Health Care Progress

The Senate passed a bill yesterday that will expand health insurance coverage for children. The 66-32 vote included 9 Republicans who favored the bill. The House passed the bill two weeks ago by a vote of 289-139 with the support of 40 Republicans. Two previous efforts to enact the law met with George Bush vetoes, but President Obama will sign the bill into law.

One of the most significant sections of the child health bill would allow states to use federal money to cover children and pregnant women who are legal immigrants. Under existing law, legal immigrants are generally barred from Medicaid and the State Children’s Health Insurance Program for five years after they enter the United States.

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The Congressional Budget Office said the bill would enable states to cover more than four million uninsured children by 2013, while continuing coverage for seven million youngsters. The bill would increase tobacco taxes to offset the increase in spending, estimated at more than $32 billion over four and a half years.

John McCain, who became an anti-socialism crusader late in his campaign as he searched for a theme that would resonate with independent voters, expressed his concern that the bill was the first step of a larger effort to eliminate private health insurance in favor of government-funded health care. If only.

Orrin Hatch, on the other hand, has been a proponent of S-CHIP but voted against the bill because he was "upset about being left out of negotiations." Boo hoo. When Senate Democrats take on the more complex question of overall health care reform, they'll have to make sure that poor Orrin has a comfortable seat at the table so he won't feel left out. It may be a postpartisan schtick, as BTD likes to say, but letting petulant senators from the minority party feel involved is sometimes all it takes to sway their vote.

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    Not good enough (5.00 / 1) (#1)
    by Shainzona on Fri Jan 30, 2009 at 02:18:19 PM EST
    We need single payer health care for EVERYONE.  And until Obama and Friends figure that out, we need to keep their feet to the fire.

    Krugman was correct yesterday.  If BO backs away from this, shame on him - he will not deserve a second term.

    Unfortunately, (5.00 / 0) (#2)
    by TChris on Fri Jan 30, 2009 at 02:24:08 PM EST
    it will take more than "Obama and friends" to enact single payer.  As preferable as that system would be, neither of the two leading Democratic presidential candidates campaigned on a single payer system, and there is less than overwhelming enthusiasm for single payer in the House and Senate.  

    But aren't Obama's friends now.... (2.00 / 0) (#4)
    by Shainzona on Fri Jan 30, 2009 at 02:34:06 PM EST
    ....in control of the House and Senate?  So it shouldn't be hard for him to do this at all.  All it takes is a little guts - oh, and belief that all Americans should have health insurance, not just the POTUS, the House, Congress and Insurance Compant execs.

    I have no idea (5.00 / 4) (#7)
    by TChris on Fri Jan 30, 2009 at 02:45:36 PM EST
    whether every Democrat in the House or Senate is Obama's friend.  If by "Obama's friends" you mean Democrats, just say Democrats.

    In any event, my point is that Obama didn't campaign on single-payer and I don't think the political will exists in the House or Senate to enact it. And Krugman's column doesn't call for Obama to move forward with single-payer; it urges him to make the enactment of the plan he campaigned upon a priority. I certainly agree with Krugman in that respect, although I'm not sure it's fair to chastize Obama for not having done so during his first ten days in office, given all the issues on his plate.

    Finally, I agree that the S-CHIP expansion isn't "enough," nor did my post suggest it is, but it at least represents incremental progress, which we haven't seen in the past 8 years. Progress deserves praise if not full-flown celebration.


    Thank you,TChris (5.00 / 3) (#36)
    by JThomas on Fri Jan 30, 2009 at 05:51:32 PM EST
    for taking on the thankless job of reporting on the positive actions by the Obama administration. On this site ,it sets you up for derision when you do not deserve it. As we have seen, Obama can never do enough for some of the folks here and it makes your job of recognizing some laudable moves by Obama open to potshots.

    Bottom line is that this helps actual children out there despite what the critics on here say and that is a good thing.

    Rome was not built in 10 days and as we saw with the Clinton efforts to get healthcare, this is not a simple task.


    I agree with the ThankYou (5.00 / 2) (#46)
    by zyx on Fri Jan 30, 2009 at 07:52:52 PM EST
    There is a lot to do, and to undo.

    Amazing that it wasn't done already, and just the way everybody wanted, or something.

    I would like perfect and would like it now, but I guess I have a mixture of optimism and pragmatism right now--give these folks some time, and accept that sometimes there will be "good" instead of "perfect".


    The way this bill is funded is discriminatory (none / 0) (#62)
    by ding7777 on Sat Jan 31, 2009 at 06:40:13 AM EST
    The bill would increase tobacco taxes to offset the increase in spending, estimated at more than $32 billion over four and a half years

    Tax everyone to fund this bill, not just tobacco users


    Well, first (none / 0) (#66)
    by jbindc on Sat Jan 31, 2009 at 08:26:41 AM EST
    Aren't we going to have to get settled with an HHS Secratary?  Dachsle now has some problems of his own and may also have his own tax troubles.

    Seems to me we don't know what we're going to get in terms of health care.


