Oh, Mama, Can This Really Be The End?

To be stuck inside of DC with the health care debate again...

Paul Krugman exhorts House Democrats to ignore the voters of Massachusetts, ignore the national Gallup poll showing a majority wants a pause in the process, and just jump off a cliff by passing the Senate bill for Obama's signature.  Whether swing seat House Dems are that keen to rejoin the private sector in the current tough job market is untested.

I also score this from Krugman as "Maybe":

The fact is that the Senate bill is a centrist document, which moderate Republicans should find entirely acceptable. In fact, it’s very similar to the plan Mitt Romney introduced in Massachusetts just a few years ago. Yet it has faced lock-step opposition from the G.O.P., which is determined to prevent Democrats from achieving any successes. Why would this change now that Republicans think they’re on a roll?

I suppose a lot of things look centrist from the far left.  Be that as it may, the Republicans can't be the Party Of No forever.  In 1994 Newt Gingrich offered the Contract with America as the Republican agenda; presumably Republican "leaders" (are there any?) will follow that example in 2010.

I can easily imagine Republicans proposing some modest package - a down payment on reform - that could pick up 70 votes in the Senate and 300 in the House.  It won't satisfy the vast scope of Dem aspirations, but if the Democrats refuse, well, who is obstructionist and unrealistic now?  The Times describes such an approach here:

Lawmakers, Congressional aides and health policy experts said the package might plausibly include these elements:

¶Insurers could not deny coverage to children under the age of 19 on account of pre-existing medical conditions.

¶Insurers would have to offer policyholders an opportunity to continue coverage for children through age 25 or 26.

¶The federal government would offer financial incentives to states to expand Medicaid to cover childless adults and parents.

¶The federal government would offer grants to states to establish regulated markets known as insurance exchanges, where consumers and small businesses could buy coverage.

¶The federal government would offer tax credits to small businesses to help them defray the cost of providing health benefits to workers.

¶If a health plan provided care through a network of doctors and hospitals, it could not charge patients more for going outside the network in an emergency. Co-payments for emergency care would have to be the same, regardless of whether a hospital was in the insurer’s network of preferred providers.

The package could also include changes in Medicare, to reduce the growth in payments to doctors and hospitals while rewarding providers of high-quality, lower-cost care. To help older Americans, it could narrow a gap in Medicare coverage of prescription drugs, sometimes known as a doughnut hole.

Sara Rosenbaum, a professor of health law and policy at George Washington University, said the proposals were “totally doable” and could help perhaps 15 million people.

“Medicaid already covers poor children through age 18 and could be expanded to cover all nonelderly poor people, regardless of age,” Ms. Rosenbaum said. This proposal does not go as far as the House or Senate bill, but she said, “It’s an idea that has been supported in the past by health policy experts across the political spectrum.”

Those proposals don't raise my blood pressure - readers?

David Brooks identifies four grim paths forward for Obama, one of which is to ignore the voters and press on:

The Democrats now have four bad options. The first is what you might call the Heedless and Arrogant Approach. A clear majority of Americans are against the Congressional health care reform plan. Democrats could say: We know this is unpopular, but we think it is good policy and we are going to ram it through and you voters can judge us by the results.

My major, screaming-out-loud objection to that analysis is that there won't be any results until 2014, unless Democrats think a few early tax hikes will count as popular "results".  If Democrats pass this as is, they will spend the next ten months defending it instead of moving on to jobs.

Josh Marshall thinks there is a small and fading chance that Democrats will realize that there is no other road forward and that sometimes nothing is a really uncool hand.

Ezra Klein can't imagine a world with a pared back bill, but I bet he isn't trying.  Instead, he is locked up on the same argument that Obama utterly rejected during the campaign - if there is a ban on exclusions based on pre-existing conditions then there must be mandates, from which it follows that there must be subsidies.  Hillary backed that logic during the campaign, Obama opposed it (irrationally, IMHO, but I am not smart enough to be a Democrat), and the voters spoke.  OK, Obama then flip-flopped back to reality and supported mandates, but voter support for the mandate notion has been tailgate tested and tailgate-rejected.

Comments

[GN]

These would be possible IF, a big IF, there were also some preliminary efforts at tort reform. It's not like we don't have a system to start with. All states have workers compensation schemes with clear rules and procedures for on the job industries. Of course, the plaintiff's lawyers hate this system and have been chipping away at it for years. Nevertheless, it is a good place to start the discussion.

[Danube of Thought]

Why this one?

"The federal government would offer grants to states to establish regulated markets known as insurance exchanges, where consumers and small businesses could buy coverage."

[clarice]

With the present Congress it is preposterous to suppose there could be a rational outcome respecting such a big and complicated issue. If anything the Reps should concentrate FIRST on Medicare fraud and cost savings and say once that's handled we can consider other things. It's a winning position.

[Thomas Collins]

I think the smart thing for the GOP to do would be to propose its own market oriented reform plan in its response to Obama's State of the Union speech. It should be a GOP Senate or House leader. It definitely should not be Brown, who must now start focusing on his campaign for a full term (I believe Teddy K's term expires in January of 2013, so we are talking about the 2012 election cycle), not worrying about giving the GOP response to the SOTU.

[Rob Crawford]

Insurers would have to offer policyholders an opportunity to continue coverage for children through age 25 or 26.

I hate this.

Seriously, I hate this. At age 26 I was a home-owner. I was at my second job. I was not a "child".

[Danube of Thought]

I'm with TC as to what the GOP response should contain.

I understand that it has already been determined that the response will be given by the new VA governor (McConnell?). He doesn't seem like the ideal guy to present an outline of proposed federal legislation...

