Dog Brothers Public Forum
Return To Homepage
Welcome, Guest. Please login or register.
December 28, 2014, 02:05:21 AM

Login with username, password and session length
Search:     Advanced search
Welcome to the Dog Brothers Public Forum.
83816 Posts in 2261 Topics by 1067 Members
Latest Member: Shinobi Dog
* Home Help Search Login Register
+  Dog Brothers Public Forum
|-+  Politics, Religion, Science, Culture and Humanities
| |-+  Politics & Religion
| | |-+  The Politics of Health Care
« previous next »
Pages: 1 ... 10 11 [12] 13 14 ... 28 Print
Author Topic: The Politics of Health Care  (Read 197411 times)
Crafty_Dog
Administrator
Power User
*****
Posts: 31884


WSJ
« Reply #550 on: March 05, 2010, 02:52:27 PM »

Very good to see reconciliation broken down like that  cool

======================

'Every argument has been made. Everything that there is to say about health care has been said, and just about everybody has said it," President Obama declared yesterday as he urged Democrats to steamroll his plan through Congress. What hasn't been heard, however, is even a shred of White House honesty about the true costs of ObamaCare, or its fiscal consequences.

Nearby, we reprint Wisconsin Republican Paul Ryan's remarks at the health summit last week, which methodically dismantle the falsehoods—there is no other way of putting it—that Mr. Obama has used to sell "reform" and repeated again yesterday. No one in the political class has even tried to refute Mr. Ryan's arguments, though he made them directly to the President and his allies, no doubt because they are irrefutable. If Democrats are willing to ignore overwhelming public opposition to ObamaCare and pass it anyway, then what's a trifling dispute over a couple of trillion dollars?

At his press conference yesterday, Mr. Obama claimed that "my proposal would bring down the cost of health care for millions—families, businesses and the federal government." He said it is "fully paid for" and "brings down our deficit by up to $1 trillion over the next two decades." Never before has a vast new entitlement been sold on the basis of fiscal responsibility, and one reason ObamaCare is so unpopular is that Americans understand the contradiction between untold new government subsidies and claims of spending restraint. They know a Big Con when they hear one.

Mr. Obama's fiscal assertions are possible only because of the fraudulent accounting and budget gimmicks that Democrats spent months calibrating. Readers can find the gory details in Mr. Ryan's pre-emptive rebuttal nearby, though one of the most egregious deceptions is that the bill counts 10 years of taxes but only six years of spending.

The real cost over a decade is about $2.3 trillion on paper, Mr. Ryan estimates, and even that is a lowball estimate considering how many people will flood to "free" health care and how many businesses will be induced to drop coverage. Mr. Obama claimed yesterday that the plan will cost "about $100 billion per year," but in fact the costs ramp up each year the program exists. The far more likely deficits are $460 billion over the first 10 years, and $1.4 trillion over the next 10.
What Mr. Ryan calls "probably the most cynical gimmick" deserves special attention, which is known in Washington as the "doc fix." Next month Medicare physician payments are scheduled to be cut by 22% and deeper thereafter, though Congress is sure to postpone the reductions as it always does. Failing to account for this inevitability takes nearly a quarter-trillion dollars off the ObamaCare books and by itself wipes out the "savings" that the White House continues to take credit for.

Some in the liberal cheering section now claim that this Medicare ruse isn't Mr. Obama's problem because it was first promised by Republicans and Bill Clinton in 1997. But then why did Democrats include the "doc fix" in all early versions of the bill to buy the support of the American Medical Association, only to dump this pricey item later when hiding it would make it easier to fake-reduce the deficit?

The President was (miraculously) struck dumb by Mr. Ryan's critique, and in his response drifted off into an irrelevant tangent about Medicare Advantage, while California Democrat Xavier Becerra claimed "you essentially said you can't trust the Congressional Budget Office." But Mr. Ryan was careful to note that he didn't doubt the professionalism of CBO, only the truthfulness of the Democratic gimmicks that the budget gnomes are asked to score.

Yesterday Mr. Obama again invoked the "nonpartisan, independent" authority of CBO, which misses the reality that if you feed the agency phony premises, you are going to get phony results at the other end.

The President also claimed the reason his plan is in trouble, and the reason Democrats must abuse the Senate's rules to ram this plan into law, is that "many Republicans in Congress just have a fundamental disagreement over whether we should have more or less oversight of insurance companies." So most of Mr. Obama's first year in office has been paralyzed over nothing more than minor regulatory hair-splitting. This is so preposterous that the President can't possibly believe it.

Congress's spring break begins on March 29, and Democratic leaders plan on jamming this monster through Congress before then. Americans have to hope that enough rank-and-file Democrats aren't as deaf to fiscal honesty as this President.
Logged
Rarick
Guest
« Reply #551 on: March 06, 2010, 05:10:41 AM »

I remember sick call in the service.  I eneded up waiting in line with Wives and Kids who need a splinter removed, but I was running a fever of 104 when I finally got to the "vitals" they immediately jumped me into a room.  I was complaining of Itching and these new bumps........  End story I ended up being "Patient 0" for an outbreak of Chicken Pox.

Think about it....................

DMV, Soc. Sec ofice, unemployment, everywhere in government you line up before getting anything.  They do not care about a whole bunch of practical details.

The single sick call was broken down into a "More Distributed system for better service" so that the problem I accidentally discovered did not happen again. 

The other aspect of this, is the "splinter removal" crowd.  Free means there is no cost/benefit analysis on the part of the person who has the Boo-Boo (this isn't bad and it costs too much to see a doctor I will see if it clears up in a couple days)  Vs. the Broken and need fixed (whoa that hurt, my arm looks weird, time to go to the doctor).    Both these people end up waiting in a "Triage line" which has a majority of splinters, which means the real issues are delayed-maybe for too long........

I have had experince with Health Care done Government style, Like I said earlier..........
Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31884


« Reply #552 on: March 06, 2010, 05:27:44 AM »

While teaching at Fort Polk I received a nasty cut on my finger tip that needed four stitches.  I went to the hospital on base.  Things were not busy at all, but it took six hours to get it taken care of.
Logged
ccp
Power User
***
Posts: 4214


« Reply #553 on: March 07, 2010, 02:20:08 PM »

Romney interview by Chris Wallace this AM.  In general, I like his message about promoting the greatness of America not talking it down like the present guy at the top. 

With regard to the topic of health care,

His responses to the charge that the health plan he signed in Mass makes him the wrong guy to be a spokesperson for the Repubs on the issue were totally unconvincing.  He danced around the charge that Mass health premiums are 27% higher than anywhere else in the nation.  He claimed that the cahrge there is a multimillion dollar cost *overshoot* in the allowed annual budget for health care was wrong and it was the opposite.

He keeps saying that 98% of the people in Mass are insured and he brings up again the person with brain cancer who, if resided in another state would have died for lack of insurance.  Here in NJ there are poeple without insurance who undoubtedly cannot get decent routine care for chronic conditions but I know of no person with cancer that cannot somehow get coverage, charity care, medicaid, or help from the community, churches, Jewish charity organizations, etc.

He also claims that there is no free lunch.  Everyone pays into the system.  Yet he failed to explain that or go into any detail.

In conclusion - I agree with critics on the health care debate - he is absolutely the wrong guy to be a spokesperson for it on a national level.

Logged
Rarick
Guest
« Reply #554 on: March 07, 2010, 09:14:21 PM »

which puts Romney with a second strike (religion+health care) as far as a replacement for Obama. 
Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31884


« Reply #555 on: March 07, 2010, 11:16:20 PM »

That he was born into a patrician family doesn' t help either.
Logged
Body-by-Guinness
Power User
***
Posts: 2792


« Reply #556 on: March 08, 2010, 12:02:10 PM »

Health Care Is Heavily Taxed Now

By John Donaldson, MD
Congressional plans for financing the proposed health care legislation include provisions to tax health insurance of non-union citizens and medical devices vital to the delivery of medicines. We never hear that health care is already heavily taxed, but that these taxes are hidden from the consumer and have the greatest impact on the sick.

What we do hear is that costs are skyrocketing and insurance companies are gouging the public, in spite of actual data that indicate the profit for health insurance companies has lingered under 3.5% year after year. It should be obvious that those profits are not the source of significant increases in cost. Insurance companies rank 88th in profitability and hospitals 77th in U.S. corporate profitability.

Annually, we do the "Medicare Dance," whereby Congress waits until the last minute to overturn its mandate that payment to physicians and other providers will remain within a constant dollar amount. The fact that the nation has needs for increasing services to an aging and expanding population of seniors matters not. This year, a reduction of 21% has just been delayed until April Fool's Day after Senator Bunning's courageous and appropriate blocking of a temporary measure. Essentially, the government plays the doctors for suckers each year, satisfying them with no increases in payment in the face of cost increases to practice. This actually represents a decrease in payment. This year, the doctors were suckered even more: The last date to opt out of Medicare is March 17th.

I contend that almost the entire increase in the cost of care is related to hidden "taxes" -- costs imposed by government -- and not "waste, fraud, and abuse" as the politicians say in their glib lectures. Here are just a few of them:

Medicare, Medicaid Underfunding "Tax"

Each year, the government "adjusts" reimbursement to providers, including hospitals, doctors, home health, and a long list of individuals contracted for service. Hospitals are required to accept fixed payment based on diagnosis, irrespective of the acuity of the patient's illness. Currently, hospitals lose between 15% and 20% of the actual cost of providing care, justified in part by a declaration that a penalty is imposed on the assumption that they are gaming the system.

The providers are then required to recover their costs by essentially adding an additional surcharge to the rates charged other payers -- that is, the insured and the uninsured who pay their own medical bills. Managed care companies will negotiate bulk contracts that limit the amount a provider can charge them. Usually, for the provider, this is enough to cover cost plus an amount needed to cover the cost shift. As this pool shrinks, so too does the financial well-being of the provider. They must limit capital investment and eventually restrict service. Essentially, we have a crisis at this time because of government underfunding. If the federal government were to pay their bills for services received by their enrollees, some markets such as Florida would experience as much as a 30% drop in cost of care to the payers using insurance or paying cash.

Lawyer Full Employment "Tax"

This tax is seen every day of the week, but the notion that it is confined to medical malpractice is entirely fallacious. Every aspect of the provision of service has a hidden tax to cover the cost of the legal and victim industries. Product liability on medical devices, drugs, vaccines, and supplies adds substantially to the cost of care. Every aspect of health care is penalized at the courthouse. The Congressional Budget Office estimates that $54 billion can be saved over ten years with reform of medical malpractice alone.

The most annoying part of this is that it is such an easy fix that really costs us almost nothing. If we had "loser pays with guarantee," whereby the loser is responsible for the winner's costs, and if the loser is unable to pay, the liability shifts to the lawyer, the frivolous suits would dry up overnight. This does not restrict access to the legitimate victim, but certainly will remove the "roll the dice" filings.

Regulatory "Tax"

Every level of government gets involved in regulation of health care. It has become a collection of industries that all purport to contribute to the collective well-being. Frankly, much of it is no better than picking a provider from the Yellow Pages or from a sign on a bus. Government requires accreditation and until recently, JCAHO was the established religion. To keep Medicare funding, institutional providers were required by CMS to hold accreditation by this body. Huge sums of money were spent to meet ever-changing requirements, many of which were no more logical than the requirement to have Braille on drive-through ATMs.

EMTALA is another perfect example. Many states require a hospital to have an emergency room, and in order to retain federal and state funding, the hospital must provide access to virtually anyone who walks through the door -- legals, illegals, payers, and non-payers. Many use this as their primary care and have no intention of paying even if they can afford it. All of these costs get shifted to the payers as a hidden tax.

Special Interest Insurance "Tax"

It is almost impossible to buy health insurance without paying for the baggage programs inserted by politicians onto health insurance in each state. Many of these programs and providers are of marginal medical benefit at best and have only a very small constituency, which would be minute or entirely absent without the mandate of inclusion imposed on insurance companies. Why would everyone have to buy coverage for hair replacement or in vitro fertilization just to satisfy the senator whose wife practices it? Some states have over thirty insurance mandates.

Again, this is an easy fix costing nothing. The federal government outlines the requirements for a number of basic national plans and accredits companies to provide them. Providers will be required to deal with the plans in order to manage Medicare/Medicaid patients, effectively cutting out the state's special interest mandates, which can still be sold if anyone is foolish enough to buy them.

Implosion

If $500 billion is to be removed from the system from the providers of Medicare and Medicaid, then a deliberately engineered financial implosion for hospitals and physicians will take less than two years, thereby generating another "crisis" which will be managed again by the people that brought us this first crisis.

The next step will be complete absorption of the providers into global budgeting, mandated participation, and salaried positions. With this will come rationing and waiting lists. Even Obama cannot break the symbolic medical bread and wine to save the health care system on his current course.

With no more greedy insurance companies, mandated provision of care, and state-budgeted hospitals with salaried providers, whom are we to blame then?

Dr. Donaldson is a Pediatric Otolaryngologist in Fort Myers, Florida. He is the immediate past Chairman of the Board of Directors of Lee Memorial Health System, the seventh-largest public system in the USA.

