Health care deform

We are on record as favoring single-payer health care and taking certain things like vaccines out of the market system, but beyond that we don't do much health care politics here. But we have opinions, like everyone does, opinions formed by working for more than four decades within the health care and public health professions. Other than that, we are like most of you. Consumers of health care with our own particular view of the world. And since everyone else seems to be talking about it, so will we. At least we will today.

Everyone knows that what Republicans hate and fear about health care reform is not any particular element, but just that it exists and will be a major boon to Democrats if anything halfway decent gets passed. From the progressive point of view, the current bill is a stinker. But it's close to being minimally acceptable (although in our view isn't yet acceptable because mandating unaffordable private health insurance is a way to cast in stone one of the things that is most wrong with US health care, its total submission to the goals and objectives of the private health insurance industry). The Massachusetts reform plan is also pretty bad, but like the old Henny Youngman joke (Q. "How's your wife?" A. "Compared to what?"), the public far prefers it to nothing:

Public support for Massachusetts’ closely watched health insurance overhaul has slipped over the past year, a new poll indicates, but residents still support the path-breaking 2006 law by a 2-to-1 ratio.

Amid a severe recession that has led to cuts in state programs and unrelenting job losses, 59 percent of those surveyed said they favored the state’s multimillion-dollar insurance initiative, down from 69 percent a year ago. The poll, by the Harvard School of Public Health and The Boston Globe, found that opposition to the law stands at 28 percent, up slightly from 22 percent in a June 2008 survey. (Kay Lazar, Boston Globe)

With health care costs running wild, the economy in the crapper, and insurance companies increasing premiums by double digits, the Massachusetts plan, which covers 97% of the state's population, is struggling to be sure -- but with all that, still popular. 79% want it to continue as opposed to 11% favoring repeal. Imagine how popular a really decent plan (which Massachusetts does not yet have) would be. That's what's at stake for Republicans and what the Democratic Party's progressive wing is fighting for. If we instead wind of with the steaming pile of shit that the leadership and the White House "negotiated" with Republican "moderates" who want to see either nothing or something terrible, and Democratic "centrists" (what are they the center of, what used to be called conservative Democrats?) who want to abrogate a woman's right to choose or enrich the insurance industry, those who don't want the Democrats be identified as the party that brought meaningful health care reform, even it it's good for the country, will have won.

If this bill goes down -- as is a distinct possibility if it stays in its current form -- it will not be the fault of main stream Democrats who are finally balking and showing some backbone. If it goes down the ones who will do it are the entire Republican Party in the House and Senate, and right wing Democrats like Ben Nelson and corrupt insurance lobbyist Independent, Joe Lieberman. Barring total defeat of any reform, Republicans will settle for having people forced into the arms of the benevolent insurance industry who will then violate them further with increased premiums and a legal requirement that people buy their shoddy wares. No choice. Not even a weak tea public plan, with reduced administrative expense to provide minimal competition. Not even the weak Medicare buy-in for the uninsured. Just a gun-to-the-head individual mandate that will be fodder for Republicans next election cycle.

Because what's the alternative? The alternative for Republicans is that even a lousy (but not outright harmful) health care reform will be good for Democrats even if it's only a little good for the country. For Republicans, that's the bottom line.

So let's get on with it. Dump the individual mandate if there's no meaningful competition to private insurers, reform insurance practices like denying coverage of pre-existing conditions and other vile practices which insurance companies say they favor but won't do even though they have the power to do it instantly and some other minimal stuff. Then we can take a breath and get on with the rest of it, including universal coverage. We can't get everything at once? Then do it in pieces. Democrats won't have 60 votes after 2010? Hell, they don't have 60 votes now.

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I'll second that, though not with enthusiasm.

Revere, this isnt healthcare... Its a takeover. I can only hope that as we move towards the election that the Democrats start getting even MORE nervous about their possibilities of getting their asses kicked out of Congress.

Once the word gets out that this taking control by government of the healthcare industry and that people are going to be fined for NOT getting health insurance, there is going to be hell to pay. It matters not who ends up with the money its the government that is mandating a takeover and the revolt may not be a peaceful one. People are being tipped over now because they cant pay house notes, car notes, and this bill clearly steals 500 million from Medicare. I would say that the support of Landrieu, Nelson and others is going to go down like the Titanic. The final vote on this bill wont come til early spring or maybe summer and those voters in the South are going to rip these people up like the communists they are.

