Matthew Holt

We’ll be back here in 2016, unless

I’ve been meaning for a while to put up a common sense post that points out that if we don’t do reform now, we’ll end up with cost at close to $30K per family as opposed to the $15K as they are now, and in turn that will mean 80–100 million uninsured as opposed to 50–60 million we have now, and of course the end result will be a health care industry that looks like General Motors.

But luckily Joe Paduda just wrote the post for me and added a date—go read at Managed Care Matters.

Which just leads to one conclusion. The health care industry had better buckle down with the Blue Dogs, put more on the table, and get something passed that they can live with now. AND in addition, they need to figure out some way to stop the loony fringe at the town halls and listening to Rush Limbaugh from making the next best alternative be doing nothing—which is what they want.

Otherwise the conversation they’ll be having with the President and the Chinese central bank in 2016 will be very, very unpleasant.

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  1. TheGroupGuy,
    Thanks for the good news!
    We do pay taxes and social security. Of course, to the system it looks like a real gringo was doing the paying.
    Isn’t it a miracle. Finally a free healthcare system for all of America. Yes, all: north, central and south America inclusive.
    Gracias Hermanos del Norte! Arriba, Arriba, Andalé!
    Your Illegal Alien, Speedy Gonzalez

  2. Margalit – Republicans don’t need to have a 1000-page bill but they do need to come out with something more credible than basically a 2-3 Powerpoint slide presentation with 6 or 7 basic ideas that don’t have much unison or real chance to tackle healthcare inflation.
    That essentially is what Gingrich is shoveling. That’s no surprise because he leaps around policy topic to policy topic like a 5-year old who ate too much cake/drank too much sugar at a birthday party.
    Even the piecemeal ideas that are being laid out there as part of the Republican counterproposals are more ideologically driven (blunt cap on all court damages to destroy the trial lawyer lobby than really help to keep down costs or help patients who have actually been harmed) than ground in pragmatic reasoning & justification.

  3. “But Nate as per usual, shout “Ted Kennedy, HMO Act” and tell lies and at least all will be well in your not exactly expansive mind.”
    Matt that almost felt personal. It would seem the Sunday Times and NHS Physicians are also suffering from non expansive minds.
    “The investigation also found NHS has invoked a policy of refusing care altogether to patients who, often upon physician recommendation, choose to pay out-of-pocket for best-available drug treatments.”
    “Many new, privately available drugs are potential lifesavers but are de facto prohibited by Britain’s slow-changing government monopoly health care bureaucracy.”
    “Despite this proven effectiveness, NHS has refused to approve Sutent for distribution to NHS patients and is denying all taxpayer-funded care to patients who purchase the more-effective drug with their own money.”
    When you attack the person instead of their argument that leaves smarter people to think you don’t have an argument. Lets discuss why England and Japan cut off care to people who buy drugs and services not approved by their universal system instead of my mental capacity; I think everyone would agree it is the more important debate.
    If you are to have a sustainable Universal system that controls cost you do need to ration, but does that extend to deny approved care just becuase someone tries something off the menu? I don’t think American’s would take well to being told they can’t spend their own money on a treatment, even more so if they are told they can’t opt out or they will lose their Social Security Benefits.
    I understand why you want to call me a mentally deficiant lier instead of debating the actual facts, I don’t see anyway you can sell this to the public. Without these limitations the plan is not sustainable, with them you can’t get public support, unless you deny and bury.

  4. GroupGuy, you got your quotations mixed up. I didn’t say anything about piecemeal (it was MG). Everything in less than 1000 pages of legislation must be piecemeal 🙂

  5. Matthew,
    Second, EVERYTHING that the groupguy suggests has been done before and more piecemeal by the private sector.
    And where it was done correctly it worked right Matthew?
    In the absence of system-wide government reform it cannot be successful.
    Workers compensation is a system wide government reform that has lagely been unsuccessful controlling medical inflation despite 100 years+ of oversight. How did TennCare work out it was statewide right? How is Massachussets bending the curve down?
    But government regulated and led reform (of many different types) has been successful in keeping costs down in every other country.
    Yes by rationing care if this is the definition of success.
    Illegal Alien,
    Just hang in there Obama plans a path to citizenship for you then you get to pay like all us gringos.

