Because if you know anything about Christianity you know that Jesus taught about personal responsibility and everybody making his own way in the world. Jesus didn't need no damn socialism; Jesus just healed himself and everybody else.
It's all in the Neoconservative Edition of the Bible.
Sunday, July 19, 2009
Obamacare Is At War With Itself Over Future Costs
Right now, Obamacare is at war with itself. Political efforts to buy off Big Pharma, private insurers, and the AMA are all pushing up long-term costs -- one reason why Douglas Elmendorf, head of the Congressional Budget Office, told Congress late last week that "the cost curve is being raised." But this is setting off alarms among Blue Dog Democrats worried about future deficits -- and their votes are critical.
Big Pharma, for example, is in line to get just what it wants. The Senate health panel’s bill protects biotech companies from generic competition for 12 years after their drugs go to market, which is guaranteed to keep prices sky high. Meanwhile, legislation expected from the Senate Finance committee won't allow cheaper drugs to be imported from Canada and won't give the federal government the right to negotiate Medicare drug prices directly with pharmaceutical companies. Last month Big Pharma agreed to what the White House touted as $80 billion in givebacks to help pay for expanded health insurance, but so far there's been no mechanism to force the industry to keep its promise. No wonder Big Pharma is now running "Harry and Louise" ads -- the same couple who fifteen years ago scared Americans into thinking the Clinton plan would take away their choice of doctor -- now supportive of Obamacare.
Private insurers, for their part, have become convinced they'll make more money with a universal mandate accompanied by generous subsidies for families with earnings up to 400 percent of poverty (in excess of $80,000 of income) than they might stand to lose. Although still strongly opposed to a public option, the insurance industry is lining up behind much of the legislation. The biggest surprise is the AMA, which has also now come out in favor -- but only after being assurred that Medicare reimbursements won't be cut nearly as much as doctors first feared.
But all these industry giveaways are obviously causing the healthcare tab to grow. And as these long-term costs rise, the locus of opposition to universal health care is shifting away from industry and toward Blue Dog and moderate Democrats who are increasingly worried about future deficits. My sources on the Hill tell me there aren't enough votes in the House to get either major bill through, even with a provision that would pay for it with a surcharge on the richest 1 percent of taxpayers. House members don't want to vote for a tax increase before their Senate counterparts commit to one. Yet the Senate continues to be in suspended animation because Max Baucus and his Senate Finance Committee still haven't come up with a credible way of paying for health care. In his testimony last week, Elmendorf favored limiting tax-free employer-provided health benefits, but organized labor remains strongly opposed.
Obama has less than three weeks before August recess. Chances are dimming that he can get some form of universal health care passed in both Houses before the clock runs out. The Democratic National Committee is running ads favoring passage in Blue Dog states and districts, but that won't be enough. Now is the time for the President to begin twisting arms and knocking heads. To control long-term costs, he'll also have to take away some of the goodies that have been promised to the health-industrial complex, and maybe even cross Big Labor. He also needs to come out clearly and forcefully in favor of a way to pay for the whole thing -- ideally, in my view, a surtax on the top.
Ha. Kind of like "socialism" and "fascism" are used, eh? It's amazing how imprecisely this shit gets thrown about.
Yeah. I am almost as much of a crank on this issue as I am at calling U.S. conservatives "right wing." As an one time NR subscriber, I know that Buckley adopted the usage, but he should not have. U.S. conservatives are almost wholly liberals as the word is properly understood: espousing a political philosophy that comes out of the enlightenment. I have always answered most happily to the term "classical liberal."
rcmct - You may be amused but not surprised when I would mention classical liberal, or democratic republicans, there was most often bewilderment at the concept.
rcmct - You may be amused but not surprised when I would mention classical liberal, or democratic republicans, there was most often bewilderment at the concept.
Not surprised. But the was a period, I would say late 70s to mid 80s, when there was a historical revival regarding the ideology of republicanism, and the term "classical republican" was kind of in vogue, and many people whose ideology is somewhere near my own were VERY attracted to the term.
