House bill is fully phased in. That represents about 2 percent of a total of 282 million Americans under age 65.

Most people would not have access to the public plan. Under the House bill, it would be offered through new insurance exchanges open only to those who buy coverage on their own or work for small companies. Yet even within that pool of 30 million people, only one in five would take the public option.

The budget office said "a less healthy pool of enrollees" would probably be drawn to the public option by the prospect of looser rules on access to specialists and medical services.

As a result, premiums in the public plan would be higher than the average for private plans. That could nudge healthy middle-class workers and their families into private plans.


:lol: Those are just a few quotes. Also, our crisis is so bad that the public option won't even be an option until 2013.....because IT'S A CRISIS, PEOPLE!!!!

[JasonF]

It makes me laugh at the public option that Obama wants so badly....

You can tell he wants it badly by the way he's tepidly endorsed the weakest possible version of the public option.

[kvrdave]

Or you can tell based on what he has said. :lol:

I don't think he wants what is being proposed, but will take it if it means he can declare victory.

[MinLShaw]

I'm four or five parts late, so forgive me for not reading through everything already discussed. I'm assuming that most of the debate here has been like it has been everywhere else; "Public option is evil" vs. "Public option is the only thing that will save mankind." I think it's a worthwhile place to start, but there are far more relevant issues for our healthcare situation I haven't heard addressed much at all that I'd like to throw out there.

We're really just debating whose money is going to foot whose bills. Yes, the money is a major part of it, but I can't help but feel it's getting too much attention. For instance, when I was a kid in the 1980s, we had one kid in the entire school with asthma. I distinctly recall class coming to a complete halt for his occasional attacks, and I personally witnessed an ambulance being summoned for him once. It was a very alarming, disturbing thing and it always introduced a very specific discomfort into the classroom atmosphere to have him around.

Today, of course, kids without a respirator could very likely borrow one from a classmate in case of an emergency and their classmates would not be rattled, or even impressed, the way we were because they're entirely more familiar with such incidents.

I remember it was in the 1990s the first time I ever heard of anyone having a food allergy. I thought it was a joke, or at least an exaggeration. I mean, seriously; allergic to peanuts? That meant you couldn't eat a peanut butter and jelly sandwich, and that was simply a violation of all that was decent. And then I came to be aware of just how many children born in just the last decade or so who have not one, but often multiple such inabilities to safely ingest--or even contact--some of the most basic foods in our society. My wife's stepfather and his son have a deathly allergy to chicken, for instance.

Something is going on there, and we need to start doing something about it. I know the popular belief is that our industrialization has so tampered with our environment that our bodies are no longer surrounded by a healthy natural world, and that our food supply is therefore altered from what it once was. To at least some extent, this is certainly true. I remember when I was a kid, again, in the 1980s, and when I poured a glass of milk, I got bubbles. Somewhere along the line, as corporate farms pumped their cows full of more and more things, the bubbles disappeared. I'd forgotten entirely about bubbles in my milk until one day in the 90s, my mom bought a half-gallon of organic milk and when I poured it, voila! Bubbles.

These are simple examples, but I think they're universally recognizable ones. This isn't about red states, "Obamacare" or anyone's agenda. This is about seeing what's right there in front of us and admitting that by any measuring stick, things have gone very far from where they were even just a short while ago. So long as our children continue to emerge less and less healthy, we can continue this healthcare debate to only escalate--in cost, in urgency and in scale.

I have Crohn's disease and was diagnosed at a time when I was uninsured. I've come to greatly appreciate what limited use I've gotten out of the handful of pharmaceuticals that address my digestive woes, so I bear that in mind when I hear about pharma-profits. Research and development of the kinds of specialized things that help folks like me cost money. Proctor & Gamble manufactures one of the 5 ASA drugs, Asacol, that is a staple of treatment for many Crohnies. They were kind enough to provide my prescription to me free of charge (roughly worth about $150 a month, I believe) because of my low income. It was only effective for me for about a year, but that was a year in which I was mostly under control and their generosity made it possible for me to take the medicine on a daily basis, instead of having to choose between filling a prescription or paying a particular bill.

I've tried to return the favor, in the little way I can, by favoring their products over those of their competitors when shopping, even now (two years after I last took Asacol). I think it's important to note this partly to demonstrate that even the lucrative pharmaceutical companies do find ways of being helpful and accessible to needier patients, and to point out that this is just one example of how such a corporation managed to not only do so while continuing to post great earnings, but earned a loyal consumer in the process. I couldn't easily afford Asacol, but I can easily afford their toothpaste and other items. I'm sure there's a tax incentive somewhere for them, but otherwise the government had little to do with this situation. I think my fellow liberals have lost sight of some of the genuine cooperation within the industry, just as I think too many conservatives have mistaken their own personal fortunes for a sign that other people's problems are entirely of their own doing and that they shouldn't come asking for help after the fact. Medical science can't even answer the question of how a patient develops Crohn's disease, and the leading theories all point to genes and nothing within the power of any particular person to alter through choice or behavior. Simply put, there's nothing I could have done differently, and Crohn's disease--despite how loathsome I get over it at times--is hardly the worst of such chronic conditions. Even now as you read this, I'm sure you personally know someone who would roll their eyes at me even bothering to complain about it.

Ultimately, I think what I'm trying to say is that those of us who have characterized this debate as a matter of counting senators and money estimates have missed the forest for the trees. There are reasons that our healthcare costs have exploded, and they're not all due to the baby boomers reaching their golden years or greedy executives. There are things that we've done to our world and ourselves that have put us here, and these are the things that we need to be addressing. Perhaps those companies dumping God-knows-what into the rivers did more damage than we'd realized; maybe hormones for animals are worse than the F.D.A. thought. I don't know what the scope of such an investigation even should be, but I do know that I am disappointed, and at times outraged, that I've heard no meaningful effort to even begin its undertaking.

[DeputyDave]

And yet people are living longer and longer. For every year that passes, one year is being added on to a baby's expected life span, even without those bubbles in their milk.

I think a lot of what you are seeing is colored by your perceptions. Those allergies existed in the 80's, it's just we are now more aware of them do to the media and hypersensitivity.

[JasonF]

Or you can tell based on what he has said. :lol:

I don't think he wants what is being proposed, but will take it if it means he can declare victory.

As long as something passes -- and something will pass -- he will declare victory. But he's been consistent in talking down the importance of the public option and in pushing to weaken it, precisely because he wants to be sure something passes so that he can declare victory.

[mosquitobite]

And yet people are living longer and longer. For every year that passes, one year is being added on to a baby's expected life span, even without those bubbles in their milk.

I think a lot of what you are seeing is colored by your perceptions. Those allergies existed in the 80's, it's just we are now more aware of them do to the media and hypersensitivity.

They did exist, but not in the numbers we're seeing today. It's not just media reporting that's causing the increase, ask any pediatrician.

You really remember seeing an asthmatic kid have an attack while you were in school?
You remember seeing a teacher use an epi pen on a kid?
You had an autistic kid in your class?

These are all epidemics that, yes, may or may not impact life span but they do indeed effect the quality of life.

And MinLShaw, one of my personal theories is sunscreen is a big piece to the puzzle. Vit D deficiencies (in children and pregnant mothers) are rampant now and we have no idea the scope of what that means.

[dork]

And MinLShaw, one of my personal theories is sunscreen is a big piece to the puzzle. Vit D deficiencies (in children and pregnant mothers) are rampant now and we have no idea the scope of what that means.
I hope the develop a vaccine for that, and soon!

[X]

Speaking of vaccines...

US swine flu vaccine may be too late

Researchers at Purdue University in Indiana say according to their calculations by the time the vaccine arrives in the U.S. it will be too late to prevent H1N1 infections from the current wave of the virus.

Tom Frieden, head of the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia said last week that as of October 23 the U.S. had received 27.4 million doses of H1N1 vaccine.

At this time the U.S. should have received 120 million doses reports NewScientist.

The current amount isn't even enough to vaccinate America's 42 million most vulnerable and with President Obama's announcement last week declaring a national emergency the demand for the vaccine will probably increase.

Shelly Towers and Zhilan Feng at Purdue University calculate (pdf)that even though several companies are using a faster growing strain to produce vaccine, it will still be too late to prevent the majority of infections as the new vaccine won't arrive for weeks.

According to their model, about 25 per cent of Americans will get sick from this wave of H1N1, if they are not vaccinated. Since vaccinations will be coming too late for many people, only 6 per cent of those would have protection from the virus as it takes time to build antibodies in people.
Towers says that vaccination is still far from pointless. She says that 2,000 lives could still be saved "and people who get the shot now will have at least partial immunity should H1N1 mutate and cause a pandemic wave next spring," reports NewScientist.

http://www.digitaljournal.com/article/281274And an interesting article about why the vaccine will be late...

Swine Flu Vaccine--Too Little, Too Late
Long-standing liability issues leave us unprepared for a pandemic
By The Editors

As health care workers in the U.S. gear up for the flu season, they facea paradox: on the one hand, they will have too little vaccine against the novel influenza A (H1N1) strain to protect the entire population; on the other, some people will resist the shots that are offered to them. Sadly, both problems can be traced, at least in part, to the last time “swine flu” loomed. The 1976 national vaccination campaign against a pandemic that never materialized left the public with lingering doubts about whether the inoculations harmed some recipients and spawned lawsuits that cost the federal government nearly $100 million.

