RSS Feed MenuSeveral weeks ago, I argued here that Republicans would be wise to abandon their pro-business inclinations, and attack the business community in an effort to shift the health care debate.
In short, the relevant stakeholders are colluding with Democrats on a health care package, lest their business become the “pay for.” Republicans should make clear that these businesses, in seeking to protect themselves, are willing to accept and promote a health care bill that would lead to more expensive and lower quality care for the middle class Americans who have and enjoy health insurance.
This collusion has now broken into the light of day.
Yesterday Roll Call reported that Senator Max Baucus had called an emergency meeting of Democratic lobbyists informing them that they should instruct their clients not to meet with Republicans. Specifically, the Chairman of the Senate Finance Committee made it clear that a meeting organized by Senator John Thune to discuss the financing of massive new entitlements was off limits.
One lobbyist gave away the game, telling Roll Call that Baucus’ staff warned “If your clients attack the process or the product, it’s going to be hard to work with you.”
In other words, if you attempt to work with the Republicans, other than to coerce them into supporting a Kennedy-Baucus product, we will ruin your business.
Understandably, Republicans could use the assistance and dollars of the business community in arguing against the Democrats’ proposals. But with the clock ticking, it is well past time to inform the American people of this cozy relationship between government and the business community that threatens the quality of care for the middle class.
sinz54 // Jun 12, 2009 at 7:08 am
Before proposing solutions,maybe we should look at what the problem is.Namely: What is driving up health care costs faster than inflation?It can’t be insurer profits. No matter how high a company’s profits are, it can’t keep raising its prices (premiums) faster than its competition. And the profit margin is a *fixed* percentage of a business’s income. So why are premiums rising much faster than the business’ profit margins?Because the cost of medical treatment really is rising sharply, regardless of who pays for it–the private insurers, the Government, or out of pocket. Doctors who take Medicare with its strict reimbursement rates either pass that cost on to other patients, or they stop taking Medicare altogether.As I posted yesterday, the cost of treatment is rising sharply due to three things: 1. Antiquated bureaucratic procedures and information management. The medical sector has lagged far behind other sectors of American business in automating and streamlining its business operations.2. Spending a fortune to eke out an extra day or two of life of patients who are frankly nearing the end of life. State of the art medicine can do this, but at a frightfully high cost. It’s going to sound grim, but patients should be encouraged to sign waivers and proxies that, should they be diagnosed with a terminal illness, gives them a good quality of life but allows them to die sooner. 3. Social pathologies. Diseases resulting from obesity, STDs, violence, substance abuse, spousal and child abuse, etc., cost trillions of dollars. One reason why Canada can hold down costs, is that it doesn’t have our crime-ridden, drug-ridden, gang-ridden slums like in L.A. It doesn’t have a huge population of illegal immigrants from Latin America who, being illegal, live in the shadows until they show up at Emergency Rooms deathly ill. America is a more violent society than Canada or Britain, and that violence results in injuries that cost money to treat.Thus the best thing that a public health insurance option could do, would be to act as a role model that aggressively attacks these three problems, and perhaps the private insurers will follow suit. But the notion that it can employ price competition to hold down premiums of insurers is a pipe dream.
ottovbvs // Jun 12, 2009 at 7:26 am
sinz54 wrote 3 minutes ago…..You forgot to mention:+ Blatant profiteering and fraud by hospital systems, doctors, prescription providers and others (many of whom have been forced to pay mega fines for fraud) who are adept at finding scams to generate profit like doctor owned clinics, radiology centers, etc. Would it surprise you to know that many doctors actually own the insurance companies that provide their malpractice insurance. As the superb article by Dr Gawande in the New Yorker implied that’s the problem in McAllen TX which has the highest medical costs in country. Basically the practice of medicine in this country is a business first and a vocation second. That’s not to say there aren’t a lot of dedicated and very good doctors but they’ve been swept up in the system.+ A mass of parastic organizations that have grown up for purposes like managing companies drug prescription programs outside of their health insurance carrier. The daughter of a fried of mine owns one.The US healthcare system has a million moving parts which provides rich opportunities for all sorts of excess and chicanery.
