How Obama Botched and Bungled the Health Reform Message

How Obama Botched and Bungled the Health Reform Message

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While it’s comforting to just blame the GOP for the unhappiness with health reform threatening the president’s re-election, the truth is that Barack Obama repeatedly botched, bungled and bobbled the health reform message. There were three big mistakes:

The Passionless Play

While Candidate Obama proclaimed a passionate moral commitment to fix American health care, President Obama delved into legislative details.

When a Baptist minister at a nationally televised town hall asked in mid-2009 whether reform would cause his benefits to be taxed due to “government taking over health care,” Candidate Obama might have replied that 22,000 of the minister’s neighbors die each year because they lack any benefits at all. Instead, President Obama’s three-part reply recapped his plans for tax code fairness.

While Republicans railed about mythical “death panels,” and angry Tea Party demonstrators held signs showing Obama with a Hitler moustache, the president opted to leave emotion to his opponents. The former grassroots organizer who inspired a million people of all ages and ethnicities to flock to Washington for his inauguration never once tried to mobilize ordinary Americans to demand a basic right available in all other industrialized nations. In fact, he hasn’t even mobilized the nearly 50 million uninsured, who have no more favorable opinion about the new law than those with health insurance!


When CNN captured a sobbing middle-aged woman telling Sen. Tom Coburn (R-OK) of her husband’s brain tumor, only to get the reply, “Government is not the answer,” the president might have helped all Americans feel her pain. He did nothing of the sort. The public face of “Obamacare” was never a mother, father, spouse or child, but, just as the Republicans wished, it remained…Obama.

The Friend (or Enemy) of the People

Hard as it is to recall, a New York Times-CBS News poll in mid-2009 showed nearly three-quarters of Americans supported universal coverage through a government-administered plan like Medicare. But the survey also revealed “considerable unease about the impact of heightened government involvement on…the quality of the respondents’ own medical care.”

That unease surfaced even in the heart of liberal Chicago, at a Second City show satirizing the new president. A doctor tells a woman her diagnosis gives her only three months to live. When she pleads for help, the doctor tells her the good news is that Obama’s health reform plan means she’s scheduled for her next visit just six months from now. The parking lot was packed with “Obama ’08” stickers, but the audience still broke out in laughter.

The comedy worked because it connected with real feelings. GOP consultant Frank Luntz soon urged Republicans to stress quality-of-care concerns. Obama and team remained tone deaf. Three years later, the same Times-CBS poll showed only one in five Americans thought the ACA would help them personally. A full third expected their quality of care to worsen, and just 17 percent expected it would get better.

In fact, though the individual mandate to buy insurance has received the most attention, the ACA is filled with provisions to improve care quality and individuals’ care. But for many middle-class voters, the answer to, “What’s in health reform for me?” was allowed to become, “Nothing good.”

The Caricatured Crusader.

When GOP leaders decided to just say no to Obamacare, they were honest about their political calculus. The polarization worked.

The number of Republicans saying reform would make their lives “worse off” started at only 22 percent in early 2009, according to the Kaiser Family Foundation (KFF) tracking poll, before jumping to 61 percent that summer. Just 11 percent of the critical independents began by thinking that health care reform would make them worse off, but that percentage more than tripled by summer to 36 percent.

In early 2010, the White House posted a list detailing which proposals by which Republicans had echoes in the ACA. That the mandate had originated in the conservative Heritage Foundation was nowhere to be found. Nor did the White House note that the GOP’s 2008 presidential platform had called for coordinated care and other changes almost identical to ACA provisions. In the event, none of this information was used to respond to the GOP attacks that helped sweep out Democratic candidates in the 2010 election tsunami.

It was only this past March that the administration, acting as if the Supreme Court’s ACA hearing was a political pep rally, sprang into action. It activated supporters, talked up the ACA’s Republican roots and rolled out press releases touting the law’s benefits for average Americans. It was too little, too late.

A 2009 report by the Institute of Medicine concluded that the consequences of a lack of access to medical care include “needless illness, suffering, and even death,” with the victims frequently being children. Yet health reform’s opponents have managed to switch the discussion from dead kids to the Constitution’s commerce clause. All the while, Barack Obama has flailed and failed to convince the American people that “Obamacare” is change they can believe in.

Michael Millenson is a Highland Park, IL-based consultant, a visiting scholar at the Kellogg School of Management and the author of “Demanding Medical Excellence: Doctors and Accountability in the Information Age. This post originally appeared in The Huffington Post.

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105 Comments on "How Obama Botched and Bungled the Health Reform Message"


Guest

私はよく分からない理由正確な理由が、この私のために遅いサイト信じられないほど非常に極端ロードしています。 問題の問題か、ある他の誰がこのをしている問題は私の最後に? 後で後でと問題がまだ存在するかどうか私は戻ってチェックします。

Guest
Jan 4, 2014

Algo que se puede aprender de valor de cada entrada del blog y es hilo de los comentarios.