  6. Excellent points Barry.
    “Still, the comments by TheGroupGuy and Nate are generally what I have seen from the right on health care reform. No comprehensive reform but baseless retorts and piecemeal ideas.”
    One might infer that construing the entire health reform position of the right or Nate or I from the comments on a single post could could also be called piecemeal.

  7. First, regarding the notion that 20% of the people account for 80% of healthcare claims, as Margalit points out, they are not the same people from year to year. Several years back, the CBO did a study that showed that in any given year, the 5% of Medicare beneficiaries with the highest claims accounted for 43% of claims costs. However, if you look at cumulative costs over a 5 year period, the most expensive 5% of beneficiaries accounted for only 27% of cumulative 5 year Medicare spending. This is because some beneficiaries died along the way while others had a single incident like a heart attack and then recovered.
    For those interested in the politics of health reform, I think it would be worthwhile to read former NJ Senator Bill Bradley’ op-ed piece in today’s New York Times. He talks about the politics of tax reform in 1986 and compares it to health reform today. He made the point that tax reform was achieved in 1986 when a Republican President (Ronald Reagan) and a Republican Senate agreed to take on some of their sacred cows including the oil and gas industry, the real estate industry and large industrial corporations generally which all benefited from the tax loopholes under the old system. Democrats, for their part, came to accept that the marketplace was better at allocating resources than Congress and high marginal rates were not necessary to achieve tax “fairness.” Indeed, the wealthy wound up paying a higher percentage of federal income taxes under reform with its broad base and low rates than under the prior system with its high marginal rates and loopholes.
    With respect to health reform, Republicans have already accepted that universal coverage is a worthy goal and insurers have agreed to do away with medical underwriting in exchange for mandatory participation. Bradley suggests that Democrats should take on their friends in the trial bar and pass substantive tort reform which could attack what he suggests is the up to 10% of healthcare costs attributable to defensive medicine. I would add that Democrats might also try to win over the labor unions to accept a phaseout of the current tax preference for employer provided health benefits or even do away with it altogether. Finally, I also think the public option for Republicans is a deal breaker just as private accounts were a deal breaker for Democrats when President Bush proposed Social Security reform. If the public option were jettisoned, there is probably a lot of common ground that both sides could agree on.
    Personally, to bend the medical cost curve, in addition to tort reform, I think we need the following: (1) a more realistic approach to end of life care, (2) price and quality transparency, and (3) a move away from the misaligned incentives connected with the fee for service payment model. Instead, we should develop bundled pricing approaches for expensive surgical procedures and tiered co-pays based on quality and cost-effectiveness for doctors and hospitals. As a byproduct, I think substantive tort reform could be a catalyst to bring doctors on board in helping us to reduce excess utilization. To bend the cost growth curve and achieve near universal coverage, everyone needs to give up something including doctors, hospitals, insurers, drug and device manufacturers, trial lawyers, patients, and politicians.

  8. Nate says “Like in the UK, if you have the nerve to pay for your own care outside of the system they take away all of your care.”
    A usual pure tosh. There’s been a parallel private system in the UK since 1948. Anyone can pay cash or buy private insurance–and aobut 10% of Brits do so. Furthermore since the late 1990s the PCTs (that is the government) have bought care for their patients from the private sector both in the UK and Europe.
    But Nate as per usual, shout “Ted Kennedy, HMO Act” and tell lies and at least all will be well in your not exactly expansive mind.

