The Health Care Compromise: Worse Than No Bill At All?

It's pretty obvious President Obama is going to push a compromise bill. The latest reports on the details of the compromise bill make little sense to me. I'm waffling on whether to support it at all. Here's the latest:

...remarks by the White House press secretary, Robert Gibbs, on the flight to Cincinnati reflected an effort by the White House to play down the importance of a public option to the larger overhaul. Mr. Gibbs said a public option would not affect most Americans — up to 180 million — because they already have insurance through employers. (my emphasis.)

So then why do we need this? [More...]

Mr. Baucus’s proposal would offer low-cost catastrophic insurance as an option for people 25 and younger. Policy experts say many people in this age group cannot afford comprehensive coverage or see no need for it.

“The idea of a stripped-down benefits package for people who have a good income and choose not to buy health insurance makes a lot of sense,” said Stan Dorn, a senior research associate at the Urban Institute. “But a catastrophic insurance policy does not make sense for lower-income people, because they cannot afford medical care short of catastrophic expenses. A catastrophic policy does not cover routine care.”

If we don't need a public option because 180 million have insurance under their employers, aren't the kids of those 180 million already covered up to age 25? Why do they need help with insurance more than the poor who have none and can't afford it? How many of those under 25 will even face a catastrophic health crisis?

Mr. Baucus’s plan would also expand Medicaid, starting in 2014, to cover millions of low-income people, including many childless adults who never qualified before. Benefits offered to such newly eligible adults would generally be less generous than the comprehensive benefits available to other Medicaid recipients.

Why are they getting stripped-down benefits? And why does it not kick in for five years? I also don't buy this:

“Low-income people without children tend to have extensive health care needs — higher rates of mental illness, physical disability and chronic conditions.”

Nor do I like how Baucus' compromise intends to pay for the cost of providing these limited benefits:

To help pay for his plan, Mr. Baucus would impose fees of $6 billion a year on insurance companies, $4 billion a year on manufacturers of medical devices and $750 million a year on clinical laboratories.

Does anyone think the health insurance companies won't pass these fees on to the consumer by raising premiums -- especially to those with high-end health care plans? The other likelihood is the insurance companies will drop the high-end plans.

I support a public option because I want those who can't afford health insurance to get it. Not just those under 25, but everyone. I know it will mean I pay more for my high-end health insurance plan and I can accept that. But with this compromise, I'll bet my plan either gets withdrawn or becomes so expensive it will become prohibitive. And that's not okay. Not unless my giving it up means there's a big benefit to society like everyone who needs affordable health care gets it.

This compromise means we're all going to suffer for far too little benefit to the greater good. If this is the bill that's agreed upon, I'm going to hope the House rejects it because it has no public option.

Maybe I have it all wrong. I hope I do and I am more than willing for those of you who understand it better to explain why my fears are misplaced. But, I've tried to follow the details and if this is my conclusion, I bet millions of others, regardless of what plan they now have or whether they have no plan at all, are equally clueless as to what it will mean for them.

I put the blame for this on President Obama. Not only has he done a lousy job of explaining what he is willing to accept, he's done a lousy job of explaining the benefits of the bill and the sacrifices it will mean for the rest of us. And now, to top it off, he seems completely focused on passing any bill at all, just so he can say his Administration didn't fail. This compromise is a failure. If it passes, and he starts bragging about how his Administration passed critical health care reform, I'm going to tune him out.

If this is the compromise bill Obama says he supports, I hope it gets rejected in the House. There's plenty of time between now and 2014 to get it right. As with all legislation, a bad bill is worse than no bill at all.

< A Helpful , Glossry of Health Care Terms | What Will They Say When The Baucus Bill Is Gutted? >
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    I'd like just one hour alone with (5.00 / 5) (#1)
    by shoephone on Tue Sep 08, 2009 at 01:09:22 AM EST
    Gibbs, the Six Senate Mobsters and the Great Capitulator himself, our squirrely president. As someone who is currently unemployed due to physical injuries sustained over nine years running my own business -- and never able to afford proper insurance as a self-employed person -- I could teach them a lesson or two about real life. Not that they'd listen -- they have already decided to sell me out, and millions like me. I wonder if they pass around cigars every time they invent new methods of giving the country away to the corporate interests. These people contort themselves into 500 phony little pieces when standing before the microphones and lauding the American entrepreneur and the small business owner. But when it comes to providing a way for us to get affordable health care they prove exactly who and what they are.

    My only hope is that the Progressive Caucus members flip a collective middle finger at those phonies and threaten to blow up any bad bill coming their (and our) way.

    The mere fact that we are put in the position of fighting tooth and nail for what amounts to a gross compromise in the first place throroughly disgusts me.

    Well (5.00 / 2) (#2)
    by Ga6thDem on Tue Sep 08, 2009 at 02:34:42 AM EST
    Jeralyn I'm getting the same reading on this bill that you are. It's pretty worthless and no bill is better than this one. Frankly, I would take some of the parts of it like expanding medicaid and just pass them on their own and forget about this all encompassing bill.

    Interestingly, the reality is that (none / 0) (#18)
    by inclusiveheart on Tue Sep 08, 2009 at 07:36:28 AM EST
    the poor in America enjoy better coverage than a lot of working and middle class folks because of programs like Medicare.  This debate should be about the middle class and making it stronger - it is funny because more often than not I believe we focus too much on the middle class in our politics - but in this case that really is where improvement is needed - that is where our society and economy is really losing ground - and the high cost of health insurance and healthcare is a leading factor in undermining the stability of our middle class - which in turn affects a whole lot of other stuff - not the least of which is what was once a fairly stable tax base and economic engine in this country.

    In any case, the Obama Administration is registering a big fail in my books at this point. They clearly do not understand or care about the sweeping effects of this crisis - nor do they understand that lower health insurance premiums would be an instant stimulus to the economy.


    Not poor adults (5.00 / 2) (#19)
    by Militarytracy on Tue Sep 08, 2009 at 07:42:27 AM EST
    My daughter can't get anything in this state.  Now her kids can get coverage but they don't need it with an active duty father.  There isn't anything for our daughter though.  There is almost nothing out there for people who work our lowest paying jobs either.  You must be destitute in most places to get any help at all.  So you can have health coverage but you must literally be living on the streets.

    Yes - all true. (5.00 / 1) (#24)
    by inclusiveheart on Tue Sep 08, 2009 at 07:51:31 AM EST
    But I think my point is that when you get to "poor" - safety nets kick in - which is a waste really when you think about it.  What if we didn't make it so that people had to fall into utter abject poverty before they could realize benefits that might help them to continue to be productive members of society.  As we allow more and more people to fall into the viscious cycle of poverty, all we are doing is hurting ourselves.  The most obvious connection - but certainly not the only one - is that a foreclosure (for whatever reason) in your neighborhood affects the value of YOUR house too.  It is a lot harder to rebuild from the ground up than it is to maintain.  Currently, we seem to be on a course of utter destruction - and some are so arrogant that they believe that the rebuilding part will be a piece of cake - but it won't be - it will be ten fold more difficult than it would be for us to find ways of shoring up the current situation.  In addition, the distance between here and "much improved" grows everytime we allow another person or family to fall out of economic stability through no fault of their own.

    Working poor (5.00 / 1) (#36)
    by gyrfalcon on Tue Sep 08, 2009 at 08:24:03 AM EST
    is the term.

    Thank you (5.00 / 1) (#40)
    by Militarytracy on Tue Sep 08, 2009 at 08:30:31 AM EST
    And doesn't the propaganda say that there can be no such thing as "working poor" in America?  In this fine fine nation all one needs is the want and the lack of laziness that allows you to work and you can become whatever you desire to be?  I'd laugh if it wasn't so tragic.

    Medicaid not Medicare (5.00 / 2) (#49)
    by jimakaPPJ on Tue Sep 08, 2009 at 09:16:48 AM EST
    Medicaid is government provided health care insurance for poor people who meet certain guidelines.

    Medicare is government provided health care insurance that is paid for by a Medicare Tax on income that everyone pays and premiums collected from the individual, plus co-pays. It is available to people 65 or older.  It is not free.


    Yes - thanks - I thought Medicaid and (5.00 / 1) (#54)
    by inclusiveheart on Tue Sep 08, 2009 at 09:32:33 AM EST
    for whatever reason typed Medicare instead.  Weird how the brain does that sometimes.

    If this is it (5.00 / 2) (#3)
    by cawaltz on Tue Sep 08, 2009 at 02:46:43 AM EST
    I also choose the no bill option.

    Kids (5.00 / 3) (#4)
    by cawaltz on Tue Sep 08, 2009 at 02:49:30 AM EST
    My kids are not covered until 25. They can be covered until 23 if in college but if they were to choose not to go would be off the policy at 18.

    My sister has Medicaid (5.00 / 2) (#5)
    by cawaltz on Tue Sep 08, 2009 at 02:53:15 AM EST
    in FL. As she explained it, her bill is required to be $425 or over BEFORE Medicaid will pay. There is only one doctor in her area that accepts it. It's hard to imagine there being a "less generous" option for low income folk. Go figure

    I don't view the Baucus bill as 'THE' compromise. (5.00 / 2) (#8)
    by steviez314 on Tue Sep 08, 2009 at 06:20:44 AM EST
    This is the bill he was always going to produce.  Why it took so much time wasting, I don't know.

