What You Learn When You Listen


The debate over universal healthcare rages on.

My last column on this matter raised considerable debate both in response to the OregonCatalyst posting and my newsletter distribution list. More importantly, you can hardly go anywhere today that the conversation, at some point, doesn’t lead to a discussion of the concept of universal healthcare. So much is being said and so few are listening that I thought it might be time to close my mouth and open my ears. It is always amazing what you will learn when you stop talking and start listening.

While the views and arguments of my friends are interesting and I enjoy the give and take of a good debate, I tend to listen to those who actually know what they are talking about. And when it comes to healthcare I tend to listen to those involved actually involved in the field — doctors, nurses, healthcare administrators — and I tend to disregard those who aren’t— politicians, labor unions leaders, and trial lawyers.

And so here are the views and questions emanating from some of those to whom I have listened.

One of my good friends has been involved in healthcare administration his entire professional life — nearly thirty years. He has participated at every level from plant management to executive and is recognized by his peers as one of the most knowledgeable people in the field. His first comment was, “I cannot discuss this without getting emotional.” He then went on to relate his major concerns:

ï‚· Regardless of what the politicians say, this is socialized medicine. The provisions that mandate a “public option” and allow you to maintain your current health insurance only until you change insurers (new job, new insurer, retirement, etc.) at which time you must accept the “government option” is simply a migration strategy to a “single payer plan” and that is code for socialized medicine. (Both President Obama during the presidential campaign and Rep. Barney Frank in a recent interview acknowledged this migration strategy and affirmed that the end plan was for a single payer plan.)
ï‚· There are well over a hundred amendments pending to the various alternative plans. Nobody knows precisely what is in the plans currently and nobody will know the effect of all of the amendments when they vote on it. These amendments deal with everything from euthanasia to mandatory participation in abortions regardless of moral objections.
ï‚· The cost estimates already provided by the Congressional Budget Office indicate that there will be no savings under any of the pending proposals and that is because none of the proposals adequately address cost containment.
ï‚· Every government plan in America has exceeded, not by a little but by a lot, the estimates of its costs. Government then attempts to manage the cost by reducing coverage and payments to healthcare providers.
ï‚· The fact that Congress has exempted themselves and the public employee unions should indicate that the end product would be inferior to what is currently available to eighty percent of the population.

A doctor responded to my last column with a number of criticisms — most suggesting that I was using inflammatory language in categorizing the proposals as socialized medicine and suggesting that these plans emanate from far left wing of Democrat Party.

The doctor did strike a telling note when he suggested that access to emergency room services is not an adequate substitute for general healthcare. He is right and the point I was attempting to make (that the real problem is much smaller and less costly than these plans address) can be better said.

The experts say that there are approximately 47 million people in America who do not have health insurance — not access to healthcare, but health insurance. Included in the number are those illegally in the United States (nearly 20 million strong), those who are temporarily without health insurance because they have lost their jobs or in the process of changing jobs, those who decline health insurance because they are young and healthy and do not wish to pay the high costs, and those who have made a conscious decision to “pay as you go” in lieu of health insurance.

According to the United State Census Bureau approximately 40% of those household without health insurance make in excess of $50,000 per year. These are households that can afford health insurance but choose not to pay for it. Those who choose not to pay covers the last three categories of those referenced above.

Assuming that there are one and one-half persons in each such household, reduces the number of people not covered by health insurance to about 19 million. I am being generous in assuming that half of those illegally in this country are covered by health insurance. Even at that generous assumption that reduces the total number of uninsured to about 9 million. The current population of the United States is 300 million people and, therefore, those who do not have access to health insurance (9 million) represent less than three percent. And yet we propose a solution that covers not the three percent in need but the one hundred percent who neither want nor need socialized medicine.

In the end, however, the doctor acknowledged that he opposed the current plans because they are “foolhardy and costly” — precisely the right reasons.

Another doctor appeared at one of the public forums in McMinnville to ask a simple question. How can the government discuss limiting multiple diagnostic tests if the same government refuses to do anything to limit malpractice litigation? The point is that doctors often run multiple, and sometimes unnecessary, diagnostic tests and procedures simply because they fear lawsuits if they do not.

But all of these cogent points are lost in the din of political posturing. The Democrats are stage managing the so-called “healthcare forums” by stacking the audiences through the backdoor with their friends in the labor unions — principally the public employee unions. They don’t want to hear the questions or comments because their minds are already made up and they want to rush to a vote before anybody else points out the obvious, embarrassing provisions — just like they did with the “no pork stimulus plan” which contains billions of “pork” to Democrat constituencies, including ACORN. And the Republicans are so busy trying to score political sound bites for the next election that they are not making the reasoned arguments that will prevail with voters.

In the end, everybody is talking and nobody is listening. And lost in all of this is the import of this dramatic change in the provision of healthcare — a change that once begun — like all other social programs — will never retreat and will only grow. There will be no going back even when America’s healthcare system degenerates into a third world status like Canada, France and other countries who embraced socialized medicine as the big answer to a little problem.

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  • Maximillion

    Health care is not a right.
    These complete fools need to get over that notion.

    • David Appell

      First of all, Amendment IX of the Bill of Rights says:

      “The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.”

      Health care might not be listed in the Constitution, but it *is* a sign of a just nation committed to a sense of well-being for all and of community. Health care thus falls into the same category as fire protection, police protection, military protection, universal postal service, universal telephone service, public schools, etc.

      • Voter

        No it doesn’t.

      • snkbyt

        Next thing will be the Gov’t providing all of us equal housing, all driving the same car..trying to get us all eating the same thing..When will you socialists understand Freedom and the Constitution…Health care isn’t a right..

