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A Detailed Analysis of Barack Obama’s Health Care Reform Plan

Thanks to a very high Google ranking this has been the most popular ever post on THCB. And it's an excellent analysis by Robert Laszewski. who writes The Health Policy and Marketplace Blog. However, it was written during the Democratic primaries in 2008 and is of course out of date. THCB suggests that you checkout a few other intriguing posts too.

For more recent posts on health care reform, try a smattering of these:

and of course enjoy Bob's analysis too!:

Rt_obama_070116_sp_1Barack Obama’s health care plan follows the Democratic template—an emphasis on dramatically and quickly increasing the number of people who have health insurance by spending significant money upfront.

The Obama campaign estimates his health care reform plan will cost between $50 and $65 billion a year when fully phased in. He assumes that it will be paid from savings in the system and from discontinuing the Bush tax cuts for those making more than $250,000 per year.

By contrast, the McCain Republican strategy for health care reform would first emphasize market reforms aimed at making the system affordable so more Americans can be part of the system and he claims that there would be no additional upfront cost.

Obama breaks his health care reform plan down into three parts saying that it builds “upon the strengths of the U.S. health care system.”

The three parts are:

1. Quality, Affordable & Portable Health Coverage For All
2. Modernizing The U.S. Health Care System To Lower Costs & Improve Quality
3. Promoting Prevention & Strengthening Public Health

Obama claims that his health care reform plan will save the typical family up to $2,500 every year through:

* Health information technology investment aimed at reducing unnecessary spending that results from preventable errors and inefficient paper billing systems.
* Improving prevention and management of chronic conditions.
* Increasing insurance industry competition and reducing underwriting costs and profits in order to reduce insurance overhead.
* Providing reinsurance for catastrophic coverage, which will reduce insurance premiums.
* Making health insurance universal which will reduce spending on uncompensated care.

Will Obama be able to cut the typical family’s health care costs by $2,500 a year?

Well, yes and no.

All of the candidates, Republican and Democratic, are calling for most of what is on the Obama cost containment list; expanding health information technology, improving prevention and better management of chronic conditions, and a more vibrant health insurance market.

Obama is unique in calling for catastrophic reinsurance coverage in order to reduce the cost of family health insurance. Really, this is not a cost reduction but a cost shift. This idea, first proposed by Senator Kerry in his failed bid for the presidency, would have the federal government absorb a large portion of the highest cost claims thereby taking these costs out of the price of health insurance. That would reduce the price of family health insurance but would also increase federal spending by the same amount. It would also water down the incentive for insurers and employers to manage these claims since most of these costs would be transferred to the government.

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Obama’s assertion that covering more people would reduce the overall cost of insurance is likely correct because it would mean less uncompensated care that would have to be shifted onto the rest of the system. Hillary Clinton would cover at least as many people as he would so there is no advantage for Obama here. Since the McCain health plan emphasizes making the insurance system affordable before ensuring widespread coverage as the first priority, one could argue that both Obama and Clinton would make gains toward near universal care well before McCain.

In the end, Obama’s claim that he would save families $2,500 every year are based upon a number of initiatives that the other candidates also argue that they will undertake. More, these ideas, such as health IT and prevention, are under way in the market anyway.

The only real difference between Obama and Mrs. Clinton over cost containment is his catastrophic reinsurance idea that isn’t so much a cost saver as a cost shifter.

Obama’s claim that he would save $2,500 per family beyond a simple cost shift to the federal government of large claims is unsubstantiated.

When compared to Hillary Clinton, the biggest difference is that Obama does not mandate that all adults have health insurance and Clinton does. In my mind, there is actually little or no difference between the two candidates on this point because the real issue in getting everyone covered is to make health insurance affordable—not whether it is required or not. I did a full post on this topic that you can access here.

Let’s take a look at the three main parts of the Obama health plan:

1. “Quality, Affordable & Portable Health Coverage For All”

Obama follows the Democratic health care template by building on existing private and public programs such as employer health insurance, private individual health insurance, Medicare, and Medicaid. This is unlike the Republican approach that would refashion the private market by providing incentives to encourage a reinvigorated individual health insurance platform focused on personal choice and responsibility (see McCain post).

Obama’s key components here include:

    * Establishing a new public program that would look a lot like Medicare for those under age-65 that would be available to those who do not have access to an employer plan or qualify for existing government programs like Medicaid or SCHIP. This would also be open to small employers who do not offer a private plan.
    * Creating a “National Health Insurance Exchange.” This would be a government-run marketing organization that would sell insurance plans directly to those who did not have an employer plan or public coverage.
    * An employer “pay or play” provision that would require an employer to either provide health insurance or contribute toward the cost of a public plan.
    * Mandating that families cover all children through either a private or public health insurance plan.
    * Expanding eligibility for government programs, like Medicaid and SCHIP.
    * Allow flexibility in embracing state health reform initiatives.

Obama would also mandate guaranteed insurability, a generous minimum comprehensive benefits package such as that required for federal workers, the ability to take their policy from one job to another (portability) when it is purchased through the new Medicare-like public plan or the "National Health Insurance Exchange," and he would require providers to participate in a new plan to collect and report data about standards of care, the use of health information technology, and administration.

How would Senator Obama do on improving coverage for all?

This is the section that separates him most from Senator McCain—while being very similar to Senator Clinton’s health care plan.

In Europe they have a way of explaining the general philosophy toward universal health care for all. You often here the term, “solidarity.” The concept implies that everyone is in it together—all are covered in the same pool and share the burden equally.

Democrats, like Obama and Clinton, tend to make an Americanized attempt at health care solidarity by crafting a structure that ensures everyone will be covered, not by a single government-run plan but by guaranteeing access to a mix of government and private plans. Clinton and Obama both understand that the vast majority of Americans are not ready to give up their private health insurance plans and that creates a political imperative to continue making private health insurance a part of any “unique American solution.”

Republicans, like McCain, on the other hand, build their health reform plans on the classic American foundation of “rugged individualism” promoting choice and personal responsibility.

Therefore, the Obama and Clinton plans put as their first priority getting everyone in the system by spending lots of money up front to ensure that everyone can afford a benefit rich traditional private plan—or have access to a public plan. Clinton admits her plan would cost at least $100 billion a year while Obama claims his plan will cost half to two-thirds of that.

Since there is little policy difference between the Clinton and Obama plan there cannot be much cost difference either.

McCain argues that we already spend too much on health care and says his plan will not cost more than that since he will rearrange existing tax benefits to provide the incentives and support necessary for a more efficient system. It is hard to see how McCain can rearrange the existing employer tax benefits those who are insured now get, reapply them on an individual basis to those same people and also have enough money to provide assistance for the millions of uninsured who get no such tax benefits today.

Obama sets as his goal quality, affordable, and portable coverage for all.

Let’s take them one at a time:

    * Quality- Obama’s quality initiatives look a lot like Clinton and McCain’s as well as those things that are going on in the market anyway. All good points—but no advantage here or expectation there will be quick savings.
    * Affordability – Like Clinton, affordability is more about shifting the cost of insurance to the government then it is making a more efficient U.S. health care system. Health insurance is more affordable for people because he spends many billions of dollars subsidizing access for everyone.
    * Portable Health Coverage For All: While Obama does not have an individual mandate to purchase health insurance; it is likely that he would cover as many people as would Clinton because he argues he makes coverage affordable for about as many as Clinton claims to. Compared to McCain, he puts far more emphasis on getting people covered upfront.

Obama would be successful in getting most of the uninsured covered and securing coverage for those that now have it. But when it comes to crafting a system that will not continue to outstrip the rest of the economy in what it costs, I see no evidence that he has tackled the drivers in health care costs—in fact he has likely poured some highly inflationary “gas on the fire” by adding tens of billions more to the system with no effective cost containment features to offset the new inflationary pressures.

2. Modernizing The U.S. Health Care System To Lower Costs and Improve Quality

Obama would argue that I am wrong about the notion that he has no effective cost containment ideas. In this section of his plan he argues he will contain, if not reduce costs, with a long list of proposals.

He would reinsure employer plans for a portion of their catastrophic costs. This would reduce employer costs but it would do so by simply shifting them onto the government. He runs the risk of shifting these costs away from a market that now has incentives to manage them to a big government program that likely will not have the same incentives to confront and manage them. I don’t see this as cost saving as much as just cost shifting.

Obama goes on to outline a long list of quality initiatives that include disease management programs, coordinated care, transparency about cost and quality of care, improved patient safety, aligning incentives for excellence, comparative effectiveness reviews, and reducing disparities in health care treatments for the same illness.

McCain and Clinton have virtually the same list—all good ideas and all things the market has been tackling for years with only incremental success. The notion that Obama will suddenly make any or all of these more successful than others have with all the billions spent on such programs in recent years constitutes a leap of faith. Why will Obama be any more successful in this area than any other candidate or than those who have been tackling these things for years—no new ideas here and no cost containment “silver bullet?”

Obama would also reform the medical malpractice system by strengthening “antitrust laws to prevent insurers from overcharging physicians for malpractice insurance.” Clearly a malpractice reform strategy supported by the trial bar! He also makes a vague pledge to “promote new models for addressing physician errors that improve patient safety.”

Obama makes investments in health information technology an important part of his cost containment strategy. This is something every other candidate supports and is generally regarded at the heart of what’s needed to improve both cost and quality. And it is something the market has been spending billions at for many years and has shown only slow but steady progress on.

Obama would make the insurance markets more competitive and efficient by creating the “National Health Insurance Exchange” to promote more efficient competition and he would set a minimum health cost ratio for insurers—not defined in detail. Reducing insurance company overhead is important but constitutes only a small percentage of costs and those overhead costs have been increasing at the rate of general inflation while health care costs have been increasing by two to four times the basic inflation rate in recent years. The biggest cost containment challenge is in the fundamental cost of health care itself.

He would legalize drug reimportation. However, the amount of drugs imported from Canada, for example, has fallen by half in recent years, as this once popular scheme hasn’t produced the savings to even maintain itself at past levels. Somewhat surprisingly, even Republican McCain favors drug reimportation.

He would emphasize the use of generics by making it harder for drug companies to payoff generic makers to stay out of their markets—a good idea that also has bipartisan support.