Page Printed from: http://www.americanthinker.com/2010/03/healthcare_is_heavily_taxed_no.html at March 08, 2010 - 12:01:25 PM CST
Logged
ccp
Power User
***
Posts: 4214


« Reply #557 on: March 08, 2010, 02:15:47 PM »

"Dr. Donaldson is a Pediatric Otolaryngologist in Fort Myers, Florida. He is the immediate past Chairman of the Board of Directors of Lee Memorial Health System"

Interesting.  I may have met this guy.  Years back I interviewed for a position with the Lee Mem. system in Ft. Myers.
I can't recall for sure the name but I remember some administrator there who interviewed me and he was a pediatrician.  If you like hot weather and to fish, the Ft. Myers area is nice.

"The next step will be complete absorption of the providers into global budgeting, mandated participation, and salaried positions. With this will come rationing and waiting lists. Even Obama cannot break the symbolic medical bread and wine to save the health care system on his current course."

Well yes, THIS IS the goal of the academic elites with the Phoney One leading the charge.  The present bill is just the next of many steps towards that end.



Logged
Body-by-Guinness
Power User
***
Posts: 2792


« Reply #558 on: March 12, 2010, 10:34:07 AM »

If Democrats ignore health-care polls, midterms will be costly
By Patrick H. Caddell and Douglas E. Schoen
Friday, March 12, 2010; A17

In "The March of Folly," Barbara Tuchman asked, "Why do holders of high office so often act contrary to the way reason points and enlightened self-interest suggests?" Her assessment of self-deception -- "acting according to wish while not allowing oneself to be deflected by the facts" -- captures the conditions that are gripping President Obama and the Democratic Party leadership as they renew their efforts to enact health-care reform.

Their blind persistence in the face of reality threatens to turn this political march of folly into an electoral rout in November. In the wake of the stinging loss in Massachusetts, there was a moment when the president and the Democratic leadership seemed to realize the reality of the health-care situation. Yet like some seductive siren of Greek mythology, the lure of health-care reform has arisen again.

As pollsters to the past two Democratic presidents, Jimmy Carter and Bill Clinton, respectively, we feel compelled to challenge the myths that seem to be prevailing in the political discourse and to once again urge a change in course before it is too late. At stake is the kind of mainstream, common-sense Democratic Party that we believe is crucial to the success of the American enterprise.

Bluntly put, this is the political reality:

First, the battle for public opinion has been lost. Comprehensive health care has been lost. If it fails, as appears possible, Democrats will face the brunt of the electorate's reaction. If it passes, however, Democrats will face a far greater calamitous reaction at the polls. Wishing, praying or pretending will not change these outcomes.

Nothing has been more disconcerting than to watch Democratic politicians and their media supporters deceive themselves into believing that the public favors the Democrats' current health-care plan. Yes, most Americans believe, as we do, that real health-care reform is needed. And yes, certain proposals in the plan are supported by the public.

However, a solid majority of Americans opposes the massive health-reform plan. Four-fifths of those who oppose the plan strongly oppose it, according to Rasmussen polling this week, while only half of those who support the plan do so strongly. Many more Americans believe the legislation will worsen their health care, cost them more personally and add significantly to the national deficit. Never in our experience as pollsters can we recall such self-deluding misconstruction of survey data.

The White House document released Thursday arguing that reform is becoming more popular is in large part fighting the last war. This isn't 1994; it's 2010. And the bottom line is that the American public is overwhelmingly against this bill in its totality even if they like some of its parts.

The notion that once enactment is forced, the public will suddenly embrace health-care reform could not be further from the truth -- and is likely to become a rallying cry for disaffected Republicans, independents and, yes, Democrats.

Second, the country is moving away from big government, with distrust growing more generally toward the role of government in our lives. Scott Rasmussen asked last month whose decisions people feared more in health care: that of the federal government or of insurance companies. By 51 percent to 39 percent, respondents feared the decisions of federal government more. This is astounding given the generally negative perception of insurance companies.

CNN found last month that 56 percent of Americans believe that the government has become so powerful it constitutes an immediate threat to the freedom and rights of citizens. When only 21 percent of Americans say that Washington operates with the consent of the governed, as was also reported last month, we face an alarming crisis.

Health care is no longer a debate about the merits of specific initiatives. Since the spectacle of Christmas dealmaking to ensure passage of the Senate bill, the issue, in voters' minds, has become less about health care than about the government and a political majority that will neither hear nor heed the will of the people.

Voters are hardly enthralled with the GOP, but the Democrats are pursuing policies that are out of step with the way ordinary Americans think and feel about politics and government. Barring some change of approach, they will be punished severely at the polls.

Now, we vigorously opposed Republican efforts in the Bush administration to employ the "nuclear option" in judicial confirmations. We are similarly concerned by Democrats' efforts to manipulate passage of a health-care bill. Doing so in the face of constant majority opposition invites a backlash against the party at every level -- and at a time when it already faces the prospect of losing 30 or more House seats and eight or more Senate seats.

For Democrats to begin turning around their political fortunes there has to be a frank acknowledgement that the comprehensive health-care initiative is a failure, regardless of whether it passes. There are enough Republican and Democratic proposals -- such as purchasing insurance across state lines, malpractice reform, incrementally increasing coverage, initiatives to hold down costs, covering preexisting conditions and ensuring portability -- that can win bipartisan support. It is not a question of starting over but of taking the best of both parties and presenting that as representative of what we need to do to achieve meaningful reform. Such a proposal could even become a template for the central agenda items for the American people: jobs and economic development.

Unless the Democrats fundamentally change their approach, they will produce not just a march of folly but also run the risk of unmitigated disaster in November.

Patrick H. Caddell is a political commentator and former pollster. Douglas E. Schoen, a pollster, is the author of "The Political Fix."

http://www.washingtonpost.com/wp-dyn/content/article/2010/03/11/AR2010031102904.html?hpid=opinionsbox1
Logged
Boyo
Frequent Poster
**
Posts: 74


« Reply #559 on: March 13, 2010, 08:17:23 AM »

Good summary of right vs service/commodity by Walter E. Williams.

A MINORITY VIEW

BY WALTER WILLIAMS

RELEASE: WEDNESDAY, MARCH 10, 2010

 

Is Health Care a Right?

 

            Most politicians, and probably most Americans, see health care as a right. Thus, whether a person has the means to pay for medical services or not, he is nonetheless entitled to them. Let's ask ourselves a few questions about this vision.

            Say a person, let's call him Harry, suffers from diabetes and he has no means to pay a laboratory for blood work, a doctor for treatment and a pharmacy for medication. Does Harry have a right to XYZ lab's and Dr. Jones' services and a prescription from a pharmacist? And, if those services are not provided without charge, should Harry be able to call for criminal sanctions against those persons for violating his rights to health care?

            You say, "Williams, that would come very close to slavery if one person had the right to force someone to serve him without pay." You're right. Suppose instead of Harry being able to force a lab, doctor and pharmacy to provide services without pay, Congress uses its taxing power to take a couple of hundred dollars out of the paycheck of some American to give to Harry so that he could pay the lab, doctor and pharmacist. Would there be any difference in principle, namely forcibly using one person to serve the purposes of another? There would be one important strategic difference, that of concealment. Most Americans, I would hope, would be offended by the notion of directly and visibly forcing one person to serve the purposes of another. Congress' use of the tax system to invisibly accomplish the same end is more palatable to the average American.

            True rights, such as those in our Constitution, or those considered to be natural or human rights, exist simultaneously among people. That means exercise of a right by one person does not diminish those held by another. In other words, my rights to speech or travel impose no obligations on another except those of non-interference. If we apply ideas behind rights to health care to my rights to speech or travel, my free speech rights would require government-imposed obligations on others to provide me with an auditorium, television studio or radio station. My right to travel freely would require government-imposed obligations on others to provide me with airfare and hotel accommodations.

            For Congress to guarantee a right to health care, or any other good or service, whether a person can afford it or not, it must diminish someone else's rights, namely their rights to their earnings. The reason is that Congress has no resources of its very own. Moreover, there is no Santa Claus, Easter Bunny or Tooth Fairy giving them those resources. The fact that government has no resources of its very own forces one to recognize that in order for government to give one American citizen a dollar, it must first, through intimidation, threats and coercion, confiscate that dollar from some other American. If one person has a right to something he did not earn, of necessity it requires that another person not have a right to something that he did earn.

            To argue that people have a right that imposes obligations on another is an absurd concept. A better term for new-fangled rights to health care, decent housing and food is wishes. If we called them wishes, I would be in agreement with most other Americans for I, too, wish that everyone had adequate health care, decent housing and nutritious meals. However, if we called them human wishes, instead of human rights, there would be confusion and cognitive dissonance. The average American would cringe at the thought of government punishing one person because he refused to be pressed into making someone else's wish come true.

            None of my argument is to argue against charity. Reaching into one's own pockets to assist his fellow man in need is praiseworthy and laudable. Reaching into someone else's pockets to do so is despicable and deserves condemnation.

            Walter E. Williams is a professor of economics at George Mason University. To find out more about Walter E. Williams and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com.

COPYRIGHT 2010 CREATORS.COM

Logged
ccp
Power User
***
Posts: 4214


« Reply #560 on: March 14, 2010, 03:21:07 PM »

I agree.  Good argument.  It sums up the idea of taxation to pay for "entitlement" programs to a tee.
Of course the counter argument would be that all of us could some day be in a position of "needing" some form of assistance.
Or that we are only forced to pay what we "can".
The final fall back position of course the moral arugment that we need to help those in "need".
But as you point out WW turns the moral argument (and in my opinion rightly so) inside out by concluding it is immoral to force many to work as virtual slaves for the rest.
Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31884


« Reply #561 on: March 15, 2010, 10:36:12 AM »

"It's all supposed to be voluntary, those 'home visits' that are tucked into the mammoth Obamacare bill. If you have a strong stomach, and a stronger bottom, you can find home visitation on pages 568-595. That's Section 2951 of H.R. 3590, the Senate [health care] bill.... The bill provides for federal funding and supervision for this vast expansion of government intrusion into family life. This is the Nanny State on steroids. Is your family being 'targeted' for such home visitations? Let's see if you fit into one of these very broad categories: Families where Mom is not yet 21. (No mention here whether she is married or not.) Families where someone is a tobacco user. (Does this include the White House? Watch out, Sasha and Malia! Does Grandpa, whom you love and have taken in, enjoy his after-dinner pipe?) Families where children have low student achievement, developmental delays, or disabilities. As if that list were not wide-ranging enough, here's the net that can encompass tens of millions: Families with individuals who are serving or formerly served in the armed forces, including such families that have members of the armed forces who have had multiple deployments outside the United States. [Emphasis added.] ... Do you spank your children? You should know that HHS bureaucrats think you are an abuser. Do you support the Second Amendment? How would you like HHS bureaucrats asking your children if you maintain firearms in the home for family protection? Do you home-school your kids? Take care. Members of Congress who have tried to abolish home-schooling are big backers of this health care bill. Do you wonder why? ... One thing is clear: For life and liberty, we must defeat ObamaCare." --columnist Ken Blackwell
Logged
Body-by-Guinness
Power User
***
Posts: 2792


« Reply #562 on: March 17, 2010, 04:44:33 PM »

David GoldhillPresident and CEO of GSN
Posted: March 17, 2010 09:37 AM
A Democrat's Case For "No"
The President: "Would you feel the same way if you were making $40,000...? Because that's the reality for a lot of folks. I mean, it is very important for us ... to listen to the folks that we get letters from -- because the truth of the matter, John, is they're not premiers of anyplace, they're not sultans from wherever. They don't fly into Mayo and suddenly decide they're going to spend a couple million dollars on the absolute, best health care. They're folks who are left out." (President Obama at the recent health care summit)

President Obama's statement perfectly encapsulates why I and many others are Democrats - our commitment to our fellow citizens who lack the resources to protect their families from misfortune. Sadly, I believe if we apply that standard to the proposed health care legislation, a Democrat should oppose this bill. Though superficially attractive, the bill's benefits to the uninsured are likely to be temporary, while its costs - even to its beneficiaries - will be large and lasting.

We Democrats have been swept up in a straightforward narrative of health care reform. For almost seventy years, we've been fighting entrenched industry interests to provide universal access to care - a benefit enjoyed by the citizens of all other developed countries. In the Administration's formulation, we're -- finally -- on the brink of a historic victory.

However, as with many long wars, we the combatants have ignored the transformation of the landscape - a transformation that has rendered our initial goals and our methods for achieving them hopelessly outdated.

First, over those 70 years health care has evolved from a rarely utilized service to the largest industry in our economy, as our physical and emotional well-being has become increasingly medicalized. The share of resources now devoted to care has impeded growth in our standard of living, especially for our middle class. Everyone knows that the US spends an astounding 17% of our GDP on care; but how many realize that over the past five years, we've spent 28 cents of every dollar of income growth? Our government's existing health care obligations account for much of America's deteriorating fiscal prospects, with all its negative implications for our future well-being.

Second, there is extensive evidence that the poorly structured incentives of our insurance-based system are themselves the cause of our health care inflation. Yet, continuing our Party's almost unquestioned conflation of health insurance with health care, the central feature of the proposed "reform" is further extension of our flawed insurance-based system.

Third, every other developed country is struggling with the cost of its universal health care system to such a degree that fundamental reform will almost certainly prove necessary to insure long-term sustainability. It is true that the US spends far more on health care than the universal care countries today; but it is absurd for us to ignore the lessons of the high rate of cost growth in these countries - growth that in some cases exceeds our own.