    At least it's so bad, that it isn't even a starting point for some kind of compromise.  If it had a couple of "reasonable" proposals in it, Congress might get hung up on debating it for a while.  I'd like to think this one just goes into the desk drawer.  the Finance Committee has done its "duty", and now we can proceed.

    Surprise! (none / 0) (#50)
    by cawaltz on Tue Sep 08, 2009 at 09:20:11 AM EST
    Some of the folks in our coalition consider it a swell starting point. Geez.

    Being forced to purchase (5.00 / 2) (#11)
    by MO Blue on Tue Sep 08, 2009 at 06:58:28 AM EST
    "junk" insurance that you can not afford to use even if you could afford the premiums is not providing health care. Also, with no cost containment provisions more and more people will fall into this category each year.  

    The Baucus bill is nothing more than a wealth care program for the insurance industry.

    I seriously doubt that the industry will drop the high end policies as they are a good revenue source. The taxes on those premiums will be passed down in the form of increased premiums and not just to the people getting the Cadillac policies.

    No bill would be better than this travesty. The House bill is the bare minimum of what would be acceptable.

    Lost Opportunities (5.00 / 2) (#25)
    by mmc9431 on Tue Sep 08, 2009 at 07:51:57 AM EST
    Why do politician continue to focus on "low income" people when discussing HCR. I see this as another crisis confronting the middle class also, not just low income families.

    Health care costs are eroding the standard of living for all American's. By allowing the Republican's to label this as another welfare program for the poor that's going to bankrupct the nation, they've lost essential support among the middle class.

    As usual, Democrat's have allowed the Republican's to control the message and distort the facts.

    I think most American's accept the fact that the health care system we have in place is dysfunctional. It was up to the Democrat's to solve the problem. Instead they chose to play this phoney bipartisan game and waste the best opportunity we've ever had to finally make true HCR a reality..

    Voters won't forget it. After 8 years of GWB, I thought I had seen the last of the Republican agenda for a long time. By his terrible handling of this whole process, Obama has opened the door, (if not the flood gates) for the Republican's to return.

    The thing is that the Left (2.00 / 1) (#79)
    by jimakaPPJ on Tue Sep 08, 2009 at 10:41:22 AM EST
    wants free national care for the "poor."

    (You can define "poor" anyway you want.)

    The middle class, mostly conservative or mildly liberal, understand that they will be paying for it.

    The seniors also understand that Obama's planS are to be partially paid for by taking money from Medicare. (You just moved my cheese.)

    Those two groups have united in opposition.

    Scrap this plan. Do a new one in which it is paid for by a national sales tax and you might squeak it through.


    No (5.00 / 0) (#89)
    by standingup on Tue Sep 08, 2009 at 11:08:45 AM EST
    There are a lot on the left who want to address the problem the entire nation faces with our current health care system.  We don't only want "free national health care for the poor."  Many of us are paying outrageous premiums for private insurance plans with high deductibles that are nothing more than catastrophic coverage.  We understand that part of lowering the costs will include getting as many people into the system as possible so the risk is spread more evenly across the population.  We see that there can be cost reductions in overall expenditures by providing preventative care and early diagnosis.  We know our businesses are at a competitive disadvantage because they have greater expenses related to health insurance than those in countries where they have single payer or universal coverage.  In other words, don't fall into the trap of using stereotypes in this discussion because it only distracts from finding solutions.  

    And don't put words in my mouth (2.00 / 0) (#124)
    by jimakaPPJ on Tue Sep 08, 2009 at 12:34:16 PM EST
    I never said a word about anything of the things you wrote.

    Now. Tell me how you will pay for a single payer plan.


    I am not putting (none / 0) (#149)
    by standingup on Tue Sep 08, 2009 at 03:04:19 PM EST
    works in your mouth but responding to your broad oversimplification of the issue and stereotyping.  This is a national problem that impacts us all beyond the care different groups are receiving and who will pay for it.  We are all paying for it in one way or another right now.

    Don't you see how the inefficient system we currently have is costing all of us directly and indirectly but with little added benefit?  I know that any medical care I pay for is higher because the system is passing along the cost of caring for others who can't afford the care.  I pay higher insurance premiums (supposedly because of increasing health care costs) that continue to rise even though I have never used my coverage one single time.  And I am not the only one in this situation.  I am thankful that I have insurance coverage now but have no guarantee I will continue to be insurable either.  My father had the same type of policy I carry and the insurance company wanted to cancel his policy when he was diagnosed with cancer.  His policy for a self employed person carried a clause that he had to be working a certain percentage of the time for it to be in effect.  It had nothing to do with his ability to pay the premiums while he was not able to work.  If he had been dropped and survived his cancer, he would no longer be insurable.  Health care costs with no insurance would have probably put him out of business, left my mother uninsured too and left the few people he employed without work.  A lot of small business owners are in a similar situation.      

    There are direct and indirect costs to businesses related to healthcare too.  The obvious direct cost is the higher cost of insurance for those that provide coverage to employees.  But what about the cost indirect cost in productivity?  And even if some employers do not provide health insurance many have to provide workers' compensation coverage which includes medical costs.  Don't you think those are not passed on to the rest of us?  We are already paying the price, whether we are middle income, low income or retired, without getting what we should in return.  

    And I don't see them significantly reducing Medicare benefits but taking steps to reduce wasteful and ineffective spending that will result in lowered costs over time.  Is it necessarily a bad thing to change policies like Medicare Advantage that are not providing the savings they were supposed to when enacted?  If they do not do something to address the problems, I fear Medicare benefits will be a greater risk in the future than they are now with healthcare reform.  

    I said nothing about single payer but I certainly would not propose paying for it with a regressive tax.  I would probably advocate for some type of contribution from everyone with an exemption or sliding scale for those who fall below a certain income level and those  living on a limited retirement income.  


    Huh? (none / 0) (#158)
    by jimakaPPJ on Tue Sep 08, 2009 at 08:28:35 PM EST
    My comment noted that two demographics had found Obama's plan wanting and noted it needs clarification on cost and how we pay for it.

    Where you get the rest I do not know.

    And yes, the Left wants free medical care for the poor. That is what your "sliding scale" is about.

    If you don't go to a single payer system all you have done is given money to the insurance corps. That is all "mandates" and "government option" does.

    If you don't mind that I can't understand your problem with the Advantage plans.

    Some $400 billion is supposed to come from Medicare.  There is no way that much money can be saved without reducing payments to hospitals and doctors. That will lead to reduced services as sure as night follows day and that leads to rationing. That means that someone will be deciding who is worthy and who is not.


    I'd accept that deal (none / 0) (#90)
    by mmc9431 on Tue Sep 08, 2009 at 11:09:42 AM EST
    I'd be more than willing to go along with a national sales tax if it meant universal health care.

    I still wonder though where all this fiscal concern was when Washington buried us in a trillion dollar debt with Iraq? (And the meter is still running). When Washington is willing to look at all budgets for money waste, then I'll start paying attention to what they have to say about fiscal responsibility.

    I also don't agree that national healthcare is for the poor. Medicare is for all. So would universal health care. The middle class is getting squeezed at least as much as the "poor" in the country.

    Even though my partner has a good benefit package by today's standards, his benefits are cut every year while his cost and co-pay have increased each year. (This on top of the fact that his salary has stagnated over the same period).


    I didn't say (2.00 / 0) (#128)
    by jimakaPPJ on Tue Sep 08, 2009 at 12:37:56 PM EST
    that a single payer plan was for the poor. I said that the Left wanted free insurance for the poor.

    I will stand by that statement.

    I have commented for years in support of a single payer plan.


    So you're against (5.00 / 0) (#129)
    by jondee on Tue Sep 08, 2009 at 12:40:32 PM EST
    health insurence for those who cant afford to pay for it?

    Or, are you a blame-America-first Leftie now?


    As you well know (2.00 / 0) (#142)
    by jimakaPPJ on Tue Sep 08, 2009 at 02:08:12 PM EST
    the tax can be adjusted to be less on items... unprepared food, utilities, etc. .... that take a bigger bite out of the poor. Of course at the same time it will catch the people living in the grey areas and yes that would include illegal aliens.

    Paying for it (none / 0) (#135)
    by mmc9431 on Tue Sep 08, 2009 at 01:00:21 PM EST
    National sales tax is a viable option that should be explored.

    My objection with this out cry from conservatives that we can't afford it. Where was this fiscal responsibility when  for the first time in our history, they actually lowered taxes at a time of war? Or that instead of putting the war costs in the budget where it would have to be accounted for, they side stepped the issue everytime by running supplimental bills through.


    I think the outcry (2.00 / 0) (#140)
    by jimakaPPJ on Tue Sep 08, 2009 at 02:04:37 PM EST
    is that no one has stepped up with an actual cost.

    Most people can figure out pretty quickly that when someone doesn't tell you the price it is going to cost you.

    Let's factor in that medicaid goes away so those tax dollars get added in, etc., etc. IOW lay it out and let's look at it.


    if (5.00 / 1) (#42)
    by Ga6thDem on Tue Sep 08, 2009 at 08:37:52 AM EST
    bloggers like you actually believe what you are saying then you should be the first one all over President Milquetoast Goodspeech's behavior. This legislation is NO win and will actually hurt the party more than help.