  9. Hola,
    Please don’t forget us illegal aliens from Mexico all the way down to Colombia.
    We need quality healthcare too.
    Remember, we build your houses, do your lawns, clean the crap you leave behind in hotel rooms, cook most of your food (yes, those little guys that you see in the asian restaurant kitchens are actually Mexicanitos).
    We also work in your hospitals. Yes, we clean them, not only in border states but all the way up to Michigan (short for Mi Chicano land).
    And also be reminded that we will be your total workforce in approximately 20 years. See, all you gringos will be in intensive therapy for your lousy lifestyle and not doing any work. We may well up being your physicians.
    So take care of us 12 million + now so that we can be grateful when you need us.
    Adios, andale!

  10. businesses and individuals explore and exploite every loop hole they can find, pre-existing is the result of individuals exploiting loop holes. Government has never been effective at preventing it, they come in after wards spends billions and promise it will never happen again. We can’t trust government to do the right thing. Through thousands of years of history and hundreds of thousands of governments has one ever been completly trustworthy?
    “Does it really matter what happens on capital hill if the solutions that will result in a long term sustainable health delivery industry are mostly independent of legislation?”
    Sadly it does. If I invented a 100% sure fire system tomorrow that covered everyone and did it cheaply but did it outside the government they would prevent it from happening. Health Care reform has never been about lowering cost or improving care, that is why it has never lowered cost or improved care. If there ever is a solution it will come from the private sector and will be inacted over the dead bodies of politicians. The hill will never let that much money go without a fight to the death.

  11. Nate,
    The lesson to learn from that Japanese case is that:
    1. The administrative branch may not be always right in their interpretation of the law. No argument here.
    2. That is why democracy needs checks and balances, based on separation of powers.
    Are you implying that a private payer would not have explored a loophole in the law, given a chance?
    I am with you that opting out of Medicare should not be the reason to stop sending Social Security checks. See #1.

  12. I, like most of you would like to see reasonable healthcare reform passed that would lower healthcare costs and cover all Americans. If it does not pass all is not lost. The 2016 prediction may or may not come to pass. As health care cost rise so will the number of uninsured. As business struggle with healthcare costs they will be more likely to try new approaches. All this adds up to an opportunity like no other, to reinvent health delivery. Disruptive innovators who provide low cost High value health focused care will win the day. Does it really matter what happens on capital hill if the solutions that will result in a long term sustainable health delivery industry are mostly independent of legislation? The government can hinder or help but it cannot stop the evolution of health delivery.

  13. “On November 8, 2007, an individual patient successfully sued the government in the Tokyo District Court by claiming that the government violated his constitutional rights by refusing to allow him to apply his public health insurance to any of his cancer treatment because part of his treatment had included uninsured services. The government had insisted that such prohibited “mixed” treatment relieved it of its duty to pay even for the insurable portion of his treatment. In effect, the court ruled that the government’s suppression of a mixed system was unconstitutional.”
    Like in the UK, if you have the nerve to pay for your own care outside of the system they take away all of your care. Just like the US will take away your Social Security if you try to opt out of Medicare. How much more oppresive can they get before you call this what it is?

  14. I share the concerns that the current health care bills including the lack of real cost controls, additional funding necessary to cover the proposed cost, and building upon some of the worst aspects of the current health care system.
    Still, the comments by TheGroupGuy and Nate are generally what I have seen from the right on health care reform. No comprehensive reform but baseless retorts and piecemeal ideas. Instead it is spouting crap about “death panels” and attacking old liberal stereotypes really largely have been antiquated since the 1970s.
    Some of these piecemeal ideas should merit serious consideration including the ability to underwrite insurance across state lines, tort reform (and not a blunt cap on everything) etc.
    Still, these don’t count as comprehensive reform and in order to be taken seriously someone on the right has to put forth a serious and thoughtful reform bill. I have seen a couple of points (such as Gingrich’s 6 points) but these again falls into the piecemeal category and not comprehensive reform. I am also really dubious on the ability of points to be enacted as advocated and their ability to blunt health care inflation.
    The best thing that I have seen out there is still the Wyden bill that was put forth nearly 24 months ago. Yeah, it has some limitations that both not please those on the left (single-payer) and those on the right (everybody has high-deductible plans and is on their own to try and buy health insurance).

