Here, Have a Place to Talk About That Other Obama Speech

You know. The one where he overthrew the capitalist system to give illegal immigrants federally subsided breast enhancements.

Oh, sorry, wrong universe. I mean, the one where he talked about health care.

Keep it mellow, don’t stab each other in the eyeballs, and remember that slapping down the “Obama = Socialist” card will get you laughed at or deleted as a troll.

I’ll post some thoughts in an update in a bit.

Update:

Shorter Barack Obama: Okay, kids, you’ve had your fun with the death panels and the socialism and the illegal immigrants. Now cut that shit out and let’s do this thing.

Which is I suspect most people wanted to hear from the man tonight. Obama does give off the vibe of the PE teacher who lets the kids horse around for the first five minutes of class but then lightly smacks them across the head to get them in line for calisthenics, and I get a sense that people respond to that. I also get a sense that people actually don’t mind listening to him discuss things at length, which is why addresses like this are really a good medium for him. People trust him to be able to hold a thought in his head.

As for what he outlined, I found it all reasonable, but then this isn’t a huge surprise, since Obama’s strategy here is “roll this sucker right down the middle of the road,” which is where I’m at on this. I’m perfectly good with keeping my current insurance and not having to worry about the company kicking my ass out if I get sick because I forgot to disclose I’m allergic to angora rabbits, I’m fine with insurance exchanges, and if it’s necessary I’m fine with some sort of public option for the poor bastards who can’t get insurance any other way. The one thing that twinged me was the “requiring coverage” thing, since I wonder how they’re going to enforce that with either the crazy compound types or (rather more relevantly) people like the Amish or Mennonites, who have religious objections to insurance. In the latter case, at least, there’s already been some discussion.

I do feel sorry for progressives who feel that Obama’s too eager to compromise on points they feel he doesn’t have to, but as noted before at a certain point I think it should have been obvious to everyone that Obama’s essentially centrist, and that his goal is to get the fundamental concept of universal coverage on the books now, and not worry about fiddly details that can be worried about later. I think Obama’s also aware that any GOP participation now on the legislation makes it harder for a potential future GOP majority to throw it out later. And so on.

To boil it down in sports terms, progressives want Obama to throw long bombs deep into enemy territory, and Obama’s content with a “three yards and a cloud of dust” strategy. My thought on it is: with past legislative victories, the dude’s made it clear he can put points on the board, so if I were on his team, I’d let him play the game how he wants to.

As for the Republicans, well, a handy tip: When the President of the United States is going out of his way to give you props in a joint address of Congress, having one of your number shout “you lie!” loud enough to get picked up on TV makes you look bad. Especially when, the president is in fact not lying about the thing he’s being accused of lying about (federal health care coverage for illegal immigrants). Which makes that particular representative (apparently Rep. Joe Wilson of South Carolina) look ignorant. I mean, really, Rep. Wilson; if you’re going to make an ass of yourself on the floor of the House, at least make an ass of yourself on a topic you’re accurate about.

On the other hand, Wilson’s just made himself into the dickhead poster boy of unthinking partisanship for the rest of the health care debate, and don’t think the people who want to get health care passed won’t exploit the hell out of it. So, you know. Well done, Rep. Wilson. Well done indeed.

And there you have it.

Also, the text of the speech.

209 thoughts on “Here, Have a Place to Talk About That Other Obama Speech

  1. I like the idea of the federally funded breast implants speech better, but it’s easier to just go “Gaaaa” as a guy than actually have to think about healthcare.

    I think I’ll deal with the real one, though, because it’s important (and he’s saying things which need to be said).

  2. As a friend of mine pointed out to me, having a medical insurer in the market who is /not/ actively trying to screw you over will, in all likelihood, cause the industry to collapse.

    As a capitalist, I still cannot find it in myself to feel all that upset about such portents. And am very excited to see what insurance startups might climb out of the heap.

  3. This is the rowdiest I’ve seen a joint session of Congress since I can remember. It sounded more like the House of Commons than the Capitol building.

  4. I unfortunately had to work late and only caught the tail end of the speech- but what I heard certainly sounded like he was done taking crap from the idiot wingnuts on this issue. If the whole speech was like that, then I’m satisfied that it was a good one.

  5. To be honest, I don’t know how anyone of reasonable intelligence can call themselves a Republican now. While I don’t agree with parts of the health care bill, I think we all can see that the cost of health care is rising at an unacceptable rate and that without curbing the abuse of both the system and the insurance companies, those costs are going to be an albatross around our collective necks.

  6. Scott @ #15 – And he’s provably wrong. There’s still nothing in the bill about health care for undocumented immigrants.

    Oh, and to add in the voice of the man who makes the entire Republican party cower in fear, Rush Limbaugh just came out and said that going without insurance is cheaper than having it

    “You oughtta try this, folks, just a standard doctor visit, offer to pay for it yourself,” said Limbaugh. “I guarantee it’ll cost you less than if you use your insurance.”

    Having done this when I’ve been uninsured, I’m sort of amused at how wrong and stupid the guy is. I’m not even going to get into how much my dental and vision coverage save me.

  7. Josh @17

    I’m sorry, what? Seriously?

    I wonder how many people will actually DO that instead of assuming that Rush knows what he’s talking about.

  8. But you don’t understand! It sounds good, but did you ever see that movie “They Live” with where everything looked fine but then Roddy Pipper found these glasses that showed the truth, and that it was an alien plot and innocent signs were really subliminal messages? It is exactly like that but with sound.

    Obama’s speech sounded all reasonable, but what he really said, subliminally was that we should worship Karl Marx and join his collective, killing all of the elderly and inform for the greater glory of world socialism.

    The media doesn’t what to hear this though because they have been fooled by the innocent sounding message that is masking the horrible truth.

  9. @Josh Jasper #17 – I’m going to have to go with Rush on that one. He is the world’s foremost expert at purchasing prescriptions with cash, after all.

    Seriously, has he ever looked at a doctor’s bill? My primary care guy gets $110/year from my HMO, to pay for four visits and four sets of blood testing. A shmoe off the street pays more than that for one visit.

  10. I’m tellin ya, I’ve definately been rethinking my whole position of calling myself a Republican over the last couple of months. Especially with the jack*** calling the President a liar. Reminds me of those videos of places like the Indian parliment where half the room erupts into a free-for-all brawl; just shameful. I could have sworn we didn’t have this many crazies a year ago…

  11. Slight bit of obfustication of the President’s part; he’s spoken out in favor of “comprehensive immigration reform” ie slapping the illegals with a superficial fine, requiring by law for them to learn English (like the government would waste time and resources enforcing that law) and sprinkling them with magic fairy dust and presto! Instant legal residency! The term “illegal immigrant” would fall out of usage because there would be nothing illegal about it, except for the folks who are stupid enough to commit major felonies before they can get sprinkled with that magic fairy dust. So, technically, he’s right; there will be no government health care coverage for illegal immigrants, but there would be any more illegal immigrants in President Obama’s America.

  12. Joe Wilson makes me proud to be a moderate. Good riddance Republican party, I don’t need you anymore.

  13. Scott@15,

    The apology, according to the WSJ:

    UPDATE 10:33 p.m.: Wilson apologizes in a statement: “This evening I let my emotions get the best of me when listening to the president’s remarks regarding the coverage of illegal immigrants in the health care bill. While I disagree with the president’s statement, my comments were inappropriate and regrettable. I extend sincere apologies to the president for this lack of civility.”

    I definitely think this Wilson guy is a douchenozzle, but I would not characterize this as an insincere apology- seems pretty good to me as far as politician’s apologies go.

  14. The way South Carolina politicians kee pscrewing around, er, up, screwing up lately, Colbert jsut might get himself a public office after all.

  15. @25 The Other Keith — but it’s easy to apologize after the fact. You’ve said it, it’s been broadcast around the world, you made your point, and the WRA will be funding your election campaign. You can *afford* to apologize, heh.

  16. @22… you’d be wrong. I have zero patience with any Republican because you all stood by and nodded while Coulter and her ilk called people who disagreed with Bush traitors and unpatriotic. That went on for the better part of a decade – if you thought your party just started acting crazy in the last year you haven’t been paying attention – your party started going whacko with Reagan.

    I’d love the traditional conservative movement back because I think we’re healthier as a nation when we intelligently debate issues… but Reagan invited far right religious zealots in and it worked to broaden power since those people are motivated as all heck and would work for Republicans and turn out to vote them into office, but you haven’t been able to control them and they’re dangerous precisely because they feel they have a handle on The Truth rather than an opinion.

  17. @ Mike Mullin #17. That’s because the doctor and/or hospital has more leverage to charge whatever the hell they think they can get away with for the average schmo off the street. I work in federal law enforcement on the administrative side; I was in Cleveland awhile back and had to go to the ER; EMS was around $600 initially because I didn’t have my insurance card with me. Once I let them know who my insurance carrier was, the actual bill dropped to $300; 25 of which was my co-pay. My aunt is the director of rehabiltation services for a hospital in western new york; she has said the insurance companies routinely tell her how much they are paying for services, either the hospital has to lower its bill or try to get the patient to pay what the insurance won’t cover. about 3/4 of the time in these instances, the hospital writes off the portion of the bill because the patient will point to their insurance paperwork and say, this is what i owe for my co-pay for this service, this is my portion of whatever the insurance doesn’t cover (mostly 60% insurance, 40% individual with an individual cap of whatever out of pocket expenses the insurance paperwork calls for). If we had less barriers to entry for insurance companies in all 50 states, tax incentives for people to save for medical costs, high risk insurance pools for people with no way to pay for insurance or pre-existing conditions (I’m in favor of a government subsidy here), then I don’t think we’d need a new bureacracy to run 1/6th of the nation’s economy. Think smart, not big and grandiose.

  18. You do nto point out that you disagree with someone wjile yo uare apologizing. Apologies are all about the “I screwed up, sorry for that” and nothing else. What he did was say “I’m sorry, but you really are wrong” which is a continuation of the argument.

    Middle School kids are really, really good at this. It’s be nice if our national representatives weren’t using Middle School tactics on each other in front of the entire freaking world.

  19. You know things have gotten bad for the GOP when they loose Bob Dole

    Bob Dole, a former Republican presidential candidate and Senate leader, said members of his party should be cautious in their response to the president’s “very, very important speech.” Though adamant opposition might be an effective political strategy short term, it ultimately could backfire, Dole said: “After a while, people are going to start to wonder, what are Republicans for?”

    (USA Today)

    They lost Bob Dole. Bwahahaha!

  20. The difference in the language and substance of the speeches between this president and his predecesor continues to amaze me. It has been a very long time since we’ve had a president that wasn’t the least smelly of the choices (and sometimes sadly not). I think he really believes what he is saying also, another refreshing change. I hope he can produce in this present climate we have in DC.

  21. Christopher Shaffer:

    Leaving aside that your summation of Obama’s proposals on immigration are grossly caricatured and omit actual relevant data, which suggests you’re either intentionally dishonest or ignorant on detail, it should be noted that a) immigration reform doesn’t have enough votes to pass at the moment, which is something the White House acknowledges, which is why it’s not working very hard to pass it, and b) immigration reform is not tied into the health care proposals in any event. So your contention that there wouldn’t be any more illegal immigrants in Obama’s America is both inaccurate, certainly now and likely for the foreseeable future, and pretty silly.

    Beyond this, nothing Obama said on the matter is in the slightest bit obfuscatory. Obama is working toward changing the immigration status of illegal immigrants does not suggest that before they are citizens or legal residents, that they are somehow eligible for these federal programs. Obama not discussing a program that’s unrelated to the topic of a major speech in not obfuscation; it’s staying focused on his topic.

    I should note at this point that I don’t want the thread to derail into discussion of immigration reform; as noted above, it’s not at all relevant to the discussion at hand.

  22. The “apology” basically said, “the president lied. I was correct in calling him a liar. But I’m sorry I did it an inappropriate time”.

    no, that’s not an apology.

    “I was wrong. I’m sorry.” is an apology.

    All he did was give a shout out to his wingnut base.

    In other news, Fox News is really going all out giving this a sound political study. They sent some ijiot with a microphone and camera to a Tea Party celebration and kept asking each one “what did you think?”

    Not surprisingly, none of them were capable of any thought at all.

    The only way to force insurance companies to stop gouging customers for outrageous profits is a public option that allows people an alternative. Do it not with government money but with people’s premium payments.

    Otherwise, regulation alone will always be relative to the worst corporate offender.

  23. The Other Keith @ 25

    I tend to read the apology more like “Sorry I called you that on camera while you were speaking, but you’re still a liar. PS, I’m really not all that sorry because regrettable doesn’t mean ‘I regret that action'”

    It might be a good apology for a politician, but I don’t think it makes it a good apology.

  24. @ #28 … Well yes, we have had our share of crazies over the past decade, but at least – for the most part – they had an argument of sorts, skewed though it may be. The lunatics that are running off to South America for a quick screw are relatively new.

    The idiot calling out Obama reminds me of the anti-war protesters chanting down Bush. Let the man speak, dangit. It just makes the screamer look like an ill-informed nutjob (for both sides, whomever it might be), and the President hasn’t even finished getting his points across.

  25. The lunatics that are running off to South America for a quick screw are relatively new.

    You wish. They’re just getting caught more now.

    Oh look, there goes another one. This one was schtupping a major lobbyist, and is now under investigation for selling votes for sex. He got busted for bragging about it in front of a hot mic he thought was off.

    And you know the next one to along will get worse.

    The idiot calling out Obama reminds me of the anti-war protesters chanting down Bush.

    A US federal Representative shouted down Bush during an address to Congress? Who was it?

  26. Caved. He caved. No federal dollars will pay for a legal procedure. How is that not the government deciding on coverage? How is that not discriminating against the poor?

    Betcha your tax dollars pay for Viagra. What about plastic surgery? How elective is elective? How cosmetic is cosmetic?

    Not to mention, how exactly are they going to make sure that happens, except to make it almost impossible for women to choose to undergo a legal procedure — one for which there can be any number of valid medical reasons* — without digging into their own pockets??

    *not that this should be an issue, because (I think I may have mentioned this) it is legal.

  27. @RUSH LIMBAUGH
    “You oughtta try this, folks, just a standard doctor visit, offer to pay for it yourself,” said Limbaugh. “I guarantee it’ll cost you less than if you use your insurance.”

    Yeah, that’s a lovely idea. And given how much I pay just for catastrophic coverage (surgical and emergency stuff only, no coverage for office visit, labs, etc), it’s actually not too far off the mark.

    Except…

    …except around here I can’t even get a doctor to take me on as a patient without office coverage insurance, whether I plan on paying for it myself or not.

    So yeah, that doesn’t quite work out the way you think it would, Dittobrain.

    Instead, I’m playing health care pong with spotty primary care from the local county health dept (overworked, overbooked and intentionally impossible to reach doctors = fail) and signing on with a Naturopathic Physician (the ones who have actual med-school training, and who take anyone because they can’t file for insurance payments anyway) to fill in the gaps. All at my own expense, natch.

    This year, I’ve picked up some sort of chronic, partially debilitating muscle pain/twitchy thing that’s terrifying the crap out of me. I’ve had it for months now, and because the only care I am allowed to pay for out of pocket (county care) is so hard to schedule, I still don’t even have a diagnosis. Going for several weeks between visits to docs who see a gazillion patients and whom you can’t actually talk to between visits makes differential diagnosis a bitch. I’m surprised they even remember who I am from the one visit to the next*.

    *Note, I’m not dissing the docs. They do good work for needy folks in impossible circumstances. But dammit, I could afford regular primary care if someone would just let me in.

  28. $900 billion is a big number, especially on top of the existing trillions we have racked up this year already. Any you know it wont be just $900 billion regardless who tells you the number. That O blames Bush for the handing him a large deficit is a laughable lie consider that he tripled that in 8 months.

    Visit a ER on any given evening, you will see people who claim they cannot pay parking their Escalades. Of course this is not true for all but it happens frequently. As long as you have a job you have a choice of having health insurance or not. Some choose not to, maybe because it is high, but the choice is there. That they do not fit it into a budget is not my problem. But instead of throwing money at it, my money, why not figure out why insurance is so high and fix that? Yes, it would be hard to fix that as opposed to taxing the hell out of people and redistributing the “wealth” but isnt it worth a try?

    As for the outburst, poor behavior to be sure. But I thought it funny as hell, Dems did similar in years past. About time for payback. Besides, our govt pays bills for all kinds of things for illegals now, how could they prove this to be different?

    Obama still has yet to prove any ability to lead. I have absolutely no respect for him at all. It has nothing to do that he is black, against gay marriage or that he prefers dogs to cats. Rather it is his arrogance, something which he has nothing to feel that way about.

  29. John@33
    Seems to me that while Obama’s declaration that illegal immigrants will not be covered is not obfuscatory, in light of the fact that he and his party have publicly stated the intention to legalize a large portion of illegal immigrants as quickly and easily as possible (whether they can pass it right now or not), it’s at least disingenuous.

    As for the speech itself: Healthcare does, in fact, need to be overhauled. I’ll believe the self-sufficient government option when I see it. I’ll also believe that the government can arrange for millions more people to be covered, many of whom have costly conditions, while lowering costs, when I see it. It’d sure be nice but I don’t hold out much hope. The government has had its fists in the healthcare pie for a really long time now and it’s just been getting worse.

    Happily, the scheduled implementation of his healthcare plan is AFTER his next presidential bid. Surely he’s not afraid the actual implementation of the bill might hurt his re-election chances. Surely!

  30. @ #35 “The only way to force insurance companies to stop gouging customers for outrageous profits is a public option that allows people an alternative. Do it not with government money but with people’s premium payments.”

    I certainly agree that’s one way to do it, but does Obama’s plan even go this far? The way I understood the speech tonight, this option will only be open to folks who don’t currently have insurance available to them. Meaning I won’t be able to trade in my craptastic HMO for whatever government plan might be enacted.

  31. I’ll believe the self-sufficient government option when I see it.

    I suggest looking at what the US government spends per-capita on health care, then looking at the thirty-six countries with better healthcare outcomes, then observing that they inexplicably pay less total than the US government does – and on a per-capita basis, too.

    Because, you know, it looks like those countries are doing it relative to us. Thirty-six of them, even.

  32. I just want to say to all you Americans here. Having a politician (and a leader) that can speak beyond a sound bite. That while clearly a politician and not a messiah… and for the most smart a centrist. A Centrist for change.

    Obama has lost his shine to many… but to me a Canadian.. I envy you Americans so much. I would love an Obama type to lead Canada.. or hell 2 or 3 Obama like leaders to lead each of our political parties… to foster real debate.. answer real problems. Talk about real issues.. in depth… not play petty politics.. and name calling. Respect the voters and citizens and give them real issues and real thoughts.. and not mere soundbytes.

    Even if you disagree with Obama.. I do not see how you can dislike him… or not want his discourse on issues. What the worlks needs on Global warming, Aids, war, on every major issue is real debate and talk… not crappy soundbytes, fear and lies.

    I hope we can see a hundred or a thousand Obama’s emerge around the world. Leaders who ask for effort form their people, and real debate and thought on issues and treat the public with respect and thought.. and do not merelt try to instill fear in them.

  33. @ #42 Whoknows

    “Visit a ER on any given evening, you will see people who claim they cannot pay parking their Escalades.”

    Folks could very well both be driving an Escalade AND unable to pay their medical bills. Have you compared the cost of an Escalade to say, open heart surgery lately? I could have bought half an Escalade for the price for three days of ICU for my father, recently. Three days.

    “As long as you have a job you have a choice of having health insurance or not.”

    This is false. Many employers do not provide any medical coverage. Many employed people can’t get medical coverage due to pre-existing conditions.

    “Besides, our govt pays bills for all kinds of things for illegals now, how could they prove this to be different?”

    The whole debate is sort of specious, in my view. The fact is, we pay for medical care for illegal immigrants already, and we’ll continue to. Right now we pay via higher medical costs passed along by hospitals to those who can pay. The only alternative would be to allow illegal immigrants to die outside the hospital’s doorway. Would you really want to live in a country where basic regard for human life were that low?

    “It has nothing to do that he is black”

    Thou dost protest too much.

  34. The one thing that twinged me was the “requiring coverage” thing, since I wonder how they’re going to enforce that with either the crazy compound types or (rather more relevantly) people like the Amish or Mennonites, who have religious objections to insurance.

    In Massachusetts, there’s a form you get from your insurer that proves you have insurance. You need to include it when you file your income tax return. If you don’t have insurance, and your income is above a certain amount, you pay a penalty.