Guest
Peter1
May 29, 2012

“They add no value to the system.”

Bill, doctors (self employed) add no value to the system? Hospitals add no value to the system?

“At some point it would make sense to incorporate.”

It usually makes sense to incorporate. Heard of an “S” corp? Millions of them, but none are what I would consider, “entrepreneurs”. They don’t create anything but for themselves – no jobs, no investment, just personal income with the protection of limited liability . Entrepreneurs usually create waves, others just ride them – as a single self employed you’re riding a wave.

“The average person who may have all the right stuff to start a business is shut out because of initial costs, while people who already have money fill the void. And when they succeed, they just get more.”

Age old problem. But if it were easy you’d have much more competition and the potential rewards would not be as great. Would you want the government to make it easier for you?

“What you and I experience is hardly a market. There is no price transparency, no ability to shop around, no choice. There are exactly three insurance companies offering individual policies here in NH, dominated by Anthem.”

You may not “experience a market” but I do. As a self pay uninsured I always attempt to get a discount and shop around with providers. It’s not easy and I agree price transparency is non-existent, but with work and a hard mental attitude it does work to a degree. If you have a high deductible plan with health savings then you need to bargain just as hard as I try. Have you ever tried to get a discount from your doctor?

I don’t like the system and would prefer single-pay where I don’t have to negotiate price with my provider – but for now I have to.

By the way, most retail choice and price competition is an illusion. A limited number of manufacturers dictating MSRP that inflates the price to allow “sales” discounts give the consumer a false idea that they’re in control. Auto dealers are the worst offenders. Ever wonder why Ford dealers can offer $1000s off MSRP – because MSRP is just a marketing number. And you can’t get a written quote to take from dealer to dealer – they make you sign a binding sales contract to get the “price”.

Would you want the same system for your doctor? Would you want your doctor putting ads on TV offering sales discounts? In health care do you shop price or look for best qualified?

Guest
May 28, 2012

I am not sure if your last comment on education was ironic or serious, but either way you have hit on a very core issue —

namely, what costs are the responsbility of society and what costs are the responsibility of the individual?

Most areas of American life have pretty good clarity on this classic question.
The public pays for the fire department with taxes, but you have to buy your own fire insurance and sprinkler systems. Taxes pay for public libraries, but if you want to own a book or get it fast you have to buy it yourself.

Health care has much less clarity, which is partly why we have been debating it for the last thirty years.

Pregnancy is a perfect example of our muddled-ness. Poor people on Medicaid get free childbirth, and new mothers on group insurance get childbirth with deductibles, but new mothers outside these categories have to worry about every hospital bill.

I am on the side of those who feel that childbirth should be free for anyone.
If we can pay $500 billion a year to keep seniors alive to age 78+, we can pay about $35 billion a year to make all 4 million annual childbirths into risk-free events.

But instead of the clarity which I would desire, we have some states with mandates and some employers with coverage, and our usual crazy quilt of spending huge amounts of money to prove we are not socialists.

Bob Hertz, The Health Care Crusade

Guest
May 28, 2012

Buying health insurance across state lines, at the present time, is beneficial primarily to men under age 45 in states like New York and Massachusetts.

There is a very specific reason. Those states require individual health policies to cover pregnancy. This causes all premiums to go up. Pregnancy is the most common cause of hospitalization under age 65.

Whereas that man can go to Idaho and buy a policy without maternity coverage. That might save him $400 a month, which is a lot.

This is not a trivial issue, but at the same time it is not the silver bullet of health care reform that some Republicans have been implying. The insurance companies which sell cheap policies to younger men are the same ones who decline anyone with a health history………it is the core of their business model.

Guest
Peter1
May 28, 2012

“Whereas that man can go to Idaho and buy a policy without maternity coverage. That might save him $400 a month, which is a lot.”

What might a policy in Idaho with pregnancy coverage cost? Surely with less risk spread it would quite expensive?

About 75% of property taxes go to support schools. We’ve never had kids, don’t plan to as do most people over 50. I’d love to be able to opt out of paying to educate other peoples kids.

Guest
Bill
May 27, 2012

It raises interesting questions. I use a payroll service that charges a very reasonable monthly rate. This initial rate stays the same for the first five employees (if I had employees), in any state in the US. The complexities of state-by-state payroll laws would appear to fall in line with the thinking of the report you cite, and yet this company is able to continue to offer their service at a low price.

Conversely, applying this model to Amazon would surely make book and other merchandise pricing skyrocket there because of compliance costs. So, are we saying we are able as a nation to turn a blind eye to the state regulation for enjoying book reading, but that it is impossible for health insurance? Is our thinking really that limited?

We need a paradigm shift. I don’t doubt the results of the report, but I do question the presumption that existing state rules are etched in stone.

Guest
May 27, 2012

I don’t think you’ll need to shop out of state to find lower health care costs. I bet you can find wide swings within a fifty mile radius. With the right PCP for advise, you and a few others might think about becoming your own health care co-op. It my be feasible to keep a concierge practice on retainer.
http://en.wikipedia.org/wiki/Concierge_medicine

(I’m going to bed Good night.)