Since that episode, both public mistrust of vaccines and vaccine makers’ mistrust of a litigious public have only grown—hampering the nation’s ability to respond to the current, very real, pandemic. The Centers for Disease Control and Prevention expect the virus to sicken up to a third of the population this fall. But the nation will have barely enough vaccine for a third of its residents because methods used to make U.S. flu vaccines have changed little in half a century. Health officials decided early in the summer to stick with slow, egg-based production techniques and to eschew dose-sparing additives that might have tripled the vaccine supply.

In “Boosting Vaccine Power,” Nathalie Garçon and Michel Goldman describe a new generation of ad*juvants—immune-stimulating vaccine ingredients—that take advantage of scientific advances in understanding immune cell interactions. A few years ago the clinical trial of an experimental pandemic vaccine against bird flu containing one of these new adjuvants provided protection using less than a third of the usual amount of virus antigen in seasonal flu vaccines and produced minimal side effects. Another novel adjuvant has been approved for use in European seasonal flu vaccines for more than a decade.

Yet the U.S. does not permit use of the new adjuvants in vaccines, except in emergencies declared by the Food and Drug Administration (which is hardly likely to inspire public confidence). Even procuring a pandemic vaccine using traditional methods required the government to grant vaccine makers immunity from lawsuits and instead take the liability onto itself, as it did in 1976. Without such protections, vaccine makers were unwilling to enter the market. Fear of litigation had already driven most of them to leave the business. In the 1970s 25 companies made vaccines of all kinds. By 2004 only five remained.

In 2002 the SAFETY Act also granted immunity to potential makers of antibioterror vaccines and drugs. But the expedient of blanket immunity in an emergency is hardly a long-term solution to the crisis in vaccine development. In existing legislation, however, we have a model for a mechanism that would give reasonable compensation to victims of unforeseeable vaccine injuries while also shielding manufacturers from unpredictable legal liability for vaccines that work as intended. In 1986, recognizing the possibility that fundamental childhood vaccines could become unavailable if no one were willing to make them, Congress passed the National Childhood Vaccine Injury Compensation Act. It established a no-fault court to handle injury claims, with ceilings on potential damages. The settlements are financed by a tax on every vaccine dose. This system could be extended to all vaccines.

In 1985 an Institute of Medicine report, “Vaccine Supply and Innovation,” advanced several other options for safeguarding vaccine research and thereby vaccine safety and supplies. Few viable alternatives have been offered since. It is impossible to know what vaccine technologies might have been available to meet the challenge of the influenza pandemic of 2009 had vaccine science not been bogged down by liability concerns for so long. But almost certainly one reason the U.S. has too little vaccine going into the fall is that attention to the decades-old issue of vaccine liability has been too late in coming. As policy makers tackle health care reform in the coming months, we call on them to address the problem of vaccine liability—both to restore public confidence in this critical health intervention and to ensure that the best and safest vaccine technologies are available before the next pandemic.

http://www.scientificamerican.com/article.cfm?id=swine-flu-vaccine

[mosquitobite]

I hope the develop a vaccine for that, and soon!

:lol: :p

[kvrdave]

As long as something passes -- and something will pass -- he will declare victory. But he's been consistent in talking down the importance of the public option and in pushing to weaken it, precisely because he wants to be sure something passes so that he can declare victory.

This is probably a stupid question, but i woke up wondering it. Using CBO numbers that I have read, we are looking at $896 billion over 10 years, The numbers of those taking the public option are 2% and the premiums are suppose to carry it, and that doesn't start until 2013. So what is that $896 billion suppose to pay for? What does it give us? What is in the bill that costs money, especially that much?

[classicman2]

Now - I really don't believe you woke up wondering that. ;)

[spainlinx0]

I get upset when I have a shitty dream about work. I can't imagine how annoyed I would be if I was dreaming about health care reform.

[kvrdave]

Now - I really don't believe you woke up wondering that. ;)

:lol: I actually did. It felt like one of those things where you are having some deep thought in the morning, only to wake up more and realize you were talking jibberish. I felt that way, but it didn't go away.

[Dr Mabuse]

I had a dream last night that a hamburger was eating me!

[spainlinx0]

:lol: I actually did. It felt like one of those things where you are having some deep thought in the morning, only to wake up more and realize you were talking jibberish. I felt that way, but it didn't go away.

Is waking up a new euphemism for being stoned?

[MinLShaw]

And yet people are living longer and longer. For every year that passes, one year is being added on to a baby's expected life span, even without those bubbles in their milk.

But that's keeping score simply by addressing how long someone is expected to live and ignoring entirely the deteriorating health expectations of those people. Consider the ever-increasing incidents of autism and cancer alone. I don't know what the specific statistics of those two things alone are, but I can tell you that in my firsthand experience, I've seen and heard of more people having to endure them. When I was younger, cancer was something that old people got, typically from years of smoking. Now, the father of a guy I've known most of my life, has had to deal with prostate cancer. And his son, my friend's brother, just had to have some dubious tissues removed from his colon. He's 32, and this was just a year after his mother had colon issues. These are not issues that are acknowledged by life expectancy figures.

I think a lot of what you are seeing is colored by your perceptions. Those allergies existed in the 80's, it's just we are now more aware of them do to the media and hypersensitivity.

Isn't it more accurate (and exceedingly obvious) to say that my perceptions are constructed from what I am seeing? Isn't that true of all of us? And, no, I'm not more aware of these things entirely due to media and "hypersensitivity." I'm aware of them because they're happening more frequently, and more consistently to people right around me, and I happen to have been paying attention.

When I graduated high school in 1997, there was one "special education" classroom that had about five students. They ranged from down's syndrome to far more debilitating conditions. Today? One of my friends's wives teaches in one of two special ed classes at a school in the same county. Don't tell me that over-reacting liberal media is responsible for my perception of things getting of whack.

[jfoobar]

Another perspective. The fact that much of the money that will pay for this will no longer, in effect, exist when the time(s) come is one that cannot be stressed enough, even if you otherwise support the bill.

http://meganmcardle.theatlantic.com/archives/2009/11/the_true_cost_of_the_house_hea.php

The True Cost of the House Health Care Bill
02 Nov 2009 10:36 am

The New York Times health care blog has a post about the games that politicians are playing with the cost of their health care bill--in this case, the new House bill that was initially reported as costing less than $900 billion. A more accurate assessment would have been $1.05 trillion:

(quoted text from NYT)
Throughout Thursday, news accounts, including our own, focused on $894 billion, the total cost given out by aides to the House speaker, Nancy Pelosi, before the official cost analysis was released by the Congressional Budget Office.

But a closer look at the budget office report suggests that the number everyone should have reported was $1.055 trillion, which is the gross cost of the insurance coverage provisions in the bill before taking account of certain new revenues, including penalties by individuals and employers who fail to meet new insurance requirements in the bill.(/quote)

Because Obama set a $900 billion target--probably sensibly, since the politics of a $1 trillion health care bill are tricky--the House wanted to get their proposal under that line. The problem is, they also want to subsidize lots and lots of people, which is expensive.

I expect that the reaction of many people, maybe even most, is "Who cares whether we use gross or net cost, as long as it's deficit neutral?" I'm sympathetic, but there really are very good reasons to care:

1. This bill will not actually deficit neutral; it's just scored deficit neutral. This is not the fault of the CBO, which is doing its job. But the bills are loaded down with a bunch of "automatic spending cuts" and similar gimmicks which are very unlikely to happen. We did the same thing with Medicare in the Balanced Budget Act of 1997, and by 2003--i.e., the first year that the cuts really started to cut--Congress had mostly undone them.

Doug Elmendorf, the source of that "deficit neutral" score, has made it pretty clear that he does not think the cuts will take place; he's just scoring them because that's what the CBO process requires him to do. After all, the reason that we need these automatic spending cut mechanisms is that Congress can't make a credible committment to cut costs now. And the reason they can't be relied upon to cut costs in the future is that doing so is politically costly.

The larger the gross cost, the larger the hole it will rip in the budget if these gimmicks fail.

2. We have a gigantic existing budget deficit, which will require hundreds of billions of dollars worth of spending cuts or tax increases. I call your attention to the chart I posted the other week, showing what the budget deficit would look like with and without the Baucus Bill:

http://meganmcardle.theatlantic.com/assets_c/2009/10/Deficits-17483.php to see graph

In other words, even if everything in this "deficit neutral" bill happens the way that the CBO expects it too, we still end up with a $600 billion deficit. We need to pay for that, somehow.

But of course, keeping the bill "deficit neutral" also requires some combination of tax increases and spending cuts. These are very politically difficult, and as is generally true, the current bills use the ones that are politically easiest to cover their costs: things like tax increases on the rich, cuts to unpopular provider reimbursements, and rejiggering Medicare Advantage. Yes, these things are not easy--some of them are so hard that they may not happen. But whatever comes after them must, almost definitionally, politically even more difficult to pass. In the case of tax increases on the rich, there is simply an economic limit--the Laffer Curve does not apply at current levels of US taxation, but that doesn't mean it doesn't apply at any level of taxation, and we're already headed to marginal income tax rates of more than 50% in some jurisdictions.

So the larger the gross cost, the more of the political "low hanging fruit" it eats up. That means that closing our existing budget deficit becomes more politically costly, and therefore less likely to happen--or, rather, more likely to happen too late, when the crisis is almost upon us.

3. Even if you are not particularly worried about shrinking the existing budget deficit, gross costs are, well, costs. Tax increases reduce the consumption people are able to do, of either goods or leisure. Benefit cuts mean fewer benefits. This has to be considered against the benefits.

[classicman2]

The question is whether there will be a movement within the Democratic Caucus to remove Joe Lieberman from his chairmanship of the Homeland Security Committee if he doesn't 'come around' on the public option.?