    The compliance rate for returns filed in 2008 was (according to the sources I found) around 95%. Of those who didn’t get insurance, about half were people who made enough money to have to pay the penalty.

    IIUC, the point of an individual mandate wasn’t to make sure that everybody in the country signs up: it’s to avoid a situation where healthy people don’t bother paying for insurance until they actually get sick. Right now smart people don’t do delay insurance like this because insurance companies might refuse to take them on. But if insurers can’t deny coverage based on preexisting conditions, this might become an actual risk. Hence: individual mandates!

    {At least that was the logic here in MA.}

  35. Skar –
    Seems to me that while Obama’s declaration that illegal immigrants will not be covered is not obfuscatory, in light of the fact that he and his party have publicly stated the intention to legalize a large portion of illegal immigrants as quickly and easily as possible

    Not unlike that Bush fellow, eh?

  36. Whoknows@42:
    Having a job most certainly does not mean you “have a choice of having health insurance or not”- at least if you are talking about employer-based health insurance, which I suspect you are. None of the employees (including myself) at the small business I work at get health insurance through the job. There’s no way to afford it.

    I suggest you spend a couple of Friday nights in an emergency room parking lot, counting all the Escalades.

    By the way, how much have your taxes gone up this year?

  37. “Folks could very well both be driving an Escalade AND unable to pay their medical bills. Have you compared the cost of an Escalade to say, open heart surgery lately?”
    Yes that is exactly both my points. Drive a expensive vehicle but shirk responsibilities to pay your bills. Try selling the escalade, buy a used car for cheap and be self sufficient. Also, my other point was let’s look at why insurance is so expensive (medical costs so expensive) instead of throwing our money at the problem.

    You have a point with pre-existing conditions. However, I don’t think having the govt provide health insurance is the answer. Yes, some companies dont provide insurance but so what? Consultants and contractors are responsible for their own insurance completely. I did it myself when I went through my “be a consultant” phase. It was more expensive than some companies later provided me but not always. I shopped around.

  38. “By the way, how much have your taxes gone up this year?”

    The term is still young and the debts are rising. I expect them to rise.

  39. Josh Jasper:

    “Not unlike that Bush fellow, eh?”

    Indeed.

    Also, I’m not seeing how Obama was being disingenuous, either. His desire to offer a route to citizenship for people who are currently here illegally may offend people who have a bug up their ass about illegal immigrants, but it is really is neither here nor there regarding how people who are adjudged to be here illegally are eligible for care under the various health proposals. This is an utterly irrelevant conflation, and people who are concerned about illegal immigrants are really better served addressing that proposed legislation than this.

  40. I suggest looking at what the US government spends per-capita on health care, then looking at the thirty-six countries with better healthcare outcomes, then observing that they inexplicably pay less total than the US government does – and on a per-capita basis, too.

    Because, you know, it looks like those countries are doing it relative to us. Thirty-six of them, even.

    And I suggest you look at the financial health of those countries related to healthcare. It’s unsustainable.

    And I suggest you actually look at how that list on which we are 37th was compiled. Keep in mind that Colombia ranks higher than us. Either we actually have worse healthcare than Colombia, or something about the list stinks.

  41. Well, I’m an Australian and I have to admit I am absolutely fascinated by the US Health reform debate.

    Not to sound too smug here… but our system works pretty well, and I think it is pretty much exactly what President Obama is trying to get to.

    Our Medicare system – which covers everyone – is supplemented by a private health system of insurance. So right now, for example, I’m pregnant, and I have private health insurance. It works like this….

    My obstetrician check-ups cost me say $70 a visit, but I am entitled to a Medicare rebate on that of about $50. Out of pocket $20. When I deliver I’ll do so in a private hospital, and almost all the cost will be covered by my private health insurer. The bit that isn’t, (the epidural-angel-guy) will be mostly covered by Medicare. Out of pocket yes, but not unreasonably so for the level of care I want.

    On the other hand, had I no medical insurance, I would still be entitled to full care at a public hospital. I’d still get my epidural and a watchful doctor/midwife. (What I wouldn’t get is the optional extras – the level of specialist care I need during the labour. I also wouldn’t be allowed a non-emergency ceasar was I so inclined.)

    Anyway, the point I’m making is that in Australia, medical care for everyone is something we take for granted. I mean, we complain about the quality of free care without even considering that the rest of the world have no care or unbelievably expensive care.

    We’re lucky, no?

  42. @ #51

    “Try selling the escalade, buy a used car for cheap and be self sufficient”

    I’ll be sure to pass your fine advice on to my sister-in-law’s mother, whose chemotherapy costs $20,000 a dose. She gets them weekly. So how many doses do you think a used Escalade will cover? Oh wait, she doesn’t have an Escalade… doh, so much for WhoKnowscare.

    Someday you’ll realize there are things in this world that just happen, and no amount of personal responsibility or preparedness will get you through them. Helping citizens prevent, avoid or cope with these kind of things is the only reason I can think of to bother with having a government at all.

  43. You have a point with pre-existing conditions. However, I don’t think having the govt provide health insurance is the answer. Yes, some companies dont provide insurance but so what? Consultants and contractors are responsible for their own insurance completely.

    No, the answer is to regulate the private insurance market. That’s the current plan, in case you didn’t realize it.

    And look at those four sentences there. No, seriously. Look at them. You start off admitting that there’s a problem with pre-existing conditions. You say that govt-provided health care wasn’t the answer. Then you segue into talking about companies that don’t provide insurance “but so what?”

    How does the fact that consultants and contractors provide their own insurance address the problems caused by pre-existing conditions? It doesn’t, of course, but it’s something you’re comfortable saying, so you fall back on it without even considering whether you’re making sense.

    You’re not coming across very well.

  44. progressives want Obama to throw long bombs deep into enemy territory, and Obama’s content with a “three yards and a cloud of dust” strategy

    Exactly. Also: if the president isn’t an Ohio State fan, he really should be.

  45. “$20,000 a dose”
    So how is this paid for now? And at $20k a dose, I guess no one thinks that is a little high?

    “Helping citizens prevent, avoid or cope with these kind of things is the only reason I can think of to bother with having a government at all.”
    :-) Really? I guess JFK had it all wrong.

  46. WhoKnows, you’re trying to deflect Mike Mullin’s point with an irrelevant question. He’s pointing out to you that your “advice” regarding how people should pay for health care doesn’t actually work in the real world. The cost of care — and in particular continuing care — quickly outstrips an individual’s ability to pay for it without assistance.

    Aside from this, I call bullshit on the “Caddies outside the ER” line. This strikes me very much like the Reagan “Welfare Queen” bit — a nice bit of misleading rhetoric to suggest that a very real problem (basic medical care being handled by ERs, which is one of the most expensive ways possible) is an issue of choice, rather than necessity.

  47. I see the point of $20k a dose, yeah that is expensive and I know I could not pay it more that a few times. So, how is it getting paid now? How should that get paid? Is the only answer to have the govt pay?

  48. The thing about “$20k a dose” is that if you check the bills, the insurance company probably gets a $19k/dose discount. Because of “group discounts”, insurance companies often pay a fraction of what an uninsured patient would pay. It is a way of insurance companies keeping themselves in a loop and it ends up charging those unable to get insurance *more*, something which is absolutely despicable.

  49. WhoKnows:

    “Is the only answer to have the govt pay?”

    Did you actually pay attention to the speech tonight, WhoKnows? The plans laid out have payment covered by insurance, one plan of which may be administered by the government but which would pay out via the same mechanisms as other insurance companies, i.e., via money accrued through payments.

    If you’re not planning to keep up with the actual facts of the conversation, WhoKnows, consider sitting out from it until you do.

  50. @42 – Many people I know (including myself) are self-employed contractors. We can’t buy into the same group plans companies are generally offered, or at least at nowhere near the same rate for equivalent quality, even at the same income levels, and my understanding is that the public option would be there to address that section of the citizenry.

    @48 Yeah, you can follow the logic train. I just get a little worried when the frequently stated justification for forcing young, healthy people to buy private insurance is that then insurance can afford to keep older/sicker people, as it seems to roughly correspond to the initial, sensical logic behind setting up Social Security/Medicare – and both are rapidly running out of money, because there just aren’t enough young workers to pay for the expense. It doesn’t seem to be an effective long-term cost-control solution of its own accord, though I’m not sure I’d have an alternate suggestion (short of a complete system reboot, which would likely do more good long-term but isn’t politically feasible.)

  51. Scalzi @ 64 regardin. Whoknows: word.

    Rachel @58 – Ohio state fan? But then he’d just about get the big win and totally whiff. I’d politely suggesting recruiting Florida’s own All-American-Hero-Tim-Tebow to take this one home.

  52. @37… Bite me. Coulter and all of the other calling people like me traitors and unpatriotic did NOT have an argument, they were spewing hate. You tolerated it it then, just as you justify it above, because you were on top. Now that your crazies have taken over the party and are in the process of making Republicans look like morons you try to distance yourself? No, sorry, not letting you.

    You loved it when they damned perfectly fine citizens as traitors and questioned their loyalty. You were fine with signing loyalty oaths to get into campaign rallies. You were fine with an administration that went through amazing logical contortions to avoid calling torture torture. You planted these seeds… it’s your harvest. If you want these people out of your party work to marginalize them. Take your party back. But you’re getting exactly what you asked for over the last decade and your half-hearted attempt to justify their past tactics places you squarely in their camp.

  53. Rick:

    Deep breaths, please. I’m not quite sure the comment you’re responding to merited such a shotgun blast.

    And a reminder, as I head to bed, to play nice with each other. Don’t make me wake up in the morning and have to bring down the Mallet of Loving Correction first thing.

  54. Quoth our host:
    The one where he overthrew the capitalist system to give illegal immigrants federally subsided breast enhancements.

    Um. “Federally subsided” sounds like the epitome of slump… even worse than all the levees which were due for overhaul before onslaught of H. Katrina. Which would not exactly be the number one selling point for breast enhancement in this perky, modern world, would it?

    And if our leader made promises concerning subsidied breast enhancements – well, hello: President Obama is a guy. Guys do this sort of stuff – sometimes even when it’s not in the best interest of the nation as a whole.

    If we didn’t want a guy at the head of our nation, perhaps we should have elected a lady. :-|

  55. Rick @ 67 – I would consider myself a republican. I didn’t tolerate anne coulter and her ilk. I didn’t justify it. I didn’t support ridiculous logic pretzels to make torture not torture. I don’t support in anyway the outright acknowledgement that torture is acceptable under certain circumstances. I wasn’t fine with loyalty oaths. And I am not reaping anything like what I sowed.

    My point is just because a person is a republican or democrat doesn’t mean they blindly agree with everything their party says. Just be careful about making angry generalizations like that.

  56. @68 Scalzi – my bad if my response in anyway fuels a flame war. I missed your post before typing mine. Consider it retracted.

    I’ve got a real phobia of mallets.

  57. whoknows@42: That O blames Bush for the handing him a large deficit is a laughable lie

    No, I’m pretty sure we were doing great when Clinton left and we were in the toilet by the time Bush was gone.

    Visit a ER on any given evening, you will see people who claim they cannot pay parking their Escalades.

    And welfare queens driving cadilacs.

    As long as you have a job you have a choice of having health insurance or not.

    Unless you start costing the insurance company money and they decide to boot you from the rolls. And then a preexisting condition prevents you from getting covered anywhere else.

    But instead of throwing money at it, my money,

    Instead of throwing my money into (thing I don’t agree with)….

    Oh, wait, this is a government. They tax the people and use that to pay for stuff. That’s how government works.

    why not figure out why insurance is so high and fix that?

    Gee whizz, Forest, did you figure that out on your own?

    Yes, it would be hard to fix that

    How can you guage difficulty if you have no clue what the problem is?

    as opposed to taxing the hell out of people and redistributing the “wealth” but isnt it worth a try?

    redistributing the wealth? Isn’t that what they do when they send my money into Iraq and Afghanistan?

    you haven’t made any sort of logical argument yet or proposed any sort of real solution. All you’ve done is throw out some lies, some stereotypes, and some cliches.

    As for the outburst, poor behavior to be sure. But I thought it funny as hell, Dems did similar in years past. About time for payback.

    A democrat called Bush a liar during a presidential speech? You sir are an out and out liar.

    Besides, our govt pays bills for all kinds of things for illegals now, how could they prove this to be different?

    Maybe because of the ammendment that specifically says illegals won’t be covered?

    Obama still has yet to prove any ability to lead.

    Like Bush did, eh? Led us right into a quagmire in Iraq based on lies and anotehr quagmire in Afghanistan based on a complete lack of history education.

    I have absolutely no respect for him at all. It has nothing to do that he is black, against gay marriage or that he prefers dogs to cats. Rather it is his arrogance, something which he has nothing to feel that way about

    Arrogance? Did you just call the president “uppity”?

    whoknows@51: Drive a expensive vehicle

    what is it with you and cadillac driving welfare queen cliches?

    but shirk responsibilities to pay your bills.

    “responsibilities to pay your bills”???? Half of all bankruptcies are medical bankruptcies. 80% of those were people with insurance.

    THey got dumped by the insurance companies when they got sick.

    Try selling the escalade, buy a used car for cheap and be self sufficient.

    Unless you live in a mountain cave in Afghanistan, you are hardly “self sufficient”. Who built those roads you were driving on the other day? Just curious.

    Some things the government does benefits everyone even if its indirect. Roads are a good example. You want private industry building and maintaining your roads and charging you tolls every mile or so to pay for it? Or can we have taxes pay for it?

    Also, my other point was let’s look at why insurance is so expensive (medical costs so expensive) instead of throwing our money at the problem.

    Yeah, because, you know, people have only been trying to push health care reform for 60 years or so. They probably all got the solution wrong. Better to demand that we start all over. maybe that will let you obstruct any real progress for a few more years.

    You have a point with pre-existing conditions. However, I don’t think having the govt provide health insurance is the answer.

    Hello, I’m a right wing talking point. When the options are “lead, follow, or get of out the way”, I obstruct.

    If you have a solution, propose it. If you don’t know what you’re talking about, try finding out before you ask 101 type questions. If you’re going to ask 101 type questions, then you shouldn’t start out by telling everyone else that they MUST BE DOING IT WRONG.

    Yes, some companies dont provide insurance but so what? Consultants and contractors are responsible for their own insurance completely.

    Consultants and contracts usually make more money than direct employees to make up for the fact that they usually aren’t employed all year long and have to provide their own benefits, like health care. You’ve made a completely irrelvant point here.

    I did it myself when I went through my “be a consultant” phase. It was more expensive than some companies later provided me but not always. I shopped around.

    I’m OK so everyone else should be OK?

    whoknows@52: “By the way, how much have your taxes gone up this year?” The term is still young and the debts are rising. I expect them to rise.

    Ah, I see. So, when you said “taxing the hell out of people and redistributing the “wealth””, you made it all up. And when called on it, rather than straight up admit you made it up, you insist that it will be true… someday

    Hello, my name is whoknows and it’s been 3 days since I obstructed a progressive political reform.

    whoknows@60: “$20,000 a dose” So how is this paid for now?

    The mind. It boggles.

    And at $20k a dose, I guess no one thinks that is a little high?

    Uhm, yeah, that’s why health care reform is being proposed.

    One study estimated that at the rate health care costs are rising a family of four might end up spending %40 of their income on insurance premiums and health care costs.

    :-) Really? I guess JFK had it all wrong.

    Another non-point, non-argument.

    Whoknows@62: I see the point of $20k a dose, yeah that is expensive and I know I could not pay it more that a few times. So, how is it getting paid now? How should that get paid? Is the only answer to have the govt pay?

    Holy crap. You’ve already spent several posts exclaiming that the governmetn shouldn’t get involved in health care reform. then here you admit that you don’t know the first thing about the actual health care problems and want people to explain health care 101 to you.

    Interesting how you’re so certain that government isn’t the answer, and yet you don’t even know what the question is.

    Do you have a real alternative solution to the problem? Or are you simply obstructing as much as possible to derail the conversation?

  58. If there is a legitimate alternative for people to chose vs. the current insurance companies, I don’t care what they call it. If the alternative can not be bribed, threatened, cajoled, undercut, litigated out of business, bought or destroyed by industry insiders it will work no matter what it is called. Call it something other than the Public Option, the effects are the important thing.

    Any real alternative to business as usual that allows people to vote with their feet will get the point across real soon. Simple as that. Anything else results in bonanza time. For example, if mandates start now while a nebulous option waits for four years, let the rape and pillage begin. Trigger? Trigger means never happens.

    Think I’m kidding? Credit card containment passes with a three year lead in. With in a week all the credit card companies have tripled or worse their rates on existing customers.

    Oh, and WhoKnows @ 42.

    Your first point alone is suspicious. Your Deficit boogy man revolves around the point that you refuse to admit that most , if not quite all, of the ‘deficit climb’ you’re so scared of, is the result of Obama putting the massive amounts the Bush crew was keeping off the books (2 multi-year occupations, etc) into the public record.

    With this sort of start, I don’t think I’m going to bother with the rest of your illogic.

    Hmmmm. Haven’t I pointed this out to you at least once before? Less then a month ago?

  59. 42. WhoKnows: Obama still has yet to prove any ability to lead. I have absolutely no respect for him at all. It has nothing to do that he is black, against gay marriage or that he prefers dogs to cats. Rather it is his arrogance, something which he has nothing to feel that way about.

    You may not care to follow him. But don’t assume that no one does.

  60. Personally I’m in favor of federally subsidized breast implants if only for my own entertainment.

    “federally subsided breast enhancements” not so much. Why reduce a a perfectly good breast?

  61. WhoKnows @ #52 – The term is still young and the debts are rising. I expect them to rise.

    Like that Bush fellow was so certain that there were WMDs in Iraq. Or like how he was certain tat repealing the Glass-Steagall act (the one the regulated trading to prevent “too big to fail” banks from rngaging in default credit swaps and suchlike) was going to help the economy?

    Your team doesn’t have a good record of makng predictions. Contrawise, Obama is on record as being against the Iraq occupation, and his team is on record as being against the repeal of Glass-Steagall.

  62. Another Damn Medievalist: I think you missed the part where he said that the “public option” was not going to be subsidized, but self sufficient and paid for by the premiums it collects. Presumably, it will somehow be magically affordable for low income people who don’t have insurance. (I’ll get back to that in a minute.)

    #55 Actually, I’m appalled. What you are saying is that if you need a specialist (I assume you mean a high risk ob or maternal-fetal medicine specialist) to attend your delivery, or if you have a medical need for a scheduled c-section, you can’t get these through the public health care option in Australia. What you describe is a violation of good standards of medical care, and I hope you are mistaken, because this is a big deal. In the US Medicaid would be the equivalent program that might be paying for deliveries, and you can get exactly the same care under medicaid that you can with private insurance–including specialists and any medically necessary procedures. (By the way, I don’t believe health insurance *should* pay for elective, non medically necessary c-sections.)

    Regarding my thoughts on the plan, mostly I like it. I do wonder how the “public option” is going to be affordable enough. Granted mandatory coverage is necessary as someone said above any time you exclude preexisting conditions. Otherwise the young and healthy won’t enroll, won’t be part of the pool, and the insurance companies won’t be able to cover their costs. But there is already such a thing as a nonprofit health insurance company. We have had group health insurance from nonprofits in the past, and it was still very expensive for our family. I would say over a decade ago, for just two of us, we were paying about $900/month in Cobra premiums for nonprofit insurance. Even if they could somehow get the premiums down to, say, $200/month for a family, there will be people who can’t afford it. How can it possibly work without a subsidy?

    As to religious objections, why should anyone get this? If you don’t believe in health insurance, don’t use it. But dollars to donuts some of those people who don’t believe in it are going to end up in the ER when they have an emergency and they have no choice. Many amish cross the border to Canada for health care there, so I am not willing to let them off the hook.

  63. I have a bad feeling about this, like we’re being slowly sucked into an 80s black hole. First Night Ranger, then a serious treatment in the comments here of the “welfare queens in Cadillacs” meme (okay, they didn’t have the Escalade in the 80s, but a Cadillac’s a Cadillac), and next a shout-out to the directors of the early Star Trek movies.

    Scotty! Can we reverse the engines and get out before it’s too late?

  64. GregLondon@72

    I started to write some rebuttals to whoknows and decided that the final post would be too long for my liking. I thank you for doing the leg work.