    If there are losses in 2010 and 2012 Obama will have to take responsiblity for letting the GOP set the agenda again.

    The best we can do..... (5.00 / 1) (#63)
    by Carolyn in Baltimore on Tue Sep 08, 2009 at 10:04:52 AM EST
    This is it??? It is an individual mandate (you MUST buy insurance) with the only players the big companies who love to deny treatment and rake in 30% profits. And with no government option and no cost-saving, all it is is a big gift to the insurance companies. That doesn't start for a few years.....
    They charge rents, the rents go up every year, the landlords suck and get rich.

    If this is the best, possibly closing the gap is our best option - incrementally adding 55+ and then 50+ to Medicare, expanding Medicaid to higher income levels and making CHIP available to all kids up to 25 or so. Bit by bit we could add to the people covered by a government plan and improve the plans as we go.

    Politically adding a few years or adding funding to expand current popular programs would be less difficult than starting a new plan.

    So scrap the lousy plan the SFC is putting out there. It IS worse than no plan.

    Adding to Medicare like 60, 55, 50... (none / 0) (#88)
    by lambert on Tue Sep 08, 2009 at 11:08:30 AM EST
    ... was how Kennedy set his single payer bill up. You'd think it would be an easy sell.

    If the $15,000 car doesn't have a (5.00 / 1) (#76)
    by jimakaPPJ on Tue Sep 08, 2009 at 10:34:27 AM EST
    motor it would be best to wait.

    "Pass the yes-butter...." (5.00 / 0) (#98)
    by lambert on Tue Sep 08, 2009 at 11:26:41 AM EST
    I like the "throwing fits" part. Teh funny!

    I mean, it's not like thousands of lives and trillions of dollars were at stake, or anything.

    Catastrphic care is key (none / 0) (#7)
    by Jack Okie on Tue Sep 08, 2009 at 05:49:28 AM EST
    Donald from Hawaii, I glad you've held off both illnesses.  As a conservative, I have no problem with some kind of arrangement for folks in your boat, but I don't see why we should all be shoehorned into a one-size-fits-all approach.

    I'm 69, have been fortunate to have serious problems like yours pass me by, but who knows what will come around the corner tomorrow?  I have a Medicare Advantage plan (HMO) that has covered a weird scalp infection and a colonoscopy.  I have detected no difference in my care under this plan that when I was working and had my employer's insurance.  I think Medicare Advantage is great and am quite disturbed that Obama wants to do away with it.

    Given the reality, not just grim anecdotes, about NHS and Canada's health care, I would rather stick with private insurance, but with policies across state lines, eliminating state mandates, and personal ownership rather than employer provided.  Ownership of the policy will allow coverage to be tailored as with auto insurance.  Tax credits towards insurance, and medical savings accounts can help defray insurance costs.  Too many people expect their insurance to cover routine medical expenses.  Those folks should be paying higher premiums.  

    It wasn't so long ago that Melanoma was virtually untreatable.  I suggest that your outcome is due to the U.S. health care system.  Innovation and research are not cheap; I would rather have expensive effective care than government care:  The VA, Indian Health Service, NHS and Canada are all examples of what we can expect if we allow a public option that drives out private insurance.  Either we ration on cost, or ration on availability.  I prefer the former.

    P.S.  My Mom was a tough old bird, surviving heart problems and cancer.  Sounds like you have a pretty tough constitution as well.  In a nutshell, my wish is that we find a way to cover your situation without messing up MY situation.

    When I read opinions like yours (5.00 / 1) (#10)
    by Militarytracy on Tue Sep 08, 2009 at 06:54:00 AM EST
    All I can do is shrug.  It is a minority opinion of a person who has not struggled with the existing healthcare ripoff nonsystem.  Does it really not bother you that America's violent crime rate is through the roof compared to that of other industrialized nations who simply provide healthcare for every single citizen?  Do you ever wonder if this complete dog eat dog society we have where the have nots will continue to be have nots and have almost no chance of digging out of it ever, and that hasn't eaten you yet, won't eventually eat you too?  You are only a more fortunate commodity thusfar, nothing more.

    So Militarytracy, (none / 0) (#13)
    by Jack Okie on Tue Sep 08, 2009 at 07:23:30 AM EST
    Are you one of the haves or have-nots?

    I don't understand your linking violent crime to the health care system.  Are the other industrialized nations tranquilizing their miscreants?  Actually, there is now quite a bit of violence in Britain, France, Holland, and other countries.  When the British issue an edict that the Boy Scouts can no longer have pen knives it's an unfortunate reflection on their state of affairs.

    Why do you assume I am indifferent to problems when my solutions differ from yours?  I don't know what your life experiences have been to make you feel this is such a dog-eat-dog society.  Here in the heartland we take care of each other.

    I'll tell you what seems dog-eat-dog to me:  The woman in Oregon whose "public option" folks told her they wouldn't pay to treat her cancer, but would pay for assisted suicide.  Link:


    For someone who claims to be for the marginalized in society, you seem pretty oblivious to the fate of those facing rationing of care in those universal health care plans.  How do you think they control costs?  Yes, Grandpa can have his pace-maker, but the waiting period is 6-months.  Oh, Grandpa died before the 6 months were up? Bummer.  But we only had so much money budgeted for pacemakers, so somebody had to get stiffed.

    Out for my morning walk.  Back later.


    I'm a HAVE (5.00 / 2) (#16)
    by Militarytracy on Tue Sep 08, 2009 at 07:31:05 AM EST
    Of course it comes with a price.  My husband vows to go kill whoever he is told to kill by whoever the President is at that time, and he didn't do this to be a HAVE, he serves whole heartedly.  I link violent crime to our current society where one third of America and their children are told to go eat sh*t so the rest of us can mostly either be lower middle class or so wealthy it is disgusting.  Our poverty problems are disgusting when compared to those of Canada and Europe, and then I have to deal with people going off about how inferior those systems are when they are anything but.  Poverty rates and crime rates have always gone hand in hand.

    And my serving soldier Tricare (5.00 / 2) (#17)
    by Militarytracy on Tue Sep 08, 2009 at 07:33:10 AM EST
    insurance has denied my son who is disabled more times than I can count. It's a game, where one parent must always be able to be in play at a moments notice to fight.  Nothing more, just fight with the system that makes money by denying him care.

    Well it's no wonder (5.00 / 1) (#39)
    by Jack Okie on Tue Sep 08, 2009 at 08:30:29 AM EST
    you feel the way you do.  I don't know anything about Tricare and how it's funded, but I'll find out.  Over the past twenty years before I retired my employer offered Principal, Aetna, Blue Cross Blue Shield, and a local product put out by a hospital consortium.  The last one was the best, and the blues sucked big time.

    Many thanks to your husband for helping keep me and mine safe, and many thanks to you for shouldering the burden of being a military spouse.  I know you are paying in a myriad of ways.  Yeah, I know, that and a dollar will get you a cup of coffee, but nonetheless....



    Many employers do not offer (5.00 / 2) (#45)
    by nycstray on Tue Sep 08, 2009 at 08:43:56 AM EST
    choices anymore. Last employer I had, tried to keep the one plan affordable, but every year it went up and coverage went down. Seems to be the trend . . . And then you have to find a Dr who will take the one plan you are offered.

    If you care about how poor my coverage (none / 0) (#44)
    by Militarytracy on Tue Sep 08, 2009 at 08:42:33 AM EST
    is, what about everybody else out there?  Why am I so special?  If Tricare tries to bankrupt this family I'll call Senators, stuff will get done.  What about everybody else who doesn't have a serving military Senator card to pull?

    I don't agree that everyone else' coverage is poor (none / 0) (#61)
    by Jack Okie on Tue Sep 08, 2009 at 10:02:47 AM EST
    My experience, with the exception of a stint with Blue Cross/Blue Shield has been fine.  But my family never had to confront a life-threatening or chronic illness, just things like maternity coverage, a broken ankle, shingles, etc, so my personal experience doesn't necessarily apply.  My Mom was civil service and had a disability retirement.  Her health insurance provided good coverage through cancer and a lot of heart problems.

    When polls show most people are happy with the current situation, we need to solve what doesn't work now and tweak was does work.  Some of you folks seem to think I want to keep my coverage and deny it to others.  Not so.  I want everyone who is a citizen to have good coverage, but  I don't want government paid insurance for illegal immigrants.  I believe tort reform, portable policies and elimination of mandates will go a long way to bringing down costs.  People who can't afford insurance can be covered by the government, state or federal, without overturning the whole structure.  You're skeptical about my approach; I'm skeptical about yours.  Do we have any home-grown examples of your approach?  How about Massachusetts?  How about Oregon?  Why not let the blue states take the lead with the public option in those states.  Let's see how it works out after a few years.

    Simple plan:  Congress can only have the same coverage as that provided to those who currently can't afford it.


    All right (5.00 / 3) (#66)
    by standingup on Tue Sep 08, 2009 at 10:12:38 AM EST
    Enough of this.  Provide the supporting documentation of any piece of legislation is going to establish health insurance for "illegal immigrants?"  I am all for discussion on solutions for the national health care problem but please leave the propaganda out of it.  

    And I can find many polls that show people are not happy with the status quo.  I don't believe there is any room for debate about the need for us to take action to extend access to health care, provide better coverage and reduce the costs of what we are spending now and in the future.  