By M. Randolph Kruger (not verified) on 19 Dec 2009 #permalink

OH NO NOT TAKEOVER! Next those dirty commies will be taking over the public schools and the roads and...

Reading W. Randolph Kruger leaves me shaking my head, thinking... "Wow, people really still talk like that?"

Better no bill than a bad bill, and boy, is this one bad. Only winners are the insurance companies, and since they are exempt from anti-trust regulations, they can just collude to fix the pricing as they have been, backed up by the power of the IRS to throw folks in jail for not paying up (or paying the fine for not buying, which can always go up).

Pretty soon the banks will be offering loans for health insurance at high interest rates, who knows, maybe no higher than 30%. Everybody wins except for the consumer, screwed as always, by the left or the right, no matter, business as usual.

Do people really not see it?. The emperor, republican or democrat, has no clothes and serves the interests of big business. The 2 party system allows them to play good cop, bad cop; which is good and which is bad depends on your faith, or should I say party affiliation, but both parties serve the same masters. Votes are bought with 30 second commercials paid for by the masters who contribute money to both sides. It's Democracy Iranian style, where the supreme leader determines who can run for President and the people vote. Only difference is big business determines who runs (and I mean big, not the little guy who runs a business).

Regulations are written by big business and intended mainly to increase costs for the smaller competitors so as to reduce competition and facilitate monopoly (cartels) capitalism. Those charged with enforcing the regulations retire at 50 and then collect a big paycheck from one of the big companies in the industry they regulated, or they came over from the Industry for a 4 year sabbatical (like Paulson) to grease the skids and then go back to industry.

In the insurance companies case, they have anti-trust exemption and are already a defacto monopoly, and this bill is a big win for them. Merry X'Mas guys, hope you enjoy the gift.

Thank you, Revere, for running---finally!---something on this issue. I too second your suggestion--as hopefully a way for the Democrats (that is, the major opposition to the Republicans) to claim sort sort of victory without totally screwing us all with a bill you correctly characterize as having turned into a big etc. And Kruger, you're right, if not about much here, about the ripoff from Medicare in the proposed bill (in fact, in all the bills proposed except the single-payer ones). And thank you too, pft--a fine and concise description of how insurance and the rest of big biz guns (well, that "g"'s a typo, but leave it) America. Merry holidays to you, too; onward the Predators.

Kruger, "here" meaning re today's post.

UHC is cheaper and better.

That's not just hot air, those are closely measured stats from many, many different versions around the world. UHC IS CHEAPER AND BETTER. Full stop.

The cost to America of shoddy expensive healthcare is tremendous. Medical expense related bankruptcy is a constant drag on what is supposed to be America's strengths: innovation and enterprise. How many small businesses fail due to this? Actually, the stats are there, and it's a lot. The question then is how many never start? How many people want to do something new, innovative, courageous, but can't because it will leave their families uninsured, literally exposing them to a higher chance of death? What cost to the economic life of the country is FEAR?

People who oppose UHC clearly hate America, or are so immersed in propaganda from the people who profit from fleecing Americans that they can't see straight.

Any other country would look at how everyone else is doing it better, and would adapt something like it for their needs. Indeed, that's how many did it, and why the rest fo the industrialised world has UHC. Alone of all nations America can look only inwards.


2 PARTY SYSTEM HELL ! Its 2.5 trillion and not 848 billion. Perhaps you need a little red book MK...Better, here is the admission as we are in the video age and all.…

And MK if it is 2.5 trillion for sure or anything past 1.5 from Congressional goodie BS you wont have to worry about me keeping it from being implemented. You will be able to tell it to the Russians or the Chinese when they attack one of their neighbors or back up to your door with a truck to take you out of your home.

As it was under Carter and definitely Obama they will cut defense spending to the bone to pay for it... A little country called Afghanistan was taken in 79 for just this same reason. You were probably still in your diapers. You guys dont get it that this musical chairs act is going to end with a total economic disaster. And you will be the first to try to blame Bush for it. Yeah right. 4.5 trillion and now 14.5 a year. You raise the debt ceiling so you wont have to raise taxes. You borrow and spend, borrow and spend and then one day you cant borrow any more.

Thanks Obama !