    While thinking about this several things occurred to me:

    1st – I think that any serious healthcare reform needs to also address the cost of medicines in the United States. Obama did a good job of addressing some key concerns and unless I missed something (I do have the attention span of a 3 year old and haven’t had a chance to go back and re-read the transcripts of the speech yet) there was no serious mention of controlling the cost of prescription medication. To me this says “Big Pharma still has too much political pull for serious change”. What political motivation does Obama have for not mentioning this?

    2nd – I am getting tired of the partisan bias that people are using to judge the actions of the president. (i.e. Bush could do no wrong and Obama can do no good). I believe that the president’s actions and motivations should always be scrutinized regardless of political party.

    3rd – I know this is probably an ideological cliche but I am also tired that “conservatives” never seem to have fiscal issues with defense spending but the moment tax dollars go towards helping someone there is outrage. How can Republicans continue to defend Bush’s war in Iraq and continually criticize government subsidized Healthcare reform?

    Rabid

  65. How can Republicans continue to defend Bush’s war in Iraq and continually criticize government subsidized Healthcare reform

    Because we’ve got to be strong. Using the military to invade and occupy countries shows how strong we are.

    Whereas the poor are weak and the weak should not be rewarded with help from the strong.

    The logic is so transparent and so much the thought process of a 13 year old that it’d be hilarious if it weren’t killing people every day.

  66. @77 Catherine Schaeffer – you said “Actually, I’m appalled. What you are saying is that if you need a specialist (I assume you mean a high risk ob or maternal-fetal medicine specialist) to attend your delivery, or if you have a medical need for a scheduled c-section, you can’t get these through the public health care option in Australia”.

    @55 Vic K actually said “On the other hand, had I no medical insurance, I would still be entitled to full care at a public hospital. I’d still get my epidural and a watchful doctor/midwife. (What I wouldn’t get is the optional extras – the level of specialist care I need during the labour. I also wouldn’t be allowed a non-emergency ceasar was I so inclined.)”

    You appear to have accidentally misinterpreted what she said regarding the c-section (re scheduled vs non-emergency), and taken the worst possible case interpretation of the rest.

  67. #81 Hugh She said “I wouldn’t get the level of specialist care I *need.*” If she needs it, I assume it’s a medical necessity and not that she’s engaging a shaman to help her spirit walk through the delivery or something. She said she can’t get a non-emergency c-section on the public plan. What’s not clear about that?

    I am perfectly willing to hear a clarification, but I am pointing out from what she said that the public option represents a lower standard of care, based on the fact that you seem to have to sacrifice some “optional” items that are indeed medically indicated. If she means you can’t get a completely elective, convenience c-section, then shame on them at the private hospital for offering such a thing. This, too, is a violation of medical standards.

    Vic K can you clarify?

  68. Catherine Schaffer @ 77 — He flat out said no federal money would be spent to fund abortions. If what you’re saying is that this is true because the plan is going to be self-sufficient, well … maybe. But if people are getting federal subsidies to help pay for insurance, and they choose to have abortions, how is that going to work?

    Now I have no problems with insurance companies, public or private, refusing to pay for purely elective cosmetic treatments like face-lifts, etc. I even understand why my insurance company makes me jump through hoops to get my acne meds, because they are often used by other women my age to look younger, and the guy at the insurance company can’t know that I have an actual medical, rather than cosmetic, need for them.

    But to me, Obama’s claim is purely pandering to the right and entirely unworkable, except by pretty much banning abortions wherever federal monies might be involved. Hmmm … from a purely economic point of view, it’s far more cost-effective to pay for abortions than to pay for health care for another growing person, at least until that person is a taxpayer.

    Anyway, it’s not that I’m objecting to the plan so much, as to the pandering and the worry about the effects of trying to keep a promise that he never should have made because abortion is legal in this country, and the only restrictions on first trimester abortions are cost and accessibility. Caving to the right, I say.

  69. Having not yet read the speech and having no notion of the particulars, let me just ask this. Why would anyone, anywhere object to the notion of universal health care? Isn’t it a good thing that everyone has access to basic health services, not to mention I’m pretty sure it’s in the UN charter of human rights?

    I’m Australian, and we have a very good system down here in which the government provides health cover which will get you looked after in public hospitals. If you want better rooms, cable TV or less waiting time for surgery you can pay for private health cover and go to an upmarket private hospital to get the same thing done. It’s up to the individual whether they think it’s worth the effort.

  70. My impressions of the President’s speech were that overall it was a pretty good speech.

    The beginning was good and I agreed with all of it until he got to the public option part. Then he handwaved his way though this and the paying for it part. These parts were to me weak and unconvincing. He didn’t even seem to believe it.

    Then he ended very strong. He is of course correct in that we do need to reform how healthcare works in our country and he clearly is impassioned about this.

    And he went on risky ground by proposing tort-reform, though, as with the public-option part and the paying for it part, he seemed be just saying it, not believing it. But here I’m not sure if it was because he is fearful such reform will never be approved by Democrats or because he is not really for it. I tend to want to believe the former and that he would sign such a bill if it made it through Congress.

    If you listened to the Republican response, it seemed to me there were a number of points that were congruous and if these things were alone were carved out, not only would significant reform be accomplished, but it would test the Republicans to see if they were just being obstructionist or not.

    And if Democrats would call their bluff, and Republicans still refused to vote for it, that would go a long way in mitigating the impeding Democratic Party disaster next year.

    And if they did vote for it, you could call health-care reform a bipartisan agreement which would also help mitigate the impeding Democratic Party disaster next year.

    Such reforms that both the President and the Republicans agreed on would go a very long way in reforming healthcare and the parts that are left on the table could always be implemented in the future if they don’t effect the change we want.

  71. Getting back to one of Scalzi’s comments: You’re going to need an exemption from compulsory insurance for those with religious objections to medicine, like Christian Scientists.

  72. Frank, lets see. As I remember the president said we would pay for the public option the same way other insurance plans pay for their service, through the collection of premiums. Not sure that constitutes “hand-waving”, but YMMV.

  73. @88

    Frank, lets see. As I remember the president said we would pay for the public option the same way other insurance plans pay for their service, through the collection of premiums. Not sure that constitutes “hand-waving”, but YMMV.

    Well, I wasn’t just referring to the paying for the public option but the paying for the whole thing.

    He said most of it would be paid for by eliminating waste in Medicare and Medicaid. Right. How ’bout starting on that? Like right now? Wouldn’t it be good thing to do regardless ’cause god knows both these programs are in fincancial trouble right now.

    And the problem with the public option is that few believe the public option will be self-supporting unless you mean self-supporting like Amtrak or the post office or more likely Medicare/Medicaid or the VA.

    And it is unbelievable that the “public option” would have less administrative costs that a private operation as the President claimed. Have you even seen an efficient government bureaucracy?

    So all of the “this-is-how-wer’re-paying-for-this” stuff was just hand waving.

    But it is serious and it is the devil that could kill reform. And he needs to be honest about it because people have a heightened awareness of the cost right about now. Just saying “The middle class will realize greater security, not higher taxes” is not enough. Everyone believes that no matter what is done, taxes will have to pay for it. Tell us how much and defend the tradeoff.

  74. If federal money isn’t going to be used to pay for abortions, then what I want to know is what about birth control? How much other contraceptive care is going to get lumped in there inappropriately? That and the language that will be used concerns me. If abortion is a legal procedure and it’s not covered, why not? Because it’s elective? What other procedures will count as elective? By this I mean, what is going to be the reason given for not covering the procedure? “Because some other people in Kansas I don’t know don’t believe in it”?

    My health insurance doesn’t cover birth control. I hate it, and I wish I had something else that gave me options. Not covering *full* reproductive care is counterproductive to some of the real problems Americans are facing with poverty, teen pregnancy, etc.

  75. STL –

    If federal money isn’t going to be used to pay for abortions, then what I want to know is what about birth control? How much other contraceptive care is going to get lumped in there inappropriately?

    The moron who lumped birth control pills in with abortion was a Bush appointee. He’s out on his ass, and good riddance. Sibelius says she’ll cover birth control.

    A little googling, and the answer is there. Research – it works. Use it.

  76. STL @94

    Getting the pill covered by insurance is going to be a tough road to hoe, especially on the public’s dime. On the other hand, if we get a public option and the private insurers are really forced to bring their A game, you might see more of them offering to cover that just to sweeten the deal.

  77. My apologes John, I should know better to post when I’m tired and see something that pisses me off. I’ve just had my fill of things like “Well yes, we have had our share of crazies over the past decade, but at least – for the most part – they had an argument of sorts, skewed though it may be.” which seem to say that yes, the people who spent the Bush years justifying torture and telling me I’m not patriotic had a point and then acting all shocked that their party now has birthers, teabaggers and morons like Wilson.

    Other Bill @70 – Can you please take your party back? Because I would like a principled, intelligent opposition… but the Republican party of 2009 isn’t it.

  78. Dear Joe,

    Nice to see you coming to life after 8 years of sleep. You said something about lie–here’s a few world class things you must have missed:

    I guess you got those WMD’s,

    and Valerie Plame’s retirement checks,

    and the transcripts of the billions of emails and telephone calls recorded by the NSA over the last 6 years

    and the no bid contracts for billions to Haliburton and KBR

    and the apologies to the US service personnel killed and maimed because of George Bush’s directive from the first cabinet meeting on Jan 31, 2001–“Iraq, find a way”

    and video of Cheney screaming “Deficits don’t matter” as he channeled billions that would have paid for the health care of every man, woman and child in America for 20 years

    and the names of those republican hacks he appointed to the SEC who stood by as people destroyed our whole economy and 17 trillion dollars in retirement savings too.

    You need to get down on your knees and beg forgiveness for being stupid enough to have voted not once but twice for George W Bush, the man who just about destroyed America. And with your help actually got away with it

  79. You know, the number of people who have religious objections to medical treatment in this country is really pretty low. I wouldn’t even bother to bring them up in a discussion about the particulars of mandated health care, as they’re not a large enough demographic to make a difference either way.

    That being said, Christian Scientists allow for things like dental work, eye exams and bones being set, so they’d still need to pony up under mandated coverage.

    Also, I love the idea of “Sell everything you own to pay for medical care, and THEN we’ll help you.”

    BRILLIANT! Rather than spend a (relatively) nominal amount of money per capita helping people afford insurance (either through reform, public options, or subsidizing), let’s make sure people who need help are destitute, have lost their jobs due to health problems, and are now desperately scraping for unemployment, food stamps, and medicare! THEN we’ll help them!

    It’s also a MUCH better idea to tie all affordable insurance to full time jobs and make it more difficult for people to attend college. Nothing makes more financial sense than permanently reducing a person’s earning potential by making them choose between tuition and medical care!

    Yay!

    …For fuck’s sake.

    But back to the speech. I almost cried. I have a child with very expensive medical needs, and in this economy, losing my job would be disastrous for my family. Sure, we’d be able to put the kids on SCHIP, but the adults in the family (you know, the caregivers and breadwinners?) would be twisting in the wind. One good illness would break us in half.

    Because of this, my employer holds my family’s survival in their indifferent hands.

    That’s fucking wrong.

    The idea that my children might not have to bow and scrape to some pissant in middle management to protect a sick child fills me with hope.

  80. To be honest, I feel like a guy on a lonely highway. Obama drives by in a rickety taxi that looks like it will fall apart five miles from here and the rate he quotes is ridiculous. When I object, he says well you can take your chance with those guys…pointing at the hill folk from Deliverance. So you get in the cab….

    You can take that as a hearty endorsement of this administration’s early days or as harsh criticism. YMMV

  81. WhoKnows @ 42:

    As long as you have a job you have a choice of having health insurance or not.

    Wrong. Wrong, wrong, wrong, wrong wrong. I have a job, the same job I’ve had for the last 18 years. We used to have company-supplied health insurance, and it was good insurance, and it saved my life—and I mean that literally. But the company I work for is small, with only 4 employees, and the insurance company raised the rate every single year on some pretext or another, and what with the effects of aging (cumulative pre-existing conditions, don’tchaknow), and the mere fact of aging, the company can no longer afford the premiums. Changing insurance companies was, for those same reasons, not a viable option. Oh, sure, the company could put itself back in the running….by firing every last one of us and re-booting with younger personnel without any such disadvantages. And that would leave all of us…where? High and dry, twisting in the wind, that’s where.

  82. the number of people who have religious objections to medical treatment in this country is really pretty low

    Not to mention the number of people who had religious and moral objections to invading Iraq was pretty large. Bush invaded anyway.

    If find it hypocritically repulsive when people in the majority gladly bulldoze minority opposition opinions but then when those same bulldozers find themselves in the minority, they scream bloody murder that everything must be unanimous.

  83. GregLondon @103

    Think there’s a pretty sizable difference between another yelling that we shouldn’t be bombing someone and someone yelling that we shouldn’t be trying to save their own lives.

    How about you?

  84. Steve @99

    I believe the phrase you’re looking for instead of “hand waving” is “he explained it, but I don’t believe him.”

    No. Because he made a statement and wanted us to take it as a given. But it’s not a given.

    He needed to explain how it is that this government bureaucracy would function in a way that is significantly more efficient than how the private sector operates. Clearly the private sector has as much, if not more of an interest in bureaucratic efficiency: less people working less paperwork = more profits.

    It would also be useful that if t government has such a mechanism he should open-source it so that all off America could become more efficient, if not, at least, other branches of Government.

    So the fact is by saying simply that the “government option” would be more efficient because it would be more efficient really is just hand waving.

  85. Wow, the discussion today is well…interesting is the best way to describe it.

    Having read the speech twice (couldn’t watch because I had other obligations), President Obama did some hand-waving when discussing the options for those who have insurance through their companies. He had other things to discuss, and he covered those topics well. He failed in my opinion to discuss how to keep companies from dumping their employees into this “insurance exchange” as he called it. He has said that individuals would be required to purchase health insurance, and businesses would be required to offer health care. Now, my concern, and the concern of people I work with, is what will be done to keep companies from dropping us?

    To me, it seems counterproductive to set up the exchange and require businesses to provide health care or to “…chip in to help cover the cost of their workers.” What does this mean? Does this mean the company drops me from the insurance program that fits me nearly perfectly right now and chips in towards something on the exchange? Because the company chipping in is vague and meaningless. Is it going to be a similar amount to the benefit I get now? Or is the penalty or portion they are required to pay going to incentivize them to drop me into this exchange?

    Next, who regulates and controls the exchange? This was not covered in the speech, but since he says WE in the speech, I’m guessing this is the government. So, we have a government panel that establishes and regulates an insurance exchange, right? I want to know the answer to this question because that does seem like a government take over of the insurance industry to me, especially, if protections are not put in place that requires companies to provide, at least, the same health care options they currently do. I truly hope my President, who I do disagree with a lot, is right that this will lead to better service.

    Now, the public option? Don’t care. Death panels? We should have them for the birthers and 9/11 truthers. (Was that statement as absurd as the original death panel statement? ‘Cause that’s what I was trying for?)

    Personally, while being a Rightie who defected from the Republican party long, long ago, I want to give the President (but not Congress) the benefit of the doubt that he could not discuss these things because of the inanity coming from my side of the equation, way, way away from me but still my side. These are the questions from the “Main Street” ex-Republicans that I know that we would like answer.

    I would appreciate if any one can point me to the President’s words OR the wording in one of the bills to correctly answer these questions.

    Thanks for your time. Cheers!

  86. As it stands I think millions of people will be forced to give money to the insurers. The insurers will game the drafting and implementation of the bill and they will claw back each tiny element of real reform under different Congresses and Presidents. In the long run they will find a way to milk every last dollar while degrading the overall level of coverage to everyone, not just the people insured because of the bill. We will lump it for a few years. When it gets bad enough a new “reform” regime will get in and give us just enough so that there is no insurrection. Then the whole slippery slide back to the bad days will begin again. It is not even that long term a process anymore, just look at the snap back from the financial industry in less than a year.

  87. Frank @105 “Clearly the private sector has as much, if not more of an interest in bureaucratic efficiency: less people working less paperwork = more profits.”

    That’s only true if the insurance company’s top line is unmovable. As we’ve seen with insurance premium increases in the double-digits (by percentage) most years, that’s not the case. It’s far easier and more profitable to charge $.01 more per unit than to find $.01 per unit in savings on the back-end (this is said as the former business consultant).

  88. I see the ‘tort reform’ red herring is starting to flop around.

    First, If you look at the transcript, I believe that you can see that those words were not used in the speech. The phrase used could even be regarded as ‘fix the tort reform mess’ . Second, tort reform, as phrased and claimed by the right, does not work. There are several states where tort reform has been cranked up to the max (Texas and MN for example) and the promised benefits never materialized. No positive effects at all. Well, except for the insurance companies’ bank accounts.

    Semi-amusing side note: the Republican responder (sacrificial goat) has had three malpractice suits before he changed to the safer occupation of politician. Result – 2 convictions and 1 settled out of court. In the one case I had the time to research in a bit more detail, his victim (er, patient) lost a leg. His judgment in this case was paid for by a state fund (government in medicine, what?).

  89. Scott asked: “Why would anyone, anywhere object to the notion of universal health care?”

    Whenever I ask this, the “universal health care is the work of the devil!” responses I get are based on four assumptions:

    1. The assumption that all health care under a universal-health care system will be worse than what’s currently available to the portion of our population who care afford health care. I heard lots of assurances that if I came down with fatal cancer, I’d have to wait three years to see a doctor, and seven years for treatment, all of which would be inconvenient if the cancer killed me in ONE year. This would account for the populations of various other countries with universal coverage having died off and dwindled since establishing universal health care, rather than having BETTER healthcare than we get here… Oh. Hang on. Spotting possible flaw in argument.

    2. The assumption that private health insurance, for those who want it, will be unavailable and unattainable and illegal, under a system of universal health care coverage. Because apparently private enterprise will disappear once everyone has health coverage.

    3. The assumption that society will go broke paying for universal coverage. As oposed to the excellent system we’ve got right now where one aspirin costs $3 if given to you in a hospital, and friends of mine spend $10,000 per year out-of-pocket to cover medical costs NOT covered by the $20,000 per year that their one-person health insurance policies cost.

    4. Universal health care = SOCIALISM!!!! ‘Nuff said.

    Laura

  90. Frank@91 and elsewhere,

    How would the government option save money? They wouldn’t need to be more efficient than the private sector. What would save the money is taking shareholder profits out of the equation.

  91. #17 and #19

    Rush’s comment confuses me. First, it might actually be true that paying out of pocket can reduce your costs on some things because of the wierd pricing structure that the health insurance companies impose (unlikely to be true for catastrophic care, particularly because you are less likely to shop around when your femoral artery is spewing blood and my primary concern when I have cancer is not looking for the cheapest treatment). But there is a deeper problem:

    If health insurance doesn’t reduce costs for the masses, why does it exist? Who does it benefit? People complain that a public option would drive private insurers out of business. Why should we care? If they don’t reduce costs and only exist to make themselves richer then they aren’t helping us, so good riddance.

    Is that really the point that that he wants to make?

  92. @ Laura Resnick:

    Great explanation of the particulars of the objections on universal health care.

    I wonder if there something more fundamental going on, in addition. The way the “empathy” meme played as red meat to Republicans during the Sotomayor confirmation hearings seemed telling to me. I’d honestly like to understand it better.

    Any of the conservatives here care to comment? What’s the fundamental emotional-level objection to universal health care?

  93. “He needed to explain how it is that this government bureaucracy would function in a way that is significantly more efficient than how the private sector operates.”

    The private sector is efficient? Oh yeah, efficient at booting people off without paying claims after taking their premiums, and making companies pony up for healthcare for all their employees and then denying some of those employees for pre-existing conditions, all making themselves a big fat profit. (That is, those businesses which can afford to supply healthcare at all.) Leaving 47 million uninsured and that number growing every day, choking up hospitals, ER’s and driving up healthcare costs and government costs and taxes.

    What the private insurers aren’t efficient at is getting healthcare and pharmaceuticals to lower their costs. The government, however, which can regulate, can be. A large part of the reform is cutting costs — accidental waste in Medicare (some $500 billion in savings,) parts of the country charging way more for healthcare costs than other parts in profit-chasing, rescinding Bush’s unnecessary tax cuts to the very wealthy, which cost us trillions in revenue, regulating private insurers to increase competition, lower uninsured healthcare costs — which are far larger than if they were insured, and, gasp, make the private insurers more efficient, less pirate profiteers.