    My friend... (5.00 / 1) (#77)
    by Dadler on Tue Sep 08, 2009 at 10:40:44 AM EST
    ...the ONLY reason the health insurance industry exists is to be a profit-leeching middleman, to stand between doctors and patients and PROFIT from their blocking position.  And they can only make money on their business by raising premiums and denying care to enough people to make it work.  The indistry serves no useful purpose for the doctor or patient.  The industry, logically, is predatory in its strategy -- meaning, it will make the most money on the people who are the least likely to have the means to fight them, just like predators tend to go after the young, the sick, the old, the weakest in general.  Which is why you hear so many stories about HAVE NOTS being denied care, while if you have the means to put up a fight you are less likely to be denied.

    And eliminating the health insurance industry almost entirely is really the only long-term solution.  Take the jobs lost there and transfer them to the public sector that will need many more folks to function when we cover everyone.

    But this is America, the greatest nation on earth, we just can do big and new and creative things.


    we just CAN'T do... (none / 0) (#80)
    by Dadler on Tue Sep 08, 2009 at 10:42:30 AM EST
    ...nothing helps sarcasm more than typos.

    Not taking care of immigrants... (5.00 / 1) (#91)
    by lambert on Tue Sep 08, 2009 at 11:10:09 AM EST
    ... is going to be a problem if there's a pandemic, wouldn't you agree?

    Come on MT (2.00 / 0) (#52)
    by jimakaPPJ on Tue Sep 08, 2009 at 09:30:02 AM EST
    How much of the crime you point to is to provide food, clothing, shelter and health care??

    And your comment on TriCare interesting. I have friends who are retired and one is active and they have no complaints. Can you be more specific?

    (Remnember I am for a single payer system.)


    Nowadays (none / 0) (#60)
    by cawaltz on Tue Sep 08, 2009 at 10:02:32 AM EST
    ALOT of crime is for food, clothing, shelter or healthcare. Arsons have gone up as foreclosures have and the number of people apologizing for knocking off the local convenience store for money to pay for diabetes medication or other needs also seem to have increased due to the recession.

    Sorry (none / 0) (#84)
    by jimakaPPJ on Tue Sep 08, 2009 at 10:49:42 AM EST
    But  A LOT is meaningless. And burning down a house you can't pay for is just a crime of anger.

    All states have medicaid. You don't have to rob a store to.


    I live in the heartland (5.00 / 3) (#29)
    by MO Blue on Tue Sep 08, 2009 at 08:05:54 AM EST
    and too many people here do not have health care. Even those who have health insurance are being denied the health care that they paid for. So, please excuse me if I don't buy into you meme of

    Here in the heartland we take care of each other.

    A while ago i posted a comment (none / 0) (#47)
    by The Last Whimzy on Tue Sep 08, 2009 at 08:51:18 AM EST
    about rationing health care wondering if we've reached a malthusian dynamic where no matter what system we install, someone's going to die because we simply don't have enough resources to save everyone.

    you seem to think that's the case, others may feel free to agree or disagree.

    frankly, i'm hoping such a vision of health care is wrong....

    but if it's right, then fundamentally, the choice is this:  ration based on cost/ability to pay.  ration based on some other method.

    what i hope is that we ration based on need.  that some sort of intelligence can be brought to a system where those who have the most life threatening diseases can be saved.

    of course, in a triage Emergency Room environment during a catastrophe (bad analogy?  limitted resources, huge spike in patients) a doctor has to decide how much time to spend on one patient based on how many others he can save spending that time elsewhere?

    difficult decisions indeed.

    i suppose here's an idea.

    upon being diagnosed, a patient receive a list of names, with pictures.

    "Here's the people and their ailments who won't receive health care because you have the ability to pay and they don't."

    i'm sure there would still be a subset of those "haves" who, while looking at those list of names tell themselves, "damn straight, i got the job and the cash, i'm worth saving and they're not," but i think we all recognize such a person is, while HONEST, rather despicable.

    don't you think it's time to figure out a better way??????!!!!!!!


    I understand your moniker (none / 0) (#51)
    by jimakaPPJ on Tue Sep 08, 2009 at 09:25:55 AM EST
    Ah yes (5.00 / 7) (#12)
    by MO Blue on Tue Sep 08, 2009 at 07:12:31 AM EST
    the horrible, horrible national health care systems of Europe and Canada.

    It is funny how those horrible systems produce lower infant mortality rates, lower preventible deaths and have higher life expectancy rates than the U.S.

    But what the heck, it feels good to think that we have the best system in the world even if it is not true.


    Their entire populations (5.00 / 1) (#14)
    by Militarytracy on Tue Sep 08, 2009 at 07:25:13 AM EST
    are healthier and happier than ours is.  Oh yeah, and they are more productive at work than ours is.  It's like two different worlds and America is the suck one where people are dragged through the mud and the filth - and then belittled because they are stressed out, sick, dying, and angry and violent about it.  

    and they do it (5.00 / 3) (#28)
    by cawaltz on Tue Sep 08, 2009 at 08:05:22 AM EST
    for LESS money. The idea we have the best health care is a myth.

    Not just "less" -- HALF as much (5.00 / 1) (#92)
    by lambert on Tue Sep 08, 2009 at 11:14:53 AM EST
    Per capita health care spending (2007):

    United States: $7290
    Switzerland: $4417
    France: $3601
    United Kingdom: $2992
    Average of OECD developed nations: $2964
    Italy: $2686
    Japan: $2581

    And the French, at least, have better outcomes. Their life expectancy is two years greater than ours.


    People who are supporting a (none / 0) (#105)
    by MO Blue on Tue Sep 08, 2009 at 11:35:22 AM EST
    health insurance system like Switzerland need to give us the insurance regulations and premiums that their system has.

    Anyone who thinks the Baucus plan is even close to their system needs to stop speaking (writing) and start doing an item by item comparison that includes regulations and costs.


    And yet, none of these reductions has to do (none / 0) (#109)
    by vicndabx on Tue Sep 08, 2009 at 11:48:10 AM EST
    substantially with savings associated w/lowering the cost of the insurance premium.  The cost reductions comes w/the lowering of the costs of services, better management of chronic conditions, better management of care delivery, and heck, healthier lifestyles.  None of which are things we talk about.

    Details (none / 0) (#15)
    by Jack Okie on Tue Sep 08, 2009 at 07:28:59 AM EST
    Here is an analysis of U.S. infant mortality and life expectancy:


    It shows significant differences based on racial and ethnic background;  African-Americans fare worse in both infant mortality and life expectancy.  This tells me we need to focus on providing that segment of the population with better opportunities for success rather than just focusing narrowly on health care.

    Here is an analysis of medical bankruptcies:


    The authors suggest something like the Canadian system as a solution, but that means rationing through access like Oregon.  I would rather see a buffer that keeps medical providers from turning to collection agencies or small claims courts so quickly.  This article shows how ridiculously small the amounts can be to tip one over into bankruptcy:



    Those countries who have national (5.00 / 5) (#20)
    by inclusiveheart on Tue Sep 08, 2009 at 07:42:57 AM EST
    health programs do far less "rationing" than our private insures do.  They let people go to the doctor before there is a full blown crisis for one thing - which in turn reduces costs because many ailments when treated early are relatively inexpensive and the patients have better odds of continuing to be productive, contributing members of society - because they aren't so damn sick that they can't work or care for themselves.

    How do private insurance companies (2.00 / 2) (#55)
    by jimakaPPJ on Tue Sep 08, 2009 at 09:32:33 AM EST

    They don't. They perform to an agreed to contract that the insured as accepted. That is not rationing.


    Seriously? (5.00 / 4) (#58)
    by inclusiveheart on Tue Sep 08, 2009 at 09:42:54 AM EST
    You're serious?  The documentation of the private insurers' failure to meet even the most basic terms of their agreements is long and deep at this point.  That's the only - the ONLY - reason that this debate has come to the fore at all.  Had the private insurers not been so increasingly aggressive about denying care over the past 20 years, this reform movement would never have even gotten off the ground.

    I don't know anyone who doesn't have a story about denial of care.  I personally have a story about being injured on the job where I went to the HMO doctor who followed the HMO's procedure of not referring and not doing even the most basic testing - which in my case would have been an x-ray and a doc who knew what he or she was looking at - and I was out of work for a week until I went to see the worker's comp doc who not only did the necessary investigation, but also handed me a prescription that had me back on my feet within 24 hours of my taking it.

    The private insurers spend most of their time devising policies and procedures that are designed to limit your access to care - and more often than not that approach results in worse outcomes and more lost productivity.  The company I was working for was highly motivated on the other hand not to be paying me to lay around in bed unable to perform my work - which is why their doc took the required steps towards diagnosing and treating my ailment.


    That is not rationing (none / 0) (#64)
    by jimakaPPJ on Tue Sep 08, 2009 at 10:07:08 AM EST
    If we are going to win the argument for single payer health care, which I favor, we have to stop calling everything "rationing." What you describe is just a failure to meet the terms of the contract.

    You further describe a doctor failing to meet his/her commitment to their oath of service and claim that was the norm for the HMO. Whatever that is I am sure an attorney would be interested in looking into it.

    Again, I note the above not to defend the bad actions, just to say that the issue of rationing needs to be discussed as actual rationing, not something else.