[DeputyDave]

But that's keeping score simply by addressing how long someone is expected to live and ignoring entirely the deteriorating health expectations of those people. Consider the ever-increasing incidents of autism and cancer alone. I don't know what the specific statistics of those two things alone are, but I can tell you that in my firsthand experience, I've seen and heard of more people having to endure them. When I was younger, cancer was something that old people got, typically from years of smoking. Now, the father of a guy I've known most of my life, has had to deal with prostate cancer. And his son, my friend's brother, just had to have some dubious tissues removed from his colon. He's 32, and this was just a year after his mother had colon issues. These are not issues that are acknowledged by life expectancy figures.



Isn't it more accurate (and exceedingly obvious) to say that my perceptions are constructed from what I am seeing? Isn't that true of all of us? And, no, I'm not more aware of these things entirely due to media and "hypersensitivity." I'm aware of them because they're happening more frequently, and more consistently to people right around me, and I happen to have been paying attention.

When I graduated high school in 1997, there was one "special education" classroom that had about five students. They ranged from down's syndrome to far more debilitating conditions. Today? One of my friends's wives teaches in one of two special ed classes at a school in the same county. Don't tell me that over-reacting liberal media is responsible for my perception of things getting of whack.

Cancer isn't reflected in life expectancy numbers? There may be a rise in cancers but I think a lot of that has to do with proper diagnoses than other factors. I’d like to see some numbers between now and way back in time in the late 90’s, but I doubt they’re very drastically different. I could be wrong. For me life expectancy is the only way you can truly gauge a nation’s health. The numbers can’t be colored and can’t lie.

I never blamed anything on the “liberal” media, just simple over reporting and over saturation. When I was a teen in the 80’s we had 4 TV channels (including PBS) that aired one hour of news a night (half local and half national). Now I get about 200 (including half a dozen 24 hour news stations). They have to talk about something and you are simply going to hear about it a lot more often, especially bad news.

As far as autism, I am under the opinion it is being grossly over diagnosed. Like ADD before it, it has become the catch all for a lot of stuff that was just as common in previous years. When I was a teen “Autistic” meant Dustin Hoffman in Rain Man, what they call autism today we called nerd, shy, socially awkward, and introverted. One of my son’s friends has been classified as autistic and I have met him many times. I knew a dozen guys who acted exactly like him in my high school.

Don’t get me started on today’s schools and their “special needs” programs. Like you said, when I was a kid the special needs class consisted of genuine window lickers. My school had the only special needs program in the city so their were quite a few of them being bused in but the numbers were still very small and consisted of kids with actual mental retardation. Today it’s a money making business for schools as they collect their extra funds for every kid classified.

My son (who is incredibly smart, just profoundly lazy) got misclassified as special needs because he answered leading questions by the school psychologist during a single interview (where we were not present). My son simply thought he was getting out of being in trouble for getting bad grades. “Yes, it’s not that I didn’t do my homework because I was lazy, it’s because I couldn’t do it. It’s not my fault.” It took me almost 2 years to get him completely out of the program. I even had administrators try to convince me to keep him in the program even though they admitted he didn’t belong there. They told me that he would have unlimited time to take state tests (like the SAT) and other benefits.

As far as the “hypersensitivity” comment; when I was a kid in the 70’s I knew of a kid who was allergic to peanuts. It wasn’t a big deal. Peanuts were still served on planes and were put in everything. No one freaked out. The mantra pretty much was, “If peanuts will kill you, don’t fucking eat them.” Why should one kid’s weakness affect our enjoyment of Mr. Carver’s magic nut? It was that way for everything back then. If you were allergic to anything you dealt with it yourself and people didn’t hear a lot about it. People were embarrassed of allergies.

[X]

The question is whether there will be a movement within the Democratic Caucus to remove Joe Lieberman from his chairmanship of the Homeland Security Committee if he doesn't 'come around' on the public option.?I'm not sure he would be the 60th vote anyway.

[WallyOPD]

But that's keeping score simply by addressing how long someone is expected to live and ignoring entirely the deteriorating health expectations of those people. Consider the ever-increasing incidents of autism and cancer alone. I don't know what the specific statistics of those two things alone are, but I can tell you that in my firsthand experience, I've seen and heard of more people having to endure them. When I was younger, cancer was something that old people got, typically from years of smoking. Now, the father of a guy I've known most of my life, has had to deal with prostate cancer. And his son, my friend's brother, just had to have some dubious tissues removed from his colon. He's 32, and this was just a year after his mother had colon issues. These are not issues that are acknowledged by life expectancy figures.

As DeputyDave already mentioned, most of the "rise" you see in incidence rates for cancer and autism are due to new methods of diagnosis. For cancer we have so many more tests for cancer these days and the media campaigns have prompted many more people to actually get these tests so that incidence rates were bound to rise. We are simply catching cancers that existed but weren't detected in the past.

For autism much of the "increase" has to do with a changing definition of autism. Autism rates are actually the same across all age groups when the same criteria is applied.

Isn't it more accurate (and exceedingly obvious) to say that my perceptions are constructed from what I am seeing? Isn't that true of all of us? And, no, I'm not more aware of these things entirely due to media and "hypersensitivity." I'm aware of them because they're happening more frequently, and more consistently to people right around me, and I happen to have been paying attention.

When I graduated high school in 1997, there was one "special education" classroom that had about five students. They ranged from down's syndrome to far more debilitating conditions. Today? One of my friends's wives teaches in one of two special ed classes at a school in the same county. Don't tell me that over-reacting liberal media is responsible for my perception of things getting of whack.

Are all of your perceptions constructed from anectodal evidence? That's not very convincing.

[kvrdave]

Is waking up a new euphemism for being stoned?

No, but Friday night I had a dream where I had decided to become a pot smoker as part of who I was. Keifer Sutherland (as he appeared in The Lost Boys) was my dad, and he was incredibly upset with me over this. But I yelled, "You're not my real dad....you abandoned me and I was raised by my real parents" etc.

I woke up pondering how and why the idea of becoming a pot smoker seemed to make so much sense to me until I was fully awake. :lol:

[nemein]

The question is whether there will be a movement within the Democratic Caucus to remove Joe Lieberman from his chairmanship of the Homeland Security Committee if he doesn't 'come around' on the public option.?

What I would be curious to know is how many people who criticize the Reps for voting in "lock step" are the same that wouldn't have any problem w/ punishing Lieberman like this...

[jfoobar]

I woke up pondering how and why the idea of becoming a pot smoker seemed to make so much sense to me until I was fully awake. :lol:

Chemically-induced apathy + Cheetos. It has an unmistakable allure.

[DeputyDave]

The Wall Street Journal: The Worst Bill Ever (http://online.wsj.com/article/SB10001424052748703399204574505423751140690.html)

The Worst Bill Ever

Speaker Nancy Pelosi has reportedly told fellow Democrats that she's prepared to lose seats in 2010 if that's what it takes to pass ObamaCare, and little wonder. The health bill she unwrapped last Thursday, which President Obama hailed as a "critical milestone," may well be the worst piece of post-New Deal legislation ever introduced.

In a rational political world, this 1,990-page runaway train would have been derailed months ago. With spending and debt already at record peacetime levels, the bill creates a new and probably unrepealable middle-class entitlement that is designed to expand over time. Taxes will need to rise precipitously, even as ObamaCare so dramatically expands government control of health care that eventually all medicine will be rationed via politics.

Yet at this point, Democrats have dumped any pretense of genuine bipartisan "reform" and moved into the realm of pure power politics as they race against the unpopularity of their own agenda. The goal is to ram through whatever income-redistribution scheme they can claim to be "universal coverage." The result will be destructive on every level—for the health-care system, for the country's fiscal condition, and ultimately for American freedom and prosperity.

•The spending surge. The Congressional Budget Office figures the House program will cost $1.055 trillion over a decade, which while far above the $829 billion net cost that Mrs. Pelosi fed to credulous reporters is still a low-ball estimate. Most of the money goes into government-run "exchanges" where people earning between 150% and 400% of the poverty level—that is, up to about $96,000 for a family of four in 2016—could buy coverage at heavily subsidized rates, tied to income. The government would pay for 93% of insurance costs for a family making $42,000, 72% for another making $78,000, and so forth.

At least at first, these benefits would be offered only to those whose employers don't provide insurance or work for small businesses with 100 or fewer workers. The taxpayer costs would be far higher if not for this "firewall"—which is sure to cave in when people see the deal their neighbors are getting on "free" health care. Mrs. Pelosi knows this, like everyone else in Washington.

Even so, the House disguises hundreds of billions of dollars in additional costs with budget gimmicks. It "pays for" about six years of program with a decade of revenue, with the heaviest costs concentrated in the second five years. The House also pretends Medicare payments to doctors will be cut by 21.5% next year and deeper after that, "saving" about $250 billion. ObamaCare will be lucky to cost under $2 trillion over 10 years; it will grow more after that.

• Expanding Medicaid, gutting private Medicare. All this is particularly reckless given the unfunded liabilities of Medicare—now north of $37 trillion over 75 years. Mrs. Pelosi wants to steal $426 billion from future Medicare spending to "pay for" universal coverage. While Medicare's price controls on doctors and hospitals are certain to be tightened, the only cut that is a sure thing in practice is gutting Medicare Advantage to the tune of $170 billion. Democrats loathe this program because it gives one of out five seniors private insurance options.

As for Medicaid, the House will expand eligibility to everyone below 150% of the poverty level, meaning that some 15 million new people will be added to the rolls as private insurance gets crowded out at a cost of $425 billion. A decade from now more than a quarter of the population will be on a program originally intended for poor women, children and the disabled.