    You keep asking how the government is going to pay for reformed healthcare. The government pays for healthcare NOW, not just Medicare and Medicaid, and they can’t afford it. The reform is to change business practices and cut costs so that we can then pay for healthcare, private and government, because if we don’t do something, we will be broke, especially as the uninsured increase in number. And we will be so because the private insurers and the healthcare industry are intent on bankrupting us in the name of profit.

    The private insurers and pharmaceutical companies and healthcare industry know this too. That’s why they are negotiating with the government. That’s why the pharmaceuticals offered a cost cutting deal. But the private insurers are also spending millions lobbying against the reform so that it will be as weakened as possible, so that they will be as unregulated as possible to make maximum profit, and leave government — us — to deal with the mess and absorb the costs.

    I guess that’s efficient, as either way, they win. And yes, we’re giving away a lot of the store to them to get healthcare reform, letting them rip the government off somewhat. But if reform is passed, the amount that the private insurers and healthcare can rip off the government will be lessened from what it is now, costs will be reduced and the platform will be in place to continue that, no matter the business/political climate.

    Reform is about cutting costs while improving service. Because the private insurers right now are lousy at cutting costs and improving service. They’ve been doing a lousy job for decades. So now we’re reforming THEM, so that they will do a better job and costs will be reduced. Or we could just let them continue to do a lousy job, increase the number of uninsured and go broke, while every other industralized nation looks at us like we’re crazy. I prefer Option A.

  94. AlanM @ 112: So, one of the things that’s weird about health insurance is that we expect it to behave very differently than, say, car insurance. I mean, I devoutly hope that, over my lifetime, I pay more into my car insurance than I ever need to take out of it. But it’s there for the time when something goes severely pear-shaped, covering the catastrophic costs. So in that sense, insurance doesn’t necessarily save money for any given customer. People seem to have different expectations for health insurance, though.

    I guess the benefit that being insured has is that (in a world in which insurance works the way I think it’s supposed to) your costs are predictable (pay $x/month, rather than all at once when you need care), and ceilinged (after $y co-pay amount, the insurance covers the rest). So, even if the total payout over decades isn’t lower, the costs are more manageable.

  95. Mike wrote: “Any of the conservatives here care to comment? What’s the fundamental emotional-level objection to universal health care?”

    Mike, I am definitely NOT a conservative, but I think simple observation makes it clear that fear is the primary emotional-level objection.

    Fear, rather than fact, is the basis of beliefs that an Americans’ health care quality will deteriorate under a universal health care system.

    Certainly fear rather than fact is the basis of erroneous beliefs that Obama’s proposed plan will eliminate an individual’s -choice- in health care decisions.

    Fear is the basis of assumptions that universal coverage would bankrupt our society, even though all statistics show that our CURRENT system is too costly for our society to bear, and costs are being BETTER managed by many societies with universal coverage.

    And INCITING fear is quite clearly the basis of campaigns in the opposition that declare there will be “death panels” and so on. (The totally false claims about British health care being made during this “debate” in the US have been a goldmine for British comedians this summer. Who else here listens to BBC Friday Night Comedy?)

    However, there is a very, very, VERY practical reasons for politicians and TV hosts to oppose health care reform. There is a LOT of money being made in the current, bloated, poorly regulated, horrifically expensive, for-profit system. (When a single aspirin costs $3 when handed to you in a hospital, SOMEONE is sure making boatloads of money!) The companies and groups and individuals profiting hugely from the current system, by remarkable and unforeseeable coincidence, spent a LOT of money on TV ads and on politicial campaigns.

    Do I wish that everyone in government and in the media who benefits from that sea of money would put self-interest aside and base their rhetoric and decisions solely on what’s best for the rest of us? Yes! Do I think they will? Not so much.

    What baffles me, though, is that in a system where vomiting can cost you $1200, it doesn’t seem to occur to “man in the street” opponents of health care reform that there are HUGE FORTUNES invested in frightening them into opposing a better regulated and more competitive system.

    Laura

  96. And speaking of comparisons between car insurance and health insurance, here’s the most relevant point, IMO, which demonstrates just what a disaster the current system is:

    I have an excellent driving record. Haven’t had a ticket (or made a claim) in over a decade. Consequently, I was automatically enrolled in my insurer’s “safe driver” pool years ago, which reduces my payments for the exact same coverage I was getting before. Since then, my payments actually keep GOING DOWN every year, in acknowledgement of my driving record. Consequently, for the same coverage that I had 10 years ago, I now pay LESS than I was paying then.

    By contrast, even if a person NEVER GOT SICK OR INJURED during that same decade… their health insurance payments in this country would have doubled, tripled, or even quadrupled over the past decade to maintain the same policy that they started out with 10 years earlier.

    Laura

  97. Insurance is a bad term for what we have. The idea behind insurance is that you only use it when something bad happens. Companies make money betting on how many people will have bad things happen vs how many people don’t. With health insurance you use it even for routine maintenance.

  98. I think much of the philosophical objection to universal health care (and other entitlements) is based in something far more sinister than fear: The notion that only the threat of pain and death motivates people to work.

    Despite years of research proving that carrots work better than sticks, there’s a contingent of the population that keeps insisting that stick methods–including violence and death–are the only way to keep people responsible.

    It’s not surprising that many of these same people are of a religious mindset that uses the threat of eternal damnation to keep people from sinning. They also use corporal punishment on their kids, favor the death penalty and want WMDs available.

    The idea that anyone could want to work and live a responsible, self-sufficient life without being afraid of suffering is beyond them.

  99. frank@105: Clearly the private sector has as much, if not more of an interest in bureaucratic efficiency: less people working less paperwork = more profits.

    I hear the choir singing worshipful praise to the “invisible hand” in the background.

    Prisoner’s Dilemma and dogmatic strategies.

    read page 19 (Laissez Faire Capitalism Modeled as Multiple Iterated Prisoner’s Dilemma) and page 20 (Inefficiencies in the Free Market).

    And if you wish to continue this Free Market Must be Better Than Regulation nonsense, read the entire doctument first. It’s under 30 pages. You’ll live.

    Meanwhile, explain to me how “efficient” the private sector can be when it’s turning down 20 to 40% of claims? That was the latest numbers of the biggest insurnace companies in california.

    Eric@106: Does this mean the company drops me from the insurance program

    I think a fundamental underlying principle of health care reform is that the insurance companies can’t do anything that forces you to drop from their rolls. They offer a price to join, if you pay, you’re a member, and they can never boot you off as long as you keep paying.

    I believe any “exchanging” that may go on will be for current customers who want to switch or people who are currently uninsured due to preexisting conditions and such.

    Iron@107: As it stands

    Just want to point out that everything you say after this is not “as it stands” but as you fear it may become.

    As it stands, the current situation is unsustainable by everyone’s accounts.

    Which means, given a choice between “known future doom” and “possible solution”, you chose option 3, “possible solution turns to doom”. Does that mean you oppose “possible solution” and favor “known future doom”?

    Yeah, I’m worried they’ll get teh bill wrong. That doesn’t mean it’s better to do nothing. If we get the bill right we can definitely avoid certain catastrophe. Seems like we ought to try that than letting certain catastrophe run us over as we lay prone on the road.

    Or, as Obama put it, We did not come to fear the future. We came here to shape it.

    We’re in serious trouble if we do nothing. But if you’re so afraid of doing the wrong thing and making it worse, that you end up doing nothing, then that’s fearing the future.

    Nargel@109: There are several states where tort reform has been cranked up to the max (Texas and MN for example) and the promised benefits never materialized.

    Somewhere I found some numbers comparing Canada to America. Canada spends about $2100 dollars per person on health care. America spends about $5000 or more per person. of that, Canada spends about $4 dollars per person due to malpractice insurance. America spends about $16 a person.

    That means that “tort reform” in it’s most non-right-wing nuttery and most effective approach, would save about $12 dollars a person in an issue that costing thousands of dollars more per person due to unregulated insurance companies running amuck.

    Anyone tryign to say “tort reform” is the solution is ignoring the actual numbers and forwarding pure dogma.

    Mike@113: What’s the fundamental emotional-level objection to universal health care?

    paranoia. Distrust of your fellow human beings.

    No, seriously.

    The conservative dogma is that laissez faire is the best, most efficient solution, far better than any government can be. They may point to the iterated prisoner’s dilemma model and explain that cooperation is the best thing for everyone, so everyone will naturally cooperate.

    But if you view the world through the eyes of a prisoner always going through constant iterations of the prisoner’s dilemma, you would always feel distrust towards the other prisoner, fearing they might rat you out. Mathematically, it makes sense to rat out for short term gain. And depending on how many iterations you have left in the future, you may not be able to recoup your losses of that betrayal.

    So, you’re constantly paranoid.

    The notion of applying regulation to the prisoner’s dilemma comes from the idea of everyone in the population coming together through government and saying “whoever rats will get punished when they return here”. Everyone agrees to this before the next iteration starts. And from that point forward, every iteration uses a different payoff matrix. The matrix is such that the best choice is for every prisoner to cooperate withtheir fellow prisoners. rats may get an immediate reward (profit or early release) but the government regulations will impose post penalties that will neutralize any reward for non-coopeation.

    But the conservatives, especially the rabid screamers you’re hearing now, don’t view government that way. They don’t view it as something everyone can work together with to help everyone. They view the government either as (1) they’re in power and they get to use that power to demand the game theory outcome they want or (2) they’re not in power and the government could suddenly be used by the other “prisoner” in the dilemma to be used against them.

    Health care reform would benefit everyone a lot if everyone sacrificed a little bit. In the prisoner’s dilemma, everyone is better off if everyone cooperates. But to cooperate, you have to sacrifice a little bit. You have to give up getting out immediately. You have to give up not paying any taxes at all. You have to give up allowing corporations unlimited profits. The prisoner’s dilemma shows that short term greed results in non cooperation. So using teh government to regulate the dilemma can change the matrix so everyone cooperates.

    But conservatives don’t look at it that way. They look at the way they abuse government power when they have it. torture. rendition. illegal wiretapping. reduced liberties. They use government against the other “prisoner”, rather than usign it to benefit everyone.

    So, they’re paranoid that that’s what the reformists want to do, use government against them. Use government to create death panels and kill grandma and while simultaneously helping illegal aliens. It doesn’t make any logical mathematical sense, but this “deathpanel” nonsense fits exactly into their paranoid worldview: The government is a weapon to be used against the minority.

    That’s how they use it. That’s how they expect reformers to use it. Which means they’re not so sure that laissez faire is the most efficient, it’s just that they’re terrified that government regulation will mandate that all conservatives be turned into soylent green. It’s paranoia, not mathematics.

    I tried to sort out the emotional stuff that anti-reformists are going through here:

    http://www.warhw.com/2009/09/04/the-regulated-iterated-prisoners-dilemma-and-health-care-reform/

  100. JimF, that’s a good point. Having been self-employed for over 20 years, I’ve never had health insurance coverage that covered my maintenance; similarly, my car insurance has never covered my maintenance trips to the mechanic.

    Which highlights another broken part of the health care system. When I go to my mechanic, there’s a basic fee for walking in the door; but after that, before they fix or replace anything, they give me a breakdown of what the work will cost, and we discuss the list, prioritize it, and cut it off based on what I can afford. (Hence my car’s a/c will not be fixed until next year, since it’s not a safety issue and the safety-issue repairs had already gone $100 over my budget on my most-recent visit.)

    My only experience of elective surgery (I had lasik surgery 4 years ago) was virtually identical to that: We discussed my options and choices for the surgery, and we also discussed =exactly= what every option would cost and what my payment-plan options for it were.

    By contrast, when I made an appointment at my doctor’s office a few months ago to get a simple, routine blood test that I get every single year, which common lab test looks at one sole factor (so that my annual prescription can be adjusted, if necessary)… I made three calls to the office AND asked again when I got there, but no one could tell me what my visit-and-test would cost. Finally, on my fourth call, they gave me an estimate; it subsequently proved to be off (an underestimate) by more than 200%.

    They were more than 200% wrong in their -estimate- (since they don’t actually HAVE a prices determined, I gather) for a routine 15-minute office visit to have a nurse draw blood, and a common lab test examining one sole factor.

    Which does actually make it a lot more challenging to participate in routine health maintainence at one’s own expense, compared to the logic of the car mainteinance and elective surgery systems.

    Laura

  101. Car insurance is closer to a reverse lottery. We all pay them in case something bad happens, such as an accident or theft (but not non-emergency car repairs.) People pay out a lot regularly on car repairs and maintenance, but only a small percentage are going to need payments from their car insurers for emergency events. So the big pool of all of us pays for that slice who need to file claims and the car insurers pocket big profits.

    But healthcare is more like regular maintenance and car repairs. Children need more than adults. The percentage of people who don’t have to file much in healthcare claims is exceedingly small, the amount filing claims is much bigger. And bad things, just like a car accident or theft, occur to only a small percentage, but they are much, much more involved than just replacing a car.

    So healthcare and emergency healthcare is a much bigger cost per person than car emergency care. Medical insurers have to pay out much more, process more claims, hire more staff, etc. They still make a profit, but comparing healthcare insurance to car insurance is talking about two different systems. (Car insurance and disability/life insurance, though, are very similar.)

  102. I’m getting a strong sense of “It’s turtles all the way down” in conservative arguments for against Obama’s health care reform. There’s really no way to argue against the conservatives using counterexample from Canada or Australia – they’ll keep insisting that there’s a fundamental flaw in those systems that will inevitably destroy them, and we just haven’t seen it yet.

    Post hoc, ergo propter hoc.. Except there’s not even a correlation, there’s a phantom menace of an mythical inevitable evil future that they’re correlating with.

    And the Republican plan? It’s a *joke*. It’s industry self regulation, and extra deregulation tacked on to that.

    I lived in CA back when the energy markets were deregulated. Energy companies created fake blackouts in order to spike energy costs. But of course, Republicans still trust industry to police its self. I’m not saying that democrats are perfectly progressive about things, but they’re a far cry from the Republicans, who manage the masses with a fear of “socialism”.

    People who’re protected by publicly funded fire companies, who drive on publicly funded roads, who’s police protection, food safety regulation, energy regulation and a dozen other necessary utilities can get conned into believing that health care being managed in a similar way would kill them or beggar them with taxes.

    Everyone is basically gambling that they won’t be the one hit by a crippling medical bankruptcy. And you know, make that bet, chances are, you’ll win. But that’s what it comes down to. The Republican plan will not in any way promise that a significant number of people who lack coverage are going to be covered. If you’re unemployed for a while in between jobs, you’re out of luck if you can’t afford COBRA level payments. And plenty of people can’t if their only income is unemployment.

  103. Laura, I think the game theory goes like this:

    Alice doesn’t want to pay for routine exams. She decides to risk getting sick long term in exchange for saving some money in the short term

    She ends up getting sick, getting a lot of bills that she can’t pay, and maybe going bankrupt. The hospital takes those unpaid bills and passes the cost along to all its customers.

    Therefore everyone is affected if Alice doesn’t do routine checkups.

    I think that’s one of the reasons for supporting the public option. Cheap insurance for the people who can’t afford outrageous private insurance. Everyone gets routine exams with only a copay. Health problems are caught before they end up costing a lot more money.

    In the prisoner’s dilemma, either prisoner can betray the other. people can risk not getting insurance for short term greed and risk harming everyone. And insurance companies can risk short term greed by booting customers and overcharging them, harming everyone.

    Regulation solves the insurance company greed. Public option solves the uninsured problem, and acts as sort of a ruler for how inefficient the private insurace companies are.

  104. Just heard a very interesting piece on Fresh Air on NPR where they interviewed the guy who wrote “Republican Gamora.”

    Sheds some light on where alot of the really silly claims (death panels, obama == hitler == stalin etc…) originated. I’ll give you a hint, it’s crazy religious leaders you’ve probably never heard of.

  105. “”I think that’s one of the reasons for supporting the public option.””

    This is certainly among the reasons that I support it.

    I’ve been self-employed most of my adult life. One of the results of this in our society is that I get inadequate health care, and particularly inadequate health maintenance care, because I can rarely afford or justify the mysteriously unnamable and unknowable expense (which subsequently always turns out to be for hundreds of dollars) to see a doctor when I’m feeling fine–and, fortunately, I feel fine most of the time.

    Moreover, I took a friend in pain to see a doctor three years ago (she had fallen on my front stoop and craked a rib). They charged her $1100 so say, “We can’t do anything for you. Go home and try not to make it worse before it gets better by itself.”) So when I DON’T feel fine, I still don’t go to a doctor, because I can’t afford $1100 for someone to say, “I can’t help you, but it should get better by itself.”

    I have a friend who spent all night vomiting, so she went to a doctor. After $1200 of tests, he had no idea what was wrong with her and suggested she get more tests. She decided she’d rather die. (Fortunately, it got better all by itself.) I had a bad stomach disorder last year. Lasted five days. I didn’t have $1200 to find out why I as vomiting, so I hoped it would get better by itself, rather than kill me.

    So you BET I want a public option. Not because I’m a freeloading nogoodnik, as many Congressman (who get health coverage) seem to think. But because, as someone who’s been working and paying taxes since I was fourteen, I’d like to be able to see a doctor now and then.

    Laura

  106. @77:

    I think you missed the part where he said that the “public option” was not going to be subsidized, but self sufficient and paid for by the premiums it collects. Presumably, it will somehow be magically affordable for low income people who don’t have insurance.

    I’ve heard that before, during discussion of all sorts of programs from school lunches to road construction. It’s not impossible for social programs to pay for themselves, but it is highly unusual and thus improbable. They usually end up being subsidized because no one is willing to cancel the program once it’s established.

    Does that count as a shell game? It’s probably not intended as one by Obama – but sincerity of belief != rationality of belief.

    I for one look forward to the implementation of Obama’s plan. If I’m wrong, I’m pleasantly surprised and everybody’s better off. If I’m right, I get to be right, which is sufficient in itself.

  107. Frank @ 105:

    “He needed to explain how it is that this government bureaucracy would function in a way that is significantly more efficient than how the private sector operates. Clearly the private sector has as much, if not more of an interest in bureaucratic efficiency: less people working less paperwork = more profits.”

    I think the evidence shows otherwise.

    Wendell Potter, former executive with CIGNA, told Bill Moyers that private insurers spend “about 20 cents of every premium dollar on overhead, which is administrative expense or profit”, compared to Medicare’s administrative expenses of 3% – and further, that shareholders pressure private insurers to spend less and less on paying claims:

    “back during the time that the Clinton plan was being debated, 95 cents out of every dollar was s[p]ent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent. So, investors want that to keep shrinking.”

    (The whole transcript is worth reading.)

    And the Washington Monthly reported that “when it comes to health care, it’s a government bureaucracy that’s setting the standard for maintaining best practices while reducing costs, and it’s the private sector that’s lagging in quality. That unexpected reality needs examining … It turns out that precisely because the VHA is a big, government-run system that has nearly a lifetime relationship with its patients, it has incentives for investing in quality and keeping its patients well — incentives that are lacking in for-profit medicine.”

    The article explains how the ability of private insurers to dump customers who file claims gives them little incentive to keep those customers healthy, while the VA has been finding ways to cut costs AND keep customers healthier.

    I don’t think government institutions are always quagmires of inefficiency, and I certainly don’t think private corporations are always bastions of efficiency. If I can get health care service that’s as reliable and affordable as my mail delivery, that’d be a huge improvement over the bureaucracy-laden, unreliable, aggravating “service” I deal with now, through private insurance.

  108. Kristi,

    I think you’re making the classic mistake of relying on information to guide your reasoning.

    Unfounded supposition, pandering, and fear-mongering is far more effective.

    Laura

  109. Rick @ 97 – yeah, youre telling me. I wish the moderate republicans would step back into the discussion. I think some of what the demcratic side of the debate had to offer during the bush years was out of line. But, the difference is that those folks haven’t generally been the voice of the party. And I think that has been largely true of republicans until the last couple years.

    But today, the far right of the republicanparty is the mouthpiece of the organization. They have lined up against their moderates and totally disenfranchised them. I live in northern virginia and have a graduate degree. Therefore I, republican, am a godless communist traitor unReal American just like the rest of you lot.

    I can only hope that their utter demise continues and that the next crop of republicans in, say 2014, have more to offer.

    Until then I cast my vote for the party that at least bases their rhetoric infacts. I’m one of those obamicans for now. Actually, I rather like the guy. I’m a fan of calm rational pragmatism and intelligent discourse. Even if he is slowly wiping my mind to prepare for the lizardpeople invasion.

  110. Ahh see that is the beauty of the plan; by the time you are mind wiped it will no longer be an invasion but a liberation and we will welcome the lizard people with open arms!