Fourth, despite the Administration's recent heated rhetoric, most of the entrenched health industry interests are quietly or openly in favor of this bill. Should the bill become law, I suspect we will look back at it as an industry bailout. Why? For the health insurance industry, the legislation not only guarantees tens of millions more customers, but also requires participation by the low-risk young and healthy. For hospitals, the legislation will reduce the cost of providing low-compensated care, by turning currently uninsured customers into full-paying private insurance ones.

But even if the health care landscape has shifted, doesn't the promise of adding 30 million uninsureds to the insurance safety net make the bill worthy of Democratic support? Only if we insist on looking at health care as an island, separate from everything else affecting American families. How else can Democrats in the depths of a recession support a massive tax increase on middle-class job creation (which is the effect of a corporate mandate)? How else could we justify diverting even more of middle class income to support our broken system of care, further starving families of funds for all their other needs? Most uninsured Americans lack insurance only temporarily; how many of them would trade lesser lifetime job prospects and lower disposable income for the short-term retention of health insurance?

Despite the bill's new subsidies to those who can' t afford whatever health insurance Congress deems to be adequate, the additional health spending in this bill heavily rests on private money - specifically the money of the currently uninsured who will be required to buy insurance. With health care now so expensive, the Government can't afford to fund the premiums for the ever-growing number of the uninsured. So it's requiring them - those $40,000 a year families - to share the costs.

The bill's subsidies may well provide some affordability benefit - but without meaningful reductions in the price of care, these are likely to be only temporary salve. How? Look at Medicare's history; its lack of real financial discipline has helped drive up care costs, leading to ever-greater premiums and out-of-pocket paid by its beneficiaries. So even with the government paying almost all of their bills, today's seniors pay a higher share of their income for health care than seniors did before Medicare.

Our current system of financing health care is also extraordinarily regressive - and the bill's mandate will make it even more regressive. Surprised? Consider corporate funded health insurance; the $15,000 annual premium for family coverage is a small share of the cost of compensation for the CEO, but a massive share of the compensation cost for the $40,000 a year employee. The Administration's own economists admit the obvious: regardless of who writes the premium check, it's the employee who's really funding the entire cost. Tack on Medicare taxes and out-of-pocket expenses, and the $40,000 a year employee is bearing health costs equal to 30% of his true cost to his employer; does this seem like a progressive system of funding worthy of extension?

For all the traditional liberal support for Medicare, even this cornerstone of government health care financing has a regressive effect, transferring resources from younger, poorer Americans to older, more financially secure ones. And the odds of the implicit "generational pact" ever being made good for today's younger people recedes daily; Medicare now has $74 trillion of unfunded liabilities, which this "reform" does nothing to fix.

And for the least well-off Americans? Expanding the eligibility for Medicaid may make legislators feel better, but with doctors abandoning the program, does this approach seem like a sustainable solution for their care needs?

The President is right that reform is urgent, but it must be real fundamental reform that alters the underlying structural incentives driving excessive health spending and prices. The true emergency is the growth of health care spending, which last year alone rose at a rate 6% above the rate of general inflation. Trying to control the cost of health insurance without meaningfully changing the incentives in health care is like trying to control gas prices by focusing on gas stations instead of oil markets. Yet without effective action against galloping care price increases, it will prove impossible for our nation to sustain real health security to our citizens.

For all its hat-tipping to cost control ideas, the legislation does little to curb health inflation. Its most important source of savings is $500 billion of unspecified Medicare cuts. If these savings should somehow be realized, shouldn't they be used to prop up this functionally insolvent program, rather than "fund" a new subsidy? Of course, does anyone expect these savings to be realized, when the same Congress debating their inclusion was also debating how - not whether - to repeal $250 billion of previously legislated Medicare cuts? If the legislation had any real prospect of controlling health care spending, would the pharmaceutical industry be funding the "yes" campaign?

We Democrats should not be requiring the middle class to spend ever more of their declining wealth on health care until we address the issue of why the $2.5 trillion we're already spending isn't sufficient. Does anyone doubt that the excess care, administrative waste, and undisciplined pricing in our current spending alone could fund all needed care for those now without it?

And while the anecdotes of Americans suffering without access to essential care tug at our heart-strings, remember that the accounting trick at the core of this legislation ("balancing" ten years of revenue and six years of benefits to produce "deficit neutral" results) means it will be four years before any additional Americans would be added to the insurance rolls. We have time to get this right.

What about the argument that Democrats should take what we can get now, in the knowledge that the bill's many failings can be fixed later? As the above makes clear, I'm not certain that what we are "getting now" is actually a positive for many uninsured Americans. Further, the bill will cement the inefficiencies and unaccountable practices in the health industries through yet more health spending; so it will be even politically harder later to get agreement on fixes, much less real reform.

The Republican Party's approach to health reform has been so hypocritical and obstructionist that it borders on the unpatriotic; all Democrats would like to see our well-meaning Administration have a political boost at the expense of a cynical opposition. But that win is likely to be achieved at real cost to many Americans - including many families getting by on $40,000 a year. We need to take the President at his word: this should be about doing what's right not what's political. With a very heavy heart, this Democrat suggests a "no" vote.

http://www.huffingtonpost.com/david-goldhill/a-democrats-case-for-no_b_502229.html
Logged
Body-by-Guinness
Power User
***
Posts: 2792


« Reply #563 on: March 18, 2010, 10:01:21 PM »

http://reason.com/blog/2010/03/18/gimme-gimmicks-getting-giddy-o
Reason Magazine


Gimme Gimmicks: Getting Giddy Over the CBO's Latest Health Care Score

Peter Suderman | March 18, 2010

The latest—though likely not the last—Congressional Budget Office score for the Democrats health care overhaul is in, and after a harried week, it's making Rep. James Clyburn, the House Democrats' whip, "giddy."  What's worth squealing about? The score, which estimates the budgetary effects of the Senate health care bill in the context of the reconciliation changes proposed by House Democrats, officially projects that the bill will cost $940 billion and reduce the deficit by $130 billion over ten years. In the following decade, the CBO's crystal ball says the package conjures up $1.2 trillion in deficit reduction (maybe), a number which it also warns should be viewed as about as accurate as the predictions from most crystal balls.

Fans of budgeting gimmicks are in for a treat, as the document reads like a sort Greatest Hits of Budgeting BS. Jacob Sullum has already noted some of its many balance-sheet deceptions, including double counting Medicare savings and the inclusion of $19.4 billion in scored deficit reduction from a totally unrelated student-loan program, but here's a few more:

The score for the Senate bill includes $72 billion in revenues generated by the CLASS act, a federally-backed disability insurance program. But that $72 billion is just premium revenue that will eventually have to be used to pay out benefits. The score counts that revenue anyway, despite the fact that, according to the CBO, it would probably add to the deficit in the long term.

Even if you buy the projected deficit reductions—I'm skeptical—the bill achieves them at the cost of raising the national debt. At Fortune, Shawn Tully explains:

That forecast, however, doesn't mean that what the CBO counts as lower deficits will lead to less debt, as taxpayers might expect. In fact, it appears that it would require the Treasury to borrow almost 40 cents of every dollar in new spending the bill requires.

It's not an easy trick to reduce deficits and yet borrow more money. CBO does it because it has to. By law, the CBO is required to use "cash" or "unified budget" accounting. Under that system, the CBO projects all the new revenues and new expenses from the legislation it's requested to "score." If the extra revenues exceed the additional outlays, the bill is deemed to reduce deficits. That's the case with the health-care bill. The rub is that the measure gets a large portion of its revenues from new Social Security and Medicare taxes—plus levies it collects upfront to pay for a long-term care entitlement program.

Counting those taxes as deficit reducers presents two problems. First, the extra revenues are mainly needed to pay for higher benefits in the future. Second, they cannot be used to fund the lavish subsidies, tax credits for small employers, and other spending the bill mandates. "The law is clear," says Donald Moran, a former Reagan Administration budget official who runs a Washington, DC-based health-care consulting and research firm. "Revenues from those entitlement taxes must go into their trust funds. That money is not available to pay for the spending commitments of the health-care bill."

Indeed, as anyone who bothers to read the first paragraph of the CBO's letter will see, the entire report is arguably something of a cheat. See, House Speaker Nancy Pelosi promised that the CBO score for the reconciliation bill would be available 72 hours before taking a vote. She's also been pushing hard to get a vote by this weekend. And, sure enough, just in time, here's the score—in preliminary, subject-to-change, implicitly rushed-to-early-release form. Or, as the CBO says in its careful bureaucratese:

Although CBO completed a preliminary review of legislative language prior to its release, the agency has not thoroughly examined the reconciliation proposal to verify its consistency with the previous draft. This estimate is therefore preliminary, pending a review of the language of the reconciliation proposal, as well as further review and refinement of the budgetary projections.

Translation: We weren't really done yet, but House leadership wanted to vote this weekend, so we rushed this sucker out early. Granted, at this point the Democrats have so thoroughly gamed mastered the scoring process that the end result would likely be similar no matter when it came out. This is why leadership has been so confident that it could pick up the votes needed for passage: Many of those wavering votes, it now seems, were probably dependent on the deficit reduction figures in the CBO score—a score that leadership achieved by spending all week tweaking and resubmitting the legislative language in order to produce the desired result. Not surprisingly, the vote count now seems to be moving in their direction. If I were the Democrats' official vote-getter today, I suppose I'd be giddy too.
Logged
ccp
Power User
***
Posts: 4214


« Reply #564 on: March 19, 2010, 11:43:21 AM »

OPINION: DECLARATIONS MARCH 18, 2010, 6:58 P.M. ET Now for the Slaughter On the road to Demon Pass, our leader encounters a Baier.By PEGGY NOONAN

Excuse me, but it is embarrassing—really, embarrassing to our country—that the president of the United States has again put off a state visit to Australia and Indonesia because he's having trouble passing a piece of domestic legislation he's been promising for a year will be passed next week. What an air of chaos this signals to the world. And to do this to Australia of all countries, a nation that has always had America's back and been America's friend.

How bush league, how undisciplined, how kid's stuff.

You could see the startled looks on the faces of reporters as Press Secretary Robert Gibbs, who had the grace to look embarrassed, made the announcement on Thursday afternoon. The president "regrets the delay"—the trip is rescheduled for June—but "passage of the health insurance reform is of paramount importance." Indonesia must be glad to know it's not.

View Full Image

Fox News Channel
 The reporters didn't even provoke or needle in their questions. They seemed hushed. They looked like people who were absorbing the information that we all seem to be absorbing, which is that the wheels seem to be coming off this thing, the administration is wobbling—so early, so painfully and dangerously soon.

Thursday's decision followed the most revealing and important broadcast interview of Barack Obama ever. It revealed his primary weakness in speaking of health care, which is a tendency to dodge, obfuscate and mislead. He grows testy when challenged. It revealed what the president doesn't want revealed, which is that he doesn't want to reveal much about his plan. This furtiveness is not helpful in a time of high public anxiety. At any rate, the interview was what such interviews rarely are, a public service. That it occurred at a high-stakes time, with so much on the line, only made it more electric.

More Peggy Noonan
Read Peggy Noonan's previous columns

click here to order her new book, Patriotic Grace
I'm speaking of the interview Wednesday on Fox News Channel's "Special Report With Bret Baier." Fox is owned by News Corp., which also owns this newspaper, so one should probably take pains to demonstrate that one is attempting to speak with disinterest and impartiality, in pursuit of which let me note that Glenn Beck has long appeared to be insane.

That having been said, the Baier interview was something, and right from the beginning. Mr. Baier's first question was whether the president supports the so-called Slaughter rule, alternatively known as "deem and pass," which would avoid a straight up-or-down House vote on the Senate bill. (Tunku Varadarajan in the Daily Beast cleverly notes that it sounds like "demon pass," which it does. Maybe that's the juncture we're at.) Mr. Obama, in his response, made the usual case for ObamaCare. Mr. Baier pressed him. The president said, "The vote that's taken in the House will be a vote for health-care reform." We shouldn't, he added, concern ourselves with "the procedural issues."

Further in, Mr. Baier: "So you support the deem-and-pass rule?" From the president, obfuscation. But he did mention something new: "They may have to sequence the votes." The bill's opponents would be well advised to look into that one.

Mr. Baier again: So you'll go deem-and-pass and you don't know exactly what will be in the bill?

Mr. Obama's response: "By the time the vote has taken place, not only will I know what's in it, you'll know what's in it, because it's going to be posted and everybody's going to be able to evaluate it on the merits."

View Full Image

Fox News Channel
 That's news in two ways. That it will be posted—one assumes the president means on the Internet and not nailed to a telephone pole—should suggest it will be posted for a while, more than a few hours or days. So American will finally get a look at it. And the president was conceding that no, he doesn't know what's in the bill right now. It is still amazing that one year into the debate this could be true.

Mr. Baier pressed on the public's right to know what is in the bill. We have been debating the bill for a year, the president responded: "The notion that this has been not transparent, that people don't know what's in the bill, everybody knows what's in the bill. I sat for seven hours with—."

Mr. Baier interrupts: "Mr. President, you couldn't tell me what the special deals are that are in or not today."

Mr. Obama: "I just told you what was in and what was not in."