Even though the House will assume 91% of the "matching rate" for this joint state-federal program—up from today's 57%—governors would still be forced to take on $34 billion in new burdens when budgets from Albany to Sacramento are in fiscal collapse. Washington's budget will collapse too, if anything like the House bill passes.

• European levels of taxation. All told, the House favors $572 billion in new taxes, mostly by imposing a 5.4-percentage-point "surcharge" on joint filers earning over $1 million, $500,000 for singles. This tax will raise the top marginal rate to 45% in 2011 from 39.6% when the Bush tax cuts expire—not counting state income taxes and the phase-out of certain deductions and exemptions. The burden will mostly fall on the small businesses that have organized as Subchapter S or limited liability corporations, since the truly wealthy won't have any difficulty sheltering their incomes.

This surtax could hit ever more earners because, like the alternative minimum tax, it isn't indexed for inflation. Yet it still won't be nearly enough. Even if Congress had confiscated 100% of the taxable income of people earning over $500,000 in the boom year of 2006, it would have only raised $1.3 trillion. When Democrats end up soaking the middle class, perhaps via the European-style value-added tax that Mrs. Pelosi has endorsed, they'll claim the deficits that they created made them do it.

Under another new tax, businesses would have to surrender 8% of their payroll to government if they don't offer insurance or pay at least 72.5% of their workers' premiums, which eat into wages. Such "play or pay" taxes always become "pay or pay" and will rise over time, with severe consequences for hiring, job creation and ultimately growth. While the U.S. already has one of the highest corporate income tax rates in the world, Democrats are on the way to creating a high structural unemployment rate, much as Europe has done by expanding its welfare states.

Meanwhile, a tax equal to 2.5% of adjusted gross income will also be imposed on some 18 million people who CBO expects still won't buy insurance in 2019. Democrats could make this penalty even higher, but that is politically unacceptable, or they could make the subsidies even higher, but that would expose the (already ludicrous) illusion that ObamaCare will reduce the deficit.

• The insurance takeover. A new "health choices commissioner" will decide what counts as "essential benefits," which all insurers will have to offer as first-dollar coverage. Private insurers will also be told how much they are allowed to charge even as they will have to offer coverage at virtually the same price to anyone who applies, regardless of health status or medical history.

The cost of insurance, naturally, will skyrocket. The insurer WellPoint estimates based on its own market data that some premiums in the individual market will triple under these new burdens. The same is likely to prove true for the employer-sponsored plans that provide private coverage to about 177 million people today. Over time, the new mandates will apply to all contracts, including for the large businesses currently given a safe harbor from bureaucratic tampering under a 1974 law called Erisa.

The political incentive will always be for government to expand benefits and reduce cost-sharing, trampling any chance of giving individuals financial incentives to economize on care. Essentially, all insurers will become government contractors, in the business of fulfilling political demands: There will be no such thing as "private" health insurance.

All of this is intentional, even if it isn't explicitly acknowledged. The overriding liberal ambition is to finish the work began decades ago as the Great Society of converting health care into a government responsibility. Mr. Obama's own Medicare actuaries estimate that the federal share of U.S. health dollars will quickly climb beyond 60% from 46% today. One reason Mrs. Pelosi has fought so ferociously against her own Blue Dog colleagues to include at least a scaled-back "public option" entitlement program is so that the architecture is in place for future Congresses to expand this share even further.

As Congress's balance sheet drowns in trillions of dollars in new obligations, the political system will have no choice but to start making cost-minded decisions about which treatments patients are allowed to receive. Democrats can't regulate their way out of the reality that we live in a world of finite resources and infinite wants. Once health care is nationalized, or mostly nationalized, medical rationing is inevitable—especially for the innovative high-cost technologies and drugs that are the future of medicine.

Mr. Obama rode into office on a wave of "change," but we doubt most voters realized that the change Democrats had in mind was making health care even more expensive and rigid than the status quo. Critics will say we are exaggerating, but we believe it is no stretch to say that Mrs. Pelosi's handiwork ranks with the Smoot-Hawley tariff and FDR's National Industrial Recovery Act as among the worst bills Congress has ever seriously contemplated.

[kvrdave]

Fuck, that all just pisses me off.

[kvrdave]

So when I asked what we are getting for the money, we are "getting" heavily subsidized health insurance for people that make more money than me. Great.

[MinLShaw]

First of all, cancer's inclusion in the life expectancy rates is still dubious. Treatment options have become more effective and patients are being diagnosed earlier than before, so they are surviving cancer at a better rate than before, yes. But consider that in say, the 1970s, a patient would have gone undiagnosed until too late and died. Today, that patient is being diagnosed and surviving, but in the process racking up a much larger health bill bouncing from oncologists to radiologists. He's still alive, yes, but his life is still dominated by that cancer, even during remission. You can rightly claim that the life expectancy figure reflects that cancer is more treatable, but it still only addresses a trend in patients dying from, or surviving, cancer and does not fully describe the impact that cancer has on those lives.

To be fair, I realize this sets up an inevitable dispute over what point a patient with cancer should simply be grateful to still be alive thanks to those costly treatments. To a point, that's certainly true. But gratitude doesn't pay bills and can't be used as a co-payment.

Don’t get me started on today’s schools and their “special needs” programs. Like you said, when I was a kid the special needs class consisted of genuine window lickers....Today it’s a money making business for schools as they collect their extra funds for every kid classified.

First off, I never said that when I was a kid the special needs class consisted of "genuine window lickers." What I said was that there were only about five or so students in that class when I graduated in 1997 and that now, barely a decade later, one of my friends's wives--who is just a year older than me--is a teacher in one of two classes of such students at a school in the same county. You assumed that the class population increase was due to some kind of money scam. I can assure you, her students are not "rounded down" to score some free government cash.

As far as the “hypersensitivity” comment; when I was a kid in the 70’s I knew of a kid who was allergic to peanuts. It wasn’t a big deal. Peanuts were still served on planes and were put in everything. No one freaked out. The mantra pretty much was, “If peanuts will kill you, don’t fucking eat them.” Why should one kid’s weakness affect our enjoyment of Mr. Carver’s magic nut? It was that way for everything back then. If you were allergic to anything you dealt with it yourself and people didn’t hear a lot about it. People were embarrassed of allergies.

So you resent people for not wishing to be exposed to potentially cross-contaminated items to which they may have volatile reactions? And why should anyone be embarrassed of having a food allergy or any other kind of medical condition? Talk about blaming the victim!

Are all of your perceptions constructed from anectodal evidence? That's not very convincing.

Nice try. That's not what I said. I said that my perceptions are constructed from what I am seeing, whereas DeputyDave argued that "I think a lot of what you are seeing is colored by your perceptions." His statement would have us believe that I am choosing to believe what I have said because it is evidence that suits my pre-existing conclusion. Instead, I am saying that, like most rational people, I am instead following the trail of evidence before me to reach a perception--not a conclusion--about the situation. And my perception is that we have a larger population experiencing more frequent incidents of greater health issues than ever, and that that trend seems to only be escalating.

[kvrdave]

First off, I never said that when I was a kid the special needs class consisted of "genuine window lickers." What I said was that there were only about five or so students in that class when I graduated in 1997 and that now, barely a decade later, one of my friends's wives--who is just a year older than me--is a teacher in one of two classes of such students at a school in the same county. You assumed that the class population increase was due to some kind of money scam. I can assure you, her students are not "rounded down" to score some free government cash.


1) We gave up on "survival of the fittest" and gave crack addicts raises in their government hand out to have more babies. Then we act surprised when we have more "special needs" students. We have rewarded people by giving us more and that is what they have done.
2) Many things that were not diagnosed as "special needs" are now. I'm on the local school board. That's just an undeniable fact.
3) Special Needs includes a lot more than just mental retardation, which is what most people associate with the term. There is an increase in physically disabled people that never would have made it past their first 3 months of life a few decades ago.

Our life expectancy is fine and has increased due to medical advancements. It sure hasn't increased because of our diets. If life expectancy was so important to us, we'd all live like Mormons and Seventh Day Adventists, who live an average of 10 years longer than the rest of us.

[DeputyDave]

First of all, cancer's inclusion in the life expectancy rates is still dubious. Treatment options have become more effective and patients are being diagnosed earlier than before, so they are surviving cancer at a better rate than before, yes. But consider that in say, the 1970s, a patient would have gone undiagnosed until too late and died. Today, that patient is being diagnosed and surviving, but in the process racking up a much larger health bill bouncing from oncologists to radiologists. He's still alive, yes, but his life is still dominated by that cancer, even during remission. You can rightly claim that the life expectancy figure reflects that cancer is more treatable, but it still only addresses a trend in patients dying from, or surviving, cancer and does not fully describe the impact that cancer has on those lives.

To be fair, I realize this sets up an inevitable dispute over what point a patient with cancer should simply be grateful to still be alive thanks to those costly treatments. To a point, that's certainly true. But gratitude doesn't pay bills and can't be used as a co-payment.



First off, I never said that when I was a kid the special needs class consisted of "genuine window lickers." What I said was that there were only about five or so students in that class when I graduated in 1997 and that now, barely a decade later, one of my friends's wives--who is just a year older than me--is a teacher in one of two classes of such students at a school in the same county. You assumed that the class population increase was due to some kind of money scam. I can assure you, her students are not "rounded down" to score some free government cash.



So you resent people for not wishing to be exposed to potentially cross-contaminated items to which they may have volatile reactions? And why should anyone be embarrassed of having a food allergy or any other kind of medical condition? Talk about blaming the victim!