  111. Kristi @129

    “about 20 cents of every premium dollar on overhead, which is administrative expense or profit”, compared to Medicare’s administrative expenses of 3%

    You have to understand that yes, Medicare has a lower overhead compared to most private insurers, but that is because they do very little to counteract fraud and abuse of the system, which is something else that costs the rest of us money.

    According to the Wall Street Journal

    insurance companies spend money to screen their claims for fraud. Medicare automatically pays more than 95% of the bills it receives. This lack of scrutiny reduces overhead, but it makes the program highly vulnerable to abuse. In June, a high-school dropout pleaded guilty to conning Medicare out of $105 million by submitting over 140,000 bogus claims before auditors noticed. It was the biggest health-care fraud in American history.

    I should add “…that we know of” because Medicare is not real aggressive about uncovering fraud and abuse.

    So I’m not convinced we are comparing apples to apples here.

    I would also point out that the issues you raise such as the ability for “private insurers to dump customers who file claims” does not require a public option to fix.

    This is also true got Greg London’s point regarding routine exams and Laura Resnik’s complaint about no knowing in advance the cost of services, and KatG’s concern about insurance companies dropping people’s coverage when they get sick, or not insuring them because of preexisting conditions.

    None of these things require a public option to fix.

  112. Frank, if you really want to make the argument that private industry is better at avoiding fraud, it’s going to be a long thread full of counter examples, starting with Madoff, Bernard M. and working from there.

  113. Frank, even if some individuals may game the system (whether that be SS, Medicare, TANF or any other government service), the money lost to such things is a drop in the bucket compared to the money lost to private companies in the form of profit and executive pay.

    And don’t get me started on the money we lose in the military sector. Even if every last person on Medicare were in fact claiming the money fraudulently, it still wouldn’t come close to the amount of money lost on things like no-bid contracts for Halliburton.

    You care about government waste? Start with the biggest wasters.

  114. Abby @ 115: The reason why people expect car insurance and health insurance to behave differently is that they are completely different. My health insurance is there to benefit me. My car insurance is there to benefit *you*. Isn’t it nice to know that, despite the fact that I have no money, my insurance will still pay to get your car fixed after I ran a red light straight into your car?

    Home insurance can be the same way. My current home insurance doesn’t really benefit me much, but Wells Fargo put their little foot down and insisted. It’s not protecting me, it’s protecting them (once I own the home it becomes more like health insurance in that it’s primarily protecting me against catastrophic damage).

  115. Re: Car Insurance v. “Medical” Insurance

    Generally speaking your car insurance doesn’t go up if you don’t claim over time because it’s really easy to look at an acturial table and say, if a person hasn’t ever had an accident nor a citation they’re unlikely to have an accident in the next 12 months.

    The probability of a male over the age of 30 getting prostate problems increases by 10% per decade until you have problems – you might be 90, but you’ll have them.

    There’s a lot of health problems like that and if you’re unlucky (key word: UNLUCKY) enough to get something serious before you’re at retirement in the US you could be in trouble.

  116. I would just like to point out, having lived in a country with national/universal/socialized/whatever-you-want-to-call-it healthcare for 7 years, and having family that is still there, that one aspect of this debate is missing. The country I lived in, had the following taxes (and this is just the ones I remember off the top of my head):

    *over 50% income tax
    *21% VAT (sales tax) (Currently they’re trying to raise this to 25%)
    *33+% luxury tax (cars are a luxury item)
    annual radio fee (if you purchased a car with a radio in it you pay an annual fee

    Nothing the government pays for is really free.

    Furthermore, having had major surgery under this country’s plan, and having several family members also being cared for, I can, speaking at least anecdotally, say that I do not and would not CHOOSE to be cared for under a national plan.

    The idea that enacting such legislation would not effect the quality of care is simply blind. It might take a generation, but be honest, would you encourage your children to become a doctor nowadays?? My FIL is a doctor, and he considers it more of a vocation than a mere job, but he has said repeatedly he wouldn’t advise his children or grandchildren to follow his path. If the best and the brightest follow different career choices, who will our doctors be in 20 years?

    If the majority of our population agree to sacrifice care and willingly increase taxation in exchange for national healthcare, then it will become law and so be it. However, to reduce and insult those that legitimately disagree to insensitive idiots is unfair. I honestly believe that there are better ways to solve our healthcare problems than to nationalize the industry.

    I do realize I’m posting this on what is a pretty lefty blog, so I’ll duck now…. :)

  117. Nothing the government pays for is really free.

    How strange, then, that countries with national plans almost uniformly pay substantially less on health care than does the United States.

  118. Furthermore, having had major surgery under this country’s plan, and having several family members also being cared for, I can, speaking at least anecdotally, say that I do not and would not CHOOSE to be cared for under a national plan.

    So, you would rather have paid for the major surgery by yourself?

  119. IY@138

    I don’t think anyone here is saying that a national/socialized/universal healthcare system will exist without problems. Right now if you do not have medical insurance in America and you get sick then you are in big trouble. You may have received substandard care (which exists in all medical systems) but you are alive (and not bankrupt or destitute due to your illness).

    At the same time I appreciate someone posting and saying “You know what I had xyz and I didn’t like it”

    Can I ask what country this was in?

    If we look at some other countries and their Healthcare systems:

    http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/

    I see a broken system and trying to model something a little more successful is not something I would oppose.

    Rabid

  120. Jim @ 132 – well, as I see it there’s so much the lizardpeople have done for us already. Our future with them can only be more radiant. Seriously, they’re a coldblooded people.

  121. #133: “You have to understand that yes, Medicare has a lower overhead compared to most private insurers, but that is because they do very little to counteract fraud and abuse of the system, which is something else that costs the rest of us money.”

    Which is why part of the reform bill is specifically to better discover fraud and reduce such costs in Medicare. Also to reduce accidental waste in Medicare — not deliberate fraud but accidental dual paperwork, etc. that due to current procedures, costs the government more. The public option is not the only part of the plan, and it’s job is not to “fix” the entire problem of preventive care, cost estimates, or dropping people off the roles. Regulations of the private insurers that are part of reform will be doing the main job of that.

    The role of the public option is thus: 200 million people will continue to get their healthcare through their employers. For people buying coverage for themselves, there would be a range of private health plans to choose from. If they can’t find affordable, quality coverage in the private insurance market, the public plan gives them the chance to have decent insurance they can afford from the government. This also forces the private insurers to compete (which they haven’t really had to do as they’re a giant oligarchy,) and improve the value of their plans for individuals.

    The public plan option wouldn’t have been necessary at all if we did not have a system in which people don’t have guaranteed access to basic health insurance and if the private insurers hadn’t been so intent on profits that they jacked the price for individual and small business premiums through the roof.

    The private insurers are worried that the public option will cause them to have to lower their fees in competition and deal with more competition from other companies who might come into the game, which will not cause them to lose money and fail, but cause them to not have quite as big profits as they’ve been enjoying at the public and government’s expense. Do you get this? The private insurers have been making you, the taxpayer, pay extra in costs to the government to deal with the uninsured and the insured whose claims they deny, so that they can have astronomical profits. They’re picking our pockets.

    The private insurers whine about how they have high overhead and they have to worry about lawsuits, etc. — that these costs are high. But the data doesn’t bear this out. They have profits far and above the costs they have. And further, the part of the reform that is working on lowering drug and healthcare costs will help them reduce their costs. The private insurers whine that they will go under if the government insures any but the old and the very poor, which is the same lie they told against Medicare and Medicaid when they were proposed.

    The private insurers have proposed that instead of a public option, that the government just pay them the difference to take people at a lower price. So instead of capitalistic competition, the private insurers want socialistic corporate welfare to keep their profits and prices artificially high. Without the public option part of reform, it will be difficult to keep the private insurers from gouging all the people they currently cover and new people who they can no longer turn away on pre-existing conditions, etc. Which means that we end up with the same problem we have now — people (and small businesses,) who need insurance, are now not denied access to it because of reform regulation, but still can’t afford it, with few alternatives. And what that means is that the private insurance industry is going to need a government bail-out when the whole system starts to sink.

    You want not to pay higher taxes and have your healthcare system fall apart, like it’s doing? You want the government to not pay out reams and reams of money trying to prop up the insurance industry and healthcare after they bleed everybody dry? You want the industry to be regulated by competitive prices that people can afford? Healthcare reform with a public option.

  122. Frank@133: “about 20 cents of every premium dollar on overhead, which is administrative expense or profit”, compared to Medicare’s administrative expenses of 3%

    You have to understand that yes, Medicare has a lower overhead compared to most private insurers, but that is because they do very little to counteract fraud and abuse of the system,

    So, you’re saying ALL private insurance overhead goes to combatting FRAUD??????

    Otherwise, if only 5% goes to combatting fraud, then Medicare would have 8% overhead and private insurance would still have 20%, which means that extra 12% is paying for someone’s porsche. Even then, it’s a savings. A substantial savings.

    Or does that not really matter to you? Is it not really about savings, about going with the choice that’s cheapest, even if it is government run, but really about finding any fricken excuse possible to kill the bill?

    I’m just curious.

    Unless you’re saying that entire difference is used to fight fraud, then YOU ARE SAYING MEDICARE IS CHEAPER THAN PRIVATE INSURANCE. If so, thank you for making that point. If not, please provide the proof that says the entire difference between the two is made up entirely of fraud-fighting costs.

    IY@138: I would just like to point out

    (insert comlete red herring comparing taxes of different countries rather than comparing health insurance costs.)

    That’s a nice one. Cute little shell game you did with the numbers there. Did Rush limbaugh come up with that?

    Canada’s health care costs is about $2100 per person. America is currently paying over $5000 per person. Therefore, if comparing costs and declaring the cheaper one the better one is a valid argument (i.e. what you tried but failed to do), then CANADA’s health care system is BETTER than AMERICA’s.

    See you tried to say that the other country was WORSE because its TAXES were higher, but those TAXES include more than just health care costs. If you want to compare health care costs to healthcare costs, OK, fine. Lets do that.

    Oh wait. America ends up more expensive than every other modern countryin the world.

    Well, lets compare quality then. Who lives longer? Oh wait, America sucks at that too.

    Even if the life expectancy were the same, adopting an approach that will cut the costs in half and produce the same result should be something any idiot would agree to.

    But yet again, all the morons are running to the defense of the private insurance lobbies. No one else is benefitting from teh status quo but private health insurance. No one. EVERYONE would MASSIVELY benefit with real health care reform. And yet republicans have set up roadblocks, picked up torches and pitchforks, and are prepared to set their own town on fire than to see a private insurance company LOSE ONE DOLLAR of its already grossly overpaid profit.

    DEATHPANELS!

    Nonsense used as obstruction to real progress. That’s all we’re seeing.

  123. @139 / 141: Cheaper does not equal free. Cheaper than what we spend does not mean better or free or anything else. I keep hearing this argument, but what is the point? Maybe it’s cheaper because certain people are not receiving certain kinds of care. Maybe it’s cheaper because fewer people are obese. Maybe it’s cheaper because people are paying twice – once for the public system, and again for a private add-on (as described in this thread somewhere by someone from Australia). Nationalizing health care will not necessarily lower the costs. You can send around that link, but it proves nothing. You may draw a correlation between the two, but that is not causation.

    @140: Actually, because I was an American citizen living abroad, my American health insurance paid the bill. Of course, that is neither here nor there. Furthermore, of course I wouldn’t have rather paid OOP. Why are those my only two options? I would have preferred, given the choice, to have traveled home to receive treatment. That wasn’t possible, and you’re right, I’m alive. But then, aren’t you arguing that you accept a lower standard of care in order for greater availability of care? (And I’m not conceding the point of availability, no ER will turn away a patient in need.) If that’s the case, fine, we disagree. Again, if that’s the way the majority of Americans feel, I’m prepared to lose the debate.

    @141: Belgium. I always hesitate to say for two reasons. First, despite it’s faults, it is the country of my heritage and I hate to speak ill of it as a nation. Second, and perhaps more honestly, I get awfully sick of the stupid questions. It’s a western European nation, one of the capitals of Europe, home to the UN and NATO and a whole bunch of other stuff. It is also a country that is being crushed under the weight of its social programs. Unemployment has been around 15% for decades, taxes are through the roof and going higher, and the birth rates have declined so low that there are not enough new young people to continue supporting the society as it stands.

    I’d like to add, in response to the public option debate, that if I’m understanding it correctly, it is my estimation that in fairly short order, most employers would stop offering insurance packages and allow their employees to join the public option. Maybe, if we’re set up with a supplemental system (like Australia) some employers would cover that. But really, why would a company spend money to insure people who can get “free” insurance through the gov’t?

    I really honestly do believe that we can solve many problems with cost, etc, without nationalizing care or sacrificing quality of care. However, I don’t think we will. I think this healthcare thing, one way or another, is going to pass. And I think the idea, as Scalzi mentioned, of it passing now and figuring out the “fiddly details” later, is dangerous.

  124. @144. Not trying to come up with a shell game here. Just honest first-hand observations. Are you actually doubting that?

    As a childbirth educator and mother, I would argue that maternity care in the US would be way better if we would spend a lot LESS money on it. Active management of labor and ridiculous, non-evidence based interventions, are the reason we have such deplorable rates of maternal and infant mortality. However, I still maintain that getting the government (more) involved in healthcare is NOT going to fix that. Don’t get me wrong, I definitely believe our system needs fixing, just not this way.

    Again, couldn’t it be argued that America’s costs and life expectancy are related, at least partly, to other things? For example, our unhealthy eating and largely sedentary lifestyles?? Is the new system planning on addressing that? If so, how? There’s a scary thought – pantry police?? I mean seriously. I do not understand the leap here. Are we saying that America’s high medical costs are solely due to evil doctors and insurance companies, and that our beloved and ever-efficient federal government will really swoop in and make everything cheaper?? If that’s the argument, I have a tough time buying it. This is the same government that spends our millions studying cow farts.

  125. @ IY

    “Nationalizing health care will not necessarily lower the costs. You can send around that link, but it proves nothing. You may draw a correlation between the two, but that is not causation.”

    Obama isn’t proposing to nationalize health care, so you’re beating a straw man here. He’s not even proposing to nationalize health insurance.

    Your point about correlation is fair, but it’s a damn strong correlation. EVERY country outperforms the U.S. in costs and nearly every industrialized country outperforms the U.S. in quality of care. Including countries with nationalized health care (U.K.) nationalized health insurance (Canada) and tight government regulation of an otherwise mostly private system (Japan).

    “I’d like to add, in response to the public option debate, that if I’m understanding it correctly, it is my estimation that in fairly short order, most employers would stop offering insurance packages and allow their employees to join the public option”

    I respectfully recommend that you re-read President Obama’s speech. He specifically said that the public option will only be available to those who can’t currently get health-care. (Which annoys me, because I’d love to give the boot to my ass-sucking HMO.) The plans also impose fines to employers who don’t offer insurance, precisely to prevent them from gaming the system as you suggest above.

  126. @147 – Respectfully, I have two questions:

    You indicate the US is outperformed in quality of care. May I ask where that information comes from? I tried a search, but was met with either highly partisan sources or mixed results (best in some aspects, lacking in others). Again, I would like to reiterate my skepticism that this bill, in it’s current form, will help.

    Thank you for clarifying the public option point. I believe I tried to indicate that I was unsure of how it was going to happen. In regards the idea that it will only be available to some and that employers will be penalized for not offering insurance etc, is that listed in the plan currently before Congress?? I am uncomfortable relying solely on speeches from any elected official.

  127. @IY

    Links you requested:
    Outcome ranking: http://www.photius.com/rankings/healthranks.html
    Cost per capita data: http://www.nationmaster.com/graph/hea_spe_per_per-health-spending-per-person

    The penalty for employers who don’t purchase health coverage is in the current bills. The public option has been a moving target. As I understand it, what Obama proposed last night was a bit scaled back from what’s in the bills passed out of committee in the House or in the bill the Senate has been unable to pass out of committee.

    You’re perfectly right to be skeptical of course, and watch to see what’s actually moved from committee and voted upon. There will probably be even further changes after the floor votes (assuming we get even that far), as the conference committees try to reconcile the bills.

    When trying to assess whether any bill will help, please keep in mind that doing nothing has a terrible cost too, both in human and financial terms. The human costs, in medical bankruptcies and lives lost are more compelling to me, but perhaps harder to quantify. The financial cost is the continued acceleration of health care spending: we’ve gone from 13% of GDP to 16% in 8 years. That rate of increase will literally bankrupt all of us if left unchecked.

  128. IY: (And I’m not conceding the point of availability, no ER will turn away a patient in need.)

    Um. Yes, they will, if what that patient needs is ongoing care for a chronic condition, and not emergency care because they’re on the verge of losing a limb or dying.

    You seem to have a very screwed up idea of what health care needs people really have. Like many people on your side, you’ve split it all nicely into a few categories:

    1. Utterly preventable things like heart disease and diabetes, which you wouldn’t have if you weren’t such a lazy fatass eating baby-flavored donuts all the time.

    2. Pregnancy and childbirth, which never, ever need actual medical care, because it’s a completely natural process, which never, ever goes wrong.

    3. Broken bones, car accidents and other fate-created trauma that needs emergency care.

    Only… Those categories only cover a tiny fraction of the medical care people actually need.

    How about my mom, who had a chronic back injury that needed surgery and six months in a brace, followed by major physical therapy?

    How about my dad, who nearly died of an infection that took 12 surgeries and three months in ICU to resolve?

    How about my mother-in-law, who needs a kidney transplant?

    How about my brother-in-law, who died at age 23 because he never saw doctors enough for them to notice the cantaloupe-sized tumor until it was too late?

    How about people with allergies, with depression, with anemia, with thyroid disease, with Crohn’s disease, with arthritis, with glaucoma…

    The list of potential health problems that have nothing whatsoever to do with behavior is enough to fill massive medical texts. And you think this can all be solved by diet, exercise and hitting the ER when the kid breaks his wrist?

    On behalf of the millions of people who suffer and die every year because they can’t afford to treat chronic conditions? Screw you.

  129. I’ve worked in hospitals for years and spent my fair share in doctors offices either following physicians (while trying to improve my medical school application) or just spending time with friends I made while working in the medical community. I’m going to set aside the question of whether or not the US government, and by extension its people, should be trying to ensure that everyone is taken care of, and focus for a minute on the actual handling of patients in the hospital and the associated costs. Hopefully there are some nurses, physicians, administrators, or other hospital employees who have access to these numbers out there who can help out as well.

    I’ve had patients who got a beer with meals because it was doctor prescribed. It was not an unnecessary prescription because some people don’t need to be detoxing in the hospital while they are being treated for other, more serious issues. The hospital I worked at served Pabst Blue Ribbon (as it was the beer of choice of the area insurance providers, apparently). Each can of Pabst cost the patient $12. People have already mentioned the $3 aspirin. Everything in the hospital has an incredibly inflated price tag. And why is that? Medicine has stopped being about helping people and has become about making money. If people happen to get better, that’s just a fortunate side effect (hopefully they’ll have a really bad chronic illness because that’s just good repeat business right there). The hospital I worked at was a publicly owned hospital. The shareholders did not collect any salary or any bonuses, so all of the money generated by the hospital went back into the hospital. I assumed this would mean great things, and it did. Just not for the patients. Sure, the hospital installed 32″ plasma TVs in every room with a nice HD cable package. The cafeteria had all sorts of different food. The hospital had built brand new surgical suites, new wings, and, most importantly, a huge doctor’s lounge in the past few years. A lot of money had to go into the advertising budget because they wanted people to think of this hospital first when they were feeling under the weather. I left before the spa and fitness center were done.

    All of this is not bad. In fact, I can see why a hospital would want this from a purely altruistic standpoint. Patients who spend days, weeks, or even months in the hospital begin to worsen as time goes by. You spend two months laying in a bed and just the mental component of that time can cause real problems. If you’ve got a huge TV, HD cable, good food, and a place for your family and friends to sleep and relax, that can really help with your healing and recovery. The doctor’s lounge is also important. They installed several capsule hotel type slots so that on call physicians could get rest during their shifts. They have a fully stocked kitchen and hotbar available 24/7 because at times, they can’t take the time to wait in the cafeteria for food (you spend 16 hours on your feet for emergency neurosurgery and you need something to help replenish your energy afterwards). New surgical suites means more people can be helped at once, etc., etc.

