Ditching the Public Option

6a00d8341c909d53ef01157023e340970b-pi It looks to me like the popular objections to a health care bill being expressed by voters this month are concentrated in two primary areas:  

  1. A concern about “government control of the health care system”—mostly around the public plan option.
  2. The trillion-dollar cost of a health care bill at a time deficits are swelling and worries about who will really end up paying for it.

As a result of the first concern, we are getting the first indications that some Democratic leaders are ready to ditch the robust Medicare-like public option and are beginning the process of talking the party out of demanding it be included in a health care bill.

This from Politico today:

After the toughest week yet for health reform, leading Democrats are warning that the party likely will have to accept major compromises to get a bill passed this year – perhaps even dropping a proposal to create a government-run plan that is almost an article of faith among some liberals…"Trying to hold the president's feet to the fire is fine, but first we have to win the big argument," former President Bill Clinton said Thursday at the Netroots Nation convention, a gathering of liberal activists and bloggers who will prove most difficult to convince. "I am pleading with you. It is OK with me if you want to keep everybody honest. . . .But try to keep this thing in the lane of getting something done. We need to pass a bill and move this thing forward."

It has been clear to me for months, and I have been saying so on this blog, that the public option has not had the votes even among Democrats to make the finals. With all the heat “a government takeover” of health care has attracted from those at the town hall meetings either the Democrats ditch it or get used to the idea they have no chance of passing health care reform.

Given all of the stridency we have heard from liberals in recent weeks making inclusion of a public plan a litmus test for the minimum health bill they will vote for, it will be interesting to see just how this rolls out.But getting rid of the public option doesn’t make health care reform easy.While there are lots of other issues to sort through, I will suggest that the public’s unease with health care goes beyond the public plan. Voters seem every bit as uncomfortable with the trillion-dollar cost of reform and just how it would be paid for. They just don’t seem to buy the argument that savings from the current system and a tax on someone else will save them from eventually having to pay for it—and I think they are justified in believing that.

With talk about abandoning the public option also comes a discussion about a smaller health care bill that would cost less and just make a down payment on reform—focusing on insurance rules and the insurance exchange.

That is a possibility. However, even that will not be easy.In order to craft an insurance system where pre-existing conditions limits and medial underwriting could be largely or entirely done away with, it would also have to be a fix that got lots of the healthy people to buy coverage. To do that, get a good mix of the sick and the healthy to maintain a viable insurance pool, the subsidies for those now uninsured and unable to afford the thousands of dollars health insurance costs would have to be robust.Those insurance subsidies are what costs so much and make up the better part of the trillion dollar price tag the currentDemocratic health care plans have.So, we can theoretically get rid of the robust Medicare-like public plan option with a stroke of the pen but not the trillion dollar price tag—and with it the voters’ concern about how much a bill costs and who will pay for it.

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
, where this post first appeared.

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53 replies »

  1. It has been interesting listening to the news, US congress, and public outrage about a government run health plan. Knowing most people have known a family member who has been out of work for an extended period of time, denied a needed surgery’s , or just needed comfort care to finish living their last day’s only to be denied. Medical plans help people who have them, and they are not perfect, what is even worse is hearing how people who don’t have medical shouldn’t be covered; everyone could go into a story of how someone they know can’t get treatment. It is also public knowledge on how much Emergency rooms are costing the average tax payer in America because they are being used as doctor’s offices due to the fact they are not allowed to turn anyone away. Yet healthcare is become such a political issue, it is almost as if everyone is scared they are not going to get credit for coming up with the solution; however, they also don’t want to take credit for backing one that isn’t 100% perfect. If congressmen and women would stop putting out false claims on what could happen and trying to scare people into thinking how evil this plan is, a solution could be reached.
    It is despicable that anyone on Capitol Hill was voted for; hearing that a public option would ruin private health care was almost laughable if it wasn’t such a dangerous claim. Workers have been told that if there is a public option companies would not get the same discounts and healthcare would go up for both the company and the workers. Here’s a fact if a public option was available and it was so good that the majority a company’s employees switched over, it could save major companies millions, offering a higher net income and possibly higher wages to its employees. Now look at the fact of all the people that get an injury that with proper medical treatment they could go back to work, instead they spend month’s applying for disability, they appealing the initial denial, before finally losing almost everything they own running up countless emergency room visits, and living on welfare before finally getting the treatment they needed to return to work. Of course that doesn’t hurt other American’s right, or is that even more costly than if someone was off work for 6mths got the medical coverage they needed and then became a productive member agian. This also has to make you wonder would it also help social security if so many young Americans did not need to be on disability because they were able to get the medical help, or if people would not need to lose or quit their jobs because they were able to take the time off for medical coverage.
    The next point all the fear messages that are being sent out by the media, first the companies are not going to lose money if insurance rates have to go down to compete. Less people will be on disability if they have the medical coverage that will get them treated before they qualify, remember under the current rules you have to be off work for one year before you can even qualify of disability. Also the dreaded public option again if it is cheaper than what you are paying now or the coverage is better, would that really be a bad idea. Many people have lost their own retirement funding because of the 80/20 plans. People would abuse the system, yes in the beginning many people would probably go to the doctor frequently to take care of several issues they have neglected for years, due to not having any coverage. The same is happening at companies that are offering insurance to its employees, those that have had it for a long time don’t need it as often and tend to be healthier because they have used when they needed to, although the ones who have not had it run to the doctors several times a month for the first couple years taking care of everything while it last. That is an all too common factor for people who care about medical, if you have it and it is good coverage eventually you don’t think about it and just use it when you have too. If you have not had it and are grateful for having it you may use it in excess for a while, that does calm down, unless you are a hypochondriac. They are going to be exceptions to every rule that does not mean that the exceptions are the rules and that is what Americans are being told, by employers, and others that thrive on people fears.
    In conclusion, while a government run anything may not be the best possible solution, having no solution is even worse, at least with a government run health care system it would open the door for private run insurance companies to relieve some of its burdens and come up with some new innovated ways of doing business. It is often when you see something else done that a new idea may come up, and possibly much better solutions. I have found stats both ways supporting universal health care and against universal health care, I guess it just depends on which opinion I want to have that day. What is pathetic is how American’s continue to die or be out of work because people in the Media and Government can’t come together on what needs to be done and that is getting more people healthcare. I will leave you with one thought, I have an Aunt who has worked for the same place for the last 37 years and does not get health coverage, if she ever retires she will lose her home, not to mention she has now developed a lump on her throat, question is it cancerous or isn’t it? Does it even matter she will worry herself to death wondering because of the lack of treatment and if it is cancerous it will spread too far to be treatable by the time she does get coverage. So she will lose her home, and everything she has spent her life working for all because she can’t afford insurance. Who is going to have to pay for all the medical bills she leaves behind and the foreclosed home, you are that’s who. Makes you wonder if getting people in her situation medical coverage should be a concern, of course she will probably one of them that has to get on disability early and take an even bigger chunk from social security and still we argue and put fear into people just because you have the power to do so. The fact is when this next election happens the public will speak again and let everyone know if health care was an important issue, that is unless of course it gets pushed through now and then the tied can be turned onto a different subject, but make no mistake those that listen to the media and didn’t listen to their own states will not be there for the next health care debate.