Nice try. That's not what I said. I said that my perceptions are constructed from what I am seeing, whereas DeputyDave argued that "I think a lot of what you are seeing is colored by your perceptions." His statement would have us believe that I am choosing to believe what I have said because it is evidence that suits my pre-existing conclusion. Instead, I am saying that, like most rational people, I am instead following the trail of evidence before me to reach a perception--not a conclusion--about the situation. And my perception is that we have a larger population experiencing more frequent incidents of greater health issues than ever, and that that trend seems to only be escalating.

I still disagree with just about everything you said. Considering you didn't understand much of what I posted I figure it’s pointless to go on any more about it.

My prediction (backed up by some really, really smart guys) is that in the next 10 to 20 years we will see an explosion of new medical breakthroughs that will completely revolutionize life as we know it. Most of the major health concerns and killers will be almost eliminated. The only things I see that could slow that advancement to vastly expanded life spans is bullshit like this health plan interfering with advancement in medical research.

[MinLShaw]

There is an increase in physically disabled people that never would have made it past their first 3 months of life a few decades ago.

One part of this statement calls back to my earlier remarks about the debate between being grateful for being alive vs. living with impaired health and costly medical bills. The other part seems to invite the very exploration of the rise of such incidents that I asked for in the first place.

[MinLShaw]

I still disagree with just about everything you said. Considering you didn't understand much of what I posted I figure it’s pointless to go on any more about it.

I understood just fine. I just happen to resent people who resent others with medical issues for having the gall to seek help and attention for their cause.

My prediction (backed up by some really, really smart guys) is that in the next 10 to 20 years we will see an explosion of new medical breakthroughs that will completely revolutionize life as we know it. Most of the major health concerns and killers will be almost eliminated. The only things I see that could slow that advancement to vastly expanded life spans is bullshit like this health plan interfering with advancement in medical research.

As someone whose daily life could easily be improved by those advances, I sincerely hope you're right about the next ten to twenty years. And, ultimately, all I was trying to do was suggest that we not define our entire health care exploration by this controversial piece of legislation which ultimately only addresses money and not behavioral or environmental trends which are surely involved in explaining the greater incidents of health issues to even have to address. I believe that an ounce of prevention is worth (at least) a pound of cure, and I therefore believe it is in our shared interests to be able to prevent more of these kinds of costly issues wherever possible.

[DeputyDave]

I understood just fine. I just happen to resent people who resent others with medical issues for having the gall to seek help and attention for their cause.


Who did that? I was merely pointing out the differences in how things like allergies were looked at when I was a kid. As far as special needs programs... I think you need to do a little investigating. It is a money making scam by schools (at least here in California). The more kids assigned to it the more money the school receives. These are (for a majority) not the same kids who were in special needs classes just 10 or 20 years ago. I spent two years fighting the schools over this.

As far as the other stuff... check out Ray Kurzweil. He seems a bit out there, but his predictions for the future can't be simply dismissed.

[mosquitobite]

The Wall Street Journal: The Worst Bill Ever (http://online.wsj.com/article/SB10001424052748703399204574505423751140690.html) When Democrats end up soaking the middle class, perhaps via the European-style value-added tax that Mrs. Pelosi has endorsed, they'll claim the deficits that they created made them do it.

That's the best line right there. Deficits that they are creating NOW, but pushing off onto yet another Congress to deal with.

Our politicians are pathetic. Seriously, we need a revolution. :grunt:

[sracer]

Cancer isn't reflected in life expectancy numbers? There may be a rise in cancers but I think a lot of that has to do with proper diagnoses than other factors. I’d like to see some numbers between now and way back in time in the late 90’s, but I doubt they’re very drastically different. I could be wrong. For me life expectancy is the only way you can truly gauge a nation’s health. The numbers can’t be colored and can’t lie.
I don't think that we can discern whether the increase in the number of reports of cancer cases is due to improved detection methods, increased exposure to cancer-inducing material, or both.


As far as autism, I am under the opinion it is being grossly over diagnosed. Like ADD before it, it has become the catch all for a lot of stuff that was just as common in previous years. When I was a teen “Autistic” meant Dustin Hoffman in Rain Man, what they call autism today we called nerd, shy, socially awkward, and introverted. One of my son’s friends has been classified as autistic and I have met him many times. I knew a dozen guys who acted exactly like him in my high school.

Don’t get me started on today’s schools and their “special needs” programs. Like you said, when I was a kid the special needs class consisted of genuine window lickers. My school had the only special needs program in the city so their were quite a few of them being bused in but the numbers were still very small and consisted of kids with actual mental retardation. Today it’s a money making business for schools as they collect their extra funds for every kid classified.
My experiences and observations are similar.


My son (who is incredibly smart, just profoundly lazy) got misclassified as special needs because he answered leading questions by the school psychologist during a single interview (where we were not present). My son simply thought he was getting out of being in trouble for getting bad grades. “Yes, it’s not that I didn’t do my homework because I was lazy, it’s because I couldn’t do it. It’s not my fault.” It took me almost 2 years to get him completely out of the program. I even had administrators try to convince me to keep him in the program even though they admitted he didn’t belong there. They told me that he would have unlimited time to take state tests (like the SAT) and other benefits.
It is the logical conclusion to the "my kids are the center of my universe" mentality that started in the late 70's. It started out with "every child is special", moved on to "outcome-based education". Every child received awards, there were no longer winners and losers. Parents that pushed for that were then faced with the hard reality that "when every child is special, none are".

The last frontier for making their little Johnny or Suzie "special" was medical conditions. Many of the parents that most pride themselves in being involved and caring parents, draw attention to their children by parading their children's ailments. Many have self-diagnosed their children with all sorts of allergies. They've never brought their child to a doctor to confirm these allergies, but they are convinced that Johnny is allergic to wheat. Suzie is allergic to milk.


As far as the “hypersensitivity” comment; when I was a kid in the 70’s I knew of a kid who was allergic to peanuts. It wasn’t a big deal. Peanuts were still served on planes and were put in everything. No one freaked out. The mantra pretty much was, “If peanuts will kill you, don’t fucking eat them.” Why should one kid’s weakness affect our enjoyment of Mr. Carver’s magic nut? It was that way for everything back then. If you were allergic to anything you dealt with it yourself and people didn’t hear a lot about it. People were embarrassed of allergies.
THAT is the result of using medical conditions to make their child special... to draw attention.

[jfoobar]

The AP is now matter-of-factly referring to the cost of the House bill as 1.2 trillion.

[al_bundy]

I don't think that we can discern whether the increase in the number of reports of cancer cases is due to improved detection methods, increased exposure to cancer-inducing material, or both.



My experiences and observations are similar.



It is the logical conclusion to the "my kids are the center of my universe" mentality that started in the late 70's. It started out with "every child is special", moved on to "outcome-based education". Every child received awards, there were no longer winners and losers. Parents that pushed for that were then faced with the hard reality that "when every child is special, none are".

The last frontier for making their little Johnny or Suzie "special" was medical conditions. Many of the parents that most pride themselves in being involved and caring parents, draw attention to their children by parading their children's ailments. Many have self-diagnosed their children with all sorts of allergies. They've never brought their child to a doctor to confirm these allergies, but they are convinced that Johnny is allergic to wheat. Suzie is allergic to milk.



THAT is the result of using medical conditions to make their child special... to draw attention.

strange, a lot of the people i know with school age kids say that by the time they go to first grade they are expected to know how to read and write. and my wife and i were looking at a local daycare and they have kids there that can write full sentences by age 4. the head of the daycare who has decades of experience in working with children even said that kids are a lot smarter today than 30 or 40 years ago.

sounds more like lazy parents who expect the school to do everything for them

[mosquitobite]

Many have self-diagnosed their children with all sorts of allergies. They've never brought their child to a doctor to confirm these allergies, but they are convinced that Johnny is allergic to wheat. Suzie is allergic to milk.


And I'm one of them. But you know WHY I don't get the doctor to confirm what I already know? Because insurance could very well deny my son based on a wheat allergy. How do I know this? Because that's the VERY predicament my husband is in! My husband is a diagnosed celiac. Celiac is genetic, and my son gets eczema anytime he eats wheat. Therefore, I have self diagnosed him, and when I discuss it with his pediatrician, he agrees. He's mentioned getting him tested and when I tell him about 2 of the largest insurers denying my husband health coverage, he completely understands exactly WHY I do not want it in print in his health records!! He's ok going on the assumption.

And, by the way, someone who is intolerant to gluten OFTEN has the same intolerance to milk proteins. Is it life threatening? Not in the same way a peanut allergy is, but it still can do damage to their bodies.

[kvrdave]

sounds more like lazy parents who expect the school to do everything for them

Exactly.

[Ranger]

About the 'worst bill ever' - I don't get why people don't think it can be paid for. Up to this point, over $800 billion has been spent on Iraq and Afghanistan and it hasn't even been 10 years for either war yet.

[kvrdave]

So you think that just spending more can be done as well? Wouldn't it make more sense to say that we can't afford both, or that we may not be able to afford either? How is the logical conclusion that if we can afford one, we can afford more?

[GizmoDVD]

Is there a simple thing to read for the idiots like myself on this issue?

[jfoobar]

Is there a simple thing to read for the idiots like myself on this issue?

I think Mr. Miyagi sort of summed things up nicely.

Walk on road, hm? Walk left side, safe. Walk right side, safe. Walk middle, sooner or later...get squish just like grape. Here, karate, same thing. Either you karate do "yes" or karate do "no." You karate do "guess so," squish just like grape. Understand?