Mr. Baier: "Is Connecticut in?" He was referring to the blandishments—polite word—meant to buy the votes of particular senators.

Mr. Obama: "Connecticut—what are you specifically referring to?"

Mr. Baier: "The $100 million for the hospital? Is Montana in for the asbestos program? Is—you know, listen, there are people—this is real money, people are worried about this stuff."

Mr. Obama: "And as I said before, this—the final provisions are going to be posted for many days before this thing passes."

Mr. Baier pressed the president on his statement as a candidate for the presidency that a 50-plus-one governing mentality is inherently divisive. "You can't govern" that way, Sen. Obama had said. Is the president governing that way now? Mr. Obama did not really answer.

Throughout, Mr. Baier pressed the president. Some thought this bordered on impertinence. I did not. Mr. Obama now routinely filibusters in interviews. He has his message, and he presses it forward smoothly, adroitly. He buries you in words. Are you worried what failure of the bill will do to you? I'm worried about what the status quo will do to the families that are uninsured . . .

Mr. Baier forced him off his well-worn grooves. He did it by stopping long answers with short questions, by cutting off and redirecting. In this he was like a low-speed bumper car. In the end the interview seemed to me a public service because everyone in America right now wants to see the president forced off his grooves and into candor on an issue that involves 17% of the economy. Again, the stakes are high. So Mr. Baier's style seemed—this is admittedly subjective—not rude but within the bounds, and not driven by the antic spirit that sometimes overtakes reporters. He seemed to be trying to get new information. He seemed to be attempting to better inform the public.

Presidents have a right to certain prerogatives, including the expectation of a certain deference. He's the president, this is history. But we seem to have come a long way since Ronald Reagan was regularly barked at by Sam Donaldson, almost literally, and the president shrugged it off. The president—every president—works for us. We don't work for him. We sometimes lose track of this, or rather get the balance wrong. Respect is due and must be palpable, but now and then you have to press, to either force them to be forthcoming or force them to reveal that they won't be. Either way it's revealing.

And so it ends, with a health-care vote expected this weekend. I wonder at what point the administration will realize it wasn't worth it—worth the discord, worth the diminution in popularity and prestige, worth the deepening of the great divide. What has been lost is so vivid, what has been gained so amorphous, blurry and likely illusory. Memo to future presidents: Never stake your entire survival on the painful passing of a bad bill. Never take the country down the road to Demon Pass.

Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved
Logged
Body-by-Guinness
Power User
***
Posts: 2792


« Reply #565 on: March 19, 2010, 11:52:10 AM »

Obamacare’s Imaginary Savings
 
President Obama and Democratic leaders in Congress touted the latest cost projections from the Congressional Budget Office (CBO) as evidence that the bill they are attempting to ram through Congress this weekend is fiscally responsible. Some Blue Dog Democrats may try to use the latest projections as an excuse to switch their votes from opposition to support of Obamacare.

But if they do so, the only people they will be fooling are themselves — the public long ago saw through the gimmicks and sleight-of-hand behind the Democratic deficit-cutting claims. Voters know a runaway entitlement program when they see one, and in this case they got some crucial help from Rep. Paul Ryan and others. The bill the Democrats want to pass is a massive federal spending spree, and the claims that it will reduce the deficit do not stand up to scrutiny.

According to CBO, Obamacare’s new subsidies for health insurance would cost $216 billion by 2019 — an expense that would increase another 8 percent every year thereafter. In addition, the plan includes $130 billion in other entitlement spending, plus another $70 billion for the bureaucracy needed to implement it. All totaled, the bill would cost at least $1.2 trillion through 2019, not the $940 billion advertised by the White House.

And even that $1.2 trillion is a low-ball estimate, because the Democratic plan would do almost nothing of real consequence until 2014. But when the program’s spending measures did finally kick in, costs would soar. Over the first ten years of full implementation, the bill’s cost would grow to at least $2.5 trillion, and perhaps much more. Today, Medicare and Medicaid spend far more money — about ten times as much — as the original government estimates predicted.

Most of the offsets the Democrats are pushing to “pay for” the bill are smoke and mirrors — cuts that won’t be made, taxes that won’t be collected. But there are some measures that, if enacted, promise to inflict real damage on the American economy and on America’s seniors. Among the plan’s $560 billion in tax hikes over the next ten years is a new Medicare tax on non-wage income, a penalty on investment that would undermine business growth and job creation. And there’s the Medicare Advantage cut, more than $200 billion over ten years. This reduction would force millions of Medicare beneficiaries out of their health-insurance plans, in direct contradiction of Obama’s promise. In total, the Medicare cuts in the president’s plan now exceed $520 billion over ten years.

But most of the offsets are window dressing, helpful in making the sale but unlikely to amount to much in the end. The president wants us to believe we can count on a massive revenue surge from the “Cadillac tax” after 2020, but the unions hate the tax, and the fact that the president’s plan puts off collecting it until he is safely in retirement suggests that Democrats are not serious about enforcing the measure when the time comes.

The Democrats’ plan assumes permanent, across-the-board cuts in Medicare hospital and nursing-home payments — cuts that that would go so deep that the chief actuary of the program expects that one in five facilities would have to stop taking Medicare patients to avoid insolvency. Which means those cuts probably aren’t going to happen. We have seen this before: Even as Democrats claim these new Medicare savings can be taken to the bank, they are working to undo a similarly clumsy and ill-advised cut in Medicare physicians’ fees — at a cost of $371 billion over ten years, another massive pile of money not accounted for in the Democrats’ “savings” projections.

While much of the spending isn’t counted, a big piece of the revenue is double-counted: The Democrats’ numbers show premiums from the new long-term care insurance program, along with Social Security and Medicare surpluses, being used both to pay for the insurance subsidies and to strengthen the ailing entitlement programs. But you can’t spend the same dollar in two different places. Which means that the Democrats are trying to finance another expensive entitlement program with funds that are needed to pay for entitlement programs already on the books.

When that double-counting is omitted and the real cost of physicians’ fees is included, all of the claimed deficit-reduction from the health bill vanishes.

The recklessness of the Democratic majority is remarkable. The federal budget is already suffocating under unaffordable entitlement commitments. We can’t pay for the ones we have, and they want to create a bunch of new ones. CBO finds no “bending of the cost curve” in the president’s plan. It is nothing but high-speed spending that is almost certain to grow even more expensive than advertised. It will be financed in part with job-killing tax hikes and ideologically driven cuts to Medicare Advantage — but mainly it’s going to be papered over with accounting gimmicks and “savings” that will never materialize.

The United States is already rushing headlong toward a debt crisis, in part because of the massive spending President Obama has already pushed through the Congress. Contrary to his claims, his health plan would not reduce the deficit, in the short term or in the long term. If enacted, it would only accelerate our descent into debt, and hasten the day of reckoning.

http://article.nationalreview.com/428569/obamacares-imaginary-savings/the-editors
Logged
Body-by-Guinness
Power User
***
Posts: 2792


« Reply #566 on: March 20, 2010, 11:41:23 AM »

Michael Cannon: Innovation best alternative to Obamacare
By MICHAEL F. CANNON
2010-03-19 14:45:50

There is an alternative to the Obama health plan. It's called innovation.

Economist Glen Whitman and physician Raymond Raad found that, when it comes to basic medical sciences, diagnostics (e.g., MRIs and CT scanners), and therapeutics (e.g., ACE inhibitors and statins), the United States often produces more medical innovations than all other nations combined.

America's health insurance markets are not following suit, despite the ready availability of innovations that can improve the delivery of care, insure the "young invincibles," and provide secure coverage for the sick. Bringing those innovations to consumers requires tearing down regulatory barriers to competition – the very barriers that the Obama plan would stack higher.

Health researchers have long complained of the need for comparative-effectiveness research, health information technologies, coordinated care, and payment systems that better reward quality care.

Innovations that meet those needs are already at hand. Health plans like Kaiser Permanente and Group Health Cooperative are leaders in effectiveness research and health information technologies. Both emphasize cost-effective preventive care, and compete based on the convenience offered by their electronic medical records.

Those successes are the offspring of earlier innovations. Kaiser and Group Health use a payment system called "prepayment," combined with an integrated delivery system, which both enable and reward comparative-effectiveness research, electronic medical records, coordinated care, and prevention.

Yet these innovations lie beyond the reach of most consumers, Stanford health economist Alain Enthoven explains, because our employment-based health insurance system – a creature of the federal tax code – blocks entry by integrated, prepaid health plans.

Reformers also seek to cover millions of "young invincibles" – twentysomethings who decline health insurance because, reformers believe, they think they will never get sick.

While the Obama plan would force young invincibles to purchase health insurance, markets have developed insurance policies that can achieve the same result without coercion. Such policies pay a deferred dividend to customers who end up not filing any claims. The same miscalculation that causes young invincibles to underestimate their need for insurance also causes them to overestimate the probability that they will receive a dividend. Therefore, they insure.

Law professors Tom Baker of the University of Pennsylvania and Peter Siegelman of the University of Connecticut report these innovations are currently available in China, and were quite popular in life-insurance markets in the United States until they were demonized as a form of gambling. Lower barriers to market entry, including clear regulatory guidance about these products' legality, would cover many young invincibles without the need for more government.

Providing secure coverage to patients with high-cost illnesses may be our toughest challenge. The Obama plan tries to address this problem with price controls – i.e., by forcing insurers to charge all applicants of a given age the same premium, regardless of health status.

Markets long ago responded to consumer demand for protection against premium spikes, explains University of Pennsylvania health economist Mark Pauly, with an innovation that guarantees that those who develop a costly illness can renew their policy at the same premium as the rest of the group.

Many believe such renewal guarantees still leave insurers with incentives to mistreat their sick customers. Competition would solve that problem, too, University of Chicago finance economist John Cochrane explains, by pushing insurers to offer a total-satisfaction guarantee: "If at any time you are dissatisfied with your coverage, we will pay for you to switch to another insurance company at no additional cost to you." (Think about it: wouldn't you buy a health plan that offered that guarantee?)

Guaranteed renewability is a large step toward a total-satisfaction guarantee, and the market is busy making additional strides. Last year, UnitedHealth launched a new product that guarantees customers the option to buy coverage in the future at standard rates, no matter how sick they get in the meantime.

Expanding that guarantee so that customers could choose policies sold by another other insurance company, Cochrane explains, requires reducing barriers to competition – in particular, the very price controls that Democrats hope to expand.

Congress could jump-start these innovations with two reforms: letting individual consumers – elderly and nonelderly – control their health care dollars; and letting them purchase a health insurance plan regulated by the state of their choice.

Piling the regulations higher is a sure-fire way to block these innovations, and even more dramatic innovations that we cannot foresee.

http://www.ocregister.com/opinion/health-240160-innovations-insurance.html
Logged
Body-by-Guinness
Power User
***
Posts: 2792


« Reply #567 on: March 21, 2010, 05:16:00 PM »

The Real Arithmetic of Health Care Reform

By DOUGLAS HOLTZ-EAKIN
Arlington, Va.

ON Thursday, the Congressional Budget Office reported that, if enacted, the latest health care reform legislation would, over the next 10 years, cost about $950 billion, but because it would raise some revenues and lower some costs, it would also lower federal deficits by $138 billion. In other words, a bill that would set up two new entitlement spending programs — health insurance subsidies and long-term health care benefits — would actually improve the nation’s bottom line.

Could this really be true? How can the budget office give a green light to a bill that commits the federal government to spending nearly $1 trillion more over the next 10 years?

The answer, unfortunately, is that the budget office is required to take written legislation at face value and not second-guess the plausibility of what it is handed. So fantasy in, fantasy out.

In reality, if you strip out all the gimmicks and budgetary games and rework the calculus, a wholly different picture emerges: The health care reform legislation would raise, not lower, federal deficits, by $562 billion.

Gimmick No. 1 is the way the bill front-loads revenues and backloads spending. That is, the taxes and fees it calls for are set to begin immediately, but its new subsidies would be deferred so that the first 10 years of revenue would be used to pay for only 6 years of spending.

Even worse, some costs are left out entirely. To operate the new programs over the first 10 years, future Congresses would need to vote for $114 billion in additional annual spending. But this so-called discretionary spending is excluded from the Congressional Budget Office’s tabulation.

Consider, too, the fate of the $70 billion in premiums expected to be raised in the first 10 years for the legislation’s new long-term health care insurance program. This money is counted as deficit reduction, but the benefits it is intended to finance are assumed not to materialize in the first 10 years, so they appear nowhere in the cost of the legislation.

Another vivid example of how the legislation manipulates revenues is the provision to have corporations deposit $8 billion in higher estimated tax payments in 2014, thereby meeting fiscal targets for the first five years. But since the corporations’ actual taxes would be unchanged, the money would need to be refunded the next year. The net effect is simply to shift dollars from 2015 to 2014.

In addition to this accounting sleight of hand, the legislation would blithely rob Peter to pay Paul. For example, it would use $53 billion in anticipated higher Social Security taxes to offset health care spending. Social Security revenues are expected to rise as employers shift from paying for health insurance to paying higher wages. But if workers have higher wages, they will also qualify for increased Social Security benefits when they retire. So the extra money raised from payroll taxes is already spoken for. (Indeed, it is unlikely to be enough to keep Social Security solvent.) It cannot be used for lowering the deficit.

