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	<title>Comments on: Obamacare: More Interest Group Handouts</title>
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	<description>Building a conservatism that can win again</description>
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		<title>By: sinz54</title>
		<link>http://www.frumforum.com/obamacare-more-interest-group-handouts/comment-page-3#comment-58615</link>
		<dc:creator>sinz54</dc:creator>
		<pubDate>Fri, 07 Aug 2009 16:57:16 +0000</pubDate>
		<guid isPermaLink="false">http://www.newmajority.com/?p=9267#comment-58615</guid>
		<description>liv&amp;win:  I know something about the Medicare situation from first-hand experience.

It&#039;s not that Dems &quot;low-balled&quot; it.  It&#039;s that medicine has changed a whole lot since Medicare was enacted, more than 40 years ago.

Back then, most folks with congestive heart failure or kidney failure didn&#039;t have much of a chance of surviving more than a couple of years after diagnosis.  So they died, and stopped costing Medicare anything more.

Today, medicine has advanced to the point that it can keep heart patients and kidney patients alive--but at a very high cost.  They&#039;re paying $100,000 this past year to keep me alive.

The skyrocketing cost of insurance, both public and private, isn&#039;t really due to waste or low-balling or deliberate fraud.  Sure, those things exist in all large organizations--but they&#039;re an overhead charge on top of the actual cost.  It&#039;s not like there is ten times more fraud today than there was 40 years ago.

What has happened is that we have entered an age of cost-INEFFECTIVE medicine:  Unlike other fields such as computers, advancing technology has RAISED the cost of health care, not lowered it.  And that&#039;s because the goal--keeping the patient alive--has no upper bound on cost.  We treat each day of a patient&#039;s life as if it&#039;s infinitely precious--and we&#039;ll spend whatever it takes to keep the patient alive, if the patient wants to fight to stay alive.</description>
		<content:encoded><![CDATA[<p>liv&amp;win:  I know something about the Medicare situation from first-hand experience.</p>
<p>It&#8217;s not that Dems &#8220;low-balled&#8221; it.  It&#8217;s that medicine has changed a whole lot since Medicare was enacted, more than 40 years ago.</p>
<p>Back then, most folks with congestive heart failure or kidney failure didn&#8217;t have much of a chance of surviving more than a couple of years after diagnosis.  So they died, and stopped costing Medicare anything more.</p>
<p>Today, medicine has advanced to the point that it can keep heart patients and kidney patients alive&#8211;but at a very high cost.  They&#8217;re paying $100,000 this past year to keep me alive.</p>
<p>The skyrocketing cost of insurance, both public and private, isn&#8217;t really due to waste or low-balling or deliberate fraud.  Sure, those things exist in all large organizations&#8211;but they&#8217;re an overhead charge on top of the actual cost.  It&#8217;s not like there is ten times more fraud today than there was 40 years ago.</p>
<p>What has happened is that we have entered an age of cost-INEFFECTIVE medicine:  Unlike other fields such as computers, advancing technology has RAISED the cost of health care, not lowered it.  And that&#8217;s because the goal&#8211;keeping the patient alive&#8211;has no upper bound on cost.  We treat each day of a patient&#8217;s life as if it&#8217;s infinitely precious&#8211;and we&#8217;ll spend whatever it takes to keep the patient alive, if the patient wants to fight to stay alive.</p>
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		<title>By: liv&win</title>
		<link>http://www.frumforum.com/obamacare-more-interest-group-handouts/comment-page-3#comment-58472</link>
		<dc:creator>liv&win</dc:creator>
		<pubDate>Thu, 06 Aug 2009 15:53:11 +0000</pubDate>
		<guid isPermaLink="false">http://www.newmajority.com/?p=9267#comment-58472</guid>
		<description>Sinz:  from the WSJ editorial pages today:
As for the spending, when has a new entitlement ever come in under budget? True, the 2003 prescription drug benefit has, but those surprise savings derived from the private insurance design and competition that Democrats opposed and now want to kill. The better model for ObamaCare is the original estimate for Medicare spending when it was passed in 1965, and what has happened since.