So what we will be getting is not health care reform do "yes" or health care reform do "no" but rather health care reform do "guess so." As such, it is our nation's budget that will get squish just like grape.

I am not confident that the current Democratic regime could agree on a viable health care reform do "yes" even if they were unfettered by Republicans, Blue Dogs, etc. anyway. But given the political realities, they are cramming through a muddled mess of a "guess so."

[Dr Mabuse]

The Dems sold out right off the bat, up to and including Obama.

They were 'guess so'(following that analogy) from the start.

[jfoobar]

The Dems sold out right off the bat, up to and including Obama.

They were 'guess so'(following that analogy) from the start.

There is no way in hell they could get "yes" passed and they knew it. What they can do is get "guess so" passed and morph it into "yes" over time. Will that mean higher taxes? Hell yeah.

Once we pass this threshold, I don't think there is any going back.

[nemein]

Frankly I don't think there's any "guess so" about what they are up to... they know exactly what they are doing and what the ramifications are and are proceeding anyway because they hope it will eventually get them the end result they want.

[Ranger]

So you think that just spending more can be done as well? Wouldn't it make more sense to say that we can't afford both, or that we may not be able to afford either? How is the logical conclusion that if we can afford one, we can afford more?If we had been told upfront that these wars would cost over $1 trillion in 10 years, I think many would be thinking 'we can't afford that.'

[kvrdave]

If we had been told upfront that these wars would cost over $1 trillion in 10 years, I think many would be thinking 'we can't afford that.'

Arent' we told that we can't/couldn't? Doesn't that still mean that we are trying to put another trillion along with the last trillion that we couldn't afford? Doesn't our deficit tend to indicate that we can't afford it?

I guess I'm not sure what your point is.

[kvrdave]

Frankly I don't think there's any "guess so" about what they are up to... they know exactly what they are doing and what the ramifications are and are proceeding anyway because they hope it will eventually get them the end result they want.

Because they hate the way America was founded and what it was founded on. :)

[classicman2]

http://news.yahoo.com/s/nm/20091103/pl_nm/us_usa_healthcare_congress

In a blow to the White House, the Senate's top Democrat signaled Tuesday that Congress may fail to meet a year-end deadline for passing health care legislation, leaving the measure's fate to the uncertainties of the 2010 election season.

Majority Leader Harry Reid, D-Nev., spoke as Democratic officials said it could be December before Senate debate begins in earnest on the issue atop President Barack Obama's domestic agenda, months after senior lawmakers and the White House had hoped. The drive to pass legislation has been plagued for months by divisions within the party's rank and file.

[DeputyDave]

http://news.yahoo.com/s/nm/20091103/pl_nm/us_usa_healthcare_congress

In a blow to the White House, the Senate's top Democrat signaled Tuesday that Congress may fail to meet a year-end deadline for passing health care legislation, leaving the measure's fate to the uncertainties of the 2010 election season.

Majority Leader Harry Reid, D-Nev., spoke as Democratic officials said it could be December before Senate debate begins in earnest on the issue atop President Barack Obama's domestic agenda, months after senior lawmakers and the White House had hoped. The drive to pass legislation has been plagued for months by divisions within the party's rank and file.

Them damn Republicans.

[nemein]

Because they hate the way America was founded and what it was founded on. :)

No they just have a different take on what America can and should be. Frankly I think the founding fathers are shaking their heads at both parties now and if they had had the ability to see what would have happened they probably would have done things a little differently, better definition of what powers belong to which branch for one thing.

[X]

No they just have a different take on what America can and should be. Frankly I think the founding fathers are shaking their heads at both parties now and if they had had the ability to see what would have happened they probably would have done things a little differently, better definition of what powers belong to which branch for one thing.I don't know what more they could have done than say what the government could and couldn't do, but we see how that worked out. Maybe the definitions of treason could have been expanded upon.

[kvrdave]

http://news.yahoo.com/s/nm/20091103/pl_nm/us_usa_healthcare_congress

In a blow to the White House, the Senate's top Democrat signaled Tuesday that Congress may fail to meet a year-end deadline for passing health care legislation, leaving the measure's fate to the uncertainties of the 2010 election season.

Majority Leader Harry Reid, D-Nev., spoke as Democratic officials said it could be December before Senate debate begins in earnest on the issue atop President Barack Obama's domestic agenda, months after senior lawmakers and the White House had hoped. The drive to pass legislation has been plagued for months by divisions within the party's rank and file.

The biggest blow was not pushing it through before now. Given the off year election, a number of Democrats will think about their jobs before they vote now.

[classicman2]

I think a number of Blue Dogs will 'think about' the election results.

[mosquitobite]

Yep. They can say it'll be at least December, but I doubt anything is going to happen. If Corzine had won, they might have had a bit more courage to press on, but given his loss, I really think many blue dogs are going to "stand tough" on the costs of UHC.

I am optimistic that after last night, the Democrats have even less of a chance to pass any kind of reform. And it's a double edged sword for them. ;) They don't pass it, their constituency is pissed. I mean, you have Congress and the WH! If they do pass it, it will either be WAY watered down to basically nothing or if they ram it through, they'll have significant losses in 2010. The American people don't want MORE debt at this time. Unfortunately for the Dems, their majority will be wasted during a recession where people are trying to save money, not spend it. Watching Congress spend taxpayer money like drunken sailors during a recession is just going to cost them.

[Venusian]

Boehner claims the bill requires everyone getting the govt plan to pay a premium for abortions:

http://republicanleader.house.gov/blog/?p=666

On line 17, p. 110, section 222 under “Abortions for which Public Funding is Allowed” the Health and Human Services Secretary is given the authority to determine when abortion is allowed under the government-run plan. The Speaker’s plan also requires that at least one insurance plan offered in the Exchange covers abortions.

What is even more alarming is that a monthly abortion premium will be charged of all enrollees in the government-run plan. It’s right there on line 16, page 96, section 213, under “Insurance Rating Rules.” The premium will be paid into a U.S. Treasury account - and these federal funds will be used to pay for the abortion services.

Section 213 describes the process in which the Health Benefits Commissioner is to assess the monthly premiums that will be used to pay for elective abortions under the government-run plan. The Commissioner must charge at a minimum $1 per enrollee per month.

[kvrdave]

I had heard something about that by the Democrat head of the pro-life caucus (or something like that). They had problems with it.

[nemein]

Anyone know anything about this rally going on in DC today? I guess it started w/ something a MN representative said last week and it took on a life of it's own from there... I'm listening to it on CSPAN but not seeing much else about it. I was just curious as to what the turn out was...

[sracer]

I thought that the rally (started by Michelle Bachman) was supposed to be Friday.

[nemein]

That's the one... nope it is going on right now.

[classicman2]

House ML Steny Hoyer said today that the House will pass the health care bill Saturday.

He also said the vote will be very close.

[nemein]

So the rules committee meeting is starting now for the anticipated vote tomorrow. Wrangle's new line is that not only will this bill NOT add to the deficit but it will actually help decrease it over time rotfl Does he seriously believe this :crap: Is anyone actually buying that :confused:

[JasonF]

So the rules committee meeting is starting now for the anticipated vote tomorrow. Wrangle's new line is that not only will this bill NOT add to the deficit but it will actually help decrease it over time rotfl Does he seriously believe this :crap: Is anyone actually buying that :confused:

The CBO?

[nemein]

The CBO?

First off they only score the bill based on what they are given, it is my understanding a chunk was taken out of this bill (hard to believe since it's already 2k pages) that will be voted on later to help bring the cost of this specific bill down. I may have that part wrong considering how information and disinformation there is out there right now about this process though...

Second what is the CBO's track record on scoring bills... considering how many times Gov't programs end up running over projected costs I'm guessing that it is probably not very good but I don't know off hand.


Honestly do you really believe this bill will be able to keep costs under control?

[wildcatlh]

The CBO?

Given the extensive caveats in the CBO's report, they don't exactly believe it's going to reduce the deficit, either. That and the "cheating" that's being done by writing the lower medicare reimbursement into the deal, and then separately passing the "fix" that's going to cost $210 billion (per the CBO)

[classicman2]

People on Medicare - with Medicare Advantage - should be worried about this plan.

[BKenn01]

People on Medicare - with Medicare Advantage - should be worried about this plan.

C-man, everyone should be worried about this plan.

[kvrdave]

The CBO?

rotfl

The CBO has said that the things required to get this to only cost 1.2 TRILLION won't ever happen.

[X]

I can't wait to see what happens tomorrow.

President Obama is going up to Capitol Hill with coattails after last Tuesday that look like GWB's in 2006.

And after today's 10.2 unemployment figure, what is he going to promise the reticent congresscritters? Another stimulus bridge? Their own czar for their district? Not campaign against them in the 2010 election?

Then he's off to Asia.

[gmanca]

Two gubernatorial losses barely have the resemblance, let alone the impact, of both chambers of Congress switching parties.

[classicman2]

I'm beginning to see the need for health care reform.

I had a total knee replacement one month ago.

The bills I've already received (and that's not all of them) total about $60,000.

Damn - makes one glad that he's got insurance. ;)

[BKenn01]

I'm beginning to see the need for health care reform.

I had a total knee replacement one month ago.

The bills I've already received (and that's not all of them) total about $60,000.

Damn - makes one glad that he's got insurance. ;)

I dont think anyone argues the need for health care reform. The problem is what that (current) reform is.......

[tommy28]

"""Republicans offered an alternative"""


Seems to me about 8 years to late....

