Mission Accomplished?

November 8th, 2009 at 8:32 am David Frum | 44 Comments |

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That’s a dangerously premature victory celebration the Democrats enjoyed last night.

Not only does the Senate loom ahead, but so does the encounter with reality.

If the House bill survives in anything like its present form, the U.S. government will soon be in the business of decreeing health care prices. That’s what the whole debate over the “public option” has been about from the start: price control.

The Democratic hope has been that if the government enters the insurance business, the government will gain the power to set prices. No more market competition: health prices will be set by order from above.

The bill powerfully incentivizes smaller employees to withdraw their own health coverage and push their employees into the government plan.

Small employers can now escape the obligation to provide health care for their employees by paying an 8% payroll tax. Many small employers will seize that offer. Their employees will have to go shopping for themselves in a very complicated and confusing marketplace. Many will opt for the seeming security of the government-run plan. Over time, the public option will grow, setting private insurance on the road to extinction – or at best to a tightly regulated new role as the health equivalent of public utilities. The big decisions will be made in Washington; the insurers will comply.

At any rate, that’s the House leadership’s hope: not a single payer, exactly, but a single administrator.

To anyone familiar with the history of administered prices, it might seem that this approach must invite a quality squeeze – just the way the chocolate bars shrank in size in the 1970s when the government tried to control their price.

Democrats assume that the health care system contains so much fat and waste that they can impose price restraints – and that providers will find ways to adjust while protecting patients.

But that’s a hope, not a plan.  To borrow a phrase, Democrats replied to the Republicans “mission accomplished.”

Now the hope meets reality. What comes next won’t be pretty.

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44 Comments so far ↓

  • balconesfault

    Their employees will have to go shopping for themselves in a very complicated and confusing marketplace.

    Huh. Didn’t expect to see that here.

  • sinz54

    The health care issue has always tested my belief in free markets.

    I have never understood how a free market in health care can work in a humane society.

    Because each of us prices our own lives as if they’re infinitely precious to us. (The Lord only issues one to a customer.) Hence demand for health care to keep us alive and healthy will always outrun supply.

    Currently, health care is apportioned by ability to pay. Multiple studies have shown that those who do not have health insurance visit doctors less frequently, have less care–and are sicker.

    Hence to reform health care, there will be government intervention in the marketplace. There has to be. The only question is, what type of intervention.

    There is a whole lot wrong with the Pelosi bill. But whoever keeps criticizing it on the basis of “government intrusion in the marketplace” hasn’t thought through the implications of a laissez-faire approach.

  • mdjoey

    As this doctor and a former president have said, “There you go again” with your price controls. This plan basically takes the same path that put us where we are today, unable to afford all the “care” we’re giving out. Price controls (and fee for service payment systems) encourage doing things TO rather than taking care OF our citizens. Thanks to the AMA, doctors and hospitals, the fee-for-service system predominates, so it’ll be simple for doctors and hospitals to install new machines, order new tests, more consults, etc. to bring in the kind of money they need to stay in operation.

    When insurers negotiate with physicians to get the cost of a cardiac stent to $9000, they’ve taken $7000 off the ‘list’ price. Medicare pays 25% of that, it costs almost that much to set up the room for the angioplasty. The real price is somewhere in between, and private care subsidizes the loss the facility takes with Medicare patients. Now, we aren’t even 100% sure that stenting patients with chest pain is any better than giving people medication, losing weight, watching your diet, taking an aspirin, etc. In fact, outcomes data consistently fails to prove the stent is the better option for angina chest pain. Medications (generic) can run as high as $25/month, diet and exercise are free.

    Unfortunately this won’t fit in the “take over healthcare and control prices” equation, so once prices for angioplasty and stents have been controlled downward, doctors will need to recommend more of them. (insert= “ahh, this is why the AMA and AARP likes this bill” here) There are no published outcomes data that takes into account cost, quality, outcome, efficacy of the procedure and puts it in a form that anyone can understand.

