Health Care Passes House 220-215

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rx.jpgIt’s just one hurdle overcome. 39 Democratic defections — too many in my book. But the bill passed. Now the Senate, and then reconciliation and more.
Most of the issues I am worried about — particularly in the foreign policy and national security realms — are on hold until Obama’s health care gambit is behind us.
Center for American Progress President John Podesta has been actively engaged in this debate and put out this statement:

“Today, the House of Representatives took an historic step forward toward delivering quality, affordable health care for all Americans. The bill passed by the House today will end insurance company abuses like denying coverage to people with pre-existing conditions, extend affordable coverage to the millions of Americans who do not have it today, and relieve the anxiety of those living one illness away from bankruptcy. This paid-for bill will also make important investments in prevention to keep families healthy, cut waste, fraud and abuse from the system, and rein in costs to put our economy on a path towards a sound fiscal future.”
“Today, history called, and the House of Representatives answered by voting to give hard-working Americans a better shot at the healthy families and financial security they deserve. Now, it’s the Senate’s turn to do the same.”

– Steve Clemons

Comments

55 comments on “Health Care Passes House 220-215

  1. questions says:

    Read and weep:
    “The president of the board of the National Association of Free Health Clinics tells me why: “It’s stage four breast cancer, her body is filled with tumors.” I don’t know when that woman last saw a doctor. But I do know that if she had health insurance, the odds she would have seen a doctor long ago are much higher, and her chances for an earlier diagnosis and treatment would have been far greater.”

    “After watching for hours as the patients moved through the clinic, it was hard to believe that I was in America.
    Eighty-three percent of the patients they see are employed, they are not accepting other government help on a large scale, not “welfare queens” as some would like to have us believe. They are tax-paying, good, upstanding citizens who are trying to make it and give their kids a better life just like you and me.
    Ninety percent of the patients who came through Saturday’s clinic had two or more diagnoses.
    Eighty-two percent had a life-threatening condition such as cardiovascular disease, diabetes, or hypertension. They are victims of a system built with corporate profits at its center, which long ago forgot the moral imperative that should drive us to show compassion to our fellow men and women.”
    http://crooksandliars.com/
    “Throughout their all-out campaign to stop health care reform, Republican leaders have relied on questionable forecasts from the Lewin Group, a subsidiary of insurer UnitedHealth Group. Now, another study funded by UnitedHealth has some unwelcome news for the GOP braintrust: the red states they represent are the unhealthiest in the nation. Following on the heels of the Commonwealth Fund’s 2009 Scorecard of state health care system performance, the United Health Foundation’s report is just the latest confirmation that health care is worst where Republicans poll best.”
    Also from Crooks and Liars.
    So we find desperation from the working people of the country over basic health care issues that were never properly diagnosed (high blood pressure makes your brain, umm, explode (well, your blood vessels in your brain, that is) and cancer just eats you up from the inside), and we find that Republican states are the sickest around and that health care reform will send northern dollars south and still their representatives are freaking and the people keep supporting those same reps. Kind of crazy.
    What’s underlying all of this? The Republicans are tactically terrified of disappearing as a party should the dems get this one notched on their belts. Racial voting patterns probably don’t help either. It’s a lot of crazy for something people should be supporting. So much for ENLIGHTENED self-interest.

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  2. questions says:

    I read all kinds of stuff I disagree with, even stuff on the left I don’t like. But Paglia is, ummm, certifiable??? I HAVE read her stuff and I have judged it to be something not well thought out. Isn’t her background in lit/English? Does she actually have the legislative/poli sci/econ background to evaluate the health care bill? I don’t think so.
    In the one paragraph I half looked at above, she was complaining about the changes in Medicare and screaming that it was so so so unfair to our “seniors”. My response? Well, Medicare and Social Security are transfers of wealth from the young and poor to the elderly. Fine. But as transfers, they choose to decrease the poverty of the elderly and increase the poverty of the young. Fine again. We have to do stuff like this as a society. There simply are trade offs. But if we have to reverse some of the trade offs, or shift them a bit, or means test some benefits so that, say, Bill Gates isn’t getting quite such a great deal off Medicare when he hits 65, well maybe that isn’t a betrayal of “our seniors.”
    I hate hate hate that kind of rhetoric. It’s not an honest way to deal with the utterly necessary trade offs that simply have to be made. There are some painful decisions and couching them in “our seniors” doesn’t help at all.
    Governing has to happen. Policy has to be made. Trade offs are required. It’s something of a democracy/republic after all.
    And the whole “we’re pro-reform” but Pelosi wants a legacy is also unhelpful. Worshiping at the feet of the MARKET, celebrating scam-mobiles as some great leap into the market future, Ayn Randing us all — none of this is going to help.
    Reform has to cut back on the ability of insurance companies to suck down resources. It has to evaluate procedures so that we’re not paying for HRT, flawed cholesterol drugs, annual mammograms that suddenly are seen as risky rather than helpful, anti-depressants that might actually increase the suicide rate and so on. There’s a lot we don’t know, and we pay for this stuff over and over. The drug companies, researching, treating — all of this needs some impartial evaluation. Really.
    What it doesn’t need is an English prof without an econ or medical or policy background charging the abandonment of “our seniors.”

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  3. nadine says:

    I see. You know you are right because you never read anybody who disagrees with you except maybe me, and you certainly don’t read what I say. I should make you repeat my arguments back just to prove that you read what I wrote.
    Look, Paglia wants reform. I want reform. Nancy Pelosi doesn’t care about reform. She wants a Historic Legacy, and if it’s a total disaster, so much the better. She can go back again for even more!

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  4. questions says:

    http://www.huffingtonpost.com/2009/11/17/countdown-producer-attend_n_361286.html
    Read it and weep for all of us.
    Camille Paglia is not at all on my reading list EVER. I can’t get through even a paragraph of her writing anymore.
    Find a liberal health care economist who thinks the market is perfectly fine and solves everything.
    On the scans, you totally misunderstand the point.
    No one know how to read the scans. I repeat, no one knows how to read the scans. Without knowing what the data mean, there are no data.
    A weird shape, a shadow, an unusual-seeming something? Why, surgery’s the answer always.
    It’s not that someone’s life is being saved, it’s that huge numbers of bodies are being cut up for no discernible reason.
    On the mammograms, people thought they knew how to read the scans. Turns out not. The radiation is a risk. The biopsies are risky. The unnecessary anxiety is a risk. People’s families collapse, people’s sense of attachment to life collapses, people fall into depression…. Al for a scan that it turns out is ill-advised. It’s not a money thing. It’s the point at which the chances of finding something real that really needs treatment crosses the risk of procedure line. When the lines cross, you do the scan.
    But scan-mobiles offer scans that NO ONE knows what to do with. And they frighten people, cause low income uninsured and medically ignorant people to flip out and spend more money. Ever have a mechanic tell you there’s a “problem” with your brakes, but really there isn’t? Thousand bucks down the drain…. Now what if there’s a “problem” with you body? You really want to subject people to this in the name of the almighty market? Really?

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  5. nadine says:

    True, the scans are useless for most people (that’s true for mammograms too, btw – it’s a matter of the numbers). At some point the insurance companies say the odds are too low of finding anything, do we won’t pay.
    But if you are the one person in a thousand who gets a real positive on the scan, it could save your life. Do you allow people to do research and make their own choices, or do you think government should be the nanny who makes all the decisions?
    A big left/right divide is that the left thinks people are too stupid to make their own decisions but needs all-encompassing government protection. The right thinks people do better for themselves and ought to be encouraged to do so, and even if they don’t do so well, they have the right to be left alone and not bossed about.
    I see we’re back to “nobody can price healthcare because it’s all emergency care”. That’s not true. A small minority of procedures are emergency care. The most common surgery in this country is for cataract removal. It’s not done on an emergency basis.
    If you see the health care market as a morality play instead of a market, you will “cure” a drought by ordering water to run uphill. Then you will wonder why it didn’t work.
    Let me finish by quoting Camille Paglia, a pro-health care reform Democrat, who writes a lot better than I do anyway:
    As for the actual content of the House healthcare bill, horrors! Where to begin? That there are serious deficiencies and injustices in the U.S. healthcare system has been obvious for decades. To bring the poor and vulnerable into the fold has been a high ideal and an urgent goal for most Democrats. But this rigid, intrusive and grotesquely expensive bill is a nightmare. Holy Hygeia, why can’t my fellow Democrats see that the creation of another huge, inefficient federal bureaucracy would slow and disrupt the delivery of basic healthcare and subject us all to a labyrinthine mass of incompetent, unaccountable petty dictators? Massively expanding the number of healthcare consumers without making due provision for the production of more healthcare providers means that we’re hurtling toward a staggering logjam of de facto rationing. Steel yourself for the deafening screams from the careerist professional class of limousine liberals when they get stranded for hours in the jammed, jostling anterooms of doctors’ offices. They’ll probably try to hire Caribbean nannies as ringers to do the waiting for them.
    A second issue souring me on this bill is its failure to include the most common-sense clause to increase competition and drive down prices: portability of health insurance across state lines. What covert business interests is the Democratic leadership protecting by stopping consumers from shopping for policies nationwide? Finally, no healthcare bill is worth the paper it’s printed on when the authors ostentatiously exempt themselves from its rules. The solipsistic members of Congress want us peons to be ground up in the communal machine, while they themselves gambol on in the flowering meadow of their own lavish federal health plan. Hypocrites!
    And why are we even considering so gargantuan a social experiment when the nation is struggling to emerge from a severe recession? It’s as if liberals are starry-eyed dreamers lacking the elementary ability to project or predict the chaotic and destabilizing practical consequences of their utopian fantasies. Republicans, on the other hand, have basically sat on their asses about healthcare reform for the past 20 years and have shown little interest in crafting legislative solutions to social inequities. The usual GOP floater about private medical savings accounts is a crock — something that, given the astronomical costs of major medical crises, would be utterly unworkable for families of even average household income.
    International models of socialized medicine have been developed for nations and populations that are usually vastly smaller than our own. There are positives and negatives in their system as in ours. So what’s the point of this trade? The plight of the uninsured (whose number is far less than claimed) should be directly addressed without co-opting and destroying the entire U.S. medical infrastructure. Limited, targeted reforms can ban gouging and unfair practices and can streamline communications now wastefully encumbered by red tape. But insurance companies and the pharmaceutical industry are not the sole cause of mounting healthcare costs, and constantly demonizing them is a demagogic evasion.
    How dare anyone claim humane aims for this bill anyhow when its funding is based on a slashing of Medicare by over $400 billion? The brutal abandonment of the elderly here is unconscionable. One would have expected a Democratic proposal to include an expansion of Medicare, certainly not its gutting. The passive acquiescence of liberal commentators to this vandalism simply demonstrates how partisan ideology ultimately desensitizes the mind.
    http://www.salon.com/news/opinion/camille_paglia/2009/11/10/pelosi/index.html

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  6. questions says:

    Deductibles so high as to bankrupt a person long before the coverage kicks in!
    How ’bout a million dollar deductible and out of pocket?
    The whole point of insurance is to avoid payouts — from the insurance company’s perspective. It doesn’t help people to have coverage that doesn’t pay for anything.
    How high a deductible/out of pocket should people have? 50 thousand? 25 thousand? Where do you draw the line for catastrophic care? And note, it’s the catastrophic stuff that usually brings on the rescission game.
    Paying less than the premiums is fine. Paying substantially more is unwelcome. 200 bucks a month isn’t going to cover a lot of cancer care for a lot of premium payers, so they’re going to make sure that they dump the cancer patients.
    On the other hand, if we don’t cover lower end care, then lots of people end up with catastrophes!
    So, no, mere catastrophic coverage is insufficient, but it is certainly a conservative’s preference.