  • Rupert in Springfield

    The health care problem, to what ever extent there is one, is indeed a small problem. I think its good you point this out. The number of legitimately uninsured is grossly overstated, for reasons you state.

    Sure, there is a small percentage of the population that is legitimately uninsured that perhaps could be addressed in some manner. Those uninsured by choice: illegal aliens, people who don’t buy insurance by choice, or people who drop their insurance by choice could be dealt with by simple credit collection means as we currently do with dead beat parents. Garnishment of wages and civil/criminal penalties for failure to pay emergency room bills because you didn’t feel like buying insurance are powerful incentives.

    The one thing we do know is government health care is not the answer to solving the spending side of the health care equation. Listening to the members of BO’s administration who have expertese in these matters confirms this.

    The CBO tells us there are no savings in BO’s plan. BO’s medical advisor to the OMB ( the White House version of CBO ) Ezekiel Emanuel, also tells us there will be no real savings under a government plan except those achieved by rationing. If that weren’t enough we also know that according to Peter Orszag’s ( the White House Director of OMB ) congressional testimony last June, government and private health care costs have grown at pretty much the same rate since the 1970’s. In other words, past experience shows that if containing costs is a consideration, government is hardly a panacea according to the current administration.

    Therefore, since cost containment really isn’t a serious motivation here, what the proposal boils down to is should health care be rationed for all so as to extend coverage to this small minority? Frankly I don’t think the American people are willing to make that sacrifice. Given the risk they would be exposing themselves to, government in charge of their health care, that seems a very logical choice.

    • David Appell

      > The one thing we do know is government health care is not the answer to solving
      > the spending side of the health care equation.

      Actually this is the one thing we *do* know, as industrialized countries with single payer systems all spend less on health care than we do, cover almost all of their citizens, and typically have better results.

      What they don’t do is allow large corporations to demand a cut of the action while giving very little added benefit.

    • David Appell

      Insurance costs are increasing at about 8 times the rate of incomes. For how long is that sustainable, Rupert?

      Businesses almost always see 10-20% annual rises in the cost they pay for health premiums. How long is that sustainable for, Rupert?

      • snow

        Yes, but look at the reasons the health care premiums are increasing.

        1. Government involvement with mandates

        2. Lawsuits.

        There is increasing numbers of people trying to get rich from lawsuits. Oregon Does Not allow a basic policy, that covers doctor visits and hospital. When you purchase insurance, in Oregon, you must be covered for 33 other mandated items that probably don’t even concern you. Those things that are mandated should be options not requirements.

        • David from Eugene

          Government mandates are not the cause of the annual increases in health care premiums. They may be the rationalization that the insurance carriers provide to justify their annual increases but after the first year they are in effect they are no longer the real cause.

          As to the premise that plaintiff’s attempts to become rich are driving malpractice suits I do not believe it has merit. Rather, I believe that the motivation behind most of the malpractice suits is a combination of plaintiff’s attempts to avoid bankruptcy or to see that a negligent medical practitioner is sanctioned that are the real driver. In many cases a successful law suit is the only way that an individual or family can survive the misfortune of being on the wrong side of a medical procedure’s success rate. This is not fair to the doctor or his malpractice carrier and is adding to health care costs but it is the only option that is currently available. One of the hidden benefits of a universal single-payer system, particularly if it is accompanied by a disability pension system, is that that the unlucky individual or family faced with long term medical costs would not have to resort to a law suit to pay for future health care costs as they would already be covered. And being covered any law suit that was pushed anyway would not have that argument to put before the jury. Further just as universal single payer should reduce Automobile, Workman’s Compensation and General Liability Insurance premiums because the carriers would no longer be on the hook for medical treatment so should Malpractice Insurance. This reduction in the need for malpractice suits should also reduce the need for Doctors to practice defensive medicine further reducing costs.

          Oregon does have a basic health care policy that covers doctor’s visits, hospitalization and necessary medical treatments and procedures. Because it has been proven necessary to spell out a number of these treatments and procedures to insure that they are covered the Oregon Legislature has after study and debate specifically mandated they be included in the standard police. And yes, that list of mandated coverage does include items that you specifically will not need but they are items that a large number of Oregonians will need and as that most health insurance is provided in the form of employer provided group policies they need to be included. As to individual policies it is not clear that eliminating the mandates would in fact reduce premiums as doing so would reduce the size and make up of the risk pool that the policy holder is in.

          • snow

            Everytime a new mandate is added, my premiums increase. Please explain that

        • David Appell

          (Two days later).

          Rupert, let’s note your lack of a response. I didn’t think you’d have an answer.

    • David Appell

      > should health care be rationed…

      Rupert, how many stories/data items do you have to hear about before you understand that health care *is* already rationed in this country, as anyone who has ever been denied by an insurance company knows. And, of course, health care is rationed if you can’t afford it as well.

  • dartagnan

    “There will be no going back even when America’s healthcare system degenerates into a third world status like Canada, France and other countries”

    This has to be a joke. It is the United States, not the “socialized medicine” countries, where health care is deteriorating to Third World status. Look at the data. We rank somewhere in the neighborhood of 37th in the world by most indexes. The only area in which we rank Number One is in COST. This is not just because of uninsured people but because our profit-driven medical industry is corrupt to the core. Assembly-line medicine (an average of 12 minutes allowed for each office visit), unnecessary expensive tests ordered to fatten the profits of hospitals and clinics (and the doctors who often own the clinics that do the tests), doctors on the take from pharmaceutical companies, insurance companies looking for every possible pretext to deny claims — the list of abuses goes on and on and on.