I was doing a graduate paper on the origins of republican thought, and remember feeling like a kid in a candy store at all the relevant books, many fairly recent. I particularly remember being mesmerized by J.G.A. Pocock, one of whose books, the "Machiavellian Moment" is a real classic. But there were many others.
And people started to be interested in all these fairly obscure English republicans, some of whom were executed or imprisoned during the Restoration: guys like Algernon Sidney and James Harrington (though I confess I could not quite get through Harrington's "Oceana." There also was a revival in reading the classical sources that helped shape republican thought, such as Plutarch, particularly his life of Cato the Younger (I am "Catothemuchyounger" on Huffington Post, Cato the Younger being taken).
The American Medical Association has weighed in on the new Obama health care proposals.
The Allergists voted to scratch it, but the Dermatologists advised not to make any rash moves. The Gastroenterologists had sort of a gut feeling about it, but the Neurologists thought the Administration had a lot of nerve.
The Obstetricians felt they were all laboring under a misconception. Ophthalmologists considered the idea shortsighted. Pathologists yelled, "Over my dead body!" while the Pediatricians said, "Oh, Grow up!"
The Psychiatrists thought the whole idea was madness, while the Radiologists could see right through it. Surgeons decided to wash their hands of the whole thing. The Internists thought it was a bitter pill to swallow, and the Plastic Surgeons said, "This puts a whole new face on the matter...."
The Podiatrists thought it was a step forward, but the Urologists were pissed off at the whole idea. The Anesthesiologists thought the whole idea was a gas, and the Cardiologists didn't have the heart to say no.
In the end, the Proctologists won out, leaving the entire decision up to the ass holes in Washington.
__________________ In Fitness & Friendship, MAHLER
______________________________ __________________________ There is no light at the end of the tunnel. You carry the light with you.
Salaries for doctors. I've seen this proposed as a way to bring down unnecessary testing. But I can't see this becoming a requirement of every hospital and clinic (nor a requirement of every doctor) in the country so it will have a limited effect.
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"A government big enough to give you everything you want is a government big enough to take from you everything you have."
Our local hospital group is buying medical practices and setting salaries for the doctors in the practice. The catch for the doctors is that their productivity is used as part of the calculation for their compensation. The organization tells the doctor how long they can spend on an appointment and how many appointments they have to schedule each day.
I hove no doubt they also monitor the types of tests and procedures the doctors order. That's the funny thing because so many people rail about government getting between doctors and patients when private enterprise in the form of insurance companies, hmos and hospital groups have been doing that all along.
The Daily Show was excellent tonight. I'll post video when it's up, but Stewart discussed health care with Bill Kristol (perhaps the only man ever wrong about everything). Kristol's usual talking points blew up in his face when he admitted that the Government run health care for the military is better than what is available for the public.
No real answer then to the follow up as to why some similar system couldn't be put in place for all Americans.
__________________
Working "hard," or the perception of working hard, doesn't really mean anything. Sweating, vomiting, and breathing hard could be a good workout or a tropical disease kicking in.-Dan John
The military health care system, both the one I work within as well as the VA, work exceedingly well.
Do we order unnecessary tests? Oh sure. Doctors are awful about that sort of thing, but generally it's to just makedamnsure that something weird isn't going on. I need to sleep at night. Do we perform unnecessary procedures? I would argue far, far less than civilian counterparts. I don't get paid by the CPT code.
However, flip side: I get paid 25% of what I'd make in the real world. So that, to me, is the suckage side of the coin, and why (ok, only one of hundreds of reasons, but a significant one, nonetheless) there is no way in hell I'd stay for 20--at least not in the armed services component.
As far as rolling this out for all americans--it ain't cheap. There would need to be serious changes in the way we do business... starting with not dispensing tylenol and benadryl, both available over the counter yet still on formulary to the tune of millions/year spent on that alone.
FTR, I really loathe Bill Kristol. Not that it matters, but he is one smarmy SOB.