Guest
Bill
May 27, 2012

John,

I’ll check out your blog and the co-op idea. Thanks.

Have a good night.

Guest
May 27, 2012

Oh I don’t think it has as much to do with regulations as the byzantine webs of contract arrangements and network configurations holding together the insurance people and the actual health care providers. I figured out a few years ago that health care billing (unlike whatever business you probably have) is not based on ordinary accounting. It’s more along the lines of “throw a bunch of sh** against the wall and see what sticks.” Unlike the Amazon inventory, healthcare isn’t something to be purchased on line and delivered by UPS. Here’s a post I put together recently about the crazy variations of health care costs.

http://www.newshoggers.com/blog/2012/04/hcr-crazy-health-care-costs.html

Take a look at the airlines comparison video. No need to watch it all the way through… You’ll get the idea pretty quick.

Guest
Bill
May 27, 2012

Peter1:

I’m used to the type of disdain you exhibit towards the self-employed and micro-businesses. We’re a legitimate work force of professionals, my friend.

My point is that entrepreneurship should be encouraged through a level playing field vis-a-vis health insurance costs. There are a host of jobs that can be done working from home, and most would agree the side effect of fewer cars on the road would be a good thing.

Guest
Peter1
May 28, 2012

“My point is that entrepreneurship should be encouraged through a level playing field vis-a-vis health insurance costs.”

Why just a level playing field for “entrepreneurship”? Why not everybody?

“Everything else about Obamacare is noise.”

Even being able to deduct 100% of your self-employed health costs?

“as Obama-care will compel folks to buy comprehensive policies, premiums will actually grow.”

So, pooling risk across state lines will lower costs and pooling risk across the entire country will raise premiums? A mandate will bring in a large pool of the healthy and young which will spread risk – even for you.

When people talk about buying across state lines they really mean they don’t want to pay for someone else’s risk but just buy what their risk represents in a pool system that fractures risk pooling.

“Or better yet, how about an actual market of 300 million Americans shopping for insurance across state lines?”

That would be government run single-pay. Other countries show that it can be done for about half of what we pay.

Guest
Bill
May 28, 2012

“Why just a level playing field for “entrepreneurship”? Why not everybody?”

Because the playing field is quite obviously tilted in favor of public and private unions and employees working for major corporations. For them, there is no healthcare crisis. Why would we devote energy to an area where there is no problem to begin with?

We should take steps to facilitate access to affordable health through work, not government subsidies. We need to make it easy for anybody to start a company or work for themselves. Say what the GOP will about wealthy job creators, but the fact is that anybody can be a job creator given the chance. Government workers paying $1,500/year for health and self-employed paying $20,000 is a grossly unfair system of crony politics. So, that’s why we should start with entrepreneurs.

(If I had to guess, you have very good health insurance. By and large, the only people I meet who are supporters of Obamacare are people who already have good coverage, and have never experienced what it’s like being outside of the government’s crony circle of favorites)

“Even being able to deduct 100% of your self-employed health costs?”

You obviously have never worked for yourself. Please enumerate the long list of breaks that the self-employed get. Let’s see, the financial crisis begotten from ill-conceived CDO’s, bad legislation, Fannie/Freddie… and oh wait, and the self-employed?

The self-employed have only been able to deduct health costs for the last two years. You are apparently tone deaf to that. Meanwhile, big companies have been able to deduct those costs forever. And guess what? The self-employment deduction is subject to review at year-end. This notion that self-employed have some big advantage is highly inaccurate, to say the least.

“That would be government run single-pay.”

No, it wouldn’t. It would be a market, which is apparently a foreign concept to you. I lived in Japan for over a decade with their single payer system, by the way. Our system is far superior, and a single payer system would be a huge step backwards. I don’t have time to list all my experiences there, will post on that later.

Guest
Peter1
May 28, 2012

“We need to make it easy for anybody to start a company or work for themselves.”

I guess you’d enjoy the increased price competition then? Working for yourself is about risk. The “market” is supposed to reward risk takers.

“We should take steps to facilitate access to affordable health through work”

I agree, affordable health care IS the issue, but that would mean significant price reductions from providers – many of which are self employed – like you. Would you like to take income away from them for your benefit?

“that’s why we should start with entrepreneurs”

Please don’t confuse being self employed and no employees like yourself with being an “entrepreneur”. Usually entrepreneurs risk large amounts of their own cash to build an organization/market where they employ people, and ironically then provide company paid health care to attract good employees.

“(If I had to guess, you have very good health insurance. By and large, the only people I meet who are supporters of Obamacare are people who already have good coverage, and have never experienced what it’s like being outside of the government’s crony circle of favorites)”

Actually I’m uninsured, mostly by choice. I don’t really support Obamacare as it did not address costs, and mandates we contribute to the most expensive system in the world. But on principle, a mandate is what is needed for a properly functioning system with no free riders.