He proposes lifting the ban on Medicare being able to negotiate drug prices—including those for the senior Part D program. However, recent Democratic proposals to do so do not allow Medicare to take a drug off the Medicare formulary when the manufacturer is not willing to reduce its prices. If Medicare doesn’t have the power to walk away from a drug maker, its power to negotiate is a hollow one. Obama does not tell us if he would give Medicare the leverage it would need to get real results.

When the day is done, Obama gives us a list of generally good cost containment ideas that are more often than not in both Senator Clinton and Senator McCain’s health proposals and have been part of a market struggling to being costs under control—nothing really new and nothing that promises to get better results than each of these cost containment ideas are going to be able to get us anyway.

What would it take to really contain costs?

McCain would say a more robust market and more reliance on personal responsibility and consumer choice to make the market work better.

Obama, like Clinton and McCain, came up with the same generally good list of things that are underway in the market anyway with only a limited success to point to so far.

To really get at costs you have to gore some very powerful political oxen among all of the key stakeholders.

McCain won’t do it because he simply doesn’t believe that a direct assault on the market players is the right thing to do—put market incentives in place and it will encourage and reward efficient behavior.

Obama and Clinton won’t do it, not because they don’t like government intervention, but because they don’t want to offend key stakeholders who could derail any meaningful health care reform effort.

The Democrats learned a very powerful lesson in 1994 when many of the special interests all united in opposition to the Clinton Health Plan.

Capping or even reducing costs means you have to cap or reduce costs. There are no magic bullets that reduce payments without doctors, hospitals, insurers, and lawyers getting less than they would have gotten. All of the health IT, prevention, wellness, and the like will not reduce costs by any big amount at least in the short term.

McCain avoids the notion that aggressive cost containment is important because he just doesn’t believe in it—a vibrant market will do the job.

Obama and Clinton avoid the notion that their cost containment list will be inadequate because it is politically expedient to do so—they aren’t going to risk their health care reform proposals by taking on the big stakeholders head-on.

I have been convinced for some time that we will actually do health care reform in two parts—access first and cost containment second.

These Democratic proposals are about access—getting just about everyone covered. Getting everyone into this unsustainable system will then make things even more unsustainable creating an imperative for a second wave of real cost containment when the feel good list of cost containment proposals now in their plans falls short. My sense is that most Democratic health policy experts already know this but see no other political alternative.

3. Promoting Prevention & Strengthening Public Health

At the core of this Obama health care proposal is the notion that, “Each must do their part…to create the conditions and opportunities that allow and encourage Americans to adopt healthy lifestyles.”

Obama lists employer wellness programs, attacking childhood obesity in the schools, expanding the number of primary care providers, and disease prevention programs as part of his effort.

Again, his emphasis on healthier lifestyles is embraced by all of the other candidates and doesn’t give him an advantage.

Perhaps the most important thing a new president can do in this regard is to use the “bully pulpit” to place far more emphasis on just how unhealthy Americans are becoming. We can pass all of the health care reform proposals we like and spend the many more in billions of dollars each year but that will do little as we watch our youngest generation on its way to becoming the first in American history to be less healthy than the prior generation.

Will the Obama health reform plan work?

The Obama health reform plan would get almost everyone covered. In spite of Senator Clinton’s claims, I don’t see her plan covering more people.

The Obama and Clinton plans are nearly identical in that they focus on access by making it possible for everyone to have coverage in an existing private or public plan and by making a Medicare-like program also available for those who don’t have private coverage. Both would spend about the same to accomplish near-universal coverage—at least $100 billion a year.

Neither plan really is a universal health care plan. A universal plan, like those in Europe and Canada, start out by including everyone in a plan they are automatically enrolled in and that is paid for by various mandatory taxes. While people in these truly universal systems can sometimes opt out for a private plan, as in Britain, they are in one on day one.

Clinton and Obama build on the American tradition of people having to buy their coverage. Both claim to make it affordable to buy—but the consumer must make the purchase. Clinton mandates it and Obama makes that an option for adults. In the end what matters is not the mandate but whether coverage is in fact affordable to everyone.

McCain takes a completely different view continuing to build on options and choices and relying upon the market to do the work in creating an affordable system.

Would the Obama/Clinton health care system work?

It would clearly get almost everyone covered sooner rather than later.

The real question is how would it be sustained. Are their cost containment strategies going to support a system that is affordable in the long run?

No.

The Obama/Clinton cost containment proposals are only incremental cost containment proposals that are layered over $100 billion of upfront spending to cover tens of millions of more people—far too little cost containment for the new massive injection of money, almost overnight, into the health care system.

Both Clinton and Obama offer us a long list of good cost containment ideas—most of which they share with McCain. Most have been underway in the market for many years with limited success. Undoubtedly, a government infusion of resources or requirements aimed at a more efficient system would have a positive impact but it is hard to see how they would be enough fundamentally alter things and bring the system under real control.

More likely, a $100 billion infusion of new health care spending by an Obama or Clinton plan would actually increase the rate of health care inflation and ultimately create an imperative for more draconian government intervention in the health care markets both Obama and Clinton would preserve.

Cost containment is the big missing link here.

The big question John McCain has to answer is how will his health care program cover everyone—particularly the older and sicker—and how will he be able to provide enough assistance to those who are now uninsured by simply redistributing the tax breaks now only enjoyed by those currently covered?

The big question for Obama and Clinton is not in getting almost everyone covered—their plans spend enough money up front to likely do that—the question for them is how will they create an affordable health care system with only incremental cost containment ideas?

Robert Laszweski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. Before forming HPSA in 1992, Robert served as the COO, Group Markets, for the Liberty Mutual Insurance Company. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog

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115 replies »

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  3. It’s not working in Canada and it’s not going to work in the u.s. At least in u.s when you pay for it you get help. In Canada you wait forever.

  4. I agree with what you are saying…I do believe alot of our health problems come from our food as well..How are food is grown. However cheap food is very bad and good food is very$$$$..you want people to be heathly, it is expensive to be healthy, that is just one thing I think needs to change first.

  5. The centerpiece of the health care legislation is its provision of tax credits to low and middle income individuals and families for the purchase of health insurance.

  6. I recently retired as a customer service rep from a major insurance provider (Health and Dental) We never refused to pay claims that were legitamate. One thing most of our customers did not understand, is that: the employer picked the plan and dictated to us what they would pay or not pay. Management of the employers usually had better covereage than other employees. Healthcare is extremely expensive in the US and it seems that noone is addressing this issues. Hospitals and Doctors can charge what they want and get away with it. However, since employers limit coverage and amounts paid for each procedures, then the Dr;s and Hospitals increase their fees to compensate for the lower insurance payments. Also, we could easily afford national healthcare if we simply stopped giving money to foreign countries and bring all US Military Personnel back home.

  7. President Obama’s plan is a perfect plan. I love it.
    LET’S TRY OFFERING A BIT OF RESPECT BY CALLING HIM WHO HE IS ” President Obama”.

  8. there just using this bill as an excuse for gouging you. ask them what part of the bill has gone into effect that caused these fees…they wont be able to answer you.

  9. thats the whole point…ins co. wont be able to drop you anymore and just think, no more pre-existing conditions go untreated.

  10. actually the Bush wars/tax cuts and republican filibusters did that. kinda hard to change the economy when you cant get anything passed.

  11. what an idiot…probably never been sick a day in his life. Dont worry it’s coming and hopefully you wont be working when it does.

  12. Not sure where you stand, but I’m with teh guy that you reponded to…. Do NOT see HC as a “right”…it’s ridiculous. Why should I pay in for the morbidly obese when I take care of myself.. Just stopped in for gase and saw 3 women working there none over 5’8′, but all well over 200lbs each sucking on a 44oz soda… Really? I should want to be in the same program as them… Where’s my incentive to support thier stupid habits? Where is their incentive to change their bad habits if it’s all covered by the paternal state?

  13. haha yeah bet you enjoy paying taxes for free health insurance to prisoners. lmao

  14. Health insurance companies have prospered because they don’t provide coverage to people with pre-existing medical conditions. They also profit from employing teams of people whose job it is to do everything they can to help the company avoid paying claims.
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  16. I am unemployed and have been for over 18months. My cobra hasexpired. How do I get the free health coverage discussed above ?

  17. The centerpiece of the health care legislation is its provision of tax credits to low and middle income individuals and families for the purchase of health insurance. For tax years ending after 2013, the new law creates a refundable tax credit (the “premium assistance credit”) for eligible individuals and families who purchase health insurance through an exchange. More Info.

  18. All i know is that my wife works for a cardiology practice and they fired 10 people, froze pay and cut back everyone’s hours. Meanwhile her main doctor just bought a $1.5M house.
    Then our PCP (Family Practice Specialist LTD in Phoenix, AZ) sent out a letter to all their patients saying that they will be charging a $40 admin fee to make up for the new law…..so much for direct doctor patient care.
    This new bill is costing our family money already and we haven’t even made our first doctors appointment yet.

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  22. Health insurance companies have prospered because they don’t provide coverage to people with pre-existing medical conditions. They also profit from employing teams of people whose job it is to do everything they can to help the company avoid paying claims.
    Forcing these greedy companies to provide health insurance to sick people who actually need it will drive premiums through the roof. These insurers will no doubt also try to limit the services provided to those on basic or lower priced plans in order to recoup $$$.
    If the government regulates the industry preventing the insurers from raising premiums, changing policies and discriminating against the sick, they will all go bust. Maybe that’s what the government wants and if so, great.
    Health care should not be for just those who can afford it, but for everyone.

  23. In a country where everybody is for civil rights, why is there such an outcry against public healthcare? As a UK resident for most of my life, I took for granted paying a small amount out of my wages to receive free healthcare. If you wished to have nicer surrounding whilst receiving healthcare, you paid for private healthcare. England is considered a classist society and yet American is far more pro the rich getting richer and the poor getting poorer. I do not condone people having to work hard to pay for those that are lazy and choose to live off the government. I worked hard all my life, paid for my free healthcare and used it too. Isn’t this what is being proposed here? Not everyone is lucky enough to receive healthcare with their job or can afford their own healthcare. If you pay for public healthcare out of your wages, you will be entitled to use it too, no? Hopefully this will only serve to bring down the cost of private healthcare when people have another choice rather than having to buy from the monopolies. Shouldn’t we open our minds to the benefits that can help everyone equally rather than only those that can afford things? I am certainly no socialist but do believe that everyone is entitled to free healthcare from birth to death. Don’t we already pay for Medicare anyway out of our wages? Why not pay for something we can use ourselves.

