NM Symposium Part 2 Universal Coverage: Right Goal, Wrong Principle?

107 responses so far

• 1 balconesfault // Aug 22, 2009 at 11:21 am

  Yes.

  a) our population contines to grow, and continues to grow more compact. Sure, we don’t have the filthy lower Manhattan immigrant ghettoes of the first half of the last century, but with urban infill, climbing energy prices, the need to keep some prime farmland from being turned into tract housing complexes, the higher water demands of suburbia versus urban areas …. higher densities are our future. In such environments, infectious diseases have a much faster route to turning into serious health risks to our productivity and well-being. Universal health care will provide a needed front line of defense.

  b) On the same point … when discussing universal care, I’ve had people saying “yeah, but then people will be running to the doctor the first time they have the sniffles” To which I say – exactly. Ideally, a nurse will triage most of the “sniffles”, but if they get into clinics the nurse will also be able to determine who needs to see a doctor immediately. And don’t you want the guy who wraps your burger at McDonalds, or the waitress who brings you your prime rib, to find out immediately if they have a serious infectious disease? How about the kid who sits next to your kid in school?

  c) While global trade agreements limit protectionism and subsidies, our competitors are directly subsidizing their industries by picking up their healthcare tabs.

  d) America is filled with brilliant entrepreneurial people, but people who might be willing to take a risk on lost wages for some period of time to jump out and start a new business … but not willing to take a risk on their ability to provide healthcare for their family. It is very possible, if not likely, that universal coverage would unlock one of the biggest entrepreneurial booms the country has seen. And the nice thing about smaller entrepreneurial businesses is that they tend to develop and hold jobs and skills in America, rather than farming them off overseas the first time there is a narrow profit margin to be made by doing so. (and it doesn’t hurt for megacorp when they no longer have to pay healthcare costs for those jobs in that country they’ve shipped them to).

  e) Small businesses are afraid of taking on workers onto permanent payrolls, because they’re afraid of taking on someone’s health care costs, unless they’re absolutely sure they can ensure those costs long term. For a megacorp dealing in thousand of hirings and firings in a year, this doesn’t play as much a psychological role for the Board of Directors … but for Joe the Real Plumber in Smalltown America who is hiring on people from his community, people he sees in church each day, whose kids go to school with his kids, who are the coaches and Scoutmasters who surround him, it is a major step to add healthcare for an employee. Because you know the consequences, and potential damage to the community around you, if you ever have to take that healthcare away for economic reasons. Government covering healthcare would allow businesses to more readily hire people without the responsibility/fear that if there’s a downturn you’ll not only take away an income, but a family’s healthcare plan.

  f) Do we really want our emergency rooms to be a means of providing Universal coverage?

• 2 sinz54 // Aug 22, 2009 at 12:11 pm

  The GOP cannot hold itself up as a defender of the free market, and continue to enjoy the support of its base, if it endorses universal coverage. The GOP will have to be content with advocating something more modest: “Improved access”; “Help for the truly needy”; etc.

  The GOP base is aware, correctly, that anything that’s truly universal can’t happen without Government action. Without Government action, we wouldn’t have gotten universal mail delivery or universal phone service. There is no credible way to argue that universal health coverage will somehow arise naturally from a free market.

  So for the GOP leadership to endorse universal coverage, implies the GOP will endorse those Government actions necessary to achieve it. Such as a mandate on all Americans to obtain coverage of some kind. And that will alienate the GOP base, which is dead set against any Government actions except those that expand the free market.

  Right now, the GOP’s strongest weapon is their unified opposition to Obamacare’s public option. While the Dems are fighting amongst themselves and self-destructing. Let’s not advocate something that the GOP base strongly opposes, and fragment the GOP as well. The GOP, now a small minority in Congress, can’t afford any intra-party splits.

  A few moderate Repubs, like Snowe and Grassley, can continue to negotiate with the Dems while Steele and the rest of the GOP leadership keeps their distance.

• 3 ottovbvs // Aug 22, 2009 at 12:27 pm

  sinz54 // Aug 22, 2009 at 12:11 pm

  “The GOP base is aware, correctly, that anything that’s truly universal can’t happen without Government action. Without Government action, we wouldn’t have gotten universal mail delivery or universal phone service.”

  …….Or an interstate highway system, or unemployment insurance, or the space program, or clean water, or social security, or the national parks, or emergency disaster relief, or homeland security, or the internet, or, well you get the idea

• 4 Churl // Aug 22, 2009 at 12:41 pm

  To continue Otto’s list:

  American losses in World War I, Prohibition, Harry Anslinger,J. Edgar Hoover, House Unamerican Activities Committee, Tuskeegee Institute Untreated Syphilis Study, Internment of Japanese Americans in World War II, Korean War, Bull Connors, Lester Maddox, Bay of Pigs, Vietnam, War on Drugs, Kelo Decision, emergency disaster relief for Hurricane Katrina, Afghanistan, Iraq War I, Iraq War II, wildly increasing national debt…

  Yes, I get the idea.

• 5 ottovbvs // Aug 22, 2009 at 12:52 pm

  balconesfault // Aug 22, 2009 at 11:21 am

  ……..Basically you said it all about the merits of the case……..in political terms it would do the GOP an enormous favor if they could but see it because it would take off the table one of the Democratic party’s USP’s……..Ironically and maybe my memory is a bit shaky but I seem to remember Nixon’s plan got a fair way along and then was derailed by…….wait for it……Ted Kennedy….He wanted some provisions included or excluded that I can’t really remember and when he couldn’t get what he wanted led the democrats against……maybe it was more nuanced than this so if someone has a better recollection I’d be happy to accept it.

  …….Turning back to the universal issue…..the govt is the only one with the muscle to see this through and of course make the sizeable downstream changes at the provision end that are going to be required to bring our cost structures into line with others…….the bottom line is we’re already spending $2.4 trillion a year when we should be spending no more than $1.4 trillion (so a trillion has to come out of someone’s hide)……..we could be a bit more self indulgent and say $1.7 trillion(that’s 12% of GDP) but even then vast real savings are required

• 6 ottovbvs // Aug 22, 2009 at 12:58 pm

  Churl // Aug 22, 2009 at 12:41 pm

  “Yes, I get the idea.”

  ……….Never short of flawed value judgements and non sequiturs

• 7 ottovbvs // Aug 22, 2009 at 1:01 pm

  Churl // Aug 22, 2009 at 12:41 pm

  ………You also left of they haven’t cured cancer yet or found a way to make us all multi-millionaires…tut tut

• 8 Churl // Aug 22, 2009 at 1:17 pm

  Otto, my point is that government does some things that are good and some things that are not so good and we should examine proposed government proposals with this fact in mind.

• 9 ottovbvs // Aug 22, 2009 at 1:29 pm

  Churl // Aug 22, 2009 at 1:17 pm

  ……..the problem is there isn’t the remotest equivalence in their impact on most people’s lives of say the interstate highway system or indeed any of the items I listed and J. Edgar Hoover, internment of the Japanese or the bay of pigs……..Our participation in WW I was a plus btw…..we emerged from it the worlds richest country and if the Germans had won the allies would have defaulted on all their debts to the US which were vast

• 10 sunroof // Aug 22, 2009 at 1:29 pm

  Balconesfault point “d” is bang on. If you want a true free labor market, you need true portability. If an individual is in a job with health care and retirement benefits tied to his or her employment, that is a disincentive to move on or start a business. It locks in many people who hate the work they are doing but fear losing benefits if they leave. It encourages companies to lay off people prematurely with the onset of a recession in order to save on health care costs – here, the loss of employment might have no reflection on the individual’s abilities or the company’s feature prospects. In another country, a valued employee who might be vital to a project in development might be kept on. In the US, the employee is laid off or fired and the project goes on hold.

  Universal coverage – and pension portability – would unlock huge reserves of productivity.

  There is also a fairness question. If somebody who is, say, 25 and healthy, makes a choice not to have coverage because they can’t see the need, everyone else is paying higher premiums as a result, but come old age, they expect the same Medicare benefits as everyone else.

  Universality is portability. It is fairness.

• 11 oldgal // Aug 22, 2009 at 1:36 pm

  The GOP needs to start coming up with cost-effective solutions instead of constantly spouting ideology. If they can come up with a cost-effective method of providing universal health care, they should by all means do it. If they started putting the best interests of the people of this country before the best interests of the party, they might start growing their base. The same can be said for the democratic party, however, they have the edge here because they are not as ideologically coherent and thus less one-dimensional when it comes to problems solving.

• 12 ottovbvs // Aug 22, 2009 at 1:41 pm

  sunroof // Aug 22, 2009 at 1:29 pm

  ……..Absolutely right…..a universal system would have a huge impact on labor mobility

• 13 sinz54 // Aug 22, 2009 at 3:03 pm

  ottovbs sez: “in political terms it would do the GOP an enormous favor if they could but see it because it would take off the table one of the Democratic party’s USP’s”

  If they did it right now, it would split the GOP base off from their own leadership–because the GOP base won’t accept ANY role for the government in health care. (Most of them even oppose Medicare and Medicaid.)

  Right now, the GOP has but one advantage over the Dems: It’s unified, while the Dems are in disarray with their left wing base fighting with their moderates. The GOP can’t afford to squander that advantage and give the media a new spectacle of a split GOP.

  oldgal sez: “If they can come up with a cost-effective method of providing universal health care, they should by all means do it.”

  Not possible in a free market. Universal anything requires government action.

  And the GOP leadership can’t alienate their base by setting universal coverage as their goal and then admitting that a free market can’t get us there (so government action is required). The GOP base has made it clear that they won’t support ANY Republican who advocates health care reform by more activist government.

  At some point, the GOP base is going to have to jettison the extremist libertarian rhetoric about how every social program is unconstitutional. But that’s going to take time. Now is not the time.

• 14 cmtp // Aug 22, 2009 at 3:53 pm

  The public is worried about reducing cost, not increasing it by extending their responsibilities.

  If the rhetoric of “universal healthcare” were the best way to frame such a drive for free market reform, then it may have some merit — but, the fact that the dogmatic enemies of such reform employ it suggests that the opposite is quite likely the case. The essence of “universal healthcare” is that there is no exit. No exit means much less consumer power.

  The real enemy for conservatives should be bundled healthcare and bulk packaging. Lots of people wouldn’t like it if going to New York for the weekend meant you had to buy into a single package deal (with flights, meals, hotel in midtown, etc… all included as necessities). Obviously, for some people they may be, but for others, getting a bus and crashing on a friend’s couch does the job just fine and saves $100s in the process.

  Young people who compose a lot of the uninsured, who delight in the age of the $10 BoltBus to New York, aren’t crying for a return to the age where you are forced to pay $100 to Amtrak to get there in comfort. It’s hard to see why this would be true for healthcare. Indeed, there’s a reason why young people choose catastrophic-only coverage in the states where it is freest from mandates — they have no reason to pay for what they don’t need.