    Conservatives take advantage of the insularity and ignorance of most Americans to keep peddling the lie that we have “the best health care system in the world.” That might have been true in Marcus Welby’s day, but that day has long since passed.

    • Steve Plunk

      I wouldn’t confuse those “rankings” with reality. Some rankings are life expectancy rankings that include auto deaths and infant mortality. We try to save infants that other countries do not. The proof is in the pudding in that people admire our system but not the cost.

      All of the proposed “solutions” come woefully short on any cost control measures. There are many cost cutting ideas like tort reform which would not only reduce liability insurance costs but reduce unnecessary “defensive medicine” tests. It’s the lawyers that cause those tests not hospitals trying to “fatten the profits”.

      Insurance is simply shared risk. If you look closely you’ll see they make about the average profit (return on investment) of most businesses. Demonizing insurance companies gets us no where. Controlling costs does.

      The current method of reform is frightening people on it’s own without any influence from conservatives. Blaming those asking questions and wondering why things have to move so fast exposes unfair tactics of this Administration. We need to slow it down and look to savings, not just more money into the system, for real reform.

  • v person

    Where to start?

    “Regardless of what the politicians say, this is socialized medicine. ”

    No it isn’t. At most, it is an expansion of “socialized insurance.” And even at that only for a few. I wish it were more socialixed, like in single payer.

    “The fact that Congress has exempted themselves and the public employee unions …”

    I have a hard time understanding what this statement even means. Congress and government unions are citizens of the United states. The bill(s) include provisions that apply to all of us. Federal employees and congress people choose their health insurance froma menu of options, a much broader aray than most of us get. For some of us, we will get access to that same array. What is wrong with that?

    “Included in the number are those illegally in the United States …”

    I don’t think this is correct Larry. The 47 million, which is an estimate for any given time, does not include those here illegally. It is American citizens only.

    “According to the United State Census Bureau approximately 40% of those household without health insurance make in excess of $50,000 per year.”

    That may be true. But a family of 4 at $50K a year, netting maybe $35K, could not afford a $15-$20K health insurance policy, assuming they could find one that would take them on (no pre-existing conditions). Do the math.

    “Another doctor appeared at one of the public forums in McMinnville to ask a simple question. How can the government discuss limiting multiple diagnostic tests if the same government refuses to do anything to limit malpractice litigation? ”

    So argue for that to be included in the bill. Don’t trash the whole thing.

    “There will be no going back even when America’s healthcare system degenerates into a third world status like Canada, France and other countries ….”

    Larry, do your homework. France has the highest rated health care system in the world based on actual health outcomes, and costs about 60% of ours per capita. Canada, with all its problems, ranks higher than the US and costs 1/2 as much.

    • Max

      Why don’t people flock to Canada, then, for their health care? Or France? Because the care in both places is sub-standard.
      Do the reality.

  • rural resident

    Good comments, v person. Conservatives have an interesting idea of rights versus privileges. Carrying a gun is a “right,” but being allowed to continue breathing isn’t. So much of what passes for health care accessibility in this country is related to one’s employment status. With unions having an ever-diminishing role in our society, employers can be arbitrary and capricious. They can (and do) fire people for any reason – or no reason at all, regardless of the employee’s productivity, skills, and commitment to the job. I have trouble with the concept that one’s ability to maintain good health should be dependent upon one’s willingness to kiss someone’s backside to remain employed.

    I asked several Canadian friends whether they would trade their health care system for ours. It took several minutes for them to regain their composure, as they practically fell on the ground laughing. Despite the stories one runs across on Faux News, Canadians’ are quite pleased with their single-payer system. Any politician suggesting its abolition (or even a major change to it) would have zero future in Canadian politics.

    Max, people don’t tend to leave their own country, even when healthcare isn’t the best. They stay and work within the system to make their country better. But given your assumption about mobility, my question back to you would be, “Since health care there is so poor, why aren’t Canadian and French citizens flocking HERE to escape sub-standard care and access our (supposedly) better services? There may be a few Canadians coming across the border, but it’s a trickle, not a torrent. (U. S. citizens can’t access their system, so we’ll never know how many would if they could.)

    Larry, you state that, “Nobody knows precisely what is in the plans currently and nobody will know the effect of all of the amendments when they vote on it. These amendments deal with everything from euthanasia to mandatory participation in abortions regardless of moral objections.” Apparently, that applies to you. There is no provision in any of the proposed bills that would mandate that someone take the “public option” once they leave their current jobs. (Frankly, I wish it were so. I’d rather see a single-payer plan, but that won’t happen with this legislation.) Neither, despite your shrill attempts to whip up hysteria among the low-information, poorly educated citizen is there anything requiring euthanasia (this is just weird Palin crazy talk) or abortion coverage (again, too bad; it’s a medical procedure, and those who see it as a choice should have that option).

    Frankly, when you talk about the elderly dying sooner than necessary, our current system is responsible for plenty of that. I had two relatives who were denied procedures because of their age, even though those procedures would have significantly lengthened their lives. Those decisions were made by insurance company bureaucrats, not the government. We have “death squads” already, and you can find them in insurance company boardrooms.

    As for illegals getting medical care, there isn’t anything that guarantees them care in the bills I’ve seen. However, for argument’s sake, let’s assume the following: an illegal immigrant with a highly infectious, potentially fatal disease comes across the border and comes into contact with a no-care-for-illegals policy. Would you rather have this person infect some number of people, who would then infect more, etc., or would you want to get this person into treatment quickly to prevent the spread of his virulent disease? Quick, you don’t have a lot of time to decide! That’s the problem with simplistic, xenophobic approaches. Life gets in the way.