ottovbvs // Jun 12, 2009 at 7:34 am
sinz54 wrote 31 minutes agoottovbvs: Surveys have shown that as many as 30% of doctors are refusing Medicare patients in some states…..What surveys would they be……who did them…..which states were they in…..sorry but I’m deeply suspicious of a lot of material that gets generated about the healthcare system……there has been some trouble about medicare payments congress recently had to pass a special bit of legislation to ensure they kept up with inflation…..but does all this constitute the collapse of Medicare because of doctors revolt……not really…..it’s the extrapolation of anecdote or an incident (eg. Mike K’s Richardson tale) into a trend……the anti universal healthcare crowd do it all the time….turn the particular into the general……it’s largely nonsense.
ottovbvs // Jun 12, 2009 at 7:45 am
sinz54 wrote 25 minutes ago”But the notion that it can employ price competition to hold down premiums of insurers is a pipe dream.”…….Sinz dear boy you say the darnd’est things at times…….What you’re saying here is that capitalism doesn’t work…..Of course price competition from a public option would force private premiums down……that’s why the insurance companies and their Republican allies are fighting it tooth and nail.
balconesfault // Jun 12, 2009 at 7:56 am
sinz: “3. Social pathologies. Diseases resulting from obesity, STDs, violence, substance abuse, spousal and child abuse, etc., cost trillions of dollars. “Some of these issues are obviously things that can be addressed via the health care system (obesity, STDs). Some are things which can be tangentially addressed by a system (physicians detecting substance abuse, or violent tendencies, and referring a patient for counseling/psychotherapy)One major problem with our current system is that it creates little or no incentive for an insurer to spend the money to promote preventative/diagnostic programs in those areas. There’s enough mobility between insurance plans such that the likelihood is that any given company will not receive long term benefit from their investment.So if these things cost money … and there’s a pretty good chance that down the road some competitor will reap the benefits … why spend the money, rather than just improving your own current bottom line?
ottovbvs // Jun 12, 2009 at 7:57 am
barker13 8:58 PM” just spent ten minutes trying to find a citable number with no luck. I did however find the following…”…..An oped on the ed page of IBD, a well known objective source, by guess who……David Gratzer of the Manhattan Institute….two more well known objective sources…and riddled with extrapolations and unsubstantiated claims…..None of this is to say the Canadian or British systems are perfect but it’s a matter of relativity…..at the end of the day the US is paying twice as much for a system that isn’t universal and produces by many measures inferior outcomes not to mention all sort of other collateral problems like harm to our competitiveness
ottovbvs // Jun 12, 2009 at 8:00 am
balconesfault wrote 1 minutes ago”One major problem with our current system is that it creates little or no incentive for an insurer to spend the money to promote preventative/diagnostic programs in those areas”…….In fact the system is riddled with incentives to increase treatment, testing, prescribing, surgeries, etc.
barker13 // Jun 12, 2009 at 11:57 am
Re: Midcon; 5:07 AM –”Barker suggested I offer concrete proposals for health care. So here they are.”Good for you, Midcon! (*CLAPPING MIDCON ON THE BACK*) (I’ll review them a bit later if that’s ok…)Re: Balconesfault; 6:53 AM –”In both cases, did I expect a bust? Yep. Did I expect busts with anything near the breath and depth that we experienced – nope – I’d be a much more wealthy man today if I had.”A+ for honesty… B for accuracy. (*WINK*)Good man, Balc! (Or is it good girl…??? I lose track!) (*GRIN*)Re: Sinz54; 7:08 AM –”Before proposing solutions…”(*GOOD-NATURED “BOO”*)Re: Ottovbvs; 7:57 AM –Otto. The adults are trying to have a discussion here. Go surf the web for porn till it’s time for comic relief.(*SMIRK*)BILL* Here: http://www.shufuni.com/** And DON’T be abusing those damned Viagra pills!