[DebinNC]

Here's the David Brooks link. Team Obama (and Brooks based on his writings) believed "it had a leader in Barack Obama who could uniquely inspire a national transformation." Other than that, Brooks says no more about Obama, repeatedly referring instead to what "the Democrats" thought/did re health reform. After MA, I'd have to agree with Brooks and Coakley/Deeds/Corzine that Obama has turned out to be a transformational leader.

[Ignatz]

--Those proposals don't raise my blood pressure - readers?--

Most of the problems with healthcare are caused by present government (especially federal) intervention and its attendant distortions.
None of those proposals address that and essentially all of them expand the feds role in healthcare, which I would think should raise the blood pressure of everyone reading them.
Expanding the federal role even further should work about as well as the feds expanding role in education.

[Danube of Thought]

I think the nation needs to come to grips with the fact that "insurance" is, in the final analysis, based upon actuarial data regarding risk, and the aggregate of the premiums paid to insurers must be sufficient to meet the expected payouts, while allowing for a reasonable return on investment. Either we treat it that way or we don't.

It seems to me that a large portion of the adult population--maybe a majority--accepts that fact with respect to auto insurance, life insurance, homeowners' insurance and the like, but not health insurance. Rather, they view health insurance as a prepaid medical plan, and they want someone else to do the paying. I think we have to draw the line in the sand on that issue here and now, or there will never be any turning back.

It is that mindset that informs those who think it is somehow unjust to deny coverage on the basis of pre-existing conditions, even for adults who could have insured themselves before becoming ill or injured, but didn't do so.

[Steve White]

I'm an academic physician. On those Times points --

¶Insurers could not deny coverage to children under the age of 19 on account of pre-existing medical conditions.

That raises the costs to everyone else. Children without pre-existing conditions are already in the system; insurers love them (Mummsy and Dadsy pay the premium but no claims come in). Children with pre-existing conditions are like adults with same: either you adjust rates to account for the risk, or you essentially demand that insurers suck it up. Guess who pays with the latter?

¶Insurers would have to offer policyholders an opportunity to continue coverage for children through age 25 or 26.

I realize that liberals believe that we're all children forever, but is it necessary to codify that as policy?

¶The federal government would offer financial incentives to states to expand Medicaid to cover childless adults and parents.

With what money do we offer these financial incentives? States are already going broke over unfunded Medicaid mandates, and we're going to make them take on another?

¶The federal government would offer grants to states to establish regulated markets known as insurance exchanges, where consumers and small businesses could buy coverage.

We don't need to do that. Let insurers sell across state lines, and let small businesses band together to buy insurance, and the markets will take care of most of the rest.

¶The federal government would offer tax credits to small businesses to help them defray the cost of providing health benefits to workers.

Thereby continuing to hide the true cost of health care. We need to educate people what the true costs are if we're ever going to get people to make realistic choices about health care. The idea in the Times suggests that we can continue to subsidize health care and get away with it. We can't.

¶If a health plan provided care through a network of doctors and hospitals, it could not charge patients more for going outside the network in an emergency.

Then what's the point of having a network? The network pools its risks and funds and provides care. If you let people go outside the network for 'emergencies', first, everyone does it for whatever 'emergency' they have, and second, you put pressure on the network to let people go outside of it for everything else without an additional cost.

The package could also include changes in Medicare, to reduce the growth in payments to doctors and hospitals while rewarding providers of high-quality, lower-cost care.

Oh, that chimera again. If you reduce growth in payments to doctors, we doctors have a simple solution: we'll drop Medicare. Some of my colleagues are already doing it.

As to 'rewarding providers' of high-quality, lower-cost care, while you can have some success measuring costs, good luck measuring quality in a meaningful way, particularly when you tie reimbursements to it. You'll end up with a lot of new boards and panels, a lot of new rules, and a larger bureaucracy that eats all the supposed savings.

Tom writes: Those proposals don't raise my blood pressure - readers?

No to each and every one of these proposals.

[MikeS]

I think TC nailed it. The time is right for conservatives to define themselves as the party who has been offering common sense health care solutions since 2004. Should be easy since that's what has been happening.

The pre-existing conditions issue is exacerbated by any plan that continues to pretend it's insurance problem. That idiocy leads directly to necessary mandated coverage.

The 2004 proposal regarding pre-existing conditions was to put those people into a separate pool that could be aided by government subsidies and insurance industry contributions. I don't see a downside to that approach.

The Times list provides a place to start talking to Dems about "incremental" reforms that target the problems, and drive down the costs of health care, as opposed to a comprehensive monstrosity with a price tag of trillions of dollars.

[Storybec]

Ok, I'll bite. I believe there should be a period between the crafting of a piece of legislation and the vote to enact the legislation, where the bill is rigorously found to be within the constraints of the Constitution. If found wanting, the bill is discarded and the Tenth Amendment applies.... the same reason the state of Massachusetts can enact a state wide health care bill, or the people can provide for their own health care, but the United States government cannot!

[orthodoc]

None of these are particularly horrible; I don't agree with all, but they won't destroy US medicine.

¶Insurers could not deny coverage to children under the age of 19 on account of pre-existing medical conditions.

I'm OK with this.

¶Insurers would have to offer policyholders an opportunity to continue coverage for children through age 25 or 26.

If the policy-holders (I assume it's the parents here) don't mind paying for it, not a problem. Let's face it, the age 18-30 group uses the least medical care, and costs would be minimal to anyone other than the policy-holder.

¶The federal government would offer financial incentives to states to expand Medicaid to cover childless adults and parents.

Don't agree on this. Let childless adults (again, probably young and healthy) pay for their own insurance. However, this is not the hill to die on.

¶The federal government would offer grants to states to establish regulated markets known as insurance exchanges, where consumers and small businesses could buy coverage.