    If patients opted for the stent, published outcomes data would show them that hospital A has a 3% complication rate, and people go back to work in 10 days, while hospital B has a 5% complication rate and people stay out of work 3 weeks. Patients would vote with their feet, better centers would thrive, costs would go down with economies of scale, lousy centers would look for another line of work, costs would go down some more.
    If patients knew they really DID have a choice, and had more shared responsibility for the less effective option, they’d control the price themselves. That would result in, sigh, better health at less cost.

    Had they just started here, saved a few billion while making americans more healthy (and wealthy and wise), then roll out this through colonoscopy, mastectomy, cataract surgery, insulin pumps, etc. and our citizens would be getting so much better care while saving money and choosing their own path. Doctors have been disincentivized from doing this thanks to the perverse fee for service system. Hospitals need to have and use the newest technology to be able to attract patients. Not doing procedures is no way to pay down your $150,000 malpractice bill every year. Clearly, neither the AMA nor those in favor of price control never wanted to try these ideas, control is much more fun.

  • sinz54

    David Frum: Democrats assume that the health care system contains so much fat and waste that they can impose price restraints – and that providers will find ways to adjust while protecting patients.
    Depends how we define “waste.”

    Here in Massachusetts where I live, a nationally known major hospital is proud of the fact that every patient who is admitted there gets his or her own private room with Internet Web TV hookup. No semi-private rooms or wards.

    And the affluent baby-boomers I discuss this with are adamant that they are entitled to their own private room.

    Your care won’t suffer if you’re in a semi-private room with another patient. And that would be cheaper.

    It’s a hospital, not the Hyatt hotel.

  • sinz54

    mdjoey: If patients knew they really DID have a choice, and had more shared responsibility for the less effective option, they’d control the price themselves. That would result in, sigh, better health at less cost.
    Wait a minute!

    I have a serious chronic illness. For my treatment, I have gone to multiple doctors and gotten multiple opinions on treatment options.

    But my top-level concern was EFFECTIVENESS, not PRICE.

    If treatment option A will raise my red blood cell count into the normal range at a cost twice as much as treatment option B which leaves me somewhat anemic, I’m going to choose treatment option A, cost be damned.

    No patient is going to trade off his health for lower price. Every patient is going to look for the treatment options that make him healthiest and extend his life span the longest, regardless of cost. That was the entire point of my earlier post.

    Bill Clinton was told he needed a quadruple bypass to stave off a heart attack. He never said “That’s too expensive; I’ll just take low-dose aspirin and take my chances.” He took the bypass–at a cost of perhaps $80,000.

  • forgetn

    On the private room issue, here in Montreal (Canada) we are building two new teaching hospitals, to cater to each of our two medical schools. Both hospital will be with private rooms only, turns out that having more than one patient in a room increases dramatically the risk of infection. Yes each room will have TV (patient are borded) and internet — the system is already in place for hospital use.

    Oh, and we have socialize medecine.

    It seems that medicine has improved to the point where hospital stays are shorter (dramatically) and hence patients are sicker. These are public health issues — not luxury.

  • mdjoey

    Let’s not confuse treatment of catastrophic illness with what’s come to be known as “standard of care” for general health care. You and Mr. Clinton needed what you got, and cost rightfully was not be a concern. Health savings accounts, public and private insurers all provide full coverage for catastrophic, serious and chronic illnesses.

    Clintons effective and expensive care was necessary and paid in full. BUT- we don’t know his medical history, it’s possible he’s just like some of my patients, if they had taken their medications, watched their weight, exercised, gotten regular preventive care they may have never needed the bypass. If a doctor spends an hour with you every 2 months and helps you with this preventive regimen, he gets $75 per visit. If he sees you for 5 monutes and orders 6 tests and a procedure, he pays the rent for the office that week. And you and I as patients, get the short end of the stick. It’s an old saying because it’s true- an ounce of prevention beats a pound of cure. Prevention should not be reimbursed at 10 cents on the dollar while technologically advanced useless ‘cures’ abound and are paid in full.