  2. Dear President Obama,
    Please do not accept a bill that excludes a public option for health care. It is essential that we have a public option to keep the private insurance companies honest and competitive.
    Melodie Miller

  3. Public Option is Competition!!! Cooperatives do not work. Failed in Florida over ten years ago. Public Option will increase competition and price pressure. Come on capitalists — are you afraid it will reduce greed in insurance companies?

  4. A better idea for health care reform:
    -require that insurance companies cover all people with preexisting conditions for a maximum of $200/month more than the price of their plan for those who do not have preexisting conditions.
    -make a government “public option” available, but only for family households making under $50,000 a year or individuals making under $35,000 a year.

  5. I believe the current Obama and/or congressional plans are incredibly naive…. and will ultimately result in hurting a lot of innocent people.
    I worked for an HMO for 22 years and in that time became aware of more and more businesses trimming back on health care benefits as premiums skyrocketed. Big business is just looking for an excuse to get out of the health care benefit business because of this premium issue….If there’s going to be a ‘public option’ they’re ready to hand their employees over to that!! Irrespective of whether there’s a penalty attached to it!!!
    Additionally, the current approach on this reform could be very costly for people on Medicare who have gap insurance with HMO’s….It is my understanding that this reform proposes to cut back on the per capita payment the Feds make to HMO’s for Medicare people; the plan is also to remove the rate setting from Congress in favor of the executive branch where there is less likelood of honest debate and transparency. As soon as the HMO’s get less from the Feds, guess what, they’ll want more from the Medicare population … or, in the alternative they’ll just drop the insurance and force that population into the public option as well.
    You tell me how any public option is going to be able to handle these enormous populations. The Feds couldn’t even handle the ‘cash for clunkers’ traffic and, last I heard, had to hire an additional 1000 people and still the car dealers haven’t gotten their rebates. So, not only are people going to be forced into this option, they’ll be caught up in a beaurocracy that can’t handle the volume while they just get sicker and sicker. And, of course, the Feds, again, will have to hire tons of people to handle the traffic… most of which new employees won’t be trained and on it goes….
    I hear so much from the current administration and congress how the wealthy are going to have to start to pay….Do you really think this is going to make them pay? PLEASE….they can get insurance no matter how much it costs and even if not, they can afford the health….This is going to hurt, once again, the middle class and, I sincerely believe, really hit the aged…
    I really want people who can’t get insurance to get it….I know there’s a population out there –even more so now with the high unemployment — who are forced into personal insurance and refused due to pre-existing, or the rates are so high they can’t do it….BUT THIS IS NOT THE ANSWER…
    I am no expert but I’m smart enough to realize that problems of this enormity cannot be solved quickly. Why is this administration so committed to ramming this through? How much have they and/or congress sought out the advise of the many, many successful people in this country on putting together something that profits all…I know it can be done but for this to happen this sickening political party squabbling would have to stop. And the whole effort would need to slow down instead of heading on this ‘change for change sake’ path.

  6. Problem is those bluedogs aren’t really democrats and surely not liberals that represent struggling working people,probably shills who’ll find work in the industry when they’re gone. Republicans have gotten so good at politics that even when they’re a minority they influence like a majority.
    Yes the party of the corporate lobbies wins at every turn. Amazing what a undereducated overpaid corporate whore can do

  7. Your understanding of the need for total population participation in order to conttrol health expense is exactly what has been undermined in the evolution of the health insurance industry in our country. http://bit.ly/na9yc In order to overcome high risk for small group insurance, a new insurance company would have to have long term 3+ year contracts to succeed. Any disenrollment prior to that minimal time would have to incurr very large financial penalties. Premiums would have to be set on a rolling go forward basis. The benefit design would have to require preventive health and vlaue based health plan concepts.
    Thank you for your insight.

  8. NO CO-OP’S! A Little History Lesson
    Young People. America needs your help.
    More than two thirds of the American people want a single payer health care system. And if they cant have a single payer system 77% of all Americans want a strong government-run public option on day one (86% of democrats, 75% of independents, and 72% of republicans). Basically everyone.
    According to a new AARP POLL: 86 percent of seniors want universal healthcare security for All, including 93% of Democrats, 87% of Independents, and 78% of Republicans. And 79% of seniors support creating a new strong Government-run public option plan, available immediately. Including 89% of Democrats, 80% of Independents, and 61% of Republicans, STUNNING!! Senator Max Baucus, You better come out of committee with a strong government-run public option available on day one.
    The History:
    Our last great economic catastrophe was called the Great Depression. Then as now it was caused by a reckless, and corrupt Republican administration and republican congress. FDR a Democrat, was then elected to save the nation and the American people from the unbridled GREED and profiteering, of the unregulated predatory self-interest of the banking industry and Wallstreet. Just like now.
    FDR proposed a Government-run health insurance plan to go with Social Security. To assure all Americans high quality, easily accessible, affordable, National Healthcare security. Regardless of where you lived, worked, or your ability to pay. But the AMA riled against it. Using all manor of scare tactics, like Calling it SOCIALIZED MEDICINE!! :-0
    So FDR established thousands of co-op’s around the country in rural America. And all of them failed. The biggest of these co-op organizations would become the grandfather of the predatory monster that all of you know today as the DISGRACEFUL GREED DRIVEN PRIVATE FOR PROFIT health insurance industry. And the DISGRACEFUL GREED DRIVEN PRIVATE FOR PROFIT healthcare industry.
    This former co-op would grow so powerful that it would corrupt every aspect of healthcare delivery in America. Even corrupting the Government of the United States.
    This former co-op’s name is BLUE CROSS/BLUE SHIELD.
    Do you see now why even the suggestion of co-op’s is ridiculous. It makes me so ANGRY! Co-op’s are not a substitute for a government-run public option.
    They are trying to pull the wool over our eye’s again. Senators, if you don’t have the votes now, GET THEM! Or turn them over to us. WE WILL! DEAL WITH THEM. Why do you think we gave your party Control of the House, Control of the Senate, Control of the Whitehouse. The only option on the table that has any chance of fixing our healthcare crisis is a STRONG GOVERNMENT-RUN PUBLIC OPTION.
    An insurance mandate and subsidies without a strong government-run public option choice available on day one, would be worse than the healthcare catastrophe we have now. The insurance, and healthcare industry have been very successful at exploiting the good hearts of the American people. But Congress and the president must not let that happen this time. House Progressives and members of the Tri-caucus must continue to hold firm on their demand for a strong Government-run public option.
    A healthcare reform bill with mandates and subsidies but without a STRONG government-run public option choice on day one, would be much worse than NO healthcare reform at all. So you must be strong and KILL IT! if you have too. And let the chips fall where they may. You can do insurance reform without mandates, subsidies, or taxpayer expense.
    Actually, no tax payer funds should be use to subsidize any private for profit insurance plans. So, NO TAX PAYER SUBSIDIES TO PRIVATE FOR PROFIT PLANS. Tax payer funds should only be used to subsidize the public plans. Healthcare reform should be 100% for the American people. Not another taxpayer bailout of the private for profit insurance industry, disguised as healthcare reform for the people.
    God Bless You
    Jacksmith — Working Class
    Twitter search #welovetheNHS #NHS Check it out
    Senator Bernie Sanders on healthcare (http://www.youtube.com/watch?v=RSM8t_cLZgk&feature=player_embedded)
    American HEROES!! 🙂 Click replay to play http://bit.ly/j31oU
    (http://www.youtube.com/watch?v=IbWw23XwO5o) CYBER WARRIORS!! – TAKE THIS VIRAL