    Yesterday, I heard Tom Tancredo say that the “public option” would mean the end of private insurance (funny, Medicare seems to have spawned a huge supplemental insurance industry) because private companies couldn’t compete with government plans where profits weren’t a consideration. This is exactly why we need single-payer. Too many people are denied coverage or have procedures denied because of the need for huge industry profits. Those outlandish compensation packages for insurance industry CEOs come at the expense of average Americans. I wonder how many elderly patients were denied the chance to continue living because the CEO of United Healthcare received hundreds of millions in compensation? A non-profit approach that provides additional care instead of wasted overhead and egregious profits would be a big improvement.

    • Steve Plunk

      Quick question or two. I assume those two relatives that were denied life extending procedures because of their age were on Medicare. Correct?

      When speaking of rights does it make sense that a gun right pertains to a persons ability to keep what is theirs while health care also includes the necessity of taking from people in order to finance what other people want? That’s why conservatives are consistent with those positions.

      Lastly, given the state on government education does it make sense to give health care over to the government? I see more bureaucracy and red tape.

      • rural resident

        One was on Medicare, one wasn’t. The one who was had supplemental insurance, for which she paid substantial premiums, despite using virtually no services until she was in her 80s. It was the private supplemental insurance company that made the decision to deny her the care she needed. I lived through this, and saw how this worked. Don’t piss on my leg and tell me it’s raining, Steve.

        Since, unlike you, I’m not one of these “the government is always evil, private industry is always great” believers, I’m not of the opinion that a) public education is terrible or that b) Medicare and Social Security are big disasters. Public education generally works OK. It could be better, but much of the problem has nothing to do with teachers unions or the public institutions that run it. Private schools would work a lot less well if parents were as generally uninvolved as parents of public school kids are and those private schools didn’t have the public schools to fall back on when they want to kick a kid out.

        A Single-payer medical system will work fine if our “leaders” (and I use the work advisedly) had the courage to raise the Medicare tax rate a few percentage points to a level that would support the system. Along with some (limited) use of income tax funds, requirements about getting preventive care, and some required payments for services (for those having the ability to pay), the single-payer system would cover most services, as Medicare does now. Supplemental private insurance should always be available, just as it is for Medicare recipients. No responsible person is talking about “free health care” for anyone, despite the baloney perpetuated by people like Rep. Mike Pence. Most people don’t expect the moon, just a fair deal. They’re willing to do their part.

        • Steve Plunk

          Asking a question is not pissing on your leg and saying it’s raining. Knowing the answer I can now say Medicare made the choice to deny care in one of those cases. That’s a valid point in the debate.

          I’m far from the opinion that government is always evil while the private sector is always good. I believe in limited government because historically it has worked better. That’s all, limited government.

          Any government system will work if we raise taxes high enough. The problem is there are more efficient ways to accomplish the goals. Government has a long track record of inefficiency and doubt we can endure the tax rates needed to make this work.

          There is too much at stake for this “reform” to be rushed through. The act of rushing it through has led to trust issues and misinformation on both sides. We need to slow things down and discuss this in much more detail.

          • rural resident

            Much as I hate to burst your bubble, Steve, it was NOT Medicare that made this decision. It was the private insurance company. I talked with them. (Of course, unlike you, I was only THERE dealing with the situation, so how would I know better than you?) Medicare had nothing to do with it.

            However, as a member of the tin hat crowd that apparently disregards facts in favor of believing, well, whatever it is you want to believe, don’t let those darned old facts stand in your way. Heaven knows that your side seldom does.

          • David from Eugene

            Steve

            And the current private insurance based system will work as long as premiums are raised enough. The problem is more and more people cannot afford these increasing premiums.

            As to your observations regarding how the process being used in this health care reform is flawed and that there should be a better way to do it, you are right it is flawed. But it is the best available. Starting the discussion at the theoretical level to establish basic principles and concepts and then moving on to specific proposals and then the exact implementing language would be a better method but it is not available. First because there is not enough time, political realities limit the time available to not more the 12 months, the first twelve months of a President’s term. Second, because the bulk of the American public is not comfortable with lofty theoretical level discussions they are much more concerned with the details and how those details will affect them. Which means any theoretical discussion will be hampered by public fear mongering in the media on the part of effected parties in an effort to insure that they are positively rather then negatively effected by the final result. And lastly our legislative system does not lend itself to that type of discussion where the public is intensely involved.

            Our present situation is the result of Congress not acting fast enough rather then being too fast. If each house of Congress had passed a health care reform bill we could be having a discussion of specific items not a nebulous set of possible changes and large quantities of incomplete or outright mis-information.

        • Sybella

          Wow, That must have been a gold plated suppliment. I’m on medicare and I also have a suppliment insurance that covers everything medicare does not. I pay less than $100 per month for my suppliment

    • Max

      I think they do come here or they just suffer in silence while not getting treated and then they die so you don’t hear much from them.

  • Rupert in Springfield

    Just got back from DeFazio’s town hall in Cottage Grove.

    The crowd was pretty good. Plenty of crankiness and heated tempers on both sides of the issue. Personally I found myself craving a pack of firecrackers so as to add to the hyjinx

    The one message that did seem to get across and which DeFazio said he was absolutely on board with is that any changes have to be paid for. How that was to be achieved is anyone’s guess. Obviously the standard trick of vastly under estimating the cost, as in Medicare inception, paying for that and then going “Ooops” in a few years is always available to congress.