• 15 liv&win // Aug 22, 2009 at 5:02 pm

  The only real way to reduce costs is to decrease the number of health care treatment interactions and decrease the cost of each treatment episode. Logically…if administration is 20% of health care costs and the rest is the cost of health care, would you rather focus your main efforts on 80% of the problem or 20%. A 50% reduction in administration expenses is equal to 12.5% reduction in actual health care costs. If you are looking at Medicare, there is no way to reduce administration expense. In fact, I would argue that it is too low. Then ALL your savings would need to come from the actual cost of care. If that is true, why not attempt to do that within the current private system? How many more unemployed do you really want in this economy? Devastate the insurance industry, and that is guaranteed to happen. Work within the system toward a common goal, and we can have cost reduction and maintain a bunch of jobs.

• 16 liv&win // Aug 22, 2009 at 5:06 pm

  balc: your point D is very astute. In fact, I wonder, cynically of course, if that is a factor dragging on getting health insurance more progressive…employers have a hostage situation that they won’t be able to deal with…in fact, forcing reforms within the workplace as the result of portability, might have a further positive impact on the economy.

• 17 liv&win // Aug 22, 2009 at 5:09 pm

  Insurance companies are at the table asking government to help them reform their industry. they need government to force uniform underwriting practices. While I appreciate libertarian sentiments, there is a role for government in health care, albeit limited.

• 18 ottovbvs // Aug 22, 2009 at 5:23 pm

  liv&win // Aug 22, 2009 at 5:02 pm

  “The only real way to reduce costs is to decrease the number of health care treatment interactions and decrease the cost of each treatment episode. Logically…if administration is 20% of health care costs and the rest is the cost of health care, would you rather focus your main efforts on 80% of the problem or 20%.”

  ……….We agree entirely for once……having said that the insurance industry take isn’t chump change and they are going to have to take a bit of haircut like everyone else in the process

  ” If you are looking at Medicare, there is no way to reduce administration expense. In fact, I would argue that it is too low.”

  ……..Can I believe my ears on another thread you’re claiming were going to spend $34 trillion on them in the next 75 years

  ” How many more unemployed do you really want in this economy? Devastate the insurance industry, and that is guaranteed to happen.”

  ……..And no one is suggesting “devastating” the insurance industry …….how much do you get paid for posting these illogical fallacies

• 19 liv&win // Aug 22, 2009 at 6:11 pm

  funny otto. you actually made me laugh. Claims, adminstration, underwriting and plan design. these are the basics of health care. Paying the claim, administering the details, underwriting (an extention of acutarial science) to match revenues and expenses and designing a plan that sells…the basics…all interrelated…all critical.

  otto: last time, Medicare has low administrative costs. Is that an apples to apples comparison to the administrative costs of insurance companies? No, not by a long shot. Did I ever say the deficit had ANY THING to do with administration…NO.

  otto.”having said that the insurance industry take isn’t chump change and they are going to have to take a bit of haircut like everyone else in the process” Yes, they will, and the doctor will and the patient will. We all need to ask what can I do, change or sacrafice to get the cost of health care under control.

  ……..And no one is suggesting “devastating” the insurance industry
  that’s not my take. As I said, create a competitive advantage for a government plan, and the private health care industry will have no way to compete, effectively devastating the health insurance industry.

  …….how much do you get paid for posting these illogical fallacies
  sorry, but being illogical is not one of my faults. In fact I am practical and logical to a fault. In other words, I will follow practicality and logic to a place everyone else thinks is impossible. I will say, its practical and logical that X be the case. I will then adjust (change, do or sacrifice) to make that practical logical solution a reality.

  By the way, I think President Obama should pay you for your posts.

• 20 liv&win // Aug 22, 2009 at 6:12 pm

  correction, claims, administration etc are the basics of health INSURANCE (whether public or private)

• 21 LJS // Aug 22, 2009 at 6:18 pm

  A lot of people think there are two choices National Health care or the status quo. That is simply not true there are solutions short of national health care and the tatus quo is a false choice, it can not contiue at the same pace it has.

  National health spending is expected to reach $2.5 trillion in 2009, accounting for 17.6 percent of the gross domestic product (GDP). By 2018, national health care expenditures are expected to reach $4.4 trillion—more than double 2007 spending.

  http://www.nchc.org/facts/cost.shtml

  Something that will reduce cost has to be done.

  I have a small business, last week we got our insurance rates again it is up over 2o%, 23.62 to be more correct. Sadley, over the 20 years in business this is a typical increase.

• 22 ottovbvs // Aug 22, 2009 at 6:30 pm

  liv&win // Aug 22, 2009 at 6:11 pm
  ” Did I ever say the deficit had ANY THING to do with administration…NO.”

  ……..Actually you’ve constantly muddied the water between the two…….as you did on the other thread….it’s OK I now fully understand that it’s Medicare as a concept you hate….along with previous generations who’ve screwed you apparently…..if you’d said that in the first place it would have prevented a lot of wasted ink

  ” And no one is suggesting “devastating” the insurance industry
  that’s not my take.”

  ……..just an opinion from someone who works in the industry

  “sorry, but being illogical is not one of my faults.”

  ………you might want to read some of your posts……the brits call them snow jobs

  ” By the way, I think President Obama should pay you for your posts.”

  ……….I’d say his money was better than the insurance companies money…..at least he’s trying to advance the common good while they’re just protecting their profits

• 23 liv&win // Aug 22, 2009 at 7:26 pm

  LJS, practical and logical, I appreciate your view.

  otto:……..Actually you’ve constantly muddied the water between the two……. Sorry, not true. I don’t confuse administration expenses with claim expenses. I understand exactly what each one is about.

  it’s OK I now fully understand that it’s Medicare as a concept you hate….I don’t hate medicare, otto. I argue that it has been underfunded, postponing necessary reductions in benefits or increases in taxes until the boomer generation hit retirement and was able to leave the heft of the program costs to the next generation.

  ” And no one is suggesting “devastating” the insurance industry
  that’s not my take.” From your posts otto, that is the only possible conclusion. You HATE the insurance industry. Fine, so long as you are honest about your bias.

  ………you might want to read some of your posts……have I had perfect posts? Probably not. Do I stand by them? Well yes, until I change my mind or the practical and logical implications of my views become unreconcilable. You should try some humility and mental dexterity. It is helpful.

  In fact, if you are so brillant, why don’t you argue for a limited government solution to health care reform? I challenge you otto. Try to argue the converse. Come on, show us that intellect.

• 24 ottovbvs // Aug 22, 2009 at 7:39 pm

  liv&win // Aug 22, 2009 at 7:26 pm

  “I don’t hate medicare,”

  ………….Really?……..you could have fooled me judging by this little rant :

  ” F*&K them back, take your country back and make them pay!”

  …….the full text just in case anyone thinks I’m being selective in my quotes

  “liv&win // Aug 22, 2009 at 5:54 pm

  Let me say that again, if you are under 45 years old, you have been screwed by your parent’s generation, probably by your grandparent’s generation and possibly by your great-grandparent’s generation. For you who are much younger, you have been screwed since long before you were born. the previous generations did nothing to provide you with a sustainable system. they ruined the environment, they raided the treasury, they heaped trillions of dollars of debt on your backs. They never thought about what comes next.

  Those that are blindly supportive of a government takeover of health care are also guilty of not considering what comes next. They refuse to address that. That will be your burden and the burden of your children and theirs.

  Do you know why their is such fierce, illogical appeal to government run health care? Because the boomers want to make sure you fund their retirement. The boomers don’t give a shit about you. Their entire existence has been about them. It was always about them. It will always be about them. F*&K them back, take your country back and make them pay!”

• 25 ottovbvs // Aug 22, 2009 at 7:49 pm

  ……………Another tirade from the ultra logical liv&win……unfortunately it escaped his notice that a majority of the payments made into the program using his numbers will ACTUALLY be consumed by those “under” 45 not those over 45 all of whom will statistically at least have proceeded to Valhalla within 35 years

  ” 42 liv&win // Aug 22, 2009 at 6:23 pm

  To those under age 45, who don’t believe me. Look what is in store for you, courtesy of the GAO:

  For example, under our alternative simulation closing the fiscal gap would require spending cuts or tax increases equal to 6.7 percent of the entire economy over the next 75 years, or about $54 trillion in present value terms. To put this in perspective, closing the gap would require an increase in today’s federal tax revenues of more than one-third or an equivalent reduction in today’s federal program spending (i.e., in all spending except for interest on the debt held by the
  public, which cannot be directly controlled) and maintained over the entire period.

  My young american friends, very little of this is your problem. Why should you be burdened by the failings of the prior generations? This report says that for the rest of your life, and most of the life of your children, you will be paying out the ass for those that came before you. this is debt, not a capital building campaign. You are not getting anything in this bargain. All you are doing is paying off someone else’s debit. You will not be saving more, enjoying life more. You will be in virtual servitude to the boomers. You need to wake up NOW.”

• 26 anniemargret // Aug 22, 2009 at 11:01 pm

  Frum asks, “Should Republicans Endorse Universal Health Coverage?”

  Yes. Because it is the right thing to do.

  Or do you Republicans prefer to choose among Americans who shall suffer – and perhaps even die – without healthcare, or who shall not?

• 27 ProfNickD // Aug 22, 2009 at 11:13 pm

  David,

  Please explain how a national halth care system can be Constitutionally justified.

  This is important because American conservatism is defined, if anything, by the principles of Constitutionalism and limited government, along with law and order and a strong national defense, and adherence to traditional values.

  National health care is about as anti-Constitutional as any policy could be: it violates the principle of federalism, destroys liberty of contract, imposes onerous taxation, and intrudes upon the traditional privacy guarantees of a physician-patient relationship.

  No American conservative thinker of any stature at any time has ever advocated a national health care system — because it isn’t conservatism.

  (In fact, it isn’t liberalism — it’s characteristic of Euro-socialism and the Euro-conservatives that meekly go along with it in order to win elections.)

  To be charitable, one could call naitonal health care advocacy by someone on the political Right a vague mish-mash of progressivism, Rockefeller-Republicanism, and populist gibberish.

  Conservatism, it definitely isn’t because it completely undermines the Constitutional adherence that forms the basis of American conservatism.

• 28 Spartacus // Aug 23, 2009 at 12:35 am

  “Should Republicans endorse universal coverage?”

  They can’t because they value unregulated free markets more than they value the provision of quality healthcare to all Americans.

  There simply is no possible way to provide sustainable, universal coverage without increasing government regulation and diverting federal tax dollars to the care of individuals, both of which offend Republican ideology.

  Republicans controlled Congress and the White House for 6 out of the last 8 years. They would have gladly proposed a plan to solve the healthcare problems IF they could have done so without offending their core ideology. It’s simply not possible and NO CONSERVATIVE on this blog or anywhere else has offered any ideas that come close to plausibly solving the problems of expanding coverage, containing costs and obtaining better outcomes for the healthcare services we do consume.

