Matthew Holt

Rantology: Sympathy for the blue devils?

6a00d8341c909d53ef0105371fd47b970b-320wi I do have some vague sympathy for the Blue Dogs, the group of mostly red-state Democrats who have to pretend that they care about fiscal responsibility. They, like me, think that we shouldn’t be increasing taxes on the non-health sector to pay for universal coverage. Unlike me they think that we should be reducing any commitment to universal coverage by reducing the level at which subsidies for people mandated to buy health care coverage cut off—which will leave us in a situation with lots of people who forgo coverage because they can’t afford it. I of course think that we should be finding the money to cover the uninsured from within the 16% of GDP we already spend on health care and then ratchet that overall number down, but then again I don’t have to get elected to Congress.

But I do have one modest question. Where were the dogs/devils’ concerns about the deficit when George Bush was borrowing for the future to pay for income and dividend tax rebates for the very wealthy, by invading Iraq and hiding the accounting, and by creating the boondoggle that was the Medicare Modernization Act. Now it’s late at night and I’m not going to go chasing voting records from 2001–3. But I sure have my guess….

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21 replies »

  1. You people are so stupid is fun. I have government healthcare, you don’t have anything you are dumb fat and Christian. You spend all you money on a HUGE military to defend me and I don’t give a shit about you and you don’t have any healthcare at all I love it. You are so stupid. Listen if you lose your job you lose your healthcare. God bless American and all its HUGE guns. Please stay really dumb the rest of the world needs you stupid. If you think I’m not right… how in the world would I know you are fat.

  2. “But in the political payback deal of the century, Congress guaranteed premium pricing for pharmaceuticals, by prohibiting Medicare from negotiating drug prices, and it provided hundreds of billions of dollars in U.S. taxpayer subsidies to pay for these premium drug costs.”
    Greg, I can still see a grinning Congressman Billy Tauzin holding up his $2 MILLION check in “Sicko” as his first “installment” of a lobbying job after he pushed the bill through.

  3. It has been difficult for the Medicare program to contol the substantial costs of cancer drugs. In an issue of the New England Journal of Medicine, an article by Dr. Peter Bach stated that the costs to Medicare of injectable cancer drugs given in doctors’ offices increased from $3 billion in 1997 to $11 billion in 2004, an increase of 267% at a time when the costs for the entire Medicare program increased 47%.
    The MMA was supposed to change how the CMS paid for medical oncologists’ services. It called for rewarding medical oncologists to communicate with patients and to spend more time, like dealing with patients’ chronic health conditions caused by infusional therapy.
    Under the Medicare bill, medical oncologists would be reimbursed for providing evaluation and management services, making referrals for diagnostic testing, other procedures as necessary, and offer any other support (which could include “financial couseling) needed to reduce patient morbidity and extend patient survival. In other words, being paid to think rather than just dispense drugs.
    More might have been achieved if ASCO and other fraternal groups had lobbied as much for the issue as they did for office-practice expense reimbursement. They fought long and hard to retain the chemotherapy concession.
    The MMA had not harmed patients’ access to care in the way critics feared it might, according to a study led by investigators from the Duke Clinical Research Institute.
    But in the political payback deal of the century, Congress guaranteed premium pricing for pharmaceuticals, by prohibiting Medicare from negotiating drug prices, and it provided hundreds of billions of dollars in U.S. taxpayer subsidies to pay for these premium drug costs.
    Dr. Bach also stated that one of the ways the Medicare program could control costs is to fund a comparative-effectiveness program to assess whether or not treatments are really better than other treatments. But this is not information the private sector will generate on its own, or that the “industry” wants to share. Companies want to control the data, how it is reviewed, evaluated, and whether the public and government finds out about it and use it.
    While the MMA bill was trying to pay medical oncologists for being doctors again, instead of being in the retail pharmacy business, private payors still go along with the chemotherapy concession.