Don't agree, but not deadly. A better solution would be to remove restraints on interstate insurance purchases: if you live in New Jersey, you can buy insurance in Kentucky if that's your bag. Within a year, every insurance company in New Jersey would offer a comparable plan. Removing mandates on coverage (every plan has to cover IVF, wigs, chiropractic, homeopathy) would be a huge step.

¶The federal government would offer tax credits to small businesses to help them defray the cost of providing health benefits to workers.

This is fine with me. It essentially lets small businesses and individuals get the same tax framework that larger entities do.

¶If a health plan provided care through a network of doctors and hospitals, it could not charge patients more for going outside the network in an emergency. Co-payments for emergency care would have to be the same, regardless of whether a hospital was in the insurer’s network of preferred providers.

To my knowledge, this is the case for most plans anyway.

Tort reform has to be on the table.

If we insist on "rewarding providers of high-quality, lower-cost care," then we need to be very clear on what that is. Typically, when payers decide that they will base bonus payments on parameter x (be it antibiotics within 60 minutes of surgical start time, percentage of cardiac patients on aspirin, or whatever), doctors get very good at parameter x, often at the expense of other, potentially more important parameters.

In my view, any health care "reform" is going to be like protection money: you'll pay it to get the statist boobs to leave you alone.

[clarice]

Hi, Steve White. Stick around and you'll realize that a good many of TM's posts--like this one undoubtedly--are deliberately meant to provoke the reader o come to an opposite conclusion.

We need all the good minds--like yours--we can get to keep this place fun and illuminating.

[Danube of Thought]

I agree with every word Steve White said, and I am grateful to him for saying it all so succinctly.

Storybec, the problem with your proposal is that there is no entity that can authoritatively determine whether a measure is within the constitution until the measure actually takes effect and has an impact on someone.

[Danube of Thought]

Poll results from, of all places, Connecticut via Hot Air:

* Connecticut residents oppose the current bills in Congress by a margin of 51-34 percent

* By a margin of 62-29 percent, Connecticut residents believe Congress has rushed the process and should take more time to get it right

* More than three-quarters of voters, 77 percent, say they are very concerned or somewhat concerned that changes in health care will result in more government spending, higher taxes, and a bigger budget deficit. 61% described theselves as “very concerned” about these possibilities

* Half of state residents say the changes to health care being considered will do more harm than good

[steve sturm]

Steve White nails it. Every proposal to expand insurance coverage makes it more expensive for those who already have coverage, whether through higher premiums, co-pays and deductibles, or through higher taxes. With the economy what it is and health care already expensive, I'm not feeling the urge to pay more... and my guess is that most people who have coverage feel the same way.

Now come up with some proposals to actually make it less expensive to get treated and I can get on board... but now with pretend policies like lowering reimbursement rates as that doesn't make health care less expensive, it just requires the doctor to help pay.

[Old Lurker]

Ditto kudos to Steve White. Hope you stick around here.

DoT you are dead on today as well, particularly your 12:35.

[Melinda Romanoff]

What's with all the Steve's all of a sudden?

Sheesh.

[Barbara]

I have absolutely NO confidence in the government - Republicans as well as Democrats. Once the politicians get their collective feet in the door, Congress will expand whatever reduced health care plan that passes at a future date.

This win in Massachusetts was wonderful and expressed the will of the people loud and clear for Washington to hear. But are they really listening? They've made all the appropriate noises, but already they are talking about Health Care II, a sort of watered down version of what is on the table now. I simply do not trust the weak Republicans in the Senate - even with the addition of Scott Brown - to stand up against the opposition.

Somewhat O/T:
All through these past months of struggle against Obamacare, I have believed that had John McCain (go-across-the-aisle-at-any-price) been elected President, he would have put forward programs on health care and cap and trade similar to those currently before the Congress. The following article, Conservatives: Beware of McCain Regression Syndrome, by Michelle Malkin on her web site (see Article at LUN) sends out a warning to be wary of this big-government proponent who is trying to portray himself as a frugal, prudent conservative so that he can be re-elected to the Senate. She writes:

Pay attention: In the afterglow of the Massachusetts Miracle, there are flickers of peril for The Right. I hate to be the bearer of bad news, but like Paul Revere’s midnight-message, consider this warning “a cry of defiance, and not of fear.” Conservatives have worked hard over the past year to rebuild after Big Government Republican John McCain’s defeat. But McCain isn’t going gently into that good night.

He's not a "maverick"; he's a pain in the neck, and he loves the role because it gets him the attention he craves. During the Senate debate on the Health Care Reform bill, his main criticism against the proposal was that the insurance companies and drug companies had brokered a deal with Obama. Other Senators were raising more salient points against the proposal as a whole, but McCain focused mainly on criticizing "big insurance" and "big corporations". At times, I wondered if he even knew what the topic was he sounded so off-base and frankly not very sincere. He should retire - or be retired - but the McCain loves the spotlight too much.

Sorry that I went on so long, but McCain and his like cannot be trusted.

[Jane]

Double dittos to Steve White.

OTOH I don't think republicans should say a word about health insurance in their rebuttal to the SOTU. I think the entire thing should be about how reps need to be committed to listening to the people or be voted out forever.

[anduril]

The GOP has actually written up several bills incorporating market based proposals, such as allowing insurance companies to compete across state lines, enabling insurance cooperatives, etc. Has TM really never heard of these proposals (which were all shit canned by the Dems and ignored by what appears to be TM's one source of information: the NYT)? The GOP should push very hard for their very reasonable proposals, which are common sense and understandable to one and all. They are in a position to drive a very hard bargain and claim substantial credit--let the Dems be cast as would-be radicals now acting as obstructionists if they oppose this.