  9. Look, can we all just settle down a little first? We all agree on the following facts: We don’t like doctors, or hospitals. They are scary, intimidating, and complicated. Things we don’t understand are scary!
    Western Medicine continues to poison the symptom, hopefully killing whatever ails the body, before it kills your body!
    Let’s all get healthy with crystals, meditation, pilates, and colonics. Most disease comes from parasites and toxins. You just need the right oils and healing ointments, and you will be fine.
    You don’t even need the permission of your insurance company to use these healing agents!
    So I say, quit going to the doctor, quit taking the pills. Let’s all boycott western medicine! Bam! Problem solved! Thank you!

  10. I am opposed to the current health care reform plan and the public option specifically. The public option is supposed to be designed to compete fairly and equally with private insurance companies. This is not possible because the public option will never be allowed to go bankrupt. It would be politically impossible to close this program. It can function inefficiently, provide poor service and lose money without the threat of going bankrupt unlike private insurance companies. It will reimburse at an unreasonably low rate and provide limited coverage to compete with the private insurance companies. There will be no incentive for the program to be run well and it will drive private insurance companies out of business resulting in a single payer system. This is like the government telling me to live on a budget, but if I spend excessive money on cars, boats and houses. I will not lose any of my possessions and the government will give me more money. I can tell you I would start spending money right away without any regard for the consequences.

  11. Look, I’m no internet comment person, but today I had to get on and say something. HEALTH CARE REFORM NOW! With or without the republicans. This was a promise Obama made during the prez race. Let’s follow through!

  12. President Obama, we are tired of the Whitehouse trying to sell us health care reform. You know, I know and the American people know this is really about more government power and control. Our biggest problem has become our government! Stop! Just stop all this nonsense! Do not treat U.S. like we are stupid, ignorant morons! Join U.S.!
    Do Not Sell Out “We the People” of the U.S.A.! We Trusted You!
    President Obama, great Presidents do Great things! They have great Honor and Integrity! We know you can do it! “We the People” know the truth! We want to hear it from you! Please join U.S.! Tell the American people the Truth! Confess! Americans are forgiving! We feel if this took place, a renewed Spirit of Patriotism could spread through our government! The American people have never lost our Spirit of Patriotism! We never will! Join U.S.!
    “Few men have virtue to withstand the highest bidder.” –George Washington
    President Obama, You owe nothing to the manipulators who bought your way into office. Those people only used you! Americans do not want to use you. People have been using you and lying to you all your life.
    You Have to Betray Them or Betray the U.S.A.! What’s Your Choice?
    Look at the people of the United States. We are real! We are good people! We are intelligent and can think! The elitist mind is really small and weak! The elitist people are selfish and twisted. We just want a President with Honor and Integrity. This is your big chance to become the Greatest President of all time! You need to lead our government by example, with Honor and Integrity! President Obama just do the right thing!
    Join “We the People” of the U.S.A.!
    “Experience has shown that even under the best forms of government those entrusted with power have, in time, and by slow operations, perverted it into tyranny.” -Thomas Jefferson
    President Obama:
    Can you stand on your own?
    Can you make your own decisions?
    Can you be a man of Honor and Integrity?
    If we have any other elected or appointed “public servant” leaders in our government who have any Honor or Integrity left inside them, they should come totally clean with “We the People”! If most of our leaders have any intestinal fortitude, then we should have a long line of them holding resignation papers in their hands or begging to ask our forgiveness! Do they no longer think they are accountable to U.S. and believe they can do whatever they please? They have developed a “spirit of insubordination” that has gotten way out of control! We no longer need employees working for us that practice malfeasance in office.
    We need laws stating that any Representative, Senator or President that has the audacity to sign any bill without reading it and fully understanding it should go immediately to jail without any bond? We must raise the bar of Integrity and Honor for our employees! Elected or appointed “public servants” need to achieve a much higher standard. How did it get so low? If they are found guilty, a 30 year minimum sentences would not be out of line! This complete lack of responsibility is a very serious issue! It’s totally scandalous, outrages and just plain wrong! It’s Criminal!
    We Must Never Again Allow Our Leaders to Have Unaccountable Trust! EVER!!!
    People are corruptible! We must always question and watch very closely everything they do! Our Freedom, Our beloved Constitution, Our National Sovereignty, “We the People” and the fact that we are a Constitutional Republic is why the United States of America is the Greatest Nation in the World! Any bad truths about our Country are the slow results of the corruptible human nature of a few individuals! Power and wealth can corrupt a person if not kept in check! After we fix our current problems, and we will, we must put in play many more “checks and balances”. We must figure out a way to completely take away the opportunity of corruption! Nothing personal – but “We the People” must always come first and be protected!
    “We can all commiserate forever about how bad things have been, are, and will continue to be. But I don’t think that we can afford to wait for elections in order to have our say about putting a stop to this madness. Enough, already! Let’s start talking treason, prison, and death penalties for all malefactors in government who subvert, ignore, skirt and otherwise trash the Constitution of these United States of America. Those who have sworn to uphold the Constitution and have then ignored their oaths of office are guilty of perjury and malfeasance in office.” -Stephen A. Langford (personal communication to this author)