    For patients not facing chronic serious or catastrophic illness, you say ” Every patient is going to look for the treatment options that make him healthiest and extend his life span the longest, regardless of cost”. Right now, nearly everyone equates price with quality and this is simply not true. When you are looking at routine care for diabetes, early breast cancer, prostate cancer, the most expensive treatment plans are often not the best. Patients don’t know what is best, and if it costs $25 to get a $100 test and $25 to get a $1600 test, who wouldn’t pick the pricier one, it must be better. With outcomes data you’d know. Right now you don’t.

    By the time your blood count or your arteries need some serious medicine, cost should not be a concern but you should have the right to know which treatments give you the best shot. You’re charged a lot for what you get, better make sure you’re getting what you’ve paid for.

  • MFarmer

    The public option is only one reason to resist this monster. If the debate is not elevated to delineate the differences between statism and anti-statism, then we will piddle around the cusp thinking we can tinker this madness to something that resembles sanity — we can’t. It’s either stop the progressive healthcare reform and implement rational free market reforms or accept certain free market failure.

  • Kanzeon

    This is the reason I just can’t listen to the Republicans anymore on health care. The arguments are too stupid, shallow, and irresponsible.

    The most vexing problem with the American healthcare system is runaway cost. Any serious attempt to reform it will focus on cost containment. Any serious attempt to contain those costs can be viewed as “price control” – except that the phrase is dishonest. The government isn’t decreeing prices. The public option – which is by no means a fait accompli – isn’t an instrument to decree prices, since it is, in its present proposed form, funded by premiums, not subsidies. If you believe in the free market, you have every reason to believe that the private insurers can compete with a government plan.

    Will any Republican deal with the basic facts – that our private healthcare system costs twice as much as government-administered or government controlled plans in other countries, while not delivering better results? Will any Republican ever deal with the reality that healthcare is sui generis, and that analogies with other sectors of the economy are just a waste of time?

    This is a serious issue. Why do you refuse to take it seriously? Do you value nothing? Are you simply a moral black hole who doesn’t believe that there is any reality beyond scoring political points? The reason you have no thinking people left in your party isn’t just Glenn Beck and Sarah Palin’s fault.

  • ProfNickD

    David said,
    “If the House bill survives in anything like its present form, the U.S. government will soon be in the business of decreeing health care prices.”

    Take out the last word in that senetence and you’re correct. It’s not the price of medical care that progressives want to control but medical care itself. If it were solely about cost then progressives would enact tort reform and strictly curtail the legal grounds for medical malpractice — that alone would save a quarter-trillion dollars per year.

    No, I’m afraid this is about control itself: progressives believe, and have always believed, that people generally make irrational, self-interested, and anti-social decisions in the marketplace. (That’s why, for example, we get this ludicrous claim made by progressives that physicians order the most expensive procedures or those that aren’t needed: physicians, like everyone else, are greedy and need to be controlled.)

    Progressives think they understand who should get what levels of treatment and under what circumstances, because they think they are more intelligent, clear-headed, and caring than their fellow human beings, so, ergo, progressives think they should run everything for our own good.

  • sinz54

    Kanzeon: If you believe in the free market, you have every reason to believe that the private insurers can compete with a government plan.
    As I’ve pointed out before,

    Congress won’t allow the public plan to fail. If they see it losing market share to private insurers, they will subsidize it heavily, or even give it a guaranteed market, just like the Postal Service. (The Postal Service would have gone out of business years ago, if FedEx were allowed to deliver first-class envelope mail. They are forbidden to do so, by Federal law.) While imposing ever more onerous regulations on the private insurers.

    Several times on this blog, I have pointed to how the City of New York drove the privately operated subway and bus lines out of business (and then took them over), by funding a heavily subsidized “private option”–city-owned mass transit. While imposing such onerous regulations on the private insurers that they were unable to compete with this public option.

    No private company can expect to compete against THE GOVERNMENT.

  • sinz54

    ProfNickD: If it were solely about cost then progressives would enact tort reform and strictly curtail the legal grounds for medical malpractice — that alone would save a quarter-trillion dollars per year.
    The studies I have seen suggest that tort reform would save about $60 billion a year.