    The problem is that these were not the reasons for all of these improvements. One of the other local hospitals had taken to installing bigger TVs in their rooms, so we had to up the ante and install bigger ones. Another hospital had brought in some restaurants to start making food so our hospital started hiring chefs and started making better food (and charging more for it). Doctors are more likely to come perform elective surgery at the hospital if the doctor’s lounge is tricked out and everything is new. You want the orthopods and neuro guys doing procedures because their patients are going to be able to pay and will probably spend a few days in the hospital recovering (there is a time limit for insurance payments, if they say you only need two days for a total knee, they are only paying for two days) and then you can kick them out and slide a new patient right in.

    Even these reasons aren’t so bad because at least the hospital and patients are getting more stuff, right? The entire time they were installing TVs and building new surgical suites to give us more patients, they were cutting back on staffing. The patient to staff ratio went from 5 to 1 up to 8 to 1 on my floor. I worked on a cardiopulmonary floor that was a stopover point for patients either heading towards or out of Critical Care. New nurses, fresh out of nursing school, found their orientations cut in half and themselves facing 12 hours shifts with 8 patients a piece and only one nurse on the floor who had more than a year worth of experience. The hospital stopped authorizing overtime past 50 hours a week, made the floor managers stop offering shift bonuses for nurses who agreed to come in and work when we were too short staffed. This was happening on every floor and I’ve seen it happen at every hospital I go to.

    The hospitals are run solely as businesses now. Everything is about the bottom line and the bottom line is dictated by the insurance companies. They will say how much they are willing to pay for procedures, how much they are willing to reimburse the hospital. And as hospitals cut back on staffing so that they can add the creature comforts that make them more commercially appealing, the number of iatrogenic deaths will continue to rise. The AMA, in 2000, found that hospital errors were the third leading cause of death in the nation. 225,000 people a year dying because the nurses are overworked and understaffed, because the pharmacies are handling more orders with fewer pharmacists, and because the physicians live their lives on a tightrope, worried about litigious patients.

    I think, at the very least, we should make healthcare accessible for everyone. One of the best ways to do that is to start chipping away at the power that the insurance companies have over healthcare in this country. Having a public option would help tremendously with that. And as a Christian, I don’t see how I could view trying to help those less fortunate than me as the right thing to do. That’s one thing that always amazes me about so much of the Right, that they seem to have completely missed that point.

  130. @IY regarded #138

    “My FIL is a doctor, and he considers it more of a vocation than a mere job, but he has said repeatedly he wouldn’t advise his children or grandchildren to follow his path.”

    Why doesn’t he want is children or grandchildren to follow in his path? I feel like the answer to this could explain a lot.

  131. I would have liked to have seen Obama do more than toss a bone to the conservatives so far as tort reform is concerned. I had a conversation with my cardiologist last week regarding the state of Medicare and the coming reimbursement reductions that go into effect in January 1, 2010.

    The doctor was quite candid about it and said that cardiologists and endocrinologists are going to be especially effected by the cuts as nearly 70% of their patients are on Medicare. He stated that the rate cuts will be to the tune of 40%. The question is, who is going to make up the difference for this reduction? Does it get passed on to the patient? Do the specialists write it off? Can they write it off? Can they even afford to write it off?

    Running a medical practice, especially a specialized one, is an expensive proposition and the rates they charge for services don’t all go to pay for that shiny BMW parked out front. However, I was stunned to find out that 60% of his practice’s operating budget goes to pay for medical malpractice insurance.

    If there was a substantive effort on the part of the administration to produce health care reform legislation that includes putting a stop to frivolous malpractice lawsuits and take the teeth out of the slip and fall trial lawyers then I would start to have a little more faith in what they are trying to do. Despite what Howard Dean said regarding the trial lawyers and picking your fights, tort reform is a major component in lowering the cost of health care, which in the end makes it more affordable for everyone.

  132. Ryan,
    My cardiologist answered your question during my conversation last week. He advised his children not to go into medicine because he believes that it was a career that in the coming years that will not produce a living that is worth the time, effort and expense to be in it, i.e. rewards. His belief is that there are a lot of ways to take the smarts required to be a physician and make a comparable or better living without all of the angst and that comes with being medical practitioner – especially if U.S. health care does indeed go the way of Canada and Great Britain.

  133. BigGuido,

    I think that says something about your cardiologist. Specialists are in a bit of a bad position due to malpractice insurance, but you need to realize that doctors in Canada and Britain still make quite a good living. In fact, 50 years ago, doctors in the States made quite a good living, until medicine went entirely commercial. An orthopod I know makes $500k a year, has a few sports cars, a huge house, a huge ski cabin in Big Sky, and all of the trappings that come with that salary. So yes, I can see why people would think that medical school is worth it. If his salary gets cut down to $300k a year, or even $150k a year, is he going to be unable to live? No, he might have to only drive one sports car and rent when he goes on lavish vacations. If you are just after money, I don’t want you to be my doctor. I know doctors like that, they are okay to golf with but they spend more time in the office talking about hobbies then they do listening to patients.

    This is what I was assuming IY would say. However, since the US is not going the way of Canada and the UK (where the doctors only make a great salary), doctors could actually end up making more money or at least having any losses offset by, hopefully, a drop in malpractice insurance and better payouts for newly insured patients.

    @IY

    I forgot to mention this earlier, why do you automatically assume that more access to care means less competent care? There is not a finite amount of medical care. Will we need more nurses and doctors? Yes. Does that mean more higher paying, stable jobs? Yes, I think it does. On the other hand, what does it say about us, the richest country in the world, that we cannot take care of our own people?

  134. Catherine@77, Vic K here. Sorry I didn’t get back to reply earlier. Time zone thing and all that. : )Hope you’re still following.

    To clarify, there is excellent care for high-risk pregnancies in our public system, but you will not necessarily see the same specialist every time. (Subject to shift and availability etc.) I prefer the benefits offered by having a single, dedicated obstetrician overseeing my case. This is my preference and I pay for it accordingly. (Through my private health cover.)

    My point about ceasars in Australia’s public system was in regards to vanity ceasars. You know, when someone wants one because she is too ‘posh to push’. If you want the privilege of picking your time and date for non-medical reasons, you can absolutely do it in Australia -but only through the private system.

    Hope this clarifies my point,

    Vic K.

  135. Yawn…it’s amazing how much more readily typos stand out at 7:00 a.m. than they do at 2:00 a.m. I have decided to stop using the word “that” for at least a week…this could be interesting.

    Anyhoo (this one is intentional), concerning Ryan’s reply and the orthopedics doctor who makes 500k and his proposed pay cut to 150k, all I have to say is this: Where in the Constitution does it say that the federal government has the power to limit anyone’s salary or ability to legally obtain personal wealth? In a capitalistic, free market system such as the one we currently (for now) have in the U.S. the marketplace sets the price for goods or services based on the demand and what the consumer is willing to pay for it.

    One of the major problems with our health care system is the majority of us are out of the loop so far as “paying” for it goes. The “paying” is handled by a third party (insurance companies, Medicare, etc.) and as such we pay little attention to what is actually being spent on us when we go to the doctor’s office. If the patient (the actual consumer) was more involved in the payment process, better consumer practices would come back into the mix – people would look for the best value for their dollar and there would be an incentive for lower, more competitive pricing for health care services.

    Frankly, (and I know I will probably get flamed for this) I believe it is time for people in the U.S. to take on more personal responsibility and not look to the “Nanny State” to solve all of their problems – especially when the government has demonstrated they are the most irresponsible party around when it comes to managing our money.

  136. IY@145 – you stated “Belgium. I always hesitate to say for two reasons. First, despite it’s faults, it is the country of my heritage and I hate to speak ill of it as a nation. Second, and perhaps more honestly, I get awfully sick of the stupid questions. It’s a western European nation, one of the capitals of Europe, home to the UN and NATO and a whole bunch of other stuff. It is also a country that is being crushed under the weight of its social programs. Unemployment has been around 15% for decades, taxes are through the roof and going higher, and the birth rates have declined so low that there are not enough new young people to continue supporting the society as it stands. ”

    Proposition 1 – Belgian unemployment 15%
    CIA Factbook – Belgian unemployment 7%

    Proposition 2 – birth rates have declined so low etc
    CIA Factbook – Population Growth rate 0.94% (versus USA 0.975%)

    Another interesting fact, since we are discussing healthcare –
    Infant mortality rate
    Belgium – 4.44 per 1000 live births
    USA – 6.26 per 1000 live births

  137. IY @145 re 138 (2)
    Sorry, a few bits I missed out

    Proposition 3 – Belgian tax rate of over 50%
    Fact 3 – Belgium has a sliding tax scale
    Marginal income tax starts at 25%, (after an exemption of 6040 EUR)
    30% at over 7,420 EUR,
    40% over 10,510 EUR,
    45% over 17,610 EUR
    50% above 32,270 EUR.

    Proposition 4 – Sales Tax of 21%
    Fact 4 – mostly true, except for Food and Transport which are 6% (and for most people, food and transport are the important things, imho)

    Addendum to Proposition 1
    Belgium Unemployment has been at 15% for decades
    Fact – Belgian unemployment peaked at 14.3% in 1984, went down to 8.5% by 1999, and since then has varied between that and 6.5%. Not really “15% for decades”, is it?

  138. Big Guido @153, how do “slip and fall trial lawyers” affect your cardiologist’s malpractice premiums? Are his patients all suffering from slip-and-fall induced cardiovascular injuries?

    It is flat-out false that malpractice costs affect health-care costs significantly. Your cardiologist believes they do because a) doctors don’t really understand how malpractice insurance works and b) doctors don’t like lawyers. That’s really it.

    What “tort reform” will do is lead to greater regulation and stricter oversight of his day-to-day practice by a regulatory body. You get regulation or you get the courts; pick one. He’s OK with that, right?

  139. BigGuido,

    I never said that he would get a pay cut. I was saying that even if something did cause his salary to drop that much, he would still be doing very well. I never said that the government should or would limit his salary. In fact, you might notice that I ended that part of the post with :

    “doctors could actually end up making more money or at least having any losses offset by, hopefully, a drop in malpractice insurance and better payouts for newly insured patients.”

    As for the prices being set by the market and supply and demand, how does that work when the demand is for something like emergency bypass surgery? How about someone who needs to have dialysis every other day for the rest of their life because of renal failure? This is a list that could go on for a long time, so we’ll leave it with those two examples. As for what the consumer is willing to pay for it, that goes out the window when you aren’t talking about a car or TV. How much are you willing to pay for a quadruple bypass?

    You can get a detailed breakdown of your hospital or office visit bill. The problem is, when you spend time in the hospital there are a LOT of things that go on. If you get sent to a room, even for a few hours, they are going to set the room up for you. That means all of the toiletries, IV tubing, janitorial service, pharmacy, etc. The problem is, you have no say in what gets put in your room. So let’s say you go in for a simple procedure like having your tonsils removed. They list all of the medicines you were given, all of the tools used, OR time, physician fees, staff fees, hospital fees, linen fees, room stay fees, amenity fees, and the list goes on. What is seeing that list going to do after the fact? They could give you a list beforehand, but what can you do? You don’t want linen in your room? Maybe you don’t feel like paying the administrative costs?

    For a much more simple example, we’ll just take a visit to the doctor’s office, like you suggested. Most doctor’s don’t make their money from office visits. The orthopod I mentioned earlier sees anywhere from 25 to 40 patients every day and makes less seeing those patients than he does from one surgery. So you go see your doctor for the office visit and what? You want to add a review of the bill before you see the doctor? You can’t argue with them and ask to have your fees or overal cost lessened. They will continue to price their ‘services’ so that they can get as much from the insurance companies as possible because it is a constant tug-of-war over what the insurance companies will pay out for and what the doctor’s office can justify. Doctor’s offices won’t lower what they ask for from the insurance companies and so they can’t lower the cost for anyone else.

    Okay, so you think people should take more responsibility for themselves. How does that apply to healthcare? They aren’t the most irresponsible, I think we’ve seen that from the investment bankers depleting the giant pool of money. Seriously though, how does personal responsiblity curb the insurance companies and skyrocketing medical costs in this country?

  140. Big Guido: “If the patient (the actual consumer) was more involved in the payment process, better consumer practices would come back into the mix – people would look for the best value for their dollar and there would be an incentive for lower, more competitive pricing for health care services.”

    Says the person with decent health insurance from his employers or a higher income that lets him see a swanky cardiologist who makes utterly bogus claims about Medicare under healthcare reform. But there are millions of people who don’t have insurance and who have to pay for services and go bankrupt trying to do it. 80% of those people had insurance, but the insurer refused to pay, so the people had to. (Perhaps you are on Medicare, where you can’t get kicked off, but you don’t want others to have the same privilege. If not, let’s hope you continue to be lucky with your insurer.)

    We’ve been over this before. People trying to buy individual policies are facing enormous premiums they can’t afford. So they go without and hope they don’t get sick because the costs will ruin them. There is no shopping for the best value because the insurers are a small group of mega-companies who work very hard to make sure populations and smaller businesses have little choice. There is no shopping for best value in healthcare because people have limited choices as to what doctors and hospitals they can go to in their area, and that’s only for non-emergency care. For emergency care, you don’t get to make the choice.

    Healthcare is not a product, like a t.v. It’s necessary to keep you alive. Patients are not simply consumers. And doctors inflating their profits wildly above costs — cheating their patients — and private insurers inflating their premiums and not then providing services — cheating their customers — are taking advantage of that over people’s suffering because the people are trapped and have no choice. A large part of the reform agenda, including the public option, is to give people more choice, increase competition and lower costs so that they can actually afford some semblance of the healthcare you’re already getting.

    But you, the spoiled baby with the cardiologist, is saying everybody else should just suck it up and pay the enormously inflated healthcare bills that are just getting higher, which they can’t. So they die. Like my aunt, who got laid off of her job of twenty years and died of breast and brain cancer, which might have been preventable if she’d gone to a doctor earlier, if she could have afforded tests, if she’d had freaking insurance. She died at 57.

    We’re not trying to flame you. We’re trying to wake you up to what the rest of the country is suffering. And that this suffering is costing you too, you just don’t notice. You think those people don’t have anything to do with you, except to make your cardiologist complain. But if we let your cardiologist keep trying to do what he’s doing, the country will itself go bankrupt.

  141. @162: “Healthcare is not a product, like a t.v. It’s necessary to keep you alive.”

    Please, can we cut out the absurd statements? Healthcare is both a product, and generally not necessary for life. It’s desirable for getting people well faster (hopefully) and extending their lives if they develop a serious injury or illness.

    If people can’t even acknowledge simple, obvious truths, how are we supposed to deal with complex ones?

  142. Sometimes, the best way to get the facts out, is with a catchy pop song.

    It’s actually pretty good.

    pass it along. Tell all your friends.

    Also, according to polls, Obama’s speech shifted America’s opinion significantly. Before, Americans favored reform by about 53%. After the speech, it was about 66% in favor of health care reform.

  143. melendwyr: Please, can we cut out the absurd statements? Healthcare is both a product, and generally not necessary for life.

    If you’re volunteering to live on a deserted island where medical care doesn’t exist, I can give you a volleyball to keep you company.

    Otherwise, life expectancy for humans has always been in the range of 20 to 30 years. Only with the invention of modern medicine has it jumped. In the early 20th century it rose to 30-40 years. Currently it’s around 65 years.

  144. @163: “Says the person with decent health insurance from his employers or a higher income that lets him see a swanky cardiologist who makes utterly bogus claims about Medicare under healthcare reform. But there are millions of people who don’t have insurance and who have to pay for services and go bankrupt trying to do it. 80% of those people had insurance, but the insurer refused to pay, so the people had to. (Perhaps you are on Medicare, where you can’t get kicked off, but you don’t want others to have the same privilege. If not, let’s hope you continue to be lucky with your insurer.)”

    Kat,
    I went without health insurance for nearly 4 years 3 years ago due to being one of those “uninsurables”. At the same time, I was paying $275.00 a month for major medical insurance for my wife, who WAS insurable under a private plan. I do not have Medicare (I’m too young) and I didn’t apply for Medicaid because I didn’t believe in it. I paid out of pocket for ALL of my medical expenses – and I am a diabetic and have/had high blood pressure/cardiovascular issues.

    Guess what I did, I took responsibility and became a good consumer, looked for the best values in health care and medication and took better care of my health. I also paid out of pocket two years ago for gastric bypass surgery that cured my blood pressure issues and put my diabetes into complete remission. I took the money to pay for it out of my IRA – nearly $30k. I worked hard and saved that money all on my own. I have never made more than $48k a year during the course of my 24 year career (and that is only in the last 10 years), yet I own a house and have money in the bank. I paid for my own college education by working nearly 35 hours a week and going to community college for two years before going to a 4 year university – I lived on my own and lived frugally. I continue to live frugally and within my means to this day.

    Health insurance is not a right. Health insurance is a product that you purchase in order to protect yourself from going broke due to a catastrophic physical illness.

    I know that there are those out there that need assistance and I agree that they should be helped. There is a need for both reform in healthcare, tort and insurance. I just don’t believe that a grand experiment in government run health care is the way to go.

  145. @ melendwyr #163:

    Healthcare is both a product, and generally not necessary for life.

    Without health care, I would be a widower rather than a husband and father. Health care was very, very necessary for my son’s life and my wife’s.

  146. I have Dupuytren’s Contracture in both hands. There is no known cause, there is no known prevention, there is no known cure. There may be a relationship between it and some other diseases, but I’ve been tested for all of those and don’t have them.

    The only thing that can be done is surgery to remove the growth that is causing the finger(s) to contract. I have had such surgery in both thumbs and three fingers on both hands. In some fingers I have had the surgery more than once. A total of 9 surgeries, some involving more than one finger. The most complex lasted 5 hours.

    In 1993 my employer paid all of my insurance costs, The surgery was in-patient and the surgeon’s fee was $12,000. Since I had a $2000/year max payment, that was my total cost for the surgery. I’ve no idea what the hospital bill was because I never saw is.

    In 2006 I was paying slightly more than $100 every two weeks for my health insurance (my employer was paying about $550/month), the sugeon’s fee had increased to $17,000 (I consider that a resonable increase over 13-14 years), my maximum payment for in-network fees was $5000. However because my surgeon was not in network, his fees are no longer part of my cap. The insurance company had decided that this paticular surgery was now only worth $4500 so their 80% came to $3600. My share of the hospital’s bill was just under $1000, this now being out-patient surgery.

    So my cost of insurance has gone from 0 to $2600/year, my employer’s cost has probably gone from about $5000 to $6600/year. And the insurance is covering significantly less. My cost on this surgery has gone from $2000 to about $14,400 for a total medical cost to me in 2006 of $17,000. And I forgot the co-pay to the internist who had to OK me for non-emergency surgery for malpractice reasons.

    And there is nothing wrong with the best health care system in this best of all possible worlds.

  147. Otherwise, life expectancy for humans has always been in the range of 20 to 30 years. Only with the invention of modern medicine has it jumped. In the early 20th century it rose to 30-40 years. Currently it’s around 65 years.

    Because of vaccinations. Life expectancy is averaged over all lives. People routinely lived to their sixties and beyond even when life expectancy hovered around the early twenties. It’s the people who died in infancy or early childhood that cause the average age of death to be so low.

  148. There’s a lot of waste and abuse in the current system, and I’ll give you an example. To treat migraine headaches, there’s a class of drugs called triptans. There are a bunch of different ones, chemically similar but each a little bit different, sold by different companies. The oldest of the bunch, Imitrex, recently had its patent expire and is now available as a generic.

    Around the time GlaxoSmithKline lost their patent protection on Imitrex, they introduced a new patented drug called Treximet, which is Imitrex combined with naproxen. (Naproxen is the over-the-counter drug Aleve.) They marketed Treximet aggressively–I saw the ads frequently in magazines. Clearly, their intention was to get Imitrex patients to switch to Treximet before the generic came out for Imitrex, so they could continue to charge monopoly prices to those patients, who could have simply bought the generic Imitrex and a bottle of OTC Aleve. Of course, if the insurer pays the bill and the patient never sees it, what does the patient care if they are wasting money?

    I would have no problem with insurance companies, or a government-run health plan, denying coverage for Treximet and saying, “go get generic Imitrex and a bottle of Aleve, and we’ll pay for that.” It’s not rationing. It’s common sense.

    I wonder how much of our health-care spending is generated by the pharmaceutical companies marketing their products directly to consumers?

  149. I wonder how much of our health-care spending is generated by the pharmaceutical companies marketing their products directly to consumers?