  ForRepublicans, it’s simply a matter of preferring ideology over practical solutions.

• 29 balconesfault // Aug 23, 2009 at 1:24 am

  “Please explain how a national halth care system can be Constitutionally justified.”

  Check United States v. Butler http://supreme.justia.com/us/297/1/index.html

• 30 SFTor1 // Aug 23, 2009 at 2:42 am

  The distillate of this thread is as follows:

  Access to quality health care for all Americans is an economic, strategic, and life quality asset. It has the best outcomes. It carries the lowest cost. These are indisputable facts. Let them sink in. You know it’s true.

  As with many other things (the space program, the military, police and fire, infrastructure, etc.) the government is the only agent with the power, will, and resources to deliver it effectively and consistently.

  Therefore the role of insuring the population’s health belongs in the public sector. End of story.

  Also note that the private sector is a major player in all government programs, and delivers a large percentage of the goods and services needed for these national undertakings.

• 31 sinz54 // Aug 23, 2009 at 9:10 am

  profnickd asks: “Please explain how a national halth care system can be Constitutionally justified.”

  The same way that Medicare is constitutionally justified.

  And if conservatives start arguing that Medicare is unconstitutional too, they will lose the votes of seniors at a time when seniors’ anger at Obama makes those votes reachable.

  Reagan promised to leave Social Security and Medicare untouched. (And, as President, he appointed a commission whose recommendations ensured the solvency of SS for years.)

  Reagan was smart enough to know that telling voters that SS and Medicare were unconstitutional is a political death sentence. Let’s hope today’s conservatives are too.

• 32 sinz54 // Aug 23, 2009 at 9:20 am

  The GOP base is opposed to even banning denial of coverage for pre-existing conditions, or banning recission. To them, even these regulations constitute an unwarranted intervention into the free market; and they maintain that these regulations would drive up costs for healthy policyholders.

  Without this reform, the insurers would no longer have any reason to support universal coverage either. (They see universal coverage as their way to spread the higher costs of insuring pre-existing conditions over a larger base of policyholders’ premiums.) And thus there would be no health care reform at all.

  Which is basically what the GOP base wants. Their alternative for the long-term poor and unemployed–direct government grants–would be a welfare program, with all the stigma of a welfare program. And without the middle and upper classes having any stake in such a program, it would have few defenders.

• 33 sinz54 // Aug 23, 2009 at 9:24 am

  spartacus: The Republicans have offered a brief alternative on their vision of health care.

  http://www.cbsnews.com/blogs/2009/06/17/politics/politicalhotsheet/entry5093897.shtml

  So far, the GOP has refused to submit their proposals to be scored by the Congressional Budget Office. Until and unless they do, I won’t speculate on their effect on costs.

  You will note, however, that they draw a sharp distinction between universal access and universal coverage. In their plan, every American would have access to some form of private insurance. But whether they can afford it, and whether millions of Americans would go without it as they do now, are issues left without discussion.

• 34 ottovbvs // Aug 23, 2009 at 10:10 am

  sinz54 // Aug 23, 2009 at 9:20 am
  “Which is basically what the GOP base wants.”

  ……….And the supreme irony of all this is that the Republican “base” is largely made up of working, lower middle and middle class Americans most of whom are already on govt programs although some don’t seem to know it (Medicare or state sponsored), or is very vulnerable to loss of health insurance or its ever rising cost…….Amongst the “protestors” I didn’t see many Armani suits, Kate Spade handbags, or Calvin Klein and Donna Karan creations…….heck I didn’t see many Brooks Brother bow ties…….One is left with the inescapable conclusion that the Republican base harbors deeply self destructive tendencies as a consequence of their ideological obsessions

• 35 ottovbvs // Aug 23, 2009 at 10:14 am

  sinz54 // Aug 23, 2009 at 9:24 am

  “spartacus: The Republicans have offered a brief alternative on their vision of health care.

  So far, the GOP has refused to submit their proposals to be scored by the Congressional Budget Office. Until and unless they do, I won’t speculate on their effect on costs.”

  …….They have been unofficially scored, to be honest I can’t quote chapter and verse, beyond the fact they didn’t make much sense and were riddled with weaknesses in areas like acceptance of pre-existing conditions……probably why they don’t want the CBO to score them

• 36 LFC // Aug 23, 2009 at 10:34 am

  liv&win said… The only real way to reduce costs is to decrease the number of health care treatment interactions and decrease the cost of each treatment episode. Logically…if administration is 20% of health care costs and the rest is the cost of health care, would you rather focus your main efforts on 80% of the problem or 20%. A 50% reduction in administration expenses is equal to 12.5% reduction in actual health care costs.

  Actually, the figures I’ve read are 30% in administration costs for the best run health insurance companies, and high 40% pushing (but not quite reaching) 50% for the inefficient ones. Being able to reduce healthcare costs by 15%-24% would be significant. If an average family policy is about $12,000 (I think that’s pretty close), we’re talking $1,800-$2,880 annually, which is hardly chump change.

  And those figures are expected to rise faster than inflation … something else that needs to be tackled.

• 37 ottovbvs // Aug 23, 2009 at 10:47 am

  23 liv&win // Aug 22, 2009 at 7:26 pm
  ” In fact, if you are so brillant, why don’t you argue for a limited government solution to health care reform? I challenge you otto. Try to argue the converse. Come on, show us that intellect.”

  …………That would be because I have the intellect to realize a “limited govt” solution to healthcare reform doesn’t exist(which is why the Republicans can’t come up with one)……..given the competing constituencies; the vast sums at stake; the political and ideological differences; the ethical issues involved; and above all the enormous size and complexity of our present patchwork system spread across a nation of 305 million people in 50 states all with different laws and regulations; surely it doesn’t take that much of leap of imagination to realize that the only body with anything like the muscle to sort this out is government……..Would we use a limited govt approach to run our national defense system?…….and this is a much more complex exercise……. The realist rather than the fantasist recognizes this; identifies some broad strategic goals like universality and bringing our cost base in line with others; understands this will probably take 20 years to accomplish; and hands the job over to the experts in govt to get on with it.

• 38 LFC // Aug 23, 2009 at 10:51 am

  Ottobvs, after reading the quotes you posted from liv&win, I’m finding it hard to disagree with much of anything he said. Starting with Reagan, a supposed fiscal conservative, the national debt skyrocketed. He cut taxes and greatly increased spending, and the deficit soared. Under George HW it continued. Clinton started getting a choke-hold on spending immediately, and the growth of the annual deficit finally started slowing. That started even before 1994, so no giving credit to a GOP run Congress who wanted massive tax cuts which, of course, would have increased the deficit. These tax cuts, passed under Bush, actually did throw us back into big deficits.

  Since I started voting in 1980, I see no time when a GOP administration was fiscally conservative, so liv&win is quite right that the people who voted them in are to blame. They simply didn’t care that debt skyrocketed, and that future generations would be left to clean up the mess. The Boomer generation and probably the generation prior to them, particularly under Republican administrations, have become addicted to unfunded spending. They screamed “TAX AND SPEND LIBERALS!!!”, but I’ll take tax and spend over borrow and spend any day. For a concrete example, just look at the Medicare drug plan passed under Bush and a GOP Congress, which they didn’t even PRETEND to try to fund. Or two wars they refused to fund.

  Now I am worried about how to pay for a reformed health care system, but I don’t compare it to an artificial baseline of $0 as the GOP is now doing. Plus, you have to look at the increased burden on business, the increasing difficulty of entrepreneurship due to insurance concerns, and the near certain rise in the uninsured as people/companies are priced out of the market to get a true “cost”, not just a cost in directly spent dollars. Unless you compare the cost of reforms to all the real costs of doing nothing, you are being intellectually dishonest.

• 39 sinz54 // Aug 23, 2009 at 10:53 am

  lfc: In virtually every developed nation, health care costs are rising at a rate faster than that nation’s GDP growth (typically 1-2% higher annualized).

  Studies have shown that the two biggest contributors to this rise (and they’re not mutually exclusive) are: Aging of the population; and the use of the latest, most advanced medical technology as soon as it’s available. One’s final year of life is by far the most expensive medically. Yet almost no one wants to die; so as soon as the latest anti-neoplastic drug or radiation treatment becomes available, desperate patients will demand it.

  And I don’t see how you can tackle either of these problems without some form of societal rationing.

  Nobody wants to talk about that issue–because it’s going to be painful.

• 40 LFC // Aug 23, 2009 at 11:01 am

  And to answer the question “Should Republicans Endorse Universal Health Coverage?”, for the good of the nation the answer is “yes”.

  That being said, politically they are held captive by the rightest of the right-wing. They have become the party of Limbaugh, Beck, and Hannity, thoughtless drones who simply gin up fear and anger to push up ratings. Any attempt to raise up an intellectually reasoned position gets strangled in its crib. So, to the vast majority of America who don’t feel that defeating Democrats is the only thing that’s important in running a nation, they have become useless.

  sinz54 said… At some point, the GOP base is going to have to jettison the extremist libertarian rhetoric about how every social program is unconstitutional. But that’s going to take time. Now is not the time.

  I agree totally. To move away from its extremists, the GOP will need a strong, pragmatic leader. They don’t have one, there isn’t one on the horizon, and it will take years of defeat and powerlessness to allow one to arise.

  The closest potential they have today is Romney, and he’s been frothing at the mouth ever since trying to get the Presidential nomination in 2008. Plus, being a Mormon, he will never really be trusted. If he became President, would he go back to being pragmatic like he was as governor of Mass.? That would be the $64 question for non-partisan voters.

• 41 LFC // Aug 23, 2009 at 11:04 am

  sinz54 said… And I don’t see how you can tackle either of these problems without some form of societal rationing.

  Nobody wants to talk about that issue–because it’s going to be painful.

  Does this mean that many people are more comfortable with the current system of insurance company rationing simply because they don’t have to look the problem straight in the eye and take a stand? After all, it pretty much happens behind closed doors and the average person doesn’t see the people that are impacted. (No snark. I’m serious with this question.)

• 42 ottovbvs // Aug 23, 2009 at 11:07 am

  36 lfc // Aug 23, 2009 at 10:34 am
  ” Actually, the figures I’ve read are 30% in administration costs for the best run health insurance companies, and high 40% pushing (but not quite reaching) 50% for the inefficient ones”

  ………..There’s a lot of debate about this……Generally the insurance companies claim their admin/profit represents about 18% of receipts and there is some evidence to support this view from their published results where they have to show their “loss” ratios(losses are paid claims!)…….of course it’s possible for accountants to fudge these numbers and since the insurance companies notoriously don’t provide much hard data which they claim is proprietary it’s hard to verify exactly what the figure is….some unofficial research suggests it’s much higher which is where you probably get your nunber from……..I have been told by people in the know that it’s 25-30% but who can say……it’s certainly around 18% at minimum in the best run companies like Wellpoint

  ……….Another point which gets glossed over is that only about half of health insurance provided by companies for their employees actually is purchased from insurance companies……the other half is self insurance by the company for their own employees……this is often obscured by the fact that many companies self insure and then hire say Wellpoint to run the program for them so it “appears” the insurance is coming form BCBS when in fact the claims are actually paid by the employer himself…..the breakpoint for self insurance is probably around 7000 plus employees as a rough guide

• 43 LFC // Aug 23, 2009 at 11:20 am

  Another point which gets glossed over is that only about half of health insurance provided by companies for their employees actually is purchased from insurance companies……the other half is self insurance by the company for their own employees

  Interesting. FMI, do you know if these companies then take out something akin to a liability policy from an insurance company to protect against excessive loss, or do they just assume the risk themselves?