Here is the link to the extended debate between Kristol and Stewart.
Good stuff.
__________________
Working "hard," or the perception of working hard, doesn't really mean anything. Sweating, vomiting, and breathing hard could be a good workout or a tropical disease kicking in.-Dan John
July 28 (Bloomberg) -- The last time a president tried to overhaul U.S. health care, Americans were spending $912 billion on the system and 40 million were uninsured. Today they’re spending $2.5 trillion and almost 50 million lack coverage.
....
Health-insurance premiums for families have risen 119 percent since 1999, according to the Kaiser Family Foundation, a Menlo Park, California-based policy-research firm. Inflation has risen 28.5 percent over that period, according to the Labor Department.
Premium costs are projected to rise another 9 percent next year, an increase that 42 percent of employers plan to pass on to their workers, according to a report last month by PricewaterhouseCoopers. That’s likely to further squeeze millions of Americans who find themselves in high-deductible insurance plans as wages stagnate because of the recession.
....
“If we don’t fix the spiraling cost of health care, it will have such a destructive impact on our economy that every sector of the economy will deteriorate,” Gerstner said in an interview last month with Bloomberg Television’s “Conversations with Judy Woodruff.”
Health-care spending will account for 20 percent of U.S. gross domestic product in 2018, or $1 in $5 spent, compared with 16 percent of GDP, $1 of $6 spent, in 2008.
Good episode of Fresh Air on NPR today . Terry Gross interviewed economists Paul Krugman (NYT, Nobel Prize, etc) and Stuart Butler (Heritage Foundation) on how America's healthcare system is financed.
The Daily Show was excellent tonight. I'll post video when it's up, but Stewart discussed health care with Bill Kristol (perhaps the only man ever wrong about everything). Kristol's usual talking points blew up in his face when he admitted that the Government run health care for the military is better than what is available for the public.
No real answer then to the follow up as to why some similar system couldn't be put in place for all Americans.
I would disagree that the health care available to the military is better than for civilians. Maybe if you're located near a large, modern military hospital (like what we have in San Diego) but not so much outside the big mil populations. Also, in addition to what Tina said regarding pay, much of the work (at least in Navy/Marines) is done by generally low-paid junior enlisted, many of whom receive relatively little training - you have guys doing work similar to that of a civilian nurse but without the 4-year degree (and pay) required by the civilian sector. Tina, let me know if it's similar in the AF.
Note also that (dependents aside) you have to be fairly young and generally good health to join the military in the first place. Do you really anticipate a national healthcare system to exclude people based on their health status the same way that the military health system does in a de facto manner? It seems that if we are to take the military health system model and expand it, we have to accept gigantic costs associated with it.
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Well I have an uncle and a couple of cousins with significant health problems that get pretty good care at VAs in the rural Midwest. But I'll defer to you guys as you are obviously more familiar with the system.
But I don't think the point is that we should adopt the exact model, as I think the consensus is changes would need to be made.
But back to the care, my Aunt passed away from cancer a couple of years ago, and her treatment and 30 day hospital stay ran something like $700,000. There is no WAY they could have gotten that treatment without subsidized care due to service.
As for me I was just notified by our insurance company that our Chiro/ART practitioner is no longer in network.
Seeing as keeping my back healthy is a necessity for my job...well that means either my cost went up 500% or I have to settle for someone not as good. In other words the private insurers took away my freedom to choose my doctor, just to recite a common industry/right wing talking point.
__________________
Working "hard," or the perception of working hard, doesn't really mean anything. Sweating, vomiting, and breathing hard could be a good workout or a tropical disease kicking in.-Dan John
Seeing as keeping my back healthy is a necessity for my job...well that means either my cost went up 500% or I have to settle for someone not as good. In other words the private insurers took away my freedom to choose my doctor, just to recite a common industry/right wing talking point.
You still have the option of changing to a different insurance provider. How is your freedom limited?