    I think my favorite person there was a woman who appeared to be around seventy with a “single payer” type sign standing in front of me. She felt Medicare should be expanded to everyone would be a simple solution. When it was pointed out to her by another man her age that Medicare was going broke she replied “no it isn’t, I mean it works for me”. When the man responded that didn’t change the fact that it was going broke and was hardly a long term plan; she simply replied “I don’t know what you are talking about, it works for me”. I can’t say that this interchange affected the way either of these two thought about things, but it did make me think a little bit about the perspective some people come from.

    I think they are probably the same people who leave shopping carts in the parking spaces at stores or ask to see all the flower or bird stamps when the line is out the door at the post office.

    • v person

      “When it was pointed out to her by another man her age that Medicare was going broke…”

      So is our private insurance system. Costs have doubled…..doubled over the past 8-10 years. Companies are dropping policies, postponing salary increases, and/or raising the share that employees pay in for health insurance as a result. Our entire medical insurance system, private and public, is going broke. This is the system you want to preserve?

      • Rupert in Springfield

        >So is our private insurance system. Costs have doubled…..doubled over the past 8-10 years.

        Again, according to OMB director ( this is the White House version of CBO, in other words this is Obama’s own man saying this ) in his June testimony, has stated that public and private sectors have done about the same in containing health care costs since the 1970’s

        “The truth is, as
        Peter Orszag showed us again last week, private and public health care costs have grown at

        practically the same average rate since 1970. Therefore, our current “single payer” buyer ( referring to Medicare ) has

        been no more effective at containing costs over time than the private sector.”

        Source –

        Statement of Len M. Nichols Director, Health Policy Program New America Foundation Heath Care and the Budget: The Healthy Americans Act and Other Options for Reform before the Committee on the Budget United States Senate June 26, 2007

        >Our entire medical insurance system, private and public, is going broke. This is the system you want to preserve?

        No. I have never argued that. I have continually argued against that.

        Please show me where I said I want to preserve that system?

        Failing that – given my past comments, of which you are well aware, continually advocating for change in the current system ( among such changes, allowing people to buy insurance across state lines, you argued against – instituting aggressive debt collection, much like the dead beat parents program to collect costs from those who refuse to buy insurance and use the ER as primary physician, you argued against ) please tell me on what you base this statement that I want to preserve the current system?

        If you do not have statements made by me indicating I want to preserve the current system, please explain how you make the logical inference that arguing against one system means I am for preserving the status quo.

        • v person

          I’m not picking on you. You wrote up above: “The health care problem, to what ever extent there is one, is indeed a small problem.”

          That sounds to me like someone who wants to preserve the status quo. The first change you call for, broadening the insurance purchase options, are in the congressional proposals, called “exchanges.” If I understand them correctly, they would break down the state insurance boundaries and increase competition. The bills that include the public option broaden choices even further.

          Mandating insurance purchase by individuals is also included in several of the bills. That would eliminate the ER issue altogether.

          OK…so if the changes you advocate are in the current bills, then why aren’t you supporting them?

          As for cost containment, the problem is that absent global budgeting (i.e. single payer) or going to a true free market, there is no effective way to keep costs under control. Obama is finding that out.

          • Rupert in Springfield

            >The first change you call for, broadening the insurance purchase options, are in the congressional proposals, called “exchanges.” If I understand them correctly, they would break down the state insurance boundaries and increase competition. The bills that include the public option broaden choices even further.

            I have read about the “exchanges” and asked DeFazio about the “exchanges” and can’t get a straight answer. DeFazio admitted as much and was very frank about this, these sorts of details are very fuzzy, especially since there is not a final bill out of conference ( and by that I mean conference of both house and senate after passage, that has not happened yet ).

            To me, once you throw in the public option, government insurance, it all becomes academic. Insurance companies would be driven out of business by a competitor that could constantly undercut them since it can run at a loss indefinitely, al la Medicare. I frankly think the “public option” is a totally disingenuous proposal in that regard.

            >Mandating insurance purchase by individuals is also included in several of the bills. That would eliminate the ER issue altogether.

            I could sort of go along with that concept. However auto insurance is mandated and we still have uninsured motorists.

            Why not simply go after dead beat patients? We already have the infra structure in place.

            How will you verify insurance? Would I be pulled over walking down the street at random to check my insurance ID card?

            >OK…so if the changes you advocate are in the current bills, then why aren’t you supporting them?

            Because they aren’t as explained above.

            In addition there are other things in the bills with which I strongly disagree – namely the $1T or so price tag which I have a strong feeling is underestimated if past performance is any indication.

            >As for cost containment, the problem is that absent global budgeting (i.e. single payer) or going to a true free market, there is no effective way to keep costs under control.

            Well, I frankly don’t understand why it is governments business to control costs for private health care. I don’t see why it is their concern. Escalating private health care costs arent a good thing, but they hardly threaten the country in anywhere near the fashion escalating deficits have.

            If one accepts that it is governments purview to assure low costs of something, then surly one should try methods first that cost nothing. These would include the steps I outlined in my previous post. Does that solve every health care issue at hand? No. It seems far more logical to me to try and solve what we can, that costs no money to do so before we launch a whole new entitlement.

            I think congress should concentrate on controlling their spending as it represents a far greater threat to the countries longevity than private health care costs. Sure, the escalating costs of Medicare are a concern, but they are just a part of the overall spending problem Washington has. We have a problem with containing government costs far more than we have a problem containing health care spending costs.

          • v person

            “To me, once you throw in the public option, government insurance, it all becomes academic. Insurance companies would be driven out of business by a competitor that could constantly undercut them since it can run at a loss indefinitely, al la Medicare. I frankly think the “public option” is a totally disingenuous proposal in that regard.”