  4. It is worrying these things, because a time ago behind wise that the medical services were a problem for many persons and up to the moment they neither find they do not even give any solution, apparently the government forgot what promised and it is now where it is that to there be remembered, before that is very late, the medical assurance is important for many people, like that they indicate it in findrxonline, where they deliver a lot of information about this topic.

  5. Amen, tcoyote. GW meant ratings for much of the media and they are desperately clinging to it. How many times do we need to hear Obama say “I inherited…”? It’s almost become a safety net for him.
    I’m thinking we need a tcoyote/Peter ticket in 2012. You guys would balance each other out nicely!

  6. “the people who are going to fuck this up are your people, Matthew. . . ”
    “What does it mean to impose taxes on the “non-health sector.” At present we do not have any kind of VAT applied to the health sector or any other sector.”
    “What happened to expanding Government Employees Health Association, Inc. benefits to any comer.”
    “The spinelessness that most liberal Democrats have exhibited by refusing to support taxes on high cost health benefit plans is just as hypocritical as conservative Republicans who never met a tax cut they didn’t like.”
    “Most Blue Dogs understand what is in the short-term interest of the businesses that fund their campaigns.”
    Yes to all of the above!!

  7. Matt,
    We were correct in opposing the Medicare and Modernization Act of 2003. It’s a financial disaster even though it supposedly has cost the gov less than projected at the time.

  8. ON a more serious note. WaPo has an expose of the news that Lewin is owned by UnitedHealth Group, which Modern Healthcare reported when the deal was done in June 2007 and Columbia Journalism review covered a month or two ago. Anyway, the news release announcing that Lewin was acquired by UnitedHealth’s Ingenix subsidiary doesn’t say who owned the consulting firm before Ingenix bought it. I know Lewin’s had several owners, but Google’s no help in tracing its previous owners. Just curious.

  9. I love the posts on policy but I hate that it brings out the yahoos and crackpots.
    tcoyote, you often provide good insights into Washington, but I had to laugh at this one:
    “Most Blue Dogs actually understand business, because businesspeople fund their campaigns. They are enterprise oriented Democrats, and if there is sanity to be brought to this process, it is where it will come from”
    Most Blue Dogs understand what is in the short-term interest of the businesses that fund their campaigns. I get no sense that they understand what is in the long-term interest of business any better than more liberal Democrats.
    If you want to maximize corporate profits in the next two quarters, let Blue Dogs write your legislation. If you want to ensure the financial and social stability of the nation over the next 20 years, Blue Dogs will not lead you there. What it meant to be a Blue Dog in 1990 is not the same as what it means to be a Blue Dog today.

  10. Listening to Obama tonight, I’ve came to the conclusion that Obama has ADHD. He wants something done in 2 weeks, but he doesn’t know what it is nor can he provide any information about it. I saw how he rushed to waste my taxpayer dollars with the stimulus, and I don’t even remotely trust him with health care. Obama touching Health Care is simply a scary thought!

  11. You should go back a few decades to the Great Depression when politicians broke a fundamental rule of the Republic by paying for today with tomorrow’s dollars. That it continues to this day is a shame on American Citizen’s for their continued antipathy and lack of accountability in their lives, much less holding elected officials accountable.

  12. Here’s the thing: we all want everyone to have good, affordable health insurance. But we also want to keep what we currently have, we want to get whatever care our doctor recommends whenever he/she tells us to get it.
    And, as much as we might want to, none of us can afford to pay for anyone elses care-let the “rich” do that.
    Oh-and this is really important–I REALLY REALLY REALLY want to keep my job. So please don’t do anything that puts extra burdens on my employer that might put my job in MORE jeopardy.
    But other than that-I am all for health reform, Mr. President.
    Here’s a more complete take on where I think the general public is on this:
    http://www.ovationbenefits.com/blog/2009/07/hope-concern-lies-and-half-truths-what-the-public-really-thinks-about-health-reform/
    The poll data is a month or so old but has trended even more to my point.
    Lets face it-this is a really, really complicated problem that needs to be fixed. But jamming through the crappy legislation that is being proposed before everyone figures it out is insulting, immoral, offensive and for what?? The self-serving political interests of the Democrat “leaders”-give me a break-show us some respect!!!
    http://www.ovationbenefits.com/blog