For many health care providers, they get to choose if they are in or out of a certain plans network. I would assume most of the time it is because they want more money than the particular insurance company is willing to pay for their services. The health care provider can still be a part of other insurance plans that will pay them more, and since there are many insurance companies this is an option. If we get one really big insurance provider (the gov't), the health care provider will many times not have the option of getting of off their plan.
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"So many of our dreams at first seem impossible, then they seem improbable, and then, when we summon the will, they soon become inevitable."
- Christopher Reeve
Sure, we can take a plan with a shittier insurance company with higher deductibles, or not accept any employer benefits at all. Terrific choices!
Many if not all of the time it is the insurance corporation that is the problem in regards to denying claims. On can't overstate what a drag that is on practitioners and their patients.
Many docs in my area are no longer accepting any insurance at all because of repeated cases of anal rape by insurance corps. My brother sold his practice because of it.
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Working "hard," or the perception of working hard, doesn't really mean anything. Sweating, vomiting, and breathing hard could be a good workout or a tropical disease kicking in.-Dan John
Sure, we can take a plan with a shittier insurance company with higher deductibles, or not accept any employer benefits at all. Terrific choices!
And this is why insurance needs to be broken away from employers. People should be able to go out and buy health insurance on their own, tailored to their needs. These people should still get the same tax breaks that they would get if they received their insurance through their employer. They should also have access to things like HSAs without any need for their employer to support it.
Quote:
Originally Posted by kuri
Many if not all of the time it is the insurance corporation that is the problem in regards to denying claims. On can't overstate what a drag that is on practitioners and their patients.
It's called trying to control costs. If you think the insurance companies are bad wait until the government comes in. They want to lower premiums to the populace at large and still provide the same coverage (or more if you believe some of the talking points). How will they do this? Lower what they will pay for treatment and deny claims.
You should also do some research about what a drag medicare/medicaid is on practitioners and patients. Things like the 72 hour rule, rules against home nursing, etc... are just as bone headed as the stuff you see coming out of insurance companies.
Quote:
Originally Posted by kuri
Many docs in my area are no longer accepting any insurance at all because of repeated cases of anal rape by insurance corps. My brother sold his practice because of it.
I've seen docs offer lower prices cash prices, but stop accepting any insurance? Who are their patients then? The news keeps telling me that healthcare in prohibitively expensive yet we have enough people who can afford to support cash only doctors?
__________________
"Only those who will risk going too far can possibly find out how far one can go." -- T.S. Eliot
"We are what we repeatedly do. Excellence, therefore, is not an act, but a habit."-- Aristotle
I get a choice of several insurance companies through my employer. However, there are doctors who are not providers for any of the policies. I do have choice, I can skip the better insurance companies and get a self insurance company like Assurant that bagged out of paying millions of dollars of claims because their customers didn't fill out their insurance applications properly.
My good policy limited my physical therapy so I am paying $12,000 out of pocket for physical therapy sessions. My insurance company only paid $2500 for my prosthesis. Sounds like a lot until you realize my temporay leg was around 7k and my permanent leg ended up costing me 12 k.
I'm not really complaining, but I am afraid that people less well off than me would have went under.
I am angry because the House Blue Dog Democrats apparently came to an agreement with the rest of the House Democrats to exempt small businesses from being required to provide health care or pay the penalty.
Where do they think the uninsured work? How do we cover the uninsured then?
I am angry because the House Blue Dog Democrats apparently came to an agreement with the rest of the House Democrats to exempt small businesses from being required to provide health care or pay the penalty. Where do they think the uninsured work? How do we cover the uninsured then?
That's where the left wing talking points kick in, Greg - the "rich" will pay for it.
__________________
"A government big enough to give you everything you want is a government big enough to take from you everything you have."
Do we order unnecessary tests? Oh sure. Doctors are awful about that sort of thing, but generally it's to just makedamnsure that something weird isn't going on. I need to sleep at night. Do we perform unnecessary procedures? I would argue far, far less than civilian counterparts. I don't get paid by the CPT code.