  13. It’s amazing to see how far down the road we are without addressing the basic realities needed for such an undertaking. It reminds me of one of those early science fiction movies where people are walking around in space without a space suit or gravity shoes. Business realities of health care must be developed. We cannot just take this pile of medical technology and service 350 million people, unless that is all we as a people want to do. The Mayo Clinic has made a sparkling start in this direction but there effort was not a qualified “design prototype” for universal implementation, it just answered their needs.
    If Hewlett Packard or IBM had attempted to grow their businesses like our health industry has “evolved” you would be wondering whom I had just mentioned. Real business engineers need to come together to, analyze, model, run test facilities, and then provide the franchise to the public. Here are a few points to consider:
    1. Most doctors, especially GPs, are not artists they are proceduralists. They, just like a slot car, cannot deviate at all from the track they run. They must follow exact and highly defined office procedures or be held accountable to peer orgs such as the AMA, or worse, suffer the wrath of their malpractice insurer and lawsuits. I understand malpractice insurance costs patients today between $40,000 and $300,000 yearly per doctor and, as an industry, about $100 billion annually. I’m not suggesting Dr robot or health kiosks but simply to imply that well trained medical individuals could follow the rules just as well and free up doctors for higher-level pursuits. Design and workflow models will bear this out.
    2. Information technology is the key to the success of almost all of today’s modern businesses. This is an absolute failure in the medical industry. It must not be solved individually as a stand-alone or “add-on” but as part of a comprehensive redesign of the medical business model. It must be secure, clean and simple, and used by all medical staffers.
    3. Facilities optimization in a modeled business is critical to reducing costs. Look at Burger King, NewEgg, or FedEx.
    4. A 21st century redesign would likewise require a corresponding redesign of the 19th century medical educational process possibly even into the high school years.
    5. The rules of “supply vs demand -> pricing” apply here more than ever. With our current low level of business efficiency the supply side is necessarily low thus causing high prices. In any other business this would eventually spell death to the business but, by the nature and human necessity of health care, the price is paid one way or another. A public health option will overcome the price limit but greatly drive up demand which will swamp the supply side leading to the necessary “rationing” we have all heard about. This is the making of the perfect storm and the bane of the proposed HR-3200. The health industry must be a lean and fit business before 40 million additional users are added but if they were lean and fit then we wouldn’t need the sweeping socialist legislation represented by HR-3200 to just pick up a few more people.
    6. A new way to pool money for financing health care needs to be developed. I don’t like the term “Insurance”, that’s not really what’s needed. I think we need something like a national, well managed (no risks), non-profit co-operative with voting privileges for members on issues such as payment scales and management selection. Some government regulation but no government fingers in the pot.

  14. While all the news sources are abuzz about the dropping of the public option, I’d like to suggest that there are much more fundamental and important questions that we should be focusing on instead. The health reform we so desperately need is about much more than health insurance. We need to focus instead on driving a new vision of personal health that improves care and saves costs by shifting the focus from institution to individual and hospital to home. We need to give clinicians the flexibility they need to give patients the care they need, whether that means in-person visits or in-home virtual monitoring.

  15. Phillip – You made a couple references to other countries. I would suggest using some caution when making those comparisons. While we are more similar to France that we are to say, Namibia, we are also very different. In America, more, bigger and faster is better. The freedom, independence, and diversity that I mentioned previously can be found in other countries, but not to the extent that it can be found in the U.S. We are more obese precisely for that reason.
    When it comes down to it, this is less of a healthcare problem and more of a deeper societal problem. Greed and social irresponsibility are not unique to healthcare. They just happen to take center stage in healthcare because it’s a service that we all need.

  16. We’re not debating Health Care or even its cost, we’re just debating how to pay for it.
    That’s why Obama’s rhetoric has started calling it “Health insurance reform.
    $500 billion in potential Medicare cuts. Huge increases in the national debt, according to the CBO. Already, a quarter of the annual budget goes just to pay interest on the existing debt. This will push it even higher.
    Sadly, AARP’s leadership is mis-representing its members and pushing the general concepts of the Democrats’ plans. Is no one fiscally accountable any more?

  17. Phillip,
    Companies no longer move to Canada for lower healthcare, the auto manufacturers stopped 5 years ago because the cost equaled out. A large portion of the advantage was exchange rate as well.
    From 2007; “Canadian auto manufacturers issued the starkest warning yet that their industry is headed for a deep crisis, telling federal lawmakers yesterday the loonie’s fast rise and other factors have made Canada the most expensive place in the world to make cars.”
    “While it was not as cheap to make a car here as in Mexico, it was less expensive than the United States, due largely to a lower Canadian dollar against the U.S. dollar, and savings from universal healthcare.
    But newly negotiated agreements between the Detroit automakers and the United Auto Workers union that lowers their healthcare and labour bills, plus the 19% rise of the loonie against the greenback since Jan.1, has changed the equation, Mr. Nantais said.”
    The old UAW contract was 100 times better insurance then what anyone got in Canada, if your going to do a fair comparison you need to adjust for that fact. Even after the recent UAW givebacks a UAW insured has better insurance, better access to care, and better benefits then anyone covered by the Canadian system. Our insureds pay more because they get better and more care.
    Worst average outcomes argument don’t fly here. You can’t name one outcome where our healthcare system leads to lower average results. i.e. our lower average age is because we crash cars and get killed at a far higher rate. Our infant mortality is because we measure life different and sooner. Our life style and social aspects lead to higher cost, our system does not lead to lower averages.
    Every system you think we should implement has shown to be equally or less sustainable then our systems. None has shown as resilient as our private employer based system.
    Your second post is clueless ramblings, Medicare is a complete and utter failure. Medical research is equally funded by private insurance and investments. Public healthcare does not work better, your just not exposed to it so you don’t know the failures. If the US media spent 10 years bashing NHS you would think less of them as well.

  18. The WH keeps saying that we need competition in healthcare, because insurance companies have a monopoly on the market. I cant stop thinking “when banks compete-YOU WIN!” and “when government competes- well, post office, freddiemac, fanniemae, medicare, medicaid, etc.etc.” The answer to our problems is never the government. The answer to our problem is accountability.
    I was thinking of moving and opening a business, which would have resulted in the loss of my (excellent) insurance. I did a little research to find out how I could get coverage with the least contribution. This is what I found. UPS, JCPenney, Starbucks, Target, and Hard Rock Cafe all offer full time benefits to part time employees. I wonder if all this nonsense passes and bankrupts our country and its citizens- “who will the democrats blame?”

  19. Nate & Donald,
    Your anti-government diatribes are just pure ideology. Rather boring and really says and does nothing. Your hatred for government is irrational. I guess 30 years of being told government is bad will do it to you.
    First of all without government’s current role in healthcare it would be much worse. The obvious is Medicare. A system that generally works, despite the fraud and some mismanagement. It takes some of the most expensive patients (older) off the hands of the private insurers. A great deal of the medical research is government supported. Most innovation comes out of government supported academic labs and institutions. I could go on and on about how much government is currently involved in healthcare in the U.S.
    How also do you explain that public healthcare seems to work better in just about every other country on the planet?
    I assume you are ardent free marketers. We all are. However, I would point out that healthcare is really not all that competitive in the U.S. Consumer generally blindly buy their services. There are no prices list and quality surveys that rate doctors and hospitals. Consumers have no idea what they are buying and whether it is worth the money. Sure the health insurance companies play the intermediary, but the consumer still pays the bills (whether it is the citizen directly or the corporation they work for).