That year, Congressional actuaries (CBO wasn’t around then) expected Medicare to cost $3.1 billion in 1970. In 1969, that estimate was pushed to $5 billion, and it really came in at $6.8 billion. House Ways and Means analysts estimated in 1967 that Medicare would cost $12 billion in 1990. They were off by a factor of 10—actual spending was $110 billion—even as its benefits coverage failed to keep pace with standards in the private market. Medicare spending in the first nine months of this fiscal year is $314 billion and growing by 10%. Some of this historical error is due to 1970s-era inflation, as well as advancements in care and technology. But Democrats also clearly underestimated—or lowballed—the public’s appetite for “free” health care. 

ObamaCare’s deficit hole will eventually have to be filled one way or another—along with Medicare’s unfunded liability of some $37 trillion. That means either reaching ever-deeper into middle-class pockets with taxes, probably with a European-style value-added tax that will depress economic growth. Or with the very restrictions on care and reimbursement that have been imposed on Medicare itself as costs exploded.

On the latter point, the 1965 Medicare statute explicitly stated that “Nothing in this title shall be construed to authorize any Federal official or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided.” Yet now such government management of doctors and hospitals is so pervasive in Medicare that Mr. Obama can casually wonder in a recent interview with Time magazine how anyone could oppose the “benign changes” that he supports, such as “how the delivery system works.”
http://online.wsj.com/article/SB10001424052970203609204574314622075560890.html</description>
		<content:encoded><![CDATA[<p>Sinz:  from the WSJ editorial pages today:<br />
As for the spending, when has a new entitlement ever come in under budget? True, the 2003 prescription drug benefit has, but those surprise savings derived from the private insurance design and competition that Democrats opposed and now want to kill. The better model for ObamaCare is the original estimate for Medicare spending when it was passed in 1965, and what has happened since.</p>
<p>That year, Congressional actuaries (CBO wasn’t around then) expected Medicare to cost $3.1 billion in 1970. In 1969, that estimate was pushed to $5 billion, and it really came in at $6.8 billion. House Ways and Means analysts estimated in 1967 that Medicare would cost $12 billion in 1990. They were off by a factor of 10—actual spending was $110 billion—even as its benefits coverage failed to keep pace with standards in the private market. Medicare spending in the first nine months of this fiscal year is $314 billion and growing by 10%. Some of this historical error is due to 1970s-era inflation, as well as advancements in care and technology. But Democrats also clearly underestimated—or lowballed—the public’s appetite for “free” health care. </p>
<p>ObamaCare’s deficit hole will eventually have to be filled one way or another—along with Medicare’s unfunded liability of some $37 trillion. That means either reaching ever-deeper into middle-class pockets with taxes, probably with a European-style value-added tax that will depress economic growth. Or with the very restrictions on care and reimbursement that have been imposed on Medicare itself as costs exploded.</p>
<p>On the latter point, the 1965 Medicare statute explicitly stated that “Nothing in this title shall be construed to authorize any Federal official or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided.” Yet now such government management of doctors and hospitals is so pervasive in Medicare that Mr. Obama can casually wonder in a recent interview with Time magazine how anyone could oppose the “benign changes” that he supports, such as “how the delivery system works.”<br />
<a href="http://online.wsj.com/article/SB10001424052970203609204574314622075560890.html" rel="nofollow">http://online.wsj.com/article/SB10001424052970203609204574314622075560890.html</a></p>
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		<title>By: sinz54</title>
		<link>http://www.frumforum.com/obamacare-more-interest-group-handouts/comment-page-3#comment-58454</link>
		<dc:creator>sinz54</dc:creator>
		<pubDate>Thu, 06 Aug 2009 12:56:09 +0000</pubDate>
		<guid isPermaLink="false">http://www.newmajority.com/?p=9267#comment-58454</guid>
		<description>ottovbvs:  I&#039;m always in favor of more standardization.  (Where would America be today without time zones and common carriers?)