I have never worked for government and have worked for myself as well as companies.

You’ll also find most people with company paid health care do not support Obamacare as they’re afraid they’ll loose something.

“No, it wouldn’t. It would be a market”

You seem to want it both ways, no government control (a “market”) but government facilitating easy access to affordable care. A “market” in health care is what you and I experience every day – the individual market, where we have to negotiate what we pay and what we can afford to have access to – without benefit of subsidies (private of public).

Why don’t you stop paying $20,000 per year to insurance companies and bank that money for your own health care? That’s what I’m doing.

Guest
Bill
May 28, 2012

“Would you like to take income away from them for your benefit?”

Yes, absolutely. And not for my benefit but everybody’s. They add no value to the system.

“Please don’t confuse being self employed and no employees like yourself with being an “entrepreneur”. ”

I respectfully disagree. A successful self-employed could just as easily start by farming work out to others as his/her business grows. At some point it would make sense to incorporate.

You are right about risk/reward. Your instinct about significant capital outlays being a prerequisite to entrepreneurship is wrong, though. In fact, if you make that a prerequisite, no wonder the wealth gap is only growing larger. The average person who may have all the right stuff to start a business is shut out because of initial costs, while people who already have money fill the void. And when they succeed, they just get more.

“You’ll also find most people with company paid health care do not support Obamacare as they’re afraid they’ll loose something.”

True.

“You seem to want it both ways”

No. The government has legislated a thicket of rules that prevents a market from happening. By ‘facilitate,’ I mean that the government would have to slash and burn much of those rules and get out of the way.

What you and I experience is hardly a market. There is no price transparency, no ability to shop around, no choice. There are exactly three insurance companies offering individual policies here in NH, dominated by Anthem.

When I shop for a used car, though, that’s a market. Tons of choice. A plethora of ways to research the product and pricing that supports it.

When I go buy groceries, same deal. In fact, let’s aliken grocery shopping to the health market. Imagine if you will… A union member going to buy a gallon of milk. His member card is processed when he checks out, and the milk costs a $1. A self-employed isn’t part of the club. When he checks out, the same milk costs $20.

In a nut shell, that’s how the health market works. Click on the link posted by John Ballard below and watch the ABC clip. Pricing is totally random. I’d wager that the person charged $50,000 for a routine procedure in the clip is self-employed.

You could argue in the example of the used car market, one person could negotiate a better deal than another. True. But, you would never get one person paying $15,000 for a used Tacoma with xxx miles, and another paying $75,000 for the same thing. And the reason that never happens is because of market forces.

“Why don’t you stop paying $20,000 per year to insurance companies and bank that money for your own health care?”

Because I am supporting my wife and two young kids. If it were just me I’d think about it.

Guest
May 27, 2012

Save me the pity party, Bill, and quit trying to game the system. Self-employed individuals and whatever you are calling microbusinesses have been popping up in America in good times and bad since before group insurance came about, and it’s still happening. One of the forgotten objectives of the Bush administration (which never happened) was tweaking the tax codes to uncouple health care from business altogether.

http://www.aei.org/article/society-and-culture/poverty/tax-reform-and-health-insurance/

When auto makers pay more for health care than for steel, or Starbucks pays more for coffee than group insurance — it’s time to take a few bricks off the wagon. Your “micro-business” is gonna be a helluva lot more successful if you can devise a way to get health care off the balance sheets altogether.

The smart self-employed people I know are using extremely high-deductible plans in conjunction with health savings accounts. That’s not disdain. It’s advice.

Guest
Bill
May 27, 2012

Thanks for the advice, John! Know of a higher deductible plan than the $10,000 one I already have? Geez, if it weren’t for expert advice like yours, what would I do?

No, you’re right. That’s not disdainful at all.

Microbusinesses = companies with 10 or fewer employees

Uncoupling health from business is exactly what I’m talking about. Pooling risk across states lines among 22 million self-employed seems a good start, and makes a lot more sense than a government takeover of the entire system.

Or better yet, how about an actual market of 300 million Americans shopping for insurance across state lines?

Guest
May 27, 2012

That “across state lines” trope is simply that — a trope.
The reality is that insurance is crafted in the several states in accordance with each state’s very different regulations. A recent study indicates that operating in several states has the unwanted result of driving up premiums.

http://www.insurancejournal.com/news/national/2012/05/08/246688.htm

The study compared the regulatory compliance costs of 85 insurance companies doing business in multiple states with 147 multi-state RRGs and found that traditional insurance companies have significantly higher compliance costs because of those multiple regulations. For instance, he found that the average traditional insurance company in his sample spends $187,000 a year on licensing fees in multiple states, while the average RRG spends only $49,000 for one.

In total, his research showed the average standard insurance company spends about $9 million a year to comply with regulations. RRGs, however, spend an average of $2.9 million to comply with regulations.