A government takeover of all federally financed student loans — which obviously has nothing to do with health care — is rolled into the bill because it is expected to generate $19 billion in deficit reduction.

Finally, in perhaps the most amazing bit of unrealistic accounting, the legislation proposes to trim $463 billion from Medicare spending and use it to finance insurance subsidies. But Medicare is already bleeding red ink, and the health care bill has no reforms that would enable the program to operate more cheaply in the future. Instead, Congress is likely to continue to regularly override scheduled cuts in payments to Medicare doctors and other providers.

Removing the unrealistic annual Medicare savings ($463 billion) and the stolen annual revenues from Social Security and long-term care insurance ($123 billion), and adding in the annual spending that so far is not accounted for ($114 billion) quickly generates additional deficits of $562 billion in the first 10 years. And the nation would be on the hook for two more entitlement programs rapidly expanding as far as the eye can see.

The bottom line is that Congress would spend a lot more; steal funds from education, Social Security and long-term care to cover the gap; and promise that future Congresses will make up for it by taxing more and spending less.

The stakes could not be higher. As documented in another recent budget office analysis, the federal deficit is already expected to exceed at least $700 billion every year over the next decade, doubling the national debt to more than $20 trillion. By 2020, the federal deficit — the amount the government must borrow to meet its expenses — is projected to be $1.2 trillion, $900 billion of which represents interest on previous debt.

The health care legislation would only increase this crushing debt. It is a clear indication that Congress does not realize the urgency of putting America’s fiscal house in order.

Douglas Holtz-Eakin, who was the director of the Congressional Budget Office from 2003 to 2005, is the president of the American Action Forum, a policy institute.

http://www.nytimes.com/2010/03/21/opinion/21holtz-eakin.html
Logged
Rarick
Guest
« Reply #568 on: March 21, 2010, 09:30:37 PM »

What is the Bill#  on this.  It passed congress on sunday on the way to the senate.
Logged
prentice crawford
Power User
***
Posts: 784


« Reply #569 on: March 22, 2010, 08:43:40 AM »

Woof,
 No, the bill passed went to the President to be signed into law; the bill the Senate will take up will make changes to that law, comrad.
                                                  P.C.
Logged

Rarick
Guest
« Reply #570 on: March 22, 2010, 09:01:22 AM »

welcome to untied socialist amerika then........ evil
Logged
prentice crawford
Power User
***
Posts: 784


« Reply #571 on: March 22, 2010, 01:12:04 PM »

Woof,
 Yes, but it's a small price to pay so our nation's crack whores can get a "FREE" pap smear twice a year. tongue
                                        P.C.
Logged

Crafty_Dog
Administrator
Power User
*****
Posts: 31884


« Reply #572 on: March 22, 2010, 04:12:13 PM »

"If you think health care is expensive now, just wait until the government makes it free."

PJ O'Rourke
Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31884


« Reply #573 on: March 23, 2010, 05:34:09 PM »

Some of these are petty, but plenty are not.

From IBD
--------------------------------------------------------------------------------

20 Ways ObamaCare Will Take Away Our Freedoms
By David Hogberg Posted 03/21/2010 03:24 PM ET

If some reports are to be believed, the Democrats will pass the Senate health care bill with some reconciliation changes later today. Thus, it is worthwhile to take a comprehensive look at the freedoms we will lose.

Of course, the bill is supposed to provide us with security. But it will result in skyrocketing insurance costs and physicians leaving the field in droves, making it harder to afford and find medical care. We may be about to live Benjamin Franklin’s adage, “People willing to trade their freedom for temporary security deserve neither and will lose both.”

The sections described below are taken from HR 3590 as agreed to by the Senate and from the reconciliation bill as displayed by the Rules Committee.

1. You are young and don’t want health insurance? You are starting up a small business and need to minimize expenses, and one way to do that is to forego health insurance? Tough. You have to pay $750 annually for the “privilege.” (Section 1501)

2. You are young and healthy and want to pay for insurance that reflects that status? Tough. You’ll have to pay for premiums that cover not only you, but also the guy who smokes three packs a day, drink a gallon of whiskey and eats chicken fat off the floor. That’s because insurance companies will no longer be able to underwrite on the basis of a person’s health status. (Section 2701).

3. You would like to pay less in premiums by buying insurance with lifetime or annual limits on coverage? Tough. Health insurers will no longer be able to offer such policies, even if that is what customers prefer. (Section 2711).

4. Think you’d like a policy that is cheaper because it doesn’t cover preventive care or requires cost-sharing for such care? Tough. Health insurers will no longer be able to offer policies that do not cover preventive services or offer them with cost-sharing, even if that’s what the customer wants. (Section 2712).

5. You are an employer and you would like to offer coverage that doesn’t allow your employers’ slacker children to stay on the policy until age 26? Tough. (Section 2714).

6. You must buy a policy that covers ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services; chronic disease management; and pediatric services, including oral and vision care.
You’re a single guy without children? Tough, your policy must cover pediatric services. You’re a woman who can’t have children? Tough, your policy must cover maternity services. You’re a teetotaler? Tough, your policy must cover substance abuse treatment. (Add your own violation of personal freedom here.) (Section 1302).

7. Do you want a plan with lots of cost-sharing and low premiums? Well, the best you can do is a “Bronze plan,” which has benefits that provide benefits that are actuarially equivalent to 60% of the full actuarial value of the benefits provided under the plan. Anything lower than that, tough. (Section 1302 (d)(1)(A))

8. You are an employer in the small-group insurance market and you’d like to offer policies with deductibles higher than $2,000 for individuals and $4,000 for families? Tough. (Section 1302 (c) (2) (A).

9. If you are a large employer (defined as at least 101 employees) and you do not want to provide health insurance to your employee, then you will pay a $750 fine per employee (It could be $2,000 to $3,000 under the reconciliation changes). Think you know how to better spend that money? Tough. (Section 1513).
10. You are an employer who offers health flexible spending arrangements and your employees want to deduct more than $2,500 from their salaries for it? Sorry, can’t do that. (Section 9005 (i)).

11. If you are a physician and you don’t want the government looking over your shoulder? Tough. The Secretary of Health and Human Services is authorized to use your claims data to issue you reports that measure the resources you use, provide information on the quality of care you provide, and compare the resources you use to those used by other physicians. Of course, this will all be just for informational purposes. It’s not like the government will ever use it to intervene in your practice and patients’ care. Of course not. (Section 3003 (i))

12. If you are a physician and you want to own your own hospital, you must be an owner and have a “Medicare provider agreement” by Feb. 1, 2010. (Dec. 31, 2010 in the reconciliation changes.) If you didn’t have those by then, you are out of luck. (Section 6001 (i) (1) (A)).

13. If you are a physician owner and you want to expand your hospital? Well, you can’t (Section 6001 (i) (1) (B). Unless, it is located in a country where, over the last five years, population growth has been 150% of what it has been in the state (Section 6601 (i) (3) ( E)). And then you cannot increase your capacity by more than 200% (Section 6001 (i) (3) (C)).

14. You are a health insurer and you want to raise premiums to meet costs? Well, if that increase is deemed “unreasonable” by the Secretary of Health and Human Services it will be subject to review and can be denied. (Section 1003)

15. The government will extract a fee of $2.3 billion annually from the pharmaceutical industry. If you are a pharmaceutical company what you will pay depends on the ratio of the number of brand-name drugs you sell to the total number of brand-name drugs sold in the U.S. So, if you sell 10% of the brand-name drugs in the U.S., what you pay will be 10% multiplied by $2.3 billion, or $230,000,000. (Under reconciliation, it starts at $2.55 billion, jumps to $3 billion in 2012, then to $3.5 billion in 2017 and $4.2 billion in 2018, before settling at $2.8 billion in 2019 (Section 1404)). Think you, as a pharmaceutical executive, know how to better use that money, say for research and development? Tough. (Section 9008 (b)).


16. The government will extract a fee of $2 billion annually from medical device makers. If you are a medical device maker what you will pay depends on your share of medical device sales in the U.S. So, if you sell 10% of the medical devices in the U.S., what you pay will be 10% multiplied by $2 billion, or $200,000,000. Think you, as a medical device maker, know how to better use that money, say for R&D? Tough. (Section 9009 (b)).
The reconciliation package turns that into a 2.9% excise tax for medical device makers. Think you, as a medical device maker, know how to better use that money, say for research and development? Tough. (Section 1405).

17. The government will extract a fee of $6.7 billion annually from insurance companies. If you are an insurer, what you will pay depends on your share of net premiums plus 200% of your administrative costs. So, if your net premiums and administrative costs are equal to 10% of the total, you will pay 10% of $6.7 billion, or $670,000,000. In the reconciliation bill, the fee will start at $8 billion in 2014, $11.3 billion in 2015, $1.9 billion in 2017, and $14.3 billion in 2018 (Section 1406).Think you, as an insurance executive, know how to better spend that money? Tough.(Section 9010 (b) (1) (A and B).)

18. If an insurance company board or its stockholders think the CEO is worth more than $500,000 in deferred compensation? Tough.(Section 9014).

19. You will have to pay an additional 0.5% payroll tax on any dollar you make over $250,000 if you file a joint return and $200,000 if you file an individual return. What? You think you know how to spend the money you earned better than the government? Tough. (Section 9015).
That amount will rise to a 3.8% tax if reconciliation passes. It will also apply to investment income, estates, and trusts. You think you know how to spend the money you earned better than the government? Like you need to ask. (Section 1402).

20. If you go for cosmetic surgery, you will pay an additional 5% tax on the cost of the procedure. Think you know how to spend that money you earned better than the government? Tough. (Section 9017).

 
Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31884


« Reply #574 on: March 24, 2010, 12:02:35 AM »

THEODORE DALRYMPLE
The Fix Is In
Why Britain’s National Health Service spends so much and does so little
22 March 2010

Americans would do well to ponder a recent admission by a former British minister in the Blair government. On March 2, the Guardianreported that the ex-minister, now Lord Warner, said that while spending on Britain’s National Health Service had increased by 60 percent under the Labour government, its output had decreased by 4 percent. No doubt the spending of a Soviet-style organization like the NHS is more easily measurable than its output, but the former minister’s remark certainly accords with the experiences of many citizens, who see no dramatic improvement in the service as a result of such vastly increased outlays. On the contrary, while the service has taken on 400,000 new staff members—that is to say, one-fifth of all new jobs created in Britain during the period—continuity of medical care has been all but extinguished. Nobody now expects to see the same doctor on successive occasions, in the hospital or anywhere else.

The ex-minister admitted that most of the extra money—which by now must equal a decent proportion of the total national debt—had been simply wasted. (The same might be said, of course, of the increased outlays put toward state education.) But his explanation for this state of affairs was superficial and self-exculpating, to say the least: he said that the NHS received more money than it knew what to do with because of managerial inexperience. “It was like giving a starving man foie gras and caviar,” he said.

As it happens, the NHS knew exactly what to do with the money: give it to its staff, new and old. British doctors, for example, are now the second-highest-paid in the world, though not necessarily the happiest. They have accepted the money on condition that they also accept—as quietly as mice—increasing government interference in their work. When you go to a family doctor in Britain, he is more likely to do what the government thinks he ought to do and will pay him a bonus for doing than what he thinks is right. This is sinister, even when what the government thinks is right happens to be right.

There is a possible explanation other than managerial inexperience for the waste, namely that the waste was intended and desired: indeed, that it was the principal object of the spending. Experience has long shown that further spending by state-monopoly suppliers of services (if services is quite the word I seek) benefits not the consumers but the providers. And they—ever more numerous—naturally vote for their own providers, the politicians. Thus the NHS has become an enormously expensive method of ballot-stuffing. Personally, I would rather have outright electoral fraud. It would be less expensive and slightly more honest.

Just before the last election, the chief executive of one of the hospitals in which I once worked was overheard saying, “My job is to make sure that the government is reelected.” (The government’s job, in turn, was to make sure that she remained chief executive.) She also explained that the hospital could expect no increase in its government funding, unlike other hospitals—because it was located in an area in which most people voted for the government anyway.

Theodore Dalrymple's most recent book is The New Vichy Syndrome.
Logged
ccp
Power User
***
Posts: 4214


« Reply #575 on: March 24, 2010, 10:31:10 AM »

Interesting article.  The British doctors are the second highest paid in the world?  I didn't know that.  Well like I have said money can buy anyone.

I can tell you that the model, getting doctors to do what the gov. tells them to do is EXACTLY what is going to happen here.
There is no question those who are driving the changes (the IVY leaGUE phDs and other statisticians) are going to pay physicians and hospital based on their "performance" and not fee for service.  Performance is going to be based on "cost effective" outcomes and will include rationing.  Everyone of any means will get the same (not initially) but ultimately because of the liberal notion it is NOT FAIR that some can pay for better and more care than others.

Bama IS not telling the truth when he says we are not transforming 1/6th of the economy.  Yes the present bill only does this to a degree but there is no doubt the ultimate goal is more like Britain.  He know this you know this and I know this.  The MSM of course lets him off the hook and smirk at those who point this out and help to marginalize them as "far" right.  MSNBC of course throws in the adjective "loons".

Unfortunately the truth is also that a large proportion of the population do want government sponsered care.