But on health care, we could have gotten standardization, a mandate on insurers for guaranteed issue, and lots of other good things--WITHOUT the insistence by liberals on a public option whose rates are set so low that the public option can unfairly compete with private insurers and drive them out of the market.  (The CBO study didn&#039;t think that would happen, but it assumed a reimbursement rate for the public option that was MUCH higher than what liberals are demanding--that it be set by Medicare rates.)

That has been the only major sticking point.

If there were real constraints on the public option so it can NEVER, EVER lead us to single-payer, I would have found ObamaCare a fairly good plan.  Just like I thought RomneyCare had much to recommend it.

The liberals are losing center-rightists like me by their lying and scheming to sneak single-payer past us by stealth.

That point is non-negotiable.  If ObamaCare is designed to lead us to single-payer, those of us in the center-right (as well as those on the right) cannot support it.</description>
		<content:encoded><![CDATA[<p>ottovbvs:  I&#8217;m always in favor of more standardization.  (Where would America be today without time zones and common carriers?)</p>
<p>But on health care, we could have gotten standardization, a mandate on insurers for guaranteed issue, and lots of other good things&#8211;WITHOUT the insistence by liberals on a public option whose rates are set so low that the public option can unfairly compete with private insurers and drive them out of the market.  (The CBO study didn&#8217;t think that would happen, but it assumed a reimbursement rate for the public option that was MUCH higher than what liberals are demanding&#8211;that it be set by Medicare rates.)</p>
<p>That has been the only major sticking point.</p>
<p>If there were real constraints on the public option so it can NEVER, EVER lead us to single-payer, I would have found ObamaCare a fairly good plan.  Just like I thought RomneyCare had much to recommend it.</p>
<p>The liberals are losing center-rightists like me by their lying and scheming to sneak single-payer past us by stealth.</p>
<p>That point is non-negotiable.  If ObamaCare is designed to lead us to single-payer, those of us in the center-right (as well as those on the right) cannot support it.</p>
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		<title>By: ottovbvs</title>
		<link>http://www.frumforum.com/obamacare-more-interest-group-handouts/comment-page-3#comment-58447</link>
		<dc:creator>ottovbvs</dc:creator>
		<pubDate>Thu, 06 Aug 2009 00:18:37 +0000</pubDate>
		<guid isPermaLink="false">http://www.newmajority.com/?p=9267#comment-58447</guid>
		<description>liv&amp;win // Aug 5, 2009 at 7:42 pm 
&quot;Otto: Homogenizing is my term, &quot;

.........So he never said it......the red pill/blue pill metaphor was simply a parable to explain we need quantitive analysis of treatment effectiveness........A good idea I would have thought 

&quot;every human is different. Our body chemistry is different and medical solutions don’t fit work for each and every person the same. In truth, a lot of medicine is trial and error to get the right dose and mixture of drugs and other treatments. Hell, you made the same argument.&quot;