  24. Ok I have been watching this for ever. and the bottom line is what or how does it work for people who cannot afford health insurance. I mean my wife she has Medicare but noone takes it so really it cash for her as well. i have a life threatening illness and them eds to treat it are 1000.00 of dollars each month in cost when we are one a income ssdi family. I have tried some DHS services and they have helped once but recently i found myself back in the hosp near death due to not being able to to afford to get my meds or see a doctor. How is this health care going to help me or my wife? If i still have to pay for it its money i do not have. as for my wife she pays 94.00 a mo for something noone will take due to its flawed, restrictive and slow pay process.
    i think its simple if we can pull 100milion out of our butt for Haiti relief in a matter of days we can afford a health care system here in the USA. it should work like this. You need health care you goto a doc if you can find one with an open practice then you provide proof of citizenship and residence within that county or providence you then receive your care and prescriptions you need. OK there you have it now noone can abuse the health care system and anyone who needs it has it. It should not be based on age or race or religion equal to all. This will make it available to those who cannot afford it at all and only need it sometime. Now the next part Insurance companies feel they will be competing with the government on health care plans. Well they will the government will make it more afford able and more comprehensible and this will force Insurance companies to lower their rates and be more competitive and fair to paying physicians for the care of policy holders.
    They are making this way to hard than it is. They need to stop talking to lobbyists and speak more to the public and their opinions other wise this is going to be a mess that will only help a very small portion of people here in the USA.
    They could also find funding options for this. Personally I think anymore making 250k a year should help the lesser people. I have never ever made that much money in the 40 years of working year even with my wifes combined salary. We could also impose a small tax on gas to fund the health program or a small tax on prescriptions drug companies have to pay into the plan. We should also allow more generic companies that can create these meds for less. This would drive down the cost of meds and make it more competitive. Now lets stop talking about this and actually do something. I swear we don’t need a president well because he has no power on passing something he wants all he gets is to pass what every lobbyist business and lawmaker on the hill want to mold into a mess that completely doesn’t even resemble the original plan that was discussed.

  25. I am astounded that republican representatives and senators, after bald face lying to their constituents for the past year about Obama’s Health Care bill, have the audacity to claim “the american public don’t want this bill”.
    WHO WOULD want the imaginary bill that republicans LIE about?
    That bill does not exist.
    What is astounding is that republican leaders (Liars) are actually getting away with this! (Bald Face Lying).

  26. Why not give aa $12,000 or $1000 month tax credit to families who can prove they exercise 12 times a month with a personal trainer at a gym?
    There is finger print software that can confirm the person’s participation for the 12 times with the trainer.
    the $1000 would cover the montly 12 sessions for both parents, the gym membership and the child care at the gym.
    This would lower a host of health ailments, increase production, reduce absenteeism at work and on and on. There is so much data to prove this why not give it a try?

  27. The American Medical Association stated that this reform covered most of the issues, and as of yet I search for the {most of the issues} to post the good and the bad under one web site to forum the balance of the views of 250 million people and what Health Care vs. the Dollar is all about.
    The Medical Association in 1810 was a different type of ORG., like the Social Security Adminastration. in and for health care in the 1800s. Now it would seem that to end life early saves the dollar. Hey I have it posted side by side at our site, until someone tells me this information is a lie.
    I wish to say thank you to President Obama and the Obama Administration for being the first Government Officials that have created the first Anomaly, recorded in all of U.S. History. And I do offer my congratulations again to the theses Law Makers In And for The People Of The United States Of America.
    I do not belong to any party and I am right smack dab in the middle and I state this as a funny and allow my words to forum a truth…. As Government Officials fight over this health care issue, it looks like a bunch of chickens fighting over a scard little bug. So I reached down I took this Little health Care Bug and now I have it in my hands. This statement to Govenrment Officials by me put a smile on thier faces, but I asure you this is true and this health care reforum belongs to the People..
    This time President Obama is right, By asking GOP and the Republican Party to share ideas of how to help those who are sick, this is why he got elected in the first place, it shows that he cares and is more concerned about what the people think about him then, GOP and the Republican Party thinks…
    This Health Care Reform will not work until a job force is put into action, I would ask all who voted for President Obama or did not, to cast a vote to approve this Job Act Concept of Obama s and order GOP and the Republican s to help or stand down. You humor yourself with this statement of mine, I humored myself when it was stated that the people needed permission to voice opinion in the Health Care Bill….
    Understand this I have a little gift and I have all ways been able to see the truth and lies in things, and President Obama did what was right, so if I was you I would help him rebuild America.
    I have protested this Health Care Bill hard and long and I have gained the respect of a great many people, But now I ask for President Obama to put his faith into the people, and not into any Party.
    The dirty little secret that Health Care Insurance Companies and certain Officials Of Government do not wish to be known is that the value of the dollar is more important then human life.
    Out of all of the Government Officials only one opened a blogged at
    The American Spectator . This company posted http://www.fascmovement.mysite.com on the net and Congressman Ryan dropped off his little blog. As a course of action. Where he stated because of all of the diversity between people that Governing Parties intervened
    as a course of action needed. For days I worked the word diversity in my mind and it came to me that because of this it is not Americas weakness it is our greatest strength. And this is how I will show you.
    Constitution-
    Bill Of Rights –
    The Declaration of Independence-
    United under one forum, builds what is called the Trinity of the Protection Of Laws. This is because these Laws were built by people of faith who gave thanks to God for this wisdom. One would have to see and admire the simplicity of the three as one and at the same time they maintain their independence.
    As for my views that the People Of the United States have the right to build a Health Care Forum with in the the working Institution Of the United States Government and place the task of Officials Building Security for the safe keep of this building block of ideas.
    As I stated a long time ago, the age of Health Care Insurance Companies has ended, nature has selected them to be no more. Because of the failures within and the facts that the human life has no value over the dollar.
    Insurance Companies and all of the Democrat and Republican Parties do not have the power to stop a United Health Care Forum within our Government, built by the people.
    And this is why;
    Tucker vs. Government page 33 at our site.
    You see ,I do not and will not make the first penny off of this building block, I do not wish to meet any of theses Officials. I do not want anything but for this failed system out of my life, to go back to my world where I will watch and wait for Amendments of Law Against the People to be sought after again. I invite those who wish to try again, to do so in , Lets say 200 years from now and I will come back.
    Henry Massingale
    FASC Concepts in and for PAY It Forward
    http://www.fascmovement.mysite.com on google

  28. Bill G from Santa Maria, CA:
    Medicare is an example of how single-payer works *Efficiently*? You apparently are unaware of the fact Medicare is GOING BROKE because it’s a massively inefficient program.
    The patients on Medicare are mostly satisfied with their coverage, but most of the elderly must still have supplemental insurance. My 86 year-old mother pays $475 per month for supplemental because Medicare won’t pay for all her medications.
    It would be great if everyone in the US was on a Medicare-style program, but the fact is our government would go broke (more broke than it is now?) because it’s inefficient.

  29. i hear that the wonderful president is going to fine people who do not have medical insurance coverage? wtf? are things not bad enough? explains why rich people like magic johnson live for years with hiv. i was a demorcart, but all this bs has converted me away from that. sounds like nothing but empty promises. they are punishing the poor further and feeding the rich, and keeping our troops in other countries for no reason. i am no longer a patriot of the united states of america. this country is nothing but a corrupt, contradiction. instead of helping our problems, they run to other countries and try to dictate them. i think adolf hitler has come back. the end times are here for sure. we will be a third world country before long.

  30. For Emily, Kelsy, and all other people on this subject that can’t pose an intelligent argument.
    This is a little off subject, and those who create a intelligent argument with this topic I commend you. But please, keep things intelligent people, saying (quote) “fuck you nobama in my house” or stupid little nabs like that, please go be immature somewhere else. Unless you have an intelligent conversation, I suggest you go belittle yourselves with more of your kind. It’s a downer to see this kind of behavior.
    ****EVERY single president of the U.S has made stupid mistakes, or seem like they cannot achieve the goals in which they plan for our country. But arguing with one another about who should have been in office, or making racial differentials between one another and other petty arguments aren’t going to help the situation. Before you speak, you need to know what you are talking about, you need to educate yourself in what the topic is, and then come to a conclusion; not just listen to what your friends, teachers, religious leaders or anyone else have to say. Research it and LEARN about it. Make your OWN decision. AND, instead of arguing with random people on the internet, how about you reach out to your political leaders about your opinion? Sure, most times it is in vain with trying to reach them… but if you believe in making this country better, if you believe people make mistakes and can see past that, I believe we can all change. So, next time you go on a site and make a fool of yourself, realize you can actually have an intelligent arguement and maybe you can help change things. BUT if you plan to just say “this is all stupid Obama will never be able to keep his promise its way to big. I HATE BARACO OBAMA.” learn to spell “Barack” and learn to be more mature 🙂
    xoxo

  31. this is all stupid Obama will never be able to keep his promise its way to big. I HATE BARACO OBAMA.

  32. there is a calling campaign saying we should call our comgressmen now or we wil have to pay more fo health care it was so vague that I was suspicious and found out that it was from repblicans against health care to get in be fore the next more specific vote. sarah.

  33. I see a lot of mention about family and how it will save them $2500, but not everyone is married with children. I am a single unemployed person living in my parents basement. How does this affect me?

  34. To reform health care, and Social security at the same time, we must force Congress to use the same programs we use. Including the same cost we have to pay to use them. No more freebees at our expense.

  35. I like how they estimate this plan to cost about $60 billion yet other people estimate it to cost well over $100 billion. Obama’s plan says that he will have taxes for people that have an income $250,000. Why is it far for people who make more to be taxed more? It’s completely unfair and unmoral. Just because someone is making more money than other people doesn’t mean they should have to pay for other people’s problem. This is suppose to be the country of freedom, yet we are going to be taxed until the day we die…So much for having that freedom. Not only is this plan going to cost a fortune but it is also going to cost of patients waiting months to get an appointment to visit a doctor.