    You should be asking how much of our health-care spending is the result of pharmaceutical companies marketing their products to doctors.

    They give physicians free stuff, ‘seminars’ that are really paid vacations if they attend brief presentations on the latest drugs, and often arrange to pay for doctors to learn about the “latest advancements in the field”, which usually involves learning what new drugs have come out and what they’re supposed to be good for.

    You people really don’t seem to grasp how screwed up the medical system is. It’s not as if there’s some evil group impairing the valiant attempts of everyone else to do the right thing. Everyone‘s corrupt.

  150. @171: “You people really don’t seem to grasp how screwed up the medical system is. It’s not as if there’s some evil group impairing the valiant attempts of everyone else to do the right thing. Everyone’s corrupt.”

    Melendwyr,
    I do get it. Corruption is running rampant throughout the USA. This is especially true in the deeply entrenched bureaucracy that is the U.S. federal government. These are the same folks that have run Medicare, Medicaid, Social Security and Fannie Mae/Freddie Mac into bankruptcy. They can’t even get the auto dealers who took part in “Cash for Clunkers” their money in a timely fashion. Why in the world would we want the same folks that have screwed-up these programs put in charge of a far more complex and far-reaching health care reform program – which by its very nature contains greater opportunity for fraud and corruption? It would be like putting a serial pedophile in charge of an El Salvadoran girls’ middle school field trip to the Baltimore, Maryland offices of ACORN.

  151. #165: Otherwise, life expectancy for humans has always been in the range of 20 to 30 years. Only with the invention of modern medicine has it jumped. In the early 20th century it rose to 30-40 years. Currently it’s around 65 years.

    Be careful when calculating life expectancy. Much of that increase has come from a reduced child mortality rate and not so much from an actual increase in how long people are living (although this, of course, can be laid at the feet of modern medicine. It does seem, however, that unless you are young or about to give birth, modern medicine hasn’t done much, in general, to increase your lifespan).

    It’s also worth noting that some bronze aged cultures had better life expectancies than most industrial societies before modern medicine. I guess that smaller populations meant fewer diseases and that helped reduce child mortality.

    Fun fact: Life expectancy has increased almost exactly linearly (3 months per year) for the last century and a half. People keep trying to explain why that can’t continue and they keep being wrong.

  152. melendwyr: Everyone’s corrupt.

    BigGuido: especially true in the deeply entrenched bureaucracy that is the U.S. federal government. These are the same folks that have run Medicare, Medicaid, Social Security and Fannie Mae/Freddie Mac into bankruptcy.

    Everyone is currupt. Everyone in the federal government is corrupt. It’s good to establish basic facts like these while discussing important policy proposals in an intelligent fashion. Otherwise, the debate might break down into little more than people repeating crazy nonsense.

    Wait, my spidey-sense is tingling…..

  153. London, please go read this.

    Then try to cope with the realization that you’re not on the side of truth and justice. There is no “side of truth and justice”. There’s just the D&D ‘Blood War’ forever: two sides with incompatible but abhorrent ideologies fighting over control of the Abyss.

  154. Hugh @158
    Thank you for clarifying those numbers. I had given the numbers I had always been told – I’m sorry that in some cases they were so far off. I should’ve verified them before posting. I lived in, and my family hails from, Wallonie, which is the french-speaking part of Belgium. That region’s unemployment is far higher than the national average (http://www.eriknetwork.net/regions/wallonie.html). Please accept my apologies for the incorrect info.

    As for the income taxes, yes, it is a sliding scale, but with everyone earning over $47,098 annually (at current exchange rates) paying over half their salary, I maintain the point. Remember, they pay half to the gov’t, and then, with what’s left, they’re paying 1/5 of the cost of most items to the gov’t as well.

    @150. Look, I’m trying to be civil here. There’s no need for name-calling or being insulting. If you’d like me to rattle off a list of negative anecdotal stories about national healthcare in three different nations, I’d be happy to. However, it’s hardly germaine. Furthermore, I absolutely reject your attempts to put my opinions in a box and call me stupid. To your points: #1. Hey, those are part of it the conversation. #2. Did you miss that bit about what I do? #3. Urgent care is important too. Where you are wrong is to assume that I don’t care about chronic conditions. They effect me and my family as much as anyone else. However, I continue to maintain that nationalizing the system is not the solution.

    Here’s the problem folks. Ultimately, there are two sides to this debate, and one of three things will happen. Side A will win, Side B will win, or there will be some compromise. But vilifying and otherwise insulting the opposite side is juvenile. I am not a hard-hearted unsympathetic meanie who wants all the uninsured folks to die from lack of care or being bankrupted by their misfortune. I am not unmoved by the many anecdotal stories listed here. I have many of my own. I simply believe that the solutions to our healthcare problems will not come from government. It is my contention that getting the government involved will not reduce costs, and will effect the quality of care.

    Ryan @152 – He spends more time filing paperwork than doing actual doctoring. He’s a GP and ER doc, he’s on the front lines every day. He’s a great guy and wonderful doctor, really old-school. It makes me sad that he’s so frustrated with his profession.

  155. Ultimately, there are two sides to this debate, and one of three things will happen. Side A will win, Side B will win, or there will be some compromise.

    You left out the fourth possibility: Everyone loses.

  156. @174 “Everyone is currupt. Everyone in the federal government is corrupt. It’s good to establish basic facts like these while discussing important policy proposals in an intelligent fashion. Otherwise, the debate might break down into little more than people repeating crazy nonsense.

    Wait, my spidey-sense is tingling…..”

    Greg,
    I didn’t say that everyone in the government is corrupt, but that corruption runs deep within the government bureaucracy due to entrenchment and a lack of real accountability. I believe that the government’s track record speaks for itself on this matter.

    In his speech on Wednesday night, President Obama himself makes note of the issue of corruption within the Medicare program. A substantial part of how he plans to fund his health care reform program is by eliminating the waste and fraud that currently exists in Medicare. Surely he doesn’t believe that all of the waste and fraud exists outside of the government agency itself?

    On another note, if he is aware of all the corruption, fraud and waste currently taking place within Medicare – an existing program that he currently has the power to reform – why doesn’t he start taking action to rectify the problems now? Why wait to pass a still nebulous health care reform plan that will not go into effect until 2013?

    I AM here to discuss this in an intelligent fashion. Just because I may not agree with you, my input doesn’t rate being labeled as “crazy nonsense”.

  157. melendwyr: London, please go read this.

    Wow. It’s full of little gems of wisdom. For example:

    “A genuine libertarian or conservative healthcare solution would terrify the American public as much as the Left-liberal vision does. That’s why the Republicans aren’t offering much of an alternative.”

    Yeah, THAT’S why the republicans aren’t offering a solution. It’s not that they don’t have a plan. No. They have a plan. It’s “suck it up and die”.

    Hm, actually, you may be right there. Thta might actually be the libertarian and conservative plan, but if laid out in cold hard detail like that, most Americans would balk at it.

    “Yes, rationing will occur, and does occur, whether by government or insurance companies. Scarcity is a fact of economic life. But in politics everything is possible and resources are infinite. Every man a king!”

    Hm, so rationing will occur whether it’s government or private. OK let’s pretend that’s true. Then doesn’t that mean that if government-regulated is half the cost of private-insurance (and both will ration) then doesn’t that mean we’d be idiots to defend the coffers of private insurance? No? Hm.

    So, both will ration, but we’re better off letting private insurance double the cost of health care in the US? Why is that? Oh, right, because the plan is “suck it up and die”.

    Doctors make a lot of money because licensing limits the labor supply and they can bid up their services.

    Oh. My. God. So, the solution to medical reform is to get rid of medical licensing for doctors which will then do what? Increase competition between doctors? Doctor salaries are the root cause of the health care problem?

    Hm, that’s a little odd. Because of all the many, many, many nations who have better and cheaper health care than we do, they still have doctor licensing. Maybe one could compare the number of doctors per capita in all the different countries. If the numbers are the same, then your idea is total fantasy. If everyone else has many more doctors per capita than the US, then maybe that’s part of the solution.

    Then try to cope with the realization that you’re not on the side of truth and justice. There is no “side of truth and justice”. There’s just the D&D ‘Blood War’ forever: two sides with incompatible but abhorrent ideologies fighting over control of the Abyss.

    Ah, every once in a while, your “Everyone else is a two-party fool. Third party is the true party.” mentality comes shining through.

    So, what you’re basically saying is you’ve got no solution, other than to lower doctor licensing requirements to increase the number of quacks, er, I mean, doctors, and increase competition between doctors?

    That and “suck it up and die”.

    OK. Got it. Clear as day.

  158. I didn’t say healthcare was a right. I said it was necessary. It’s a NEED. To the people who need it — which is everyone — it is necessary, and without it, they die. (Plus, before they die, they are not nearly as productive.) Therefore it is a product, but it is not a product like a t.v. or a car. People are held hostage to the system because healthcare is necessary to them, even more so than food and shelter. They will destroy themselves financially so that they and their loved ones do not die. They will go without food, or shelter, etc., to get healthcare. And they have little to no choice in healthcare, especially if it is emergency care.

    Big Guido: I didn’t say you were rich, I said you were lucky. And you still don’t understand how lucky you have been. Nor do you want to deal with what is actually going on if you are talking about a government run healthcare system, since that isn’t what’s on the table. Or the fact that no matter how industrious you are, how much you save and how well you take care of your family, you are still connected to the fate of other people.

    It’s got nothing to do with making the government a white shiny knight, redesigning the government or society, or any of that other crap. It has to do with the big anchor that is around your neck and mine because of what’s going on, and reforming the system so that there is more choice, lowering costs, and less profiteering. The government will not do all it has to do. It will be inefficient in many ways. It will give in a lot to the private insurers and healthcare industry, who will continue to take advantage of the system in any way that they can. But whatever basic reform we can get through the corrupt SOB’s in government will reduce some of the anchor around our necks, will increase productivity and improve the economy.

    Or we can do what we did with the financial sector, which was deregulate, sit on our asses, let them run up massive profits while cheating shareholders and customers, and then have it all crash and burn and cost the government (and me) billions of dollars, which only slowed down, not eliminated the worst financial disaster in decades.

    Did you get through this recession unscathed? If you did, you were lucky. Luck runs out. Reform improves the odds.

  159. Because of vaccinations. Life expectancy is averaged over all lives. People routinely lived to their sixties and beyond even when life expectancy hovered around the early twenties. It’s the people who died in infancy or early childhood that cause the average age of death to be so low.

    Is there some part of the universe in which vaccinations & other treatments for childhood illnesses don’t count as healthcare?

  160. @182: “Is there some part of the universe in which vaccinations & other treatments for childhood illnesses don’t count as healthcare?

    Is there some alternate universe intruding into our own in which American children aren’t getting their vaccinations because of a lack of insurance?

  161. BigGuido: I AM here to discuss this in an intelligent fashion. Just because I may not agree with you, my input doesn’t rate being labeled as “crazy nonsense”.

    When you say how corruption is rampant, especially in the federal government, and that this rampant corruption caused them to run Medicare, Medicaid, Social Security and Fannie Mae/Freddie Mac into bankruptcy, I’m not sure how you can come back with the notion that you’re trying to discuss things in an intelligent fashion.

    As far as I am aware, Medicare and Social Security are not bankrupt. Certainly, right wingers who hate programs like that, will often fortell the impendign DOOM of these programs, but it hasn’t happened.

    You want to start talking about this in an intelligent fashion? Then lets start by agreeing on some premises.

    The first premise is this: (1A) governmetn controlled health care in a country like Canada costs half as much per person than the mostly unregulated health insurance system in teh US.

    Agreed? If you disagree, say so. The alternative is (1B) Canadian healthcare costs MORE than in America. If that’s your premise, then say so. And everyone on this list will direct you to numerous studies that 1A is true, not 1B.

    The second premise here is either (2A) America can implement regulation just as well as any other country can do it or (2B) While other countries can implement regulation and improve/lower their health care costs, America is unable to do that. Attempts at regulation in America can only make things worse.

    If you believe 2B is true, then please explain why you think teh American government is so much more incapable than all these modern nations in teh world. Please explain why all these other nations, each with different details in their constitutions and implementions, what is it about their government that makes them so much better than our government?

    If someone believes 1A (regulation in other countries achieves cheaper health care) and 2A (America can govern just as well as these other nations), then one can conclude that America can regulate its health care and costs should go down.

    if you believe 1A and 2A, then American can implement regulations and improve health care costs.

  162. melendwyr – Is there some alternate universe intruding into our own in which American children aren’t getting their vaccinations because of a lack of insurance?

    There’s a vaccine that prevents cervical cancer, and many American children are denied it because they don’t have insurance.

  163. Melendwyr: Is there some alternate universe intruding into our own in which American children aren’t getting their vaccinations because of a lack of insurance?

    Is there some alternate universe in which free childhood vaccinations in the U.S. aren’t the result of government intervention?

    Also, I was unaware that childhood vaccinations prevented every illness. How about that! I’ll be sure to let my friends with celiac, thyroid disease and breast cancer know that they just missed getting a shot when they were 2.

  164. IY: If you’d like me to rattle off a list of negative anecdotal stories about national healthcare in three different nations, I’d be happy to. However, it’s hardly germaine.

    My personal anecdotes about chronic conditions are far from isolated incidents. They are instead representative of well-documented data about how thousands of people suffer and die every year in the U.S. because they are unable to afford healthcare.

    Where you are wrong is to assume that I don’t care about chronic conditions. They effect me and my family as much as anyone else. However, I continue to maintain that nationalizing the system is not the solution.

    And your brilliant solution would be…?

    Also, having a public health insurance option is hardly nationalization. Nor is it going to make private providers go out of business. Last I checked, Harvard was doing plenty well despite the existence of the Mass. public university system.

    It continues to astonish me that the right keep wetting themselves with patriotic glee over rehashing the 3,000 deaths on 9/11, and yet do absolutely jack shit for the 30,000 Americans who die every six months due to lack of health care.

  165. tal@187

    While I agree with the content of you post I think I would avoid using Harvard in any comparison as a “successfully run institution”. Harvard is in shambles financially and it has less to do with institutional problems and more to do with catastrophic failure to effectively manage money at the university. I won’t go into detail here (off topic) but I believe Vanity Fair had a rather interesting article 3 – 4 weeks ago about this.

    And I am glad that everyone was able to call IY out on the “personal narrative” devoid of any factual information. I appreciate IY’s participation but found the original post devoid of any compelling information.

    Rabid

  166. Playing the “You can’t prove I don’t care” game with libertarians and others making arguments based on libertarian goals is a waste of time. Anyone can *claim* they care. Heck, they might even donate money to charity. But while they’re happy to accept government spending on roads and fire departments and police without much complaint, the minute the government starts doing something that only helps the really poor, they go bugnut crazy, and throw a temper tantrum any time someone accuses them of a lack of compassion.

    It’s a mugs game.

    Viewed from the top down, more people are getting sick, going bankrupt, or dying than should be, and conservatives expect us to believe that, just now, by coincidence, they decided that this was a bad thing, and they have a better way of fixing it, when they’ve consistently been on record as protecting healtcare industry profits over patient care?

    The correct response should be “Republicans lied their heads off for 8 years. They got us trapped in Iraq, deregulated banking so badly that companies like AIG were allowed and encouraged to destroy the world’s economy, trampled the Geneva conventions, and generally lied and cheated.

    If you trust them, you’re an idiot. End of story.”

    Let’s leave arguing who is compassionate or not out of the picture, and focus on who screwed the country for 8 years and change, and who the people chose to turn that around.

  167. @189: “But while they’re happy to accept government spending on roads and fire departments and police without much complaint”

    Funny, all of the libertarians I read do a great deal of complaining about those things.

    “Let’s leave arguing who is compassionate or not out of the picture,”

    Why did you bring it into the picture again?

  168. To those who still don’t understand that the system is broken:

    I am 37. I start every day with stretching and strength training, than take a 1.5 mile walk. I don’t smoke, drink, or do drugs. I eat reasonably well. I’m not overweight.

    One night I woke up with some of the worst pain I’d ever experienced (and I’d been through childbirth twice). I called 911 and went to the ER, where tests found that a loop of scar tissue from an earlier appendectomy had entrapped a loop of my small intestine. This condition is fatal if not treated, so I was rushed into surgery. I made a complete recovery.

    At my post-surgical appointment, the surgeon told me that in 20% of patients, this condition recurs, as often as once a year. I asked her, “Is there anything I can do to prevent it from recurring?” She said, “Absolutely nothing.”

    BAM. All of a sudden, I had a preexisting condition. Through no fault of my own, I was rendered uninsurable.

    At the time, I was self-employed and covered by my husband’s employer-based insurance. Fast forward a bit. He gets laid off. Fortunately, my income is enough to cover us both. We pay the COBRA premiums until they expire.

    Now I have to get insurance on the open market.

    Fortunately, I live in a state (Washington) which has a law specifically protecting people in my circumstance. It says that if I was covered under employer-based insurance, and after that I pay for and use up all my COBRA coverage, no insurer can turn me away. They can’t even make me fill out the health questionnaire, which is the information insurers use to dump you after you get sick.

    Therefore, I get insurance–but ONLY because the state law protected me. I don’t think most states have this law. If I’d lived somewhere else, I’d be screwed.

    It’s pretty crappy insurance. It only pays 70%, and it has a $2M lifetime coverage limit, which means that if I get a devastating diagnosis and my treatment costs over $2M, I will have to decide between impoverishing myself in an attempt to stay alive, or killing myself to preserve my assets for my children.

    Speaking of that, I have a Republican family member, a Rush Limbaugh listener, who is 67 and covered by Medicare. He has a friend in her 50’s who was recently diagnosed with cancer. She has no insurance because she can’t afford the premiums, and she is too young for Medicare. So she killed herself. True story. My family member, though still very Republican, now supports health care reform.

    It is WRONG WRONG WRONG for insurance companies to profit from your premiums while you are young and health, then dump you when you are old and sick. I have earthquake insurance for my house. Imagine that I pay my premiums every year for 20 years, and in the 21st year there’s an earthquake. The insurance company decides to dump me from its rolls and not pay for the damage. What? That’s not insurance. It’s a scam!

    I have been responsible all my life. I’m financially self-sufficient, I take care of my health, I pay my insurance premiums. And yet I am one devastating diagnosis away from financial ruin for my whole family. How is this good for my country?

  169. IY: “I simply believe that the solutions to our healthcare problems will not come from government. It is my contention that getting the government involved will not reduce costs, and will effect the quality of care.”

    Um, so the solutions should come from space aliens? Because they certainly aren’t coming from the private insurers or the healthcare industry. Who the government isn’t trying to take over, but get them instead to reduce costs and improve the quality of care. If you don’t think the government can do this, then I guess we’re going to have to stick with costs continuing to go up and quality and availability of care to continue to go down.

    “He’s a GP and ER doc, he’s on the front lines every day.”

    Yes he is, that’s why we’re trying to help him with reform.

    Big Guido: “On another note, if he is aware of all the corruption, fraud and waste currently taking place within Medicare – an existing program that he currently has the power to reform – why doesn’t he start taking action to rectify the problems now? Why wait to pass a still nebulous health care reform plan that will not go into effect until 2013?”

    Right, because Obama has been given a magic wand that the other presidents didn’t have, that he can just wave and reform Medicare and no one will argue with him about it at all and everything will be instantly changed. Given to him by the space aliens, no doubt. Of course, if he did have the wand, that still wouldn’t help with the problems with the private insurers and rising healthcare costs. But hey, we’re not allowed to attempt to fix those parts of the problem, because we like the people who are failing and costing us reams of money.

    Suck It Up or Die: “Is there some alternate universe intruding into our own in which American children aren’t getting their vaccinations because of a lack of insurance?”

    Yes, it’s called poverty. Children in and near the poverty level in the U.S. have lower vaccination coverage. Although it’s been improved through government efforts, it’s still a problem. Over 60 percent of children who don’t receive timely and complete immunizations come from poor areas, and may be on Medicaid (which is the government, not the insurers.) Frequent moves, lack of doctors and lack of a consistent medical home, etc., make it difficult for these children to get vaccines. If the government didn’t attempt to vaccinate them and to improve the rates of vaccination, these kids would receive no vaccines at all because private insurers have no interest in them.

    If you guys want to argue that shooting yourself in the foot is the best way to go, you’re free to do so. But so far, your “solutions” — when any have been bothered to be suggested — are awful and still cost me an increasing spiral of money.