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  7. questions says:

    And one more thing, I’m writing a letter to my doctor as follows:
    Dear Doctor,
    I was just in a car crash and I have a fair amount of blood pouring down my face. I think I might have broken a leg and my spine. Could you tell me what you’d charge to put me back together? I’ve got a few hundred in savings. Would that cover it?
    Please let me know soon, as I feel I might pass out from blood loss.
    Sincerely,
    questions
    What in heaven’s name does it mean to negotiate prices when there is a medical problem? Shopping when you’re in cancer pain? Shopping when you have an ear infection? Shopping when you’re in chest pain?
    Medical care is simply different from other commodities and we need to understand the differences in consumption patterns.

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  8. nadine says:

    What in heaven’s name would a 200 dollar a month policy cover?
    The same thing the $1100 policy covers, with a higher deductible, so that it won’t cover routine medical checkups. You don’t understand the concept of insurance. Insurance can offer large benefits for small premiums IF and ONLY IF it is unlikely they have to pay out in any particular case. You cover more people by having larger risk pools and portability of insurance. If insurance wasn’t tied to employment, the person who got sick in middle age would already have a policy they had been paying into for 20 years.
    Most of the pre-existing condition mess is due to tax-induced linkage between jobs and insurance. But every time the Republicans have tried to change it, the Democrats stop them. Why? The Democrats don’t want to improve the situation, because if the situation were improved, they couldn’t use the crisis to nationalize health care – an attempt which has minority support in the public. The Democrats also fight any attempt to lower the costs of the system, which would lower the benefits to be paid out, and thus the cost of the policy.

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  9. questions says:

    ZOMG!!!!!!!!
    First, huge numbers of general body scams — oops, I mean body scans are CRAP. You get information that NO ONE knows how to interpret. There’s some unusual whatever and so suddenly you’re having a panic attack and exploratory surgery to see what it is and it turns out to be meaningless.
    The scam level is so far beyond anything the slightest bit acceptable. Fucking with people’s minds over life and death issues this way is beyond cruel.
    Part of the reason for the back off on the mammograms is that they are diagnosing irregularities that cause panic beyond panic, they are doing surgery for “cancer” that much of the time won’t go anywhere or do anything. They are making women insane for no health benefit at all.
    The whole body scan industry is crap, and it’s frightening how the market responds to this. This stuff needs to be regulated away. Really. Someone whose 139 buck should be paying for a visit to the dentist gets nonsensical scanning, an offer of “cheap” exploratory surgery and “treatment” of nothing…. Please. This isn’t medicine. This is cruelty.

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  10. questions says:

    Follow up –
    Why do people buy insurance when it so often sucks?
    I think that there’s probably a lot of interesting work to be done on this one, but I’ll speculate a bit for fun and entertainment.
    1) One buys insurance ASSUMING that it works, and one finds the failures only when one is already so sick and has paid in so much that it’s too late to do anything about it.
    2) Insurance will cover some cheap things, will go up to the premium level and even a little bit over, but if you go way way over the premium level, you trigger the rescission process. So mostly, you find stuff covered and it isn’t until it’s too late that you find stuff isn’t covered.
    3) Insurance works for many people. Large employers give decent subsidies and reasonable stability. PPOs can be broad enough that you feel you can find practitioners as needed. HMOs have probably improved a fair amount since they started (remember, they used to have a pool of money that covered either referrals to specialists, OR the doctors’ year end bonuses — talk about conflict of interest….)
    4) Under normal conditions, you have no idea you’ve purchased a defective product, so you keep paying.
    5) People actually want some assurance that they’ll have financial support for cancer care, stroke care, heart attack and transplant care, and the many diseases that strike over time. So they buy insurance. It’s pretty rational given how devastating health care bills can be.
    6) The cost-spreading (wait, isn’t that socialism???) is a fairly effective way of dealing with potentially huge payouts of unknown risk.
    So there do seem to be some good reasons for buying insurance. Sadly, the product is defective for a large number of people, and is too expensive for many others. A lack of insurance is tied probably causally to something like 15,000 deaths per year, and a lot of extra pain and suffering.
    But because the product works for many people, and those many people generally feel insulated from product failure, they don’t want to alter things.
    Kind of like, you got yourself a Lexus and you therefore don’t worry about the piece of crap Yugo someone else is driving, so you don’t support annual car inspections. But that Yugo might crash into your charmed Lexus, or you might lose your job and your Lexus and be stuck with a used Yugo.
    We should all be worried about crashing into infectious diseases made worse by lack of universal health care, and we should all be worried about losing jobs, jacked up premiums, slashed benefits, dropped coverage, rescission, life time maximums and so on. THERE’S your enlightened self interest by the way — drawn with different boundaries — funny how you can do that!
    None of us is so alone, so independent, so able to manage for all times and in all places that any of us should be willing to live without a certain level of cooperation, a certain level of being coerced to do some socially good things. One day, it really could happen that you need support. You should work to have the institutions in place. For YOU if for no one else.
    (Note that Rawls grounds his entire redistributive system on a notion of self-interest, so it’s not a foreign concept to me, even if it’s not quite how I think.)

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  11. nadine says:

    questons, I happened to get something in the mail today that shows the market at work – a brochure for Life Line Ultrasound screenings. These are screening tests for vascular conditions that insurance does not currently pay for, so the company has to persuade people to pony up from their own pockets. They have arranged travelling clinics so they can register a large volume of people to sign up, to get the costs down. It costs $139 for four screening tests.
    Now I know that if I went to my doctors and asked to get these tests, I would be charged at minimum $300 per test because that is how hospital list prices work – they are very high as part of their negotiating process with the insurers, who never pay the full price. It doesn’t bother most of the patients since they never know the price, but woe betide you if you’re a patient paying out of pocket. You have little leverage to say, I’m not paying that much, cut the price.
    But when price is known beforehand and negotiated between patient and provider, an entirely different set of mechanisms comes into being, and you have the result of a Life Line clinic which is both convenient (it’s coming right to my town) and reasonably priced and (I presume) profitable for Life Line.

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  12. questions says:

    What in heaven’s name would a 200 dollar a month policy cover? Umm, let me guess, one visit per year to a minitclinic to see a nursing student who currently has a C+ gpa, one generic prescription a year under five dollars, and a website that will provide you a computerized list of possible diseases and the names of wild herbs that Chinese herbalists use. Good luck getting to China to harvest them….
    Insurance does a huge amount of cherry picking and it doesn’t want spoiled or diseased cherries. It wants healthy cherries who pay in and never submit claims. If all they can charge is 200 bucks, either they will cover NOTHING or they will only take super healthy people and cover NOTHING.
    Insurance companies look really hard to find ways to kick out sick people. And according to some stuff I’ve read, this behavior might be impossible to legislate away; hence the public option is all the more crucial. There are ways to advertise to signal to potential customers that they and their diseases aren’t welcome, and that will happen even with significant regulation.
    The fact is that pricing health disasters properly prices a lot of people out of the market, especially when profits are so important to the price-setters. What the public option does vis a vis pricing is to dump the profit part. All the other price options are deeply problematic.
    So where else can we fight high prices — well, pay doctors less, use less-qualified technicians, deny sick people care, figure out if cholesterol drugs and HRT drugs and pain killers and chemo drugs and the like actually work before approving them (this would actually be good, but isn’t possible — look at the NYT today on mammograms — here we go again with years of bad and expensive advice that is either well-intentioned or utterly corrupt…), not cover first dollar preventive care and let people suffer if they can’t come up with 90 bucks to see a pediatrician. What’s going to give on the price side?
    The Repubs seem to prefer doing work on the demand side — simply don’t cover people who can’t pay. Voila, reform. But wait, that’s already what we do! Proof that the market works, hallelujah!
    Newt Gingrich is not my favorite, umm, thinker, so any use of his name is going to send me running the other direction!
    Your enlightened self-interest/invisible hand stuff doesn’t hold up well in a lot of more thoughtful contexts anymore.
    The behavioral economics people have shown quite convincingly that we don’t end up in optimal positions when we operate at normal thoughtfulness.
    And the game theory people have shown fairly convincingly that if we pursue our own interest without working in cooperation with others, we end up with a result that could have been better, but isn’t because of a lack of cooperation (that’s the SELF part of “enlightened self-interest.) Look up the payouts for the Prisoners dilemma and you find that the Nash equilibrium, the point at which either actor acting alone can only worsen his position should he take action, and note that they can do better only if they work together. Umm, maybe that’s enlightened social-interest or something.
    I read somewhere that Adam Smith’s work is mightily perverted by current thinking. Since I’m only a little bit of the way into The Wealth of Nations, I’ll leave that for someone else to comment on.