[DGibFen]

Vote is on. Dems say that have 224 yea votes.

It's passing, but at the bare minimum it needs to win, it looks like. 218-214 right now.

Final vote: 220-215. 1 Republican voted yes, 39 Dems voted no. Now it has to magically pass Senate.

To be fair, the Republican (Joseph Cao - LA) didn't vote until after vote #218 had passed.

[coli]

I am in shock the dems are doing this, as there is going to be a backlash like no other. It is only the House version and it still has to go the Senate, but to have a vote on a Saturday night is pretty pathetic. I thought the Republicans would probably win 3-4 senate seats and 20 house seats in 2010, if they ram through this healthcare bill, you will see a change in congress, because every democrat in a red district is going to get voted out.

[kenbuzz]

It passed the house 220-215. All but 1 Republican voted against it. Joseph Cao (R-LA) was the only Republican to cross the aisle and vote in favor. The dems voted 219-39 in favor - a LOT closer than they thought it would be.

There are going to be a lot of representatives personally responsible for this bill's passage if it makes it out of the Senate and becomes law.

[Ranger]

The anti-abortion amendment passed 240-194. No elective abortions but would be ok in case of rape, incest, and life of mother in danger. Surprised vote was still that close.

So the big healthcare bill should now get more support from some Dems.

So, c-man how's the knee? My uncle had the knee replacement done last year and he still has some pain.

[dork]

Historic Health Care Bill Passes with Bipartisan Support!

[birdseye]

The Stupak-Pitts anti-abortion amendment gave the blue dogs cover to vote for the bill, but the Dems wouldn't guarantee it would survive the conference committee. Which means it probably won't.

[Ranger]

It passed the house 220-215. All but 1 Republican voted against it. Joseph Cao (R-LA) was the only Republican to cross the aisle and vote in favor. The dems voted 219-39 in favor - a LOT closer than they thought it would be.

There are going to be a lot of representatives personally responsible for this bill's passage if it makes it out of the Senate and becomes law.Wow, they voted on that already. Just a minute ago they were voting on the abortion amendment.

They're working so hard today. :lol:

[coli]

I am a from a district where one of the blue dogs (John Adler, Democrat - NJ) voted against it, so I guess now I must focus on my two liberal senators (Lautenberg and Mendendez).

I went to 2 town hall meetings with Adler and the first one back in early August, he was on the fence, and the turnout that day was about 95% against it. The next week Adler was defiant that he wouldn't vote for the bill, almost sounding like a republican that day as he said, "I am going to do anything I can to make sure this doesn't pass!" I swear those are the exact words he said.

As for my 2 Senators from NJ, they are so damn liberal, I will send my emails to them to urge them to vote against, but I guarantee they vote for. There is only so much I can do at this point.

[kvrdave]

Historic Health Care Bill Passes with Bipartisan Support!

rotfl

[Rypro 525]

anyone else watching Geraldo? It seems like he's reading Obama's repsonse with a 'this is bullshit' type tone

[Numanoid]

I'm beginning to see the need for health care reform.

I had a total knee replacement one month ago.

The bills I've already received (and that's not all of them) total about $60,000.

Damn - makes one glad that he's got insurance. ;)The one thing I've noticed during this debate is that it's the people WITH health care that are against health care for all. Amazing on its face.

[DAC]

The one thing I've noticed during this debate is that it's the people WITH health care that are against health care for all. Amazing on its face.

It's because those with health care are going to end up with worse health care once the govt takes over.

[dork]

The one thing I've noticed during this debate is that it's the people WITH health care that are against health care for all. Amazing on its face.
True, the people who stand to benefit do seem pretty supportive.

[BKenn01]

It's because those with health care are going to end up with worse health care once the govt takes over.

and more expensive......

[JasonF]

It passed the house 220-215. All but 1 Republican voted against it. Joseph Cao (R-LA) was the only Republican to cross the aisle and vote in favor. The dems voted 219-39 in favor - a LOT closer than they thought it would be.

Do you really think the Democratic leaqdership can't count to 218? They knew how many votes they needed. They chose to free people in vulnerable districts to vote No, but don't think they couldn't have moved those people over to the yes column if they needed to.

They also freed Rep. Kucinich to vote No (and maybe others on the left -- I haven't gone through the roll call Representative by Representative to figure out who is where), and they did that for a reason too. As much as people on the right want to bellyache about this bill, let's remember that it's nowhere close to what the left wants either.

[coli]

The one thing I've noticed during this debate is that it's the people WITH health care that are against health care for all. Amazing on its face.


As a small business owner, I have great healthcare, but I am for reform. Just not THIS reform.

Two of the biggest problems with Healthcare:

1. I cannot shop out of state for the 1,200 healthcare plans that are offered across the country. Being in NJ, I am forced to choose from a few plans(5 to 6) for my employees and myself in NJ only, so essentially that creates less competition. More competition = lower prices.

2. Tort Reform: Most doctors have to pay huge amounts a year for medical malpractice insurance just to ensure they keep their practice against lawsuits. Do you know who foots the bill for that? The consumer, but the democrats have the trial lawyers in their corner, so there was NO tort reform in the house bill last night.

The Healthcare system does need fixing in this country, but you don't change it for the worse, by creating 'the public option' and essentially put 35 million people on the payroll in which somebody has to pay for it?? You know who that is? The American Taxpayer, yet we are already running a 1.2 trillion deficit this year, with a National Debt of around 10 trillion.

Wish I could spend more every year then my net takehome pay! Only in Washington can they pull this shit;)

[classicman2]

The one thing I've noticed during this debate is that it's the people WITH health care that are against health care for all. Amazing on its face.

None of the bills being considered offer health care for all.

I'm for it. Show me how to fund it.

[DeputyDave]

2. Tort Reform: Most doctors have to pay huge amounts a year for medical malpractice insurance just to ensure they keep their practice against lawsuits. Do you know who foots the bill for that? The consumer, but the democrats have the trial lawyers in their corner, so there was NO tort reform in the house bill last night.


Actually this bill is the opposite of tort reform; it forces states to remove what little protection exists (in the form of caps on judgments).

Pelosi, Obama, and the Democrats are flat out liars. Not just in the specifics (72 hour review, Illegal aliens, costs, taxes, etc.) but in the general sense of actually wanting real reform. This bill is simply a power grab that will do far, far more harm than good.

[classicman2]

To be fair, the Republican (Joseph Cao - LA) didn't vote until after vote #218 had passed.

What a wimp!

[classicman2]

As much as people on the right want to bellyache about this bill, let's remember that it's nowhere close to what the left wants either.

You favored it, didn't you?

To be fair - it's closer to what he people on the left wants than what he people on the right wants.

[JasonF]

You favored it, didn't you?

I did, but I recognize that politics is the art of the possible. If I were given the power to redesign our health care system, it would look a lot closer to the one in the U.K. than what's in this bill.

To be fair - it's closer to what he people on the left wants than what he people on the right wants.

That depends on which people on the left you're talking about and which people on the right. It's a lot closer to what Olympia Snowe wants than to what Bernie Sanders wants. On the other hand, it's a lot closer to what Stenny Hoyer wants than what Ron Paul wants. So -- it depends.

[John Drake]

I did, but I recognize that politics is the art of the possible. If I were given the power to redesign our health care system, it would look a lot closer to the one in the U.K. than what's in this bill.



That depends on which people on the left you're talking about and which people on the right. It's a lot closer to what Olympia Snowe wants than to what Bernie Sanders wants. On the other hand, it's a lot closer to what Stenny Hoyer wants than what Ron Paul wants. So -- it depends.

I wish people like you would just move to the U.K., and leave the rest of us alone. The whole fucking world doesn't need to be made over in your ideological image.

[RoyalTea]

What happened to the whole "legislation will be posted for 72 hours before voting" thingy? If this is such WONDERFUL legislation, why do the legislators refuse to be transparent?

[coli]

I did, but I recognize that politics is the art of the possible. If I were given the power to redesign our health care system, it would look a lot closer to the one in the U.K. than what's in this bill.
.

What the democrats in Washington dont understand is you don't try to overhaul our healthcare system when we are in a recession. The biggest thing that hurts an economy trying to recover from a recession is uncertainty.

As a small businessman of 40 employees, I don't know what to expect of this healthcare bill. In this bill passed by the house last night, there will be a 5% tax on employer with sales of $500,000.00.

So our sales were down 20% this year, we are just trying to get by week to week to make payrolls, and these morons in Washington want to start slapping mandates on us and 5% more taxes on us? As a businessman, I wont take any chances investing or hiring anyone in the future, because I don't know what my ultimate bill will be after this is all said and done. We will simply make due with what we have now, and stand put.

And democrats wonder why the unemployment keeps rising as it is up to 10.2%

[BKenn01]

What the democrats in Washington dont understand is you don't try to overhaul our healthcare system when we are in a recession. The biggest thing that hurts an economy trying to recover from a recession is uncertainty.

As a small businessman of 40 employees, I don't know what to expect of this healthcare bill. In this bill passed by the house last night, there will be a 5% tax on employer with sales of $500,000.00.

So our sales were down 20% this year, we are just trying to get by week to week to make payrolls, and these morons in Washington want to start slapping mandates on us and 5% more taxes on us? As a businessman, I wont take any chances investing or hiring anyone in the future, because I don't know what my ultimate bill will be after this is all said and done. We will simply make due with what we have now, and stand put.
And democrats wonder why the unemployment keeps rising as it is up to 10.2%

Exactly and the problem with Washington is that most of the reps (both D and R) are lawyers. They view buisnesses as cash cows.