    The terms of the contract (none / 0) (#67)
    by cawaltz on Tue Sep 08, 2009 at 10:16:06 AM EST
    are the whole point of the term rationing when your contract is about access to health care.

    You are parsing a word that (none / 0) (#72)
    by jimakaPPJ on Tue Sep 08, 2009 at 10:26:02 AM EST
    means one thing to shoehorn it into another context if you use it in conjunction with private insurance.

    Rationing means that there is only X amount available of "something" and it will be spread... rationed....based on a predetermined criteria. There is X + N available of health care available through private insurance.


    You say... (none / 0) (#75)
    by inclusiveheart on Tue Sep 08, 2009 at 10:33:31 AM EST
    "Whatever that is I am sure an attorney would be interested in looking into it."  LoL

    Health insurers are so insulated from tort action thanks to Congressional action over the past 20 years that there is not a snowflake's chance in hell that anyone would pursue a claim like mine.

    But you are really missing the point of the anecdotal story here.  It is a perfect illustration of what incentivizes a company to perform.  In the case of my HMO, their goal was to take the premiums and pay out as little as possible on the services.  Whereas the worker's comp insurer was interested in getting me back to work as fast as possible - and in that case our collective interests intersected.  Under our current system with the private insurers, the interests of the consumers and the service providers' interests are at odds.  In theory, the government has a vested interest in maintaining a healthy, productive citizenry and therefore would be motivated to promote health and wellness over profit-taking.  The reality is that the private insurers' model is perfectly "fair" in the sense that their objective is to make money for their investors.  The problem is that that objective undermines their committment to providing the services they are selling access to.  Healthcare insurance as a money-making prospect is really not viable in the free market sense.  There is no symbyotic relationship that can satisfy either participant in the equation - either the seller or the buyer - or both - will get "injured" in this relationship - therefore I believe private health insurance is essentially a failed model that needs to be eradicated and replaced with a government program.


    If you want to say your HMO (none / 0) (#96)
    by jimakaPPJ on Tue Sep 08, 2009 at 11:24:14 AM EST
    did bad things deliberately I am not going to argue with an anecdote.

    I am in favor of a single payer system for a variety of reasons.

    But what you have described is not rationing.

    BTW - Currently if a Medicare patient using Part D (Rx insurance) has a script for drugs that Medicare deem to require "step therapy" your doctor will have to justify Rxing it to the insurance company. That is Medicare rules, not the insurance company.

    The same thing happens on the straight treatment side. I had a friend who was sent home from the hospital based on "rules" of Medicare.

    So the government is no better than the insurance company.


    LoL (none / 0) (#108)
    by inclusiveheart on Tue Sep 08, 2009 at 11:44:30 AM EST
    "So the government is no better than the insurance company"  Very, very funny.

    Coming to that conclusion because of Medicare Part D - a bill written by and for Pharma and the insurance companies - is pretty ridiculous.

    Arguing that our current Congress is corrupt and screwed up, I can accept.  But arguing that government can't effectively administer a well-constructed program written by members of Congress who have the best interests of the people at heart is just bunk.  History disproves your assertion and Medicare is one example of good government program administration - not to mention an example of an invaluably positive impact on the overall stability of life for people over the age of 65 - and their kids who would otherwise be saddled with the entirety of their care needs.


    You make sweeping statements (none / 0) (#65)
    by Jack Okie on Tue Sep 08, 2009 at 10:12:18 AM EST
    without providing any documentation.  "Everyone knows" and "its a proven fact" don't carry one very far in understanding.  Please provide links that back up your assertions.  It sounds like you didn't receive the care you should have had, but that doesn't necessarily extrapolate to the whole country.

    I'm not asking you to provide the following, (I intend to research it if I can find the info), but I would like to see a geographic and demographic breakdown (per Militarytracy) of poverty and health outcomes.  I have already mentioned somewhere on this site the Indian Health Service, which is a significant factor in my skepticism that bureaucrats can be entrusted with health care.


    Bureacrats can't be entrusted with (none / 0) (#70)
    by inclusiveheart on Tue Sep 08, 2009 at 10:22:14 AM EST
    healthcare, but they can be entrusted with administering payment for such as evidenced by Medicare - which is an efficacious, successful and cost effective program which provides participants access to the services of healthcare professionals not bureaucrats.

    I'm sorry (none / 0) (#78)
    by TeresaInSnow2 on Tue Sep 08, 2009 at 10:41:13 AM EST
    but you've gotta be kidding me.  Medicare is yet another beast the Congress has starved to the point where it's yet another rationing healthcare system.

    I have loads of stories:
    Here's a good one:

    And yet another of the Physicians Opting out of Medicare stories

    This one talks about how Midwest and Southern doctors are forced to take Medicare patients because there aren't enough private insured patient, and it would mean that they may eventually have to close their practices entirely.

    Rationing takes many forms.


    Just because the beast has been (none / 0) (#83)
    by inclusiveheart on Tue Sep 08, 2009 at 10:48:20 AM EST
    starved of late, doesn't mean that the system that is is place is not a good one.  Medicare is an exceptionally successful program which is why the GOP has only ever been able to take small nicks out of it and haven't been able to shut it down.

    Who passed Rx insurance? (none / 0) (#97)
    by jimakaPPJ on Tue Sep 08, 2009 at 11:25:51 AM EST
    And here I was think Bush was a Repub.

    Who knew?


    Part D is not in line with any (none / 0) (#104)
    by inclusiveheart on Tue Sep 08, 2009 at 11:33:31 AM EST
    of the basic principles of Medicare's original configuration.  You must know that and if you do not, then I think you are probably out of your depth in any meaningful discussion of healthcare issues affecting Americans at this point in history.

    What ever it is (none / 0) (#152)
    by jimakaPPJ on Tue Sep 08, 2009 at 04:25:45 PM EST
    I went from paying around $330 a month for my spouse and I to around $60...

    And millions got Rx insurance for the first time...

    Is it perfect? No. But is a darn sight better than anything passed by the Democrats.

    But I think you know that..

    BTW - You sure you want to comment on my intellectual abilities??


    What for? (none / 0) (#93)
    by lambert on Tue Sep 08, 2009 at 11:17:28 AM EST
    "Everybody in, nobody out" is a moral justification. That happens to save $350 billion a year, too.

    What need to slice and dice by demography? What you're looking for is, I think, the Dartmouth study, which I should warn you does not control for illness in the population.


    Again your link (none / 0) (#102)
    by jimakaPPJ on Tue Sep 08, 2009 at 11:32:07 AM EST
    The short answer is that they found, in a study published in 2003, that the US spends about 31% of its health care dollars on administration and Canada spends about 16.7% of their health care dollars on administration [this is all administration, not just that attributable to insurance administration]. Which means that we are spending 14.3% of our health care dollars on what is probably useless administration, and they feel that this is a low estimate. Fine-tuning the estimate a little bit yields a difference of about 15.6%.

    makes no real sense. Plus it assumes a lot.

    Having dealt with too many government agencies I refuse to believe that they will be more efficient than private industry.

    Are there savings in consolidation? Yes. But nothing like what is being claimed.


    Why does it make no sense? (none / 0) (#156)
    by lambert on Tue Sep 08, 2009 at 06:19:53 PM EST
    Is your argument that the only kind of administrative cost is insurance administrative cost? That's what  your bolding would seem to indicate.

    But do refuse to believe! Some, after all, might find your anecdotal evidence highly persuasive. Here are the stats for total per capital health spending. Clue stick: What makes the difference is heavy governmental involvement:

    Per capita health care spending (2007):

    United States: $7290
    Switzerland: $4417
    France: $3601
    United Kingdom: $2992
    Average of OECD developed nations: $2964
    Italy: $2686
    Japan: $2581

    France, incidentally, has better outcomes than we do. If you're French, you get to live two years longer than we do, and society gets to pay half as much. That's a sweet deal,  no?


    That's also not rationing that's Workmen's (none / 0) (#94)
    by vicndabx on Tue Sep 08, 2009 at 11:19:44 AM EST
    Compensation Insurance.  Your private insurance is not supposed to pay a claim that results from you being "injured on the job."

    For every 1 claim that's "denied," there are probably thousands, if not tens of thousands, that are paid daily.  


    The claim wasn't denied. (none / 0) (#100)
    by inclusiveheart on Tue Sep 08, 2009 at 11:30:41 AM EST
    The care was limited by policies set forth by the HMO handbook.  The doc did not order a very basic and necessary test - an x-ray - did not refer me - and handed me an assortment of pill prescriptions that were completely ineffective.  She didn't have a clue what my problem was aside from the fact that I could not walk and was in devastating pain.  For all she knew I had a fractured vertabra.  As for whether or not my HMO was responsible for coverage - that is effectively completely irrelevant since they controlled my access to care and therefore my only option in the interim period between the time my appointment was set with the workers comp doc and when the incident occured was to go to my assigned doc at the HMO.  It would be up to them to make a claim against the company's workers comp insurers - not my responsibility.  But again the importance of the contrast between how two different entities handled the exact same situation was completely missed here.  The workers comp insurers had an interest in getting me back to work which prompted them to authorize comprehensive basic investigation and care.  While the HMO had no stake in actually fixing my problem.  Their sole motivation in the situation was to minimize my effect on their bottom line - which means that they "rationed" the care they offered me.