  36. Obamma’s plan is a huge waste of valuable money. Public healthcare is a socialistic policy. The USA is a CAPITALISM, in case you havnt noticed. The Economic damage this plan is going to do is only going to further cripple our economy. Granted, McCain was not much of a better choice, but atleast he had expeirence. Obamma is the 40 Year Old Virgin of the political world, face it. Maybe the fates shall conspire, the planets disaline, and hell will freeze over, but until ice see it happen I highly doubt Obamma’s succes in office.

  37. MY COMMENTS ON The Obama-Biden Plan
    (ALL of my comments are capitalized to distinguish them from the Obama-Biden plan copied from the change.gov wegsite.)
    On health care reform, the American people are too often offered two extremes — government-run health care with higher taxes or letting the insurance companies operate without rules.
    THERE ARE OTHER OPTIONS IF ONE IS WILLING TO ADDRESS THE SYSTEM AS A WHOLE.
    Barack Obama and Joe Biden believe both of these extremes are wrong, and that’s why they’ve proposed a plan that strengthens employer coverage,
    NOT THE APPROPRIATE APPROACH AND THE FACT OF EMPLOYER CONTRIBUTION GOES A LONG WAY TO UNDERSTANDING WHY THERE IS A PROBLEM TODAY. EMPLOYER CONTRIBUTION WAS INTRODUCED 70 YEARS AGO FOR A SPECIFIC REASON AND THAT REASON NO LONGER EXISTS. END THIS FARCEFUL AND ILL CONCIEVED CONCEPT AND RETURN THE COST WHERE IT BELONGS- TO THE INDIVIDUAL. IT IS THIS CONCEPT THAT CREATES THE CURRENT UNINSURED AND UNDERINSURED ISSUES.
    makes insurance companies accountable
    ABSOLUTELY, MAKE THEM ACCOUNTABLE FOR ALL HEALTH CARE DOLLARS REQUIRING THAT AT LEAST 85% OF PREMIUM DOLLARS GO TO DIRECT INSURED HEALTH CARE COVERAGE.
    and ensures patient choice of doctor and care without government interference.
    The Obama-Biden plan provides affordable, accessible health care for all Americans, builds on the existing health care system,
    IF THIS IS TRUE THEN THEIR PROPOSALS WILL FAIL IN THE VERY NEAR FUTURE JUST AS ALL OTHERS HAVE.
    and uses existing providers, doctors, and plans. Under the Obama-Biden plan, patients will be able to make health care decisions with their doctors, instead of being blocked by insurance company bureaucrats.
    PLACE THE AUTHORITY OUTSIDE THE COMPANIES IN LOCAL (NATIONAL) ORGANIZATION(S)
    Under the plan, if you like your current health insurance, nothing changes, except your costs will go down by as much as $2,500 per year. If you don’t have health insurance, you will have a choice of new, affordable health insurance options.
    THIS IS UTTER NONSENSE SINCE THE BASIC ISSUE IS UNIVERSAL COVERAGE AND NOTHING HAS BEEN MANDATED TO ASSURE THAT. IF HEALTHCARE IS TO TRULY BE UNIVERSAL THEN IT MUST INCLUDE THOSE WHO HAVE OPTED OUT OF COVERAGE. GIVEN THE WAY THAT INSURANCE IS CURRENTLY MARKETED AND SOLD THERE IS NOTHING TO ASSURE A REDUCTION OF EVEN ONE DOLLAR. ELIMINATE RISK POOLS, ELIMINATE SALES TO EMPLOYERS, DEFINE THE BASIC HEALTH INSURANCE PACKAGE AND MANDATE THAT COVERAGE MUST BE PAID FOR BY THE HEALTH INSURER WITH NO CO-PAYS, CO-INSURANCE OR OTHER OUT-OF-POCKET CONTRIBUTION BY THE INSURED.
    Make Health Insurance Work for People and Businesses — Not Just Insurance and Drug Companies.
    • Require insurance companies to cover pre-existing conditions so all Americans regardless of their health status or history can get comprehensive benefits at fair and stable premiums.
    SO, FIRST DEFINE THE BASIC HEALTHCARE PACKAGE, THEN ELIMINATE PRE-EXISTING, DISENROLLMENT AND WAITING PERIODS. ELIMINATE THE CURRENT INSURER DEFINED RISK POOL NONSENSE CREATING A MANDATE THAT INSURANCE MUST BE SOLD TO ALL RESIDENTS AS MEMBERS OF A SINGLE RISK POOL.
    • Create a new Small Business Health Tax Credit to help small businesses provide affordable health insurance to their employees.
    THERE IS NO NEED FOR THIS SINCE IT GOES BACK TO RISK POOLS AND EMPLOYER CONTRIBUTION WHICH I WOULD ELIMINATE ENTIRELY.
    • Lower costs for businesses by covering a portion of the catastrophic health costs they pay in return for lower premiums for employees.
    AGAIN, THIS A CREATION OF THE INSURANCE INDUSTRY, SINCE THEY HAVE PUT LIMITS ON COVERAGE WHICH I WOULD ELIMINATE. THIS IS AN ISSUE FOR THE HEALTH INSURER TO DEAL WITH AND NOT THE EMPLOYER OR BUSINESS.
    • Prevent insurers from overcharging doctors for their malpractice insurance and invest in proven strategies to reduce preventable medical errors.
    SIDE ISSUE WITH SOME BUT NOT SIGNIFICANT IMPACT. SEE CALIFORNIA WHERE MEDICAL AWARDS ARE STRICTLY LIMITED BUT HIGH PREMIUMS CONTINUE.
    • Make employer contributions more fair by requiring large employers that do not offer coverage or make a meaningful contribution to the cost of quality health coverage for their employees to contribute a percentage of payroll toward the costs of their employees’ health care.
    ELIMINATE EMPLOYER CONTRIBUTIONS ALTOGETHER. ESTABLISH A FLAT TAX ON ALL CORPORATIONS AND WAGE EARNERS TO BE TAKEN FROM PRE-TAX EARNINGS.
    • Establish a National Health Insurance Exchange with a range of private insurance options as well as a new public plan based on benefits available to members of Congress that will allow individuals and small businesses to buy affordable health coverage.
    ESTABLISH A HEALTH INSURANCE COMMISSION WITH AUTHORITY TO DISPERSE TAX DOLLARS ON A PROPORTIONATE BASIS TO STATES BASED ON THEIR RESIDENT REQUIREMENTS. THIS COMMISSION WILL ALSO BE THE AUTHORITY ON THE BASIC HEALTH PLAN WHICH WOULD BE BASED ON THE PLAN PROVIDED TO CONGRESS AS AMENDED.
    • Ensure everyone who needs it will receive a tax credit for their premiums.
    NO NEED AS THEY WILL HAVE THEIE PREMIUM CONTRIBUTION TAKEN AS PRE-TAX DOLLARS RESULTING IN TAXES BEING APPLIED TO A LOWER GROSS INCOME TO WHICH DEDUCTIONS MAY BE APPLIED.
    Reduce Costs and Save a Typical American Family up to $2,500 as reforms phase in:
    • Lower drug costs by allowing the importation of safe medicines from other developed countries, increasing the use of generic drugs in public programs, and taking on drug companies that block cheaper generic medicines from the market.
    REMOVE ALL BARRIERS IMPOSED BY FDA AND CONGRESS RESPECTING LIKE PHARMACEUTICALS BEING PROVIDED IN OTHER COUNTRIES FOR A LESSER PRICE.
    • Require hospitals to collect and report health care cost and quality data.
    THIS ALREADY EXISTS IN EVERY STATE AND FOR MEDICARE AND MEDICAID. USE THE DATA TO CREATE A MORE REASONABLE PER DIEM- NONE OF THESE HOSPITALS ARE FOUR SEASON HOTELS YET THEIR BASIC RATE IS 3-4X OR MORE AS COMPARED TO THOSE HOTELS.
    • Reduce the costs of catastrophic illnesses for employers and their employees.
    NO NEED TO CONCERN SELF WITH THIS ISSUE BY ELIMINATING LIMITS ON HEALTH INSURANCE AND MAKING IT THE LIABILITY OF THE HEALTH INSURANCE COMPANY.
    • Reform the insurance market to increase competition by taking on anticompetitive activity that drives up prices without improving quality of care.
    ELIMINATE THE TAX DEDUCTIONS USED BY INSURERS TO ADVERTISE THEIR PRODUCT AS PROVIDERS OF CARE. FORCE INSURERS TO DEMONSTRATE THEIR EFFECTIVENESS AS MANAGERS OF THE HEALTH CARE DOLLAR THEREBY IMPACTING COST AND IMPROVING QUALITY OF CARE.
    The Obama-Biden plan will promote public health. It will require coverage of preventive services, including cancer screenings, and increase state and local preparedness for terrorist attacks and natural disasters.
    THIS LATTER REQUIREMENT SHOULD NOT BE PART OF THE HEALTH PLAN BUT BELONGS IN HOMELAND SECURITY.
    A Commitment to Fiscal Responsibility: Barack Obama will pay for his $50 – $65 billion health care reform effort by rolling back the Bush tax cuts for Americans earning more than $250,000 per year and retaining the estate tax at its 2009 level.
    ACTUALLY, ROLLING THESE TAX CUTS BACK IS FINE SINCE ALL WILL HAVE A TAX PROPORTIONATE SHARE BASED ON EARNINGS TO CONTRIBUTE. FOR THOSE EARNING LESS THAN 250K IT MIGHT BE A WASH AND FOR THOSE EARNING MORE, THEY WILL SIMPLY GET LESS.

  38. There are so many broken portions of our healthcare: insurance companies that profit by dissing their insured, pharmaceutical reps that get paid the bucks to push medications to doctors when a cheaper (non-patentable) drug would do, and of course the lack of universal accessability. The list goes on, but I have yet to see a major point emphasized (at the risk of being obnoxious I will type in caps). There is NO WAY or country can afford universal health care if we do not address the issue of PERSONAL RESPONSIBILITY in prevention. With the number of Americans whose smoking habits, eating habits and lack of movement set them up for heart disease, cancer, and diabetes, we can not simply have everyone covered. Can anyone list any country in the world the offers universal care to such an unfit population? The cost of diabetic health care alone is four fold that of a non-diabetic. If universal health care were mandated could we offer insurance breaks to those who make wiser lifetyle choices (gym attendance, smoking cessation, nutritional education courses)?