  20. Nate,
    Your comments are relevant on the margin. Sure other countries like Canada potentially will open the door to some private services, but the vaste majority of healthcare will remain under government control. The vaste majorities of people in those countries do not want their public systems to change and they will not. Nobody around the world wants the U.S. private healthcare system.
    And sure every other healthcare system in the world has problems, but no where near the kinds of problems the U.S. system has; ie. the overall costs are much higher in the U.S. for worst average outcomes and 25% of the population is not adequately covered. One of the number one reasons why companies like to locate in Canada (whether they be non-North American companies or even U.S. companies) is because of the better and cheaper healthcare.
    Islands of excellence, but a see of inadequacy in the U.S.
    Deron S.,
    There is an element of truth to your comment, but is there not freedom, diversity, and entreprenurial spirit in ever other Western country. Your response is typically American. The U.S. has not cornered the market on capitalism. The rest of the world is just more pragmatic about the role of government. Healthcare in the U.S. is too the point of hurting capitalism, competitiveness, independence, and entreprenurial spirit.

  21. Jfeldias I would like to introduce you to Occam’s Razor. To claim that eliminating the very acts that cause the problem is not a solution defies logic. Remove said acts there is no problem. How much easier and quicker of a solution would you like? Sadly I can only assume you are infected with a terrible strain of progressivism. Any solution lacking major tax hikes, redistribution, and additional government control is invalid, no matter how successful it would obviously be.
    “The underlying causes of our situation are so complex”
    No they aren’t, I can sum them up in one word, GOVERNMENT. That applies to the concern of normal Americans who want affordable insurance and high quality health care. I will agree there is a problem with a complexity no one can solve. How can we hijack 1/6th of the economy, raise trillions in taxes, ration care even further then Medicaid and Medicare does now, redistribute more of the top 5%’s income and on top of all that do it in 2 months and get reelected? How to be a socialist in America is so complex, almost like ti doesn’t belong here…..
    Donald’s point about Kennedy can be summed up by HMO Act 1973, how can any arrogant SOB who declared he knows better then everyone else that they should be enrolled in an HMO, and then made it federal law even have a seat at the table? How bad do you have to screw things up in Washington before you get fired? How many people does Kennedy have to kill…pun intended.

  22. Legislators are multi tasking know nothings. They don’t have the time to learn health economics and politics, but they sure have plenty of time to talk to the lobbyists who help them finance their campaigns.
    The legislators’ ignorance and greed is costing all of us in so many ways.
    Sorry about the typos.
    P.S. Deron is right. What the politicians and employers call costly waste smart people call the price of choice, diversity and innovation.
    If we had a centralized system like Medicare, we’d waste even more paying for the fraud, abuse and unfunded benefit liabilities and for the huge mistakes that politicians would make every time they modified the program.

  23. Good comments, Nate.
    Politicians have so distorted health markets that they’re dysfunctional. The Postal Service is unmanageable because politicians require it to put post offices in ghost towns and to give its unions unworkable wages and work rules. A public option health plan would be saddled with mandated benefits, and once it drove private insurers out of business, it would be required to deal only with unionized providers, drug makers, distributors and medical supply and equipment makers.
    What’s needed are major rewrites of Federal and state health insurance laws an regulations. They’ve been distorted under the influence of greedy providers and insurers who don’t care how high their premiums are so long as they get their 3%.
    What we have is a system designed by lobbyists for providers and insurers who want to make nice livings and avoid all risks. Real patients have had little to say about how insurance markets are regulated, and the markets are regulated to benefit providers and insurers, not patients.
    This probably won’t change. The executives of the insurers and lobbyists have spent their careers manipulating state legislators and governors as well as members of Congress. Legislators are multi-tasking no nothings who depend on one or two of their peers to tell them how to vote. Those peers generally have their own agendas that have nothing to do with reality or the needs of patients. Waxman and Kennedy, for example, are in it for their power and egoes. They are hard left, big government guys who don’t care who they hurt, and they’re trying to hurt most of the 200 million privately insured Americans in one ugly health care deform (sic) bill.
    They have their clones in every state legislature, and that’s why we’re in this mess.
    Bush’s legacy is Obama. You can’t do much worse than that.

  24. U.S. healthcare is the most expensive because our country has the highest level of freedom, diversity, and independent/entrepreneurial spirit in the world Not saying that makes it right, just trying to highlight what we’re up against. We are up against the things we thought were most important to us.

  25. Nate,
    In response…
    As you’ve conceded that employer based health insurance has failed to control costs, (” The only reason employer based private insurance has failed to control cost is government cost shifting, regulation, and market manipulation.”), I needn’t belabor that as we are in agreement on that point.
    I am not so focused on figuring out how we got here as much as I am interested in figuring out how we are going to get out of this mess. The US is rapidly approaching a point, by virtue of a rampant health care crisis (obesity,poor diet, poor health habits, et al) and the attendant costs of care,where the US labor force will be unable to compete and unable to sustain the quality of life Americans expect. We Americans are sadly “round” when we live in a “flatter” world. With the ease with which companies can offshore manufacturing and services, we (the US) have to be able to compete and no business sector is immune to the corrosive effect of health care cost inflation.
    Eliminating cost shifting or government meddling isn’t a solution. That is a rant. The underlying causes of our situation are so complex and the consequences of failure (to reform) so dire, that it is frightening to listen to our politicos faithfully recite their talking points while pandering to their lobbying and ideological constituencies. Their every word bought and paid for, you have to question if anything can happen.
    If we end up status quo ante…. then everybody in the US loses.

  26. Jfeldias, what is your background to make such a statement? What standards has it failed to achieve that would allow you to say it is a failure? You sound like the typical progressive without a clue what drives cost or how things got where they are today?
    The only reason employer based private insurance has failed to control cost is government cost shifting, regulation, and market manipulation. While technically this is a failure, it is not by any way an indictment of the system nor its ability. If politicians had not passed terrible laws and shifted cost then the system would have worked and no one would be complaining.
    If you truly believe what you said explain to us how it would be a failure of the American dairy farmer to do their job if the federal government passed a 300% tax on domestic milk production while not taxing imported milk. Would you say we need to nationalize the dairy farms because they can’t control cost?
    “The other fact is that every other industrialized country in the world has some form of government healthcare that provides better outcomes and costs less.”
    It is also a fact every other industrialized country is suffering a healthcare system they can’t afford and will be making radical changes. It is also a fact a number of those nations are looking at a switch to fee for service, and copying the American private system. It is also a fact our poor results and high cost are the results of existing public plans and their failures.
    Finally it is a fact the average citizen is moe intelligent then a progressives and thus knows copy the worst part of our systems, the public ones, will not improve anything. Medicare and Medicaid will be reformed or eliminated before private healthcare systems are.

  27. PookieMD, no one is asking the insurance companies to police themselves. I make my living helping employers police the insurance companies. When the government isn’t tying one or both of my hands behind my back I have no problem policing them.
    When the government legislates winners, like Ted Kennedy did with HMOs, or prevents employers from acting in their best interest, like ADA, HIPAA, COBRA, etc. that is when insurance companies gain an unfair advantage.
    Between cost shifting, regulation with no or minimal benefits, and government distortion of markets the cost of private insurance could be cut 20%+ with no effect on consumers or their benefits.
    Beyond-The-Political-Spectrum, UPS and FedEx don’t compete with the USPS, by federal law USPS has a monopoly on mail delivery, the other carriers are only allowed to compete in the narrow urgent/priority delivery market and that is only allowed because USPS was such a failure and couldn’t perform that it was hurting the economy.
    Blackwater is nothing like police, they don’t conduct investigations, traffic, or countless other activities. Branding people racist carte blanch is the argument of someone from the dark ages.