• 44 ottovbvs // Aug 23, 2009 at 11:27 am

  lfc // Aug 23, 2009 at 10:51 am

  “Ottobvs, after reading the quotes you posted from liv&win, I’m finding it hard to disagree with much of anything he said.”

  ………….I don’t disagree with his history of how we got here…In the 44 years since Medicare was enacted the Republicans have been in power for 28 years and the Democrats for 16 so if anything the Republicans are even more culpable for a underfunded Medicare than the Democrats………where he’s wrong is in claiming that the over 45’s baby boomers or even the previous “greatest” generation are the source of his misfortunes……Medicare doesn’t technically become insolvent for another few years (2017 I think) so using his 75 year time line(given male/female life expectancy of 77 years) the greatest net beneficiaries of the 34 trillion of deficits he’s ranting about will be Americans who are currently UNDER 45 years of age not over 45……namely himself if he’s between 25 and 45…..Compris?

• 45 ottovbvs // Aug 23, 2009 at 11:35 am

  43 lfc // Aug 23, 2009 at 11:20 am

  ” do you know if these companies then take out something akin to a liability policy from an insurance company to protect against excessive loss, or do they just assume the risk themselves?”

  ………I can’t give you a definitive answer……probably a bit of both……they are very sophisticated financially at GE!……….I ran a group of companies with just over 3000 permanent employees and we took a look at self insurance but decided against it because we had ops in several states……as best I recall it was potentially marginally cheaper but very messy……I think the consensus is you need 7000 plus employees for it to stack up….and they need to be concentrated geographically

• 46 liv&win // Aug 23, 2009 at 11:51 am

  43 lfc // Aug 23, 2009 at 11:20 am

  ” do you know if these companies then take out something akin to a liability policy from an insurance company to protect against excessive loss, or do they just assume the risk themselves?

  there are companies which are fully self-insured. Companies larger than 5000 typically self-insure. Companies from 50 employees to 5000 can partially self insure. The mechanics are this:
  They go to an insurance company, specializing in Stop Loss insurance products, with a suggested plan of benefits. The insurance company analyzes the coverage liability and provides the employer with suggested funding targets. They also price in Stop Loss insurance coverage.

  Stop Loss insurance coverage is of two types: Specific and Aggregate. Specific protects the employer from a single large claim. Aggregate protects the employer from a lot of claims exceeding the funding target.

  the employer utilizes a third party administrator to administer the coverage.

  The benefits of this approach are that the employer has more control over the benefit design than it does with a fully insured plan. It also eliminates (on the self-insured part of the plan) insurance company margin. Margin, if you are paying attention otto, is an element of administrative expenses. Margins can loosely be described as reserves held by the insurance company to protect them and the plan viability. Companies that self insure also take advantage of improvments in cash flow. And finally, administrative costs are typically lower for self funded plans because Third Party Administrators are highly cost effective benefit plan administrators.

  Your question about self funded health insurance is a subset of an insurance market called Re-insurance. At base, it is about spreading risk among many risk bearing companies rather than consolidate all coverage at one company. For example, without re-insurance, hurracane Andrew would have decimated the domestic insurance market. Andrew was reinsured around the world.

• 47 liv&win // Aug 23, 2009 at 12:00 pm

  lfc // Aug 23, 2009 at 10:34 am I have been around this too many times to do it again. The cost to administer fully insured benefit plan, on average, is 15-20%. I know of no company in America which would stand still for an insurance company that charged that much for administration and paid that little in benefits. It just doesn’t happen. Are there crooked insurance companies out there? Yes. Do some plans have low payouts? Yes. AFLAC sells some stuff which I am certain doesn’t pay out more than 60% in benefits. But AFLAC is not a group insurance plan. They sell individual policies to groups of employees. There is a big difference.

• 48 liv&win // Aug 23, 2009 at 12:08 pm

  otto: Generally the insurance companies claim their admin/profit represents about 18% of receipts and there is some evidence to support this view from their published results where they have to show their “loss” ratios(losses are paid claims!)…….of course it’s possible for accountants to fudge these numbers and since the insurance companies notoriously don’t provide much hard data

  Consider me in the “know”. When an insurance plan is up for renewal, the insurance company will have to demonstrate, in exacting detail, where every single dollar was spend. they will show every prescription, every doctor visit, every claim paid in detail. They will also breakout their administrative expenses into their component parts. They then propose, based on their extensive experience, what is needed to fund the plan for the next year. The employer and insurance company negotiate the details, and the plan is renewed. As I said, having this information, which employers do, there is no company in America, which would keep their insurance plan with an administrator who is charging 40%. It just doesn’t happen. But there will be one exception. There always is.

• 49 liv&win // Aug 23, 2009 at 12:26 pm

  otto: Medicare doesn’t technically become insolvent for another few years (2017 I think) so using his 75 year time line(given male/female life expectancy of 77 years) the greatest net beneficiaries of the 34 trillion of deficits he’s ranting about will be Americans who are currently UNDER 45 years of age not over 45……namely himself if he’s between 25 and 45

  Otto: Since you are always looking at this issue from a self-centered boomer perspective, I need to slap up upside the head (slap).

  I don’t give a hoot who $ucked up, rep or dem. As far as I am concerned, every pol who didn’t address this since 1970 (Medicare) is culpable. Otto, you have NO CLUE about long term funding.

  What Congress should have done beginning in 1970:
  To Boomers: We are going to raise your Medicare taxes and segregate that money for the rainy day which is coming in 2011-2017. You need to pay your fair share.
  To the Medicare beneficiaries: We are must limit or restrict your coverage to whatever necessary. You paid into a system which was fluid, not static. There are new, expensive treatments and prescription drugs developing every day. If you want 21st century benefits, you will need to participate in a supplement plan that covers those new treatments.

  My point is that you can’t have permanent programs that span generations unless the previous generation is self supporting and leaves something behind for the next generation. the boomer generation has never been self supporting. They dodged all responsibilities. That is their hallmark.

  The boomers have already left us with Trillions in debt and legal liabilities. It is the worlds greatest scam. Consider that the boomers parents werre amoung the wealthiest generations in the world. All that wealth eventually flowing to the next generation. And what did that generation do? Selfish, self-centered consumerism. ME ME ME. And here we are, boomers begining the biggest migration in the history of the world into the public programs of medicare and social security, and not only are the boomers tragically under-saved, they want their children to pay for them. Hey kids, lookie what dad did to you.

• 50 ottovbvs // Aug 23, 2009 at 12:29 pm

  liv&win // Aug 23, 2009 at 12:08 pm

  “Consider me in the “know”.”

  ………It’s long been apparent to me you were “in the know” despite attempts to avoid the issue…..I don’t have a problem with the claim the minimum is around 18%……didn’t I say so?…..I’ve certainly never claimed it was anywhere near 40%……my in the know sources and to be fair this was a few years back used to say it was somewhat higher than the 18% which has been the figure I’ve heard from insurance companies since Hector was a pup……and since insurance companies have a vested interest in minimizing this number I’m sure some of them do a bit of fudging…..even you admit it……and I am familiar with the procedure for both renewing policies and switching carrier having once had a HR lady working for me who was complete pit bull in this department

• 51 ottovbvs // Aug 23, 2009 at 12:48 pm

  liv&win // Aug 23, 2009 at 12:26 pm

  ” Otto: Since you are always looking at this issue from a self-centered boomer perspective, I need to slap up upside the head (slap)……..Otto, you have NO CLUE about long term funding.”

  ……..Instead of the head slaps why not stick to facts of which I have apparently got a somewhat better grasp than you………Is Medicare currently solvent.? Yes! It’s insolvency theoretically commences in or around 2017 and therefore as I demonstrated the principal beneficiaries of the 75 years of deficits totally $34 trillion will be the under 45’s and not the over 45’s……True or false?……When I cut through all the often juvenile bs that are an unfortunate hallmark of your compositions what we’re left with is that you’re complaining about the existence of the entitlement……fine vote it out in 25 years time……..as for wealth transfers……over the next 25 years we’re going to see the greatest transfer of personal wealth to the next generation ever seen in US history……it’s more concentrated than it should be(however you favor that) but in both absolute and inflation adjusted terms it’s the biggest ever buddy so what are you whining about

• 52 sinz54 // Aug 23, 2009 at 1:07 pm

  Hey David Frum,

  today on New Majority, I see you’ve got nine different positions on universal coverage:

  “Universal Coverage: A Fait Accompli”
  “Universal Coverage: Make it Our Bill”
  “Universal Coverage: Code for a Comprehensive Plan”
  “Universal Coverage: Unaffordable and Unpopular”
  “Universal Coverage: A Personal Ambivalence”
  “Universal Coverage: Endorse the Concept”
  “Universal Coverage: A Policy, Not a Program”
  “Universal Opportunity, Not Universal Coverage”
  “Universal Coverage? Universal Responsibility”

  So some columnists like it, some don’t like it, one isn’t sure and two suggest alternatives.

  Instead of having nine separate and mutually contradictory ideas, each with its own discussion thread, may I suggest getting some of these columnists to actually DEBATE online with EACH OTHER? A transcript of that debate would be more enlightening and stimulating, than having to plow through all these nine columns separately.

• 53 ottovbvs // Aug 23, 2009 at 4:29 pm

  49 liv&win // Aug 23, 2009 at 12:26 pm
  “Consider that the boomers parents werre amoung the wealthiest generations in the world. All that wealth eventually flowing to the next generation. And what did that generation do? Selfish, self-centered consumerism. ME ME ME. And here we are, boomers begining the biggest migration in the history of the world into the public programs of medicare and social security, and not only are the boomers tragically under-saved, they want their children to pay for them. Hey kids, lookie what dad did to you”

  ………..To try and compensate for your misinformation on this topic below is a link to a few charts showing household net worth going back to 1952……as you will see despite the events of the past 18 months when something like 14 trillion has gone up in smoke we are still at about the net worth position of 2004 and obviously we’re going to see something of a recovery that has already started over the next few years……in short your daddy is going to leave you in infinitely better shape than his daddy left him…….sorry to rain on your generational hatefest

  http://online.wsj.com/article/SB123687371369308675.html#project%3Dwealth0903%26articleTabs%3Dinteractive

• 54 RHG // Aug 23, 2009 at 6:10 pm

  Dear Grandma and Grandpa,

  I know you like your Medicare health insurance and you should! This government-run public health care plan is a great bargain for you. On the average, your lifetime tax contributions to Medicare cover about one-third of the dollars that Medicare will spend on you. I will be working after college, and my taxes will help cover the rest.