Logged
Rarick
Guest
« Reply #576 on: March 27, 2010, 04:01:00 AM »

Found a link to the text of the bill:
http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3590eas.txt.pdf

If you look around page 1290-1320, you can see where a new "Public health service" has just been created as a parallel to the uniformed services!  The bill is not just to fix some systemic problems, it is a direct bid of the goverment for control of our health and our body-  A direct attack on self ownership in my opinion.............

I was hoping I would not find something like this in the bill............
Logged
Body-by-Guinness
Power User
***
Posts: 2792


« Reply #577 on: March 30, 2010, 11:33:58 AM »

Waxman’s Vendetta
If the liberal lion is genuinely surprised at the real world departing from CBO projections, he should brace himself for more shocks.

Henry Waxman is peeved. He expects corporate America to swallow health-care reform without a peep of protest — and, apparently, without revealing new costs to shareholders or the Securities and Exchange Commission.

Last week, AT&T announced it will take an immediate $1 billion write-down thanks to a new tax in the health bill that will cause Caterpillar ($100 million) and Deere & Co. ($150 million), among other large employers, to do the same. The benefits consultancy Towers Watson estimates that the change may reduce corporate profits by as much as $14 billion over time.

That’s real money. For comparison: It’s enough to bribe Sen. Ben Nelson of the Cornhusker Kickback 140 times over; it’s three times the amount Democrats poured into a (failing) weatherization program that once was a highlight of the stimulus bill; it represents 10 percent of the supposed deficit reduction of health-care reform over ten years. It may be that the health bill’s most immediate, high-profile effect is the destruction of shareholder wealth.

Not to fear. Waxman, the liberal lion who chairs the House Energy and Commerce Committee, is on the case. He doesn’t want to change the tax provision; he wants to browbeat the affected corporations. He has called the CEOs of AT&T, Caterpillar, and Deere to testify before his committee, accompanying his summons with a far-reaching document request lest the corporations miss the point: This is naked political harassment.

Citing the Congressional Budget Office, Waxman says his concern is that the write-downs appear “to conflict with independent analyses.” If he’s genuinely surprised at the real world departing from CBO projections, he should brace himself for more shocks. Is he going to demand OMB director Peter Orszag testify when the projected deficit reduction doesn’t materialize? Waxman maintains his interest is ensuring the bill “does not have unintended consequences.”

Because an immensely complex bill of more than 2,000 pages would never have any of those, right? But Waxman’s vendetta and the offending write-downs are hardly unintended or unforeseen.

Democrats clearly plan to blame the private sector for all the downsides of their health plan. Pres. Barack Obama told liberal lawmakers in a private lobbying session that the bill is only “a beginning.” Any increase in costs and premiums — both of which are inevitable — will be attributed to corporate malfeasance requiring yet more government intervention.

Democrats can’t say they weren’t warned about the coming write-downs. Companies began to receive a tax-free, deductible subsidy in 2003 to continue prescription-drug coverage for their retirees, a ploy to keep the firms from dumping retirees into the new government prescription-drug program. Outside experts and big employers counseled against ending the deductibility, pointing out that it would adversely affect the companies’ financial statements immediately (accounting rules require that corporations note the long-term effect of the new liability right away).

These warnings got shelved under a category ensuring their brusque dismissal: Information Inconvenient to the Passage of Health-Care Reform. Now that the prediction has come to pass, it’s all AT&T’s fault.

The companies will reconsider providing prescription-drug coverage for their retirees at all. The Employee Benefit Research Institute calculates that companies could now save $1,000 per beneficiary by handing them off to the government. As many as 2 million more retirees could end up on the government program, according to James Klein of the American Benefits Council. These retirees might wonder about the truthfulness of Obama’s constant promise that everyone can keep his current insurance.

The CBO estimated that the new treatment of the subsidy would generate roughly $5 billion in revenue. If companies stop taking the subsidy, that revenue disappears, while the costs of the drug program increase. A Towers Watson study stipulates that “employer plans generally provide much better protection than the standard Medicare benefit.” And subsidizing those employer plans is cheaper to the government than providing the coverage itself.

In short, a lose-lose-lose proposition — no doubt, the first of many. Henry Waxman will be a busy man.

— Rich Lowry is editor of National Review. © 2010 by King Features Syndicate.

http://article.nationalreview.com/429748/waxmans-vendetta/rich-lowry
Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31884


« Reply #578 on: March 30, 2010, 04:09:57 PM »

Rarick:

That comes up blank for me.
Logged
Rarick
Guest
« Reply #579 on: March 31, 2010, 03:50:27 AM »

How about this link: http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590ENR/pdf/BILLS-111hr3590ENR.pdf

It is a PDF file, those sometimes take a while
Logged
Body-by-Guinness
Power User
***
Posts: 2792


« Reply #580 on: April 05, 2010, 07:35:58 AM »

Bluegrass Bummer
Does Kentucky’s experience with health-insurance overregulation hold lessons for repealing Obamacare?
 
In the mid-1990s, Kentucky was one of eight state governments that boldly went where the rest of the country refused to go: The commonwealth imposed Clintoncare’s restrictions on its insurance companies, even though Clintoncare had been vanquished from the national stage. In Kentucky and the other seven states, insurance premiums skyrocketed, healthy people stopped buying insurance, and insurance companies exited the market in droves. Only three of the eight were able to untangle themselves from the harmful provisions; only one, Kentucky, was able to pull off a full repeal.

Trey Grayson was elected Kentucky secretary of state in 2003, the year before Gov. Ernie Fletcher was able to finalize the repeal — you’ll note it took ten years to accomplish. Grayson, who is currently running for the Republican nomination to replace Jim Bunning in the U.S. Senate, says that those pushing to repeal Obamacare can take a few lessons from the Kentucky experience. “On the one hand it gives you some hope, because in Kentucky we were able to gradually repeal the elements that were driving up the number of uninsured, that were increasing premiums at a rate higher than the national average, that were driving insurance companies out of the state,” Grayson says. “But unfortunately it took ten years, caused rates to be higher, hurt our economy and hurt our state government from a revenue standpoint. So a lot of damage was done.”

In 1994, Democratic governor Brereton Jones strong-armed a version of Clintoncare through the Democratic-controlled state legislature over the reservations of Republicans and some conservative Democrats. Much like Obamacare, Kentucky’s House Bill 250 forbade insurance companies to deny coverage or charge higher rates based on pre-existing conditions, thus negating the point of insurance — which, properly understood, involves paying premiums to hedge against risk. Under Kentucky’s laws, as under Obamacare, you could wait until you got sick to buy coverage and still obtain it at the same rates as everyone else. (Obamacare includes a requirement that healthy people have insurance, which its proponents say will prevent the premium hikes and insurance-company flight that Kentucky experienced. But the penalty for evading this requirement is relatively small; its constitutionality is suspect; and it might not even be enforceable.)

The problem with such regulations is that healthy people make the rational decision to drop their coverage and wait until they get sick to renew it. As healthy people stop paying into the risk pool, premiums for those who remain skyrocket. If insurance companies are forbidden from increasing premiums to keep up with costs, they leave town or close down. Unsurprisingly, average premiums in Kentucky increased between 36 and 165 percent in the wake of the reforms. Within four years, over 40 insurance companies had stopped offering individual insurance coverage. The two remaining providers, Anthem Blue Cross/Blue Shield and a state-run plan called Kentucky Kare, teetered on the brink of insolvency (Kentucky Kare went under in 1999).

By the late 1990s, Grayson says, “If you said House Bill 250, it was a four-letter word.”

In 1998, the Kentucky legislature, still controlled by Democrats, started repairing the damage by passing a reform package that modified the insurance requirements but didn’t repeal them. In 1999, party switches gave Republicans control of the state senate, and the legislature repealed most of the harmful provisions. Finally, in 2003, Kentucky elected a Republican governor for the first time since 1967, and one of his first acts was to sign a moratorium on new insurance mandates. These reforms slowed the rise of premiums and started bringing insurance companies back to the state.

“What was interesting,” Grayson notes, “is that the repeals were done in a bipartisan manner. Democrats, many of whom voted for House Bill 250, saw the negative impact.” Rising premiums and fleeing insurance companies gave opponents of the bill a compelling story to tell. “When we had evidence, we used it,” Grayson says. “That was what convinced Kentucky voters.” The bill’s opponents armed themselves with facts, and the case against House Bill 250 grew too overwhelming to resist.

This is the first lesson proponents of repeal should take from Kentucky: Construct a narrative around all of the bill’s negative consequences. “So, for example, we’ve already had John Deere and Verizon and some other companies take charges for the next quarter,” Grayson says. “As we learn about businesses choosing to drop insurance or delay expansion plans or whatever they have to do to avoid this, I think we have to take those real-life consequences and tell the public.”

The second lesson, he says, “is that you don’t have to do a full repeal right off the bat. If you can start getting rid of some of the bad elements, try that.” Repealing the most unpopular parts of the bill — new taxes on investment, on income, on medical devices — can pave the way for repealing the spending provisions: “If those taxes have to be repealed or phased out,” Grayson says, “then you start to have a financial concern: How you are going to pay for all this stuff as the subsidies are phased in?”

Liberals are much more influential in Washington than in Kentucky’s statehouse in Frankfort: When the big problems with Obamacare start surfacing, they will push, not for repealing the bill, but for nationalizing even more of the health-care industry. They will call for a stronger penalty for not purchasing insurance or, if the Supreme Court invalidates that provision, they might push for a “public option” to offer a taxpayer-subsidized alternative to the private insurance companies they have broken. When the public option doesn’t work (and we know it won’t, thanks to another failed state experiment in Maine), liberals will argue that the only way to fix the broken system is to make the government the “single payer” for all medical costs.

Opponents of Obamacare must be prepared to make the opposite case, starting with this election cycle. The strongest lesson from Kentucky is that the longer Obamacare stays on the books, the more damage it will inflict on the economy. Conservative candidates such as Grayson can and should run on this issue. Health-care reform “is clearly on the minds of voters,” he says — it’s the second thing people want to talk to him about, after the University of Kentucky’s performance in the NCAA tournament — “and most folks I talk to are not real pleased. I think voters want us to do something about it — hopefully before the damage gets done.”

— Stephen Spruiell is an NRO staff reporter.

http://article.nationalreview.com/430274/bluegrass-bummer/stephen-spruiell
Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31884


« Reply #581 on: April 05, 2010, 08:46:02 AM »

Interesting.

Two questions for everyone here:

1)  What should be the rules concerning someone with a pre-existing condition?  What is the conceptual basis for your opinion?

2) What should be the rules for insurance companies when someone develops a serious condition?  Should the insurance company be allowed to drop them?  Raise their rates until they drop out?  Or?  What is the conceptual basis for you opinion?

I think answering these two questions important.  IMHO it is fear of these two issues that drives much of the support for the HC Law.

I look forward to everyone's answers.
Logged
DougMacG
Power User
***
Posts: 6178


« Reply #582 on: April 05, 2010, 10:44:36 AM »

First, remember poor people have free coverage, elderly have coverage, the rich have coverage (even if it is self insured) and the employees of most medium and large firms have plans, so we are filling a gap mostly where the cost doesn't show value to the person declining coverage.

I'll go with the easy one first: "2) What should be the rules for insurance companies when someone develops a serious condition?  Should the insurance company be allowed to drop them?"  

No.  That is what you are carrying healthy insurance for, IMO, so it will be in place when you are not healthy or eligible for affordable coverage.  The policy pays up to the policy lifetime limits if the premiums are maintained.  Otherwise, who would ever insure while they are healthy?

1)  What should be the rules concerning someone with a pre-existing condition?  What is the conceptual basis for your opinion?

Conceptually, there is no easy answer.  We can deny coverage but we don't deny treatment.  This current law will requires 'repeal and REPLACE'. You can't politically just repeal and this is the heart of it.

Generally when I see a 3-way financial dispute, in this case the taxpayer, the insurance company and the patient, I say split it 3 ways in compromise.  There should be a one-time settlement to allow all people with pre-conditions now to get in.

Going forward without an individual mandate, the incentive needs to be to take coverage now while you're healthy and a strong disincentive to wait.  All you can really do is require a spend down of people's future assets and income if they wait.  Isn't this done with nursing home costs now?
« Last Edit: April 05, 2010, 10:46:58 AM by DougMacG » Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31884


« Reply #583 on: April 05, 2010, 11:07:19 AM »

Thank you.

Please allow me to add a third question for everyone:

3)
   a) Should Medicare and Medicaid exist?  If yes, what is the conceptual basis?  If not, what should be done? 
   b) If they should exist/can't be terminated, are they solvent?  If not, what should be done?
Logged
Body-by-Guinness
Power User
***
Posts: 2792


« Reply #584 on: April 05, 2010, 05:37:20 PM »

Crafty,

We've visited these questions before; is there a specific response you are seeking?

Think of much of what would follow depends on the market philosophy one initially embraces. Free market purism invokes specific and predictable parameters; a private/public solution does the same, as does a public only. Unfortunately the tangled mess we are currently encumbered with upon which the new 2000 page mess is overlaid does not lend itself to clean cleavages or quick answers so I'm loathe to start deconstructing as only "yes buts," will follow. Will say that the current amalgamated mess has me thinking along lines applied when someone bites you: the best strategy is to jam the affected body part deeper into the gullet and wait for the gag reflex to do the work for you. Confess currently waiting for this mess to collapse under it's own weight and then being poised to deal with the pieces strikes me as the only foreseeable path.

Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31884


« Reply #585 on: April 05, 2010, 09:19:14 PM »

Fair enough.

I guess what I am looking for here is the ability to concisely state what we believe and why.  If we can't do that, then we are not poised to do anything.
Logged
Rarick
Guest
« Reply #586 on: April 06, 2010, 05:06:45 AM »

Interesting.

Two questions for everyone here:

1)  What should be the rules concerning someone with a pre-existing condition?  What is the conceptual basis for your opinion?

2) What should be the rules for insurance companies when someone develops a serious condition?  Should the insurance company be allowed to drop them?  Raise their rates until they drop out?  Or?  What is the conceptual basis for you opinion?

I think answering these two questions important.  IMHO it is fear of these two issues that drives much of the support for the HC Law.

I look forward to everyone's answers.

3)
   a) Should Medicare and Medicaid exist?  If yes, what is the conceptual basis?  If not, what should be done? 
   b) If they should exist/can't be terminated, are they solvent?  If not, what should be done?
 
 

1)  Is the Preexisting condition and "acquired condition"?  Lung cancer from smoking, High Blood pressure from overweight/flabby body for example. In which case I would say "conditional coverage" lose the weight/quit smoking/ etc. in a certain amount of time to gain coverage.

Is it a regular disease- cancer, polio, or other type of condition that happens despite what would be a normally healthy life style?  In which case my question would be who dropped coverage?  That insurer would then be responsible for meeting his contract.  If there has not been any previous coverage, then coverage at an increased premium would be the option.

People are responsible for keeping themselves healthy- they are the owner of their life and body, if they are failing in this responsibility another should not be held accountable.  The Insurer has the right to set conditions on what they will cover and how given their assumption of risk. Individuals who do not care enough to take care of themselves can hardly expect anyone else to care.  If they choose a high risk uninsurable life style- then they have to assume the responsibility all the way.   Ther are instances where a healthy and responsibly acting individual just gets sick thru no fault of his own, the premiums he has been pating should cover this, and the insurance company should not be able to "minimize losses" by suspending coverage when a person has been paying in.  If a person is trying to be a leech by insuring themselves only when they think they might have a major risk, then they should be charged somwething more as part of paying their fair share.

2) The Insurance companies have a responsibility to charge a fair rate for their coverage, if they are cutting their premiums so much that they cannot sustain the losses on the other end of the policy (ie, I have been paying for 20years to cover myself now, but the company dropped me) then they are not doing their job.  If companies are undercutting then it is lawsuit time?  I do not know what laws would apply but there are several under restraint of trade of business practices?

3) Medicare and Medicaid probably would be unnecessary if the insurance companies were doing their job.  If you are an individual that did not plan properly, then you are free to pay the consequences as far as I am concerned.
Logged
Body-by-Guinness
Power User
***
Posts: 2792


« Reply #587 on: April 06, 2010, 07:46:52 AM »

I think free market purism is the avenue that will return the greatest number of positive results for the greatest number of people, while providing disposable income enough for those inclined to do so to donate to assist hard luck cases. I think the current political climate, however, leaves one side of the aisle dependent on a permanent underclass demanding that basic services be inefficiently distributed by the federal government, which in turn creates an ever expanding redistributive bureaucracy. I don't see much being done to address this status quo until it collapses under its own weight, expect instead that band-aids will keep getting slapped on to the current structure to keep it barely afloat, though hope at some point Americans wake up and realize the current special interest hodgepodge does not serve our interests and so vote out the the non-managerial non-mathematicians that brought us this current mess. Alas, this subject is all too easy to demagogue, so I don't hold out much hope for rational progress.
Logged
ccp
Power User
***
Posts: 4214


« Reply #588 on: April 06, 2010, 09:46:27 AM »

Can we do without Medicare?
I don't know.
Is there any realistic chance this can be abolished.
I really don't see how.

The most important thing to a senior is their medical care. I remember when I lived in Florida and every single time I sat somewhere, say a restaurant  (including toojays) and I was near a table of seniors 100% of the time the topic of their conversation would turn to medical issues.  Whose your doctor, their medicines, their insurance, their HMO, their medical problems.  Every single time.  NO exceptions.

Some seniors seem happy with their care.  Others complain about the costs of their meds, they say the "donut" hole helps but some still complain about having to pay almost anything for medicines.

I guess my point is it is political suicide to even suggest eliminating Medicare.   IMHO forget about it.  Your like tearing their hearts out.  In their minds it IS a fight to the death.

As for cigarettes I agree.  I used to be against the cigarette tax as I am with most taxes.  Yet when I watch people continue to smoke despite their knowing better, despite for some of them incurring huge life and limb threatening medical problems as a result I find it hard to have sympathy.  I had a patient recently tell me she did not want to quit now.  Her father was sick.  I asked if she wanted to quit.  She said yes.  So I asked what was the reason you didn't quit before he was sick.  I got no answer.  I pointed out there is always some excuse in the "rat race" of life to have a reason not to quit.

Therefore I urged he to stop making excused and to please get serious about thinking about a strategy that will work for her.

Frankly it is exasperating.  While I hate to see people suffer, see people get medical problems I find it hard to feel sorry for people who won't quit.  They are doing it to themselves.  I am glad they are paying tax.  They who smoke are costing this country a gigantic bundle in medical care.
Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31884


« Reply #589 on: April 06, 2010, 10:17:02 AM »

I agree that advocating abolishing Medicare would be political suicide.  So do we simply say that, or is there a principled reason which reaches the same conclusion?

Am I also correct in thinking it already or about to be bankrupt?  If so, what, if any, principles apply?
Logged
ccp
Power User
***
Posts: 4214


« Reply #590 on: April 06, 2010, 12:28:24 PM »

"or is there a principled reason which reaches the same conclusion?"

I just did a search on this and cannot find much though it may be the search words I use.

I guess some would claim Medicare is not an entitlement per se since we pay into it.

We will eventually wind up with rationing of some sort.  Look at all the other countries that have gone this path and they all ration.
And they are going broke anyway.

The wheels are in motion.  As this bill leads us to have gigantic cost overuns (and it certainly will) the powers to be will continue to implement fixes that eventually will lead to rationing.  I have not heard anything that convinces me there is any other alternative.  Certainly not from the repubs.



Logged
Rarick
Guest
« Reply #591 on: April 07, 2010, 07:40:54 AM »

I wish that congress and the IRS did not have control over this program.  I wish they had chosen to do something like make a deal with the AMA and a large non-traditional medical organization.  If those 2 mereged and ran "basic" medical and life saving like the post office runs "basic" mail and package? Base the costs of this basic care off of the "medcal expense account" that everyone has access to. (The one limited by the current bill to 2.500/yr)  Use the revenue from the "dissappearing" savings account to go to Basic Care? (people could use it as a chritable tax shelter while using some of it for themselves?)

As it is I see no real way out aside from full repeal and rework from the start.
Logged
ccp
Power User
***
Posts: 4214


« Reply #592 on: April 07, 2010, 10:43:19 AM »

Rarick,
I agree with you.
But doctors are far from organized and a large heterogenous group of different specialties, ages, men vs women, ethinic groups, foreign born vs American born, and philosophies.

There are many articles in the med journals making "calls to action".   Like, "we doctors must take action now or we never will, etc, etc, yadda, yadda, etc".
"We are the buyers in health care not the patients(since we are the ones ordering tests, etc)".  Blah blah blah blah blah.

I can go on ad nauseum.   Usually a few people will write letters to the editor in response to these articles some agreeing some the other way.  The medical organizations have different stances too.  The American College of Physicians has already accepted for *many* years now the fait accompli (sp?) of government takeover of health care and sucks up to the government agreeing to nearly every concept they come up with in hopes we can salvage at least a minimal say in what happens.  For example if we can at least get some tort reform.  Or some payment reform to salvage primary care from the ruins it is in.  Of course the Feds take payments away from specialists to give us a few bones fragmenting the medical community more.  The Cardiologists who for all intents and purposes have done everything they can to soak the  system for every dime have attempted to sue the Feds for payment cuts.  Of course that didn't work.  I have no sympathy for what one primary doc rightly called the "priviledged class" when referring to cardiologists.

Of course the dishonest Phoney One  goes around claiming that illegals are not covered now suggesting no one need worry about that.  Of course he fails to say that all their American born children are.  And what a joke this will turn out to be the true minute they grant amnesty cloaked as some sort of program that requires them to pay fines, learn some English, pay back taxes etc.

There is NO escaping the conclusion that any rational person can come to that the policy makers that come up with these gov. health care plans and the politicians that push for them including the great liar in chief, do not know the sytem WILL go broke when millions more are added onto the rolls requiring the government to step in and save it from itself with single payer.  (Keeping these people out of ERs won't do it.  In fact I predict it will just make costs go up even more.)

THE REAL TRUTH IS THAT THIS IS THE STRATEGY.

Pelosi/Bela Lugosi has already basically said as much when she claims this bill is just the start.  "Kicking in the door" and more bills to fix the system towards their ultimate goal.  Bama has said as much too.

I am sure that Bama told this to Kusinich on that air force one plane ride.  He must have told him not to worry.  That the present bill is the only one politically viable enough to get passed, but not to worry as it is only the start of a process to get "our" ultimate goal passed which is single payer government run rationed care where everyone is treated exactly like everyone else. 

I am sure he told him he agrees with Kusinich in principle and probably promised him that they will together succeed but it takes time.  "Pretend to be one of them if you want to change them".

There is no question we will have debt skyrocket as a result.  Don't think for even a second, or a pause that all this talk of bundling payments, research into cost effective care, getting rid of the middle men insurers, single payer, preventative care, etc, will be enough.  It problably will help but as soon as millions more are on the rolls for free to them - the game is up.  Look at Massachussets. Romney is the poster boy for this.

 
Logged
ccp
Power User
***
Posts: 4214


« Reply #593 on: April 08, 2010, 01:40:15 PM »

From the New England Journal of liberalism, woops I mean Medicine.  Notice PhDs are getting this political piece published in the NEJM that purports to be non partisan.
Look at this line carefully:

***On the political front, Republicans unanimously opposed the final bill in both the House and the Senate. They have expressed outrage at the Democratic leadership’s decision to “ram through” reform using budget reconciliation to modify the Senate-passed bill sufficiently to make it acceptable to the House. The outrage is baseless***

Oh really,  the outrage is "baseless".  Says who?  These policy liberals are the ones who are going to decide all health care in this nation.  Make no mistake about it.  They are drooling at the prospect of getting the power to say yes or no to our health care.  I wonder what they make.  FOX news should do some research on these people and their financial interests.  Notice they all seem to fall behind the scenes.  Yet they are making policy the Dems are shoving down our throats - I know this claim is "baseless".  Where is the journalism that should be looking into these progressives?

****from the publishers of
the New England
Journal of Medicine
The War Isn’t Over
Posted by NEJM • March 24th, 2010 • Printer-friendly
Henry J. Aaron, Ph.D., and Robert D. Reischauer, Ph.D.

Health care reform advocates will and should celebrate their history-making legislative success. For many, the past year has been all health care all the time. Celebration should be limited, however. Major challenges lie ahead, and hard work remains to be done. Opponents will continue, and probably intensify, their opposition. They have promised legal challenges and are likely to seek repeal of all or part of the legislation. Moreover, formidable implementation hurdles must be surmounted if health care reform is to achieve its goals.

On the political front, Republicans unanimously opposed the final bill in both the House and the Senate. They have expressed outrage at the Democratic leadership’s decision to “ram through” reform using budget reconciliation to modify the Senate-passed bill sufficiently to make it acceptable to the House. The outrage is baseless, but the fury is real and will poison future debate.

The first political testing ground will be the November 2010 midterm elections. Republicans have pledged to make the substance of the reform and the procedures used to enact it central to these elections. The Democratic majorities in both chambers of Congress are likely to be reduced, probably by even more than is usual for an off-year election. With 2010 gains under their belts, opponents will almost certainly continue and intensify attacks on the reform legislation during the 2012 presidential and congressional campaigns; they may well regain control of the Senate — 21 Democrats and 2 independents who vote with them, but only 10 Republicans, will be up for reelection — and could win the White House.

The reform legislation’s implementation schedule gives these political possibilities particular salience. Although many provisions of the bill will take effect immediately or soon after enactment, implementation of the big-ticket items is deferred. The individual and employer mandates, the subsidies to make insurance affordable, the Medicaid expansion, and major insurance-market reforms will all start in 2014. And the tax on high-cost insurance plans goes into effect in 2018. Given the intensity of Republicans’ opposition to the substance and manner of passage of this reform, if the GOP regains the presidency and control of Congress in 2012, implementation could be substantially delayed or the law could be significantly modified or even repealed before its major elements have been implemented.

Making the legislation a success requires not only that it survive but also that it be effectively implemented. Although the bill runs to more than 2000 pages, much remains to be decided. The legislation tasks federal or state officials with writing regulations, making appointments, and giving precise meaning to many terms. Many of these actions will provoke controversy. Performing them will take staff, money, and time. Given the current federal deficit and beleaguered state treasuries, needed staff and funding will be hard to come by.