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  13. nadine says:

    I know the market can solve the problem. Not a pure unregulated market; there needs to be regulation and a safety net; but a market in which most of the spending decisions were made by patients for themselves would definitely lower costs.
    The health care crisis exists because everything is so damn expensive. If a lower income family tries to buy insurance on their own, it’s currently $1100 a month on average. That’s a crisis. If the market was allowed to work, they could buy a policy for $200 a month and their crisis would be over.
    This is not a religion btw but a theorem; it’s proven to work and is repeatable and quantifiable.
    “The market is just as much a collective fiction and it doesn’t really have to answer to people quite the way that government does”
    The market is a system – a real, live functioning system. It’s not a fiction at all. Every business has to answer to people every day – first and foremost the people who write checks to that business, customers or clients. If they fail to answer to their customers, their customers go away and the business closes its doors. That’s the wonderful thing about the system – it has a built in reality check. You don’t have to select altruistic businessmen, you can get altruistic behavior as a side-effect of greed. This is called “enlightened self-interest”. Greed is way, way, way more abundant as motive than pure altruism so you this way you get a system which actually works.
    If you would like to see the details of Republican solutions, Newt Gingrich has been speaking extensively about them and the Republicans of both the House and Senate have bills prepared. They just don’t get reported on much.

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  14. questions says:

    What is your better solution than either single payer or the public option?
    Do you honestly think the market (your religion?!) can solve the problem? Do you honestly think that private individuals can deal individually with their own health care bills? Do you think miraculously kind and selfless non-profits will spring up and provide comprehensive care? Do you think the market loves million dollar health cases? What would you do instead?
    As for the collective will, what that means is the government — pushed by electoral politics and arriving at some kind of imperfect compromise that deals with some problems, creates some other problems which we will then have to deal with. There is no perfection, there is a lot of agonistics, and that’s fine. There will also likely be fewer deaths, or perhaps only different deaths. But the deaths we’re having now are pretty damned ugly if you ask me.
    What would you trust instead of the government? The market is just as much a collective fiction and it doesn’t really have to answer to people quite the way that government does.

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  15. nadine says:

    What is this “collective will” questions? You make it sound like a mystical concept. Maybe for you it is. I don’t see a collective will. I see a giant Federal bureaucracy, or to be more precise, 111 new bureaucracies which are created by Pelosicare.
    With bureaucracy this massive, it doesn’t matter how much good will it possesses. It will be insanely inefficient regardless.
    We are talking past each other. You keep saying,
    “But people are suffering, don’t you understand?”
    and I keep replying,
    “But this won’t alleviate the suffering, it will only make things worse. We must work with the markets to get costs down, that is the root cause of the problem.”
    “Have you no heart! people are dying!”
    “But this won’t save them! it won’t work! it can’t work! It’s not even meant to work!”
    “But people are dying I tell you!”
    “This will bankrupt the Federal government and then it still won’t work! Then we’ll have 10% inflation, gas at $10 a gallon, and we still won’t have a doctor.”
    “But people are dying. Trust the collective will.”
    Oy. I give up. You cannot use reason to argue someone out of their religion, and this is yours, plainly.

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  16. questions says:

    LA Times ran a piece yesterday/today? on trauma care and a significantly higher death rate for the uninsured. There are causation/correlation questions to be answered still, so it’s not a definitive study, but it is pretty damned suggestive that even trauma care in the ER is less well done for the uninsured. They wait longer and die along the way, perhaps.
    Re the Medicare denial rate, I’ll get to is as I can, but a denial rate itself out of the context of the kinds of claims being made and so on is not meaningful. This kind of problem is endemic in health care info. It’s really hard to figure out what we know from the data we get. So, just as my take on lobbying doesn’t match the TWN prevailing winds, so my take on Medicare’s denial rate might not match what you want to take from it. Numbers are funny that way when they’re used to make a point.
    In the end, I’m far more nervous about for-profit corporations’ controlling my access to meds and procedures than I am the government’s doing so. This basic difference is probably partially fact-based (it’s not like the corporations have done so well by many people I actually know), and partially ideological (I trust the collective will more than I trust the individual wills of profit-seeking private-good seeking corporations who hire legions of people to look for ways to deny care.)
    Pelosi doesn’t frighten me. Pharma does.
    Note that 2 recent cholesterol drugs might end up pulled from the market as ineffective compared to some vitamin pill or something…. Still don’t want evaluations of treatments? Impartial evaluations, that is??? (Read about this one yesterday or the day before.)

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  17. nadine says:

    From the AMA’s 2008 National Health Insurer Report Card:
    “The Medicare denial rate found in the study was, on a weighted average basis, roughly 1.7 times that of all of the private carriers combined (99,025 divided by 2,447,216 is 4.05%; 6.85% divided by 4.05% =1.69).”
    http://newsbusters.org/blogs/tom-blumer/2009/10/06/deny-guess-who-has-highest-medical-claim-rejection-rate

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  18. nadine says:

    “The public option is just that, by the way, an option. It’s not government controlled care. It’s another insurance company, and one, sadly, that’s going to have to negotiate rates with providers instead of using the Medicare plus 5 version. So cost control will be limited.”
    No, no, no. Let me explain to you why not.
    On the one hand, it’s true that the public option might be set up as just another insurance company, just one owned by the government (why you think government owned does not equal government controlled, I can’t begin to fathom).
    However, when government starts to compete with private business, it doesn’t have to play by the rules. Government owns the playing field and the rulebook, and can reset the rules any way it likes.
    The government option will have two enormous advantages over private entities: it can get friendly legislators to tilt the whole playing field its way, and it doesn’t have to make a profit. It will be tax-subsidized. It cannot go bankrupt (tho imo it can bankrupt the whole Federal Govenrment, in the not too distant future). Once again, I emphasize that anything Pelosi says about the public option being premium-supported is an obvious lie; if it could be premium-supported, it wouldn’t need to be public at all.
    So, will the public option choose to compete with private insurance, or will it just put private insurance out of business by mandating so much and pricing so low that private entities cannot compete with it?
    All the signs point to the second outcome. The bill mandates expensive “health exchange qualifying” plans. Any plan less than that becomes illegal within a few years. The ban on pre-existing conditions will make the costs of private insurance soar. (Imagine what homeowner insurance would cost if you could wait to apply for it until after your house burned down.) The tax incentives in the bill already make it far cheaper for most companies to drop their policies and dump their employers into the public option; that will be even more true once private premiums soar as they must under the new mandates.
    Nancy Pelosi, like Barack Obama, has said in the past that she favors a single payer system. Once you drive the private insurers out of business, well there you are, there’s no other choice left.

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  19. questions says:

    Again, we just don’t agree on the facts, even. The emergency room handles critical care, gives you a prescription and sends you on your way. No insurance, no money, no meds. Oh well. The insurance company bills you, too. No money, oh, then bankruptcy unless they dump your bill onto other paying people via the charity care section.
    People go without care that they should receive. That’s enough for me to want to do something about it.
    And no, I’m not after the “perfect,” I’m after the “better.” And single payer or the public option would be the better, in my view at any rate.
    Re denials, I don’t know much about it, but I do know there’s lots of fraud and that may be part of the problem. It’s something I’d need to look into. Any links handy?
    The public option is just that, by the way, an option. It’s not government controlled care. It’s another insurance company, and one, sadly, that’s going to have to negotiate rates with providers instead of using the Medicare plus 5 version. So cost control will be limited.

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  20. nadine says:

    btw, did you know that Medicare denies a higher percentage of claims than private insurance companies do? You are putting an unwarranted amount of faith in government controlled systems.

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  21. nadine says:

    “indeed, I’m guessing we have the worst of all worlds. We’re denied coverage and care, we pay insanely high premiums, we have very little public health infrastructure AND WE HAVE NO POLITICAL CONTROL over the system”
    No political control? There is tremendous political control, that’s exactly the problem. Look right now: perverse tax incentives, medicare, medicaid, S-chip, all the state plans, it’s not enough, so Congress is essentially planning to nationalize the system. This is the old statist two-step: first inject enough political control to screw the system royally, then demand a total government take-over because the system is royally screwed.
    What’s to defend in the current system? How about the most advanced care in the world? The one with the latest equipment and best standards of care. If you are diagnosed with cancer or heart disease, your odds are much better here than elsewhere. Period.
    It’s a glass half-full thing. You see the empty part of high cost and uneven delivery (though it is flatly untrue to say that this country denies care to poor people. You go sick into an emergency room, you will be cared for. By law.), I see the full part of advanced technology, new discoveries, the latest equipment. I worry that since you don’t see that part, you won’t mind wrecking it in your search for equality.
    This is most leftist thing about you: the willingness to ditch the imperfect in search for the perfect. Conservatives know that perfection is not an option, whatever system is followed. Conservatives also know that is very hard to make complex systems work at all, so taking a wrecking ball to an imperfect but working system is not a wise idea.
    The conservative approach to reform (and yes there is one) is step by step: add another support here, remove a perverse incentive there, let the system adjust to the changes. That way it won’t collapse, and market-oriented reforms will actually work. But the conservative approach has been stymied by Democratic passion for the Holy Grail of Federal Health Care Reform.
    You’re fooling yourself if you think the Congress is primarily motivated by health care concerns. This is political. Once this goes in, the entire political arena has been hauled to the left. This is a tool for permanent Democratic control. Why do you think SEIU has backed Obama to the hilt? They see a vision of heaven: a new American NHS with 10 million employees, all members of the SEIU. When your care goes down and your costs go up, it won’t be any skin off their nose.
    Let me ask you this: if Congress really believed that this bill would address the present health care “crisis”, why doesn’t it start implementation until 2013? They want to be safely re-elected before the public gets a taste of what this bill is really going to do, that’s why!

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  22. questions says:

    And one more “quick” thing….
    If you think that insurance companies don’t already play “NICE”, think again.
    Maybe you feel that if the government is NICE, we’re all in trouble cuz you can’t get a new government so easily, but if an insurance company plays NICE, you can always get a new insurance company.
    Oh, but the irony. Pre-existing conditions and open enrollment periods and disallowing coverage of certain illnesses for a period of time and the fact that your employer only contracts with one insurance company anyway and, umm, the lack of competition in vast regions of the country all mean that you can’t really get a new insurance company quite so easily. So they can play NICE all they want.
    And you might say, hey, just open the state borders to all insurance companies (regulatory nightmare, but who cares about the regulation of insurance companies anyway since regulation is the problem apparently!).
    So here’s the ad campaign I’m envisioning for the NEW INSURANCE WORLD ORDER:
    Hey everyone, gotta disease your bad old insurance company won’t cover? Got cancer and can’t afford premiums? Need surgery? Went chronic at some point? Well come on down to WELLCARE because we have low premiums and guaranteed high coverage. First dollar even!! Woohooo! You’re saved!!!!!!!
    Now, think about the incentives. Is there going to be a single insurance company anywhere in the universe that is looking forward with eager anticipation to covering the multi-million dollar cases? Of course not. The market simply cannot provide for this. The cherry picking is there for a reason. NICE-American-Style is there for a reason. For profit insurance is, well, FOR profit. Not FOR payouts. So they play NICE just like Britain. And they have a monopoly just like Britain.
    Indeed, I’m guessing we have the worst of all worlds. We’re denied coverage and care, we pay insanely high premiums, we have very little public health infrastructure AND WE HAVE NO POLITICAL CONTROL over the system. Yikes. What’s there to defend in all of this? What?