Leverty says those costs then drive up a firm’s expenses and are passed along to policyholders in the form of higher premiums. But more than that, he writes, they also limit consumer access and market competitiveness by acting as a drag on expansion into new states. Leverty’s research showed that the average standard insurance company pays $74,500 in new expenses whenever it enters a new state to comply with regulations in the new market.

It’s one of the favorite GOP talking points, I know. And it sounds great to me as well. But since the insurance lobby is probably second only to the defense industry, my guess is that they already knew it sounds good but is a stinking idea, or it would have long ago come about.

(Of course I’m not sure how they might square the circle of 10th amendment vs federalism. Interstate insurance commerce would be a Constitutional invitation for even more federal intervention than is already being complained about. )

Guest
Bill
May 27, 2012

Here in NH, the state employs roughly 10,000 full-time staff who pay very little for their health. I confirmed the exact amount by submitting an inquiry to http://www.nh.gov/transparentnh/, asking how much they pay. I would tell you, but there is a strongly worded confidentiality clause in the email from the Admin Dept that says I can’t.

So, despite the high irony of ‘confidential transparency,’ what I can tell you is this. As a self-employed person who is also self-insured in NH, I pay over 90% more per annum than they do.

Next. As part of the same inquiry, I asked how many self-employed there are in NH. They said they don’t know. Not surprising, because what else would we expect from the state of New Hampshire (and the rest of the country)? They don’t care about the small business segment of this economy. I discovered through reaching out to a small-business non-profit that about 130,000 self-employed work in NH.)

Pooling risk is supposed to be the centerpiece of Obamacare for bending the cost curve, but the above numbers directly contradict that. A tiny group of 10,000 pays a pittance compared to what 130,000 people would have to pay were they all to self-insure? It is insulting. We all know that several state and federal laws work in concert to explicitly prevent us from pooling risk.

There is a need to recognize self-employed and micro-businesses as contributors to the economy.

Allowing the self-employed to pool risk would not only do that. It would propel underemployed people back into the work force. I’m sure many people would try to work for themselves if they knew they could access fairly priced health insurance. It would dismantle the ‘cliff’ that one falls off when losing a job. But as the architects of the cliff know, if a skilled union employee saw a chance to quit the union and work for him or herself, he’d leave in a heartbeat. Union bosses know that there are many talented people who work for them. So it really pays to have a system in place where a union member pays under $2,000/year, and the self-insured pays $20,000/year.

Problem is, a side effect of keeping union rosters full is the death of entrepreneurship.

Come 2014, you might feel a little better if you earn below Obama’s subsidy lines. If not, as Obama-care will compel folks to buy comprehensive policies, premiums will actually grow. So the future is now for the self-employed. A grim, brutal reality of being ignored. Everything else about Obamacare is noise.

Guest
Peter1
May 27, 2012

“I pay over 90% more per annum than they do.”

You would probably pay 90% more than any employed person (public or private) who gets their health insurance paid (tax free) by their employer.

Bill, as a self employed person how much of that 90% do you deduct from your federal/state taxes on your return?

“There is a need to recognize self-employed and micro-businesses as contributors to the economy.”

How, by giving them more tax breaks?

Guest
May 13, 2012

Good points, John. For over 20 years, Medicare explicitly allowed hospitals to amortize the cost of new facilities inside the reimbursements for care. In other words, the feds paid hospitals to expand.

The result is that the fixed costs of US hospitals are about $600 billion a year.
Even if all the waste and corruption that you cite is flushed out, and it should be, the fixed costs might be $525 billion a year.

You are proposing some good ways to cut the fat, but I fear we might have to cut into bone as well to keep Medicare afloat.

Guest
May 13, 2012

Thanks.

One of my pet peeves after looking closely at the big picture for about eight years (I am a retired cafeteria manager, but my post-retirement life has been with senior care which as you know furnishes the biggest revenue stream for health care) is the status of what is euphemistically called “non-profits.” As far as I can tell, the operational and accounting practices of not-for-profit operations would quickly cause crash and burn results in the for-profit market. But thanks to their tax status there is no reason to be what for-profit operations call good business and ordinary people like you and I call being “thrifty and responsible.”

As a result, non-profits in health care, mostly hospitals but also a few insurance outfits (BCBS comes to mind) are mainly money laundering operations in a very profitable FOR-profit ecosystem from individual practices to drugs to clinics to large specialty practices. Patients are managed by the medical-industrial complex in the same manner that dairy cattle or poultry are managed by agri-business. They may as will be getting milked or laying eggs. And when I come across references to “transitions of care” it really pushes my button.

As long as we regard basic health care as a commodity these problems will not be resolved.

Guest
May 12, 2012

Excellent point. The question of where the money comes from is a sticky one, indeed. As you point out, both Social Security and Medicare/Medicaid have designated payroll taxes which seem to be generating two really big revenue streams. Tweaking Social Security would be fairly straightforward but the GOP continues to salivate every time they look at all those dollars actually going to beneficiaries without first being skinned by brokers and bankers so the same old privatization schemes keep getting pushed.