Paula-Down South we learn math and by just about everyones count this President and Congress will tip this over. If it passes I have already advised my formerly 25 member staff thats down to 12 that they will all be put on part time status. That way I wont have to pay the 720 bucks per employee healthcare cost. That means they will have to buy it. Fining someone for not having healthcare coverage. Probably a lawsuit there, I am sure of it as its not constitutional. We are not insuring a care, we are insuring Mexico. They will be across that border as fast as they can skulk in here. There is no margin in businesses to pay for this crap, the states are going to tip or secede. Its as simple as that. They cannot raise taxes any higher and well if they try just to pay for the states portions, secession is a likely result. No troops may be quartered in any state without the written permission of a governor. So I am just running it out here to a logical conclusion. Reminds me of people steaming into an ice field at full bore in a tub named Titanic. We will go down just about as fast.

Take a long look who is spending the most on healthcare. Per capita, most of the So. States are paying more than New York, Mass, Penn. We have 6.5 million people in Tennessee and this is a DEM website. Take a look at New York. Do the math. How CAN the states spend more?…

I see nothing but disaster if we have to increase spending MORE than we are now. 32 billion against what in Mass? 32 billion as opposed to OHIO?. They have 4 times the population. Yep, you supporters of this are going to need to get your checkbooks out.

All through history there has been a key issue, a tipping point that put a country on the road to total ruin. Sometimes good, most of the time bad. Its not supposed to raise your taxes? Well how about adding at least 5% to a 29,000 employees taxes. Me? So far from what I have read its going to cost me 15% more and I am already in the 33% bracket. Remember also that there are a BUNCH of sovereign states that have been declared and this will hasten it coming to be in every state. As in what do they do if the states tell them to go pound sand? What are they going to do, sue?

Tennessee is along with MS, AL, GA, FL preparing to file a lawsuit to prevent the implementation because they want the same gigs that Landrieu and Nelson got. Wouldnt want to be in their skins come November. But same difference, there is no Mouse in the MIckey any more and they are going to have to cut spending on everything else to pay for this stuff. And stuff is a polite name for it.

I really wonder if the states that have suggested secession might just do it? Or, just refuse to comply with it? Subject to arrest for NOT obtaining health insurance? I see nothing but dead people. They dont have that many jails anyway.

Reveres confederation of states scenario is very possible. If even one state did it, this spendathon and all the other games the US is involved in would come into play. The total debt will not even display in excel now... Its has too many zero's behind it. China is refusing to buy any more of our debt, debt ceiling raised regardless. That means all sorts of new taxes. We are broke and thats the end of it. This passes and unemployment will reach 30% within a year of implementation cause we get taxed and we get nothing for three years not to mention the seniors start getting their care rationed.

Well, we will just have to wait and see if it makes it into law.

By M. Randolph Kruger (not verified) on 19 Dec 2009 #permalink

First my disclosure: I am an independent and GD proud of it. We really cant make any serious comments on the health care reform since Reid is on the verge of committing tyranny and keeping its development behind closed doors and unaccessible. We really have absolutely no idea (I have not seen any of the most recent document or revisions-- have you? Hell, neither my congressperson nor one of my senators have seen it) and we all know that dirty duty Reid is doing-- give the public and the lawmakers 48-72 hrs to review it before voting. Thank God for Lieberman and so much for the transparency .

As a doctor who provides over $150K of free care annually I don't like the state of affairs in health care anymore than you Revere, but the govt might be on the verge of writing checks its ego cant cash. The dems want everything but dont want any tort reform because the trial lawyers pay huge contributions to them. We need reasonable rationing of care but no one is talking about that. I intubated a 80 yo last night with end stage lung disease because the family wanted everything done. While I thought it was a futile act (I will see if she is alive later today when I get into the hospital) I have no support to say so by the govt or society so Medicare will receive a $50K bill for the holidays for just one soul who has no quality of life. So much for reform.

BTW Mass Health has all but bankrupt the state.

By BostonERDoc (not verified) on 20 Dec 2009 #permalink

BostonERDoc-I questioned all of my docs before this started down the home stretch..They said to a man and 3 women, they are going to keep and stay private care. If you drink the Kool-Aid then you will simply die like the rest of the Jonestowners. These people just dont understand what this means. It means no military and that Russian Bear and that Chinese Dragon are just waiting for us to do this. Once the numbers come in and we are at "peace" with our neighbors the ChiComs will go for Taiwan and push us out of any position of influence in the region. The domino effect in a fast quick hurry. The Norks will go for S. Korea. Its happened before when we didnt stand up. No telling what that Russian Bear will go after.