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  23. questions says:

    quick typo above — “you’re” should be “your”…. Early morning typing….

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  24. questions says:

    Re buying cars for the poor — try trains and buses — publicly subsidized and used by the poor. Try roads and bridges — publicly subsidized and used by the poor. Try gas prices — publicly subsidized through international policies that keep gasoline on the cheaper side — and used by the poor.
    The issue underlying all of this is the KIND of commodity we’re dealing with. Roads are non-excludable. Many pieces of the health care system excludable. Having a CAT scan machine in town doesn’t mean it’s available for all, but having a road through town does mean it’s available for all.
    Because we can exclude the poor from health care, and because we DO exclude the poor from health care (read some stats on infant mortality and disease rates — very sobering stuff), we as a society have some moral obligation to provide the services somehow.
    We don’t provide enough transit, and the lack of transit provision causes the “island-ification” of segments of our population and in turn causes unemployment to be localized. We provide even less health care. And that lack of provision kills people.
    I know you have a great deal of faith in this thing that you call the “market,” but I don’t. That may be the hallmark of the conservative/liberal divide, or maybe the conservatives are disingenuous in their statements of faith. Indeed, it’s quite possible that what gives you confidence in the “market” is that you’re already well-positioned vis-a-vis health care and other services and as long as YOU are well-provisioned, you figure the system works well enough. After all, you can say to yourself, “Hey, I’m doing ok, so what’s you’re problem?!”
    But, in fact, the market fails to provide all sorts of things that humans are capable of providing, and the collective power of us all (that’s the gov’t, by the way) is there to help (even if Reagan is quaking in his boots at the thought of it.)
    The world is full of bad actors, bad faith, a desire for a quick profit, financial bubbles, stupidity, selfishness and so on. These qualities don’t have to be universal to be very destructive. In fact, a few bad actors (the ones who KNEW the bubble was a bubble) are sufficient for dooming the rest of us (the ones who just hope to make enough money to retire early).
    In health care, the equivalent is that there are those who understand that epidemics break out and doom us all if we have no public health system. and even the relatively well-off are now hitting the wall on health insurance. You lose your job (U6 is at 17.5% now — that’s a LOT of lost health insurance!) you lose insurance. You got a pre-existing condition, you lose your insurance. You got a co-worker who gets cancer, YOUR premiums get jacked up to the unaffordable and your boss cancels insurance. You get REALLY sick, you lose your job and your insurance. You get really sick and you don’t have manageable out of pocket limits, you lose your insurance…..
    Clearly, you don’t feel any of these concerns, and so you don’t worry about loss of insurance, medical bankruptcy or the like. But there are enough people who do face these problems that I think intervention is crucial and moral.
    Kind of boiler-plate liberalism, but with Kant and Rawls behind it. And a dollop of Plato on the dissolution of the state and Aristotle on the balancing between the claims of the oligarchs and the claims of the democrats. Those are powerful forces and you’re supporting the oligarchs on this issue.
    And re the car example — a better analogy would be something like, you’re allowed to have a rust bucket and pay a little more than it’s worth maybe, but you can squeeze by… But as soon as you go to drive the car, it automatically has been programmed to have its engine fall out. See, junk health insurance with high deductibles and high co-pays and rescissions and refusals to cover, oh, say, cancer care or whatever — it ain’t health insurance. It masquerades as health insurance and it evaporates the moment you try to use it. Presto magico and all.
    So, still, we’re not really agreeing on the facts underlying the problem And we’re also NOT heading towards a British system. And yes I’ve read about NICE. And I’ll say the following about doing something about the use of effectiveness research –
    Hormone replacement therapy was de rigueur until they found that it was BAD to do.
    Back surgeries turn out not to help back pain most of the time.
    A range of pain medications turn out to be really dangerous and way overprescribed.
    The wisdom of treated stents for blocked arteries is under question.
    Much cancer care doesn’t extend life.
    And so on. Fact is, there’s a lot of stuff we do and we pay for that we haven’t really studied carefully enough to know if we’re helping or harming, but we do it out of a desire to DO SOMETHING.
    Wouldn’t you like not to be given a risky procedure that does nothing? Wouldn’t you like it if someone told you that most ear infections are viral, so don’t dump antibiotics into your kid at the first sign of ear pain, do the watchful waiting thing instead — the outcomes are better that way….
    Our current system has a lot of death in it that you ignore, preferring to find the death in the British system (which is not even on the table). We’re not headed towards doctors’ working directly for the US gov’t. Medicare didn’t do that to anyone. Medicaid didn’t do that to anyone. The public option, which will be available to 3 people at the start, will not do that to anyone.
    Insurance companies already have a massive interest in controlling health spending because actual health spending limits their profits. They can’t stop it. The government probably can’t stop it either. Health care just is expensive. Most likely, the industry will suck in way more workers, there will be more minit-clincs popping up. Quickie docs in a box places do a decent job on the accessibility front and on the quick treatment for really easy stuff you need a doctor for. And those will moderate costs a bit. There will be more para-professionals to handle a lot of hands on patient care. And that will control costs.
    The major costs are: labor and technology. More scans will lower the per-scan cost. More technicians will lower the per-technique cost. Aggregate spending may well rise, but the per-procedure cost will go down a bit. Until, of course, we hit things like cancer treatment and anything that uses new and improved technology in the hands of the highly skilled few. Costs will go up because that’s inherent in the field.
    But to leave out vast numbers of people because of the cost is contrary to the reason we come together as a society in the first place.
    But again, we’re not really going to see the world the same way. I’m kind of on the left pretty fundamentally.

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  25. nadine says:

    You really should pay attention to Britain’s NICE rules, because they are headed your way if Pelosicare passes. If the bill does not include incentives that will control cost, and the House bill does not, then costs will not be controlled. If costs are not controlled, the Federal government will go bankrupt and be forced to cut costs. Centralized bureaucracies cut costs by rationing. Every government system does this. It will happen because there is no choice once the system is set up.
    Sigh. I wish I could get you to attend to the reasons the system is so messed up and so expensive today. It is not natural. It is only in part due to medical innovation. It is not due to the wickedness of the insurance companies. They make a profit but not an inordinate one. It IS due to all the mandates and perverse incentives that the laws have injected into the system to screw it up royally and prevent normal individual choices from containing costs they way they do when you buy a car.
    Believe me, for most people wheels are even more of a daily necessity than health insurance. Yet nobody seems to think they have to rush out to buy cars for the poor. That’s because you have a car market with choices from high end sports cars down to 20 year old pickups and sedans for the poor.
    Imagine if the law said that you had to buy a new Toyota Prius every time you changed jobs or moved to a new state, with a new insurance policy that covered everything from oil changes to new engines to collision and theft at 100%. The cost would be enormous – $50K at least.
    Today you can buy a old rustbucket to get you from A to B if you’re poor, with a minimal high deductible insurance policy. But suppose they outlawed old cars? Mandatory cash for clunkers, even if you can’t afford the new car! Then wheels would become just like health insurance, too expensive for all but the well-off. We would have a “car crisis” to match the “health crisis,” and for the same reasons.
    Even Robert Reich, who as I’m sure you know is desperately for health care reform, is begging Harry Reid to attend to cost containment in the Senate Bill. The high costs are the root cause of the entire crisis. Even Reich knows that. If you don’t understand what makes the costs so high, you will follow exactly the wrong prescription and wind up by wrecking the current system, not reforming it. Whatever it is now, it could get a lot worse.

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  26. questions says:

    Note that your Texas stats provide only one side of the issue and not any hardship on the other side. Without a fuller account of the results over a longer period of time, I’m not going to jump up and down. I still think the horrors of torts are over-exaggerated and the savior quality of reform is lesser than one would think.
    Note that the US is stuffed full of horrible death stories from lack of care, so one from Britain, WHICH IS NOT THE MODEL FOR THE PELOSI PLAN, is not going to make me tremble. What makes me tremble are: lifetime maximums on benefits, out of pocket costs that make it unaffordable to stay well, rescission, the individual market, pre-existing conditions, the number of people whose job it is to deny claims, “lose” claims, refuse claims. Did you know that there are pre-printed stickers for doctors’ offices that say something like “this claim was already submitted” and are stuck onto insurance forms and sent in? There is actually a market in pre-printed stickers for this?!!
    Note also that the point about avoiding lawsuits isn’t focused on “defensive medicine” but rather on the observation that if doctors explain things to patients and apologize as needed and generally have decent relationships with their patients, they don’t get sued. Funny, that. Set up a non-competitive relationship and your patients won’t try to beat you.
    The caps on lawsuits and the extra hurdles are not going to make the universe a better place unless there is compensation money from elsewhere, and unless doctors are disciplined in some other way when there is gross negligence.
    I have read a little about mediation boards, there may be something to that. But I do not have any desire to have the courts stripped of the power to adjudicate. That’s why we have courts, after all. It’s weird that the conservative position is to strip courts of power when it is the courts that make us something other than royalists. Maybe conservatives are really royalists?
    Definitely spending more time on this than I should….