  15. The way statistics are abused on this site is criminal. I would have hoped they taught you in grad school you can’t measure the poverty of retired people by their income. When someone retires and stops working you need to measure their assets. For when you do a meaningful analysis you get results like this;
    “However, data submitted for the record from a 1960 University of Michigan study showed that “87 percent of all spending units headed by persons aged 65 or older” had assets whose median value matched asset ownership of people aged 45-64 and exceeded the asset ownership of people under age 45 (U.S. House Hearings 1963-64: 242-43).”
    They didn’t have insurance because they didn’t need it. There was a time before the government destroyed healthcare you could pay for it yourself out of pocket. In fact over half of all health care was paid out of pocket in 1965.
    More seniors are in poverty today with Medicare then where in poverty without it, you can’t talk your way around that fact.
    I told you how we reform the system, start by having an honest accounting of what system is spending the money. You can’t have functioning systems when they are funded by back door taxes and cost shifting. One way or another Medicare and Medicaid expenses must be accounted for by those plans. If we need to raise taxes to pay their obligations then so be it, but it needs to be an honest and transparent accounting. Are you really advocating we continue to hide the true cost of these plans and manage them in the dark?
    “But government regulated and led reform (of many different types) has been successful in keeping costs down in every other country.”
    NAME ONE! Every other country is also in the process of reforming their system because the financing is not sustainable. No country in the world has found a sustainable universal system.
    “After all nowhere else in the developed world is ANYONE EVER in that category.”
    Shovel the hyperbole a little deeper.
    “Doctors Without Borders, for example, estimates that over 300,000 people in France are now, after the most recent “reforms,” totally without health-care coverage. The organization, best known for its work in the developing world, has begun providing medical care at clinics in Paris and Marseilles for patients who are denied insurance coverage under the new reforms.”
    “Only .2 percent of Germany’s legal residents are uninsured,” Notice they exclude illegals.
    “Japanese law is very strict about the distinction between the provision of insured and uninsured care and prohibits medical institutions from providing both insured and uninsured services as different components of a single series of medical treatments.” Pretty strict rules if there were no uninsured people.
    “As a result, Japanese society is fast becoming the oldest society in human history, and the long-predicted collapse of the public healthinsurance system is becoming reality.”

  16. Margalit,
    One indicator that the health care sector still has healthy employment is that it showed the smallest increase in COBRA elections of any US economic sector in a recent survey. Why? Because employment is still possible and those losing their jobs get another with health care negating the need for COBRA.More here While you are there read up on how I have savaged Pharma and PBM’s–something Matthew & I happen to agree on by the way.
    How can one argue that health care is not government business, but it is employer business? Perhaps because employers choose of their own volition to offer the coverage in order to attract and retain talent. This contrasts to a government mandate they do so or pay a fine which is questionable constitutionally to all but the most ardent statists.
    Are we implying that we trust corporate America to do the right thing by us more than we trust our elected government? You’re damn right they do. People can change their employer. Do you actually believe Americans trust their government? I rather think the late Bob Novak got it right when he said Love your country but don’t trust your government.
    If that’s the case, something fundamental in our political system must change. This is happening right now. Pay attention to the man in the street versus the intellectuals in the Salon. they are speaking very clearly that the proposed changes are not what they had in mind.
    The moment has arrived when our elected officials have to focus on what they agree on and generate real reform or face the consequences as Matthew has succintly pointed out in the original post–we just disagree on the cure. That is all.