    The two biggest cost drivers are:

    a) The aging of the population (and the older you are, the more likely you are to pick up one or more chronic illnesses);

    b) The use of the latest and most advanced (and most expensive) medical technology. This happens for the reason I outlined: Desperate patients, desperate to live, will demand the latest medical breakthroughs, rather than accept death.

  • sinz54

    One more thing. It is estimated that as much as $100 billion a year is wasted on medical errors and correcting those errors.

    We would save more money by putting procedures in place to ensure that a nurse doesn’t give a patient the wrong medication, than by tort reform involving lawsuits against the hospital afterward.

  • mdjoey

    sinz54:
    “Every patient is going to look for the treatment options that make him healthiest and extend his life span the longest, regardless of cost.”

    Let’s multiply that sentiment by 36 million times in a Medicare-style, Government-adminstered reimbursement system (ala Public Option) and see what that will do to our economy.

    How can we say “…cost be damned (someone else should pay for it)…, I’m entitled to every procedure whether its medically effective or not…”, that is the precise mentality that is driving Medicare off the cliff ($60 Billions/year in fraudulent and wasteful billings) and helped camouflage the REAL DRIVERS of Healthcare’s cost: the litigation industry, medical device industry, specialty vendors, idiosyncratic State Legislations and Big Pharma.

    I challenge any supporters of the Public Option to explain how this debt-addicted government is infinitely qualified to lower ‘cost’ when it’s already:
    1. $12 Trillions (and rising) in foreign owned debts
    2. The Treasury is Broke (yes, broke…)
    3. Social Security and Medicare has been mismanaged into insolvency by 2041 and 2017.

    That’s like the Wolf promising the Shepherd that it can do a better job than the Sheepdog of guarding the flock .

  • Kanzeon

    sinz54

    “As I’ve pointed out before, Congress won’t allow the public plan to fail…”

    What Congress? The public plan won’t even be operative for several years. There are many blue dogs that aren’t in favor of the public plan. Health insurance companies will still have millions of dollars to throw at the legislative process.

    You have absolutely no basis whatsoever to make this statement. Comparing this to a local subway system is ridiculous, and to suggest that all government plans act like the New York subway system is absurd. There is every reason to believe that any push to greatly expand a troubled public option will receive at least as much opposition as the attempt to create it in the first place, and if it in fact “fails,” it is more likely that the forces against its expansion will have powerful arguments.

    A more sensible argument is that a successful public option will gain enough political support to strengthen the liberal arguments. But, of course, that isn’t an argument against the public option, and I wouldn’t make an argument on the theory that I could determine what a future Congress and President will do in the face of a hypothetical.

    That isn’t even a legitimate area of discussion, because I can argue against any other bill I don’t like by predicting an unpleasant future. Anyone can speculate what the Congress will do in five or ten years, and virtually every person who makes a prediction will be wrong.

    Is this the best argument you have?

  • Oldskool

    Some pesky facts:

    - Left up to Republicans, nothing at all would be done. They proved it in 1994, 2000-2006, and in 2009.

    - This bill may not be ideal but so far it’s the only one to get past the House. Even Nixon was willing to go farther than the House bill back in the day when his party was made up of rational people. By the way, he actually gave us government control on the price of everything in 1971.

    - We wouldn’t dream of handling other life-and-death services that way we do health care. We’re perfectly happy to fund police and firefighters out of the public treasury because it’s in the best interest of our communities even though the cost of those services have to be budgeted. Not to mention the fact that those municipal employees are also on subsidized health care just like Congress and our armed forces.

  • Reason60

    Oldskool beat me to it, but I will state it another way:

    I am not a economist or policy wonk, and honestly haven’t read the 1,900 pages to know exactly what it says or how;
    And we may in fact look back on this a decade from now and conclude it was a boondoggle.

    On the other hand- it is the best proposal on the table. the other party had control of the levers of government for decades, and not once attempted to do anything about the problem.

    And adding to Oldskool’s comments about public services, we have a publicly run school system that so far hasn’t bankrupted the private schools; I hear that Harvard is actually managing to compete against a system that- (how did Dick Armey put it?) “can print their own money”.