Medicare is a different story. I am of the opinion that there is enough money for health care, but not enough for the ancillary non-medical baggage that has grown on the system like an acute infestation of warts.

If Medicare and other medical expenses are to be lowered the answer lies not with rationing but with the reduction of the numerous non-medical expenses sucking the system for other purposes. This looks like another good place for me to paste my favorite list of non-medical expenses, all of which have but one revenue stream — medical
bills.

§ TV ads — some of the most expensive air time for some of the most costly productions in the ad industry.

§ Mammoth executive bonuses and golden parachutes for both health care
administrators and insurance companies

§ Facilities with manicured landscaping, marble floors, lived plants, flat-screen TVs in every room, and concierge food service

§ Elaborate accounting arrangements by which large so-called “not
for profit” health care systems, often augmented by equally large,
embedded insurance companies (BCBS comes to mind) launder bills mostly for the benefit of very profitable clinics, specialty practices and device manufacturers.

§ ”Free scooters” advertised for Medicare beneficiaries. Sometimes
comes with a free recipe book or lighted magnifier “just for making the
call!”

§ Catered meals and other treats for hungry office staffs,
compliments of your favorite drug or other supplies sales
representative.

§ And speaking of sales, don’t forget the sales bonuses for high
performers. The only people in America with no limit to how much they might earn are not in medicine or other specialties, but in sales.
(Investment bankers are in the running, of course, but they are in fact
limited by how much capital and/or credit they have. Enterprising sales
people have only transportation, cosmetics and a few other expenses.

§ Don’t let’s leave out some red meat for the tort reform crowd —
legal and accounting services, and a grey area often called “defensive
medicine.”

With the exception of a dedicated group of community volunteers who provide a few ancillary goods and services, every dime of all that has but two sources:

1.) Medical bills
2.) Government grants for teaching hospitals and research by NIH. (taxes)