barker13 // Jun 12, 2009 at 12:14 pm
Now… back to Midcon’s proposals:1. Every citizen must have unfettered access to the health care system.”Unfetted?” What’s that MEAN…??? “Access?” Same question. Would a multi-day, multi-week, or even multi-month wait to see your GP and then some multiple of that wait to see a Specialist and then time on top of that before treatments begin count as “unfetted” and “access?”2. Health care is paid for based on an individuals needs and desire similar to auto and home insurance models where you choose the coverage based on your perceived risk.So you’re out of luck if you’re struck ill by an uncovered illness? You’d equate “losing” a car or perhaps dealing with a flooded home without homeowner’s insurance to an uncovered illness that without prompt and expensive treatment would KILL you…???3. Every citizen must have a basic health insurance policy that covers preventative and curative care. Fine. And what happens to the “covered” citizen who refuses to utilize preventable and curative care?3b. In the event that a citizen is unable to afford basic health insurance the individual will be enrolled in a government basic health insurance plan.Define “unable.” Where’s the line between unable and unwilling? 4. Every citizen can pay for their basic health insurance using pre-tax dollars.Why? Or rather… why not extend this tax break to food, shelter, clothing? 5. Businesses are permitted to offer supplemental insurance as perks to enhance employee retention. Insurance offered as a perk will be paid for with post tax dollars and the cost of the insurance benefit to the company will be treated as income to the employee.I agree with the caveats… but in that case a business “offering” such a “perk” wouldn’t make any sense – in other words, it would be no more a “perk” than a salary raise is.* Now, note, Midcon… I’m not being a wiseass nor are all my questions actually criticisms. They’re not. I’m just trying to get you to clarify… just trying to open up the discussion by striving for additional specificity.** To be continued…BILL
barker13 // Jun 12, 2009 at 12:31 pm
* Continuing with Midcon’s proposals…6. Unrestricted groups of people and organizations are permitted to organize in order to negotiate lower costs with health insurance companies.Part of the problem seems to be unequal pricing due to “negotiable” discounts which by comparison make “regular” prices seem unreasonably high.7. The government will govern basic preventative and curative care, including costs, litigation, standards, and access.Socialism. (*SHRUG*) 8. Individuals are permitted to supplement basic health insurance…Why… that’s mighty “white” o’ you, Massa Midcon!(*SNORT*) 8b. …by either expending their disposal dollars or purchasing supplemental insurance on the open market.(*THUMBS UP*)9. The government will regulate medical care standards…Poli-Sci majors? Finance professionals? Lawyers? Anything for the AMA to do?BTW, as I’ve pointed out time and again, health insurance (including treatment requirements and “patient rights”) is already heavily regulated both at the level of 50 individual states as well as at the federal level.It’s such “regulation” that you, Midcon, seem to be opposed to based upon your own #2 of your own list. (*SHRUG*)9b. …and insurance plans to ensure citizens are protected against fraud and substandard care.Although you “allow” private plans and private treatments to backstop “your” plan, I still urge you to read Chaoulli v. Quebec.10. Because health care is a basic need of its citizenry, the government shall regulate the production and availability of medicine to control quality and cost. The government already does so, Midcon.10b. The government will make no regulation or law that restricts a company from recouping the full cost of research, development, test and acceptance of new prescriptions.”Recoup costs,” huh? (*SNORT*) Again… quite.. er… “generous” of you, Midcon. (*SNORT*)10c. Thereafter the government is permitted to restrict profits to the benefit of its citizens and their access to prescriptions.So taxation itself isn’t enough power for you? (*SNORT*) Awhile back we were having a spirited back and forth on use of the word “socialist.” Well… somehow I don’t think we should remove it from the lexicon. (*WINK*)BILL
ottovbvs // Jun 12, 2009 at 2:02 pm
barker13 11:57 AMOtto. The adults are trying to have a discussion here. Go surf the web for porn till it’s time for comic relief…….Actually you’re my comic relief barking…..I urge all visitors to this site to get the same effect by spending time reading your contributions
Mike K // Jun 12, 2009 at 6:04 pm
“The fact you bring in Richardson whose accident is totally irrelevant to the workings of the broader system is indicative that emotion and not data or empirical evidence is what guides you. I’m afraid I have a low tolerance for emotion based arguments about something as serious as this and it does show occasionally.”Fortunately, there are other sites where serious discussion of health care reform is possible. This isn’t one. Do you know the story of Ms Richardson? Have you ever been involved in the care of a head injury patient ? Do you know what the wait is for neurosurgical consultation and procedures ? Do you know how many patients are being sent to the US for neurosurgical care by the provinces because it is not available in Canada ?I know you don’t but that does not even slow you down in your rendering of opinions. I spend most of my time elsewhere and you are an example of why.