  But my parents and I are not so lucky. We only can afford to purchase private health care insurance with a large deductable and a lifetime cap on the total amount they will pay. A chronic illness with many visits to the hospital can quickly exhaust this total, leaving us to pay the rest. And, if we have a serious illness or accident and cannot work, the insurance company may decide to drop our coverage, and we may not be able to get any health insurance at all.

  Grandma and Grandpa, my parents and I love you very much and I know you love us too. But what will you do if my parents or I have a life-threatening illness that costs hundreds of thousands of dollars for treatment and we have no health insurance to pay for it?

• 55 joedee1969 // Aug 24, 2009 at 7:23 am

  We have to look down the middle on these things:

  http://americaspeaksink.com/2009/08/democrat-all-that-power-wasted/

• 56 ottovbvs // Aug 24, 2009 at 8:32 am

  rhg // Aug 23, 2009 at 6:10 pm
  ” But my parents and I are not so lucky. ”

  ………Neither you or your parents are going to qualify for Medicare?…..are you illegal aliens?……..I have to assume they are over 45 and therefore fit into liv&win’s hated boomer category who will start to receive Medicare in less than 20 years…….see 44 above

• 57 ottovbvs // Aug 24, 2009 at 8:33 am

  joedee1969 // Aug 24, 2009 at 7:23 am

  “We have to look down the middle on these things:”

  …………..down the middle or up the middle?

• 58 joedee1969 // Aug 24, 2009 at 8:38 am

  Ottovbvs, I just believe Medicare for all can be done and funded proper.I think the right is wrong fightng it and it keeps us from a distance of most people.

• 59 LFC // Aug 24, 2009 at 9:55 am

  There’s been some great info tossed around here. After doing a bit of surfing around, I have some questions on administrative costs as they’re being discussed here, specifically what these costs do and don’t include. Do they include all costs associated with running an insurance company, or only those used for things like policyholder sign-ups and claims processing? Specifically, do they include:

  - Advertising and marketing costs?

  - Commissions to insurance agents? I read that this can be 15% of a premium up front and 10% recurring, a highly significant figure.

  - Profit margin?

  - Underwriting costs? Underwriters make profits too.

  If these (or most of these) aren’t included, perhaps that’s where the 30% figure comes from. The stated 18% above plus a 10% agent’s fee would be pretty near that. If they’re not included, then the 18% figure seems kind of meaningless when trying to compare a privately administered plan to a publicly administered plan, since the public plan would have few of the above costs.

• 60 balconesfault // Aug 24, 2009 at 10:55 am

  ireign – the bills being tossed around specifically exclude illegals.

  And yes, this does leave a gap. But you know what … as Republicans argue, there really is a role for non-profit charities to fill some of the gaps in the healthcare system. And this one looks perfect for them.

  Unfortunately, covering all Americans who can’t afford or obtain insurance is way too big a gap for charities to fill, particularly since most of the people who believe that charities should have the main responsibility of filling that gap send most of their charitable contributions to the Heritage Foundation or the Cato Institute.

• 61 sinz54 // Aug 24, 2009 at 11:04 am

  balconesfault sez: “most of the people who believe that charities should have the main responsibility of filling that gap send most of their charitable contributions to the Heritage Foundation or the Cato Institute.”

  That’s false–and a cheap shot besides.

  Those Religious Right folks you liberals despise so much are heavy contributors to charities run by the Church.

  The problem is that Religious Right Churches aren’t going to help illegals either. But they do help the poor quite a bit.

  In America, religious-led organizations like Catholic Charities do a lot to help the disadvantaged.

• 62 Bulldoglover100 // Aug 24, 2009 at 11:43 am

  Yes. It’s pretty simple when you look at the numbers and realize what ignoring the situation does to our country in 20 years. The cost right now, the way we are handling it, are sky rockering and they will break the back of Government within 20 years. Reform MUST occur and THAT is what should be scaring people…unless of course they listen to FOX NEWS-WHERE THE TRUTH LIES

• 63 Bulldoglover100 // Aug 24, 2009 at 11:48 am

  Oh and by the way? From ALL polls I have seen? Including one out today from one of the demographics of a BlueDog? The majority of Republicans DO endorse reform. It’s the elderly, who are afraid of losing what they have, and the uneducated who just like a good fight.

• 64 Universal Coverage, No; Low Health Costs, Yes // Aug 24, 2009 at 11:57 am

  [...] For other contributions to this symposium, click here. [...]

• 65 Universal Coverage Will Only Lead to a Single Payer System // Aug 24, 2009 at 12:00 pm

  [...] For other contributions to this symposium, click here. [...]

• 66 balconesfault // Aug 24, 2009 at 12:03 pm

  That’s false–and a cheap shot besides.

  I don’t think so, on either count.

  Those Religious Right folks you liberals despise so much are heavy contributors to charities run by the Church.

  The Religious Right folks who contribute heavily to Church charities for the most part are not the strongest to oppose Government involvement. For example, those are the same folks who were calling for MORE Government involvement in funding those Christian charities during the last Administration (remember Faith Based Initiatives?).

  In America, religious-led organizations like Catholic Charities do a lot to help the disadvantaged.

  And I’ll bet dollars to doughnuts that Catholic Charities currently provides more assistance for illegal immigrants than any other charity in America .

• 67 Universal Coverage: A Disgrace It’s Taken So Long // Aug 24, 2009 at 12:05 pm

  [...] For other contributions to this symposium, click here. [...]

• 68 Balloon Juice » Blog Archive » Conservatives on universal health coverage // Aug 24, 2009 at 12:05 pm

  [...] recommend the post “Should Republicans Endorse Universal Health Coverage?” for an interesting sampling of [...]

• 69 Universal Coverage: A Recipe for Deficits Over the Horizon // Aug 24, 2009 at 12:06 pm

  [...] For other contributions to this symposium, click here. [...]

• 70 Universal Care: Not Now, Not Later // Aug 24, 2009 at 12:06 pm

  [...] For other contributions to this symposium, click here. [...]

• 71 Universal Care: Not Now, Not Later // Aug 24, 2009 at 12:06 pm

  [...] For other contributions to this symposium, click here. [...]

• 72 Universal Coverage: A Fait Accompli // Aug 24, 2009 at 12:07 pm

  [...] To read other contributions to this symposium, click here. [...]

• 73 Universal Coverage: Fix Old Problems Before New // Aug 24, 2009 at 12:07 pm

  [...] Pharmacy Benefit Managers and Transparency: Pharmacy benefit managers (PBMs) are middlemen hired by insurance companies to handle their drug benefits. These companies have been the target of many lawsuits because PBMs don’t disclose the rebates and discounts they get from drug companies for pushing certain drugs or pass the savings on to insurers. To read other contributions to this symposium, click here. [...]

• 74 Universal Coverage: Avoid Big Promises on Healthcare // Aug 24, 2009 at 12:11 pm

  [...] To read other contributions to this symposium, click here. [...]

• 75 Universal Coverage: One Man’s Story // Aug 24, 2009 at 12:14 pm

  [...] To read other contributions to this symposium, click here. [...]

• 76 Raider1 // Aug 24, 2009 at 12:40 pm

  Otto are you really equating insuring all Americans in complexity, cost and difficulty with building a road or declaring a piece of land a national park? I’ve heard these arguments before and they are hollow. Of course government has a place. But projects, like building the internet, the interstate highway system or getting a man on teh moon, were just that “projects.” Not on going entitlements.

  And of course many of these projects were of military origin…again which most conservatives believe is the government’s proper role. Well, you get the idea.

• 77 balconesfault // Aug 24, 2009 at 2:51 pm

  So is insuring 30-40 million (some of whom choose not to pay for healthcare) at the rest of other tax payer’s expense and not achieving universal coverage worth it? I don’t think so.

  I listed at the top of this article the reasons why I believe that moving towards universal coverage, via a public option, is a long-term economic winner. I forgot to add the significant number of bankruptcies that happen each year due to medical costs … often to people who were carrying insurance, but whose caps were exceeded via some serious ailment or procedure. Bankruptcies carry a huge economic burden to us all.

  The big gain for most of the proposals floating around are to the drug and insurance companies who get more people under their payroll

  That certainly is a problem I see with any government mandate requiring people to carry insurance, or with any mandate that companies cover people who they had previously pared from their liability pool as too high of a risk. Forcing big insurance to cover these people will just force rate increases for everyone, and mean more money for insurance companies.

  Again, that’s why I favor the public option.

  Unless, we can figure out a way to get better service and/or cheaper costs than it just seems like a another entitlement program that creates far greater costs in the future.

  I don’t think we can realistically get over that hurdle you want to clear without creating a public option. I know, I sound like a broken record, but I think that it is too burdensome and costly to just try to accomplish it through new mandates on the insurance industry.

• 78 Balloon Juice » Blog Archive » Politics By Magic 8-Ball // Aug 24, 2009 at 3:15 pm

  [...] I’m reading that new majority link DougJ provided earlier, and needless to say, I am less than impressed with these pearls of [...]

• 79 sinz54 // Aug 24, 2009 at 4:23 pm

  balconesfault: The Religious Right are neither in favor of, nor opposed to, government social action on principle. They draw a sharp distinction between government actions that are consistent with Christian values (such as de-funding pro-abortion NGOs or teaching creationism in school), versus government actions that are secular. They support the former but not the latter.

• 80 LFC // Aug 24, 2009 at 4:42 pm

  ireign said… So is insuring 30-40 million (some of whom choose not to pay for healthcare) at the rest of other tax payer’s expense…

  Unless the people who “choose not to pay for healthcare” are capable of paying any and all possible medical bills out of pocket (i.e. they are millionaires) or are willing to turn down care they can’t afford, they have actually chosen to place a portion of their risk on all of those paying for insurance. If something major happens, they can (and WILL) show up at an emergency room and they will not be turned away. If they have few assets and low income, but accept $50,000 in treatment, they have forced others to assume the bad outcome of their “gamble”.

  If the people who choose not to be insured can guarantee that they can either pay the bill or else will turn down care, then fine. But we all know that that ain’t never gonna’ happen. These people may SAY they are taking on the risk of not being insured, but unless they are willing to face the actual realities of that risk, it’s bulls***.

• 81 balconesfault // Aug 24, 2009 at 4:55 pm

  Sinz – I do not dispute this. I just assert that those in the Religious Right who are most adamant against secular government social action tend to be those who donate more money to advocacy groups than they do to Christian charity organizations.

  Now, do you include the Catholic Church in the Religious Right or not? Be very careful how you tread here. The United States Conference of Catholic Bishops is adamant about America needing a Universal Healthcare System, with the caveat of course that it should not cover abortions.