  17. GroupGuy, do you really think that health care is an “an economic sector in the US that is doing well”? How do you define doing well? Share holders dividends? Payer/Pharma profits?
    As to employers and their aligned interests with those of their employees, I wonder…. Are employers, like the Cleveland Clinic for example, going to refuse hiring smokers and bemoan their inability to do the same for obese people? Maybe take it a step further and check any other “risky” behavior….
    I know that some businesses treat their employees well, as Nate also mentioned, but this is in no way the norm and we should not expect it to be.
    How can one argue that health care is not government business, but it is employer business? Are we implying that we trust corporate America to do the right thing by us more than we trust our elected government? If that’s the case, something fundamental in our political system must change.
    Nate, what’s with those numbers (20% responsible for 80% of claims)? That 20% is not a constant. We all gradually drop into that 20% and then we die and other previously healthy folks replace us. Sudden deaths are nice, but not the vast majority.

  18. Go Nate!
    Let’s not forget to rewrite EMTALA, the bill that has mandated the surrender of billions in uncompensated care on demand by the nation’s hospitals and emergency physicians.
    What a bargain for the “system”. I must assume reaponsibility for the patient’s stability. The patient has no responsibility to do anything, including pay for it. The feds have no payment responsibility either.

  19. Yes its true Matthew the steps I outlined above are being done piecemeal in the private sector. That fact does not change that it has been effective in bending the cost curve down for those who have pursued the path. With 70% of healthcare costs attributable to behavior–tobacco use,diet, insufficient exercise– that leads to cardiovascular, diabetic and cancer issues that impair and end life sooner.
    How is educating employees on effecting behavioral changes that will prolong and enhance their lives later and allow them to avoid maintenance meds now somehow a fixation on corporate costs Margalit? Just because corporate and employee interests are aligned does not diminish the truth that for our nation to bend the cost curve downward we need to aggressively eliminate preventable disease.
    To date the US governments total experience at controlling health costs has centered on cost shifting to private payers and ratcheting down provider reimbursement.The US government today accounts for 60% of the health care spend. If they have not figured how to bend the cost down out by now most ordinary Americans out protesting seem to place very little faith in their governments ability to do so in the future. After the bank bailouts, and the auto bailouts additional statist solutions will be rightly viewed as just new infringement on personal freedom and liberty.
    As far as what happens to the enlightened employee when they lose their employer provided coverage Margalit don’t you know ARRA just improved on COBRA by extending a 65% subsidy for COBRA premiums for at least 9 months? We will not need to worry at that point about a job to pay the 35% premium because the stimulus will have kicked in or the congress will simply extend ARRA. Welcome to the welfare state.
    American’s are not drinking the Kool-Aid about mirroring universal health care in other nations. They see health care reform proposals as they exist today as the rather transparent attempt to seize perhaps the only economic sector in the US that is doing well.

  20. Margalit,
    “at its very core, the only consideration is financial benefit to the company.”
    This is insulting to tens of thousands of companies that treat their employees like family. Your allowing the rehetoric and partisanship to blind you from reality. I have small clients now that are going without paychecks or borrowing and risking personal BK so they can keep all their employees working and with paychecks and benefits. The level of distortion comming from the left is sick. Why should people care and help others when no matter what they do you on the left will still attack them and deny they do anything?
    “Nobody stays healthy forever”
    Actually they do, 20% of a population accounts for 80% of your claims, majority of people will pass away with minimal healthcare expense. Heart Attacks, accidents, strokes, all examples of people who die not costing the system much of anything.