ottovbvs // Jun 13, 2009 at 6:04 am
Mike K 6:04 PM…..Why don’t you stick to the substance Mike and stop throwing around the insults and injured amour propre. It’s wet as Margaret Thatcher would have said. Of course I’ve never been involved treating head injury patients because I’m not a doctor. I have however been trained both educationally and in the school of hard knocks to to avoid turning snapshots into motion pictures. What I do know is that evoking emotive incidents like Richardson’s have no relevance to the broader state of Canadian medicine with which most Canadians are happy. It’s like saying all doctors are corrupt because this Kuklo character was taking kickbacks from a company producing medical products. I wouldn’t be silly enough to make that sort of extrapolation which is what you’re doing over this incident for which hundreds of fu’s in the US could easily be traded.
sinz54 // Jun 13, 2009 at 7:38 am
ottovbs sez to me: “What you’re saying here is that capitalism doesn’t work…..”I have said *repeatedly* that pure free-market forces don’t work in health care–maybe you weren’t reading my posts.The law of supply and demand cannot work in health care, because the supply and demand curves do not intersect at a price point that any society can afford without cost controls. Demand will always outrun supply–because almost nobody will volunteer to die due to care being too expensive.Take me for example. I’ve got kidney failure and I need dialysis. It costs over $60,000 a year (not counting regular medical checkups and tests). No matter how poor and bankrupt I may be in the future, I will never say to the doctors “$60,000 is too expensive–just let me die.”The economic reason for that is that in health care, there is no concept of replacement cost. Right now, my old television set has failed. I can decide between paying to repair it, or junking it and buying a new one. But with my failed body, I CANNOT just junk it and buy a new one. I am forced to pay for the maintenance and upkeep and repair of my body–because God only issues one to each customer.Up till the 1960s, America dealt with this problem in a brutal way: The poor and the underclass were left to die. The elderly got inadequate care and they died sooner. And death is cheap–you only have to pay the mortician.Medicare “solved” this problem with price controls–they strictly control their reimbursement rates.So I, a conservative, freely admit that health care, like global warming, represent market failures. And no matter what solution we come up with, it’s going to involve significant government interference in the economics.
sinz54 // Jun 13, 2009 at 7:42 am
ottovbvs: One more point. A 100% free market in health care could only work if our society was prepared to euthanize those who are so old or sick that their health care is too expensive for society to pay for (the “Soylent Green” model).That would be the equivalent of junking an old car, or old computer, that is no longer worth its upkeep.Otherwise, the demand curve will never intersect the supply curve at a price point that society can afford. No matter how much supply is increased, demand will continue to outrun it. Everybody wants to live as long as they possibly can. If medicine can increase the average life span to, say, 90, then everybody will try to beat the odds and live past 100. And so on.