    Yeah, but 54% of americans support it. (none / 0) (#34)
    by masslib on Fri Jan 30, 2009 at 05:02:45 PM EST
    65% support medicare for all.  I just hope we don't go with the Massachusetts health sham.  It's a disaster.

    I'm in on UHC.... (5.00 / 0) (#10)
    by kdog on Fri Jan 30, 2009 at 03:11:47 PM EST
    but only with strong assurances that there won't be laws/regs saying what you can and can't eat/drink/smoke coming down the pike soon after.  Or bans on dangerous hobbies like skydiving.

    Bloomberg is declaring war on salt here in NY...if that's part of the deal with UHC I don't want it.


    or (none / 0) (#12)
    by zyx on Fri Jan 30, 2009 at 03:22:41 PM EST
    having octuplets?

    Yep... (none / 0) (#14)
    by kdog on Fri Jan 30, 2009 at 03:32:08 PM EST
    even octoplets...though I'm all for discouraging it through education/persuasion:)

    we don't have to ban it (5.00 / 1) (#15)
    by CST on Fri Jan 30, 2009 at 03:37:02 PM EST
    but we sure shouldn't have to pay for it either.

    If someone wants octuplets under universal health care, I hope that's not covered.

    That doesn't mean they can't do it, if they got the money (like this case) fine, it just means the tax payer isn't on the hook.


    Works for me... (none / 0) (#18)
    by kdog on Fri Jan 30, 2009 at 03:55:58 PM EST
    but it might get dicey on elective stuff like invitro and birth control.  I don't think vasectomies should be covered under UHC, for example.  Or ED drugs.  That stuff should be on your own dime.

    Then again, it is dicey now under private insurance too.


    Well (5.00 / 1) (#21)
    by Steve M on Fri Jan 30, 2009 at 04:03:49 PM EST
    if I run an insurance company that pays for vasectomies, and you run one that doesn't, mine is probably going to make more money at the end of the day because I'm going to be paying less for childbirth-related expenses and child care, given that more of my customers are snipped.

    I think the government should be in the business of encouraging responsible family planning as long as it doesn't end up taking away from people's right to a free choice.  It's a good investment of taxpayer funds, considering the sort of things that ensue when people don't engage in responsible planning.


    If it has to do with the male (5.00 / 5) (#22)
    by Anne on Fri Jan 30, 2009 at 04:04:11 PM EST
    reproductive system, it's covered; there's nothing dicey about it.  If it relates to the female system, it is never that simple.  

    How is Viagra not an elective drug? And yet, under many policies, drugs for ED are covered, and birth control pills are not.  I guess ED is a "condition," and all birth control does is prevent pregnancy, which is not a condition or a disease, but a natural function of the female reproductive system.


    Just another example of the inequities that women have been dealing with since the beginning of time.


    Viagra... (5.00 / 1) (#32)
    by kdog on Fri Jan 30, 2009 at 04:50:21 PM EST
    to me is a recreational drug, unless you're trying to procreate.  Something you take for fun.

    I'm amazed it is covered under private insurance plans...I guess we can chalk that up to old dudes running insurance companies.

    That beef is totally justified.

    I've been bouncin' this around in my head since the family planning brew-ha-ha erupted...I really don't know if elective drugs or treatments to prevent pregnancy, either on females or males, should be covered...I really don't.  You've got people with religous/moral objections, and though I disagree with those objections and as to when life begins, I can respect them not wanting to pay for something they consider to be a sin.

    It's health care, but it ain't like a broken leg or cancer.


    O.K Anne, lemme (none / 0) (#50)
    by NYShooter on Fri Jan 30, 2009 at 09:54:53 PM EST
    straighten (oops) it out for you.

    Viagra is covered because Elizabeth Dole wanted it covered. Liz, together with the Republican leaders, demanded it be covered as a precondition in pushing a reluctant Bob into running for the Presidency, knowing that any Repub. would get their butt wupped by Bubba. For agreeing to run as the sacrificial lamb, a little Viagra made "autograph signing" with the inevitable groupies a lot more palatable.

    And like they say, "you know the rest of the story."

    Do I have to tell you people everything?

    p.s. I know I have the link somewhere; I'll post it a little later.


    Good to know... (5.00 / 1) (#51)
    by Anne on Fri Jan 30, 2009 at 10:19:00 PM EST
    I was thinking it had something to do with a little paying gig for Bob Dole when the whole running-for-president thing didn't work out.  I mean, sheesh, I guess losing on that scale might take the starch out of the ol' johnson, huh?

    But just between you and me?  If I were Elizabeth Dole, I would hide the freakin' Viagra...


    My guess is... (none / 0) (#53)
    by NYShooter on Fri Jan 30, 2009 at 11:33:31 PM EST
    She slipped the little blue pills into his pocket, then shoved him OUT the door.