[Jack is Back!]

Hey, is that THE Steve White from Rantburg?

[Jack is Back!]

Mel,

You're right. You'd think there would be more Scott's around here by now:)

[anduril]

Oh mama! Could these Dems be ripe for compromise, even sell out?

White House caught in Dem crossfire
By: Glenn Thrush and Jake Sherman and Lisa Lerer
January 22, 2010 04:45 AM EST

Congressional Democrats — stunned out of silence by Scott Brown’s victory in Massachusetts — say they’re done swallowing their anger with President Barack Obama and ready to go public with their gripes.

If the sentiment isn’t quite heads-must-roll, it’s getting there.

Hill Democrats are demanding that Obama’s brain trust — especially senior adviser David Axelrod and chief of staff Rahm Emanuel — shelve their grand legislative ambitions to focus on the economic issues that will determine the fates of shaky Democratic majorities in both houses.

And they want the White House to step up — quickly — to help shape the party’s message and steer it through the wreckage of health care reform.

“The administration has got to be in the forefront now, instead of throwing some meat on the track and seeing what the House can work out,” said New Jersey Rep. Bill Pascrell, expressing the frustrations also voiced by about two dozen Democratic elected officials and aides interviewed by POLITICO.

“I haven’t seen Rahm Emanuel except on television. We used to see him a lot; I’d like him to come out from behind his desk and meet with the common folk,” added Pascrell.

...

[anduril]

Also from the Politico:

"Emanuel, for his part, is now pushing for a stripped-down health care bill that could be passed within a few weeks and force Republicans, for a change, to take a few tough votes."

Good luck. The GOPers will just demand that their own proposals be resurrected, and Dems will not look good to the public if they refuse.

[Rick Ballard]

I would find it unbecoming of the Republicans to try and beautify this corpse. Barabara is correct concerning the likelihood of 'My Friends' McCain being completely capable of reanimating Zombiecare to the point where our grandchildren would likely become very unhealthy serfs.

I don't mind Bozo wearing the stinking corpse as a necklace during his SOTU apologia but burial is the only decent thing to do thereafter.

[Rick Ballard]

Forgot -

To Steve White:

Hear! Hear! Bravo.

[anduril]

More on the medical malpractice front:

Poll: Youngest Americans More Pro-Life on Abortion Than Baby Boomers Washington, DC -- As hundreds of thousands of pro-life Americans young and old participate in the March for Life in Washington today, a new poll finds most marchers will likely be from the millennial generation or Generation X. The most recent Marist survey finds them the most pro-life on abortion. http://www.LifeNews.com/nat5914.html

[Desirae500]

Steve White is on the money. Unless the reforms are market and individual responsibility based, nothing should be passed.

[LouP]

To me this whole Health Care issue has lost the fox. The most fundamental issue of all is the current cost, and continuing upward spiral in cost. Democrats have turned the whole issue into one of who gets health care and who pays for it, while Republicans seem to be too timid to do what they are supposed to do best, and that is use free-market principles to control cost.

The most fundamental approach of all is to examine the very basic supply and demand sides of the equation. There is not now, and for a long time (if ever) has been no competition in the whole industry - from big Pharma, to doctors, to medical suppliers. It is, and has been, a closed shop throughout the whole of the industry. How many times have you heard that there can be no quality care if you allow competition. Baloney! Everything in the system is rigged to eliminate any competition to control costs.

On the demand side of the equation it is almost as bad, and no one talks about it. If medical personnel are in short supply, then how can we rationalize draining off a large proportion of that very limited supply for vanity? Cosemetic surgery, anyone? (as an example) When I was growing up, my parents didn't rush me to the doctor's office for antibiotics every time I got a sniffle. We've adopted an entitlement attitude about "health care" that is driving demand to unsustainable levels, particularly given the problems on the supply side of the equation.

Of course it will take the wisdom of Solomon to figure out the reasonable balance in all the above, but cost containment is the place to start. And Republicans should be perfectly placed and qualified to tackle the fundamental cost (supply & demand) issues within their own ideology.

[Rocco]

How can Krugman ignore this? Has he no heart?

[Danube of Thought]

And while we're at it, who, if anyone,is going to address the Medicare time bomb? We're talking $35 trillion (present value) of unfunded mandates, i.e. benefits that are scheduled to be paid out in excess of the revenues that will be available to pay them.

As a grateful Medicare patient myself, I know that it can't last. And I also recognize that it is nothing more than a gift from the taxpayers. Finally, I haven't a clue as to what can feasibly be done.

[Jim Rhoads a/k/a vjnjagvet]

Anyone see the preview of the SOTU. Another campaign speech. Now he's taking "questions".

[sam]

republicans should do nothing about the HC bill but oppose, oppose, oppose. On everything - cost, quality, freedom, govt control, etc.

Anything the Reps propose will not be enacted, but will be used by the Dems and media to divert attention from their own failures.

All the focus should be on the Dem failures, till they are out of office.

[PaulL]

Jay Cost is great. He just tweeted about Obama in Ohio:

Concise summary of Elyria Speech:I, I, I, I, I, I..."This is not about me!"...I, I, I, I, I

[Jim Rhoads a/k/a vjnjagvet]

That was the impression I got as well, PL. The questions are softball as can be.

[PaulL]

I can barely handle listening to Ibama in Rush's excerpts. No way am I going to listen to one of his campaign speeches.

[Danube of Thought]

Fewer and fewer people are paying attention to him every day.

[PaulL]

Jay Cost couldn't stand it and had to turn off the sound (and play the Beach Boys instead):

Everytime I have POTUS on mute (as I do now), I am always struck by the large amount of finger pointing.