  170. IY@176: I am not … unsympathetic

    don’t confuse “sympathy” with “feeling badly”

    Sympathy: an affinity, association, or relationship between persons or things wherein whatever affects one similarly affects the other b : mutual or parallel susceptibility or a condition brought about by it

    Ebeneezer Scrooge may have “felt bad” about the sick, but he wouldn’t pinch as much as a penny for them. Scrooge was not sympathetic.

  171. I admit that I still really, really don’t understand the mindset here.

    I don’t get how someone can be so adamantly opposed to the idea of even one person fraudulently getting government services that they’re willing to let thousands of innocent working poor suffer and die rather than spend the money on the program.

    I also don’t get why the same people don’t seem to have even remotely the same problems with the gross amount of waste and fraud that happens with military spending.

  172. Tal, I’m sure you know the answer, but I’ll put it out there in case people try to pretend it’s not obvious: it’s just an excuse.

    They are hiding behind the excuse of deep concern over people fraudulently obtaining services because they don’t want the poor getting medical care at taxpayer expense. They want to keep decent healthcare a perquisite of the wealthy.

    As for why the military spending doesn’t bother them…that’s less clear. But I suspect they’ve bought the propaganda that says that unless we murder hundreds of thousands of Iraqi civilians, Al Qaeda will poison our coffee.

  173. @184
    Greg,
    Thanks for pointing out my error when I lumped Social Security and Medicare/Medicaid in with Freddie and Fannie having gone bankrupt. I meant to say that they are running those programs into bankruptcy. Even the most liberal analysts admit that if something isn’t done, the systems will be bankrupt by 2019. By the way, I don’t hate the programs, but as they were conceived and implemented, they are unsustainable from an economic standpoint. We won’t even take into consideration discussing the constitutionality of the programs because we are already here and there are a lot of people who have paid into it that are depending on these programs to take care of them in their senior years. We owe it to them to have the plans in place that they paid into or pay them the money back plus interest to put into their own private medical savings plans.

    So far as your premises are concerned, I’m not going to bite on the straw man you are setting up there. The issue is far more complex than “If Canada can do it, why can’t the U.S.A.?” I have a good friend in Canada that went deaf waiting to see a specialist about his hearing loss – a hearing loss that could have been prevented with proper diagnosis and treatment with anti-inflammatory drugs. He is now on a two-year waiting list to get a cochlear implant. Meanwhile, he did qualify (after a year) for a hearing assistance dog. At least he has something to pet while he waits for his surgery.

    We have a document called the United States Constitution that gives enumerated (limited) powers to the federal government. I don’t find establishing a system of nationalized health care among them. Real health care reform is possible without creating a fiscally unsustainable, thoroughly unconstitutional nationalized system that supposedly will provide everything and anything to everybody per President Obama’s speech last Wednesday. Obama’s promises in that speech reminded me of the episode of The Simpsons where Homer is elected to the office of trash collector and proceeds to bankrupt the entire town by having his work force do everything for everybody at anytime.

    Any nationalized, single payer plan will lead to rationing of services due to tight hospital operating budgets and restraints on acquiring expensive medical technology. In Canada there are consistently problems with limited access to services resulting in procedural delays. Also, attempts to control spending for physician and hospital services encourage insufficient provider practices. Despite what Obama said in his speech on Wednesday, he is on record numerous times during his days in the Illinois legislature and as a freshman senator as stating that he is a proponent of the single payer plan and that he believes that getting to it would have to be done incrementally as the American people would not accept such dramatic change all at once.

    In a YouTube video from June 2003, when Obama was a state senator in Illinois and a possible candidate for the U.S. Senate, he plainly stated his support for a single-payer system:

    “I happen to be a proponent of a single-payer universal health care program,” Obama said. “I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its gross national product on health care, cannot provide basic health insurance to everybody. And that’s what Jim is talking about when he says everybody in, nobody out. A single-payer health care plan, a universal health care plan. That’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we’ve got to take back the White House, we’ve got to take back the Senate, and we’ve got to take back the House.”

    Obama has voiced his support of the single-payer in concept in additional statements, but has always included qualifiers:

    In February 2004, about a month before the primary election in the U.S. Senate race, the Associated Press reported the stance of all the candidates on universal health care. “Obama says he supports the idea of universal health care but does not think a single-payer government system is feasible. He says the government should be the health care provider of last resort for the uninsured.” In a rundown of all the candidates’ positions, the Associated Press summarized Obama’s position as “Support, but ‘probably not at this stage,’ a single-payer government system.”

    In his book The Audacity of Hope, published in October 2006 when he was a U.S. senator, Obama described single-payer as the hope of the left, while those on the right wanted a market-based approach. “It’s time we broke this impasse by acknowledging a few simple truths,” Obama wrote, suggesting a system much like the one he spoke of during his Wednesday night address to Congress.

    In April 2007, the Chicago Tribune has then presidential candidate Obama saying the following, “Obama has pledged that, if elected, all Americans would have health care coverage by the end of his first term. He has said he is reluctant to switch to a ‘single-payer’ national health insurance system because of the difficulty in making a quick transition from the employer-based private system.”

    The 2003 video has a very different tone from the remarks Obama makes in 2007. Obviously, Obama, as a state senatorial candidate, trying to appeal to mostly liberal electorate, took a strong stance on single payer, but as a senatorial and later presidential candidate moderated his position time and again to appeal to a more moderate/conservative national audience.

    Frankly, I just can’t believe what Obama says about much of anything. Obama is a political opportunist who will say anything to get what he wants. As for me, his brand of change is one that I believe America can do without.

  174. KatG@ 192: “Big Guido: “On another note, if he is aware of all the corruption, fraud and waste currently taking place within Medicare – an existing program that he currently has the power to reform – why doesn’t he start taking action to rectify the problems now? Why wait to pass a still nebulous health care reform plan that will not go into effect until 2013?”

    Right, because Obama has been given a magic wand that the other presidents didn’t have, that he can just wave and reform Medicare and no one will argue with him about it at all and everything will be instantly changed. Given to him by the space aliens, no doubt.”

    Actually, Kat Obama does have a magic wand of sorts in that he has a Democratic controlled congress that would probably be more than happy to pass less volatile legislation for him along the lines of real Medicare and Social Security reform.

  175. Something to note about the idea of SS “running out” of money: Birth rates have skyrocketed in the last five years. There may be a small slowdown in incoming SS revenue between when the bulk of Boomers have finished retiring and when this generation starts paying in, but they are a large enough group that they’re likely to make up for the supposed deficit caused by an “aging” population.

  176. Tal@194: I don’t get how someone can be so adamantly opposed to the idea of even one person fraudulently getting government services that they’re willing to let thousands of innocent working poor suffer and die rather than spend the money on the program.

    It’s dogma, a mindset that says “blah” is the best way to do something regardless of circumstances. The alternative is to look at the circumstances and decide what the best action to take in response, regardless of preconceived notions.

    And it’s also paranoia coming out of the fringier right wingers who don’t trust anything they’re not in complete control of. They’ve spent the last 8 years using the government to go after their enemies, to take liberties from their own fellow citizens, and to get away with as much as they can get away with. They cannot fathom a government that is actually for the people, all people. So, gummint is out to get them, out to kill grandma, out to create deathpanels.

    And with a black man as president, the paranoia just got a big shot in the arm from the consciously and subconciously xenophobic.

    BigGuido@196: We have a document called the United States Constitution that gives enumerated (limited) powers to the federal government.

    Ah, so, you don’t have a proposed solution. And you’re not looking to fix the problems associated with health insurance corporations booting customers or the bankruptcies that people with insurance are having to go through or the skyrocketing costs.

    BigGuido wants to kill any bill.

    I think that means you really do not want to discuss this “in an intelligent fashion”. You oppose. You obstruct. And now you’ve made that intention is clear by invoking nonsensical 10th ammendment constitutional arguments.

    Any federal law regardign health reform is illegal in your mind. Your proposed solution is literally “nothing”. No federal involvement whatsoever.

  177. Tal: Something to note about the idea of SS “running out” of money

    I’ve been to a lot of the quarterly report meetings for the companies I’ve worked at. It’s not uncommon at all to hear the CEO say something like “If we keep going like this, we’ll go bankrupt.” which is immediately followed by “So that’s why we’re changing strategy and doing this.”

    I’m not exactly sure how “Social Security will go bankrupt in 20 years” suddenly means nothing about the system can possibly be changed, oh my god, we’re all doomed. It’s kind of funny when you hear it put in such blatant terms though.

    We’ll adjust. We’ll tweak how it works. And then it’ll be fine for another 20 years, at which point, maybe it needs another tweek.

    If we get to the point that people are living till 120 years old, maybe we raise the age when you start collecting a bit. Maybe we tweak the payouts a bit. Maybe we tweak the payments in.

    Anyone using the ohmygodsocialsecurityisgonnarunoutofmoneyintwodecades argument is taking a rather silly view of reality.

  178. All medical systems in all advanced countries have a problem with increasing medical costs as populations age and improved technology provides costly solutions to conditions that were untreatable previously BUT I work in the UK NHS. it costs about 50% – 60% per capita of the US figure. All my emergency care is free. I wait a maximum of 9 weeks for assessment and 13 weeks for elective surgery – and the average waits are lower than this. I am a higher rate taxpayer and pay 40% of salary in income tax.
    As far as I can see, you in the US pay through the nose for a system that mostly benefits greedy doctors and private companies. The sort of hysterical smear campaigns on this topic we see emanating from the States leaves me appalled and bemused. How can those of you on the right sacrifice something so important on the altar of your ideological prejudices? You do not like the NHS? Fine – but, your system is failing those in greatest need and you know this. When you were in power (and you were in power for a long time)why did you not come up with a solution that suited your ideological perspective? Surely that would have been the most effective preempt to something you would find ideologically distasteful when power inevitably changed hands. Or could it be that those who had the leverage/power when in office were indistinguishable from those who benefited from your current greedy mess?

  179. Big Guido: “Actually, Kat Obama does have a magic wand of sorts in that he has a Democratic controlled congress that would probably be more than happy to pass less volatile legislation for him along the lines of real Medicare and Social Security reform.”

    LOL, you are so dreaming. You seriously think the Republicans are just going to let Obama reform Medicare and Social Security — the “socialist” programs, that it won’t be volatile? They screamed bloody murder when he was giving a stay in school speech to kids. They made up death panels. They won’t even let him get his appointments fully staffed. You think the Blue Dog Democrats take orders from Obama? If Obama had the magic wand you just said he had, we’d have health reform already done. But fortunately or unfortunately, Democrats don’t march together in lock-step.

    And you also think that somehow Obama can sneak a single-payer healthcare system into the U.S. So you want to shoot us all in the foot and do nothing, costing us disasterous sums of money, letting the problems go on and the healthcare system collapse into another major financial crisis, on the paranoid fantasy that Obama is a god and so will be able to create a socialist state.

    I know this is very, very hard to understand after Bush, but Obama, unlike Bush, does not take an ideological stand based on little evidence and then refuse to change it, no matter what evidence is presented to him that it might be a good idea to do so. He learns, he looks for ways to cut costs, he listens to imput even from people outside his own party, he seeks cooperation and he adjusts his thinking from such things. So that he gets to the Senate and realizes that a single-payer system is going to be impossible in the U.S. but that a compromise system may work better, is a GOOD thing. He’s practical, he’s productive, and he might actually get something done to improve the problems we face by using his brain.

  180. GregLondon@199:

    Greg, I’m sorry to have to say this, but all I seem to hear from you is a lot of vitriolic hyperbole with little to no substance.

    Also, the only Bill I ever wanted to kill was David Carradine. However, he managed to get to that task before I could, and in a much more lascivious fashion too boot!

    To add some substance to the discussion, I submit the following: An excrept from a 1999 article entitled “Speaking the Truth about Social Security Reform” written by Nobel Prize Winning Economist Milton Freidman

    “The link between the payroll tax and benefit payments is part of a confidence game to convince the public that what the Social Security Administration calls a social insurance program is equivalent to private insurance; that, in the administration’s words, “the workers themselves contribute to their own future retirement benefit by making regular payments into a joint fund.”

    Balderdash. Taxes paid by today’s workers are used to pay today’s retirees. If money is leftover, it finances other government spending—though, to maintain the insurance fiction, paper entries are created in a “trust fund” that is simultaneously an asset and a liability of the government. When the benefits that are due exceed the proceeds from payroll taxes, as they will in the not very distant future, the difference will have to be financed by raising taxes, borrowing, creating money, or reducing other government spending. And that is true no
    matter how large the “trust fund.” The assurance that workers will receive
    benefits when they retire does not depend on the particular tax used to finance the benefits or on any “trust fund.” It depends solely on the expectation that future Congresses will honor promise made by earlier Congresses—what
    supporters call “a compact between the generations” and opponents call a Ponzi scheme.

    The present discounted value of the promises embedded in the Social Security law greatly exceeds the present discounted value of the expected proceeds from the payroll tax.
    The difference is an unfunded liability variously estimated at from $4 trillion to $11 trillion—or from slightly larger than the funded federal debt that is in the hands of the public to three times as large. For perspective, the market value of all domestic corporations in the United States at the end of 1997 was roughly $13 trillion.”

    Okay, let’s fast forward to 2009 and what we’re looking at today regarding Social Security and its bastard stepchild, Medicare :

    The 2009 Social Security and Medicare Trustees Reports show the combined unfunded liability of these two programs has reached nearly $107 trillion in today’s dollars. That is about seven times the size of the U.S. economy and 10 times the size of the outstanding national debt.

    Note: The unfunded liability is the difference between the benefits that have been promised to current and future retirees and what will be collected in dedicated taxes and Medicare premiums. In 2008 alone, this debt rose by $5 trillion. Medicare’s total unfunded liability is more than five times larger than that of Social Security.

    How will these unfunded liabilities impact future payroll tax burdens?

    Currently, a 12.4 percent payroll tax on wages funds Social Se­curity and a 2.9 percent payroll tax funds Medicare Part A (Hospital Insurance). If payroll tax rates rise to meet unfunded obligations we are looking at the following scenario:

    When today’s college students reach retirement age, somewhere in the neighborhood of 2054, Social Security alone will require a 16.6 percent payroll tax, a full one-third greater than today’s rate. When you include Medicare Part A, the payroll tax burden rises to 25.7 percent – more than one of every four dollars workers will earn that year. When you add in Medicare Part B (physician services) and Part D, the total Social Security/Medicare burden will climb to 37 percent of payroll by 2054 – one in three dollars of taxable payroll, and twice the size of today’s payroll tax burden.

    More than one-third of the wages workers earn in 2054 will be committed to pay benefits promised under current law. This is before any “shovel ready” projects are built and before any federal and state salaries are paid.

    According to the Congressional Budget Office (CBO), if Medicare and Medicaid spending continues growing annually at 2.5 percentage points above GDP growth by 2050, Social Security, Medicare and Medicaid (i.e. health care for the poor) will consume nearly the entire federal budget. By 2082, Medicare spending alone will consume nearly the entire federal budget.

    The CBO also found that if federal income tax rates are adjusted to allow the government to continue its current level of activity and balance its budget, the lowest marginal income tax rate of 10% would have to rise to 26%. The 25% marginal tax rate would increase to 66% and the current highest marginal tax rate of 35% would have to rise to 92%! This is just on individual income tax at the federal level!

    The CBO also stated that the top corporate income tax rate of 35% would increase to 92%.

    I am not an opponent of reform. As you can see, reform is necessary because the current system is unsustainable. I just don’t believe that the solution lies in government run health care.

    In President Bush’s 2005 state of the union address, he made reform of Social Security, Medicare and Medicaid a major point on his list of goals and received boos and cat calls for his efforts. Every time a Republican has tried to bring about substantive health care reform, he has been vilified and eventually cowed by the left. The republicans in congress have a number of good ideas regarding health care reform. The question is whether or not President Obama will make good on his word to actually listen to them.

  181. bigguido: all I seem to hear from you is a lot of vitriolic hyperbole with little to no substance

    And the tenth ammendment invocation on a health care reform thread was what?

    By 2082, Medicare spending alone will consume nearly the entire federal budget.

    Hm. 2082? So, we’re going to be on a 70-year long slow-motion train wreck with no possible way to alter course and fix the problem?

    I’m supposed to take this 70 year forcast of “impending” doom seriously?

    In President Bush’s 2005 state of the union address, he made reform of Social Security, Medicare and Medicaid a major point on his list of goals and received boos and cat calls for his efforts.

    Because he’s a fucking moron and couldn’t reform his way out of a paper bag. No Child Left Behind was not educational reform, it was governmetn gutting public education. Bush’s attempts to reform SS and Medicare were attempts to gut them.

    Every time a Republican has tried to bring about substantive health care reform, he has been vilified

    Because they’re fucking morons who keep pushing right wing ideology like tort reform when the facts at hand say that tort reform won’t do anything. If malpractice costs half a percent of the total health care costs, why do right wingers keep pushing tort reform? Because they believe all the lies about poor innocent never-did-anything-wrong McDonalds getting sued by mean old grandma who was out to hit the lawsuit jackpot. Nothing pushed in favor of tort reform is based on reality. Nothing. That’s why they’re villified. Because they’re lying. People are getting hurt physically and economically and tort reform idiots are lying about it.

    And here you are preaching impending 70-year doom about medicare, telling me it can’t be avoided, and saying the only “real” solution is to get rid of it, while implying that health care reform must follow the same path of impending doom, and that the only way to avoid it is to make sure we don’t implement it.

    70-year impending doom.

    Any you want to talk to me about vitriolic hyperbole???

  182. I’m amused that Bush’s attempt to privatize social security gets some sort of angelic choir form the right whenever it’s mentioned.

    Are you people so stupid that you didn’t notice how the entire world economy tanked recently? If Social Security had been tied up in the stock market, it would be broke right now, not in some possible future.

  183. Big Guido: “I just don’t believe that the solution lies in government run health care.”

    Which is why we’re not doing government run healthcare. We’re doing reform.

    “The question is whether or not President Obama will make good on his word to actually listen to them.”

    He already is listening to them. Obama is a centrist who specializes in building unlikely coalitions. Several Republicans have been involved in the bill drafts. But Obama’s initial bipartisan efforts were rebuffed by most of the Republicans, who have decided that killing the bill for political gain is more important than any kind of reform. The Republicans who want to contribute — great. The ones who want to be obstructionist are saying that Medicare doesn’t need to be reformed to eliminate costs, abuse and waste. (Cutting the waste alone as proposed in the bill is estimated to generate $500 billion, according to the CBO, the agency you quoted yourself.)

    There are some good, smart members of the Republican party. Unfortunately, they are few and having to fend off ouster from far right extremists who were sold the Republican party, continue to try to control the party, and stiffle discourse and meaningful legislation and reform.

    Bush did do reform on Medicare in 2003. But his further attempts — with a Republican controlled Congress — were not effective, did try to gut programs, and he refused to be bi-partisan. Bush and the Republicans went on a massive spending spree for over six years, turned a surplus into a huge deficit, lied to people to start an extra war, and gutted regulatory agencies and regulations, with the result that we had the Katrina mess, and the collapse of the financial industry and the greatest recession since the 1930’s. Bush tried all the strategies that you say work so great, and not only did they fail, but they plunged us into disaster.

    You say that you believe the private insurers and the healthcare industry when they say that the only reason they are cheating their customers and inflating costs is those last, remaining regulations, and if we just deregulate even further than we’ve done for them already, they’ll be good and stop doing it. I don’t. I want them forced to stop cheating and profiteering. I want them to be forced to compete, instead of having a free pass to act as a cabal, like the financial industry was.

    Minnesota has their population in excellent health, with few people uninsured. Their state regulations that keep the industry mostly not for profit keep costs low, competition high, yet they have excellent quality of care, with places like the Mayo Clinic. Healthcare there is profitable — and regulated. Minnesota is a model to look at carefully, because their policies are working.

    Whereas deregulation gets you this: http://www.nytimes.com/2009/09/13/us/13water.html?_r=1&hp

    Your methods don’t work. They cost you and me money. They weaken our economy and our infrastructure. They create crises and threaten American citizens’ lives. They don’t help the uninsured, and they don’t protect us against higher taxes, since when top businesses don’t have to pay their fair share — and right now, the taxes are the lowest in decades — the rest of us do. Your side’s track record stinks.

    Your Republicans cost me and mine a lot. So if you want people to listen to them, they and you better have something better to offer than, “Let’s deregulate some more!”

  184. Whereas deregulation gets you this

    every time I think it can’t possibly get any worse, and every time, you prove me wrong…

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