    As an FDA approved product the pill is elective (none / 0) (#63)
    by samtaylor2 on Sat Jan 31, 2009 at 07:18:27 AM EST
    Viagra is treats a medical problem.  Now the pill should be covered for uses un-related to contraception.  That is, many doctors do  prescribe it for hormonal and dermalogic problems, and most doctors I have talked to think it should be covered under these circumstances. Unfortunately it is not covered under these situations because drugs are only covered for their FDA approved purposes (maybe they would losen up the rules if we could get some Torte reform???).  Would you argue for condoms to be covered?   Where is the cut off?

    sam, I'm calling BS (5.00 / 1) (#67)
    by Anne on Sat Jan 31, 2009 at 09:24:18 AM EST
    on your being in med school.

    My husband had some problems a few years back with bone spurs in his cervical foramen, and was prescribed drugs "off-label" (meaning their FDA-approved usage was for something else) to control the pain; their cost was covered by insurance.

    Because the insurance companies have become so ruthless in denying coverage for all kinds of things, and developing draconian rules that allow them to do it, it has been up to states to mandate coverage for things like allowing women to have at least 48 hours in the hospital after giving birth, covering an overnight stay for a mastectomy, etc.  And covering the cost of birth control medication for women.

    As for "torte" reform, I rather doubt you are talking about changing the rules about baking cakes - which is what a "torte" is - but about making it harder for people to seek compensation for the negligence and malpractice committed in the delivery of their medical care and treatment.  

    If you actually are in medical training, you don't sound like a future doctor who is committed to your patients and their needs and care as much as you sound like a shill for the insurance industry.  You for sure do not sound like any doctor I would want taking care of me.


    Okay (none / 0) (#70)
    by samtaylor2 on Sat Jan 31, 2009 at 01:30:03 PM EST
    Whatever.  Tone down your anger.  

    In which case (none / 0) (#44)
    by Catesby on Fri Jan 30, 2009 at 07:43:12 PM EST
    People who have heritable illnesses, such as asthma, should pay for those conditions if they choose to have children and the illnesses show up.

    Slippery, slippery slope.


    Was the (none / 0) (#54)
    by NYShooter on Fri Jan 30, 2009 at 11:35:28 PM EST
    second "slippery" really necessary?

    Methinks a little slippery subliminal taking place here.


    No bans (none / 0) (#35)
    by WS on Fri Jan 30, 2009 at 05:50:22 PM EST
    but an obesity sin tax might be in order.  We also need to solve the problem of food deserts and providing healthy, nutritious food that is affordable and accessible by everyone.  

    "obesity" sin taxes (5.00 / 1) (#39)
    by diogenes on Fri Jan 30, 2009 at 06:58:18 PM EST
    Refer to Gina Kolata, "Rethinking Thin".  A substantial proportion of body weight is inherited; people are thinner when there isn't enough food.  If you're going to tax foods that "make you fat", then why not put a per minute tax on TV and video games so that all of us study dictionaries all day and get high SAT scores?

    ahem. A tendency to (5.00 / 1) (#41)
    by ThatOneVoter on Fri Jan 30, 2009 at 07:04:45 PM EST
    store weight may be inherited, but obesity itself is not. Just ask a Pima Indian.

    I agree (none / 0) (#3)
    by esmense on Fri Jan 30, 2009 at 02:29:14 PM EST
    I'm afraid Democrats will invest in covering a few more children and putting medical records online and call that progress (and all that Is "politically possible") -- ignoring the people who are most vulnerable in terms of lack of access to health care; unemployed, under-employed and self-employed adults who aren't a part of group plans, can't afford expensive premiums for Individual Health Insurance, yet don't qualify for public programs like Medicaid and Medicare. They represent the real failure in our system.

    Two-tier healthcare needed now (none / 0) (#68)
    by perspectoff on Sat Jan 31, 2009 at 10:12:05 AM EST
    Adding more children to the government dole is not going to help the health care system.

    Physicians, hospitals, and clinics get reimbursed at rates lower than their expenses for Medicaid (30% below costs), Medicare (10% below costs), and other programs (like SCHIP). Several states don't pay Medicaid for several months at a time, if at all. (Just this week, a large number of California Emergency Physicians are suing to get paid).

    Because of this, there are many areas where it is impossible to find a physician that will accept Medicaid, and the number of physicians that accept Medicare and other government programs is dwindling, as costs rise and reimbursements fall.

    We need a two-tier health care system, as is the norm in most of the rest of the world:

    1. a national network of state, county, and rural hospitals, clinics, and physicians subsidized by the government (financially and with free electronic medical records and bulk purchasing discounts) in exchange for accepting Medicare, Medicaid, and other government programs (such as SCHIP)

    2. a private network of hospitals, clinics, and physicians free to set their own rates in order to recoup their costs, and free to negotiate with insurance companies for fair reimbursements for services, instead of the current system (as in California) where insurance companies can set their own arbitrary low rates and are protected by law in doing so

    If we don't institute such a two-tiered system now, health care will continue to crumble. This year.