    They've been fined 19 million in (5.00 / 1) (#62)
    by cawaltz on Tue Sep 08, 2009 at 10:04:46 AM EST
    18 months in one state. What you are saying simply isn't true.

    My point is not that they are "good" (none / 0) (#68)
    by jimakaPPJ on Tue Sep 08, 2009 at 10:17:57 AM EST
    but that what they are doing is not rationing.

    Yes it is, Jim (none / 0) (#87)
    by cenobite on Tue Sep 08, 2009 at 11:07:29 AM EST
    You need to take one step back in abstraction. It's rationing of health care expenditures, of money spent on health care. Just because the money went to the insurance company's executive gulfstream fleet instead of another patient's care doesn't mean it's not rationing.

    In the end, the kind of health provider rationing you're talking about is exactly the same as this one. If there was more money for health care, enough resources would be available to not have to choose one patient over another. So it's all rationing of health care money in the end.


    If we had some ham (2.00 / 0) (#106)
    by jimakaPPJ on Tue Sep 08, 2009 at 11:41:41 AM EST
    we would have some ham and eggs if we had some eggs.

    Which is to say that if there had been enough money in Social Security to pay me my rightful amount I would not have been rationed out of my BMW into my Buick.....

    The word rationing itself refers to fixed amounts of supplies provided to a specific group. When the group gets larger the rations get smaller...

    As in reducing Medicare payments to hospitals and doctors as Obama's planS calls for. This will reduce the number of hospital services and doctors  which will cause someone to decide who gets the available supply. The senior will have been subject to rationing.


    Not so (5.00 / 0) (#112)
    by cenobite on Tue Sep 08, 2009 at 11:52:27 AM EST
    Rationing is the controlled distribution of resources and scarce goods or services. Rationing controls the size of the ration, one's allotted portion of the resources being distributed on a particular day or at a particular time.

    Health care dollars are scarce. The needs of the executive gulfstream fleet are more important than the medical needs of the insureds. Simple.

    Or do you have a private definition of rationing that the rest of the world isn't aware of?


    Money is scarce? (2.00 / 0) (#115)
    by jimakaPPJ on Tue Sep 08, 2009 at 12:16:05 PM EST
    No, the ability to make money is scarce.

    If you want to say that money is the cause of rationing then everything is rationed and the word becomes meaningless.

    You can beat up the insurance corps and still use words correctly.


    Yes, money to spend on health care (none / 0) (#123)
    by cenobite on Tue Sep 08, 2009 at 12:32:25 PM EST
    Is scarce. The demand for that money is greater than the supply. We would like to spend more of it than we have. The allocation of that scarce resource is called rationing.

    But you stick to your story now, that rationing only
    happens when there aren't enough MRI machines that you don't have to schedule an appointment to use one.


    Feel free (2.00 / 0) (#145)
    by jimakaPPJ on Tue Sep 08, 2009 at 02:13:20 PM EST
    to make up situations and definitions when you like.

    But those we have to convince to support a single payer plan will see it as some sneaky move and those who oppose will use it to beat us over the head.


    On my reality based planet (2.00 / 0) (#146)
    by jimakaPPJ on Tue Sep 08, 2009 at 02:17:57 PM EST
    people don't see denied claims and high premiums as "rationing health care."

    You may join Barney at your leisure.


    I guess Europe and Canada do not (5.00 / 4) (#26)
    by MO Blue on Tue Sep 08, 2009 at 07:54:14 AM EST
    have poor or minority populations.  The difference is that they actually receive health care.

    Per your article, if you look at only the life expectancy of "white America,"  it is still lower than Europe and Canada. The article also showed infant deaths on the first day of birth. Once again, we have poorer outcomes than Europe and Canada. Per the article:

    Inconsistent measurement explains only part of the difference between the U.S. and the rest of the world.  Were measurements to be standardized, according to Eberstadt, "America might move from the bottom third toward the middle, but it would be unlikely to advance into the top half.

    Your mortality chart is a little old (5.00 / 3) (#30)
    by Militarytracy on Tue Sep 08, 2009 at 08:10:27 AM EST
    Not much out there either that isn't over two years old, but in the 2007 figures it is very very clear that every single industrialized country is doing better than we are.  And the infant mortality rates compared to ours should be a 1st rate embarassment in this whacked out Christian right to life country where you must be born so that your future after that can be very uncertain and nobody remembers what Jesus said.  Our nation is also in more of a crisis right now than we were in 2007, but none of the other industrialized nations are in the throes of such a crisis or having citizens going bankrupt because they were unfortunate enough to become ill.  We are not first in the world though and we haven't been in a very very long time but the propaganda just keeps on coming.

    And rationing is total bunk (5.00 / 0) (#33)
    by Militarytracy on Tue Sep 08, 2009 at 08:19:44 AM EST
    My son has had to wait months for certain surgeries that aren't for life threatening conditions.  He actually did have a life threatening situation happen though and Tricare kept denying him and fighting me for about nine months until they finally stepped up to the plate to pay for the surgery.  But every single American waits for surgery and procedures that aren't life threatening while those in dire need go first.  My father had to wait about three months for a knee replacement because the specialist triages for life threatening surgeries like every other physician in industrialized countries does.

    Whereas (none / 0) (#35)
    by Jack Okie on Tue Sep 08, 2009 at 08:23:17 AM EST
    I was referred for a colonoscopy and got in the next week.  Anecdotes are not statistics.  And statistics need detailed analysis.

    Depends on how many physicians (5.00 / 2) (#37)
    by Militarytracy on Tue Sep 08, 2009 at 08:27:26 AM EST
    you have in your area serving how many patients....and now here's one of the many kickers honey.  Most physicians only see patients with insurance, and that would be insurance that they take so...if you have wonderful high dollar insurance you will be treated by a physician who selectively treats because he/she can afford to.  Everybody else though can go pack sand.

    Jebus (5.00 / 6) (#59)
    by ColumbiaDuck on Tue Sep 08, 2009 at 09:49:13 AM EST
    Actual statistics show that you are wrong:

    Wait times are comparable in Canada on average.  What discrepencies do exist happen because some people in America are made to wait longer because they are poor.

    A recent article in the journal of Clinical and Investigative Medicine finds that a move to Canadian-style wait times might actually be an improvement for the United States. The study, by Kevin Gorey and colleagues, compared wait times for breast cancer treatment in the United States with those in Canada, and found that low socioeconomic status was a major factor in creating long wait times for patients in the U.S., whereas it played no role in determining wait times in Canada.

    Moreover, everyone in Canada knows they will eventually get the care they need.  That is certainly not the case in America.  (btw - on your point on contracts, I invite you to investigate the practice of "recissions".)

    Finally, even if you do think there are ridiculuous wait times for care in Canada and "rationing" (a belief not shared by the vast majority of Canadians, btw), we currently spend more than twice as much per person on health care.  So they are getting better results at half the cost.  Imagine if we took their system and spent as much money as we are spending now!  Everyone would be getting subsidized massages.

    The reality is we spend a ton of money that doesn't improve care or make anyone healthier.  In a more rational system, it would do both.


    Those little buttons above the reply box (none / 0) (#27)
    by Molly Bloom on Tue Sep 08, 2009 at 08:04:06 AM EST
    when you replsy or post a comment There is a Subject Box. Below the subject box is


    Below that is a series of buttons

    B for bold.
    I for Italicize
    U for underline

    followed by a a link from a chain for URL's

    With regard to the first 3, highlight your text and then click the button.

    With regard to the last one, click the link button and then paste the url into the dialogue box which will appear. Then click ok.

    If that doesn't work for you try open bracket [
    follow with a URL
    then a space
    then close bracket ]


    So are Canadians and Brits stupid? (5.00 / 5) (#21)
    by Molly Bloom on Tue Sep 08, 2009 at 07:47:15 AM EST
    Given the reality, not just grim anecdotes, about NHS and Canada's health care

    Why do you suppose after all these years with their various health care systems, the Canadians or the Brits haven't scrapped it? They are, after all, democracies. Why haven't they demanded change? Why hasn't some enterprising politician successfully campaigned on scrapping their socialized health care?

    Are these voters just stupid or are they brainwashed or are they just doped on on free drugs or is there some other explanation?

    For extra points include in your response, why the voters in Sweden, Germany, France and Australia haven't  demanded change or why some enterprising politician successfully campaigned on scrapping socialized health care in those countries as well?



    Can you show us they haven't (none / 0) (#82)
    by jimakaPPJ on Tue Sep 08, 2009 at 10:43:28 AM EST
    demanded change??

    As a matter of fact yes (5.00 / 1) (#114)
    by Molly Bloom on Tue Sep 08, 2009 at 12:13:28 PM EST
    They have not changed their system. Ergo the voting majority has been unconvinced by enterprising conservative politicans (or anyone else) of a NEED to change. The weight of the evidence is the majority like their health care, since the majority has not demanded it be scrapped and elected politicians to do their bidding.

    Ball is in your court (appears to be whizzing past you- the line judge has called it in!)  


    You wrote (none / 0) (#117)
    by jimakaPPJ on Tue Sep 08, 2009 at 12:19:59 PM EST
    haven't  demanded change

    Now you speak of "voting majority."

    Looks like you are making up the rules as you go along.