  39. What degree of nationalism of our health care system is “acceptable”? Is the goal full nationalism, or something part-way? If it is part-way, then define that goal and do not change the goal or the criteria used to establish it.
    With any nationalism, the government will fund that industry. What will we gain by the funding? Funding for funding’s sake, or perhaps a stake in the companies involved in health/insurance/legal professions? This needs to be defined, as well.
    Next is the industry scope. Is this limited to the health industry, or must it include insurance and legal professions? Will the nationalism be full or part-way in these other markets? Again, these require definition.
    Once the goal is established, then how can its success be monitored? What measurables exist and how can they be most effectively regulated? Regulation will be required; that is not optional.
    I believe that a prime candidate for reform is the hospital system. Hospitals are in need of upgrading, and a few managers familiar with process flow could help redesign the layouts to improve efficiency. Hospitals are also a geographic monopoly, so they are typically inefficient. Though I don’t know this for certain, I suspect that care in hospitals has the larger percentage of law suits per patient, as compared with doctor offices or clinics.
    Accompanying this would be an assessment of the insurance system around hospitals and how that could be improved. The reason for this extension is that the monopolistic nature of a hospital also leads to inefficiencies with its material and service providers.
    Ideally, hospitals should be the places that doctors and nurses want to go. They should be a draw for the best-of-the-best. Today, this is not the case. If it were, then malpractice insurance would not be necessary within them. This opens up the legal profession and what laws are required in order to limit liability and damages within a hospital. This will cut into a lot of ambulance chaser’s cash flow, but it is part of the overall health care problem.
    I hope that some of these writings in this blog end up “making a difference”. It is with that hope that I close.

  40. Obama breaks his health care reform plan down into three parts saying that it builds “upon the strengths of the U.S. health care system.”
    The three parts are:
    1. Quality, Affordable & Portable Health Coverage For All
    2. Modernizing The U.S. Health Care System To Lower Costs & Improve Quality
    3. Promoting Prevention & Strengthening Public Health
    CHANGE ! CHANGE ! CHANGE ! WHAT CHANGE ? So far its everyones plan , Clinton’s Obama’s ?
    What happened to the system that we were required to join just so we could work in the UNITED STATES ???????
    WHAT DID THEY DO WITH THE MONEY ?

  41. Obama breaks his health care reform plan down into three parts saying that it builds “upon the strengths of the U.S. health care system.”
    The three parts are:
    1. Quality, Affordable & Portable Health Coverage For All
    2. Modernizing The U.S. Health Care System To Lower Costs & Improve Quality
    3. Promoting Prevention & Strengthening Public Health
    CHANGE ! CHANGE ! CHANGE ! WHAT CHANGE ? So far its everyones plan , Clinton’s Obama’s ?
    What happened to the system that we were required to join just so we could work in the UNITED STATES ???????
    WHAT DID THEY DO WITH THE MONEY ?

  42. “Once a costly medical condition is learned of, the company can simply drop you after the coverage period expires and or affix your premiums such that you are essentially paying for your own disease thereafter.”
    Debbie, are you an expert in this field? I’ve been a licensed agent in New Hampshire since 1985, and your statement is blatently false. In New Hampshire, once you’ve been accepted by a health plan you cannot be non-renewed or charged higher premiums due to a change in your health status. It’s against the law. Could you please explain the basis for this remark.

  43. The national health care initiative should be primarily about one central thing: PREVENTION.
    This does not mean merely prevention in the form of interventions such as getting shots, check ups, etc. These are important but not the central key.
    That key is changing the way Americans eat and engage in vigorous activity daily. Nearly ALL disease in America is self inflicted – especially the main killers: heart disease, stroke, diabetes, and cancer.
    Again: we inflict the vast majority of disease on ourselves by what we eat and through inactivity.
    Changing this is a daunting task, but it is the REAL and only path to lowering enormous health care expenses that drain government and private resources. These are expenses that are completely unnecessary for the most part.
    Some small fraction of the population suffers from disease that is genetic or accidentally inflicted, and those people should get government help.
    Concerning diet, the nation should shift toward a vegetarian regime. Many nations follow this diet historically as a part of culture and benefit greatly from it. A related benefit of such a diet on a national scale is water use will fall dramatically since most water use goes to grow food for the animals we consume at present.
    Shift to an active, vegetarian-leaning population should focus on the very young. Older Americans present too much of a challenge and show great resistance to changing most aspects of their lifestyle.
    Regarding health care (check ups, treatment, drugs, hospitals), it can be provided best and cheapest by a single payer system where doctors are either government employees, or private. Important controls need to be established to insure neither over-care or under-care exist in a single payer system.
    Attacks on single payer systems using such loaded terms as “socialized medicine”, with either government paid doctors or private doctors, are bogus attempt to keep billions of dollars flowing to private insurance companies and administration. One only need look at Medicare and the Veterans Administration to see solid, actual examples of how single payer systems can function efficiently and to the high satisfaction of users.
    Bill G
    Santa Maria, CA

  44. I think the problem with this whole discussion is that it assumes that insurance is necessary in the field of health care. People “insure” events that are truly accidents or freakishly happenstance incidents, like a house fire or car collisions. Health care is not a rare occurrence, it is needed from the moment we are in the womb. We are on a course toward death from the moment we are born, and to introduce and willingly invite a complicated entanglement like insurance and the salaries of all those additional paper pushers into every simple transaction is part of the very problem. We are making a contract with a company whose bottom line is ironically dependent on honoring as little of the contract as possible. Once a costly medical condition is learned of, the company can simply drop you after the coverage period expires and or affix your premiums such that you are essentially paying for your own disease thereafter. Not to mention the buffer insurance creates between the end user and the outrage that should occur over cost, since medical provider related costs have no actual value to the services rendered. Because of these endemic flaws, at some point, this discussion needs to escape the insurance paradigm altogether and start calling the health care community to account for their costs for certain procedures, lab tests, pharmaceuticals, and stop hiding behind R&D, plaintiff lawyer driven malpractice rates, etc.
    As a card carrying conservative and a pro-free marketeer, I think it is logically consistent to say that the entire health care industry should simply be taken over on the basis that they are essentially behaving like monopolies. There is a bit of hypocrisy in weilding the free market club on cost-affixing type regulations, when we already tolerate so many other regulations, such as who can practice medicine and whether certain pharmaceuticals can be received without a prescription, how many hospitals will actually get CONs, etc. When a hospital receives a CON (Certificate of Need) to set up, it prevents any other hospital from competing against it within a certain radius. (How about that– we give them a street corner monopoly and then tell them to divine their own “fair” prices for services rendered). The AMA artificially limits the number of doctors that can graduate, makes them endure unnecessarily tiresome residencies, all in an effort to increase their fees later with a smaller pool of physicians. We can’t have these kind of practices undermining the affordability of health care and then selectively argue that government should stay out of private enterprise.
    The issue is not whether health care is an entitlement or a privilege. The issue is what does it say about our culture that the treatment of the infirm and the weak has to be done at such an exorbitant cost and with essentially no oversight, since an insurer technically has a perverse incentive to want higher health care costs, as it will simply be reflected as higher premiums. If we are to call ourselves civilized, where we do look out for the interest of the weak and feeble, we would never tolerate usury in loans, yet we do not blink an eye and simply accept the high costs claimed by the medical establishment as proper, necessary and fair.
    One can never have affordable health insurance until health care itself is affordable. This should be our battle cry, and for Congress to start regulating the cost of medical procedures, pills, lab fees, etc. We could do this like other countries, where a family will pay in about $200/month, and then the government informs the industry that that’s the pot, now let the industry figure out who gets what.
    Neither the out of touch Republicans saw this issue as is made clear by McCain’s seriously deficient proposed plan, nor Obama in his Harvard professor concocted, just as expensive, no caps plan. Ralph Nader’s observations about Obama’s actual willingness to do anything meaningful to remedy the situation or side with the big HMOs and PPOs is yet to be seen. It will be interesting to see if Obama can actually do something to reorganize the feeding of this $2.5 trillion dollar monster before the monster can prepare the masses to sing the woes of Canada, as they blindly ignore the real enemy.

  45. I can’t wait until the time when Obama screws up the economy so much that even the really tight-ass liberals will have to say they were wrong.

  46. In New Hampshire, the Healthy Kids program (available in every state known as SCHIP), provides free high quality health and dental insurance for children of those with lower income. In our state, we repealed guarrenteed acceptence in 2003 (Obama is promising to bring it back but on a national level). Since the return to free markets in N.H. health insurance rates halved what they were, and plans got better. Rates currently for a m/f age 34 is $182 month for BCBS’s best plan, $121 for a higher deductible plan with free preventative care. Another alternative, temporary health insurance, is half these rates. Government regulations account for 50% of the total cost of healthcare. More government mandates (mental health parity, no pre-x, guarrenteed acceptance) will only make it much more expensive. Young healthy people whose premiums subsidize older sicker people will drop health insurance as it gets more expensive, further increasing pricing pressure on the people who need coverage the most (this is what happened in 1995). The private health insurance market collapsed in N.H. after the guarrenteed acceptance bill was passed in 1995. Between 1995 and 2000, 31 health insurance companies either merged, went out of business or left the state due to the legislative climate, leaving just two companies left. We are on the verge of repeating this lesson except on a national level. Our politicians know these mandates will destroy the private health insurance market. They know the destruction of the private health insurance market is the only way the country will embrace a single payor system.

  47. so what to do? i work my ass off and am single parrent of 2. i cant barely afford to keep it going but i work everyday. i need health care . i think im the guy obama is talking about

  48. If I don’t eat, I’ll die. Food should not be a privilidge, it should be a right. If I had a choice between free healthcare and free food I’ll take the free food. By the way, I need a car to get to work. Without a car I can’t work. If I can’t work I can’t earn a living. So cars should also be a right… You know, I’m getting the hang of this socialism thing. My wants are endless. Should I have addressed this to Santa Clause?