    Though I support "universal system" (5.00 / 1) (#5)
    by samtaylor2 on Fri Jan 30, 2009 at 02:37:55 PM EST
    Such policies should not be enacted until this country has a honest discussion as to what the goals of our health care system should be.  I have said this before, but if the national consensus is to be able to "save" your 85 year old mother who has a brain tumor and give her another year or so of life then universal health care is not what we want or need.  If the goal is to vaccinate children, take on diabetes, and help prevent and deal with 60 year men and women with heart attacks then universal health care should be our goal.   I think most people given these simple scenarios would answer they want the 2nd.  However, lets take a 55-60 year women with stage 2 breast cancer who needs genetic testing- where do they fall into the priority mix?  

    If your politicians would look at these ethical questions in a public way, where they could debate them, have people from multiple perspectives talk about their sense of what is "right", and thus in a public way way the pros and cons this country could come to consensus that is correct for THIS country.  I only hope that consensus would be universal health care, but I have found that my desires are most often not what most Americans want.

    Well (5.00 / 3) (#8)
    by Steve M on Fri Jan 30, 2009 at 02:48:42 PM EST
    I think we can agree that there will be difficult choices to make regardless of which system we adopt.

    Personally, I do not consider it a good idea to have a national conversation on who should live and who should die.  It actually sounds kind of soul-deadening.  The political process does not strike me as the right way to resolve these issues.

    The real issue is not whether difficult decisions will have to be made under a universal health care system - they surely will - but whether the system under consideration is an improvement over what we have now.  Let's think about that.  In both cases, if you're fortunate and have enough money then you can insist on gold-plated treatment to your heart's content, so that's a wash.  If you're less well off, you're at the mercy of your insurance company's decision as far as how much care is reasonable.  That's difficult to think about, but it's hard to imagine a real alternative.

    The only difference is that right now, the decision will be made by your private insurance cmopany, whereas in a universal health care system, it might be government bureaucrats administering a public insurance program who will make the decision instead.  There's not a big gap between those scenarios, but to the extent a difference exists, it's probably marginally more likely that the more humane decision will be made by the people who don't have such an acute profit motive.

    But I certainly don't think universal health care ought to be delayed until we solve all these issues, not just because they are unsolvable but also because they already exist under our present system.


    Great post (none / 0) (#9)
    by samtaylor2 on Fri Jan 30, 2009 at 02:57:13 PM EST
    However there is a group/ scenario that you did not discuss that is at the heart of what we should do.  That scenario is rich, poor or in the middle, generally speaking when you get really sick (deaths door) all these groups have the kitchen sink thrown at them (and we all get there).  This costs huge amounts of money and saves few lives, but as a doctor I don't want to be the one to say we shouldn't do it.  That is a collective decision that we should all be on the same page with (or at least know what is coming down the pike).

    Agree (5.00 / 0) (#13)
    by mmc9431 on Fri Jan 30, 2009 at 03:24:29 PM EST
    Having been a care giver for three family members this was a definite problem. As long as they could bill the insurer they were doing procedures such as blood transfusions and such. The minute I finally said no more or when insurance wasn't involved, the treatments were abruptly halted.

    Other countries have UHC, how are they dealing with this?


    The little bit I know is that (none / 0) (#16)
    by samtaylor2 on Fri Jan 30, 2009 at 03:41:00 PM EST
    It is different for each country.  My only experience with the Canadian system (or Universal system) was with a woman 25 year old woman with breast cancer from Canada- who needed/ wanted genetic testing.  She was scared to death and their system was working really slow (in her opinion).  In actuality she didn't need the testing results right away.  Patients often confuse speed/ immediacy with good care, which is often where the anti- universal health care argument gets its talking points from.  They will say, "person X had to wait 6 months to get her surgery, and kept on getting bumped back."  Well in actuality person X didn't NEED the surgery next week- but that doesn't make them happy.

    I know in Australia (none / 0) (#45)
    by Catesby on Fri Jan 30, 2009 at 07:49:44 PM EST
    you can buy supplemental insurance to cover whatever the government doesn't pay for.

    I don't know how it applies as far as end-of-life decisions go, but I do know it is used to upgrade from a shared to a private room, etc.


    My best friend who lives in Toronto got a faster (none / 0) (#55)
    by suzieg on Sat Jan 31, 2009 at 04:52:54 AM EST
    response to her cancer scare than I did right here in US. She had her mammogram on a Tuesday, got the phone call from her GP the next day telling her it looked suspicious and gave her the name of a surgeon who called her back on the Friday and scheduled her for the biopsy on Saturday. It was not cancerous.

    I got my mammogram on a Monday and got a call from my gyno 2 weeks later telling me I had a suspicious area and would need to see a surgeon and gave me the phone number of a breast surgeon. Could not get an appointment before 5 weeks only to be told the day before my appointment that the doctor was closing her office and would not see me + gave me the name of another surgeon. Got to see that one within 8 days. Was scheduled for a biopsy 10 days later only to be told a week later that it was cancerous and that she hadn't gotten all the cancer within appropriate borders and would have to do a lumpectomy when it healed which was 4 weeks later.