  28. Don’t forget the Blue Cross/Blue Shield movement, sharing some of the characteristics of cooperatives, eventually became more and more like their for-profit competitors. Many of the largest Blue plans became for-profit and those that didn’t are largely indistinguishable from private, for-profit insurers.
    Merrill Goozner has some good ideas about the Return of the Co-ops:

  29. I agree with jfeldias directly above.
    The most important thing is the entire country is talking about healthcare. When was the last time we did that? A year ago it was not really a huge discussion.
    If the Republicans and the healthcare lobbyists are effective at killing a public option or any real reform this time around, it will be a temporary delay, but they will not be able to stop the inevitable.
    We are heading to some much large form of government involvement in healthcare. It is inevitable. It may take longer, but we are going to get there.
    The healthcare problem is only going to get worse and many many more people are being impacted by it every year. Despite the townhall bullshit, it has already reached a critical mass with the public. The people want something done and a private solution ain’t going to get you there.
    The simple fact of the matter is taht the for-profit private healthcare system has failed. Period. We are paying a lot for poor outcomes. The other fact is that every other industrialized country in the world has some form of government healthcare that provides better outcomes and costs less.
    The U.S. needs to take the profit out of the system and it needs to be run as a not-for-profit public good or at least something closer to that.
    There is no incentive in a private for-profit system to lower costs to the end-user and to cover everyone. Higher margins come with from maximizing revenue and lower costs. You maximize revenue by continuing to increase prices and you lower costs, but not insuring expense customers. Despite the 1,300 insurance companies, there is very little competition, which allows for prices to continually go higher and the continued rationing of care.
    Republicans and lobbyists can slap each other on the back, but the inevitable freight train of big government involvement is coming and the sooner it gets here the less costly it will be.

  30. We have 50+ years of demonstrated results and we can conclude that the employer based insurance model & US health insurers have utterly failed to manage costs (as measured against other major industrialized nations)
    That current US health care “reform” is going to build upon that failed system, people should be skeptical about the $trillion+ price tag. We can safely predict that costs, post “reform”, will continue to accelerate. With more insured lives, but little in the way of cost or utilization control, we will have an even greater crisis in the foreseeable future.
    We may not have a public option in the near term but one is certainly coming.

  31. It’s funny that no one was worried about “runaway spending” when it came to invading a country which wasn’t a threat, to find weapons that weren’t there, which cost not only billions of dollars but 1,500 American lives (so far). As for a “government-run program,” Fed-EX, UPS, Blackwater, & a few others are doing better than the US Postal Service & many local and state police agencies, so private/government competition CAN work. To a 40+ conservative white person, “change” is the scariest word they know–Obama being accused of being a Muslim, Obama not a citizen, Obama a “Socialist” – all that crap springs from this fear of change and of losing their way of life and of losing a sense of power. And I guess they throw the word “Socialist” around because apparently, its the worst thing you can be…worse than even a child murderer or serial killer. Some people will always live in the ideological Dark Ages.

  32. The problem of lower-income people being able to afford the “basic” (minimum) insurance plan is one I addressed a couple of months ago, and I still haven’t been able to find any flaws in my proposal.
    Everyone would be required to purchase a regulated, defined “basic building block plan”. It’s a plan that the great majority of people would choose to use supplemental private insurance on top of. But the younger/healthier people with less income might want little or no additional supplemental insurance. The plan would be basic enough to reduce it’s premium considerably compared to cover-almost-anything style plans we are accustomed to. Thus the needed subsidy would be smaller also.
    What should be the “basic” plan then?
    My current take on this is:
    Preventive care, Emergency Care, Clinic care.

  33. The most succinct coomment is from Mr. Pawelski. The cost of medical care has balooned for several reasons: the insistence by Americans on expensive testing and procedures, warranted or not, the mushrooming of speciality care, malpractice suits, and lack of personal responsibility. Insurance companies have been allowed to fuel the fire started by the consumer. Medicare and Medicaid are slow, inefficient systems, but private health insurance is inefficient as well. However, it looks like it will be “business as usual” after Mr. Obama stated that a government option may not be included. Asking insurance companies to police themselves is like having the wolf take care of the chickens.

  34. It is astonishing how few regular posters lack a rudimentary understanding of the impact the Federal Government has had on Health Inusurance costs in America. You all should be grateful Nate has the energy to continue posting the truth. How ironic it is to see Matthew defending the objectivity of a 30 year fixture inside the beltway.

  35. Will Presidents Obama’s health Insurance Plan create jobs? I’m sure there will be a need for people to handle inquiries and explain how the plan will be administered and what it covers. These questions will come from physicians, hospitals, various health care providers, the uninsured, or those who just want to know. All should be handled in an efficient manner. Remember it may be a matter of life or death. I’m sure the plan will have glitches and unforeseen circumstances that will need to be addressed. I am a hardworking, friendly, compassionate, and very competent individual. I have handled the quality of information for a large financial corporation. I have monitored live and recorded conversations based on uniformity, precision, courtesy, and the effectiveness of how that information is distributed.
    I have also been the elected committee person in my district for several years, being the liaison between the constituents of the community and the local government. It is an unpaid position but I find helping people very rewarding. Furthermore President Obama, I need a job. Although you have bestowed upon my city over 20 million dollars the local government has not created any jobs. And nothing for people like me who walked the streets and knocked on doors to get you and these other officials elected. There should be help wanted signs hanging outside of the city halls throughout my state. I live in New Jersey. Need I say more? It’s more than probable that the reason I do not work within my local government is that I don’t always pull the party line. I am not afraid to ask questions or disagree with those who are in power. With all that against me I still manage to satisfy those who have elected me. And I do it for free.
    PS. I am a single Dad with a 15 year old daughter and am willing to relocate.

  36. Democratic plans for Health Care Reform are “Dead in the Water.” The “boogeyman” has scared the “bejeebies” out of the American public!
    HHS Secretary Kathleen Sebelius says it is not essential that a public option be in the legislation. President Obama said on Saturday that he won’t insist on a public option. Without the public option, there will be no competition in the market. The large for-profit insurers will continue to have a huge advantage. The public has no objection to that!
    Access to basic health care has deteriorated terribly in this country by the free-market system, because much of the growth in expense is in procedures performed by specialists, and doctors who work in these specialty areas have the most to fear from a public option plan. Big government would be more responsive to the people than big insurance, and doctors would have worked independently, and not for the government.
    But private insurers will keep placating physicians because they fit into their overall plan. Doctors will continue becoming employees of the hospitals, instead of remaining as independent contractors, and we’ll continue to have a corporate bureaucrat between you and your doctor.
    Looking out for “the healthcare bubble!”