This is health care at all costs. But Its really not health care, its control. Revere recognizes part of it but not all of it. They will bankrupt this country so fast either because they and I DO mean Democrats will register every illegal crossing the border with ACORN to vote that it will spin out of control. Even the GAO today said that they can show NO savings whatsoever from going to this. Say that again, last week a 1.5% savings has slipped to a .04% savings after the week long smoke and mirrors.

So we give up the country for health care.

I find no joy in this assessment. Its not Republicans/Democrats, libs/progressives. It could mean violence when there are no jobs. Many are just now getting it, they will surely get it when the pink slips come out.

The majority of Americans want them to stop and get it all out onto the table. Obama is using OUR tax money as carrots and for what? Revere is an honest guy and he has his convictions about everyone having affordable healthcare. I understand the issue. The problem with this is that someone is going to have to pay for it. That means supertaxation and healthcare you aint gonna get under this system. It also means the military will have to go. We move back under the only nukes scenario and a Jimmy Carter military where if someone starts some shit, we wont be able to respond. Remember, it took a year just to get ready for Desert Storm. Two conflicts and you better learn Russian or Chinese if they happen at the same time.

Health care is going to be the ONLY industry in the US that survives this for five years. In a year Obama will have to start cutting other things to make this goat look pretty on the books. You think this debt ceiling thing is for stuff other than health care? Nope, its to finance this bullshit and I have said it many times before..What is health care? A service or a right?

Here is what happens after we start it. We immediately start putting money into bodies. Those bodies get to a certain point and then well you become a liability and they just dope you up, hospice you for all intents an purposes and make you "comfortable". They will no longer spend any money on you because you are no longer productive. You cant and wont pay into the system. So you get palliative care. But...back to the money. The money then goes with you into your pine box-GDP into a box.

We have spent this money that equates to nothing more than debt into a box in the ground or have it come back to a family as a pile of ashes. Now the drain to the debt is gone, but because no one thought it out about health care at all costs we have just buried about an average of 250,00 bucks per person with each passing into the dirt. The interest on that debt is still there as well as the over runs for keeping you alive. We pass that debt on to the next kid literally until he too goes and then it escalates.

The idea is that this is "civilized" and that all people should have health care but without any regards to the costs in the long term. It is also the idea behind Marxism/Communism. To get to those you have to have socialism first-via health care. At some point in time the government will decide that you are charging too much for your goods to maintain the system. So price controls go into effect. Then, you get what happens over and over as government socializes, then communises everything.

People with good common sense don't make these kinds of decisions if they are presented with the same information. Why is it that only 32% of the country are now in favor of this and these bozo's just keep on cranking it out?

Doesn't matte. As I also said, we are now 12.5 trillion in the toilet and 1.5 trillion or anything beyond it will make health care, the national debt and the US as we know it unsustainable. The interest on the debt will be more than the principal. It will bring us down. Spent into destruction. They'll be lucky if it remains peaceful and that no one gets hurt.

Health care? It then becomes a throwaway card. Ends to a means and that folks means the end of the US by a coordinated effort. Cant have a single superpower calling all the shots.

Hey Revere, enjoy that destruction of Medicare too that you just qualified for. They gutted it completely in this bill by stealing the promise that you would be cared for. Americas greatest generation is now a toss away-500 BILLION DOLLARS WORTH. Trust me, they'll take more out or they'll try to use the tarp money for it. They will look for all sorts of ways to cut it. Yep, this bill is going to add 22,000 government employees and like 10 new directorates to prevent you from getting healthcare.

Everything will be management by committee and the government, not the doctors will decide if you get that care that you are being taxed to death for.

Look folks, understand these people on Medicare are being sent to the funeral homes with this bill and very likely many of them by starvation.

Change we can believe in? Now I know why Bill Ayers is one of Obama's closest confidants.

"We will destroy you from within" -Nikita Kruschev.

By M. Randolph Kruger (not verified) on 20 Dec 2009 #permalink

Having lived under the Canadian healthcare system since 1967, I still can't understand why my ex-country wants to tie itself in knots about this.

At the moment, my 40-year-old son-in-law is in a Toronto hospital, waiting for a heart-lung transplant. He's had a pacemaker since he was 12 hours old, and our healthcare has kept him alive all that time. He's had a good education and a productive career an expert for the Department of Fisheries and Oceans and Environment Canada. He's also been a good husband and a beloved member of our family.