    On the other hand, my ex-sister-in-law, who lives in Montreal, was telling me that a co-worker was diagnosed with terminal cancer and the gov't refuses to pay for further treatment when her chemo stops so her company was collecting money for her in order to get it. She's also quite pissed off because her GP of 20yrs has decided not to participate in the gov't run system and has gone private now that their supreme court has declared that it was unconstitutional to force people to join a gov't run health insurance plan.

    I've lived/worked in Europe. I've got nothing but praise for Holland, where I've had major health issues, and the care was excellent and it's paid by both private insurance and gov't a la medicare. In Britain unless you have private insurance, it sucks! Italy was great, but then again I had nothing major, when there, except for my customary bladder infections which I only get in Europe, nowhere else and was told it's because we're too clean, and France was the absolute best. They actually pay for a week in a spa if you're diagnosed with stress and no need to have to pay for a doctor's visit for a prescription, you simply go to the pharmacy, tell them your ills and you get it right there on the spot!


    Apples and oranges. (none / 0) (#69)
    by MyLeftMind on Sat Jan 31, 2009 at 10:35:43 AM EST
    There are also plenty of instances where a woman in the U.S. gets surgery for breast cancer within days of discovery of a lump by mamogram.  You can't really say our system is slower from one or two personal experiences. The speed of the response to cancer often depends specifically on the type, location and size of the lump found.  I can find examples in the small pool of people I personally know who had lumps removed and biopsied within two to three days of their mamograms.  I'm sure scheduling has an effect, but with high risk situations that require immediate surgury, if local surgery is booked up, insurance covers transport to other locations that have more availability.

    Well (none / 0) (#11)
    by Steve M on Fri Jan 30, 2009 at 03:22:15 PM EST
    I guess the choices for who should make the decision about how much care is "too much" - at least for patients who can't foot the bill themselves - are (1) medical professionals, (2) insurance company actuaries with their cost-benefit analyses, or (3) the body politic, i.e. us.

    I guess in the perfect world I'd want those decisions to be made mostly by (1) with a little room for (2) to enter the equation just to take care of off-the-wall judgments.  But gosh, I know I don't want to be a part of making that kind of decision even though it's my tax dollars at stake.  It's one thing if the voters decide "we want to pay for such-and-such medical treatment for everyone even though it's not economically efficient" - that's our right as bleeding hearts.  But if we went in the opposite direction, and started declaring that we wanted to save our tax dollars by denying certain treatment even though medical professionals recommended it, I'd hate for us to go that direction as a society.


    Sometimes gravely ill people have the (5.00 / 2) (#17)
    by Anne on Fri Jan 30, 2009 at 03:41:05 PM EST
    kitchen sink thrown at them not because the patient or the family is insisting on it, but because the physician in charge has not come to terms with the essential truth that he or she simply cannot save everyone.

    That does not mean that there aren't also many instances of patients and/or their families refusing to accept the truth that their loved one cannot be saved; how all of that plays out is dependent on skilled communication that is attentive and sensitive to concerns and feelings - sometimes families need to know that it is okay to let someone go, that no one is going to blame them for their loved one's death.

    If the communication is good, I think in most cases there is a general agreement on what is or is not to be done - and that is how it should be.  We should not be arbitrarily denying people care, nor should we be forcing it on them; being gravely ill, or being the family member of someone who is, subjects all involved to enough of a sense of loss of control that to take the ultimate decisions out of the hands of those individuals would be devastating.

    We need to find a way to care for the whole person, and not treat people as nothing more than their illnesses, or reject them if their prognosis is bad, or see them as little more than invoices with exorbitant bottom lines.  

    If all of us were covered by a single-payer plan, the risk would be spread to the point where perhaps we could afford to practice a more humane form of care, and not have to have discussions about who lives and who dies, who is worthy of saving and who is not.

    The sooner we start moving in that direction, toward a single-payer plan, the better.


    You make excellent points, (none / 0) (#24)
    by KeysDan on Fri Jan 30, 2009 at 04:06:41 PM EST
    but my worry for the development of a consensus would be the insertion of a new and insurmountable barrier to progress on universal health care. Medical ethics is an evolving field made ever more difficult with new and emerging treatments and technologies. It would be better, in my view, to put a decent universal health care system in place, and permit it to evolve along with medical ethics.  We have over 40 years of experience with Medicare to guide us, and, indeed, if we, essentially, adopt a modified Medicare for all, we will really have achieved a great goal.  A universal health care system should be viewed, in the economic sense, as a necessary component of the long-term financial recovery program.

    Orrin would have been included (5.00 / 1) (#6)
    by inclusiveheart on Fri Jan 30, 2009 at 02:39:19 PM EST
    if anyone on the team working towards passage thought he wouldn't throw a wrench into the process.

    Hatch blocked all of Clinton's judiciary appointments - he bragged about this in an interview I saw - until Clinton "had the good sense" he said to agree to work from a list of his approved judicial candidates.  