  37. The Democrats will not pass a bill without a public plan because it serves them no purpose. Only a public plan will raise enough revenue for them to save Medicare and Medicaid. They can’t siphon the hundreds of billions they need each year out of private insurance with insurance reform.
    They are doing the exact same thing they did with Medicare, create a public plan with a bunch of lies there is no way they can possibly keep, once everyone is in and there is no alternate plan to run back to break all the promises.
    When Medicare was passed it was suppose to be cost neutral, by law it had to pay providers fair rates. Once everyone was in and there was no private insurance for seniors to go back to they repealed that part of the law and forced cuts on the providers. Providers had no choice but to accept the lower rates and seniors had no other plan to go to.
    When seniors started trying to get out of Medicare because of poor quality Clinton made up a law with no voting or chance for public comment saying if you drop Medicare you lose your Social Security Benefits. What does receiving your SS benefits have to do with being enrolled in Medicare? Why are they so scared of people opting out of Medicare and paying their own bills?
    The public plan is not the problem it is what the government will do with it when funding gets short and we have no options left.
    “They are a big part of the problem because they do/will not initiate the cost cutting measures needed.”
    You need your mouth taped shut Peter, Your nose must stretch from here to the sun and back. Any willing provider, ADA, HIPAA, UR Curbs, age discrimination, benefit mandates, the federal and state government has outlawed cost cutting measures. To blame the insurance companies for not breaking the laws is a new low in stupidity. Insurance is expensive because the government made it so.
    Matt our Constitution worked great until Democrats started tearing it to pieces to force their views and programs on the nation instead of the states they already destroyed. If we would restore state rights we wouldn’t have any of these problems. MA, CA, and NY would have tried universal care and gone bankrupt and the middle of the country would have laughed at them with their sustainable but all be it not perfect free market systems that hold people responsible.
    HI has done their own thing in regards to HC as has MA, why are you insistent and forcing your failures on the rest of the country? You only hate the constitution because it is a speed bump to the left destroying the entire country like they have big cities, the coast, and every thing else they have been entrusted to manage.

  38. Mo S. Apologies for the confusion. About 50% of the posters on THCB are well known regulars (including me your host) and Bob Laszewski is certainly one of those. He’s a very very well known consultant and pundit from within the industry, and very respected for his independent views. I can assure you that his opinion is his, not one paid for by anyone else!

  39. Update: Here’s Laszewiski’s bio:
    “Robert Laszewski is president of Health Policy and Strategy Associates, Inc. (HPSA), a policy and marketplace consulting firm specializing in assisting its clients through the significant health policy and market change afoot.
    Before forming HPSA in 1992, Mr. Laszewski was Executive Vice President and Chief Operating Officer, Group Markets, for the Liberty Mutual Insurance Group. He has had twenty years of health insurance industry management experience nine of those years as a chief operating officer. ”
    Side note: it’d be a little more helpful if the blog would give a brief C.V. or link to one for the posters. Was I supposed to know who Laszewski was before I read this?

  40. “Insurance companies are not the problem here”
    They are a big part of the problem because they do/will not initiate the cost cutting measures needed. We are too focused on keeping them in business or preserving their stock price and not focused on cutting costs and providing healthcare. This is not an insurance debate, this is a healthcare debate.
    “why is that a good model to follow”
    That is not a good model to follow and probably because provider lobbyists fight against oversight, but if through Medicare universal budgets were enforced along with fraud oversight and stopping hospital/physician/patient “over over-utilization” (fraud) then there would be enough money to provide healthcare at reasonable cost to everyone. Why do you think countries that have single-pay/government controlled($$$) healthcare do it for half the cost. We do too much for too much.

  41. A public option is simply not necessary to achieve the competition so sought after. The draft legislation eliminates virtually all underwriting by insurance companies (remember when it was actually health INSURANCE?) That alone eliminates most of the variables among insurers and protects people (at a great cost not mentioned of course). Let insurance companies compete on their own efficiency.
    Insurance companies are not the problem here, it is the cost of health care. 70 million Americans are covered by self-funded employer plans and those plans experience the same cost problems as insured plans do.
    Focus on the real problem.
    Despite the rhetoric Medicare is not cost efficient (nor does it process the same type of claims as general health insurers do), its administrative costs are too low to detect fraud or do more than process claims without scrutiny or review (that from a CBO analysis), why is that a good model to follow expect if all you want to to is put 45 million more people into a flawed system.
    For some of the real issues you may want to view my Blog at

  42. In the President’s town hall meeting yesterday, he said they have to work out a plan by which the public option would compete fairly with private insurers.
    I’m no economist, but I’d like to offer the seed of a strategy that could simplify the plan creation process:
    1. Define minimal coverage for the public and all private plans to meet the Congressional health insurance plan (FEHBP).
    2. Calculate the price of premiums for the average private insurance plan—both individual and family—that corresponds to FEHBP coverage. This could be done as a national average or by state/region.
    3. Charge working people 10% of their individual or family income (or some other reasonable percentage), tax deductible, to purchase the public plan (people out of work would get it for free). To do this, we should probably eliminate employer-paid private insurance plans (employers can still give their employees benefits that can be used to purchase their health insurance).
    4. Anyone (or any family) for whom 10% of their income exceeds the private plan premium average would NOT be eligible for the public option, i.e., they would have to purchase private insurance. This would help deal with the issue of unfair competition by the public plan.
    5. Support risk-adjusted clinical outcomes research to determine which insurance plans yield the best outcomes at the least cost, and publish the results to help consumers choose the plans that give them the best value. Any plan (public or private) that delivers significantly poorer value would have to improve to remain viable.
    This basic structure of this strategy, which no doubt needs greater specificity, could help move the debate forward as it appears to be fair to everyone.

  43. I agree with Margalit. I assume the Obama Administration decision-making has been determined significantly by Rahm Emanuel whose interests and behavior are more aligned with someone like Karl Rove than someone like his brother, Dr. Emanuel. Administrative initiatives start from policies that are significantly to the right of center to begin with and then are made worse in reaction to the hooting and hollering from the extreme right.
    We’ll see, but so far not very encouraging for those who wish to see the USA public make some gains against the entrenched economic and financial interests that exploit the public rather than the other way around.

  44. Let’s just abandon all the public (government) options -Medicare, Medicaid, VA, National Guard health benefits, and FEHBP (taxpayer pays 75%), then we’ll see if those buying on the private market really want to abandon THEIR public option. If there is no (affordable) public option and we are mandated not only to pay for other peoples (and Congress) public option but also to pay higher taxes (subsidies/debt) and to purchase private, out-of-control insurance, then as tcoyote says – “both parties are irretrievably broken”

  45. I don’t think the White House has been prepared to trade the public plan away the whole time.
    I think the White House is exhibiting a very disappointing lack of willingness to “grab the bull by the horns”, and it’s not just health care reform.
    Maybe it’s just me, but so far, it’s been a pretty lackluster performance from this White House.