    And once more for emphasis- this is the best proposal on the table.

  • Aucturian

    sinz54:

    “We would save more money by putting procedures in place to ensure that a nurse doesn’t give a patient the wrong medication, than by tort reform involving lawsuits against the hospital afterward.”

    Are you saying that we don’t need Tort Reform because its completely acceptable for obstetrician-gynecologists to pay $150,000 in malpractice insurance premiums? Or its perfectly fine for the Litigation Industry to game the system? And you don’t think that cost is ultimately passed down to consumers through higher HMO premiums?

    Have you asked any Physicians what is the one most prohibitive cost of going into private practice?

    And yet you expect a tax-payer sponsored, government plan to reimburse doctors at market rate and “..save money…” while permitting the litigation cost of defensive medicine to exist?

    We don’t need Tort Reform?

    What an assertion!
    No wonder we’ve been unable to move towards meaningful Healthcare Reform when it stems from such astonishing lack of industry insights!

    And a note of correction, Oldskool. Police and Fire fighters are funded by local and municipal taxes. It doesn’t come out of the Federal Treasury (which a previous poster has mentioned is already penniless). And these local public services don’t have the gargantuan, deficit-inducing appetites of such Federally managed programs like Social Security, Medicare and Medicaid. Which, if you haven’t checked your paystub lately, constitutes a bulk of your taxes. And as a previous poster points out, will go bankrupt by 2017 and 2041.

    Now find me anyone who is “…perfectly happy to fund…” that.

  • Chekote

    Kudos to Pelosi for outflanking the GOP using the abortion issue.

  • Oldskool

    “Police and Fire fighters are funded by local and municipal taxes.”

    I assumed everybody knows that. The point is we treat them completely differently even though they’re all life-and-death services.

  • sinz54

    mdjoey: “…cost be damned (someone else should pay for it)…, I’m entitled to every procedure whether its medically effective or not…”
    I did NOT say that exactly.

    I said that as I’m battling this life-threatening illness, I will choose whichever treatment modalities have the best chance of extending my life, cost be damned. And then I’ll figure out how I can pay for them later.

    Now as it turns out, I’ve got Blue Cross/Blue Shield. So all the healthy policyholders of BC/BS are paying premiums to keep me alive. That’s how insurance works.

  • sinz54

    Aucturian: Are you saying that we don’t need Tort Reform because its completely acceptable for obstetrician-gynecologists to pay $150,000 in malpractice insurance premiums? Or its perfectly fine for the Litigation Industry to game the system? And you don’t think that cost is ultimately passed down to consumers through higher HMO premiums?
    I did NOT say we don’t need tort reform.

    I said that malpractice cases are NOT the biggest cost driver. And so it’s not a panacea that will significantly hold down costs.

    Study after study have shown that as far as health care is concerned, your most expensive year of life is your last year of life. Whatever illness finally got you–whether it’s Stage IV cancer or Alzheimer’s–you’re going to fight like hell to stay alive, running up a huge medical bill–and ultimately lose the fight anyway.

    This is why the British NHS has simply stopped paying for treatments that are unlikely to extend life more than six months. They’ve made a cold-blooded calculation that it’s not worth it to their nation to spend a fortune on medical treatments to give you just three more months of life. They would rather pay to give you the best possible palliative (hospice) care.

  • Reason60

    I think this points out what I see as an error in the conservative movement; the near-worship of the free market as a panacea for any and all problems.
    There is this thinking seems to be that the free market will be able to deliver the best product (health care) at the lowest cost to the widest number of people.

    But this seems to be based on an ideological fixation with capitalism, rather than any pragmatic sense of how to fix the problem.

    Seeing health care as just another product like cars or toasters is inherently absurd; we are not free to leave the health care market, we can’t really be informed self-empowered consumers, and the cost of uninsured people not getting their health care needs adequately addressed is staggering to the nation as a whole.

    It reminds me of the battle over mandatory education and the establishment of public schools in the 19th Century; it was finally accepted that mandatory universal education had vast benefits for all of society, and a two track public/ private scheme allowed both universal access and freedom of choice.