• 82 LFC // Aug 24, 2009 at 5:38 pm

  sinz54 said… The Religious Right are neither in favor of, nor opposed to, government social action on principle. They draw a sharp distinction between government actions that are consistent with Christian values (such as de-funding pro-abortion NGOs or teaching creationism in school), versus government actions that are secular. They support the former but not the latter.

  Consistent with Christian values? Do you mean like torture (supported by a majority of white evangelicals)? Or the death penalty (supported by a majority of white evangelicals)? Is preemptive war a Christian value? What happened to turn the other cheek?

  They screamed about Clinton’s infidelity but ignored Gingrich’s. They screamed about Clinton smoking marijuana but ignored Bush being an alcoholic and drug abuser. They listen to the likes of Limbaugh (druggie), Beck (druggie), and O’Reilly (philanderer and sexual harasser). Spitzer? Tear him apart. Vitter? God forgave him. The hypocrisy is astounding.

  I think a number of the religious right’s stances have nothing to do with their religion, unless they’ve created their own brand of Christianity which ignores the teachings of Jesus, and sets up different rules for “us” and “them”.

• 83 ottovbvs // Aug 24, 2009 at 8:42 pm

  raider1 // Aug 24, 2009 at 12:40 pm

  “Otto are you really equating insuring all Americans in complexity, cost and difficulty with building a road or declaring a piece of land a national park?”

  …….You don’t think creating a universal healthcare system and then starting a probably 20 year effort to bring our costs into line with our peer group is more complex than building a road…….my eyes roll

• 84 ottovbvs // Aug 24, 2009 at 8:46 pm

  86 ireign // Aug 24, 2009 at 7:28 pm

  ………Hello irreign’s back…..the “none movement conservative” (according to him) who just happens repeat verbatim standard movement conservative talking points with every post he makes…..how could we possibly have been mistaken

• 85 midcon // Aug 25, 2009 at 7:48 am

  While the health care challenge is difficult there are obvious paths towards meeting those challenges. Some of the better ones have been articulated by Dr. Denis Cortese President and CEO of the Mayo Clinic, who asserts that doctors and hospitals should be paid on the value they provide rather than simply paid a fee for every procedure they do. Those who have better outcomes with less risk and fewer costs to the system should be rewarded.

  More of the common sense proposed strategies can be found at: http://www.mayoclinic.org/healthpolicycenter/ where the principles which lead to the strategies are discussed: Creating Value, Coordinated Care, Payment Reform and Health Insurance for All.

  While no one is above playing politics, the Mayo Clinic is one the better non-partisan sources I use for to seek out balanced thoughts on specific issues.

• 86 sinz54 // Aug 25, 2009 at 9:46 am

  lfc asks: “Consistent with Christian values? Do you mean like torture (supported by a majority of white evangelicals)? Or the death penalty (supported by a majority of white evangelicals)? Is preemptive war a Christian value? What happened to turn the other cheek?”

  Evidently you are unaware of the last five centuries of Christian thinking about the morality of war. Christians have not been pacifists for a very long time. You should learn about the history of the Crusades and the Thirty Years War. “Just War Theory,” as developed by Christian philosophers, lays down specific criteria for deciding if a given war is just and moral. It is not against pre-emptive war per se.

  As for the death penalty, it’s clearly spelled out for numerous offenses in the Bible. Including even adultery and homosexuality!

  Real Christians haven’t been “turning the other cheek” for at least a thousand years.

  You really need to learn about real Christianity before you start shooting from the hip again.

• 87 sinz54 // Aug 25, 2009 at 9:48 am

  balconesfault: The Conference of Catholic Bishops is also equally adamant that no Federal Government programs or funds should fund abortion.

• 88 barker13 // Aug 25, 2009 at 10:53 am

  Hey… fellow regulars… I’d truly appreciate it if you folks would do me a favor.

  Simple Question: Is there ANYTHING new in ANY of these posts?

  In other words, is there any point in reading this thread or can I simple go to any archived thread on healthcare “reform” and get all the same info?

  Thanks! I appreciate any and all help here. (*WINK*)

  BILL

• 89 sinz54 // Aug 25, 2009 at 11:14 am

  barker13: Here’s something new for you:

  The blog, LittleGreenFootballs, has been compiling a list of serious questions about the proposed health care reforms. That means: No “death panels” or rants about socialism. They’re inviting anyone who knows the answers to post those answers too–but with real evidence.

  It’s a good list. Take a look:

  http://sites.google.com/a/gabryelski.com/gabryelski-com/Home/hcr-questions/

• 90 barker13 // Aug 25, 2009 at 11:53 am

  Re: Sinz54 // Aug 25, 2009 at 11:14 am (#93) –

  OK, Sinz – thanks; I’ll take a look at the list. (But again… I hope it’s not stuff we’ve all gone over time after time after time…)

  Anyway, I’ll let you know what I think after I’ve gotten around to checking it out.

  BILL

• 91 barker13 // Aug 25, 2009 at 12:04 pm

  SINZ! Are you frigg’n KIDDING me…?!?!

  This is what you WASTE my frigg’n time on…???

  Almost everything is “unanswered.”

  It’s all about the healthcare bill anyway.

  (*ROLLING MY EYES*)

  Jeezus…

  THAT’S your idea of a good site…?!?!

  (*SHAKING MY HEAD*)

  BILL

• 92 barker13 // Aug 25, 2009 at 12:28 pm

  Here, Sinz, allow me to actually provide a link to something worth reading and considering:

  http://www.ibdeditorials.com/IBDArticles.aspx?id=336004478850567

  Still… OLD NEWS… or at least it should be.

  (*SHRUG*)

  Doctors are not widgets. Government can’t simply wave a magic wand and “create” competent, enthusiastic physicians.

  Again, though… back to New Majority and Frum’s apparent goal being NOT to facilitate debate, but to simply drive up hit counts via multiple threads.

  (*SHRUG*)

  Anyone wanna tell me I’m wrong…???

  BILL

• 93 barker13 // Aug 25, 2009 at 1:04 pm

  As I type this post, the “front page” of NewMajority.com presents EIGHTEEN (18) SEPARATE THREADS concerning the health insurance/health care debate.

  Hit previous and you’ll find an additional 12 on “page two.”

  30 separate threads over just two pages…

  (*SIGH*)

  Folks. Frum is TOYING with you.

  Meanwhile…

  Well… let’s just say I suggest those wh0 haven’t done so today check out the Drudge Report. Check out the Financial Times, the Wall Street Journal, Lew Rockwell, the Washington Post and Washington Times, RealPolitics.com and RealEconomics.com

  Folks. Don’t let Frum distract you from from seeing the trees through the forest.

  Even if your only interest at the moment is the health insurance/health care debate… there are FAR better sites than this one to gain information from.

  This site’s sole purpose is to be a step ladder for Frum to get TV invites and invites to write paid pieces for print media.

  We’re doing the heavy lifting and Frum is raking in the cash.

  (*SHRUG*)

  BILL

• 94 sinz54 // Aug 25, 2009 at 1:19 pm

  barker13: Of course most of the questions in the list are unanswered.

  The list is a tool to force the proponents of health care reform to give real answers to direct, serious questions, like the ones on this list.

  The proponents of health care reform are saying that the Town Hall protesters aren’t interested in a real debate. Well, let’s challenge them on that. Let one of their advocates sit down and try to answer some of these questions.

• 95 balconesfault // Aug 25, 2009 at 2:35 pm

  sinz:
  balconesfault: The Conference of Catholic Bishops is also equally adamant that no Federal Government programs or funds should fund abortion.

  Just out of curiosity, you did read the whole sentence in my post, didn’t you?

  “The United States Conference of Catholic Bishops is adamant about America needing a Universal Healthcare System, with the caveat of course that it should not cover abortions.

  Nonetheless, if you define “Religious Right” to mean “opposed to universal healthcare system”, then you’re excluding the Catholic Church from the Religious Right.

  Staying with the Catholics (I was raised and educated a Catholic) I note that someone claimed that a preemptive war can be a just war.

  The “concept of a ‘preventive war’ does not appear in the Catechism of the Catholic Church,”
  Cardinal Ratzinger, 2002

  Now, I know that preemptive is not preventative – but the distinction often reminds me of hate-crime legislation.

• 96 sinz54 // Aug 25, 2009 at 2:52 pm

  barker13 sez: “30 separate threads over just two pages…”

  Which just illustrates that conservatives are not even close to reaching a consensus even on general goals and general principles for health care reform.

• 97 balconesfault // Aug 25, 2009 at 3:59 pm

  “Which just illustrates that conservatives are not even close to reaching a consensus even on general goals and general principles for health care reform.”

  I liked the earlier suggestion by someone. As much as it’s fun for Sinz and Barker and Otto and lfc and live&win and I and others here to hash this about – it would be useful to have a forum for us all to observe as the various headliners here conduct a rigorous debate. Because right now we have umpteen different threads with umpteen different POVs where the primary ideological consistency isn’t coming from the moderators of this board, but from we the respondents. Kind of discombobulating…

• 98 mycelf // Aug 25, 2009 at 4:52 pm

  Having lived in Canada for the past few years, I’ve had the opportunity to compare both systems. While I haven’t conducted a rigorous study, (nor am I advocating US adoption of a Canadian system) I have observed some benefits of universal coverage.

  - Without per use charges, people tend to treat small things rather than waiting until they are sick enough to justify spending the money on a doctor’s visit. This results in treating more colds (inexpensive) and fewer cases of bronchitis (more expensive) or pneumonia (most expensive). Treating ’small’ illnesses early decreases the opportunity for spread of infection as well as reducing the number of working hours lost to illness.

  - With health care coverage assured, people are not only less likely to stay in jobs that they can’t stand; they are more likely to strike out on their own. In other words, universal coverage frees up innovative entrepreneurial people to create new companies.

  - Again the lack of a per use charge encourages young people to do basic maintenance checks and preventive care which results in a healthier elderly population.

  It seems to me that if the United States truly wants to remain competitive in the next century, universal health care coverage is essential.

• 99 liv&win // Aug 25, 2009 at 6:30 pm

  The most cogent report on US health care and reform I have ever read. By a democrat.
  http://www.theatlantic.com/doc/200909/health-care

• 100 barker13 // Aug 26, 2009 at 8:16 am

  Re: Liv&Win // Aug 25, 2009 at 6:30 pm (#104) –

  Some excerpts:

  “All of the actors in health care—from doctors to insurers to pharmaceutical companies—work in a heavily regulated, massively subsidized industry full of structural distortions.”

  =====

  “…the premise behind today’s incremental approach to health-care reform. Though details of the legislation are still being negotiated, its principles are a reprise of previous reforms—addressing access to health care by expanding government aid to those without adequate insurance, while attempting to control rising costs through centrally administered initiatives. Some of the ideas now on the table may well be sensible in the context of our current system. But fundamentally, the “comprehensive” reform being contemplated merely cements in place the current system—insurance-based, employment-centered, administratively complex. It addresses the underlying causes of our health-care crisis only obliquely, if at all; indeed, by extending the current system to more people, it will likely increase the ultimate cost of true reform.”