  21. We need to clean up past reform so the market is not handcuffed in controlling cost.
    1. rewrite COBRA and HIPAA so anyone can comply with them without hiring an attorney. Provide model notices and indemnify the users from lawsuits if they use the model notice. End the ridiculous fines for not submitting 1099s or Medicare SSNs, these fines drive small insurers and self funded employers out of the market aggregating market share with a couple large national carriers.
    2. Rewrite HIPAA and ADA so employers and plans can target abuse and waste. There is not enough money in the system to treat those that need it if we spend billions on those that don’t care. There has to be financial penalties for making bad decisions. We are in America you are free to engage in risky activity, smoke or drink yourself to death, or enjoy deep fried Twinkies, but not at someone else’s expense.
    3. Medicare use to; “language in the bill specifying that amounts paid by the government to “any provider of services” under the bill “shall be the reasonable cost of such services, as determined in accordance with regulations establishing the method or methods to be used, and the items to be included, in determining such costs for various types or classes of institutions, services, and agencies.” Both Medicare and Medicaid must be forced to pay for the true cost of the care they deliver and promise. As long as government can play shell games with the liability and cost of these plans they will never be properly managed and thus drive up the cost of all the other plans. It is the failure of the public plans that are dragging the entire systems down, fix those and the rest will be fine.
    These three changes would do more to save money and permently fix the systems then anything in HR 3200. What these don’t do is shift trillions of dollars and the power that comes with it to government hands. It also would make government accountable for the promises they made and broke in the past 44 years. For this they are labeled rubbish and crapping on. You notice no one on the left will ever debate the actual merits of a proposal from the right, they just dismiss it or deny it exist. We have never had debate about reform only a propaganda snow job from the left.

  22. Two things. First a quote from this site about Medicare from PBS who seem to have some fact checking as this is about what I remember from my grad school days
    “In 1964, 44 percent of seniors had no health care coverage, and with the medical bills that come with older age, this propelled many seniors into poverty. In fact, more than one in three Americans over 65 were living below the poverty line — more than double the rate of those under 65. Medicare was an important and big change in American health care — it was called the “biggest management job since the invasion of Normandy” — and it was up to John Gardner to make it work. He helped shepherd Medicare to reality, and the results have been extraordinary: virtually all seniors now have health care, and the poverty rate for the elderly has fallen to approximately one in ten — a rate lower than that of the general population.” So in 1963 Rep Curtis was making shit up. Sounds like he’d do well in the Republican party of today.
    And of course Nate, in reality abolishing Medicare is impossible as your buddy Michael Steele has found out–so stop going on about it and instead talk about how we might reform the system.
    Second, EVERYTHING that the groupguy suggests has been done before and more piecemeal by the private sector. In the absence of system-wide government reform it cannot be successful. But government regulated and led reform (of many different types) has been successful in keeping costs down in every other country.
    And “uninsured” depends on the period you’re counting Stephen. RWJ showed that 80m were uninsured for at least 3 months in a 2 year period. Given that any one of them was a serious illness por trauma away from financial devestation, why isn’t that the proper number? After all nowhere else in the developed world is ANYONE EVER in that category.

  23. Interesting how the “47 Million” uninsured has now become 50-60M in this post. Lets keep our facts straight and academic, perhaps refrring only those truly uninsured rather than those uninsured and eligible.
    Feel free to post your reform plan at:

  24. GroupGuy, I appreciate the positive steps that your clients are taking in order to reduce their own expenditures, but what happens to an employee if/when he is no longer employed by your enlightened clients?
    The problem with the employer supplied health care is that, at its very core, the only consideration is financial benefit to the company. Patient welfare comes second, if at all.
    As long as health care is run by corporations whose only interest is to either make profit or reduce expenses, depending if they sell or purchase health services, the patients are going to lose.

  25. These arguments of “the working poor paying for the retired rich” and the healthy paying for the sick and all variations of who may be paying for someone else are really ridiculous. Nobody stays healthy forever and nobody starts out retired.
    How about everybody paying their fair share during an entire lifetime, into one system that will pay back as life circumstances change, as they always do?
    I know that’s not good enough without bending the cost curve, but combined with waste reduction and cost management (which is sorely lacking in the proposed bill), it will provide the only optimal solution.
    It will not provide a miracle though, and I fully expect that health care costs will continue to rise for the foreseeable future, maybe a bit slower, even if we did implement the “dream solution”. It took us a long time to get to the current dysfunctional situation and it will take a long time to reverse or at least temper its effects.