    Hardly (5.00 / 1) (#120)
    by Molly Bloom on Tue Sep 08, 2009 at 12:25:51 PM EST
    The premise of my question was why haven't they demanded it be scrapped and why hasn't some enterprising politican run on the platform of promising to scrap it? How do you think politicians get elected in a democracy?

    I realize you like to argue for argument's sake, but try not to pick one that makes you look... foolish.

    30 love BTW.


    No DA (none / 0) (#86)
    by jimakaPPJ on Tue Sep 08, 2009 at 11:06:59 AM EST
    Molly is the one that brought the subject up. I am just asking her for some proof.

    Then don't make a claim that (none / 0) (#116)
    by jimakaPPJ on Tue Sep 08, 2009 at 12:17:02 PM EST
    requires a negative proof.

    Shorter Jack Okie (5.00 / 4) (#22)
    by kmblue on Tue Sep 08, 2009 at 07:47:50 AM EST
    "I got mine, too bad about you, it must be your fault you can't get insurance."

    I've heard it all before.


    And we do ration health care in the U.S. (5.00 / 3) (#23)
    by kmblue on Tue Sep 08, 2009 at 07:49:40 AM EST
    The rationing begins with "Too bad you're sick.  Can you pay for it?"

    PacifiCare denied 39.6% of claims this year (none / 0) (#95)
    by lambert on Tue Sep 08, 2009 at 11:22:21 AM EST
    That's rationing. And that's even before we get to the blacklists that deny you care in the first place.

    No. That's denying claims. (2.00 / 0) (#119)
    by jimakaPPJ on Tue Sep 08, 2009 at 12:21:26 PM EST
    Use the word right.

    A claim... (none / 0) (#137)
    by MileHi Hawkeye on Tue Sep 08, 2009 at 01:07:42 PM EST
    ...is a request for reimbursement for service provided.  Therefore, the care has already been rendered.  A claim denial it not rationing care, it's shifting the financial burden for payment of the care from the carrier to either the provider or the patient.

    A more meaningful statistic for the rationing of care is the number of utilization review denials.  


    There is nothing I said (2.00 / 1) (#69)
    by Jack Okie on Tue Sep 08, 2009 at 10:20:32 AM EST
    that should cause you to think I am indifferent about those without health insurance.  We disagree about how to achieve it, not whether it should happen.

    And yes, I do have mine, having worked my butt off for almost 50 years.  My family couldn't afford to pay for my college, so I bussed dishes, washed dishes, scrubbed garbage cans, worked 12hr days / 7 days a week in the oil field, worked a 40 hr week while carrying a full load (15 semester hrs).  I have tried to do the most with the ability God gave me, but you don't know me, you don't know what, if anything, I have done to help others less fortunate than I, but I seem to fit a stereotype you like to sneer at, so rock on.


    And whining about how you worked your butt off (5.00 / 1) (#103)
    by shoephone on Tue Sep 08, 2009 at 11:32:10 AM EST
    won't fly here. Pretty much every person who posts here has worked their butt off and then some. And many of us have had to deal with serious illness in our families -- unlike lucky you.

    You're a troll (none / 0) (#99)
    by shoephone on Tue Sep 08, 2009 at 11:29:42 AM EST
    You show up about once every six months to hijack entire threads withyour nonsense.

    Like kmblue wrote, you're all about "I got mine so screw the rest of you."


    I'll say again (2.00 / 0) (#138)
    by Jack Okie on Tue Sep 08, 2009 at 01:48:06 PM EST
    Show me where I said or implied "screw the rest of you".  You must be quite a hothouse flower to consider linked counter-arguments to the CW of the thread to be trolling.  Can you actually discuss different points of view without resorting to invective and ad hominims?  You say my points are "nonsense" and I've "hijacked" the thread.  Do you want a discussion that airs out the issue or do you just want an echo chamber?  There was a great discussion of Van Jones departure on an earlier thread.  BTD (with whom I agreed) was on the opposite side from many of the other commenters.  I don't recall anyone calling him a troll or accusing him of hijacking the thread.

    I'm going to assume you can mount a rational argument and your beliefs are not as fragile as you come across.  There's a lot of heat out there about health care, and not as much light as we need.  So how about some real clear evidence I'm a cad who only thinks of himself.  Or what I would really prefer, is seeing you challenge your own assumptions.  That's why I'm here, to make sure I'm not complacently dog-paddling around the conservative pond.  If that annoys you I wish it were otherwise, but I have already learned some things here I needed to know, and I appreciate the responses (barbed as some of them were).


    I see this all the time (5.00 / 2) (#113)
    by MO Blue on Tue Sep 08, 2009 at 11:54:59 AM EST
    Agree wholeheartedly

    I had enough of a fight on my hands with melanoma. I should not have had to simultaneously joust with my insurance carrier to compel them to comply with their own obligations toward me.

    Medicare Advantage (none / 0) (#48)
    by Jeromet3 on Tue Sep 08, 2009 at 09:12:07 AM EST
    You say you're in Medicare Advantage which, of course, is part of government-run Medicare. It's a plan operated by the insurance companies, AND subsidized by the government to the tune of $50 billion a year paid to the insurance companies so you can have a few extra benefits. It allows the insurance companies to cover the 20% that Medicare does not pay and, for which you might have to buy a supplementary Medicare policy. You do have co-pays for many visits and procedures, but it's still the cheaper way to go because of the government subsidy. As a conservative you should know this.
    Obama wants to eliminate the Plan to save the government $50 billion a year!
    I'm in regular Medicare, which is wonderful, and I believe the most sensible way to go would be to gradually lower the eligibility age for Medicare to eventually include everyone.

    And I just love how people (none / 0) (#53)
    by Militarytracy on Tue Sep 08, 2009 at 09:31:44 AM EST
    who have government provided insurance with government subsidized upgrades can't wait to tell everyone else who doesn't have it to go pack sand.  How have Americans become this gross, callous, and disgusting?  Is this really who we are now?  Those who have figured out how to get on the "government dole" hand wringing and castigating about allowing anybody else on the "government dole", and making up stories about how the "government dole" will destroy everyone's life but apparently not ours?

    I worked for almost 50 yrs (none / 0) (#71)
    by Jack Okie on Tue Sep 08, 2009 at 10:24:03 AM EST
    paying into FICA / Medicare.  It will be quite a few years before I have received the amount I paid in.  And by the way, given the choice I would have taken that FICA and Medicare tax and invested it.  But since I had no choice, I have no concerns about getting MY money back out, Ponzi scheme that it is.

    And lost it all when the market crashed... (5.00 / 0) (#118)
    by Molly Bloom on Tue Sep 08, 2009 at 12:21:07 PM EST
    Mine didn't.... (2.00 / 0) (#121)
    by jimakaPPJ on Tue Sep 08, 2009 at 12:27:45 PM EST
    Of course I moved most of into a cash position.

    And if you just matched the market you would be off about 35%, not "lost it all."

    Like it or not we are going to have to figure a way to get money into Social Security and health care... the Chinese aren't gonna finance us forever.


    Through luck, not great foresight, (none / 0) (#141)
    by Jack Okie on Tue Sep 08, 2009 at 02:05:50 PM EST
    I took the bulk of my money out of my retirement account and put it in a house.  Even paying the tax I came out better than had I left the money alone.  Like I said, just coincidence, not wisdom.

    My specialists accept Medicare (none / 0) (#57)
    by MO Blue on Tue Sep 08, 2009 at 09:38:53 AM EST
    and all supplemental plans but they only will accept one Advantage plan.

    Just got off the phone with my GP and she also accepts Medicare with supplemental plans but will not accept most Advantage plans.

    BTW I'm a little frustrated with the physician's list on the Medicare website. My GP and specialists are not listed even though they are Medicare providers.


    There seems to be a lot of variation (none / 0) (#73)
    by Jack Okie on Tue Sep 08, 2009 at 10:29:02 AM EST
    around the country regarding coverage.  When I retired at 67 in Tulsa I enrolled in the Advantage plan my employers insurer offered, so no problem in keeping my same doctor.  Moving to OKC this year, I had to switch to Aetna.  I haven't seen my new primary care physician yet, but it's getting time to go in for a physical.  I'm not on any meds and am in good health, so I realize I won't really know how good my coverage is until the chips are down.

    Advantage plans (none / 0) (#74)
    by jimakaPPJ on Tue Sep 08, 2009 at 10:31:22 AM EST
    are basically HMO's. You have to use the resources within that plan. That's why I have not signed up although Blue Cross, Humana and AARP all seem to have great coverages.

    Yes, I also had concerns (none / 0) (#81)
    by Jack Okie on Tue Sep 08, 2009 at 10:42:55 AM EST
    about it being an HMO, but so far it's worked out OK.  I think the latitude allowed the primary care doctor, and that person's approach to medicine, might determine how happy we're going to be in the long run.

    I chose the Advantage plan because, if I understand correctly, the insurance company has more freedom in the coverage it offers.


    I understand the concept (none / 0) (#111)
    by MO Blue on Tue Sep 08, 2009 at 11:51:43 AM EST
    behind Advantage plans. The fact that all my doctors adopted a new policy (implemented this year) on not accepting most Advantage plans I found thought provoking. Curious about the "whys" behind this change. Anticipating changes due to legislation, problems with getting them to approve certain types of care, too much time spent in processing paper work or getting approvals?