Even with adequate resources, implementing health care reform will be complex and difficult. Much of this challenge is inherent in the complicated and diverse ways in which health care is delivered and paid for in the United States. Part of the challenge arises from the likelihood that as implementation proceeds, unforeseen challenges will emerge.

To get some flavor of what lies ahead, consider the following. The law provides for income-based credits payable by the federal Internal Revenue Service (IRS) to insurers on behalf of households that apply for coverage through state-managed health insurance exchanges. IRS filing units (whether individuals, couples, or families) are not always the same as the units covered by a health insurance policy. Eligibility for health insurance subsidies should be based on current income, but the IRS has income information only for past years. Mechanisms for exchanging income information between the IRS and the state insurance exchanges will need to be developed, as will ways of handling subsidies when definitions of a family unit vary and when family composition or income changes significantly between the time that taxes are filed and the time when insurance subsidies are to be delivered.

Other issues arise because the legislation asks state officials, some of whom oppose the reform, to play a large part in its implementation. The bill calls on each state to set up its own health insurance exchange and permits the exchanges to operate under widely varying rules. For example, states may establish separate exchanges for individuals and for small groups and may create a basic plan for individuals and families with incomes between 133 and 200% of the federal poverty level. Insurers need not offer the same plans in the exchanges as they do outside them. Averting insurance-company competition that is based on risk selection will require aggressive state oversight, which some states may be unwilling or unable to provide.

These responsibilities will be terra incognita for many state administrators. Even when goodwill prevails, administrators will find implementation very difficult. However, the experience of the Commonwealth Connector, the exchange though which Massachusetts residents without employer-provided insurance obtain affordable coverage, offers encouragement that these difficulties can be overcome.

Furthermore, parts of the reform are bound not to work as expected. For example, the legislation calls for extending Medicaid to everyone with an income below 133% of the federal poverty level. Medicaid rolls in some states will expand by 50% or more. It is unclear whether these states will be able to find enough providers who are willing to accept the anticipated payment rates to serve this expanded population, even as the demand from better-paying patients for services is growing. If they don’t, will they raise provider payment rates, curtail Medicaid benefits (as states are legally authorized to do), or simply let patients fail to find doctors who are willing to provide them with care?

To further complicate matters, some families may be able to buy insurance in several distinct ways, depending on their income, family composition, and state policy. Different family members may be eligible under Medicaid, under the Children’s Health Insurance Program (CHIP), through the exchanges with subsidies, through the exchanges without subsidies, or through a yet-to-be-created state basic health insurance plan. If employers offer plans that meet federal standards and cost households no more than stipulated fractions of the worker’s income, employees will not be eligible for insurance through exchanges, but if employment-based insurance does not meet federal standards or is too costly, employees will have the option of buying insurance through the exchanges — with or without subsidies, depending on income. Small changes in income can push some, but not all, family members from one form of coverage to another — for example, from Medicaid or CHIP to the basic plan to the exchanges. Negotiating this maze will be a challenge for many health care seekers, particularly low- and moderate-income families. Providing ample counseling will be essential. These and myriad other implementation difficulties will fuel continued political controversy.

Passage of health care reform legislation is a cause for celebration. But supporters must not relax. They should prepare to meet the serious challenges that remain. If those challenges are not recognized and surmounted, health care reform could go the way of the Medicare Catastrophic Coverage Act of 1988. That bill, enacted with almost self-congratulatory enthusiasm, provoked vociferous resistance from some observers and was repealed 16 months later. If supporters of the current reform meet the remaining challenges, its course could instead resemble that of the Medicare drug bill, which was widely regarded as a case study in efficient and effective implementation.

Far from having ended, the war to make health care reform an enduring success has just begun. Winning that war will require administrative determination and imagination and as much political resolve as was needed to pass the legislation.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

Source Information

From the Brookings Institution (H.J.A.) and the Urban Institute (R.D.R.) — both in Washington, DC.

This article (10.1056/NEJMp1003394) was published on March 24, 2010, at NEJM.org.

Download a PDF of this article
Read this article at NEJM.org
ShareThis
 © 2010 Massachusetts Medical Society  Entries (RSS)  Comments (RSS) ****
Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31884


« Reply #594 on: April 08, 2010, 07:56:06 PM »

It looks like we just got notified by our provider, Anthem Blue Cross, (yes those folks) that our rates are going up 100%. angry shocked angry

Our agent had told us we were guaranteed the rate we had for many more months.  He is out of town until Monday, at which point we will seek clarification.

If this turns out to be what it appears to be, it is a real hard hit for our family.
Logged
ccp
Power User
***
Posts: 4214


« Reply #595 on: April 09, 2010, 10:43:07 AM »

Crafty,

That is terrible.
I sympathize.
There is no doubt this is due to the health care bill.
The insurers are going to have to come up with money somewhere to pay for all the new people with medical conditions and the rest.
They started jacking up the rates this past year in anticipation of the health care bill.

My rates up 21%.  I am sure they will skyrocket even more now.

An MBA administrator I work with who works closely with some of the big insurers in NJ said that the health care companies aniticipated the health care bill passing and would have been in total disaray if it *didn't* pass.

The  health care policy makers and ALL the politicians behind the bill including of course Bama *know* this will happen.  They know rates will skyrocket, they know people will be screaming for government to step in, they will be out their populist hay out of the insurers "ripping us off" and eventually will slowly but surely have government step in and take control and dictate the rationing of health care to all of us.  He/they are lying to us when they pretend otherwise.  Talk radio is correct on calling them on this and the disingenious jerks who publish in the NEJM who claim that those who opposed the bill were doing so on "baseless" or bogus "claims" are boldfaced ideologues - no less no more.  Now if I send in a letter to the NEJM editor calling them on this the journal will simply not publish my letter.

Thus they forced down the throats of 90% of the US population their will forcing us to pay for the 10% who will get the free benefits.  And yes the benefits will be free.

Do not think for one second they don't KNOW this.  Of course they do.

And getting back to your question as to whether Medicare can be replaced by anything else - I don't know the answer and I have not seen anyone even consider this or entertain that idea - though it is a good one.

Unfortunately, as you can see by my post of the NEW ENGLAND JOURNAL OF MEDICINE article which is the medical version of the NYT, the policy people behind the wheels and gears of health care policy want to *expand* and not do away with Medicare/caid.  They want to expand it to all Americans with *them at the helm*.

I keep thinking I must cancel my subscription to the NEJM but I keep talking myself out of it because they are the premier journal in the US and I do like to read their occasional important medical publications.  That said I can tell you without quivication that most doctors are outraged by their politics and that journal does NOT speak to most of our views on the health care debate.  The journal stifles any real disagreement or letters of correspondence that hold opposing views to their liberal clones that get their articles and opinions published as though it is gospel and make it appear they speak for us.

Logged
Rarick
Guest
« Reply #596 on: April 09, 2010, 10:47:09 AM »

yeah, a 0 deductible to a 500$ deductible...........  I'm going to have to start playing a game I have been putting off, Tax Shelter and I am only average income Sad
Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31884


« Reply #597 on: April 09, 2010, 08:44:45 PM »

Well, good news-- it looks like for some reason we were billed for two months, which included a slight increase due to a , , , particular birthday of my wife.
Logged
G M
Power User
***
Posts: 12184


« Reply #598 on: April 12, 2010, 10:35:39 PM »

http://hotair.com/archives/2010/04/12/nyt-obamacare-may-have-accidentally-stripped-congress-of-health-coverage/

BwahahahaHAHAHAHAHAhahahahaha!!!
Logged
ccp
Power User
***
Posts: 4214


« Reply #599 on: April 13, 2010, 10:00:15 AM »

The new doctors will come from overseas.  As is already the case in NJ.
I was shocked when an *Indian* colleague of mine complained about the doctor competition in NJ by saying the "damn Indians, they just keep coming".  I don't balme them if they want a better life here.  But when does it end or even slow?

By SUZANNE SATALINE And SHIRLEY S. WANG
 
Getty Images
 
First-year resident Dr. Rachel Seay, third from left, circumcises a newborn in George Washington University Hospital's delivery wing on March 12.
The new federal health-care law has raised the stakes for hospitals and schools already scrambling to train more doctors.

Experts warn there won't be enough doctors to treat the millions of people newly insured under the law. At current graduation and training rates, the nation could face a shortage of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges.

That shortfall is predicted despite a push by teaching hospitals and medical schools to boost the number of U.S. doctors, which now totals about 954,000.

The greatest demand will be for primary-care physicians. These general practitioners, internists, family physicians and pediatricians will have a larger role under the new law, coordinating care for each patient.

The U.S. has 352,908 primary-care doctors now, and the college association estimates that 45,000 more will be needed by 2020. But the number of medical-school students entering family medicine fell more than a quarter between 2002 and 2007.

Related Video
Medical Training in Second Life (04/12/10)Getting Doctors, Hospitals to Use Electronic Medical Records (01/26/09)Faces of Health Care: A Doctor is in the House (12/22/09)A shortage of primary-care and other physicians could mean more-limited access to health care and longer wait times for patients.

Proponents of the new health-care law say it does attempt to address the physician shortage. The law offers sweeteners to encourage more people to enter medical professions, and a 10% Medicare pay boost for primary-care doctors.

Meanwhile, a number of new medical schools have opened around the country recently. As of last October, four new medical schools enrolled a total of about 190 students, and 12 medical schools raised the enrollment of first-year students by a total of 150 slots, according to the AAMC. Some 18,000 students entered U.S. medical schools in the fall of 2009, the AAMC says.

But medical colleges and hospitals warn that these efforts will hit a big bottleneck: There is a shortage of medical resident positions. The residency is the minimum three-year period when medical-school graduates train in hospitals and clinics.

There are about 110,000 resident positions in the U.S., according to the AAMC. Teaching hospitals rely heavily on Medicare funding to pay for these slots. In 1997, Congress imposed a cap on funding for medical residencies, which hospitals say has increasingly hurt their ability to expand the number of positions.

Medicare pays $9.1 billion a year to teaching hospitals, which goes toward resident salaries and direct teaching costs, as well as the higher operating costs associated with teaching hospitals, which tend to see the sickest and most costly patients.

Doctors' groups and medical schools had hoped that the new health-care law, passed in March, would increase the number of funded residency slots, but such a provision didn't make it into the final bill.

"It will probably take 10 years to even make a dent into the number of doctors that we need out there," said Atul Grover, the AAMC's chief advocacy officer.

While doctors trained in other countries could theoretically help the primary-care shortage, they hit the same bottleneck with resident slots, because they must still complete a U.S. residency in order to get a license to practice medicine independently in the U.S. In the 2010 class of residents, some 13% of slots are filled by non-U.S. citizens who completed medical school outside the U.S.

One provision in the law attempts to address residencies. Since some residency slots go unfilled each year, the law will pool the funding for unused slots and redistribute it to other institutions, with the majority of these slots going to primary-care or general-surgery residencies. The slot redistribution, in effect, will create additional residencies, because previously unfilled positions will now be used, according to the Centers for Medicare and Medicaid Services.

From the Archive
Opinion: How to Fix the Doctor Shortage (01/04/10)Health Blog: Would Adding Residency Slots Solve the Primary-Care Shortage? (11/27/09)Opinion: The Coming Shortage of Doctors (11/06/09)Health Blog: Obama: 'Severe Shortage' of Primary Care Doctors (08/11/09)Some efforts by educators are focused on boosting the number of primary-care doctors. The University of Arkansas for Medical Sciences anticipates the state will need 350 more primary-care doctors in the next five years. So it raised its class size by 24 students last year, beyond the 150 previous annual admissions.

In addition, the university opened a satellite medical campus in Fayetteville to give six third-year students additional clinical-training opportunities, said Richard Wheeler, executive associate dean for academic affairs. The school asks students to commit to entering rural medicine, and the school has 73 people in the program.

Journal Communitydiscuss“ As a specialist physician I will suggest that until primary care physicians can earn 70-80% of what most specialists make without killing themselves, there will be no incentive for the best and the brightest to go into primary care. ”
—Michael Brennan "We've tried to make sure the attitude of students going into primary care has changed," said Dr. Wheeler. "To make sure primary care is a respected specialty to go into."

Montefiore Medical Center, the university hospital for Albert Einstein College of Medicine in New York, has 1,220 residency slots. Since the 1970s, Montefiore has encouraged residents to work a few days a week in community clinics in New York's Bronx borough, where about 64 Montefiore residents a year care for pregnant women, deliver children and provide vaccines. There has been a slight increase in the number of residents who ask to join the program, said Peter Selwyn, chairman of Montefiore's department of family and social medicine.

One is Justin Sanders, a 2007 graduate of the University of Vermont College of Medicine who is a second-year resident at Montefiore. In recent weeks, he has been caring for children he helped deliver. He said more doctors are needed in his area, but acknowledged that "primary-care residencies are not in the sexier end. A lot of these [specialty] fields are a lot sexier to students with high debt burdens."

 Write to Suzanne Sataline at suzanne.sataline@wsj.com and Shirley S. Wang at shirley.wang@wsj.com

Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved
Logged
Pages: 1 ... 10 11 [12] 13 14 ... 28 Print 
« previous next »
Jump to:  

Powered by MySQL Powered by PHP Powered by SMF 1.1.19 | SMF © 2013, Simple Machines Valid XHTML 1.0! Valid CSS!