.........Of course but that doesn&#039;t mean there isn&#039;t a place for analysing outcomes when it comes to treatment.......what are the clinical tests of new drugs but quantitive analysis of their effects ......or that our healthcare system which is a vast patchwork quilt of different administrative systems and procedures wouldn&#039;t benefit from the application of some MacDonalds or Wal-Mart systematization......basically you have an ideological viewpoint and you&#039;re desperately scratching around to find reasonably coherent arguments to bolster it</description>
		<content:encoded><![CDATA[<p>liv&amp;win // Aug 5, 2009 at 7:42 pm<br />
&#8220;Otto: Homogenizing is my term, &#8221;</p>
<p>&#8230;&#8230;&#8230;So he never said it&#8230;&#8230;the red pill/blue pill metaphor was simply a parable to explain we need quantitive analysis of treatment effectiveness&#8230;&#8230;..A good idea I would have thought </p>
<p>&#8220;every human is different. Our body chemistry is different and medical solutions don’t fit work for each and every person the same. In truth, a lot of medicine is trial and error to get the right dose and mixture of drugs and other treatments. Hell, you made the same argument.&#8221;</p>
<p>&#8230;&#8230;&#8230;Of course but that doesn&#8217;t mean there isn&#8217;t a place for analysing outcomes when it comes to treatment&#8230;&#8230;.what are the clinical tests of new drugs but quantitive analysis of their effects &#8230;&#8230;or that our healthcare system which is a vast patchwork quilt of different administrative systems and procedures wouldn&#8217;t benefit from the application of some MacDonalds or Wal-Mart systematization&#8230;&#8230;basically you have an ideological viewpoint and you&#8217;re desperately scratching around to find reasonably coherent arguments to bolster it</p>
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		<title>By: liv&win</title>
		<link>http://www.frumforum.com/obamacare-more-interest-group-handouts/comment-page-3#comment-58445</link>
		<dc:creator>liv&win</dc:creator>
		<pubDate>Wed, 05 Aug 2009 23:42:32 +0000</pubDate>
		<guid isPermaLink="false">http://www.newmajority.com/?p=9267#comment-58445</guid>
		<description>Otto:  Homogenizing is my term, Obama referred to it when he offered the red pill blue pill.  He also referred to it when he suggested that all doctors act a certain way (I think it was the tonsil story).

One size fits all, homogenizing, can help with some, minor health care issues, but when it comes to speciality care, every human is different.  Our body chemistry is different and medical solutions don&#039;t fit work for each and every person the same.  In truth, a lot of medicine is trial and error to get the right dose and mixture of drugs and other treatments.  Hell, you made the same argument.</description>
		<content:encoded><![CDATA[<p>Otto:  Homogenizing is my term, Obama referred to it when he offered the red pill blue pill.  He also referred to it when he suggested that all doctors act a certain way (I think it was the tonsil story).</p>
<p>One size fits all, homogenizing, can help with some, minor health care issues, but when it comes to speciality care, every human is different.  Our body chemistry is different and medical solutions don&#8217;t fit work for each and every person the same.  In truth, a lot of medicine is trial and error to get the right dose and mixture of drugs and other treatments.  Hell, you made the same argument.</p>
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		<title>By: ottovbvs</title>
		<link>http://www.frumforum.com/obamacare-more-interest-group-handouts/comment-page-2#comment-58442</link>
		<dc:creator>ottovbvs</dc:creator>
		<pubDate>Wed, 05 Aug 2009 22:14:33 +0000</pubDate>
		<guid isPermaLink="false">http://www.newmajority.com/?p=9267#comment-58442</guid>
		<description>liv&amp;win // Aug 5, 2009 at 5:00 pm

...........And btw even if Obama didn&#039;t say it &quot;homogenizing&quot; the system is part of the key to getting cost out of it!!</description>
		<content:encoded><![CDATA[<p>liv&amp;win // Aug 5, 2009 at 5:00 pm</p>
<p>&#8230;&#8230;&#8230;..And btw even if Obama didn&#8217;t say it &#8220;homogenizing&#8221; the system is part of the key to getting cost out of it!!</p>
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		<title>By: ottovbvs</title>
		<link>http://www.frumforum.com/obamacare-more-interest-group-handouts/comment-page-2#comment-58438</link>
		<dc:creator>ottovbvs</dc:creator>
		<pubDate>Wed, 05 Aug 2009 21:31:39 +0000</pubDate>
		<guid isPermaLink="false">http://www.newmajority.com/?p=9267#comment-58438</guid>
		<description>liv&amp;win // Aug 5, 2009 at 5:00 pm 
&quot;Frum is out to lunch on this one.&quot;