[classicman2]

I wish people like you would just move to the U.K., and leave the rest of us alone. The whole fucking world doesn't need to be made over in your ideological image.

Come on!! :rolleyes:

[classicman2]

What happened to the whole "legislation will be posted for 72 hours before voting" thingy? If this is such WONDERFUL legislation, why do the legislators refuse to be transparent?

Because it's politics.

Don't expect (or believe) anything different.

[dhmac]

What happened to the whole "legislation will be posted for 72 hours before voting" thingy? If this is such WONDERFUL legislation, why do the legislators refuse to be transparent?
I'm not sure what you mean because I've had links to the bill online for about a week now.

[WCChiCubsFan]

2. Tort Reform: Most doctors have to pay huge amounts a year for medical malpractice insurance just to ensure they keep their practice against lawsuits. Do you know who foots the bill for that? The consumer, but the democrats have the trial lawyers in their corner, so there was NO tort reform in the house bill last night.

Tort reform resulting in lower healthcare costs is certainly one of the most laughable talking points put forth in the healthcare reform debate. Do the people who bring it up actually believe that if tort reform occurred and malpractice insurance premiums went down, which isn’t a certainty, that doctors would magically pass the savings onto the consumers?

History has shown time and time again that when a select group suddenly gains a financial windfall thanks to government regulation, (tort reform is a form of regulation) that the gains are rarely if ever passed onto the consumer. All one has to do is look at Prop 13 in California as an example of savings not resulting in lower prices for the consumer.

One of the benefits 13’s supporters talked about was that it would result in lower rent for renters since apartment complex owners would be saving on property taxes and those savings would be passed along. Of course it didn’t happen.

[Artman]

A few questions: What's with the 96% availability for Americans, who's the 4% who doesn't qualify? (or lucks out depending on your pov).

I have friends who don't have coverage, don't want to pay for it... and get by going to some local clinics when they have to. They'll suddenly have to buy a plan? I don't have an issue with government offering a low cost alternative... but why on Earth force people to have coverage?

[guildda]

They also miss the effect on those who want to start a business as we did. We see the uncertainty in what it's going to cost to hire employees and instead just decided it was better for the time being to pay off the mortgage and invest (and not here).

What the democrats in Washington dont understand is you don't try to overhaul our healthcare system when we are in a recession. The biggest thing that hurts an economy trying to recover from a recession is uncertainty.

As a small businessman of 40 employees, I don't know what to expect of this healthcare bill. In this bill passed by the house last night, there will be a 5% tax on employer with sales of $500,000.00.

So our sales were down 20% this year, we are just trying to get by week to week to make payrolls, and these morons in Washington want to start slapping mandates on us and 5% more taxes on us? As a businessman, I wont take any chances investing or hiring anyone in the future, because I don't know what my ultimate bill will be after this is all said and done. We will simply make due with what we have now, and stand put.

And democrats wonder why the unemployment keeps rising as it is up to 10.2%

[BKenn01]

Tort reform resulting in lower healthcare costs is certainly one of the most laughable talking points put forth in the healthcare reform debate. Do the people who bring it up actually believe that if tort reform occurred and malpractice insurance premiums went down, which isn’t a certainty, that doctors would magically pass the savings onto the consumers?

History has shown time and time again that when a select group suddenly gains a financial windfall thanks to government regulation, (tort reform is a form of regulation) that the gains are rarely if ever passed onto the consumer. All one has to do is look at Prop 13 in California as an example of savings not resulting in lower prices for the consumer.

One of the benefits 13’s supporters talked about was that it would result in lower rent for renters since apartment complex owners would be saving on property taxes and those savings would be passed along. Of course it didn’t happen.

The cost savings passed along would be a lot of the CYA procedures and tests would not be performed.

[X]

The cost savings passed along would be a lot of the CYA procedures and tests would not be performed.The CBO says it would "only" save $54 billion.

Tort Reform Could Save $54 Billion, CBO Says

Congressional budget analysts said Friday that lawmakers could save as much as $54 billion over the next decade by imposing an array of new limits on medical malpractice lawsuits -- 10 times more than previously estimated.

New research shows that legal reforms would not only lower malpractice insurance premiums for medical providers, but also would spur providers to save money by ordering fewer tests and procedures aimed primarily at defending their decisions in court, Douglas W. Elmendorf, director of the nonpartisan Congressional Budget Office, wrote in a letter to Sen. Orrin G. Hatch (R-Utah).

The CBO report lends credence to Republican arguments that substantive limits on malpractice lawsuits will reduce health-care costs. However, President Obama opposes one of the chief proposed changes the CBO studied, caps on jury awards, and analysts give the measures little chance of passage.

"These numbers show that this problem deserves more than lip service from policy-makers," Hatch said in a statement. "Unfortunately, up to now, that has been all the President and his Democratic allies in Congress have been willing to provide."

The letter comes in response to questions Hatch raised during the Senate Finance Committee's recent debate over health-care reform.

Elmendorf wrote that newly available research prompted CBO to update "its analysis of the effects of tort reform." The agency's conclusion: A package of reforms that included a $250,000 cap on damages for pain and suffering and a $500,000 cap on punitive damages "would reduce total national health care spending by about 0.5 percent."

The federal government would reap a substantial portion of those savings, the CBO said, primarily through reduced Medicare costs.

http://www.washingtonpost.com/wp-dyn/content/article/2009/10/09/AR2009100904271.htmlBut what do they know?

[Tracer Bullet]

What happened to the whole "legislation will be posted for 72 hours before voting" thingy? If this is such WONDERFUL legislation, why do the legislators refuse to be transparent?

Did Obama promise that? I honestly don't remember. If that was one of his, I have no problem with it being broken- the executive already has too much power over the legislative.

[X]

I think the 72 hour promise is referring to this:

Pelosi Breaks Pledge to Put Final Health Care Bill Online for 72 Hours Before Vote

Speaker Nancy Pelosi's office tells THE WEEKLY STANDARD that the speaker will not allow the final language of the health care to be posted online for 72 hours before bringing the bill to a vote on the House floor, despite her September 24 statement that she was "absolutely" committed to doing so.

House members are still negotiating important issues in the bill--whether it will provide taxpayer-funding for abortions, for example. Pelosi is pushing for a Saturday House vote, and a number of big changes will be introduced, likely less than 24 hours before the vote takes place (if in fact it does). The Rules Committee hasn't yet released its resolution, or rule, that must be passed before the bill can move from committee to the floor. The rule will set the terms of debate and determine what amendments are in order.

It seems likely that the rule will allow very few, if any, up-or-down votes on amendments on the House floor. Rather, the rule will include a series of amendments that will all be adopted at once if the rule passes.

On September 24, Speaker Nancy Pelosi told THE WEEKLY STANDARD that she was "absolutely" committed to putting the text of the final House bill online for 72 hours before the House votes:


TWS: Madam Speaker, do you support the measure to put the final House bill online for 72 hours before it's voted on at the very end?

PELOSI: Absolutely. Without question.


But tonight, when asked if Speaker Pelosi will leave the bill online for 72 hours after we see what's in the rule, Pelosi spokesman Brendan Daly replied in an email: "No; [the] pledge was to have manager’s amendment online for 72 hours, and we will do that."

Apparently Pelosi's agreement to leave the "final" bill online "at the very end" of the process wasn't such a straightforward pledge.

http://www.weeklystandard.com/weblogs/TWSFP/2009/11/pelosi_breaks_pledge_to_put_he.asp

[RayChuang]

I'm surprised that NOBODY has talked about merging Social Security, Medicare and Medicaid into a singular social services plan that covers both medical and social services benefits from a "single point" provider. That way, we could trim a LOT of government bureaucracy and save possibly at minimum US$350-US$400 billion out of Federal the budget per year.

[Jason]

I wish people like you would just move to the U.K., and leave the rest of us alone. The whole fucking world doesn't need to be made over in your ideological image.

America. Love it or shove it. :rolleyes:

[John Drake]

America. Love it or shove it. :rolleyes:

No, just quit trying to make America turn into Europe. If you want to live in a country that is run like those in Europe, then go to Europe.

Fuck. Leave the rest of us a choice.

[Goldblum]

Did Obama promise that? I honestly don't remember. If that was one of his, I have no problem with it being broken- the executive already has too much power over the legislative.

:hscratch:

Not following you. The promise of early disclosure of bills was for the benefit of the citizens, not the President/executive.

[kvrdave]

I'm surprised that NOBODY has talked about merging Social Security, Medicare and Medicaid into a singular social services plan that covers both medical and social services benefits from a "single point" provider. That way, we could trim a LOT of government bureaucracy and save possibly at minimum US$350-US$400 billion out of Federal the budget per year.

That would make government smaller and more efficient. Obama wouldn't ever allow that.

[Ranger]

I'm surprised that NOBODY has talked about merging Social Security, Medicare and Medicaid into a singular social services plan that covers both medical and social services benefits from a "single point" provider. That way, we could trim a LOT of government bureaucracy and save possibly at minimum US$350-US$400 billion out of Federal the budget per year.I doubt those savings, but I think many on the left definitely want a singular system and some believe that this healthcare bill is just another step toward that.

[Ranger]

To be fair, the Republican (Joseph Cao - LA) didn't vote until after vote #218 had passed.I forgot that was the guy who finally replaced William Jefferson.
Cao is the first Vietnamese American, as well as the first native of Vietnam, to serve in Congress, and the first Republican to serve in his district since 1890; his district usually votes overwhelmingly Democratic.So, I don't think Cao is worried about this hurting him, and this is good publicity for him, esp. this early in his career in Congress.