            Except that in the bills that have a public option, it is quite restricted, primarily to those who are self employed and in markets that don’t have any real competition. I think the argument against the public option that it can’t be allowed because it will be cheaper and/or better is a hoot. I mean, if it is cheaper and/or better and people gravitate to it then that would actually save us money and maybe improve quality. Why argue against that as long as private companies are free to compete and fail if they can’t hack it?

            “I could sort of go along with that concept. However auto insurance is mandated and we still have uninsured motorists.”

            Yep. And some would find ways to avoid the mandate in this case as well. That is not a good argument for not having a mandate though.

            “Why not simply go after dead beat patients? ”

            Because it is hard to get blood from turnips, especially injured or sick turnips.

            “How will you verify insurance? Would I be pulled over walking down the street at random to check my insurance ID card?”

            I don’t know. But they are mandating insurance in Romney’s Mass. already and I have not heard of people being stopped at random.

            “In addition there are other things in the bills with which I strongly disagree – namely the $1T or so price tag which I have a strong feeling is underestimated if past performance is any indication.”

            Half of that price (or more) is projected to come from savings within Medicare and Medicaid. The ther half will be a tax on something, presumably the most well off among us. Its a legitimate reason to oppose a bill if you think the gain is not worth the pain, even if it is only inflicted on a relatively few rich people, most of whom voted for Obama.

            “Well, I frankly don’t understand why it is governments business to control costs for private health care. ”

            The answer is that one of the biggest costs government has at federal, state, and county levels is the cost of health care to geezers, poor people, veterans, and public emplyees. If government fails to find ways to slow down health care cost increases then government won’t be able to do anything other than pay for health care. You as a taxpayer ought to be concerned about this.

            Escalating private health care costs may not directly affect government, but indirectly it does by resulting in holding down of wages, which causes all sorts of problems. Plus, much of the escalation in private costs is dues to favorable tax treatment of insurance.

            “It seems far more logical to me to try and solve what we can, that costs no money to do so before we launch a whole new entitlement. ”

            Sure. But its too late to make that argument stick. Obama was elected in part on a promise to present a broader solution that includes extending coverage to the uninsured. Had Republicans dealt with this issue on their own terms when they had power, maybe they could have put it to bed. But they did not do anything so here we are, solving it on the Democrats terms.

          • Rupert in Springfield

            >Why argue against that as long as private companies are free to compete and fail if they can’t hack it?

            For the main reason stated above. If you are not going to address that point then you really don’t have much of an argument I’m afraid.

            >That is not a good argument for not having a mandate though.

            Sure it is. An example of another very close situations failure to work is often an excellent argument a similar solution.

            >Because it is hard to get blood from turnips, especially injured or sick turnips.

            Please give evidence for how you know this to be true since it has not been tried.

            Please also give reasoning why it would make sense to go after dead beat parents regardless of their ability to pay, but not dead beat patients.

            Please also give reasoning why incarceration or denial of professional licenses to dead beat parents would make sense, but the same could not be applied to dead beat patients.

            >I don’t know. But they are mandating insurance in Romney’s Mass. already and I have not heard of people being stopped at random.

            Re-read. I was not proposing they should be. I was saying I don’t know how you enforce a mandate in a meaningful way.

            >Half of that price (or more) is projected to come from savings within Medicare and Medicaid.

            Aint it always the way? We will get all these savings from something, but we cant get them until we do what we want. Pardon my lack of faith. Government in general has a really poor record on this sort of thing. To not ask for government to achieve the savings first, then we will talk is a little silly.

            >If government fails to find ways to slow down health care cost increases then government won’t be able to do anything other than pay for health care.

            Ok, this is the crux of the matter. If you will note, there is some not so subtle sleight of hand going on here.

            The cost of health care has absolutely nothing to do with the problem.

            The problem is the expense. Those are two very different things. This is a spending problem on the part of government, not a cost problem. If government doesn’t like the cost of something, there is no logical mechanism that then says they are entitled to take that thing over.

            >Sure. But its too late to make that argument stick.

            You might want to go to a town hall, or check out BO’s polls.

            It seems to be sticking quite well thank you.

            >Obama was elected in part on a promise to present a broader solution that includes extending coverage to the uninsured.

            Who cares? Running on a position does not mean automatic enactment.

            >Had Republicans dealt with this issue on their own terms when they had power, maybe they could have put it to bed.

            They did. Democrats ranted and raved that they wanted to kill old people.

            Dissent then equals Nazi now.

            >But they did not do anything so here we are, solving it on the Democrats terms.

            And here we are again, with Democrats proposing a broad takeover that the country has repeatedly shown they have real problems with.

            Well, at least we have one bit of bipartisanship.

            When either side proposes anything, the other side accuses them of marching the elderly off to the gas chamber.

            Kind of poetic in a way.

          • v person

            “For the main reason stated above.”

            You have a weak argument. Saying we can’t let the government out compete the private sector is ridiculous on its face and not worthy of debate.

            “An example of another very close situations failure to work….”

            Only you did not show that requiring auto insurance “fails to work.” You said some people still don’t get insurance. Maybe so, but the vast majority do, and that will be the case with health insurance if it is required. 95% of residents of Mass now have health insurance, a much higher figure than for the US as a whole.

            “Please also give reasoning why it would make sense to go after dead beat parents regardless of their ability to pay, but not dead beat patients.”

            My reasoning is that it would be a lot of effort with very little in the way of return to the treasury. Hospitals already try and collect what they can. Obviouslythat isn’t working very well.