In the United States, he would have been dead before his first birthday. Instead he's alive with a hope of many more years, and we're not contemplating bankruptcy to keep him alive.

But M. Randolph Kruger thinks quoting Khrushchev is an overwhelming argument against public health insurance.

Shorter MRK on UHC: we can't possibly afford a system that's cheaper!

Yeah, it doesn't make sense, does it?

As for the bozo's who are on board with it... Its not going to save any money. But it will give government control of your ass from cradle to the grave. In fact, if you are older and this passes to Obama, when you get to 65 they will kick your ass into it.

Crof with all due respect thats not a fair statement. Even if there had been no insurance, the kid here would have gotten the same treatment (as long as you couldnt afford it) here. I am sorry though that he is in that shape.

Everyone wants someone else to provide a net for them. What do you do when the money is gone. Your 40 year old Crof very likely would be gone in the economy of today. If there is no money for it, then what DO we DO?

A helluva lot of assumptions are being made and cost savings is the first thing to go out the window. The purveyors just game the system...Thats when the price fixing starts.…

This is the closest thing to the above from Fox... AP completely IGNORES the costs issue.

"At their core the bills passed by the House and pending in the Senate are similar. Each costs around $1 trillion over 10 years and is paid for by a combination of tax and fee increases and cuts in projected Medicare spending. Each sets up new insurance marketplaces called exchanges where uninsured or self-employed people and small businesses can compare prices and plans designed to meet some basic requirements."

Sure sounds to me like they are screwing the old guys and pushing them into bankruptcy, starvation and death. But the real costs and they admit it are 2.5 TRILLION dollars and based in 2009 bucks. Ever heard of runaway inflation?

Here is another part.... Once you are off mommy and daddy's coverage... You will ONLY have the option to join the government plan... Sounds like a takeover to me. Also is unconstitutional and will result in challenge after challenge in each state. Thats if the states dont decide that they have had enough of this spendathon.

"Unpopular insurance practices such as denying people coverage based on pre-existing conditions would be banned, and young adults could retain coverage longer under their parents' insurance plans â through age 25 in the Senate bill and through age 26 in the House version."

CNBC this morning-"Analysts Major Issues in 2010-# 1 Government defaults around the world, # 2-State government defaults in the US"

As this requires just about every state other than those sacks of shit from MA, FL, CA, NY to increase spending so they can have healthcare there in those states and bail them out, I would say that its also a Constitutional challenge on the way. Equal protection under the law requires equal coverage for all. That means that if someone like your son gets screwed Crofs its going to be a trial lawyer heaven. If anyone thinks that this will last more than 5 years, they are nuts. In fact, it may never be implemented.

It goes right back to the Great Depression. Did you have the right to healthcare then? Do you now?

EVERY business owner out there is flipping out now and they have just gotten the memo and that is that it will cause mass unemployment if implemented. They had better start taking that into consideration else they'll have to deal with it when it happens. Me, I told everyone that they are going to be part time as of the 8th paycheck. 35 hours maximum and they can expect layoffs. Told them to go and call Blanche Lincoln and Nelson.

Being poor isnt a crime. Turning law abiding citizens into criminals by condition of a new law is. So, the question is where are they going to house all of these new federal criminals? Gonna have to pony up for that too Harry. It appears that the closest system to this which is Massachusetts is going broke like there is no tomorrow. Its only been in place for two point 7 years.

No healthcare in this bill at all. Its just taking your money and forcing submission to the government. Last guys that did that found themselves signing Magna Carta.

By M. Randolph Kruger (not verified) on 21 Dec 2009 #permalink

I am satisfied with the direction of the healthcare bill. Early on it was looking like Doctors were going to be heavily affected, especially in their wallets. As an owner of a medical marketing company, , I was very concerned that my business would be affected from Doctors cutting back on marketing and spending.

My hope is that the government listens to the public. We want those who can not afford healthcare to be covered, but not at the cost of losing the smartest and best due to their inability to make enough money to continue practicing medicine.

If the government wanted to cut costs, maybe they should focus on malpractice and start to passing legislation limiting these premiums and liabilities. If government cuts the pay of doctors and insurance companies continue to raise premiums, they will force the doctors out of the trade. Healthcare is still a business and the best and brightest need to stay financially motivated, unless we as patients will all be negatively affected.