  46. Sadly tcoyote I fear you’re right. But the problem is bigger than that. We need to realize that living off a 230 year old document written for a slave-owning group of freeholders–no matter how far sighted, is not much better than living off a 2,000 or 1,300 year old docuemnt dictated by God.
    In no rational organizational world is the US in 50 equally important markets, yet anything we do has to go through a super-majority in the Senate depending on states that send one representative and two Senators who are the “moderates” to write policy.
    Secondly we have public opinion which is beyond uninformed, moved by money, and open access to Congress by anyone with enough money.
    Unfortunately that’s what we got. I see no way out.
    So we have to hope for the best minimally incremental improvements that we can get.
    One thing Bob L has got right is that insurance reform plus subsidy is the key. How we got into this fight about a public plan when the White House has been prepared to trade it away the whole time, I’ll never know.

  47. Agree w/ Nate (for once). The jacksmith post is a steaming pile of horse manure. The Democrats do not need a single Republican vote to pass health reform, not one. They have the Presidency and hefty majorities in both Houses of Congress. This country is in the hands of the Democratic party. That’s what the voters wanted in 2006 and 2008. Let’s see what they do with all that power.
    As Robert points out, the problem all along has been the ideological split inside the Democratic party, and a House leadership which is substantially out of step with the mainstream of public opinion. In my view, both parties are irretrievably broken, and if neither party can solve this country’s pressing problems, it’s time to start another party that actually represents the sensible middle of our political spectrum.
    Let’s give the CAPS and the boldface a rest. . .

  48. besides spelling does anyone see anything jacksmith got right? Scary to think people are really htis clueless, I guess you go deep enough in the Amazon you might find someone who thinks the earth is flat but you would think anyone with internet access would be more educated then this.

  49. Throw The Healthcare Obstructionist Out!
    More than two thirds of the American people want a single payer health care system. And if they cant have a single payer system 76% of all Americans want a strong government-run public option on day one (85% of democrats, 71% of independents, and 60% republicans). Basically everyone.
    We have the 37th worst quality of healthcare in the developed world. And the most costly. Costing over twice as much as every other county. Conservative estimates are that over 120,000 of you dies each year in America from treatable illness that people in other developed countries don’t die from. Rich, middle class, and poor a like. Insured and uninsured. Men, women, children, and babies. This is what being 37th in quality of healthcare means.
    I know that many of you are angry and frustrated that REPUBLICANS! In congress are dragging their feet and trying to block TRUE healthcare reform. What republicans want is just a taxpayer bailout of the DISGRACEFUL GREED DRIVEN PRIVATE FOR PROFIT health insurance industry, and the DISGRACEFUL GREED DRIVEN PRIVATE FOR PROFIT healthcare industry. A trillion dollar taxpayer funded private health insurance bailout is all you really get, without a robust government-run public option available on day one. Co-OP’s ARE NOT A SUBSTITUTE FOR A GOVERNMENT-RUN PUBLIC OPTION. They are a fraud being pushed by the GREED DRIVEN PRIVATE FOR PROFIT health insurance industry that is KILLING YOU!
    These industries have been slaughtering you and your loved ones like cattle for decades for profit. Including members of congress and their families. These REPUBLICANS are FOOLS!
    Republicans and their traitorous allies have been trying to make it look like it’s President Obama’s fault for the delays, and foot dragging. But I think you all know better than that. President Obama inherited one of the worst government catastrophes in American history from these REPUBLICANS! And President Obama has done a brilliant job of turning things around, and working his heart out for all of us.
    But Republicans think you are just a bunch of stupid, idiot, cash cows with short memories. Just like they did under the Bush administration when they helped Bush and Cheney rape America and the rest of the World.
    But you don’t have to put up with that. And this is what you can do. The Republicans below will be up for reelection on November 2, 2010. Just a little over 13 months from now. And many of you will be able to vote early. So pick some names and tell their voters that their representatives (by name) are obstructing TRUE healthcare reform. And are sellouts to the insurance and medical lobbyist.
    Ask them to contact their representatives and tell them that they are going to work to throw them out of office on November 2, 2010, if not before by impeachment, or recall elections. Doing this will give you something more to do to make things better in America. And it will make you feel better too.
    There are many resources on the internet that can help you find people to call and contact. For example, many social networking sites can be searched by state, city, or University. Be inventive and creative. I can think of many ways to do this. But be nice. These are your neighbors. And most will want to help.
    I know there are a few democrats that have been trying to obstruct TRUE healthcare reform too. But the main problem is the Bush Republicans. Removing them is the best thing tactically to do. On the other hand. If you can easily replace a democrat obstructionist with a supportive democrat, DO IT!
    You have been AMAZING!!! people. Don’t loose heart. You knew it wasn’t going to be easy saving the World. 🙂
    God Bless You
    jacksmith — Working Class
    Twitter search (#welovethenhs) Check it out.
    I REST MY CASE (http://krugman.blogs.nytimes.com/2009/07/25/why-markets-cant-cure-healthcare/)
    Republican Senators up for re-election in 2010.
    * Richard Shelby of Alabama
    * Lisa Murkowski of Alaska
    * John McCain of Arizona
    * Mel Martinez of Florida
    * Johnny Isakson of Georgia
    * Mike Crapo of Idaho
    * Chuck Grassley of Iowa
    * Sam Brownback of Kansas
    * Jim Bunning of Kentucky
    * David Vitter of Louisiana
    * Kit Bond of Missouri
    * Judd Gregg of New Hampshire
    * Richard Burr of North Carolina
    * George Voinovich of Ohio
    * Tom Coburn of Oklahoma
    * Jim DeMint of South Carolina
    * John Thune of South Dakota
    * Kay Bailey Hutchison of Texas
    * Bob Bennett of Utah

  50. In most countries after 1920 most opioids could only be obtained with prescriptions for use in hospitals and for recovery from physical pain, this is a findrxonline report on the use of opioids in medicine. In 1897 Heroin (a product made from opium) was first synthesized by Adolph von Bayer and his company (Yes, this is the same guy who invented Bayer Aspirin that same year). At this time Heroin was still legal in the USA and it was used as a cough suppressant in syrups, tablets and as powder soluble in water. Nowadays some doctors prescribe cough syrup containing Hydrocodone sold under the name Tussionex because opioids are wonderful cough suppressants and you will find syrups with Codeine (another opium product) available over the counter in many countries outside the USA.

  51. This is a bleeding ridiculous shame and a pile of cowering, steaming you-know-what. Universal health care dumps millions of new consumers into the marketplace needing both medicine and medical care, making the drug and insurance people tremble with excitement.
    Many of these new customers will be coming with tax-subsidies paying part (or all?) their premiums and/or drug bills. What’s not to like if you’re selling insurance or drugs? Why should they care if it’s tax money as long as it keeps coming?
    Of course they despise any public option.
    If taxpayers and legislators think a public option costs a lot, wait til they get the bills from the private sector! They ain’t seen nothing yet.

  52. Excessive bolding is really annoying to read. Either you trust your audience’s reading comprehension to get your point or you need to either write for a different audience or rewrite your post for clarity.