  • esurience

    Stop fetishizing the “free market.” A free market is a _means_ to an end, not an end in itself. What is the end supposed to be? Well, with health care, it would be good quality health care for everyone, at the lowest possible price. The market has failed at providing that. Is the failure a genuine market failure or is it because of government interference? I don’t know. All I know is that the Democrats offered the only plan to attempt to fix the problems with health care. There are alternative proposals out there, some suggested by this website itself, but those proposals weren’t advocated by the opposition party (The Republicans).

    When you have something that is broken, and there’s only one solution to fix it that is on the table, that’s the one you go with.

    Deal with it. The Republican party needs to learn that if they’re not interested in good governance and fixing problems, they’re going to have a hard time getting back in power.

  • SpartacusIsNotDead

    MDJoey,

    You never addressed the substance of Sinz’s point in comment #5. Your responses suggest you believe healthcare services are consumed in a manner similar to, say blue jeans, in which the consumer himself has all the information necessary to make an informed decision, and that there are acceptable trade-offs between all of the options along the spectrum.

    Sinz basically said that if his doctors tell him a particular course of action will achieve optimum health for him, he’s not going to pursue a different course of action merely because it may be cheaper. It matters not that the health issue may not be as serious as heart surgery, or that behavior modification might have lessened the need for surgery, or that the latest technical advances may not produce the best outcome.

    If the professionals he trusts and relies upon recommend a particular course, he’s not going to select a different course because of the cost and I can’t imagine that, as a doctor, you would feel comfortable if your patient was willing to accept less than optimum health in order to save money.

  • SpartacusIsNotDead

    Sinz wrote: “The studies I have seen suggest that tort reform would save about $60 billion a year.”

    Can you cite any links for this? None of the studies I’m familiar with show a savings of anything close to that. Indeed, the CBO estimated that the savings would be only $54 billion over TEN years.

    http://www.medscape.com/viewarticle/710364

  • SFTor1

    “When insurers negotiate with physicians to get the cost of a cardiac stent to $9000, they’ve taken $7000 off the ‘list’ price.”

    I used to do a lot of work in the medical devices industry. As far as I remember the wholesale price of a cardiac stent was $700 in 2001.

  • SpartacusIsNotDead

    Sinz wrote: “As I’ve pointed out before, Congress won’t allow the public plan to fail. If they see it losing market share to private insurers, they will subsidize it heavily, or even give it a guaranteed market, just like the Postal Service.”

    Yet again, you’ve chosen to ignore the real-world model for a public option in the U.S. and, instead, have chosen a completely irrelevant model. None of the public option proposals call for a model that even remotely resembles the U.S. Postal Service.

    For the Gazillionth time, the closest model for the proposed public option is the public option for workers compensation insurance in California. That public option competes with private insurers, is not subsidized by the state or any public funds, relies solely on premiums collected from businesses of their own free will, and it has not driven private insurers out of the marketplace. It has, however, put downward pressure on premiums for all policies and it has ensured that all businesses can obtain workers comp insurance.

    Your repeated refusal to acknowledge these most basic facts suggests you are disingenuous in your criticisms of the reform proposals and, instead, looking only to try to score political points.

  • SpartacusIsNotDead

    Kanzeon at #15 asked Sinz: “Is this the best argument you have?”

    It is his only argument and, when not reflexively attacking any idea that might be favored by people he views as liberal, I’m sure he knows it’s a silly argument. He’s just not capable of being serious and forthright.

  • SpartacusIsNotDead

    Acturian wrote: “And a note of correction, Oldskool. Police and Fire fighters are funded by local and municipal taxes. It doesn’t come out of the Federal Treasury . . . ”

    How on earth is this pertinent to an analysis of the reform bill passed by the House? The bill passed by the liberal Democrats in the House actually REDUCES the federal deficit by $109 billion over 10 years.

    I know that deficit reduction is contrary to the way in which conservatives and the GOP govern, but the rest of the country thinks deficit reduction is not a bad idea.