    So whatever it was that Hatch would have objected to in the SCHIP bill is probably why he was "left out" of the negotiations.  If he really supported the bill "as is", he would have voted for it imo.

    What we need is AFFORDABLE (5.00 / 1) (#19)
    by SOS on Fri Jan 30, 2009 at 03:58:55 PM EST
    medical care but that's not going to happen with Insurance Company's and Giant Privatized Hospitals in bed with each other and monopolizing everything.

    Since when did the government (none / 0) (#38)
    by Slado on Fri Jan 30, 2009 at 06:52:14 PM EST
    do anything affordably?

    They can't pave a road, build a building or anything  because of rules and regulations as cheaply as a private company so why would they handle healthcare any better?

    The key is to cut costs in the current system.  Not throw it out for a whole new one with a new set of problems.

    Canada's system only works because the US is there to keep it afloat.  Britian has private hospitals to pick up the slack.  On and on.  

    Everyone is so ready to leap into the hands of the government.  It's one thing to trust the government to build a bridge.  It's another to trust it to save your life.


    Are you suggesting (5.00 / 1) (#40)
    by Steve M on Fri Jan 30, 2009 at 06:58:20 PM EST
    that anyone is proposing getting rid of private hospitals in the US?

    I beg to differ (5.00 / 2) (#47)
    by Catesby on Fri Jan 30, 2009 at 08:03:37 PM EST
    a year or so ago, my community wanted to pave our access road.  So we got quotes from both the county and private companies.

    The county came in much cheaper.

    And if you think the only problem with our system is basic cost, you need to seriously wake up.  There are those who cannot get covered at all.  Those who think they are covered, and then are not.  Those, as we see now, who lose their jobs and will completely lose their coverage if they cannot pay for one month - let alone 6.

    And then there is the additional liability costs we all carry to cover medical expenses - and the costs of transfering that money from one person to another - ie, lawsuits.

    I have lived for many years in both the UK and Australia, and I can tell you, not one person there under multi-million-dollar status would dream of exchanging their system for our Dickensian system here.

    IMHO, the best system is singler payer, with private medical providers, and private insurance to cover any 'extras' anyone might want to have.


    The problem with universal healthcare (none / 0) (#20)
    by Slado on Fri Jan 30, 2009 at 04:01:10 PM EST
    is the incentive to invent new technologies and procedures is lessended because there is no financial rewared.

    Nevermind the reality that there will be even less doctors and nurses in a profession that will eventually not pay as well.

    We already have a shortage of physicians in many specialties because of the fear that they can loose everything from lawsuit or that that specialty is primarily funded through Medicaid and pays terribly.   Hence dermatology, fertility and plastic surgery having no shortages of residents.

    America and a few other countries are the last private for profit providers of healthcare and we are the worlds leaders in technology and innovation.  

    Now the problems.  Too much red tape, doctors are not the main decisions makers on and on.

    To me some sort of hybrid system needs to be put in place where the government provides insurance to cover the fringes but allows people to make their own choices and for doctors and hospitals to make money.  

    A truly universal system will simply move the decisions making and inneficiencies from a insurance/HMO level we can't stand to a government level that will be worse and result in rationing.   Sorry son, grandma has to die because she can't wait 6 months for a CAT SCAN.

    As a three time cancer survivor who would have died under univeral care my fear is we will limit care in the idea of "fairness" and that scares me to death.

    Unless you have used a universal health (5.00 / 1) (#56)
    by suzieg on Sat Jan 31, 2009 at 05:18:18 AM EST
    insurance system, it's quite ignorant of you to come out with these "republican" and "anti universal health care" talking points!

    Half of my step family lives in Canada and I would say close to half of them have been struck by one cancer or another. As unbelievable as it might seem, 2 of my cousins have been diagnosed with nose cancer within 2 years of each other and it was taken care of as soon as diagnosed with no waiting whatsoever and also with no recurrences and no visible signs of where the cancer was removed which was extentive for both of them!

    I'm also a 2 time breast cancer survivor and I would not hesitate for an instant to have my cancer care in Canada!

    Your claims of medical innovations being restricted in those countries are unfounded! What do you base your assumption on that you would have died if you had been treated in Canada? It's been proven, over and over again that Canadians live longer than Americans so I doubt universal health care is a detriment to them.... Also the 6 months waiting claim is quite frankly getting tiresome. Yes, there is triage, therefore, the sickest get treated first as it should be!

    My brother who lost 1/3 of his heart muscle gets excellent and prompt care/attention and let me tell you if it was not the case I would have heard about it because he doesn't suffer in silence!


    My brother in law (none / 0) (#25)
    by SOS on Fri Jan 30, 2009 at 04:07:57 PM EST
    left medicine because he was tired, angry and frustrated at being told how to practice medicine by a bunch of greedy, corrupt cigar chomping CEO's who admire Rush Limbaugh.

    I here ya (none / 0) (#30)
    by Slado on Fri Jan 30, 2009 at 04:29:05 PM EST
    Problem is would he have staid if a bunch of lazy, incompetent government employees where telling him the same thing?