  49. holy hell this is fucking long, i had to read this for class. but it gave me lots of info. thanks xD

  50. Health care, everyone’s talking about it. But is anyone doing anything about it? The first step to heath care is your medical history and your medical records. Where are your medical records? What’s your medical history? Well now the first step to your heath care is now being taking care of with the MedeFile Card. My name is Alex Papas the creator and the developer of the prepaid phone card in the United States. I have just created a new medical breakthrough called The MedeFile Card. The MedeFile Card is a centralized, confidential electronic portfolio that gives you 24/7 access to your medical history So no more wasting time and filling out paperwork every time you go to see the doctor or go to the hospital. Imagine that you or your parent or child has suddenly become ill. They are in a place where no one knows them, their blood type, what medications they are on, or what allergies they have. Quick decisions could mean the difference between life and death. Each year the lack of accurate medical information or the wrong information takes a terrible toll. With MedeFile you can be better prepared with vital information should such an emergency arise. Your Medical records are going Green. I’m donating $100 million dollars in Medefile Cards to companies all over the world to give to there employees and there families. So No more talking about what we are doing about heath care we are doing something about it now! For more info go to http://www.medefilecard.com or call Alex Papas at 954 729 8888

  51. As written by Thomas Jefferson over 200 years ago, “Liberty is to the collective body, what health is to every individual body. Without health no pleasure can be tasted by man; without liberty, no happiness can be enjoyed by society.” Healthcare is a right not a priviledge; every American has a constitutional right to healthcare.

  52. I am only thirteen years old and i have alot to say about everything and alot to say about this whole campaign i think sum of u just cant app that we are fixing to have a wonderful president who is fixing to make life alot better for alot of us people who care about of life’s and taxes even though i dont pay taxes my parents do and me nor my family is rich but we have money and im sure that it’s like that for sum of u and alot of people in this world sum of u complain about obama and say he is not going to be this or not going to this but let me tell yall grown people something i dont see u up there tryning to do none of that i like him already and he is not even president yet I know im using some slang in here but that really doesn’t give whoever reads this the right to call me some ghetto black girl beacasue i am black and proud to be and i love white people i love martin luther king so i have no reason to hate white’s i think u know where im going wiht this so i dont have to say much more but back to the sistuation i like that he is running and trynnig to be president and i hope he make it and i know he has some haters but im sure he is not worried becuase those are his motavators you will always need haters in you life or shall i not call them that i should say people who are confused about who they are and who they wanna be like OBAMA now back to what i said earlier i am only thirteen at forest heights middle school in the eight grade i really dont know much about the whole thing except that people or some are running to be presidents for very good reaasons and i have benn watching some of the campaigns on tv and i enjoy them very mcuh now im just a child expressing my feelings as an very angry child that is tired of all the anamosity in the world and the hateful people and seeing my parents brake their neck for me and my life and seeing our people in and out of jail kids dropping out of school thats not good at all and i’m hopin OBAMA can see this and tell that i am a concerned child ready for war to end and him to take over to stop high taxes and early deaths now i got to this whole thing and writing this because i am asigned a project to do on someone running and ofcours i chose OBAMA for many good reasong and im doing good on this project but i need help so for u adults how feel how i do please feel free to help me and comment back and tell me how feel as an adult thanks for your time and GO OBAMA!

  53. One thing I don’t think has ben addressed under either plan—-Income Tax Schedule B. How do both plans deal with itemized medical costs? I would see this deduction going away under Obama’s administration (“Fairness”), and significantly under McCain (“Income Adjustment”). Under McCain, most might lose this dedution as they are “given” the money to “buy” their insurance. Thus, those of us who itemize would pay more in the end with a smaller refund, or end up paying more taxes.

  54. I own a small business, employ 35 people full time, have always offered health care, and currently pay for most of a single coverage, and about 60% of family coverage. If Obama’s plan is implemented I will drop my plan and let the taxpayer cover this ever rising burden. It’s just that simple, if you want more of something subsidize it. If you wnat more people on the government dependancy, make it possible. See Hawaii for reference.

  55. Obama plan will make me pay taxes on my corp available insurance premium to help for for someone elses. Many of whom to lazy to work and want everythign free. That is crap. Also gaurantee coverage will cause costs to go way up. And remember when politician estimates costs, Double it and you will be closer to the real cost. No matter how you slice it it’s socialism and the last capitalist will be hung using the rope he made(To quote Karl Marx)Goodbye America as out founding Fathers made it.

  56. I DONT HAVE TIME TO READ ALL THIS AND I WONT PRETEND I UNDERSTAND IT ALL, BUT THE BOTTOM LINE IS, IS OBAMA FOR SOCIALIZED HEALTH CARE LIKE CANADA HAS? OR IS HIS PLAN A LITTLE OF BOTH?

  57. i have a brother who will be out of high school soon and he’s not going to college. does obama’s healthcare plan cover my brother? who will pay for it if he cant?

  58. Here is a quote by the author of the Declaration of Independence which should settle once and for all whether healthcare is a right or responsibility.
    “Liberty is to the collective body, what health is to every individual body. Without health no pleasure can be tasted by man; without liberty, no happiness can be enjoyed by society”.
    Jeffrey Kreisberg, Ph.D.

  59. Some of us have had a national health care plan for many years. In fact many have threatened to vote for a strike when thier goverment funded jobs have tried to pass on the health care cost to them . I have heard comments from people on strike, “its not about the money, its about the changes in thier benifits from thier health care plan”. If you work for the school system, do road work or have a construction job working on any goverment funded projects ,or are a Politicion you problably aready are enjoying the national health care plan. Also if are very clever at hiding all your money from the goverment you also can qualify to get free or very cheap health care. As someone who has just been laid off, Iv`e been offered to continue the same coverage with my now former employer for 1036.00 amonth (12,432.00 a year).I chose to go to a major medical plan on my own for 640.00 amonth. Those of us that dont think thiers a problem with the cost of health care are probably in th group of people aready enjoying the benefits of the rest of the publics money. I say rich or poor or in between every one should have the same benefits from our taxes. (why does it cost $10,000 to have a baby ? Why does it cost $10,000 for an overnight stay in a emergency room ? Why does a 15 minute surgerys cost $10,000 ? ).

  60. So it recently came to my attention that Obama commended Oregon for the decision to legalize physician assisted suicide.
    He said and I quote, “I am in favor of palliative medicine in circumstances where someone is terminally ill. … I’m mindful of the legitimate interests of states to prevent a slide from palliative treatments into euthanasia. On the other hand, I think that the people of Oregon did a service for the country in recognizing that as the population gets older we’ve got to think about issues of end-of-life care. …” The link is http://www.mailtribune.com/apps/pbcs.dll/articleAID=/20080323/NEWS/803230336&emailAFriend=1
    After reading these words, I found myself concerned with the future of our country. So in this interview he wasn’t asked about the elderly but included it anyway. What caused him to say that? History shows that men who said one thing, but intended something else have taken over the minds and lives of innocent people. Is this a plan towards a more efficient healthcare plan? Is there a chance that maybe all the things that are questionable about him are warnings? Is anyone else paying attention to these things?

  61. The information I listed, I failed to put down that this would be under Obama’s plan.

  62. The following comments are in part taken from Dick Morris’s “Fleeced” which I was reluctant to read for various reasons (I’m a democrat here changing her position to independent) but very glad I did.
    – the extended coverage to tens of millions of people will dramatically increase the demand for medical services.
    – with immigrants allowed to work freely in US under Obama’s plan and free healthcare, there will be a rush to the US of immigrants
    – doctors will be crammed to the gills with new arrivals (immigrants for free healthcare)
    – the limits and cost controls Obama will impose on the medical community will probably limit the income of doctors
    – those limits will also have fewer and fewer young people choose medicine as a career
    – greater demand will create costs to go us dramatically
    – The more immediate answer to the issue this all will create would be ‘rationing’
    – Federal bureaucrats will have a veto on any medical procedure you want, even if you are prepared to pay for it yourself.
    – Elderly would be subject to a new cost-benefit analysis. -it’s easiest to ration (turn away) the elderly first.
    – WE HAVE NOW: 1/3 of those uninsured are already eligible for Medicaid but don’t sign up (usually until they are sick).
    – ALSO NOW: we already have “State Children’s Health Insurance Program (SCHIP), healthcare to all children wihout insurance!

  63. This renewal my group Carefirst HMO OA went from $798 a month to a staggering $1,100.
    I figured the cost would increase to $900, not over one thousand dollars.
    A cost savings of $2,500 a year is paltry. A tax deduction of $5,000 for a family is worthless.
    The offices of Carefirst are gorgeous. No wonder they need so much money. And I bet the salaries for the executives a very lucrative and posh.
    This health care crisis has everything to do with greed by those at the top, not the selfishness or immaturity of most Americans.
    American citizens want to be treated fairly. We believe in a sliding scale where every citizen contributes what they can.
    We pay more to get less. When I hear stories from my parents generation (baby boomer) and the amount of days the were allowed to stay in the hospital after giving birth I am amazed. A friends mother stayed in the hospital longer because her Doctor wanted her to get a few extra days rest before going home. My Aunt stayed in the hospital 15 days after her c-section.

  64. I agree with mm. I am all for helping the poor as well, but by just giving everyone coverage will not fix the system. You must give people a reason to want to work and better their lives. If you give someone something there entire lives, what incentive do they have to get out of their ruts? By over taxing the rich they will be less likely to give their money to charities that help the poor and disabled. These same rich people also provide jobs to get the poor working again! I agree that the Government needs to help those that are not insured, but the individuals in need have to show that they are willing to work for that coverage!! Everyone can get some type of job if they want to work, unless they have a mental illness or drug addiction.

  65. I’m sorry, I don’t see how McCain’s plan has no upfront costs. He says he will provide a $2,500 tax credit to every single American in order to purcase healthcare. That cost is well north of $100billion/year.
    To deal with that cost, he could raise other taxes, or cut other programs, or increase the deficit. These are exactly the options open to Obama, and therefore the cost is directly comparable.