barker13 // Jun 13, 2009 at 7:59 am
Re: Mike K; 6:04 PM –Doc. We’ve clearly moved beyond “Ignorance Is Bliss” to… er… “Ignorance Is Cocky.”(*CHUCKLE*) (*SNORT*)Still… it’s only Otto. Balc and Mid are open to reason. Take heart at that.(*SMILE*)BILL
barker13 // Jun 13, 2009 at 8:03 am
Re: Sinz54; wrote 21 minutes ago –One of your best posts ever, Sinz.BILL
ottovbvs // Jun 14, 2009 at 6:25 am
sinz54 7:38 AMottovbs sez to me: “What you’re saying here is that capitalism doesn’t work…..”I have said *repeatedly* that pure free-market forces don’t work in health care–maybe you weren’t reading my posts…….No Sinz what you ACTUALLY said referring to the creation of a public option was:”But the notion that it can employ price competition to hold down premiums of insurers is a pipe dream.”…..Hence you were denying one of the most basic mechanisms of capitalism and in this particular case you’re completely and preposterously wrong…….You then try and change the subject to the wider issue of the place of capitalism in healthcare and while it may be true that issues of morality and ethics raise questions about the appropriateness of a capitalistic for profit based healthcare system the suggestion that: “pure free-market forces don’t work in health care–maybe you weren’t reading my posts”……Is total baloney. They work very well. They may not work to produce socially desirable outcomes or maximize the common good, but they undoubtedly work in economic terms which is why some of the corporations operating in the US healthcare industry are some of the most profitable in the country.
balconesfault // Jun 14, 2009 at 7:09 am
sinz: “the “Soylent Green” model”I prefer to think of it as the “Logan’s Run” model …Otherwise, some excellent points. I find myself always departing from pure economic libertarianism because it seems too much like the product of a bunch of college kids sitting around late at night – and not a product of serious consideration for how the world really functions.Not to say economic liberty should not be a goal. But we need to decide where the sidelines are.You are absolutely right on the price curve issue. Cost control will need to be part of any system, and any publicly funded system is going to have to incorporate the idea that old people do … well … die.
ottovbvs // Jun 14, 2009 at 7:30 am
balconesfault wrote 17 minutes ago”I find myself always departing from pure economic libertarianism because it seems too much like the product of a bunch of college kids sitting around late at night – and not a product of serious consideration for how the world really functions.”………Amen
sinz54 // Jun 14, 2009 at 7:54 am
ottovbvs: Health care represents a market failure. Capitalism cannot “work” if all participants (buyers and sellers) negotiate among themselves to ultimately use up more than 100% of the available services and projected future services. The result of that is either skyrocketing debt, or hyperinflation to monetize that debt–with collapse inevitable.Right now, with our current system, health care costs as a percentage of GDP keep rising. If that keeps up, ultimately it will exhaust the ability of the United States as a nation to pay for it. True, the money can be borrowed, but all debts eventually have to be paid. I wouldn’t call that “working.”The reason that national exhaustion doesn’t happen in other sectors of the economy, like entertainment, electronics, aviation, etc.–is because there is a price point beyond which the consumer simply will not go. If it cost $5,000 to take the US Airways shuttle between Boston and Washington DC, everybody would drive or take Amtrak. Thus airlines have a real market incentive to hold down their costs–there are viable alternatives to flying.But when Bill Clinton was diagnosed with heart disease and told he needed an extremely expensive *quadruple* bypass operation, he had no choice but to pay for it–because the alternative was a premature death. Almost nobody considers death a viable alternative to expensive medical care.Almost nobody wants to die soonest. And Americans will sacrifice the entire GDP of the nation (and beyond, by going into debt), if necessary, for the medical care to stay alive. So would YOU, unless you have a suicide complex.And that represents a market failure.
ottovbvs // Jun 14, 2009 at 10:11 am
sinz54 7:54 AMottovbvs: Health care represents a market failure………I don’t dispute that if the criteria is the provision of universal healthcare at a cost comparable with peer groups. But that’s a long way from claiming as you did that:1) a public option would no effect on competive pricing in the health insurance market.2) market forces have no role in setting pricing levels in a public or private health market because they do. The competition between branded and generic drugs is just one of hundreds of examples.