    Pick your poison... (5.00 / 0) (#33)
    by kdog on Fri Jan 30, 2009 at 04:53:05 PM EST
    I'm of the opinion the only entity to rival insurance companies for waste, incompetence, and heartlessness is the federal government.

    You can sue an Insurance company (none / 0) (#37)
    by Slado on Fri Jan 30, 2009 at 06:47:29 PM EST
    or an HMO.

    You can't sue the government.

    Also as a health consumer you can shop around a little even in the current mess.

    There will only be one choice with government care.

    Unless you're rich and you fly to Asia.


    You obviously don't understand how UHC works... (none / 0) (#57)
    by suzieg on Sat Jan 31, 2009 at 05:30:58 AM EST
    There are no restrictions on the choice of your doctors because they are all enlisted in it so you can go to any doctor/specialist of your choice and the gov't pays for it, no question asked, no pre-approval from a $7 hr insurance industry clerk! You get a card that looks like a credit card, you give it in at the doctor office, and they send the bill to the gov't not to you! It's as simple as that!

    My sister in law is a GP and she's praying for single payer's insurance and not having to deal wih the insurance industry anymore. My cousin is the best infertility doctor in Canada and he's continually being recruited by major teaching hospitals in USA but he won't even consider it because he admits he's better paid in Canada than he would be in US.


    Try suing an HMO in Texas - not one lawyer (none / 0) (#58)
    by suzieg on Sat Jan 31, 2009 at 05:35:11 AM EST
    will take your case because of tort reform which you can only recover any damages in $50K increments! If this is your excuse for not supporting UHC, it's pretty lame!

    by suzieg on Sat Jan 31, 2009 at 07:41:49 AM EST
    I can't tell (none / 0) (#71)
    by sj on Sat Jan 31, 2009 at 10:03:30 PM EST
    Do you think it's good that people can sue or not?  In your previous message you were sounding as though it's a bad thing that a lawsuit could be filed when there has been malpractice.  Now your argument is that it's needed.

    I personally think it's needed and that malpractice insurance premiums are through the roof just because they can be.  Another case where insurance is not serving us well.  To top it all off, tort "reform" (or rather tort restriction) has made it darn hard in many states to even pursue a valid claim.

    But it sounds like your just throwing your arguments at the wall and seeing what will stick.


    Simply put to me (none / 0) (#26)
    by Slado on Fri Jan 30, 2009 at 04:12:24 PM EST
    it's a fantasy to believe that a healthcare system run by the government will operate better in terms of care and quality then the one that is currently in place.  

    The main issue is everyone having access to that system without going bankrupt.  People get basic healthcare in this country.  

    It seems ironic that we would trade an insurace company that at least you can sue for a government employee who you can't do anything about.

    I also think it would be less suited to control costs as well so you'd have the double whammy of more expensive and rationed care.

    Lets fix the system we have now without throwing the baby out with the bathwater.


    You nailed it (none / 0) (#28)
    by SOS on Fri Jan 30, 2009 at 04:15:00 PM EST
    "The main issue is everyone having access to that system without going bankrupt."

    Strawman or red herring? (none / 0) (#42)
    by ThatOneVoter on Fri Jan 30, 2009 at 07:06:59 PM EST
    Obama isn't proposing to have the government run health care. He isn't even proposing single-payer health care. He will probably create a proposal that lines the pockets of the insurers, just as he did in IL.

    with the help of Kennedy who's advocating for one (none / 0) (#60)
    by suzieg on Sat Jan 31, 2009 at 05:45:07 AM EST
    similar to the one in MA. anyway it won't happen this year as per Clyburn see: www.thehill.com/leading-the-news/citing1994-clyburn-embraces-incremental-health-reform-2009-01-25.ht ml  

    Kerry told us that universal health care is off the table for Obama's first term as Obama also told us that he would not tackle it for adults until his second term and ONLY if it worked for kids! Also tax cheater/unregistered lobbyist Daschle would be out of a job if it was implemented this year!


    My husband has no problems whatsoever with (none / 0) (#59)
    by suzieg on Sat Jan 31, 2009 at 05:37:49 AM EST
    Medicare - he's very happy with it and refuses all offers to join an medicare advantage plan - he no longer wants to be at the mercy of the insurance industry. If it was extremely well funded instead of being shortchanged repeatedly it would be a 100% success!

    Where can they get basic health care in this (none / 0) (#65)
    by suzieg on Sat Jan 31, 2009 at 07:59:16 AM EST
    country? The emergency room? You obviously have never gone without health insurance. You'd be extremely lucky if a doctor's office will even schedule you for an appointment if you don't have insurance. Try doing so, and let me know how well that worked for you and I'm speaking from experience when I had to go without for a few months because I was rejected by all major insurance companies due to a pre-existing condition, that had been resolved 10 yrs before, (they go as far back as 15yrs) until I was accepted by my state's risk pool.