What am I missing?
*
*
*
*
*
*
* Yes, of course. I almost forgot — MEDICAL CARE!

~~~~~~~~~~~~~~~~~

Don’t you love watching those ED ads where the whole landscape goes tumescent?
That’s a really great special effect, huh?
Makes you all horny just watching.

Guest
May 12, 2012

I missed this dialogue when it was “viral,”. but let me add a valuable poiint belatedly.

One reason that Obama did not push harder for the PPACA is that the funding for it was sneaky in the first place.

If the Dems had said in 2009, “We want to expand Medicaid to16 million people, and we want to subsidize 20 million others who get no employer benefits, and this will cost $150 billion a year, and we should raise income taxes by 2%………………..”

this would have been an honest proposal.

But their judgement was that it would never pass.

Instead they cobbled together a bill which used 3 year federal carrots to expand Medicaid, used phony Medicare savings twice to pay for subsidies, and added an individual mandate to keep private insurers in the game, and combined a smattering of new taxes now but benefits that start four years from now…………

It is worth noting that when Social Security passed in 1936, the Democrats controlled 80% of Congress and had Roosevelt. They could have passed a ham sandwich.

When Medicare and Medicaid passed in 1965, we had full employment plus the new taxes required in the bills were minimal. Some of this was due to ignorance of what these programs would ultimately cost.

In 2009 the public was less prosperous, so less generous, and there is much less ignorance about costs. Obama gambled that he could get his place in history with health reform, and paying for it would be someone else’s problem. (We had a fellow named Bush who approached Iraq in the same way, so it is not a partisan failing.)

Guest
DeterminedMD
May 2, 2012

Face it, PPACA as a whole is not about America, just a party’s self serving interests. I am sick of the posturing and lack of invested debate to redo this legislation better than round 1. And frankly, if the constituents of Pelosi’s district can’t figure out by now she is lame and useless as a representative and Party fixture, can’t wait for that earthquake to wake them up!!!

Sorry, not wishing death and destruction, just a f—-g wake up call to literally jolt them into seeing 70% of America does not embrace their mind frames!

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Munira Alhouti
May 1, 2012

In my pinion Obama new health care will give his community better chance to live their life. People will be eligable for health insurance without looking for their pre-existing sickness. Most of Middle class people do not recognize the important of having health insurance in their life . Off course the health insurance will more expensive then it used to be ,but people will have coverage for their health.

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Peter1
May 1, 2012

“Unlimited benefit? I suggest you lay off the questions and go read a little. Your suffering Michael knowledge deficency. Medicare is no where close to unlimited. Medicare wouldn’t even come close to qualifying as creditable coverage under PPACA.”

Then you would want Medicare to cover and pay for more coverage? You’re sending mixed signals Nate. Either Medicare needs to cut costs or it needs to cover more so that it’s not accused of using a death panel mentality.

You haven’t answered my question Nate. Should Medicare pay for transplants on 70-80 year olds since you oppose the use of “death panels”?

Guest
Apr 30, 2012

For the origins of the death panel term and debate (not how it came to be used), see The New York Times: http://www.nytimes.com/2010/12/26/us/politics/26death.html?pagewanted=all

For a nice discussion of the concept of the Angel of Death in various cultures (not including the actuarial, alas), see Wikipedia: http://en.wikipedia.org/wiki/Death_%28personification%29

And for a commentary on the propaganda on this issue, see: http://blog.seattlepi.com/williamhare/2010/12/31/republican-right-silent-on-real-arizona-health-care-death-panel/

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Nate Ogden
Apr 30, 2012

NY Times, Wikipedia, Seattle PI, that is quit the echo chamber you have going there. No wonder your understanding was so limited.

What you have is the liberal political framing of the issue, not the issue. Which raises an interesting philosophical question along the lines of a tree in the forest.

If a discussion happens outside the liberal main stream media does it really exist? Apparently Michael thinks not.

Thank you for the NY Times link as it actually reenforces what the argument was from the beginning;

“When a proposal to encourage end-of-life planning touched off a political storm over “death panels,” Democrats dropped it from legislation to overhaul the health care system. But the Obama administration will achieve the same goal by regulation, starting Jan. 1.”

So there was enough public disagreement or concern to drop a provision from a bill being voted on by the public’s representatives. Instead they backdoor implement it via regulation. But people should not be at all concerned about this because this could never lead to an LPC or anything like it, trust you it just wont?

“A national organization of hospice care providers made the same recommendation.”

That is where LPC came from, then it was expanded from Hospice into regular hospitals. No one paid any attention because it only applied to hospice and doctors would never do anything wrong. 5 years later it applied to most hospitals and doctors were murdering healthy people, i.e. misdiagnosed cancer then withdrawing food and water. That took all of 5 years. But that could never happen here right?

““Thus far, it seems that no press or blogs have discovered it, but we will be keeping a close watch and may be calling on you if we need a rapid, targeted response. The longer this goes unnoticed, the better our chances of keeping it.”

So this is how the left wants healthcare decisions made, quietly and without anyone knowing….just like the LPC.

Isn’t the left and PPACA trying to move us towards ACOs and global payments? So these organizations will be getting lump sums, at the same time they are now on the hook for providing the care the government is going to pay them to advise these costly members it is ok to die sooner. When HMOs where in this situation the left called them death panels non stop. Now you have taken it one step farther, your paying providers to convince patients it’s ok to die, I guess that is one way of lessening the opposition to them.

So I see you have walked back pretty much everything you have said prior to this. It’s not that Death Panels are mythical it’s just the left rather not have this discussion. Thanks for the honesty. Facts are not determined by ideology, you would be wise to remember that. Just because you disagree doesn’t mean it doesn’t exist.

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Peter1
Apr 30, 2012

“Do 70 and 80 year olds need transplants though? If you can afford one and choose to spend your money that way then go ahead.”

But that’s not what you are arguing. Should Medicare be paying for them? I think your answer should be yes, because otherwise you will argue “death panel”.

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Nate Ogden
Apr 30, 2012

if the person buys and pays for a policy that covers them then yes. The problem with Medicare is people don’t contribute a fraction of what they spend. It’s a ponzi scheme built on increasing population paying the claims of earlier beneficiares. I forget the exact ratio of what people pay in plus interest and what they take out but if it was a private company they would have been shut down years ago.

I don’t think its right seniors paid for a policy that covers X and are now getting 20 times X. At the expense of the grandkids and the future.

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DeterminedMD
May 2, 2012

I fully agree with Nate on this. Selfishness and narcissism are the operating words these days with boomers especially, and it will doom this society a lot sooner than those in denial will come to realize.