I dunno. I strongly doubt that most doctors are performing lots of unnecessary tests. What I do not doubt, though, is that I would rather trust my doctor to decide what tests are "necessary" than a bunch of government functionaries with a mandate to cut costs.
As to flat fees and per capita fees and the like, I learned when I got out of law school that if no one was going to pay for a great job being done on a matter, a great job was probably not going to get done.
I dunno. I strongly doubt that most doctors are performing lots of unnecessary tests. What I do not doubt, though, is that I would rather trust my doctor to decide what tests are "necessary" than a bunch of government functionaries with a mandate to cut costs.
Rich----I would have to disagree with re: unnecessary tests. As someone who makes his living interpreting various medical imaging tests, there are certain types of tests which are egregiously overused (e.g., MRI of the lumbar spine). As well, if you investigate the topic of "self-referral", you will see that there are plenty of medical professionals who overuse tests resulting in personal financial gain. Cardiologists are particularly notorious in the area of self-referral, but it isn't unique to them.
I don't know of any socialised systems where beaurocrats decide what tests you can or can't get; rather, it is through limiting access to the tests in the first place (e.g, less equipment) where it is hoped that the impetus to performing unnecessary tests is diminished. Both systems are clearly imperfect.
It's called trying to control costs. If you think the insurance companies are bad wait until the government comes in.
And this is based on what experience?
I've had government run health care and it was much better than this broken system. My wife grew up with government run health care in Japan and was shocked at how inefficient, expensive, and corrupt the system here is. And the level of care is AT LEAST as good there, if not better in many ways.
I've posted this before, but in her previous job she worked with a overseas medical group looking to invest in hospitals here, and when execs came over to meet with Kaiser people the foreign group was shocked that at no time ever in discussion was quality of health care mentioned. It was all about financials and the costs of lobbying Sacramento and D.C.. The US hospital and insurance execs were surprised that they actually wanted to talk about quality of patient care.
I don't know what the best solution is for a different US health care system, but it seems plain that some sort of free-market for profit system (as we have now) is fundamentally at odds with the best interests of patients.
__________________
Working "hard," or the perception of working hard, doesn't really mean anything. Sweating, vomiting, and breathing hard could be a good workout or a tropical disease kicking in.-Dan John
I would disagree that the health care available to the military is better than for civilians. Maybe if you're located near a large, modern military hospital (like what we have in San Diego) but not so much outside the big mil populations. Also, in addition to what Tina said regarding pay, much of the work (at least in Navy/Marines) is done by generally low-paid junior enlisted, many of whom receive relatively little training - you have guys doing work similar to that of a civilian nurse but without the 4-year degree (and pay) required by the civilian sector. Tina, let me know if it's similar in the AF.
Note also that (dependents aside) you have to be fairly young and generally good health to join the military in the first place. Do you really anticipate a national healthcare system to exclude people based on their health status the same way that the military health system does in a de facto manner? It seems that if we are to take the military health system model and expand it, we have to accept gigantic costs associated with it.
Yup, Ralph, we have medical technicians too. E5 or less, generally.
Good point on the military health care system enrolling young and healthy--but once these people reach retiree age, they have just as many problems as anyone else, and significantly cost the system beaucoup dinero.
I've had government run health care and it was much better than this broken system. My wife grew up with government run health care in Japan and was shocked at how inefficient, expensive, and corrupt the system here is. And the level of care is AT LEAST as good there, if not better in many ways.
I've posted this before, but in her previous job she worked with a overseas medical group looking to invest in hospitals here, and when execs came over to meet with Kaiser people the foreign group was shocked that at no time ever in discussion was quality of health care mentioned. It was all about financials and the costs of lobbying Sacramento and D.C.. The US hospital and insurance execs were surprised that they actually wanted to talk about quality of patient care.
I don't know what the best solution is for a different US health care system, but it seems plain that some sort of free-market for profit system (as we have now) is fundamentally at odds with the best interests of patients.
Naw man this can't be right. Your actual experience means nothing compared to economics theory and FREEDOM!!!