    My husband and I have stopped going out at night on the week-ends because the emergency rooms are on drive-by or the ambulances are turned away and I live in Houston where we have an excellent/respected medical center. No amount of money or insurance, unless you're the Bushes, will get you in under any circumstances! How's that better than Canada?


    If that were the case (none / 0) (#48)
    by Catesby on Fri Jan 30, 2009 at 08:09:44 PM EST
    how come Australia is winning all those Nobel Prizes for medicine?

    You really should look beyond the conventional wisdom.  In some places, doctors actually do medicine for something other than gobs of money.  I have never trusted a doctor since I moved here because it's obvious what their motive is.  Of course, I am sure I have insulted many fine US doctors, but this is the atmosphere they operate in.

    But think how much better off doctors would be if the cost of medical treatment is no longer part of their medical liability, because everyone is already covered.

    Think how much better off we would be if we didn't have to cover medical costs in our homeowners and auto insurance.


    I think we should (none / 0) (#23)
    by SOS on Fri Jan 30, 2009 at 04:04:28 PM EST
    have adjustable medical plans and services that offer care and medicine according to income.

    In order for that to happen we are going to have to support private practice so Physicians have the power to engage in small practice.

    If people want big and expensive and prestigious Hospital with all the perks they can fork out for it. Go ahead.

    There's plenty of Physicians who aren't greedy and just in it for the money and who can deliver great results.

    Of course (5.00 / 1) (#27)
    by SOS on Fri Jan 30, 2009 at 04:13:41 PM EST
    I know I'm dreaming in this day and age, but I'm still old enough to remember when the Doctor came to your house.

    You shouldn't (none / 0) (#29)
    by SOS on Fri Jan 30, 2009 at 04:18:15 PM EST
    have to go out and be required to get a battery of high tech test's costing thousands of dollars just to find out you have a sore throat.

    Walmart (none / 0) (#31)
    by Slado on Fri Jan 30, 2009 at 04:35:45 PM EST
    Has started the perfect solution.

    To me it's pretty simple.  We don't require the insurance company to pay for a tuneup, or a tire change just the major accident.

    Why should health insurance cover your weekly visit?  Vision? Dental?  

    Some say "well then preventative care won't be provided".  I say maybe?  I mean we're all grownups.  People still smoke, drink, and don't go to the doctor in the current system.

    It cost so much to get $50 from you to your insurance company, to your HMO, to your physicians secratary etc... and finally to your pyhsician to tell you you're healthy compared to you walking in and paying for it yourself knowing that if you get cancer you're covered.

    The whole system could have trillions of dollors in wasteful costs if the insurance companies weren't required to pay for everythihg.   I mean why should I get free contacts?  If they can afford to offer it in a competitive marketplace that's one thing but so much of the costs and small coverages are mandatory and required by state and federal laws.

    Oh well.  My two cents.


    I think you have it completely (none / 0) (#43)
    by ThatOneVoter on Fri Jan 30, 2009 at 07:08:45 PM EST
    backwards. Regular doctor visits and preventive screening/advice can be a huge cost saver.
    Look at type II diabetes, which is almost completely preventable: you could spend a lot of money on prevention and education about that disease and still save money.

    Except I have Hashimoto's (none / 0) (#49)
    by Catesby on Fri Jan 30, 2009 at 08:15:16 PM EST
    a non-functioning thyroid.

    Now, I have been on the same dose of medicine for 10 years - and without it I would die.

    But every doctor I go to see insists on me coming into the office every 3 months, then going to a lab to get blood work - just in case.  If it were up to me, I would go once a year.

    Mind you, even with good insurance, the whole shebang already costs me more than $50 a quarter.


    Do you think it's fair that I have to pay $1,397 (none / 0) (#61)
    by suzieg on Sat Jan 31, 2009 at 05:56:40 AM EST
    monthly + $1,000 deductible + $3,000 in co-pay for my personal health insurance, through my state health insurance risk pool, simply because when my company went bankrupt I could not purchase private individual health coverage through my company's insurance because the insurance co was allowed not to sell individual policies in my state?

    This is good news (none / 0) (#52)
    by ricosuave on Fri Jan 30, 2009 at 10:58:11 PM EST
    Both the expanded coverage and the fact that Hatch learned that the Senate will operate with or without his input.  It is the lesson that should have been taught to the republicans on the stimulus package.

    schip (none / 0) (#72)
    by btator on Wed Feb 04, 2009 at 04:18:26 PM EST
    although I am sure this will help alot of people it doesn't help my family as I just read where you can make 36,000 per year for a family of 4 to qualify for this program. My husband is an army veteran and continues to work hard to provide for us as we are a family of 3 we don't qualify for this program the biggest kicker our son was born premature and developementally disabled and until my husband went to Iraq our son received S.S. now he gets nothing we pay 150.00 a month for medical for our son not to mention the hundreds of dollars we spend each month for his medical supplies, have tried every gov. program don't qualify for any my husband makes roughly 3,500 per month so when is there going to be a bill to help people like us I know we aren't the only family in this situation.