[Jane]

As a matter of principle I turn the sound off when Ibama comes on and I'm always amazed at how angry he looks.

This may be the worst week of his presidency - and I really really really don't want it to end.

[clarice]

I love Jay Cost..

[DebinNC]

Was Obama trying to get the crowd to chant "I want my money back" with him? Given all the bailouts, carveouts, and Porkulus which have yielded nothing good, I hope we see crowds of people yelling that AT him.

[Gabriel Sutherland]

I'd drop the tax breaks for employers to pay their portion of your coverage directly to the insurance company. I'd change the tax incentive so the employer can record the exemption as long as that is capital sent directly to the employee. It would spark a voucher based model turning the capital pyramid upside down.

That's what we need across the board to establish more competitive markets in health care.

The US government doesn't need to win or lose in this debate. What needs to win is competitive markets. Who can achieve that is individuals controlling ALL of their coverage paid marginally through their own income and mostly through their employer contribution.

I'd also talk about tort reform, but if I was talking about tort reform then we might as well talk about tearing down the walls that prevent interstate competition. Some states already do tort reform well. Others do state regulated insurance that still maintain competition well.

When individual Americans control their own money we avoid all these roadblocks of buying off states, trying to subsidize elective abortion, and manufacturing roads to single payer. The only single payer system we should have is one where the single American controls ever penny applied for coverage.

For those that are difficult to insure I would propose a national charitable cause that could easily integrate with any thousands of American Institutions to endorse it as a means of Americans coming together to support those who need greater assistance than most.

[Gabriel Sutherland]

Another thing I would do is take a shotgun and blow a huge hole in the ridiculous talking points about "wellness savings". Until someone proves that lowering the level of consumption of food products results in the increased level of consumption in areas I suppose are more toned, healthy population would partake, then the "wellness savings" never really pan out.

[Extraneus]

This whole thing has been a shell game all along. The Democrats have let problems fester, in the hopes of bringing the "system" down, not because they want to solve any problems but because what they really, REALLY, REALLY want is nationalized health care.

They've changed the definition of success, from insuring the uninsured, to something about being defecit-neutral, to anything else they can throw at the wall that might stick.

I'm still not even sure what the problems really are, and how they rank in terms of severity.

Personally, I have a hard time supporting anyone's suggestions unless they present them in a PROBLEM, ROOT CAUSE, SOLUTION, IMPACT OF SOLUTION argument. Anyone unwilling to clearly state the problem they're trying to solve, and exactly how the solution works, gets no hearing from me.

[Ignatz]

--I hope we see crowds of people yelling that AT him.--

That is a great idea Deb.
It's revolting that this clown can spread this theme of wanting our money back by directing it at the only entities that DID pay it back while not taxing the ones who didn't; GM, Chrysler, Fan/Fred etc.

Here's an idea on not having to get our money back; don't give it away in the first place Sherlock.

[sylvia]

You people are acting like these proposals above are the greatest things since sliced bread. It's just common sense people.

And it's also common sense ...

1. for people not to get dropped for trivial fraudulent reasons once they become gravely ill

2. to get the same rate of insurance if people become unemployed for at least the time their unemployment covers them.

3 to not to have a lifetime maximum that doesn't fully cover people with cancer and other serious diseases so people with insurance don't have to go bankrupt

4. to offer a PUBLIC OPTION so that waitresses bartenders small business owners artists entrepeneurs fast food workers can get the same good rates that say secretaries and insurance salesmen get.

5. to not have insurance structured so that once someone loses coverage, say because of an illness and subsequent unemployment, a person with say diabetes or a past heart attack can never get coverage again, so we should either be eliminating or reducing the preconditions clauses.

If you don't agree with the above than you are just plain cretins. Sorry. You just don't care about having a civilized fair society. Hate to not be subtle, but it's the truth.

[scott]

The two Dr's up thread hit on a point that hasn't been discussed much if at all. In either of the now defunct HCR bills how would it have been mandated they participate in any program?

Overstating the obvious, a medical degree is quite a valuable posession. Why would one negotiate with some hare-brained gov't program as to its worth? Many would avoid it just as they currently do with medicare/medicaid.

As a side note, one of the last bills Gov. Corzine signed into law before leaving office legalized medical marijuana in NJ. My wifes business (optometry) is already fielding calls from foul mouthed losers asking when they can pick up their stash.

So... we got that goin' for us.

[Dave (in MA)]

I can barely handle listening to Ibama in Rush's excerpts. No way am I going to listen to one of his campaign speeches.

All I'm getting is the muted trombone noises like the adults in the Charlie Brown cartoons make.

[clarice]

With some notable exceptions (see above) Americans are not stupid and they've caught on that this health care fiasco is to create a legacy for The Won; to create a path to single payer; and that it has nothing to do with controlling the costs or improving a damned good health system.

[sylvia]

"Rather, they view health insurance as a prepaid medical plan, and they want someone else to do the paying."

Okay, let's get down to business. Has anyone ever ONCE told us how much insurance costs would be raised if we incorporated the above proposals? Anyone ever seen a real chart with stats? No. And you know why?

Well use your head. You think the isurance companies did not already make tons of internal studies already calculating costs? Come on. Of course they did. But you haven't seen any. Why?

You probably haven't because the insurance companies haven't wanted to show it to you. And why would they not want to show it to you? Because after studying it, and they found out that it wouldn't raise the costs that much. And if people found that out, they would want to pass insurance reform, and their sky high profits from their monopoly would be reduced. If it did raise costs by too much, you can bet the insurance companies would be trumpeting those figures all day long.

So before you start complaining about the costs, ask yourself, WHAT IS THE COST? Until you know it, there's no way to make an informed decision.