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Naw man this can't be right. Your actual experience means nothing compared to economics theory and FREEDOM!!!
Quote:
Originally Posted by kuri
And this is based on what experience?
I've had government run health care and it was much better than this broken system. My wife grew up with government run health care in Japan and was shocked at how inefficient, expensive, and corrupt the system here is. And the level of care is AT LEAST as good there, if not better in many ways.
The people I've talked to who lived and/or grew up in Europe have told not to believe th hype about how great their system is. At best they have said they liked the EU types of systems for the simple things like a cold, but if they were really sick (cancer or something serious) the US is the place to be.
IMHO, Japan is hard to use as an example for the west for any sort of social system. Society is so different there that they can do many things that would never work in the west. They still have a high regard for personal honor and responsibility to themselves and the community, something that we lack in the US.
Quote:
Originally Posted by kuri
I've posted this before, but in her previous job she worked with a overseas medical group looking to invest in hospitals here, and when execs came over to meet with Kaiser people the foreign group was shocked that at no time ever in discussion was quality of health care mentioned. It was all about financials and the costs of lobbying Sacramento and D.C.. The US hospital and insurance execs were surprised that they actually wanted to talk about quality of patient care.
I don't know what the best solution is for a different US health care system, but it seems plain that some sort of free-market for profit system (as we have now) is fundamentally at odds with the best interests of patients.
The current system IS broken. I've never argued any other way. My argument is that it makes no sense to throw it out and replace it with a government run system because while the current system is broken it does have a lot of good points.
And, personally I'm against the government getting involved whenever possible because I have worked for the government and I have friends who still work for the government. The amount of waste that I've seen personally is appalling. I went back to the private sector because I couldn't deal with the amount of waste that I saw. I have a friend now whose job is to track how a certain group spends the stimulus money. Guess what the other groups job is? To track how my friends group spends the stimulus money. This is just a white collar version of dig a hole and fill it in and dig it again. Although off topic it reminds me of something I think Japan tried (Keynesian gov. spending) during their 15 year long recession and it didn't seem to help very much.
__________________
"Only those who will risk going too far can possibly find out how far one can go." -- T.S. Eliot
"We are what we repeatedly do. Excellence, therefore, is not an act, but a habit."-- Aristotle
I live in Canada and don't know a lot about the US health care system. But I will say that the fear-mongering by the naysayers is way overblown. In most cases, the wait times are not as bad as reported, and no one up here (except for a very small percentage) want to go to a private system and the ridiculous costs involved with that.
I suffered a partial tear of my Achilles tendon a couple days ago. I was seen by a doctor specializing in sports medicine yesterday, and am scheduled for sugery tomorrow...all at no cost to me.
Yes, we have some government waste, but you are paying to give private industry massive profits and you allow them to pick and choose who they decide to cover. Our system has its flaws, but I'll take it over yours.
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I want to be pushing weights when I'm 70 instead of a walker in an old folk's home.
I don't know what the best solution is for a different US health care system, but it seems plain that some sort of free-market for profit system (as we have now) is fundamentally at odds with the best interests of patients.
Just to clarify, the US does not have a free-market system in health care. That bird has left the nest for quite some time.
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As far as you and your doctor making choices, I have to have injections in my eye of a chemothrapy drug every six weeks until the swelling in my eye goes down. Before I had these injections, my doctor had to tell me that my insurance company probably would not pay for the injections. I can afford the injections myself, but, if I couldn't, the insurance company just made a decision about my care. I currently owe thousands of dollars because my insurance company refused to pay for more than 20 physical therapy sessions in a calendar year. If I couldn't figure out a way to afford that, I would have been teaching myself how to walk and changing my own bandages on a very serious wound and treating my own staph infection. Because I have a little money, it doesn't matter as much how my insurance limits me.
Before you say, you have cheap insurance, I have one of the Cadillac policies likely to be taxed. Those of you who think private insurance is great, don't get in a serious accident or get a serious illness.
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