            “Please also give reasoning why incarceration or denial of professional licenses to dead beat parents would make sense, but the same could not be applied to dead beat patients.”

            Frankly I don’t think those measures make sense period. Putting someone in an already over crowded and expensive prison system because they owe child support is ridiculous on its face from a cost-benefit perspective. And denying someone the means to earn a living as a way to get them to pay a debt is equally stupid. So if these are your “solutions” to health care costs, good luck with that.

            “The cost of health care has absolutely nothing to do with the problem. The problem is the expense. Those are two very different things. If government doesn’t like the cost of something, there is no logical mechanism that then says they are entitled to take that thing over.”

            Strange logic there Rupert. I would think that if something costs a lot, then it is expensive. Sure, you can choose to not buy it, but in the case of health care that is not a real good option. I mean, is the government supposed to not buy insulin for an elderly diabetic because it costs too much? Dead diabetic preceded by multiple expensive amputations would be the result. Should the government, a major purchaser of health care for millions of people, not give a fig what this costs? Should they not bargain for lower cost insulin? Yikes. I’m glad “conservatives” are out of power if your logic is typical.

            As for “taking that thing over,” the obvious answer is that they are not proposing that. They should be proposing that (single payer,) but lord help us from the “socialist” squealing that would result. A significant minority in this nation, you included, apparently prefers an expensive, bloated, ineffective mixed public and private system that is the laughing stock of the first world to an efficient health insurance system managed by the dreaded gubmint, paid for out of dreaded taxes.

            “You might want to go to a town hall, or check out BO’s polls.It seems to be sticking quite well thank you.”

            I don’t think so Rupert. Just because a lot of stuff is being thrown does not mean much of it is sticking. The health care problem has been with us too long, and the stars are aligned for major reform. The yelling and screaming is good for web or cable theatrics, but in the end it won’t make much difference. I was in a Portland crowd of over 10,000 that protested against invading Iraq just ahead of shock and awe. Did it matter? Not a whit. If we had yelled a bit louder would it have mattered? No. Those protesting against health care reform are a minority of a minority, and they are not voting for Democrats anyway, so why would their presence at town halls derail a central platform of the Democratic party that presently runs Washington?

            “Who cares? Running on a position does not mean automatic enactment.”

            True. But a 20 seat majority in the Senate and a 79 seat majority in the House does mean it is highly likely a major reform along the lines of what Obama wants will pass.

            “When either side proposes anything, the other side accuses them of marching the elderly off to the gas chamber. Kind of poetic in a way.”

            Yes, very poetic. But here is the thing. It was Democrats who proposed and passed SSI and Medicare, which are the essential programs most geezers rely on to get by day to day. It is Republicans who fought these programs, still fight these programs, and wish they would just go away. So when Democrats accuse Republicans of not giving a rip about old people, they have a point. When Republicans make this claim, they have no solid ground to stand upon. When you have people like Limbaugh and Beck and Hannity whining that Medicare spending might be reduced to help pay for expansion of coverage to others, that rings a bit hollow doesn’t it? Are they now Medicare supporters? Are you?

      • Steve Plunk

        Two big problems. One, private insurance is not going broke. It’s more expensive but that’s why it’s not going broke. Two, it’s not a case of wanting to preserve the present system. We want reform but not this reform. Let’s start with tort reform and severing the link between insurance and employers.

        Why are we not trying small steps rather than a one time, totally untried, practically irreversible overhaul? This is essentially burning the bridge behind us. Not the smartest approach.

        • David from Eugene

          Steve

          It is the private insurance system that is in a death spiral not the health insurance carriers, though they will eventually be affected by a lack of people able to afford their policies. The death spiral is a simple one, the higher the premiums the few the people that can afford to pay them resulting in more uninsured causing a increase in the medical providers overhead costs which in turn causes a increase in their charges which causes a raise in premiums.

          In concept, I fully agree with you in regarding the need to separate health insurance from employment. It would make US Companies more competitive world wide, it would remove the stifling effect health care costs have on take home pay among other advantages. The question is how to do that while maintaining a large risk pool. This is one of the reasons I support a universal single payer system that puts all residents of the United States into one single risk pool.

          As to tort reform, I do not believe that limiting law suits or capping awards is what is needed. Rather we should look at the motivations behind the suits and limit or eliminate them. As I have argued above (#2.2.1.1) I believe that the motivation behind most of the malpractice suits is a combination of plaintiff’s attempts to avoid bankruptcy or to see that a negligent medical practitioner is sanctioned that are the real drivers. By eliminating those motivators we would reduce the number and size of malpractice suits and the negative impact they are having on the cost of health care

        • David Appell

          > Let’s start with…severing the link between insurance and employers.

          And what will that get you? You lose the power of pooling.

  • David Appell

    > According to the United State Census Bureau approximately 40% of those household
    > without health insurance make in excess of $50,000 per year. These are households
    > that can afford health insurance but choose not to pay for it.

    Not if no insurance company will sell it to them, due to age or preexisting conditions.

    What is your solution then?

  • Rick Hickey

    Fact Via the Center for immigration Studies of a compilation of Government numbers;

    WASHINGTON (August 2009) – One out of three people in the U.S. without health insurance is an immigrant (legal or illegal) or the U.S.- born child (under 18) of an immigrant. Immigrants and their children also account for one-fourth of those on Medicaid.
    _________
    The only reason we are considering National helath care is because we have allowed tens of millions to come here (legally and illegally) for “Cheap” labor who are broke and want “Help” from Big Brother. And so many Americans now broke are giving up and asking for help too. Massive immigration is not good for our economy or for fiscal conservative public policy, as a Nobel winning Economist said.