[Jim Ryan]

If you don't agree with the above than you are just plain cretins. Sorry. You just don't care about having a civilized fair society.

Pompous buffoon alert. Arm your narcisolators.

[Sue]

SKY NEWS: The UK's Home Office has raised the terror threat level from SUBSTANTIAL to SEVERE. A statement is expected shortly. [Andy Levy tweet]

Anyone heard anything about what might be going on?

[sylvia]

And by the way contrary to "Jane"'s qwetching, I heard a stat on tv last night that 80% of Mass residents are happy with their new healthcare system. And that when it's still new and working out the kinks. In a few years, probably more will like it.

[Jim Ryan]

I heard a stat on tv

Spongebobs can be informative.

The one where Patrick thought Squidward was dead was funny!

[sylvia]

You're not going to ever hear anything good about Mass care in the MSM. The MSM may be liberal, but the health insurance industry bought out the libs too. That's why the only article you ever see on it is propaganda from the Cato Institute.

[Hacklehead]

The Dems ought to bitch slap Krugman batch to consciousness!

What does this clown think happended Tuesday? Does he really think the voters will suddenly realize how good HRC is? This is a textbook example of the mindset of the progressive left: We know better so everybody shutup and listen to us experts.

[Charlie (Colorado)]

Seriously, I hate this. At age 26 I was a home-owner. I was at my second job. I was not a "child".

It doesn't say you must.

I know a lot of grad students, or people beginning in jobs that include apprenticeship, like chef, that this might help a lot.

[squaredance]

Not raise hackles?

The Government should not be involved in health care, period. Medicare, Medicaid, SCHIPS--all have to go. We Americans, we need to stop telling ourselves lies and we need to stop telling lies to each other. period.

The Welfare State DOES NOT WORK. Period. It is immoral. Period. It is against God, against nature and against Mankind. This is Socialism. This is Communism. This is Statism. This is theft. It is a lie to call it anything else. Collectivist plundering of the wealth of the productive is inimical to freedom, liberty, security, morality and decency. It will be our doom. There are no half measures, there is not some sort of "acceptable" Statism, Communism or Socialism.

There is no constitutional provision at all for any of this. Not one bit of it. We have departed from the rule of law; we have tossed out our great legacy onto the curb. All of this has corroded private, familial and commercial life to the point where even if we were to cease it all tomorrow, it would take a generation to build our poor, crippled, unraveling and decadent society, culture and nation back up.

ALL entitlements have to be sunset. EVERYONE ONE OF THEM. This included SS. They have to go and all that goes with them. All of it. Every bit of the New Deal. Every bit of the Great Society. Every redistributionist hustle of the last 60 year or so; all of the paranoid and manipulative politics around it; all of the Marxism--the covert and overt Marxism, the rationalized and acknowledged Marxism and the tacitly accepted and unexamined Marxism--all of it of it must be cast aside. Only when we are honest about this can we get our civilization back.

People must earn their own way.

And you people think that you are conservatives concerned with liberty. You are just centrist liberals who cannot be honest with yourselves about it.

Health care is none of the Federal Government's business. It is not the State's business. Their sticking their pigs' snouts in it is what led us here in the first place--that and the collective refusal of the electorate to be responsible for their own lives.

It is the individual's business. It is their family's business. It is, perhaps, their employer's business. It is not their neighbors' business. It is not the taxpayers' business. This is not what government is for, not in a free society for free men and women.

Stop siphoning of 30% or more of the GDP a year for corrupt (and corrupting) government and everything will take care of itself.

[Hacklehead]

Health Care Reform = a program we don't want paid for by money we don't have.

[Gabriel Sutherland]

Because after studying it, and they found out that it wouldn't raise the costs that much. And if people found that out, they would want to pass insurance reform, and their sky high profits from their monopoly would be reduced.

Can you define "sky high profits"?

I need to know because when I examine the sector the health insurance field registers profit margins of about 3.5%.

[jimmyk]

Speak of "the end," I trust it's been duly noted that Air America has finally assumed room temperature. As Tim Blair put it, "It's been a great week."

[Ignatz]

--The Dems ought to bitch slap Krugman batch to consciousness!--

While they're at it could they line sylvia and a couple of others up ala Moe and administer a group bitch slap?

[Janet]

jimmyk, here is a post headline from Ace of Spades that I thought was funny -
"Air America Off The Air - Actually Almost Nobody Hardest Hit"
—Dave In Texas

[rse]

On behalf of the pro-market cretins, sylvia:

Please go back and read DOT's comment on what insurance is and is not.

[Janet]

On talk radio just now (I think Jerry Doyle) a guest was saying this administration was behaving like a mayor in the Salem witch trial period. Whenever his popularity is sinking...burn another witch. Insurance companies, oil companies, big-pharma, etc.,
and now banks.

[Cecil Turner]

No to each and every one of these proposals.

Nailed it. Every one of those increased government control (eventually adding cost) or directly added cost . . . and further shifted the paying burden from the individual to the government. Any of those as stand-alones are unacceptable, and frankly I'm not sure it'd be worth trading any of them for sensible things like tort reform.

[daddy]

TM,

I don't know what your going to do with yourself when the NYTimes starts hiding Krugman, Brooks, Modo, Rich and Friedman behind the pay to read barrier again.

I just hope to goodness it doesn't simply result in more Sully.

[clarice]

Back to what I said. The Reps should say before we discuss anything else, we are going to cut medicare fraud and waste.

[Rob Crawford]

It doesn't say you must.

I know a lot of grad students, or people beginning in jobs that include apprenticeship, like chef, that this might help a lot.

So what? Lots of things would help lots of people. That doesn't make it a proper concern for the government.

[Rob Crawford]

I need to know because when I examine the sector the health insurance field registers profit margins of about 3.5%.