  =====

  “To achieve maximum coverage at acceptable cost with acceptable quality, health care will need to become subject to the same forces that have boosted efficiency and value throughout the economy. We will need to reduce, rather than expand, the role of insurance; focus the government’s role exclusively on things that only government can do (protect the poor, cover us against true catastrophe, enforce safety standards, and ensure provider competition); overcome our addiction to Ponzi-scheme financing, hidden subsidies, manipulated prices, and undisclosed results; and rely more on ourselves, the consumers, as the ultimate guarantors of good service, reasonable prices, and sensible trade-offs between health-care spending and spending on all the other good things money can buy.”

  =====

  “In 1966, Medicare and Medicaid made up 1 percent of total government spending; now that figure is 20 percent, and quickly rising.”

  =====

  “As new tests and treatments are developed, they are, for the most part, added to our Medicare or commercial insurance policies, no matter what they cost. But of course the money must come from somewhere.”

  =====

  “The housing bubble offers some important lessons for health-care policy. The claim that something—whether housing or health care—is an undersupplied social good is commonly used to justify government intervention, and policy makers have long striven to make housing more affordable. But by making housing investments eligible for special tax benefits and subsidized borrowing rates, the government has stimulated not only the construction of more houses but also the willingness of people to borrow and spend more on houses than they otherwise would have. The result is now tragically clear. As with housing, directing so much of society’s resources to health care is stimulating the provision of vastly more care. Along the way, it’s also distorting demand, raising prices, and making us all poorer by crowding out other, possibly more beneficial, uses for the resources now air-dropped onto the island of health care. Why do we view health care as disconnected from everything else? Why do we spend so much on it? And why, ultimately, do we get such inconsistent results? Any discussion of the ills within the system must begin with a hard look at the tax-advantaged comprehensive-insurance industry at its center.”

  =====

  “How often have you heard a politician say that millions of Americans “have no health care,” when he or she meant they have no health insurance? How has a method of financing health care become synonymous with care itself? … But health insurance is different from every other type of insurance. Health insurance is the primary payment mechanism not just for expenses that are unexpected and large, but for nearly all health-care expenses. We’ve become so used to health insurance that we don’t realize how absurd that is. We can’t imagine paying for gas with our auto-insurance policy, or for our electric bills with our homeowners insurance, but we all assume that our regular checkups and dental cleanings will be covered at least partially by insurance. Most pregnancies are planned, and deliveries are predictable many months in advance, yet they’re financed the same way we finance fixing a car after a wreck—through an insurance claim.”

  =====

  * These are all points we’ve been making for some time, L&W.

  ** More excerpts to follow.

  BILL

• 101 barker13 // Aug 26, 2009 at 8:54 am

  Re: Liv&Win // Aug 25, 2009 at 6:30 pm (#104) –

  Continuing to excerpt:

  “Modern group health insurance was introduced in 1929, and employer-based insurance began to blossom during World War II, when wage freezes prompted employers to expand other benefits as a way of attracting workers. Still, as late as 1954, only a minority of Americans had health insurance. That’s when Congress passed a law making employer contributions to employee health plans tax-deductible without making the resulting benefits taxable to employees. This seemingly minor tax benefit not only encouraged the spread of catastrophic insurance, but had the accidental effect of making employer-funded health insurance the most affordable option (after taxes) for financing pretty much any type of health care. There was nothing natural or inevitable about the way our system developed: employer-based, comprehensive insurance crowded out alternative methods of paying for health-care expenses only because of a poorly considered tax benefit passed half a century ago.”

  =====

  “In designing Medicare and Medicaid in 1965, the government essentially adopted this comprehensive-insurance model for its own spending, and by the next year had enrolled nearly 12 percent of the population. And it is no coinci­dence that the great inflation in health-care costs began soon after. We all believe we need comprehensive health insurance because the cost of care—even routine care—appears too high to bear on our own. But the use of insurance to fund virtually all care is itself a major cause of health care’s high expense. Insurance is probably the most complex, costly, and distortional method of financing any activity; that’s why it is otherwise used to fund only rare, unexpected, and large costs. Imagine sending your weekly grocery bill to an insurance clerk for review, and having the grocer reimbursed by the insurer to whom you’ve paid your share. An expensive and wasteful absurdity, no? Is this really a big problem for our health-care system? Well, for every two doctors in the U.S., there is now one health-insurance employee—more than 470,000 in total. In 2006, it cost almost $500 per person just to administer health insurance. Much of this enormous cost would simply disappear if we paid routine and predictable health-care expenditures the way we pay for everything else—by ourselves.”

  =====

  “The data are clear: in our current system, physician supply often begets patient demand. … The unfortunate fact is, health-care demand has no natural limit. Our society will always keep creating new treatments to cure previously incurable problems. Some of these will save lives or add productive years to them; many will simply make us more comfortable. That’s all to the good. But the cost of this comfort, and whether it’s really worthwhile, is never calculated—by anyone. For almost all our health-care needs, the current system allows us as consumers to ask providers, “What’s my share?” instead of “How much does this cost?”—a question we ask before buying any other good or service. And the subtle difference between those two questions is costing us all a fortune.”

  =====

  “In 2007, employer-based health insurance cost, on average, more than $12,000 per family, up 78 percent since 2001. I’ve run several companies and company divisions of various sizes over the course of my career, so I can confidently tell you that raises (and even entry-level hiring) are tightly limited by rising health-care costs. You may think your employer is paying for your health care, but in fact your company’s share of the insurance premium comes out of your potential wage increase. Where else could it come from?”

  =====

  “As currently structured, Medicare is a Ponzi scheme. The Medicare tax rate has been raised seven times since its enactment, and almost certainly will need to be raised again in the next decade. The Medicare tax contributions and premiums that today’s beneficiaries have paid into the system don’t come close to fully funding their care, which today’s workers subsidize. The subsidy is getting larger even as it becomes more difficult to maintain: next year there will be 3.7 working people for each Medicare beneficiary; if you’re in your mid-40s today, there will be only 2.4 workers to subsidize your care when you hit retirement age. The experience of other rich nations should also make us skeptical. Whatever their histories, nearly all developed countries are now struggling with rapidly rising health-care costs, including those with single-payer systems. From 2000 to 2005, per capita health-care spending in Canada grew by 33 percent, in France by 37 percent, in the U.K. by 47 percent—all comparable to the 40 percent growth experienced by the U.S. in that period. Cost control by way of bureaucratic price controls has its limits.”

  =====

  * Ahh… none of this is anything you and I and some others don’t know, L&W, but will facts and logic change the minds of the “true believers?” No.

  ** It’s like Obama and the Dems with regard to spending. Bush and the RINOs spent, spent, and spent some more. After the RINOs were out and the Dems came in, Bush and the Dems spent, spent, and spent at an even more furious rate than Bush and the RINOs. And now with Obama, Pelosi, and Reid… spending, deficits, and debt that dwarfs anything Bush and the RINOs ever contemplated.

  *** Just as “Captain” Obama and various Democrats are ordering “full speed ahead” in the WRONG direction on fiscal policy, so it is with health “reform” proposals. Mainly, these folks want to ADD to the existing dysfunction.

  (*SHRUG*)

  BILL

• 102 barker13 // Aug 26, 2009 at 9:09 am

  Re: Liv&Win // Aug 25, 2009 at 6:30 pm (#104) –

  Continuing excerpts from page 4 of 6:

  “…as long as our government shovels ever-greater resources into health care with one hand, while with the other restricting competition that would ensure those resources are used efficiently, sustained high profits will be the rule. Health care is an exceptionally heavily regulated industry. Health-insurance companies are regulated by states, which limits interstate competition. And many of the materials, machines, and even software programs used by health-care facilities must be licensed by state or federal authorities, or approved for use by Medicare; these requirements form large barriers to entry for both new facilities and new vendors that could equip and supply them.”

  =====

  “Take the ongoing battle between large integrated hospitals and specialty clinics (for cardiac surgery, orthopedics, maternity, etc.). The economic threat posed by these facilities is well illustrated by a recent battle in Loma Linda, California. When a group of doctors proposed a 28-bed private specialty facility, the local hospitals protested to the city council that it was unnecessary, and launched a publicity campaign to try to block it; the council backed the facility anyway. So the nonprofit Loma Linda University Medical Center simply bought the new facility for $80 million in 2008. Traditional hospitals got Congress to include an 18-month moratorium on new specialty hospitals in the 2003 Medicare law, and a second six-month ban in 2005. … Many hospitals still exist in their current form largely because they are protected by regulation and favored by government payment policies, which effectively maintain the existing industrial structure, rather than encouraging innovation.”

  =====

  “The net effect of the endless layers of health-care regulation is to stifle competition in the classic economic sense. What we have instead is a noncompetitive system where services and reimbursement are negotiated above consumers’ heads by large private and government institutions. And the primary goal of any large noncompetitive institution is not cost control or product innovation or customer service: it’s maintenance of the status quo.”

  =====

  “Between 1970 and 2006, annual Medicare payments to hospitals grew by roughly 3,800 percent, from $5 billion to $192 billion. Total annual hospital-care costs for all patients grew from $28 billion to almost $650 billion during that same period. Since 1975, hospitals’ enormous revenue growth has occurred despite a 35 percent decline in the number of hospital beds, no meaningful increase in total admissions, and an almost 50 percent decline in the average length of stay. High-tech equipment has been dispersed to medical practices, recovery periods after major procedures have shrunk, and pharmaceutical therapies have grown in importance, yet over the past 40 years, hospitals have managed to retain the same share (roughly one-third) of our nation’s health-care bill. Hospitals have sought to use the laws and regulations originally designed to serve patients to preserve their business model.”

  =====

  “Consider the oft-quoted “statistic” that emergency-room care is the most expensive form of treatment. Has anyone who believes this ever actually been to an emergency room? My sister is an emergency-medicine physician; unlike most other specialists, ER docs usually work on scheduled shifts and are paid fixed salaries that place them in the lower ranks of physician compensation. The doctors and other workers are hardly underemployed: typically, ERs are unbelievably crowded. They have access to the facilities and equipment of the entire hospital, but require very few dedicated resources of their own. They benefit from the group buying power of the entire institution. No expensive art decorates the walls, and the waiting rooms resemble train-station waiting areas. So what exactly makes an ER more expensive than other forms of treatment? Perhaps it’s the accounting. Since charity care, which is often performed in the ER, is one justification for hospitals’ protected place in law and regulation, it’s in hospitals’ interest to shift costs from overhead and other parts of the hospital to the ER, so that the costs of charity care—the public service that hospitals are providing—will appear to be high. Hospitals certainly lose money on their ERs; after all, many of their customers pay nothing. But to argue that ERs are costly compared with other treatment options, hospitals need to claim expenses well beyond the marginal (or incremental) cost of serving ER patients.”