    Until we elect people with the guts to support only Americans (the electors and payors) it will get worse.

    Simple and effective solution? E-Verify for a job & benefits and to vote mandatory. If Illegals cannot take a job or benefits or vote, they will leave and we’ll be a rich nation again.

    • David Appell

      > Massive immigration is not good for our economy or for fiscal conservative public policy,
      > as a Nobel winning Economist said.

      Perhaps, but why do you think we have the immigration rates we do? Who do you think is demanding them?

    • v person

      Conflating legal and illegal immigrants is ridiculous Rick. Many legal immigrants are also fully US citizens. I mean…what is your point?

    • David Appell

      > or the U.S.- born child (under 18) of an immigrant

      Also known as “an American citizen.”

  • Dan

    There are three desirable components to any health care plan or program:

    1. Low cost.

    2. High quality.

    3. Easy access.

    Now, pick any two. That’s the real problem…you can ONLY have two. Go ahead, test the theory. It works. Any two you pick will automatically eliminate the third option as completely unviable.

    • v person

      They have all 3 in France Dan.

      • capor

        I doubt that v dude. Dan is right. you will not make all three components work in this country with single payer government sponsored health care.

        Why don’t you ask some of your lib lawyer friends how they would feel about the tort reform option that most of us would like to see? Bet none of them think they are culpable for the cost problem in American health care or out reach insurance rates.

        Insurance reform is needed, but will not happen as long as we have the special interests that pay for DC representation to manipulate the system their way. Maybe we could talk about reforming DC? Of course the chances of correctly fixing that problem is as probable as correctly fixing health care…..

        • v person

          France makes all 3 components work with a single payer system supplimented by private insurance as an option.

          I don’t have any lib lawyer friends who are suing doctors, so can’t ask them. Frankly I don’t care about them anyway. I would support tort reform as part of the package being worked on.

          Waiting for “special interests” to go away before we do anything is like waiting for Godot. He never shows up.

    • David from Eugene

      Dan

      That is not quite true, you can only have two of the following three:

      1. Lowest Cost
      2. Highest Quality
      3. Universal Access

      What you can have a compromise proposal that balances low cost, high quality and universal access, once you accept that there will exist methods that would have lower costs or higher quality but that the trade offs to the other two are not acceptable.

  • David from Eugene

    Larry

    A couple of quick comments:

    First the United States already has a third world medical system. I have not heard of organizations such as RAM (Remote Area Medical) seeing the need to provide their services to the residents of France or Canada like they have to the United States and Third World Countries where affordable medical treatment is not available to all residents.

    Second, true cost containment is not possible without a universal single payer based system. Until we get there all we will get is more of the cost shifting that exists today.

    Third, the insurance model as a payment only works well when the likelihood of having to make a payout (i.e. the risk) is unlikely. House Fires and Automobile Accidents are extremely rare in terms of the number of people covered. More over the policy holders do not really want to have the need to use their coverage. This is not the case with health care, the policy holder expects to use the coverage and the carrier is fully aware of it. Payouts under health insurance are not a rare event they are a certainty. The only question is the magnitude of the payout.

    Fourth, as I have argued above (#2.2.1.1) I believe that the motivation behind most of the malpractice suits is a combination of plaintiff’s attempts to avoid bankruptcy or to see that a negligent medical practitioner is sanctioned that are the real drivers. By eliminating those motivators we would reduce the number and size of malpractice suits and the negative impact they are having on the cost of health care. If the Doctors want to reduce Malpractice Suits they need to do two things, establish a method to remove, sanction or limit the practice of negligent, incompetent, poorly trained or impaired medical practitioners and help establish a system where the medically unlucky will be able to pay for future medical needs and lost income that are the result of their misfortune.

    Lastly, what exactly is wrong with Socialized Medicine? Is it Rationing? The insurance companies are already doing it. Is it putting a Bureaucrat between you and your doctor? The insurance companies have already put one there and he gets a bonus for denying you coverage. Is it picking up the medical costs of others? Thanks to cost shifting you are already doing that and in the most costly and inefficient manner to say nothing about providing a very luxurious lifestyle to Insurance Company Executives. Is it Government control? Is system that puts control in the hands of unelected, unaccountable insurance company better?

  • Anonymous

    French people pay 16% of their wages for their national health care system and 95% have to buy supplemental insurance as well.

    • v person

      The French pay about 50% of what we pay for better care. Yes, they use payroll and income taxes, shared with employers, but what is the practical difference between that and paying twice as much directly to an insurer?

      The French system covers everyone at a basic level, and allows (encourages) people to also buy supplemental insurance, like we do with Medicare. Basically it is a 70/30 mix. They have zero medical bankruptcies. You can get any cancer treatment there is, including experimental. You can see any doctor or go to any hospital you want.

      Their system is not perfect, and their costs are rising along with their aging population. But they have a way way better system for 1/2 the cost as we do, with far fewer hassles. We are stubborn idiots for not scrapping our system and using theirs. The makeshift system we have, and that Obama is essentially retaining, is grossly inefficient.

  • Isoconetic

    Here’s something to look at if your thinking that we will end up like those “Third World Countries” in terms of healthcare costs and ability to pay. The last recorded records in 2000 by the World Health Organization (sp?) ranks the United States as 72nd overall. http://www.photius.com/rankings/world_health_performance_ranks.html. I can’t imagine we have gone up in ranking overall and would hate to see where it puts us since the bush years has only pocketed the rich corporations and individuals that don’t need more profit. Just my two cents in this whole debate.

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