  13. I think we need health plans with high deductibles, say 2,500 – 5,000 and individuals should cover all medical expense up to that point. Insurers covering all expenses after that point. Employers can offer medical savings accounts to attract employees, medical plans would become very simple to understand. The system would be very standardized. As people would be paying for all expenses up to the deuctible they would be more inclined to be aware of what things cost, and what treatments/tests are nessecary.
    Whatever happens this is going to be a problem fixed over the long term.

  14. Obama’s new deadline of August 8th could end up shooting him in the foot. According to ABC’s chief Washington correspondent the “votes aren’t there right now.” http://www.newsy.com/videos/the_health_care_bill_urgency Obama needs to allow some time for the Checks and Balances system to play itself out fully. This bill is too costly and too huge for congress to simply glance over it. In the long run it could hurt Obama’s reputation as president.

  15. Matt: What happened to expanding Government Employees Health Association, Inc. benefits to any comer. Most moderates who voted for Obama read this option on his campaign website and have not heard a peep about it since then. The Federal Government is the largest employer in the world and each of it’s employees has benefit of this insurance collective. Why does the congress think they need to recreate the wheel with health czars and all the other crap when the billing technology and other infrastructure is already in place here. The benefits put any other plan to shame and any employer would jump out of their shoes to pay their employees premiums at this cost/benefit level. You can bet your ass that congress and their staff and chefs and masseuses will still have access to GEHA – they would never dream of subjecting themselves to Barry-Care – that just for their grateful subjects.

  16. That isn’t spinelessness, that’s just protecting their union pals (and big campaign donors). Just like they aren’t doing anything about malpractice litigation reform to reward their trial lawyer friends.

  17. The spinelessness that most liberal Democrats have exhibited by refusing to support taxes on high cost health benefit plans is just as hypocritical as conservative Republicans who never met a tax cut they didn’t like.
    Skeptic

  18. What does it mean to impose taxes on the “non-health sector.” At present we do not have any kind of VAT applied to the health sector or any other sector. We fund health care though payroll taxes (Medicare Part A), General revenue (all taxes including income and corporate), premiums and out-of pocket cost sharing. All of those costs are borne very broadly…on anyone who earns money frankly.
    Or do you simply mean we should end the tax exemption on health care benefits and use the proceeds to pay for coverage expansion?

  19. Agree on some point Matthew. I go further. Let us make the basic for free with very modest copay to deter abuse. We should create incentive for people to be healthy. I am too afraid that many people may not be qualified for the federal help, but they got to eat before they spend tons of money on healthcare.
    That is the reason, I keep on advocatingfor asolution that is conducive to all those who are afraid of losing their coveted benefit to those who do not havemoney to buy any, to insurers and to doctors, to patietns and to governments.
    There isasolutionthati is good forall.
    rgds
    ravi
    blogs.biproinc.com/healthcare
    http://www.biproinc.com

  20. Of course you cannot imagine what it is like to be a Blue Dog because you live in San Francisco. Most Blue Dogs actually understand business, because businesspeople fund their campaigns. They are enterprise oriented Democrats, and if there is sanity to be brought to this process, it is where it will come from.
    Do you miss George Bush? Like Frank Rich, George Herbert and the New Yorker crew? Did George’s incompetence make it easier to make sense of the world and make it clearer who the good guys were? Get over it. I suspect when you unravel the voting records that a lot of them voted against the war and MMA, Remember MMA passed the House on a party line vote at 3 AM, and that Tom DeLay twisted Republican arms until they came off in his hand.
    Let George Bush lie. If health reform craters this time, the people who are going to fuck this up are your people, Matthew. . .

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