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  27. nadine says:

    Here is some info on Texas tort reform, which has had a substantial effect on medical malpractice premiums:
    The 2003 session (with George W. Bush was Governor)
    Enacted comprehensive reforms governing medical liability litigation, including a $750,000 limit on non-economic damages
    Initiated product liability reforms
    Made the burden of proving punitive damages similar to criminal law, requiring a unanimous jury verdict
    Comprehensively reformed the statutes governing joint and several liability and class action lawsuits
    Imposed limits on appeal bonds, enabling defendants to appeal their lawsuits and not be forced into settlements (this is what pushed Texaco into bankruptcy in its famous lawsuit against Pennzoil)
    Further limited the filing of lawsuits that should have been brought in other states or countries
    The changes to medical liability in 2003 were extraordinary, and had a very substantial impact, including:
    1. In August 2004, the Texas Hospital Association reported a 70% reduction in the number of lawsuits filed against the state’s hospitals.
    2. Medical liability insurance rates declined. Many doctors saw average rate reductions of over 21%, with some doctors seeing almost 50% decreases. (Recent information provided to The Perryman Group during the course of this study suggests that premiums are declining even further in 2008.)
    3. Beginning in 2003, physicians started returning to Texas. The Texas Medical Board reports licensing 10,878 new physicians since 2003, up from 8,391 in the prior four years. Perryman has determined that at least 1,887 of those physicians are specifically the result of lawsuit reform.
    4. In May 2006, the American Medical Association removed Texas from its list of states experiencing a liability crisis, marking the first time it has removed any state from the list. A recent survey by the Texas Medical Association also found a dramatic increase in physicians’ willingness to resume certain procedures they had stopped performing, including obstetrics, neurosurgical, radiation and oncological procedures.
    http://docisinblog.com/index.php/2009/07/27/texas-tort-reform/

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  28. nadine says:

    “Slip and fall lawyers are a convenient devil. But there are still judges and defense lawyers and juries and appeals courts in between law suits and the movement of money. SOMEone, a bunch of SOMEones, see merit.
    Remember that malpractice of the real sort could happen to you, and if your award is capped at an obscenely low rate”
    questions, you keep reading tort reform as destruction of the right to sue, which it is not. There are obviously trade-offs, and you have to examine any set of reforms. Think of one set of suits that have merit, and another set of suits that have no merit. What happens in today’s system? Both sets proceed alike, and potentially for a very long process, chewing up legal costs for for both parties. Even if the meritless suit usually gets thrown out eventually, it’s still worthwhile for lawyers to take them because they might get lucky if they go to a jury trial, or more likely, they can blackmail the innocent defendant’s insurance company into settling. What is really needed in this case is the “English rule”=loser pays court costs, something the trial bar fights tooth and nail. There are ways to allow suits with merit to proceed while weeding out a higher percentage of baseless suits.
    “As far as I know, there are a range of behaviors doctors can adopt to avoid being sued. Tort reform doesn’t appear on that list.”
    This doesn’t make sense. Tort reform applies to the courts, not the doctors. What doctors do is practice defensive medicine, always looking over their shoulder for the malpractice suit. Defensive medicine means you run lots and lots of tests, maybe twice as many as you think are medically necessary, so you can bring documentation to court. Think about the cost of every doctor in this country doing that.
    “NO ONE is handing out medical care for free. No one is handing out insurance for free. The public option will be premium-supported, with subsidies for those who need. THERE ARE ALREADY IN THE WORLD food and housing subsidies. Really.”
    There are already in the world medical subsidies. Lots of them. Really. If they don’t cover enough, expanding the existing program would be a whole lot simpler and cheaper than a gargantuan new entitlement program. Heck, it would be far cheaper to buy every poor person in this country a Cadillac health plan. Go ask your local hospital how much medical care they hand out for free. Seriously. It runs into millions of dollars a year for every hospital of any size.
    If you believe that the public option will be premium supported, then you do believe in Tinkerbell. It will be taxpayer/deficit supported. Nothing that Obama or Pelosi say about deficits or payments deserves to be taken seriously for a moment. They are in “say anything” mode. Do you actually believe that Pelosi really intends to cut $500 Billion from Medicare over the next ten years, a period when its roles will swell by 30%? Do you believe that the $250 Billion “doc fix” to avoid cutting Medicare reimbursement rates below the already too low rates won’t happen? C’mon. Estimates for the true cost of Pelosicare range form 1.2 Trillion to 2 Trillion for the first ten years – and the bill purposely takes in 10 years of taxes but gives out only 7 years of benefits during that period, so the second ten years will be much worse.
    The initial estimates for Medicare’s first 10 years turned out to be 9 TIMES too low. The estimates for entitlements are always way, way too low, because they don’t take enough account of how the new law changes human behavior. Half the country will be on the public option within a few years, like it or not. That’s what the incentives in the bill are designed to accomplish.
    “Find any reputable link that shows definitively that people will use unnecessary health care if they can have access. Who’s gonna go to a doctor to have his toe nails cut? Seriously. People go to the doctor when they are sick. They have imaging done when a doctor tells them they need imaging done.”
    Actually, diabetics routinely go to podiatrists to get their toenails cut. It is easy to find evidence that co-pays decrease utilization, e.g. here http://www.ajc.com/opinion/pro-con-are-higher-191380.html And note how low the co-pays under discussion are. Almost any co-pay will have the effect, because people will sort out trivial from real causes if they have to pay anything out of pocket. Lots of people run to the doctor for trivial causes if it’s free. Ever heard of hypocondria?
    “And if your main argument is that you’ll have to wait on a routine imaging test because all those uninsured poor people suddenly have insurance and can get themselves some x-rays or scans, well, I can’t say as I have a lot of sympathy.”
    No, my main argument is that you’ll have to wait six months to see your GP, then another YEAR to get that imaging test. That is what happens in Canada, routinely. By then you may be a lot sicker than you are now.
    Access to health insurance is not access to health care. Let me repeat that: Access to health insurance is NOT access to health care.
    Access to health care is always rationed. Always. It can be rationed by the market, by a hybrid market/government system (what we have now), or by centralized planning. There is no magic formula where everybody gets “enough”. There isn’t “enough” to go around.
    When it is rationed inefficiently, costs soar as the system overhead chews up most of the money. The British National Health employs 1.4 million people, and most of them are clerks, not health care providers. The yearly budget becomes a battle over trying to squeeze the costs of the National Health service that is bankrupting the government, so rationing creeps ever upward. Bureaucracies are immortal; it’s always easier to squeeze the doctors and the hospitals.
    I heard a story told by an American radiologist who had studied for a while in the UK. On his first day in the UK, he heard one resident claim a bet from another resident: “You owe me fifty quid.” When he asked what the bet was about, he was told that two years previously, a 78 year old man had been diagnosed with an aortic weakness that was likely to become an aneurism and kill him. Because of his age, he was wait-listed for the operation to fix it. The bet was which would come first, the aneurism or the operation. The resident who bet on the aneurism won. The patient waited on the wait list for two years, than died of the aneurism. On Medicare he would have had an operation in two weeks.
    That’s what your future looks like under Pelosicare. Despite the happy talk in the press, senior citizens are getting the message, which is why they oppose the current bill(s) by 2 to 1.

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  29. questions says:

    We definitely don’t see eye to eye! Tort reform may well cause more problems than it alleviates. But you definitely have the standard line down. I’ve read enough critiques of it that I’m deeply suspicious, despite worries about the fleeing ob/gyns and the deep pockets issues and the like.
    There are many many reasons for people’s moving practices out of places, and torts may well be a convenient fall guy.
    Premiums and tort cases don’t move in lockstep.
    Near as I’ve seen, premiums don’t fall dramatically in reformed states.
    As far as I know, there are a range of behaviors doctors can adopt to avoid being sued. Tort reform doesn’t appear on that list.
    Slip and fall lawyers are a convenient devil. But there are still judges and defense lawyers and juries and appeals courts in between law suits and the movement of money. SOMEone, a bunch of SOMEones, see merit.
    Remember that malpractice of the real sort could happen to you, and if your award is capped at an obscenely low rate and you have to live the rest of your life without any legs, a donor kidney, dialysis, the damage from sponges left in your gut, cigarette burns left during surgery, the doctor’s genetic off spring instead of that of the donor you chose, if you’re told that you shouldn’t worry about the lump and then it metastasizes (it happens!)…. Wouldn’t you want SOMEthing to compensate and to punish and to deter?
    Are there better systems than the courts? It’s hard to say. A system that lets more people in, that compensates for a lifetime of suffering and loss, that’s less hit-or-miss — could be good. But that’s not what the reformers are after. They are after killing off the money train to the dems, saving the profits of insurance companies, keeping doctors in the Republican party…. There’s no great love of humanity floating around tort reform, probably not on either side.
    But again, remember that if a judgment makes it through appeals, there’s likely some merit.
    And as for your point by point thing, again we don’t really see eye to eye, even on “facts!”
    NO ONE is handing out medical care for free. No one is handing out insurance for free. The public option will be premium-supported, with subsidies for those who need. THERE ARE ALREADY IN THE WORLD food and housing subsidies. Really. So, yes, we do hand out necessities to those in need. We’re just recognizing that food doesn’t do you a lot of good when you’re most of the way dead from untreated cancer.
    Find any reputable link that shows definitively that people will use unnecessary health care if they can have access. Who’s gonna go to a doctor to have his toe nails cut? Seriously. People go to the doctor when they are sick. They have imaging done when a doctor tells them they need imaging done. They do $100,000 a year or a dose chemo when a doctor tells them to. What medical care do people seek out just cuz there’s a sale this week only?
    And if your main argument is that you’ll have to wait on a routine imaging test because all those uninsured poor people suddenly have insurance and can get themselves some x-rays or scans, well, I can’t say as I have a lot of sympathy.
    There’s real need, real desperation, real death from lack of medical care. I’ve lost family members and a neighbor over lack of insurance, I’ve seen the suffering of friends over lack of insurance, I’ve seen people unable to get insanely expensive drugs they desperately need…. I’m not sure how anyone supports the current system. I’m not sure how you support the current system.
    A market has no love of loss. Medical care is a big loser. In such situations, one turns to the overarching power of the collective to provide. We are all equally likely to get horribly sick. Horribly, expensively ridden with cancer or some other wicked disease. We are all pretty likely to be related to a kid with autism (schooling is 50 thousand a year), a preemie (you can go through a million bucks before you leave the hospital — wait, isn’t that the standard lifetime limit on benefits? Hmmm). We’re all in the same position. We need more evenhanded care, more evenhanded insurance.
    But again, you and I don’t even seem to be working with the same set of facts, so I really don’t know what else to say. My instincts are for a robust public option, some kind of single payer system, or some other scheme that allocates resources based on something other than one’s bank account (a sum which won’t save any but the richest of us anyway. You got a million bucks sitting around after you’ve been rescissioned?)