.........Precisely.......and when will I be getting that source for the claims you made about the president&#039;s desire to homogenize the system?</description>
		<content:encoded><![CDATA[<p>liv&amp;win // Aug 5, 2009 at 5:00 pm<br />
&#8220;Frum is out to lunch on this one.&#8221;</p>
<p>&#8230;&#8230;&#8230;Precisely&#8230;&#8230;.and when will I be getting that source for the claims you made about the president&#8217;s desire to homogenize the system?</p>
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		<title>By: liv&win</title>
		<link>http://www.frumforum.com/obamacare-more-interest-group-handouts/comment-page-2#comment-58432</link>
		<dc:creator>liv&win</dc:creator>
		<pubDate>Wed, 05 Aug 2009 21:00:01 +0000</pubDate>
		<guid isPermaLink="false">http://www.newmajority.com/?p=9267#comment-58432</guid>
		<description>otto: ………….And btw if you read Frum’s post he’s criticising him for designing a system that takes care of diverse needs……so which is it

If you read my post, they are codifying something that the free market has already responded to.  Frum is out to lunch on this one.</description>
		<content:encoded><![CDATA[<p>otto: ………….And btw if you read Frum’s post he’s criticising him for designing a system that takes care of diverse needs……so which is it</p>
<p>If you read my post, they are codifying something that the free market has already responded to.  Frum is out to lunch on this one.</p>
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		<title>By: ottovbvs</title>
		<link>http://www.frumforum.com/obamacare-more-interest-group-handouts/comment-page-2#comment-58431</link>
		<dc:creator>ottovbvs</dc:creator>
		<pubDate>Wed, 05 Aug 2009 20:59:15 +0000</pubDate>
		<guid isPermaLink="false">http://www.newmajority.com/?p=9267#comment-58431</guid>
		<description>franco-2 // Aug 5, 2009 at 4:24 pm 
&quot;This is precisely why left-wing governments limp along with no middle class, just elites and a bunch of peasants with no power or wealth, and that is EXACTLY what today’s elected Democrats (not all) want. They want a special health program for themselves and a different one for us peasants. They are not “democrats” at all, they are literally totalitarians who want government (them) to run our lives.&quot;

..........you mean in socialist hell holes like Sweden, Denmark, Britain, France, Germany.........it&#039;s hard to make you up Franco but keep talking...... you&#039;re so enlightening</description>
		<content:encoded><![CDATA[<p>franco-2 // Aug 5, 2009 at 4:24 pm<br />
&#8220;This is precisely why left-wing governments limp along with no middle class, just elites and a bunch of peasants with no power or wealth, and that is EXACTLY what today’s elected Democrats (not all) want. They want a special health program for themselves and a different one for us peasants. They are not “democrats” at all, they are literally totalitarians who want government (them) to run our lives.&#8221;</p>
<p>&#8230;&#8230;&#8230;.you mean in socialist hell holes like Sweden, Denmark, Britain, France, Germany&#8230;&#8230;&#8230;it&#8217;s hard to make you up Franco but keep talking&#8230;&#8230; you&#8217;re so enlightening</p>
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		<title>By: ottovbvs</title>
		<link>http://www.frumforum.com/obamacare-more-interest-group-handouts/comment-page-2#comment-58427</link>
		<dc:creator>ottovbvs</dc:creator>
		<pubDate>Wed, 05 Aug 2009 20:52:45 +0000</pubDate>
		<guid isPermaLink="false">http://www.newmajority.com/?p=9267#comment-58427</guid>
		<description>liv&amp;win // Aug 5, 2009 at 4:43 pm
“This, by the way, is one of my chief complaints about Obama’s health care approach. He seems to think health care is homogenious. He thinks all doctors are the same. He thinks all conditions are similar and he thinks all treatments can be standardized. ”

.............And btw if you read Frum&#039;s post he&#039;s criticising him for designing a system that takes care of diverse needs......so which is it</description>
		<content:encoded><![CDATA[<p>liv&amp;win // Aug 5, 2009 at 4:43 pm<br />
“This, by the way, is one of my chief complaints about Obama’s health care approach. He seems to think health care is homogenious. He thinks all doctors are the same. He thinks all conditions are similar and he thinks all treatments can be standardized. ”</p>
<p>&#8230;&#8230;&#8230;&#8230;.And btw if you read Frum&#8217;s post he&#8217;s criticising him for designing a system that takes care of diverse needs&#8230;&#8230;so which is it</p>
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