  =====

  “Keeping prices opaque is one way medical institutions seek to avoid competition and thereby keep prices up. And they get away with it in part because so few consumers pay directly for their own care—insurers, Medicare, and Medicaid are basically the whole game. But without transparency on prices—and the related data on measurable outcomes—efforts to give the consumer more control over health care have failed, and always will. Here’s a wonderful example of price opacity. Advocates for the uninsured complain that hospitals charge uninsured patients, on average, 2.5 times the amount charged to insured patients. Hospitals defend themselves by contending that they earn from uninsured patients only 25 percent of the amount they do from insured ones. Both statements appear to be true! How is this possible? Well, hospitals bill according to their price lists, but provide large discounts to major insurers. Individual consumers, of course, don’t benefit from these discounts, so they receive their bills at full list price (typically about 2.5 times the bill to an insured patient). Uninsured patients, however, pay according to how much of the bill the hospital believes they can afford (which, on average, amounts to 25 percent of the amount paid by an insured patient). Nonetheless, whatever discount a hospital gives to an uninsured patient is entirely at its discretion—and is typically negotiated only after the fact. Some uninsured patients have been driven into bankruptcy by hospital collections. American industry may offer no better example of pernicious “price discrimination,” nor one that entails greater financial vulnerability for American families.”

  BILL

• 103 barker13 // Aug 26, 2009 at 9:36 am

  Re: Liv&Win // Aug 25, 2009 at 6:30 pm (#104) –

  Continuing excerpts from page 5 of 6:

  “…there’s been an active, competitive market for LASIK surgery of the same sort we’re used to seeing for most goods and services. The history of LASIK fits well with the pattern of all capital-intensive services outside the health-insurance economy. If you’re one of the first ophthalmologists in your community to perform the procedure, you can charge a high price. But once you’ve acquired the machine, the actual cost of performing a single procedure (the marginal cost) is relatively low. So, as additional ophthalmologists in the neighborhood invest in LASIK equipment, the first provider can meet new competition by cutting price. In a fully competitive marketplace, the procedure’s price will tend toward that low marginal cost, and ophthalmologists looking to buy new machines will exert downward pressure on both equipment and procedure prices.”

  * The author’s point is to contrast LASIK with trying to get your own CT scan or MRI; the contrast is between market forces creating lower prices yet better goods and services via free market competition and transparent pricing as opposed to “paid via insurance” (often at government price scale – always at government price scale for Medicare/caid) procedures.

  =====

  * Ahh… and now we come to the author’s “review” of current Democratic proposals…

  “How would the health-care reform that’s now taking shape solve these core problems? The Obama administration and Congress are still working out the details, but it looks like this generation of “comprehensive” reform will not address the underlying issues, any more than previous efforts did. Instead it will put yet more patches on the walls of an edifice that is fundamentally unsound—and then build that edifice higher.”

  * Take off your partisan hats, folks; keep your eyes on the ball! Let’s not make things WORSE…!!!

  =====

  A central feature of the reform plan is the expansion of comprehensive health insurance to most of the 46 million Americans who now lack private or public insurance. Whether this would be achieved entirely through the extension of private commercial insurance at government-subsidized rates, or through the creation of a “public option,” perhaps modeled on Medicare, is still being debated.
  Regardless, the administration has suggested a cost to taxpayers of $1 trillion to $1.5 trillion over 10 years. That, of course, will mean another $1 trillion or more not spent on other things—environment, education, nutrition, recreation. And if the history of previous attempts to expand the health safety net are any guide, that estimate will prove low.

  * Anyone seriously dispute the author’s guess re: low balling future cost estimates? (*SHRUG*)

  =====

  “The most important single step we can take toward truly reforming our system is to move away from comprehensive health insurance as the single model for financing care.”

  * BINGO…!!!

  =====

  “And a guiding principle of any reform should be to put the consumer, not the insurer or the government, at the center of the system.”

  * YAHTZEE…!!! (*WINK*)

  =====

  “…routine care funded largely out of our incomes; major, predictable expenses (including much end-of-life care) funded by savings and credit; and massive, unpredictable expenses funded by insurance.”

  * GIN…!!!

  =====

  “First, we should replace our current web of employer- and government-based insurance with a single program of catastrophic insurance open to all Americans—indeed, all Americans should be required to buy it—with fixed premiums based solely on age. This program would be best run as a single national pool, without underwriting for specific risk factors, and would ultimately replace Medicare, Medicaid, and private insurance. All Americans would be insured against catastrophic illness, throughout their lives.”

  * Hmm… we’re simpatico on the need for universal PAID catastrophic insurance open to – indeed required by – all Americans. It’s where he proposes delinking the underwriting from specific risk factors (in other words, actuarial reality) where I pause. STILL… at least this is the sort of plan/reasoning that is open to discussion and compromise. Perhaps this guy is right… perhaps there should be no actuarial link; but that’s a subject for reasonable fact-based, logic-based debate.

  =====

  “How would we pay for most of our health care? The same way we pay for everything else—out of our income and savings.”

  (*CLAP-CLAP-CLAP*)

  =====

  “Every American should be required to maintain an HSA, and contribute a minimum percentage of post-tax income, subject to a floor and a cap in total dollar contributions. The income percentage required should rise over a working life, as wages and wealth typically do. All noncatastrophic care should eventually be funded out of HSAs. But account-holders should be allowed to withdraw money for any purpose, without penalty, once the funds exceed a ceiling established for each age, and at death any remaining money should be disbursed through inheritance. Our current methods of health-care funding create a “use it or lose it” imperative. This new approach would ensure that families put aside funds for future expenses, but would not force them to spend the funds only on health care.”

  * Yes! YES…!!!

  BILL

• 104 sinz54 // Aug 26, 2009 at 9:41 am

  barker13 quotes: “But fundamentally, the ‘comprehensive’ reform being contemplated merely cements in place the current system—insurance-based, employment-centered, administratively complex.”

  Obviously. But politically, how could any President change that? Any hero you want, Reagan, Bush 41, JFK, LBJ. How could even one of them have ripped away the state-regulated, income tax exempt, employer-based health insurance system that 75% of Americans currently have, without scaring the heck out of them and causing the entire thing to be rejected?

  In Massachusetts, Mitt Romney didn’t even try. RomneyCare left in place the existing employer-based system. He added to it some things to widen coverage and insure the uninsured.

  What NEITHER the proponents of a more free-market health care system NOR the proponents of single-payer have ever explained, is the ROADMAP by which Americans can be transitioned to the final goal without damaging the health care they currently get IN ANY WAY, without raising their taxes IN ANY WAY, and making the transition sufficiently painless that Americans aren’t marched back and forth through miles of paperwork and bureaucracy to get from here to there.

  And given how complex the current delivery is (private, co-ops, Medicare, Medicaid, state public plans, etc.), and how many tax breaks and indirect subsidies are built into the current system, that’s a tall order.

  Yet without it, a fundamental revision of the American system is impossible.

• 105 barker13 // Aug 26, 2009 at 9:47 am

  Re: Liv&Win // Aug 25, 2009 at 6:30 pm (#104) –

  Finish up… page 6:

  “What about care that falls through the cracks—major expenses (an appendectomy, sports injury, or birth) that might exceed the current balance of someone’s HSA but are not catastrophic? These should be funded the same way we pay for most expensive purchases that confer long-term benefits: with credit. Americans should be able to borrow against their future contributions to their HSA to cover major health needs; the government could lend directly, or provide guidelines for private lending. Catastrophic coverage should apply with no deductible for young people, but as people age and save, they should pay a steadily increasing deductible from their HSA, unless the HSA has been exhausted. As a result, much end-of-life care would be paid through savings.”

  * EXACTLY…!!!

  “For lower-income Americans who can’t fund all of their catastrophic premiums or minimum HSA contributions, the government should fill the gap—in some cases, providing all the funding. You don’t think we spend an absurd amount of money on health care? If we abolished Medicaid, we could spend the same money to make a roughly $3,000 HSA contribution and a $2,000 catastrophic-premium payment for 60 million Americans every year. That’s a $12,000 annual HSA plus catastrophic coverage for a low-income family of four. Do we really believe most of them wouldn’t be better off?”

  * One caveat: The government will need to do proper accounting so that this “dole” doesn’t become the property of the recipient in the sense that your and my unused contributions would be our property. At the death of the recipient unused balances would have to be returned to the Treasury – not willed to survivors as an inheritance.

  =====

  “Some experts worry that requiring people to pay directly for routine care would cause some to put off regular checkups. So here’s a solution: the government could provide vouchers to all Americans for a free checkup every two years. If everyone participated, the annual cost would be about $30 billion—a small fraction of the government’s current spending on care.”

  * Or… better yet… we use the stick! If you don’t get your “required” preventive care (according to a minimum schedule) this will be reflected in higher catastrophic premiums and higher future reimbursements from self-borrowing.

  =====

  “Today, insurance covers almost all health-care expenditures. The few consumers who pay from their pockets are simply an afterthought for most providers. Imagine how things might change if more people were buying their health care the way they buy anything else. I’m certain that all the obfuscation over prices would vanish pretty quickly, and that we’d see an end to unreadable bills. And that physicians, who spend an enormous amount of time on insurance-related paperwork, would have more time for patients.”

  * Yep. That’s what I assume also.

  BILL

• 106 barker13 // Aug 26, 2009 at 10:00 am

  Re: Sinz54 // Aug 26, 2009 at 9:41 am (#109) –

  “But politically, how could any President change that?”

  By speaking the TRUTH, Sinz.

  By using the bully pulpit to EXPOSE the American People to such ideas, concepts, facts, and the logic behind the suppositions.

  Hell… President Obama love to read off his teleprompter, right? Let him read this entire Goddamned piece next Monday night at 9:00 p.m. with the broadcast going over every TV and Radio Station in the nation.

  (Of course I’m being a BIT flippant here… but only a bit; surely you get the CONCEPT I’m latching on to? It’s time for the President to LEAD. It’s time for politics to take a back seat to the good of the country. It’s time our political leaders talk straight to their constituents and instead of obscuring the truth begin to tell the truth! First truth… Bernie Madoff was a piker when it came to building a Ponzi scheme – Uncle Sam is the real master!)

  Sinz. Either work to provide solutions or else get the hell out of the way.

  Here’s your assignment: Call up your congressman’s office and the offices of your two senators and recommend the Goldhill article as something your elected officials should be reading.

  “In Massachusetts, Mitt Romney didn’t even try.”

  Who the f–k CARES…?!?! That’s the past. We’re aware! This is NOW, Sinz. Stick to NOW, Sinz. Stick to now and the future!

  Sinz. Your post is a bummer. You’re a bummer. How the hell are we EVER going to get anything done with people like you…

  (*SIGH*)

  BILL

• 107 liv&win // Aug 26, 2009 at 10:44 am

  Bill –

You must log in to post a comment.