  • SpartacusIsNotDead

    Here’s the link showing the CBO concluded the Democrats’s bill would reduce the deficit by $109 billion over 10 years.

    http://primebuzz.kcstar.com/?q=node/20468

  • Addie

    Spartacus – and you believe the CBO? Let me just say……. I’ve got a bridge in Brooklyn I’ll sell you. I remember what the government said about the Medicare Prescription plan and we’ve what…tripled the cost?

    When is the last time the government (CBO is GOVERNMENT) actually got a cost estimate correct? How can something that covers the cost of health care and does nothing to reduce cost possible reduce the deficit? (Can we say death panels? Maybe that’s part of the reduction?)

    Deficit reduction is NOT going to happen but you keep believing the government might actually get something right. LMAO!

  • Reason60

    I find it ironic that the example used of how the heavily subsidized government option would drive the private carriers out of business is the US Postal Service.
    The same US Postal Service that competes robustly with FedEx, UPS, and others. I don’t see them being swallowed up by the USPS Leviathan.

  • sinz54

    Reason60: The same US Postal Service that competes robustly with FedEx, UPS, and others.
    Don’t you bother to read my posts?

    For your information, UPS had to engage in costly litigation for FORTY YEARS (from the 1930s through the 1970s) to be allowed to be considered by the ICC as a common carrier, existing alongside the Post Office. The Post Office had gone to court to block them, again and again and again.

    And the Postal Service doesn’t “compete robustly.” It would have gone out of business by now, if Congress hadn’t subsidized it heavily out of general revenues, and if it didn’t have a legal monopoly on delivering first-class mail. Despite these heavy subsidies, it raises postal rates year after year.

    The Postal Service is kept in business by its legal monopoly on first-class mail. By Federal law, no private company–FedEx, UPS, or anyone else–is allowed to deliver stamped first-class mail. In the 1970s, a small startup company, Brennan Delivery, tried to challenge the Postal Service. They started a service to deliver first-class envelope mail cheaper than the Postal Service could. The Postal Service sued them and put them out of business.

    SpartacusIsNotDead: In case you’re That public option competes with private insurers, is not subsidized by the state or any public funds
    How much would you be willing to bet that if the public option for health care is signed into law by Obama, it will be heavily subsidized by future Congresses?

    Once an entitlement gets approved, it becomes IMPOSSIBLE to cut it back. It becomes an endless black hole into which we pour money.

  • sinz54

    SpartacusIsNotDead:

    You liberals have the votes in Congress, you’ve got a filibuster-proof majority in the Senate if you can pay off Lieberman. So do it yourselves.

    For us conservatives, the public option is a deal-breaker. It is absolutely unacceptable. That’s non-negotiable. We’ll fight it to the end, and lose the fight if we have to–because we absolutely cannot accept it.

    And that’s final.

  • sinz54

    SpartacusIsNotDead: Here’s the link showing the CBO concluded the Democrats’s bill would reduce the deficit by $109 billion over 10 years.
    That CBO analysis assumed hundreds of billions of dollars in cuts to Medicare. (This was widely reported on the news media too.)

    And no one in his right mind expects Congress to cut Medicare. There have been attempts, year in and year out, to rein in Medicare spending. All failed. All will continue to fail. No politician is going to buck the senior voters.

    If you take out those hundreds of billions of dollars in cuts, the real cost will be far higher.

    The CBO is not allowed to question the Congress’ stated plans. All they can do is cost them. They are not allowed to say, as I just did, that Pelosi is lying about those Medicare cuts.

    But everybody except you knows she is. Even her fellow liberals.

  • sinz54

    SpartacusIsNotDead: Indeed, the CBO estimated that the savings would be only $54 billion over TEN years.
    I believe the CBO study only considered the cost of the actual malpractice cases and malpractice insurance.

    But the biggest cost by far is doctors’ overuse of antibiotics and lab tests to protect against possible malpractice lawsuits. The problem is that if a doctor fails to order a particular lab test, and you get sick, you could sue the doctor for failing to order the test that could have detected your illness in time to cure it. So they are constantly ordering a zillion screening tests for conditions you would probably never suffer from anyway–or if you did, you could be cured readily.