  66. Any discussion of the McCain plan which overlooks that the money the employer pays now for health care WILL BE PASSED on to the employee as additional income when the employer stops subscribing to these one size fits all health care plans is not being very analytical.
    If McCain stops giving an employer a tax break on insurance benefits, then any wise employer is going to appreciate the fact that all they do is re-direct this money to the employee, and dissolve that monster health care pain in the you know what. The employee now takes this money, which is taxed income, buys their own plan, including the sort of health care they need, and then gets a $2500 to $5000 tax credit to pay the taxes. Everyone who buys health care off the street knows that you can get personal plans now for less than an employee/employer pays for “group coverage”. The reason is that “group coverage” covers everything that could possibly happen to a person, including pregnancy insurance for MEN!
    Yes, true enough, McCain’s plan doesn’t address the down and outs but one can see that his plan will reduce health care costs once these insurers begin competing for every policy they sell. And, this way, even if the federal goverment has to come up with some sort of Medi-caid for the down and outs, it will be cheaper than simply continuing to feed the monster that is health care in this country.

  67. I’m all for helping those in need, but I don’t understand why we would offer health insurance to capable adults who are unwilling to work. In my opinion, our shift toward universal health coverage should be offered to the working poor first, rather than trying to overburden the system by covering people who are capable, but unwilling to work. I think people would be more willing to take low wage positions if they were guaranteed access to affordable health care. This could also alleviate some of the burden placed on the wellfare system by people who can work, but choose not to. Wouldn’t this be a more realistic starting point rather than trying to cover everyone at once?

  68. The Democrats want the system to crash and burn. They will do this by implementing Obama’s plan by injecting millions of uninsured people into the system with government money. The system will collapse mostly because it is going to cost way more than they think. That will pave the way for Universal, European style health care. The problem is there are not enough practitioners right now. It will only get worse. To be honest, it would be nice to do only 1 surgery a week instead of 10, even if the pay is a lot lower. Plus, I would be getting government benefits. The only people that will suffer with that is the general public. Wait times for procedures will be LONG due to lack of incentive for the practitoners.

  69. I someone can help me understand the most important part of Obama’s healthcare plan I would appreciate it. He states:
    “Comprehensive benefits. The benefit package will be similar to that offered through Federal Employees Health Benefits Program (FEHBP), the plan members of Congress have. The plan will cover all essential medical services, including preventive, maternity and mental health care.”
    This simply says that as a citizen with no insurance, I will have the option of “buying into” the FEHBP. But if I am not a federal employee, the monthly premiums would be huge (over $1000 a month for a family). If people cannot afford to purchase insurance now, how is the above going to help them? Are there more details to this that I don’t know about?

  70. What do all of you think about the recent report by Public Citizen that claims that global tade agreements will pre-empt many of the cost containment methods that the candidates are pitching. In other words, they would subject the US to huge financial penalties in WTO and NAFTA tribunals for restricting free trade.
    http://www.citizen.org/hot_issues/issue.cfm?ID=1846
    “Although they have nothing to do with trade, key health care cost containment proposals on the creation of health insurance risk pooling mechanisms, reduction of pharmaceutical prices and electronic medical record-keeping, a proposal to expand coverage by requiring large employers to provide health insurance and a proposal to establish tax credits for small employers as an incentive to provide health insurance fall within WTO jurisdiction. ”
    The full report is at:
    http://www.citizen.org/documents/PresidentialWTOreport.pdf

  71. I think the dems, especially Sen Clinton, need to realize that the system is already designed for a small percentage of uninsured patients the problems arising are do to out of control costs. I like Sen Obama’s emphasis on technology in general, I believe the other candidates are lacking in promoting tech. This will be especially important in the health care space which has been EXCEPTIONALLY slow at adopting technology.
    http://Savvydoc.wordpress.com

  72. (If the National Healthcare includes all aliens in the United States plus any future aliens, will National Healthcare work. Presently many of the aliens are on our Medicare and Medicaid programs, this is a major financial drain on the Medicare and Medicaid programs)
    How is paying their health insurance bills through taxing me any different than paying their bills through Medicare taxes?
    Just coming from a different fund is all. And since it would be legal, more than likely it would be used more often.
    No thanks.

  73. If the National Healthcare includes all aliens in the United States plus any future aliens, will National Healthcare work. Presently many of the aliens are on our Medicare and Medicaid programs, this is a major financial drain on the Medicare and Medicaid programs.

  74. [AG, I’m interested in your explanation of this. Claims/Risk history, plan benefits, greater competition in each state? Are you saying the same insurance company charges those different rates in both states or different insurance companies charge those different rates?]
    Different states have different rates for the exact same policy from the same company commonly. The most typical reason is claims history, although other factors, what doctors charge, and how they treat patients (ie test and surgery rates) all will affect premium prices from state to state.
    Another poster said [So in effect, I’m subsidizing other women my age to have babies. But I figure those babies will be paying into Medicare around the time I’ll be taking advantage of it, so it’s an investment for me]
    If BO or HC has their way, get used to paying higher rates on your health insurance- substantially higher ones. You’ll be subsidizing everything from Bob Smith’s smoking habit to Jane Doe’s DUI’s and alcoholism. since insurance will have mandatory coverage requirements and insurance companies will be forced to insure everyone, that will be the end result.
    No thanks.

  75. Pretentious, you just discovered the concept of shared community. We don’t have kids but support public education. The universal single-pay heathtcare system is also shared community, but not without responsibility.

  76. Yeah, I would, but I’m more educated than your average consumer on this stuff. I’d like to choose a plan that doesn’t cover obstetric care since I’m not going to have any kids (and would hugely bring down the cost of insurance for a woman my age), but I live in Maryland and don’t have that choice. So in effect, I’m subsidizing other women my age to have babies. But I figure those babies will be paying into Medicare around the time I’ll be taking advantage of it, so it’s an investment for me.

  77. Pretentious, you would want to play disease Russian Roulette on choosing covered and not covered plans? How is this going to solve healthcare costs? “I’ll take the $10 a month plan please that only covers pancreatic cancer. It sure is nice to be covered.”

  78. Hey Peter,
    Every state has different “mandates,” which are the diseases or conditions that insurance has to cover if the insurance companies want to sell insurance in that state. This is influenced by the disease lobbies in each state. For example, Maryland has the greatest number of mandates, and I think Idaho has the fewest. If you have to cover more things, you’re going to have to price your insurance higher. Of course, this is only one of the factors that affects insurance costs, but it’s a big one.

  79. “Insurance can start at $5,000 in N.J. but start at only $1000 in Pennsylvania.”
    AG, I’m interested in your explanation of this. Claims/Risk history, plan benefits, greater competition in each state? Are you saying the same insurance company charges those different rates in both states or different insurance companies charge those different rates?

  80. I think you misunderstand the purpose of creating a national insurance market. It’s not about marketing costs. Each state now sets standards for what insurance plans are “required” to cover. What is covered is highly political. It varies widely by state. More requirements mean more cost for insurers. By letting shoppers shop across state lines, they have access to a greater variety of plans and put pressure on states to remove their regulatory burdens. Insurance can start at $5,000 in N.J. but start at only $1000 in Pennsylvania. It is important that states retain the right of regulation so that an even bigger and more politicized federal government doesn’t acquire that power and responsibility.

  81. [You’re exactly right. That’s why single-pay works and why any other plan without those controls will not. I wonder if this administration will bail out those crushed by health costs – which (unlike Wall Street) people have little control over. ]
    I have never been a big fan of government regulation. I cheered the day they deregulated the airline industry. But unfortunately, SOME regulation is necessary in an industry that everyone NEEDS (unlike flights which everyone WANTS). That’s why utility companies, for example, are regulated.
    It’s not the insurance companies that are getting rich that’s for sure. Most health insurance carriers are B rated at best and are often gobbled up at some point by another carrier as their costs soon outpace their underwriting ability. Hospitals are going broke daily. So where’s all the money going? Pharmaceutical companies for one, and medical supply companies for another. They don’t seem to come up with medications that ‘cure’ anyone any more, just medications we all seem to need to take – aka ‘maintenence’ drugs- which are highly profitable. These companies have unlimited financial resources to change legislation and manipulate markets.
    If I was looking to change the health care system to make it more affordable, that’s where I’d start. I’d also look at the medical billing system and tort reform for second. There’s an entire cottage industry of medical billing practicioners. Anytime you have to go to special schools just to learn how to pay a bill, something is definately wrong.
    Expensive premiums are not the problem, they are the symptom to much deeper issues.

  82. Well Thomas, at least that’s the line from the Fed and the administration in DC. Don’t forget this is an election year so printing money is the easiest way to buy votes. I for one did not have any risk in the market and conducted my personal and business loans with responsibility. Unlike the market cowboys who created trash (even fraudulent) paper and re-sold it over and over to leave the next chump with the risk. Bottom line is an unregulated corporate America is dangerous.
    “There is NO way that any kind of government run health care system is going to work without serious regulation and reforms to costs in this country.”
    You’re exactly right. That’s why single-pay works and why any other plan without those controls will not. I wonder if this administration will bail out those crushed by health costs – which (unlike Wall Street) people have little control over.

  83. [“have you ever seen the government run ANYTHING beter than the private sector could?”
    Wall Street bailouts for one.]
    Lol. True. But there is the other side of the coin as well- had the Feds not worked aggressively to bail out financial companies with the mortgage loan issue, we would have seen a substantial loss of market value and putting the economy into a serious tailspin and jeopardizing the world economy, not to mention the retirement funds of tens of millions Americans.

  84. “have you ever seen the government run ANYTHING beter than the private sector could?”
    Wall Street bailouts for one.

  85. There is NO way that any kind of government run health care system is going to work without serious regulation and reforms to costs in this country.
    If people think they are getting a free ride by voting in the fall for health insurance for all, they have another think coming. As it stands, Medicare is slowly going bankrupt with the ever increasing costs, and in fact, many large companies are scaling back long term medical benefits for their employees.
    Let’s put it this way…have you ever seen the government run ANYTHING beter than the private sector could?

  86. Help me with the numbers. Who would vote for Obama because of his health plan?
    I don’t think those with generous company plans will. Will those with company plans under cost/benefit attack vote for him? I guess the uninsured might, but $2500 in savings is not going to attract many and according to Eric Novak their numbers are less than a 100 people at any one time anyway. What about those on Medicaid? They’re already covered and they know their coverage won’t get any better, and they don’t vote anyway. Will the underinsured? If any of those can remove their rose colored glasses they may I guess, but I doubt the plan would improve their situation anyway. What about those in Medicare? I don’t think so as they will be looking for the slightest hint of a tax increase to fund this and vote against Obama because of healthcare along with all those who are not in a position of needing coverage or care. And lastly what about those who have been screwed by the health insurance industry. Well the plan won’t give those people an option to bolt to a government plan. So tell me who in any meaningful numbers is going to vote because of this healthcare plan?
    P.S. I wonder if any of those just fired Wall Street brokers/employees (who want the government out of their lives until they need a financial bailing out) and must now possibly buy their own insurance will vote for this plan?