Yeah, but look at the numbers. They look big to the innumerate.

(Curious question -- which is larger, the insurance industry's profit margins, or the taxes they, their employees, their suppliers (and their employees), etc. pay? If the tax figure is larger, doesn't that mean the government is "making money off people's misery"?)

[daddy]

SKY NEWS: The UK's Home Office has raised the terror threat level from SUBSTANTIAL to SEVERE...

Anyone heard anything about what might be going on?

Posted by: Sue

Not about England, but we're getting this: India

The country's civil aviation ministry announced on January 22nd that it placed India's airports on high alert after Western intelligence agencies warned the government of a possible attempt to hijack an Indian airliner. The alert warns that an unspecified militant group, likely to be Al-Qaida or Lashkar-e-Taiba (LeT), may seek to hijack flights from India or those originating in neighboring South Asian countries."

Which is surprising because we just learned from Steve on the previous thread that it was Gitmo and waterboarding that recruited terrorists, and since England and India don't do that, Islamic terrorists ought to be targeting us, not them.

[sylvia]

I need to know because when I examine the sector the health insurance field registers profit margins of about 3.5%.

You have sources for that? And yes, large numbers make a difference. If the profit is 10 trilion on a 300 trillion industry, that a lot of more take home pay than a 1 million profit on a 30 million industry. Let's also examine the overhead costs and profit per employee. It's basically a money transfer business, for the money and 3.5% is a lot for that. You don't even see the banks making that much even on savings accounts.

[Danube of Thought]

"I know a lot of grad students, or people beginning in jobs that include apprenticeship, like chef, that this might help a lot."

Not a very good test for whether it's sound policy.

[sylvia]

"Every one of those increased government control (eventually adding cost) or directly added cost . . . and further shifted the paying burden from the individual to the government."

Yeah that's why we have a federal army, we have unemployment insurance, we have fire stations. Why does the darn government have to do all that? Just raising my taxes. I am against the government doing anything the people can do for themselves! It's a principle thing. I think we should all get off our lazy asses and take a water hose and put out our darn own fires!

Come on. This is not about anti-government "religion". This is about real life and being practical.

[clarice]

My pistolas are loaded and ready. Fair warning.

[Rick Ballard]

Clarice,

Bozo promised tremendous savings from cutting fraud and waste as part of HCR. I would suggest that the Reps frame the issue as: "The Republican Party stands ready and willing to support the implementation of Medicare fraud and waste measures proposed by the President."

Put the ball on Bozo's side of the net and make him show the cowardice of his lack of conviction.

[Danube of Thought]

I think the fraud/waste figure he used was $400 billion. And not a finger has been lifted to eliminate it since the day he first mentioned it.

On reflection, I agree with those who say the GOP should leave this topic pretty much alone at SOU time. As it stands right now this preposterous fiasco is a huge festering sore on the Democratic party, and it's theirs alone. Let that perception sink in for a while, as those fools ponder what "comprehensive" nightmare they next want to inflict on a decidedly unwilling nation.

I think the GOP should talk about employment and spending, the two things people were most concerned about while the Dems wasted the past year.

[daddy]

Sylvania makes a nice lightbulb.
Sylvania, Georgia is known as "The Azalea and Dogwood City."
Sylvania tranny's are not not technically Frankenstein's, but they might be vampires.
Sylvan Learning Center has a location near you!
Sylvia Plath (October 27, 1932 – February 11, 1963) was an American poet, novelist...
Sylvester Stallone was Rocky.
Silver is going for $16.97 cents:)
Sylvia - name meaning, origin:

"The girl's name Sylvia \s(y)-

lvia, syl-via\ is pronounced SIL-vee-ah. It is of Latin origin, and its meaning is "woods, forest". The Latin form Silvia was more popular for centuries until recently. Rhea Silvia was an ancient nature goddess, mother to the twin founders of Rome, Romulus and Remus. Shakespeare used the name Silvia for the love interest in his play "Two Gentlemen of Verona", probably intending to give the impression of a typical Italian girl though the name has come to be regarded as an English name.
Sylvia has 23 variant forms: Silva, Silvaine, Silvana, Silvania, Silvanna, Silvia, Silviana, Silvianne, Silvie, Sylva, Sylvana, Sylvanna, Sylvee, Sylvette, Sylviana, Sylvianne, Sylvie, Sylvina, Sylvine, Sylvonna, Sylwia, Zilvia and Zylvia.

For more information, see also the related name Xylia."

[Cecil Turner]

Come on. This is not about anti-government "religion". This is about real life and being practical.

Dumber'n dirt. There's nothing "practical" about having the government pay for your health care. It just raises everybody's cost. You're just hoping to have somebody else pay that cost, which only works for those of us who don't work.

[sylvia]

"There's nothing "practical" about having the government pay for your health care"

Well yes they do it in Europe and pay less per outcome than we do here. And in many countries live longer than we do here. Not so dumb.

And not all people in the country work at all times Cecil, in case you havent noticed the unemployment rate is 10%. This is not about being lazy. We can't all have cushy white collar jobs here in this country. Someone has to do the manual labor for now, unfortunately until we can invent Terminator style robots. Someone needs to serve you your beers when you blow your salary man salary and get wasted in the bars! And those people need health insurance too. Get real here, please!

[sylvia]

Sylvia is not my name daddy. Just a handle.

[Jane]

"It's been a great week."

Charles Krauthammer just said it was his best week since spring break in his sophomore year in college - which he says he can't remember.

I concur. Not even sylvia can screw it up.

And I declare that this week lasts til midnite next Tuesday.

[Gabriel Sutherland]

sylvia: Here is industry summary tabulated by Yahoo Finance. You can scroll down through the entire list. Eventually you will arrive at Healthcare Plans.