    The current controversy over PSA screening for prostate cancer is a perfect example of this. The test isn’t very sensitive–it has about a 20% rate of false positives. That means that urologists are telling millions of American men that they could have prostate cancer when they really don’t. To make sure and avoid possible malpractice suits, the urologist has to order an expensive prostate biopsy (and most of the time, the biopsy will turn out negative).

    Here’s a new report that analyzes just where the waste in our current healthcare system is. It’s in the practice of medicine, not in the courts:

    http://www.reuters.com/article/topNews/idUSTRE59P0L320091026

    And it’s even MORE costly than I thought.

    If you like it, save a copy on your own computer because I have a feeling it won’t be around much longer.

  • sinz54

    Addie: When is the last time the government (CBO is GOVERNMENT) actually got a cost estimate correct?
    Most of the time, it’s not their fault.

    The CBO is only allowed to estimate the cost of the Congressional proposals they are given. They can’t question whether those proposals will be enacted as is, or amended later.

    In this case, the CBO is correct that the Baucus bill will not add to the deficit and perhaps even slightly reduce it–if that bill is signed into law as is, and never amended over its projected life span.

    But you and I know that’s highly unlikely. The Baucus bill takes hundreds of billions of dollars away from Medicare. Do you really believe Congress will allow that? Have they ever cut Medicare before?

  • DFL

    Perhaps the Right can give the Left single-payer national health insurance and the Left can allow the Right to privatize or end many of the other poorly managed federal programs like the Post Office and the interstates.

  • SpartacusIsNotDead

    Sinz wrote: “How much would you be willing to bet that if the public option for health care is signed into law by Obama, it will be heavily subsidized by future Congresses?”

    See Kanzeon’s post at # 15.

  • SpartacusIsNotDead

    Sinz @ # 34,

    Your response does not address the issue raised by Reason60 in #33. No one questions whether the USPS requires federal funds; it certainly does and a history on USPS litigation is needed to confirm what we all already know.

    The issue is whether the USPS, as a federally-subsidized entity, has run FedEx and UPS out of business, which is what you seem to fear will happen with a public option. Well, it’s abundantly clear that the federally-subsidized USPS has not run FedEx, UPS or any other private company out of business, and there’s no reason to think a public option will run private insurers out of business.

    Again, the proof of this is the public option in the California workers compensation market. Until you reconcile that real life example with all the predictions about a public option, your concerns are nothing more than hyperbolic doomsday fear.

  • SpartacusIsNotDead

    Sinz wrote: “But the biggest cost by far is doctors’ overuse of antibiotics and lab tests to protect against possible malpractice lawsuits.”

    You’ve jumped to a conclusion for which you have absolutely no substantiation. It’s widely accepted that there is overuse of medical services by providers. However, there is no evidence that fear of malpractice suits is substantial cause of this overuse. There is also no evidence that even if fear of malpractice suits was the cause of overuse that tort reform would result in less overuse.

    Providers typically follow a standard of care that does not vary from state to state. That is, doctors generally prescribe whatever treatment is recognized nationally as the most efficacious. Those doctors in states without tort reform do not deviate from the nationally recognized standard because they know they will have lower liability in the event of a malpractice suit. And those doctors in states with tort reform also don’t deviate by offering more than the standard because they fear greater liability in a malpractice suit. Moreover, insurance companies won’t pay for services that are not reasonably medically necessary.

    I’m sorry, but it’s pure nonsense to suggest that tort reform will have a signficant affect on the overuse of medical services. There simply is no evidence of this.

  • KL7212

    >For us conservatives, the public option is a deal-breaker. It is absolutely unacceptable. That’s non-negotiable. We’ll fight it to the end, and lose the fight if we have to–because we absolutely cannot accept it…

    Why?

    You’ve argued eloquently about “market failure” in the medical insurance market. What’s wrong with having a publicly funded alternative to treat people who are “unprofitable” to the health care insurance industry?

    I think you can see where I’m going with this…

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