    Like I said I'm curious.


    Why not ask them? (none / 0) (#122)
    by jimakaPPJ on Tue Sep 08, 2009 at 12:30:19 PM EST
    I certainly would.

    Did ask my specialist? (none / 0) (#126)
    by MO Blue on Tue Sep 08, 2009 at 12:36:45 PM EST
    He and my other specialists are part of a treatment, research, teaching group and the decision was made at an administration level. IOW his office didn't know.

    Then I would (none / 0) (#130)
    by jimakaPPJ on Tue Sep 08, 2009 at 12:42:06 PM EST
    go up the food chain.

    Is your specialist group in private practice (none / 0) (#143)
    by Jack Okie on Tue Sep 08, 2009 at 02:09:09 PM EST
    or are they affiliated with a non-profit or university organization?  You've got me wondering if I should be concerned.  What part of the country are you in?

    My specialists are part of (5.00 / 0) (#147)
    by MO Blue on Tue Sep 08, 2009 at 02:28:36 PM EST
    an university organization. My GP who is adopting much the same policy is in private practice.

    My user name, MO Blue should provide you with a clue to the region I'm in.


    Got it! (none / 0) (#155)
    by Jack Okie on Tue Sep 08, 2009 at 06:03:26 PM EST

    Jeez, Louise (none / 0) (#139)
    by Jack Okie on Tue Sep 08, 2009 at 02:00:11 PM EST
    Donald, I agree with you 100%.  Maybe I'm naive to think we can arrange things so that health insurance companies can't pull that crap.  I just don't think a bunch of bureaucrats are any less likely to be a--holes.  At least an insurance company can be sued.  BTW, did they have to pay a penalty for jerking you around?

    I mentioned somewhere earlier that I'd like to see some more trial solutions at the state level.  Are you familiar with Oregon and Massachusetts setup?  If so, how do you think they're shaping up?


    You bring up an interesting point (none / 0) (#154)
    by Jack Okie on Tue Sep 08, 2009 at 05:54:45 PM EST
    I'm technically on Medicare, in that I have an Advantage program.  What is Medicare's policy on pre-existing conditions?  If you were to retire tomorrow, would you slide right into the regular Medicare pool with the same coverage?  More to investigate.

    I don't dispute your point about needing bureaucracies, whether public or private, to keep things running.  We are all shaped by our experiences.  Other than with Blue Cross / Blue Shield, I have had no claims denied.  But then I've never had a life-threatening illness.  The Blue claim was for a stress test my doctor ordered, that I didn't think I needed, and that turned out negative.  Oh well.

    On the other hand, when my mother had to retire early from civil service, they jacked her around royally trying to deny work-related disability.  Our U.S. Senator at the time intervened and she got the retirement.  But over the years they kept trying to take it away, and she had to keep fighting it, through battles with heart trouble and cancer.  So like you, she did not need that stress when she was so sick.  But she survived the cancer and had such a great outlook she was often asked to speak to new cancer patients.

    To be clear, I want a setup where you will be in the same pool as the rest of us.  I'm willing to forgo the actuarial hocus pocus and pay a higher premium than I might otherwise so things even out.  From the bottom of my heart, I believe we are all in this together and need to stick together.  My concern is settling on the most effective, least costly, or better, best bang for the buck, we can come up with.  I am in favor of a mechanism to avoid anyone else having to go through what you did, although I'm not quite sure how to do it.  Perhaps having pictures in the bean counters offices of the rack and hot pokers awaiting them if they try anything.

    But having worked in both government and the private sector, small businesses and large, I trust the private sector to be marginally less sucky, and marginally more responsive, than government.  But again, I would like to see more (blue) states try varying government approaches so they can prove me wrong.  It might be, though, that even a large state wouldn't have enough "mass" to be a good test.

    BTW, I will soon be going back to work (hopefully), and will probably be offered insurance through my job.  I would turn off the Medicare as long as I am employed but I don't think it can be done.


    Let's just hope this isn't the deal. . . (none / 0) (#9)
    by andgarden on Tue Sep 08, 2009 at 06:30:46 AM EST

    I didn't think it would be this bad (none / 0) (#34)
    by kidneystones on Tue Sep 08, 2009 at 08:21:32 AM EST
    Hi andgarden,

    I stopped supporting Dems and hoped very much that McCain would win once it became clear who the Dems would nominate. McCain is the crazy we know. Dems would have still won the House and maybe the Senate. Battle lines would have clearly drawn.

    Better yet, of course, would have been to send a more experienced, more committed leader to the WH. That didn't happen. But I truly didn't imagine that Obama would make such a hash of things. One Dem supporter I know argued convincingly in Nov 2008 that Obama's economic plan had to be better than McCain's. I actually agreed.

    The US is now fighting two wars, not one. Now it looks like the Republicans and the pharmaceutical/ health monopoly are going to get their health bill passed by a Dem president and Dem majorities. Talk about exploding heads.

    The worst part is that Jeralyn and Thers are right. This bill absolutely will alienate young Dems just when Republicans look to make major gains in the 2010.

    Dems are going end up losing seats after just a year of governance, hand big pay-checks to Wall Street rogue bankers, hand big pharma the health-care bill they want, commit more US forces to the Middle East rather than withdraw, while saddling America's young people with crippling debt and high un-employment. I mean, laid out like this, it's un-believable. And let's be clear what the stakes truly are: Dems are going to do as much damage to the US long-term in one year as Bush did in eight. It's mind-boggling. And don't think votes won't notice.



    looks like can't count on "progressives" (none / 0) (#38)
    by kempis on Tue Sep 08, 2009 at 08:28:51 AM EST
    to hold the line. Apparently, some prefer to compromise on the public option to get a bill--any bill.

    So much for health care reform.

    Ugh (5.00 / 1) (#43)
    by nycstray on Tue Sep 08, 2009 at 08:39:29 AM EST
    "It sounded like he was trying to figure out how he could get something he could call a public option, regardless of what it is," one staffer familiar with the call said.

    Thanks Obama.


    Mike Capuano (none / 0) (#46)
    by Big Tent Democrat on Tue Sep 08, 2009 at 08:46:33 AM EST
    has never been a key player in this.

    McGovern will walk it all back if he decides to run for Senate.

    It seems more of a story that they wanted to write than an actual event.


    That was my reaction (5.00 / 1) (#56)
    by gyrfalcon on Tue Sep 08, 2009 at 09:35:09 AM EST
    They got on the phones and called every single Congresscritter who was in on the call and trolled for waffling so they could have a story.  They found a handful of minor figures whose waffles aren't even all that waffly.

    Capuano also strikes me as a world-class grandstander.  He will say whatever will get him some press attention.  He probably didn't even wait to be called.


    What a maroon. (none / 0) (#157)
    by Jack Okie on Tue Sep 08, 2009 at 06:43:21 PM EST
    At least he was distinctive.  Most crooked politicians get caught with their hand in the till.

    Regarding the fee to insurance co (none / 0) (#41)
    by nycstray on Tue Sep 08, 2009 at 08:36:52 AM EST
    If insurance companies passed the new fee along to customers, they would run the risk of losing out in a newly competitive environment, a source said, reflecting Baucus' thinking.

    The package would make it harder to pass along this fee. Insurers would be required to release their administrative costs included in premiums and profits. That provision is designed to help customers determine whether they are getting a fair deal at a good price.

    same article:

    Grassley said he was concerned that any fee charged to insurance companies would end up getting passed on to other premium holders, and he embraced the notion of nonprofit health care cooperatives to help provide coverage for the uninsured.


    Yes. (none / 0) (#151)
    by magnetics on Tue Sep 08, 2009 at 03:32:05 PM EST
    (In answer to the question posed in Jeralyn's title.)

    A Dream (none / 0) (#153)
    by Missblu on Tue Sep 08, 2009 at 04:26:08 PM EST
    I have tried to imagine what the rollout would have been if by some miracle the corporate
    world got religion and hopped  onboard  the public option or better yet single payor system with the philosophy that the need for a healthcare bill was a moral imperative. Together with a like president, they would be infused with a holy spirit and act with determination to get this done.

    Taking liberty with this dream, the first thing they would do is get the people dispatched to the public that really know the score.  The persons you haven't seen anywhere talking on this subject. These are the people who run the hospitals 24 hours a day, care for people in their hospital beds, comfort them in the Post Surgical suites, see them in clinics, hear patient's cries and feel their despair. They visit people in their homes, care for them in employer clinics, and are in schools doing their best for uninsured children. They are never interviewed, heard from or seen in this debate. They are the nurses.  The ones who really know the mess we are in. Corporate media would now allow this.  They might even have lobbied with their extra change to have placed a nurse in the position of Health and Human Services Secretary.  When this secretary spoke the light would be in her eyes and as she recounted the overwhelming need, the phones would ring in the office of the unfeeling, unseeing, yes uncaring representatives that seem not to see. Soul is the thing missing here

    Having seen the now SOS on stage the day she attended a funeral for a police officer killed in a motorcade with tearing over eyes, I can assure you she would get it this time with passion and perform her Annie Oakly act from morning till night.

    Sorry to hear all that, Donald (none / 0) (#159)
    by Spamlet on Tue Sep 08, 2009 at 08:30:10 PM EST
    I want you well! Your voice is so valuable here.