I am at peace that I will not see a dime from Social Security, that I paid for my parents and inlaws to get theirs and they were the supports I appreciated in their time. For boomers, and I am one of them mind you, they as a group can stick it where it don’t shine!

See Carlin 1996 show, Back in Town, near the end, when he summarizes them perfectly, “Gimme that, it’s mine; they are cold, bloodless…”

Amazing how a World War conflict can screw up a society post war!

Guest
May 1, 2012

Thanks, Nate.
Been there. Done that.
Discussions like that no longer interest me.

My career in the food business managing the working poor gave me a first-hand look at what it means to be at the bottom of the social and economic ladders. (Growing up in the South also helped shape my thoughts.) And it’s not a place where most people pecking on keyboards would want to be.

Lincoln said the Lord must have loved the common man — He made so many of them. For all of human history the ratio of rich and poor has not changed a lot, although the spread (gap between top and bottom) has varied widely.

I’ve been blessed to have as much as I need plus enough to share. But nothing in my experience has led me to think that those of us with both power and resources have no responsibility to care for those with neither.

http://whatever.scalzi.com/2005/09/03/being-poor/

For millions of our citizens having anything more than emergency health care is as distant a notion as cosmetic surgery or membership in an expensive social club. America, in my opinion, should be better than that.

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Nate Ogden
May 1, 2012

Thought you might enjoy this read John

http://volokh.com/2012/05/01/bleeding-heart-libertarianism-and-social-justice/

Different perspective on social contracts/justice and how just about every ideology supports them. The question is not that conservatives are opposed as most liberals like to argue but to the degree and what the public owes to society.

Guest
Apr 30, 2012

Well, Nate, I gave it my best shot. We can’t even agree to disagree. At least I tried.

As for the link to the AEI piece, I’m not surprised that a Conservative living in New York, encircled by Liberals, would quietly come to the conclusion that he understood both sides but those around him would never grasp where he was coming from.

As a Liberal having grown up in the South, surrounded by Conservatives (the people around me have elected Newt Gingrich, Bob Barr, Herman Cain, the late Larry McDonald, Lester Maddox, and a laundry list of other less well known arch-Conservatives) I have developed exactly the same attitude, but with the poles reversed. Like those New York Conservatives, I have also had to walk on eggs all my adult life lest I become entirely outcast by those around me.

I guess we all have our respective echo chambers.

http://www.commondreams.org/view/2012/02/07-5#.TzbarIEWkJN.facebook

http://pss.sagepub.com/content/23/2/187

It feels crude, illiberal to point out that the other side is, on average, more stupid than our own. But this, the study suggests, is not unfounded generalization but empirical fact.

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Nate Ogden
Apr 30, 2012

Unlimited benefit? I suggest you lay off the questions and go read a little. Your suffering Michael knowledge deficency. Medicare is no where close to unlimited. Medicare wouldn’t even come close to qualifying as creditable coverage under PPACA.

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Peter1
Apr 30, 2012

“I don’t think its right seniors paid for a policy that covers X and are now getting 20 times X. At the expense of the grandkids and the future.”

Isn’t that the fake fear mongering of those screaming “death panels” when they say the govmet is taking away your/my benefit (unlimited use) so that constitutes a death panel yet those same screamers (such as yourself) don’t want to pay for unlimited use and are just using it as a red herring created from invented facts.

Tell us which way you want it Nate. Either you want to control costs or you want unlimited use.

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Nate Ogden
Apr 30, 2012

There was a recent study on how people of different political persuasions grasp the concepts of the other party. Not surprising the results.

http://www.american.com/archive/2012/april/liberals-or-conservatives-who2019s-really-close-minded

I understand the concept of social contracts. I even agree that we need social contracts and in places they serve a purpose and belong. I also believe there are two sides to social contracts just like there are at least two side to all contracts. Contracts are based on consideration, those receiving benefits under these contracts have not fulfilled their end of the consideration.

Merely being born into the country or moving into it, legally or none, should not create an obligation on society to provide for someone.

While I’ll agree SS was not presented as an insurance program I would disagree on Medicare. From my readings of the congressional debates and meetings it was always presented and was sold to the public as insurance. People would like to call it a social contract to avoid the comparison to insurance, as insurance it is a complete failure on all measures, but that’s not how they got it passed. Early version of its not a tax unless we need it to be a tax.

I would disagree on why we disagree. If Medicare covered the 13% of seniors that needed help with catastrophic claims I would be ok with it for the most part.

I disagree with the additions made to SS, disability for example, while needed protection for those truly disabled, is a complete joke. There is no pretense of processing claims correctly the first time or policing those asking for benefits.

Where we seem to disagree, not to assume, is our expectations of what the public provides for their end of the consideration. I don’t see where you expect anything from them, and this I have major issues with, philosophically and christian. I take issue with able bodied people being entitled to the fruit of my 12 hour work days. At the minimum I rather keep my money and hire them to do remedial work I don’t have time for because I work so much. Instead I pay taxes so they can stay home playing video games and making babies.

Obviously there are people deserving of assistance and I have always argued those people are short changed. We don’t provide them near the assistance they deserve because we waste the majority of it on those that do not.

Guest
Apr 30, 2012

Nate, with these two very clearly written paragraphs you have summarized the entire discussion about Medicare and Social Security. My guess is that a large number of people, maybe even a majority, would agree completely with what you have said.

Having said that, however, I can only speak for myself when I say I disagree with that argument. I realize you will not agree with what I am about to say, and will very likely not grasp the point altogether, but I’s saying it in the simplest words I can find.

These two programs, Medicare and Social Security, are NOT, and NEVER WERE intended to either be or work the same as insurance. They are what historians and political scientists refer to as social contracts. In other words, they represent a political consensus not unlike collective decisions to amend the Constitution, build a network of federally planned and funded Interstate Highways or even wage war. These are national agreements and commitments linking the working population with the non-working population. At any given time, the working population is taxed to fund those commitments to the non-working population, most of whom are too old or certifiably unable for other reasons to work any more. (And to the extent that they/we DO work, that additional work is also taxed for the same reason.)

It’s time for us to agree to disagree about this simple idea. I like it and you don’t. For me it is simple humanitarian (and I might add Christian) justice. But for you it is a violation of common sense, and your sense of fair play and personal responsibility.

Is that about the shape of how we disagree?