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  30. nadine says:

    questions, tort reform does not mean that you can’t sue a doctor. It just makes it a little harder to sue a doctor and caps the ability of jury to grant 10s of millions in awards. It’s trying to weed out the slip-and-fall lawyers who see big bucks in any bad medical outcome, whether there was malpractice or not.
    You do have real life case studies about the results of tort reform, as Texas has implemented it. Several Texas HMOs have seen their litigation costs plunge. And there is a tremendous influx of doctors moving to Texas, who have been driven out of business by malpractice costs in other states. There are many places now without obstetricians because they have to pay such huge malpractice insurance to stay in business. And they are a huge target for the slip-and-fall lawyers who see a payday in every birth defect.

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  31. nadine says:

    questions, I went down your list:
    “1. Lower price doesn’t mean more extraneous consumption. That is, if a hospital runs a sale on bypass surgery, they don’t generate extra sales because people seek out bypass surgery only when it’s utterly necessary. Medical care is sought out only as needed, not as priced.”
    Nope. Only true for emergency procedures, and they are a small minority of what gets done. Medical tourism to Costa Rica and Thailand is a booming industry precisely because everything costs 1/4 as much there.
    But the problem with today’s medical decisions is that normal individual decisions which take price into account don’t happen because often some third party is paying and nobody knows what the test or procedure costs. This also means that the efficient lab that can lower costs doesn’t have nearly as big an advantage as it should over the inefficient lab with high costs. Health provider markets are thus extremely inefficient (=very high cost).
    “2. Improvements in technology in health care do not lower prices, they raise prices.”
    Agreed. Well, the old treatment becomes cheaper, but the new one is expensive.
    “3. Health care is a basic necessity that ought not to be rationed based on ability to pay. It’s like air and water. ”
    Or food or housing. Should the government hand those out for free too? Remember, he who pays the piper calls the tune.
    “It should be used carefully and only as needed, but it should be available. Mechanisms other than market-based rationing need to be developed.”
    Your first sentence is at odds with your second. What is free is never used carefully and only as needed. We already have many mechanisms other than market-based for rationing care; emergency rooms must by law treat all patients who need care, and the indigent will be signed up for Medicaid. There is Medicare, etc. You can combine such mechanisms with a system that is mostly market-based.
    “4. Health insurance companies are not subject to anti-trust laws. They have near-monopolies in many many places around the country. This is no market.”
    They have near monopolies because government regulation has forbidden competition! The huge complexities and cost of government mandates prevent companies from competing across state lines and from devising policies that suit customer needs. There was just an op-ed in today’s WSJ from somebody whose affordable NY hopitalization policy would be made illegal by Pelosicare. And if you think it’s expensive now, wait until something like Pelosicare passes, you ain’t seen nuthin’ yet.
    “5. Health insurance would seem to be a one-way contract. You pay in, you keep it. You need money, they drop you. What’s the market here?”
    If they drop you wrongfully (which happens much less often than Obama is making out), you sue them. Plaintiff’s lawyers love good cases like this. But answer me this: if Pelosicare refuses to cover you for something you thought you were promised, whom do you sue? The government has sovereign immunity. Then you’re stuck!
    “The market responds poorly to drug development for orphan drugs. The market responds not at all to actual need. ”
    It is true that the market response follows a profit motive, which as a whole is tremendously responsive to actual need. If you ask some company to spend millions of dollars over a decade to develop a new drug, it hardly seems unfair if the company wants to recoup their investment and make a profit. If you demand that medical research companies donate their services for free, you will soon have to stop worrying about the cost of new medical advances because there won’t be any.
    “7. The market really doesn’t support human need, and the collective power of us all needs to step in and push so that more money is spent on R and D for things we need rather than for all the vanity stuff we pursue”
    So the wants of real people should be ignored, and some unelected federal bureaucrat should decide what gets pursued instead? Following the latest five year plan, I suppose. Look, centralized planning of something as complex as 1/6 of the US economy DOES NOT AND CANNOT WORK. Please, for goodness sake, go read a history of the USSR if you are too young to remember anything about it.
    “Upward cost pressure comes because: it’s insanely expensive to go to med school and it’s insanely miserable to get through and people who put up with this want status and reward” etc
    All the more reason NOT to design a single payer system that essentially makes RMV clerks out of these people (who are also very smart and compassionate) with government bureaucrats overseeing their medical decisions and work environment. Plus not paying them enough to live on. Did you know that doctors currently have to overcharge private insurance patients to make up for Medicare underpayments? And Medicaid is even worse. When everybody’s on Medicare, the doctors will go broke en masse. Nobody has done anything to control their costs.
    The good ones won’t stand for it; they will head for the hills, retire or open cash-only boutiques. The current doctor shortage will become a critical doctor shortage, unless you have cash on the barrel head to pay. Which incidentally, is how it really works in a lot of socialist countries with “free” health care right now.
    “Routine care is worthwhile because dealing with an abscessed tooth when it’s just a little cavity would be a humane thing to do.”
    Agreed, it’s humane, but preventative care does not save money. There have been several good studies all pointing to that conclusion. You know what does save money? Rationing care. Once you have essentially a single payer system in place (and make no mistake, something like Pelosicare is the stalking horse for single payer), this thought does occur to the law-makers as they struggle with the every-exploding costs. Then you get formulations like Britain’s NICE rules, which calculate how many “quality years” you are likely to have left, which is used in a formula to determine whether you get that operation or not. And if they deny you, there is nobody to sue.
    Look, the bottom line is this: medical care is labor-intensive, skilled, and in finite supply. Demand for medical care is nearly infinite. Thus medical care must be rationed somehow. Do you prefer that you make individual choices for yourself using an efficient market based mechanism, or do you prefer that some bureaucrat make choices for you, using an inefficient centralized planning system?
    I know which I prefer. But even if you stick with the second choice, do please give up the idea that it will be utopia; expect long lines, mediocre service, and wide-spread shortages, and you will be less disillusioned by what comes next. Fifteen years ago Hillary Clinton had the government take over the production of flu vaccine to give it out for “free”. Look how well that has been going!

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  32. questions says:

    I suppose I’ll say on tort reform, I’m just unconvinced. Lawsuits are far more avoidable than one would think, premium increases seem to track the stock market more than they track state-level limits on lawsuits, and the bulk of the tort reform info seems to come from the fairly biased and tainted interested parties, even as anti-reform info seems mostly to come from a different set of biased parties.
    Since there’s not a huge amount of info that seems to be of high quality on this one, I tend to be a little more moderate. I don’t at all trust the doctors, the insurance companies, or Republicans. And probably some reform of some sort might be good — mediation boards, a state fund to take care of the most injured parties so that “deep pockets” issues don’t come up in jury trials, and some serious penalties for the most willful negligence. I have no love of insurance company profits, though, I can assure you of that.
    Fact is, patients need power against doctors. I’m not sure why you’d sign away your right to sue a doctor who, say, leaves you on the operating table long enough to call his/her stock broker and make a trade…. And why would you sign away your rights at all? For what good end? Apply tort reform to your own life and your own chances of being grossly misdiagnosed by someone who should know better, grossly injured by someone who removed the wrong leg or kidney (really think about that one for a while — the WRONG kidney) — you really want to give it up? Limit your damage award to direct medical costs? Really? And for what? To save the insurance companies?
    As an aside, Stupak is looking worse and worse, isn’t it…. I doubt it’ll stand as is, though. And I hope it leads to a range of consequences to some number of MCs….

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  33. nadine says:

    questions, I saw that study. It covered only the costs of litigation, not the costs of malpractice insurance or especially, the costs of defensive medicine, which is the elephant in the middle of this living room, usually estimated at something like 200 billion per year in unnecessary procedures.
    Let me put it this way: if it’s really no biggie, why isn’t in the Pelosi bill? You could make the bill a lot more palatable to the Blue Dogs if you could point to some cost containment. She might not have needed the Stupak amendment at all. But not only is no tort reform in the bill, it requires states like Texas to roll back some of the tort reform they already passed. A great big wet kiss to the trial bar. For women’s freedom of choice, not so much. Priorities are priorities, I suppose.

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  34. questions says:

    There was, by the way, a well done report on tort reform efforts recently. The conclusion is a 2-3% lowering of costs. Tort reform is a lot less of a factor than the right wants, and maybe something of a factor though the left might like to leave it out. If one cannot sue massively for gross negligence, then there’s not much of a check against doctors’ willful negligence. BUT, it turns out that many worthy lawsuits aren’t pressed, doctors can avoid being sued by doing things like apologizing, explaining what’s going on, running through the list of normal complications so that patients are well informed about what can go wrong and just how often it does go wrong. Much could be done in doctor-training, then, to avoid a large number of law suits. And it’s possible that state boards might play a legitimate intercessionary role to cut down on certain kinds of suits.
    BUT every judgment against a doctor for malpractice has survived lawyers, judges, juries, witnesses, experts…. Maybe there are some actual actionable torts out there? Maybe the insurance companies don’t quite tell the honest truth about what drives premium hikes? Maybe the stock market returns on invested premiums have SOMEthing to do with premium hikes? Maybe???

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  35. questions says:

    I was going to stop writing here, and I am certainly going to slow down, but….
    To the best of my non-economist’s understanding of the universe, health care is unlike other commodities because:
    1. Lower price doesn’t mean more extraneous consumption. That is, if a hospital runs a sale on bypass surgery, they don’t generate extra sales because people seek out bypass surgery only when it’s utterly necessary. Medical care is sought out only as needed, not as priced.
    2. Improvements in technology in health care do not lower prices, they raise prices. Biologic drugs are miracles for people with a wide range of autoimmune diseases. These drugs make life possible and even enjoyable for many. These drugs cost 20 or 30 THOUSAND dollars a year. They work better than older immune drugs. They ADD to health care costs, they don’t subtract. Compare that to what happens with new and improved computer chips and the cost of electronics over time.
    3. Health care is a basic necessity that ought not to be rationed based on ability to pay. It’s like air and water. It should be used carefully and only as needed, but it should be available. Mechanisms other than market-based rationing need to be developed. My kid shouldn’t die from an abscessed tooth because I work for a small employer. I shouldn’t die from an asthma attack just because my boss’s shop was foreclosed on and I lost my job. I shouldn’t be denied cancer care because I had acne when I was 14 and didn’t think to put it on the application because it seemed so trivial.
    4. Health insurance companies are not subject to anti-trust laws. They have near-monopolies in many many places around the country. This is no market.
    5. Health insurance would seem to be a one-way contract. You pay in, you keep it. You need money, they drop you. What’s the market here?
    6. And once more, people’s lives are actually on the line. The market responds poorly to drug development for orphan drugs. The market responds not at all to actual need. The level of greed and profiteering that is built into the system from corporate charters through a sense of entitlement through a lack of basic respect for the very lives of others should shock our consciences. But it doesn’t. It seems to be a rational response to a Hobbesian world where we are after “power after power” in a struggle that “ceaseth onely in death” and, man, we want that power.
    7. The market really doesn’t support human need, and the collective power of us all needs to step in and push so that more money is spent on R and D for things we need rather than for all the vanity stuff we pursue. The market doesn’t do this well either. High risk, low return research is best taken on by non-profits, by the collective power of us all.
    8. Upward cost pressure comes because: it’s insanely expensive to go to med school and it’s insanely miserable to get through and people who put up with this want status and reward and so they want insanely high pay; technology is expensive to develop and expensive to purchase and expensive to use and it doesn’t lower prices or increase efficiency; medical care is labor intensive and like all labor intensive fields, the inflation rate is the labor inflation rate, not the consumer price rate; (you can’t teach people more efficiently than having one prof and 10 or 20 students hanging out talking for 10 or 14 or 18 weeks (when you get 300 or 500 students, you get less learning of the sort that should happen), so education is insanely expensive.) Medicine works best with one patient at a time, a nurse or two or three, some allied health professionals and technicians, a few doctors, a bunch of machines, a ton of drugs, a lot of record-keeping and thinking and research. It’s just expensive to keep us all alive because we’ve gotten better at keeping us all alive. Insurance isn’t burdened by mandates to cover stuff; rather it is made slightly more humane and worth having for all the mandates. If we move to mere catastrophic coverage (and this is certainly one model of health insurance), then we will generate large numbers of catastrophically ill people. Routine care is worthwhile because dealing with an abscessed tooth when it’s just a little cavity would be a humane thing to do. Dealing with it when it’s a brain infection is pretty awful.
    Any thoughts? Or is this just one of those left/right divisions where you’ll never see my points and I’ll never see yours?

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  36. nadine says:

    questions, healthcare in large part does not behave like other markets because of the enormous role government has to mandate, regulate and pay, and stifle competition. The house healthcare bill does NOTHING to cut costs, which are the chief problem with the current system.
    Entire health care professions exist solely to satisfy Medicare requirements/game the system. We hear Medicare has low overhead, well it has low fraud detection too.
    Competition is largely regulated out of the insurance system, because insurers are told what they must cover and are not allowed to compete nationally. The house bill makes it all worse by mandating more coverage and no pre-existing conditions. Everyone’s cost will soar. Healthy people will drop coverage, leaving a sicker and more impoverished pool.
    This health care bill is a great big wet kiss to the trial bar, effectively requiring states to repeal tort reform if they have passed it. Tort reform could save hundreds of billions a year in unneeded defensive medicine. Many specialists have to pay six figures in malpractice insurance just to turn on the lights in their office.
    You have to get costs down. Pelosi’s bill will make costs skyrocket.

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  37. David says:

    Gonna have to give ground on taxpayer-assisted health care not covering abortions. It was an unavoidable concession.
    Time for NARAL, Planned Parenthood, NOW, and every other enlightened progessive organization to begin putting together a fund to assist women with the cost of an abortion. I would do it through direct support to the providers, making it possible for them to lower their fees as much as the financial circumstances of the person seeking an abortion dictates. Ideally, these clinics could be sufficiently well funded through the efforts of supportive groups (and individuals) for them simply to provide these health care services.
    Of paramount importance is that a woman’s right to choose not be in any way compromised. The state simply has no right to mandate that a woman continue a pregnancy if she chooses otherwise. It is her body, her health, her physical risk (women do still die because of pregnancies). Her womb is not a property of the state, and the risks associated with pregnancy are not the state’s to impose on a woman against her wishes.
    Yes, I do know someone who was told a pregnancy could cost her her life – and it did. And while most pregnancies are successful and most women’s lives are not the price, I repeat: The state has no right to demand that any woman who chooses not to continue a pregnancy be compelled to do so.

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  38. questions says:

    From TPM regarding Stupak-Pitts:
    “The letter of the amendment itself suggests that women who want to buy an insurance plan that covers abortion must not also be receiving government subsidies, provided for in the bill, to help cover their premiums. However, the overwhelming majority of women in the health insurance exchanges will be receiving subsidies from the government, and if any of them decide they want abortion coverage, under the terms of the Stupak amendment, they’d have to buy a supplemental plan paid for out of pocket.
    That could reduce private insurers’ incentive to offer any comprehensive plans that cover abortion–a view articulated by Jessica Arons, Director of the Women’s Health and Rights Program at the Center for American Progress, and adopted by some lawmakers on the Hill. Arons writes, “As the vast majority of Americans in the Exchange will need to use some of these credits [aka subsidies], it is highly unlikely any plan will want to offer abortion coverage.”
    But in an interview with TPMDC, Arons suggests it may be even more complicated than that. One of the pillars of reform legislation is a provision called “guaranteed issue,” which holds, basically, that insurers in the exchange must sell consumers whichever insurance policies they choose. However, the Stupak amendment would explicitly forbid people who are provided government subsidies from buying policies that cover abortion–and that contradiction could run afoul of the promise of guaranteed issue from day one.
    “It’s a somewhat open question about how those two provisions would interact,” Arons says.
    For the two measures to work in tandem, she says, either every plan in the exchange would have to be prevented from offering abortion coverage, or the guaranteed issue provision would have to be modified. “I would think there would have to be some sort of specific exemption to the guaranteed issue provision,” Arons says.”
    http://tpmdc.talkingpointsmemo.com/2009/11/controversial-stupak-amendment-sows-anger-confusion-on-capitol-hill.php
    ######
    Really interesting. All the hype, all the time, and yet legislatively, it’s so unclear what it all means. Funds will be raised all around while the lawyers try to interpret. And then the Senate will, per Obama’s instructions, dump the language in favor of Hyde Amendment crap instead. Wow.

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  39. PissedOffAmerican says:

    “The next time I read about the deplorable conditions for women around the world on your site I’ll remember that concern only applies to women outside the U.S.”
    Oh come on, give this site a break. After all, Wiggie and Nadine are constantly on the lookout for more humane ways to exterminate Palestinian women, and Kotz is very much involved in advancing serious rationales for putting Afghani, Iranian, and Iraqi women out of their misery.
    Neda is a big hit around here. Heck, if those Irani women are real lucky, we might even bomb the shit out ‘em, just to show them how much we care.

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  40. Lea Knapp says:

    I guess when you spend most of your time on foreign policy and national security issues, getting a health care bill passed in the House at the expense of health care for millions of women is a minor triviality. The next time I read about the deplorable conditions for women around the world on your site I’ll remember that concern only applies to women outside the U.S. But within America – women’s access to legal health procedures is an easy political give-away.
    Gee – thanks Mr. Clemons.

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  41. bob h says:

    “39 Democratic defections — too many in my book.’
    But surely most of those were allowed, political cover defections for 2010 Republican attacks.

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  42. questions says:

    Whoa, POA, where’s the refutation, the charge of fog, the usual stuff from you??!!

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  43. downtown says:

    “Every country has the government it deserves”
    J M de Maistre

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  44. questions says:

    “Would provide credits for premium costs and other health care expenses to citizens or legal immigrants who buy insurance through the exchange. Verification of legal immigration status would be required to receive subsidies.
    Households with incomes up to 400 percent of the federal poverty level ($88,200 for a family of four) would be eligible to receive premium credits, if they pay specified percentages of their income toward the premium. Premium contributions would range from 3 percent to 12 percent depending on the income. People with insurance from employers would be eligible for the credits if the cost of their premium exceeds 12 percent of their income.
    The proposal would also offer cost-sharing subsidies and reduce out-of-pocket spending limits for those under 400 percent of the poverty level.”
    Looks like reasonable subsidies, too. If you can’t manage insurance premiums when you’re household income is over 80,000, you’re probably not budgeting well. And yet, you’ll be subsidized under certain circumstances. Insurance should be a first dollar expense. It should not come after a new car or the mortgage or a vacation. There’s an attempt to try to alter people’s spending without impoverishing those who are already on the hamster wheel of life. See, Nadine, AND POA, both your concerns are being dealt with — individual responsibility to prioritize better, and a realization that those who have already bought cars and houses and private school tuition and swimming pools with their decent-sized incomes may well be in a bind over this new expense.

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  45. questions says:

    “Would require the basic benefits package to cover 70 percent of the health care spending covered by the plan. Consumers would pay the remainder, in deductibles, co-payments and other charges. The plan would cap out-of-pocket health care spending to $5,000 for an individual and $10,000 for a family.
    Insurers could choose to cover or not cover abortion as they see fit. But people who receive federal subsidies to buy insurance cannot choose a plan that includes abortion coverage. Federal tax dollars can only be used for abortion as allowed by current law, in case of rape or incest or if the life of a pregnant woman is in danger.
    Insurers could not deny coverage because of a person’s pre-existing conditions. Variation in premiums is limited. Maximum difference in premiums based on age is 2 to 1 (for oldest group, compared with young adults).
    The legislation would also revoke the exemption from federal antitrust law that health insurance companies have long enjoyed. It would outlaw price-fixing, bid rigging and “market allocations” by companies that sell health insurance or medical malpractice insurance.
    Insurance plans covering children and their parents would have to continue “dependent coverage” for children through age 26. Rules and age limits for dependents under employer plans currently vary by state.
    Besides the basic plan, the legislation would create three other levels of coverage to be offered through the health insurance exchange, covering up to 95 percent of costs. The Congressional Budget Office says the actuarial value of policies bought in the individual insurance market now averages 55 percent to 60 percent.”
    There’s a lot to like here. Ending anti-trust exemption, covering young adults to their 27th b’day, no pre-existing conditions. Sad on the abortion issue and on the premium difference. It would be better to smooth out the premiums because that’s more in the spirit of our sharing risk, but it’s not a horrible compromise. And even the abortion issue isn’t the worst compromise since we’re likely status quo on that one. Not a lot of women who currently have abortion coverage will lose it, I would guess, and abortion isn’t anywhere near as expensive as cancer treatment or diabetes treatment, or even taking care of a broken arm. It’s pretty pathetic that this has to be traded off yet again, but we do live in the same country as a bunch of narrow minded idiots. Not much we can do about that. Donate to Planned Parenthood, I guess. They could start a fund for just these women.
    http://www.nytimes.com/interactive/2009/08/12/us/politics/0812-plan-comparison.html#tab=7