  87. An emphasis on natural health care solutions would be very clinically effective and much cheaper than drugs and surgery. I’d like ot see a legislator actually go there. It’s not a risky idea culturally except the pharma lobby would flip.

  88. Bob— does your quote here”The big question John McCain has to answer is how will his health care program cover everyone—particularly the older and sicker—and how will he be able to provide enough assistance to those who are now uninsured by simply redistributing the tax breaks now only enjoyed by those currently covered?”
    mean the same thing as your quote with Bloomberg today in reference to McCain’s suggestion of drug reimportation and flat payments to doctors for diagnoses, in addition to the tax breaks he offers?
    article here:
    (http://www.bloomberg.com/apps/news?pid=20601087&sid=aeIPTBzZJZVg&refer=home)
    just asking for a clarification…

  89. Yes, it is certainly true that the health care consumer needs to change their attitudes re medical services, but this is an excuse not an explanation. It allows the responsible parties for change to avoid making the tough decisions on the road to reform. I think the first steps to reform belong to the Congress (forget about help from the current occupant of the White House). Therein lies the problem; lobbyists for the status quo won’t give up without a fierce fight. The US spends more for their health care than other nations and some special interests like it that way. I beleive this is where the battlefront starts. I believe it will take a groundswell of support at the grassroots level where the citizen demands change; Congress won’t do it on their own.

  90. Whether DSH spending is $17 billion or $30 billion, you need to keep in mind that, on average, health care spending is increasingly by over $120 billion a year (6% a year inflation on $2.2 trillion.) So that $30 billions (or $17 billion) in savings would be wiped out by just a few months of inflation–even if we didn’t cover any of the uninsured.
    Also, my guess is that, even with universal coverage, hospitals located in indigent areas will need higher payments because taking care of poor people who haven’t seen a doctor for a long time will be very time-consuming–and expensive.
    In addition, it’s not clear to me what happens with Medicaid under Obama’s plan (or Clinton’s).
    Matthew- do you know??
    Is Medicaid folded into national health insurance? If so, payments to doctors and hospitals would be much higher than they are now. (Right now, health care providers are paid significantly less to provide a serivce to a Medicaid patient than they are paid to provide the same service to a Medicare patient, or someone under private insurance.
    This is because when the Medicare/Medicaid legislation was passed in the mid 1960s, Southern Congressmen refused to vote for it if doctors and hosptials were going to be paid the same amount to care for poor (read “black”) patients as they
    were paid to care for Medicare (mainly white patients because black people died so much earlier–and still do.)
    The Southern Congressmen did not want white doctors and white hosptials caring for black patients–a two tier fee system would ensure a segregated health care system.\
    To this day, Medicaid pays so much less that many doctors will not take Medicaid patients (who are often black or Latino.)
    If health care reform is going to be equitable–and provoide equal access– Medicaid should be folded into the national plan, and docotors should be paid the same amount for taking care of those poor patients.
    That will be a major additional expense that will more than equal the DSH payemnts.

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    I serve as a reference very interestingly.
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  92. I keep raising the question and never seem to get an answer, so I’ll throw it out there again: When Obama says we need to spend $65 billion in new money to get everyone covered, and Hillary says we need $100 billion, and (formerly) Edwards said we needed $120 billion, were they offsetting the new spending with the savings that would come from (presumably) ending the Medicare and Medicaid Disproportionate Share Hospital program? This is the program by which Medicaid reimburses hospitals (mostly urban safety net and rural community) who see a disproportionate number of indigent patients who get uncompensated care. If everybody’s covered, there would be no uncompensated care, and therefore no need for DSH payments. The program could end.
    According to HHS, in FY 2008, the federal government will spend $17.8 billion on DSH payments. See here:
    http://www.hhs.gov/asl/testify/2007/10/t20071101f.html
    I have not been able to find an accounting of the state contribution to DSH spending, but I have to assume it’s a near equal amount. So we’re looking at an instantaneous $30 billion in savings, just from going universal.
    If Obama and Clinton have already calculated this into their plans, then we are looking at good numbers from them, but if they haven’t, their plans could wind up being cheaper than they are already saying.

  93. It does continue to astonish me how unwilling are politicians (and those who draw up their talking points) to acknowledge the massive gorilla in the corner–the unsustainable demand for increasing services. But of course that would mean saying no to people’s demands. We could save so much just by refusing coverage for things that, by broad consensus, simply don’t work. Demand for these things would vanish if they weren’t covered.

  94. Robert —
    Thanks you for an excellent, realistic discussion of
    the health care plans.
    I am so very tired of hearing people suggest that with national health reform and universeal coverage, we will suddenly save money.
    The truth is that will be covering more people–people who not getting healthcare today. As you point out, there will be some savings insofar as people will get timely care–rather than getting care only after they have become very sick.
    But we’ll see that savings way down the road. In the first year or two, we are going to be providing treatment for people who haven’t been seeing a doctor. There will be a lot of “catching-up” to do. That will be expensive.
    Secondly, many of the reforms that have begun (in terms of beginning to use IT, more emphasis on preventive care and chronic care management) have just begun, and
    the payback won’t come for a long time. Upfront, the costs of health care IT is as we all know very, very high. Again, in the early years, this will be an expense, not a savings.
    And in order to really emphasize preventive care and
    chronic diseaese managment, we need primary care docs, family docs and pediatricians to provide the services.
    Meanwhile, as we speak, the number of primary care and family docs in this country is shrinking.
    Recently, I attended a heatlhcare dinner where primary care physicians were just shaking their heads at the way policy-makers talk about providing a “medical home” for everyone.
    “Who exactly do they think is going to staff the medical home?” asked one primary care doc who is about to retire. “It
    will take years to train new family docs to replenish the system–even if we raise their pay or forgive their medical loans in order to attract doctors inot primary care.”
    Nurse practiioners can do some of the work of providing a medical home. But they need to team up with a doctor.
    Maybe we could import more primary care docs from developing countires but a) those countires desperately need their doctors and b)many American (particularly older Americans) are not comfortable with a doctor if English is not his native language.
    As you point out, the only way to really save money is to do some very unpopular things: standing up to lobbyists, and standing up to an American public that doesn’t want to hera the word “No.”
    For example, you write: [Ob]ama proposes lifting the ban on Medicare being able to negotiate drug prices—including those for the senior Part D program. However, recent Democratic proposals to do so do not allow Medicare to take a drug off the Medicare formulary when the manufacturer is not willing to reduce its prices. If Medicare doesn’t have the power to walk away from a drug maker, its power to negotiate is a hollow one. Obama does not tell us if he would give Medicare the leverage it would need to get real results.”
    You are aboslutely right. Medicare has to be able to refuse to cover drugs, devcies, tests and surgical procedures that are overpriced (and no better than the less expensive older drugs devices, tests and procedures availabe) and Medicare has to begin refusing to cover treatments and tests that are ineffective.
    We don’t even have to worry about “cost-effectiveness” at this point (how many additional months of life do you get for how much money?) There is so much low-hanging fruit in our system– stuff that simply isn’t effective–at all..
    I was at a world health care conference in Berlin last week where I mentioned how we continue to do PSA tests for early-stage prostate cancer, even though we know that there is absolutely no evidence that these tests save lives–or even lenghten lives by a single day. The
    British women sitting next to me–from BMJ– shook her head: “We’ve known that for years. We don’t cover them.”
    On my right, a doctor from Sweden expressed complete surprise: “Really– you still do them?!)
    Of course people in this country are completely unaware of the medical evidence that people in other countries talk about. We are so insulated–so xenophobic–if the idea wasn’t made in America, it is of
    no interest.
    This was the biggest health care conference in Europe–and I didn’t meet a single other American attending the confernece. The people who attended were not just from Europe, but from Israel, Taiwan, etc–all very interested in what people in other countries are doing.
    The consensus, btw, was that Sweden has the most efficient, highest quality system. As one brilliant speaker from the London School of Economics noted: “You can’t help but admire what the Scandanavians do. The same holds true for education.”
    There was only one American speaker at the conference–Uwe Reinhardt–who told me afterward, that he very much doubts that the U.S. will ever have a health care system that provides high quality care for everyone. Instead, he said, we’ll have a tiered system.” And at the botoom tier, we’ll have poor care for the poor and probably for the middle class as well.
    (By middle class I mean the second and third rungs on a five rung income ladder. Though if health care inflation continues at the presesnt rate, ultimately those on the second rung from the top will also find themselves getting second-rate care.)
    In his speech, Reinhardt had compared European countires to China, saying that because so many European countires are mainly middle class, they can provide a single high quality system for everyone, but in China, there are about 4 classes of people–the new multimillionaires, the urban middle class, migrant workers, and deperately poor peasants, who each need a different health care system. When I asked him whether the U.S. was more like
    Europe or China, he didn’t hesitate: “China.”
    I aksed whether, with healthcare reform, the U.S. couldn’t build a public sector health care system more like Germany’s–a system that is so good that half of Germany’s most affluent citizens chooose it over more expensive private care.
    He said “Never.”
    I asked why.
    He said “no social solidarity.”
    I’m now writing a two part post on obstacles to health care reform in the U.S. The first, which I’ll probably put up today on http://www.healthbeatblog.org will
    focus on the lobbyists. The second post will focus on the second big obstacle: the American public.
    When anyone tries to suggest that the U.S. might look to Europe for ideas about healthcare reform, inevitably, someone says “You can’t do that. Americans are different.”
    Ultimatley, my question is this: Is America really so “different” from European countries that we can’t provide high quality, sustainable, affordable health care for everyone?
    If the answer is “yes” then “different” means “so much more corrupt” (the power of the lobbyists’ in Congress) “so much more immature” (the American public’s unwillingness to accept “no” and to realize that more care is not beter care) and “so much more selfish” (the lack of social solidarity.)
    I’m not yet willing to accept that we are that “different.” But even Don Berwick says, “We need a mroe mature public.” And he didn’t mean older.

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