It was actually 3.4% margins.

These plan providers do have overhead. I'm not sure what percentage of their costs are overhead. I'm guessing it's somewhere between 4 and 8 percent.

I would hope that healthcare plan providers do have overhead costs. I want them competing for my business, but I really want to control all of insurance premium rather than just the small amount my employer asks me to contribute to one of their chosen plans.

[Sue]

I bet the systems are flashing red. I hope someone is paying attention.

[clarice]

That's what I think, Rick.I'd add that it will preserve a popular program which is running into trouble and that it would ease the burden on the states ..what's the downside? Cut fraud and waste, help grannie ,reduce the pressure on strained state budgets, and remind people of the Dems' fake and failed promise.

[sylvia]

God forbid if you or a relative, like a beloved twenty something cousin or neice of yours loses their job and then gets treatable leukemia. Are you going to pay for their one million dollar treatment to get them better, out of your savings? Or are you going to quietly back away and let the taxpayers and policy holders pick up the tab. Or would you prefer them to die. If you are telling me you do not want them to die but will not the pick up the tab, you have no credibility.

[Gabriel Sutherland]

sylvia: If free enterprise can deliver insurance coverage that is necessary for waiters and bartenders at a cost affordable to them without the presence of the government for no other reason than to enforce regulations to preserve competitive markets, would you support it?

[Cecil Turner]

Well yes they do it in Europe and pay less per outcome than we do here.

We do it here, too. It's called "Medicare." Here it costs more, and drives up the cost of other care.

And not all people in the country work at all times Cecil, in case you havent noticed the unemployment rate is 10%.

And if you implement your dumb-ass program, you think it'll go up or down? Has it dawned on you yet that the mere discussion of this stupidity is causing the unemployment rate to go up? (And the actual rate is a lot higher than 10% and rising.) Is there something difficult about the concept that shifting costs to the taxpayer makes it cost more, be less efficient, and discourage growth? Apparently there is.

[sylvia]

"We do it here, too. It's called "Medicare." Here it costs more, and drives up the cost of other care."

Wrong. Medicare is a free program for the poor. I and everyone else is talking about a pooled group for people in non-traditional jobs, so that they can pay the same amount that salarymen can pay. Not more. And if it's done in Europe, are you saying that the US is too inefficient to do it?

Sorry, the unemplyment rate went up before health care, it has something to do with a little thing called the finacial crisis. I've read that insurance industries (all of them) were also a big player in that, investing big in very risky strategies. That's one big reason why insurance has skyrocketed lately.

" Is there something difficult about the concept that shifting costs to the taxpayer makes it cost more, be less efficient, and discourage growth?"

Is there something difficult about the concept of pooled resources, that buying in bulk causes prices to go down, ala Costco. Instead of having everyone come out to a fire with their own fire truck and a water hose, hey I have a brilliant idea, how about we pool resources and have the government buy a firetruck!

And besides, sometimes you have to pay to get a benefit. If you don't want your uninsured neice to die, and you don't have the money to pay for it, then you might be glad you are paying 1% more in premiums to insure against that possibility.

[clarice]

Wrong. Medicare is a free program for the poor. I and everyone else is talking about a pooled group for people in non-traditional jobs, so that they can pay the same amount that salarymen can pay. Not more. And if it's done in Europe, are you saying that the US is too inefficient to do it?

I warned you guys. I said the pistolas were armed and ready..

&^$%**(POW!!!!!!!!!!!!!!!!!!!!!!

[sylvia]

Yes Gabriel on the ins for waiters, but so far it hasn't happened. And I am wondering why. Little suspicious that the health ins industries are working behind the scenes to prevent that.

And interesting chart. I see that health ins is comfortably in the middle in terms of profitability. What I am wondering though is what is the profit per members of the board. In other words, it's not really a capital or labor intensive industry. Money comes in and money goes out. You need a few personnel to cover the bookwork, etc. There's little risk, people get sick at a constant rate. There's little competition.

So you have a profit of 3.5%, but to compare that to employees per company might be an interesting number. What would be the stat name for that I wonder and where would you find it.

[sylvia]

Clarice no one cares about your blustering. Why don't you just join in to the discussion and contribute something valuable instead of just inane threats.

[JM Hanes]

Shoot, for a second there I thought folks were actually going to ignore Sylvia, instead of letting her derail yet another thread. She's been banging the same gong, and getting the same responses since she showed up the first time. It's the warm fuzzies of moral superiority, stupid.

[Free Radical]

>I need to know because when I examine the >sector the health insurance field registers >profit margins of about 3.5%.

You have sources for that?

Sure. It was something we heard on TV.

And yes, large numbers make a difference. If the profit is 10 trilion on a 300 trillion industry...

If you can only make 10T on 300T, you need to fire your investment advisor.

Since we are 'getting real here,' I'll start:

RULE #1: There is no such thing as 'free money.'

[Cecil Turner]

I and everyone else is talking about a pooled group . . .

No sweat. Knock yourselves out. Apparently we don't need the government to pay for it after all, which removes all my objections. I believe the GOP proposal included a national exchange . . .

Sorry, the unemplyment rate went up before health care . . .

It hasn't gone up three percent in the last year? Who knew?

[Rick Ballard]

Or the warm stupidity of amoral fuzziness. I don't actually know for sure - the Narcisolator screens out all Sylvan Bozons. I don't understand why people expose themselves to such a dangerous source of anti-intellect particles. I can almost see synapses becoming encased in moronium...

[sylvia]

Look I know most of you are trolls, including some of the regulars. You can't hide your writing style all the time. But even so, I am ready to debate the trolls. Bring it on teenage troll!