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  46. questions says:

    I found this explanation from a poster at a blog:
    “The problem with the Camp release is that it totally mischaracterizes the JCT letter which you can read for yourself here: http://republicans.waysandmeans.house.gov/UploadedFiles/JCTletter110509.pdf (3 pages, 1MB).
    First of all the letter does not reference “$15,000 Policy” Camp came up with that on his own. And the idea that $15,000 will be the typical price of such a plan absent a subsidy is unfounded. I would have to take a closer look at the definition of ‘cost sharing’ but Sec 222 (c)(2) limits it to $10,000 for a family, $5000 for an individual. Now this doesn’t include premiums so it is theoretically possible for people making over the median household income to be exposed to something approaching this level but only if insurance companies can prove they have been paying out at least 85% of combined premiums/cost sharing in the form of actual medical care. In other words Camp picked an outlier and presented it as typical.
    Second Camp’s release strongly implies that Pelosi’s bill explicitly provides for this $250,000 fine and 5 year jail term. Well it doesn’t, instead this represents the top end of a current range of punishment for falsifying a tax return. The JCT letter lays out the penalties for a Civil violation, a Misdemeanor violation, and a Felony violation under CURRENT law, further noting that the actual Code section governing this part of the law limits that fine to $100,000, and that while their were 692,000 cases of civil penalties being applied in 2008, their were only 752 indictments and 666 convictions under this law. They don’t break down how many of those are misdemeanors (punishable by a maximum $25,000 fine and 1 year in jail) but we can readily assume that most people who are pursued under felony charges are pretty major tax evaders and drug kingpins. The idea that Nancy Pelosi decided that failure to pay your penalty means you are going to end up in the slammer with a $250,000 tax lien is simple demagoguery.
    A careful reading of the letter shows that Camp deliberately set out to manufacture a talking point, one that has since dutifully shown up on Bartbreit’s site and then out to comment threads everywhere.
    There is no mandate “to buy what we tell you or you go to jail”, that is just artificially manufactured out of a couple of outliers bullshit swallowed whole by assorted wingnuts. The bill that is on the floor does not mention any of this, those penalties simply follow the general provisions of existing law.”
    http://www.washingtonmonthly.com/archives/individual/2009_11/020854.php#1660768
    This was from Washington Monthly. Everything else that referred to the jail time issue was right wing insanity. Here’s a clear statement of where the notion comes from. It’s seemingly not in the bill that just passed in the House.

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  47. questions says:

    Looks like the House version has a public option?? Not Medicare plus 5, which was the “robust” version, but a public option nonetheless.
    “Would create a new government insurance plan that would negotiate rates with doctors and hospitals, rather than using Medicare rates set by the government.
    The public plan would have to offer different levels of benefits, covering between 70 to 95 percent of health care expenses.
    Like private plans, the public plan must offer the same benefits, comply with the same insurance market reforms, follow provider network requirements and other consumer protections. The plan would not provide abortion coverage.
    Health care providers would not be required to participate in the plan. But the bill assumes that providers participating in Medicare are participants of the public plan, unless they opt out.
    The government would allocate $2 billion in start-up money but the public plan must be financially self-sustaining. The bill would require premiums, paid by beneficiaries, to cover the plan’s cost. The government would also provide loans to start up non-profit insurance cooperatives to compete with private insurers and the public plan.
    The legislation would also create a public long-term-care program that would provide cash assistance — not less than an average of $50 per day — to people who become disabled. The program would be financed through premiums deducted from paychecks of people who choose to participate. Workers would have to contribute for at least five years before they can collect benefits.”
    Here’s a thing on the mandates from the same site:
    “Would include mandate.
    Penalty: 2.5 percent of adjusted gross income over a certain level, which is $9,350 for singles and $18,700 for couples.
    Exempt those with incomes below the above-mentioned thresholds, American Indians, people with religious objections and people who can show financial hardship.”
    If there’s actual text about jail time, let me know. 2.5% of income is not going to hit 250,000 for people who are having problems buying insurance. And people who have hardship issues aren’t going to pay….. I’m curious about what you think you found.
    http://www.nytimes.com/interactive/2009/08/12/us/politics/0812-plan-comparison.html#tab=3

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  48. PissedOffAmerican says:

    Look it up yourself, questions.
    The bill carries a provision for punishment if your income is over $15,000. You MUST buy health insurance, or be subject to a fine of up to $250,000, or one year in jail. They had some asshole Dem Senator on CNN this explaining that, “Well, we require people to carry auto insurance….blablahblah…”
    And no public option is all we really need to know to determine who will profit by this. These pieces of shit in DC just handed the thieves in the insurance racket a whole new client base to fuck over and rip off.
    I know what we’ll end up with, questions; sore assholes.

    Reply

  49. questions says:

    Go to jail? Gotta link? I’m curious.
    Shape of final bill will not be exactly the House version anyway. There’s the Senate and the conference….
    Who knows what we’ll end up with.

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  50. Linda says:

    Steve surely is correct that health care “reform” will suck all the oxygen out of Congress for the rest of this session.
    The best achievement of the Democrats on this was to have a vote at a reasonable hour and do it within the 15 minute limit. Never underestimate how tough and good a politician Nancy Pelosi is, every bit as tough as Rahm who surely was twisting arms too.
    The margin of “victory” was the same as Medicare Modernization Act of 2003, but the Republicans held their vote at 3 a.m. and had to keep it open until dawn while they twisted arms.
    The worst part is the Stupak amendment that was the only way to get a bill passed. If it stays through Senate and reconciliation, it means that no insurance policy offered through the exchange can cover abortion except for the most dire life-or-death consequences, i.e., no woman will be able to purchase entirely with her own funds coverage for abortion. There was no need for it because the Hyde Amendment has been included, i.e., all bills under consideration already prohibit use of tax dollars to pay for abortions.
    I’m not sure it could survive a constitutional challenge. It seems to me that it infringes on the right of a woman to choose what to she does with her own money and her own body. And if that woman’s religion is devotely pacifist, she doesn’t have the option of opting out of her tax dollars being used to pay for wars.
    On the other hand, the current SCOTUS just might declare it constitutional–which would be a big step toward overturning Roe v. Wade.
    Then I’d look to the two outliers to understand what really was happening the past few weeks behind the scenes–Joseph Cao, the only Republican to vote for the bill and Dennis Kuchinich, the only liberal Democrat to vote against it.
    Cao is a Republican elected to fill William Jefferson’s New Orleans very Democratic seat. The bio on his Congressional website is worth a read. He came to U.S. as a child when Saigon fell, devout Catholic who almost entered the priesthood, obviously a very intelligent and honorable man. He represented his constituents well and got some commitment of favors for New Orleans and the Stupak amendment. The Democrats got a “bipartisan” bill and ability to taunt Eric Cantor and warn Republicans that they will do the same in the Senate.
    I believe Kuchinich when he says that he still would have voted “no” even if his vote were needed to pass the bill. He stood my his conviction that all health insurance should be non-profit and that we should have single payer. The statement explaining his vote on his Congressional website is worth reading. And while anyone is there, read the few paragraphs of his bio to recall his refusal to privatize Muny Light, public electric company, when he was mayor of Cleveland. Not many politicians today or even then would do the right thing knowing it would cost him/her re-election, but he was proved right in the long run.
    Some say that for political junkies, health care reform is the World Series. Game one was in the House. Game two will be in the Senate. Game three will be on conference committee,and then the
    vote in both houses of Congress.
    It takes four games to win, and the fourth game will take the next three years as HHS, DOL, IRS, etc. work out the regs and details of implementation. The public doesn’t follow those–only all the lobbying and interest groups. But that’s what ultimately will determine the winners and losers.
    So as Yogi said, “It aint’ over until it’s over.”

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  51. PissedOffAmerican says:

    No substantive public option, and go to jail if you don’t have coverage. This is a bonanza for the insurance companies. Yet questions would have you believe the insurance industry didn’t have a hand in sabotaging the public option. Only an ass would think the insurance industry will not be a huge factor in determining what the eventual ACTUAL health care bill will look like.

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  52. questions says:

    http://www.washingtonpost.com/wp-srv/special/politics/votes/house/healthcare/index.html?hpid=topnews
    A chart that lists the amount of money each House member got from health industry and their votes on the health care bill yesterday. Note that many big money getters voted FOR reform.
    It ain’t the lobbying, folks, it’s the ideology, party ID, district, re-election concerns. Note that some people w/o insurance or w/bad insurance still don’t want reform via the government.
    So, POA, it isn’t all lobbying all the time, even here…..
    And Nadine, please read up more in health care economics before you collapse completely. Health care doesn’t entirely behave like other commodities and so doesn’t work in the market the way other commodities do. If your main complaint is a doctor shortage, then what you’re really saying is that it’s better to deny necessary care to some so that others don’t have to wait a few weeks to see their internists for minor issues?? Think about the trade offs involved. People are dying because they can’t afford to see doctors for some basic stuff (like ear infections, even) and this just shouldn’t happen. If it takes me 3 months to see my internist for a physical, so be it. I’d rather be a little sub-optimal myself and know that others are alive, than do all for myself and know that others have died so I could get in same-day. Really.

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  53. DonS says:

    The US has had no excuse for not having health coverage for everyone while having plenty of money to engage in any and every conflict imaginable for no sufficient reason of national security.
    Do I have confidence that the package will be the best it can for the benefit of citizens and not the medical establishment? That’s another question. But a country can’t call itself civilized if it chooses war over health care and thinks that’s right.

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  54. nadine says:

    Is the bill designed to work, or is it designed to fail and be the stalking horse for single payer?
    In any case, the markets’ reaction should be interesting. This puppy is far more likely to cost 2 or 3 Trillion dollars over the next ten years than to be “deficit neutral” (after they got done rescinding the $500 Billion in Medicare cuts and do the $250 Billion “doc fix”). If Pelosi wants to destroy the dollar, she’s going the right way about it.

    Reply

  55. PissedOffAmerican says:

    As pointed out by the occassionally sane and usually shrewish Taylor Marsh, this bill pretty well handed the screws to women’s rights. But Pelosi doesn’t give a shit, she can afford a bionic womb and a gold plated uteris if she gets the whim.
    I imagine, after its too late for the American taxpayer, the actual text of this bill will be examined by someone not destined to profit by it, and we will once again find out that we’ve, (men AND women), been royally fucked.

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