  26. Matthew,
    Why is it that the only sensible people are the ones who agree with you? Is not the purpose of this blog to enhance understanding about healthcare and discuss ideas?
    We are at a point where theory meets reality. Yes we need healthcare reform but the reality many in both parties are acknowlidging is that current proposals are fiscally irresponsible and the lies about keeping your current coverage, or doctor,not rationing, and reducing costs are transparent and no one with a brain trusts the government to make decisions about their healthcare. Questioning bad policy is hardly “crapping on”.
    My take is on the record and my clients are real business’s that provide health care and they favor practical real world advice not the trust us to fix health care crap being peddled as reform. Right now my clients are scrambling to fund the higher claim cost associated with ARRA claims which determine their future premium/funding levels in another classic $65B cost shift to private payors. Thanks Congress.
    1.They are bending their medical trend by negotiating transparent PBM agreements incenting low cost in therapuetic class & OTC pharmaceuticals.
    2. Providing onsite clinics and self-funding.
    3. Engaging members to become active consumer’s of health care.
    4. Creating networks that reward quality.
    5. Educating members on the cost and consequences of unhealthy behavior.
    The 5 points above involve the active engagement and investment on the part of real Americans today who in their business’s cover 85% of all Americans. Congress may learn something by listening to those in the arena as they consider reforms. It is disingenuos to set forth a path to single payer without a supporting business case for change that acknowledges future intent on jugular issues like Medicare advantage and rationing.

  27. According to Kaiser their are 45 million people in Medicare. 8.8 million of those are duel eligibile. That is 19.5%.
    “Rep. Curtis questioned whether it was appropriate to “change the basic system” when 80 to 85 percent of the aged were able to take care of themselves under the existing system, recommending instead that we “direct our attention to the problems of the 15 percent, rather than this compulsory program that would cover everybody” (U.S. House Hearings 1963-64: 31, 392).”
    “Some in Congress clearly recognized that one effect of the proposed program was to require the working poor to subsidize the retired rich, as when Senator Long (D., La.) asked, “Why should we pay the medical bill of a man who has an income of $100,000 a year or a million dollars a year of income?” (U.S. Cong. Rec.-Senate 9 July 1965: 16096). Nonetheless, the predominant political motif was misleading allusion to the financial plight of the elderly, what Rep. James B. Utt (R., Calif.) called the false assumption “that everyone over 65 is a pauper and everyone under 65 is rolling in wealth” (U.S. Cong. Rec.-House 8 April 1965: 7389).”
    So Medicare managed to take us from 15% to 19.5%, destroy our systems and bankrupt the nation in the process and you deem this a success.

    Public programs pay for more than two-thirds of seniors’ health care spending at all age groups; however, as seniors age, Medicare pays a lower proportion (decreasing from 54 percent to 38 percent) and Medicaid pays a larger proportion (increasing from 8 percent to 25 percent)
    The graph shows clearly Medicare does the exact opposite of what you claim and what Democrats promised when they passed it, when you get sick the minimal coverage of Medicare leaves seniors broke.
    How are cold hard facts showing Liberals lie about the need for reform, lie about the cost, and lie about the benefits rubbish when liberals are once again trying to hoodwink us into supporting more reform? These facts and history lessons seem quite germane.

  29. Matthew,
    I don’t see anything in GroupGuy or Nates comments that mention anything about “Gingrich’s 6 points will put a cap on overall system costs”
    If you really think what GroupGuy or Nate says is “rubbish” you should refute their positions instead of pulling a straw man rebuttal.
    What GroupGuy states about “$20B pissed away in the spendulous package which has only served to freeze investment while the provider community waits for meaningful use to be meaningfully defined”
    I can attest, as a medical software developer for small medical practices, this is 100% correct and the Govt. mandate on HIT will only raise the cost of software to providers which will be passed on to patients.
    Do you have any real world evidence that this HIT “Investment” will decrease costs to a small practice?
    How is it possible to devine cost savings from a plan that has not been defined?
    I’m all ears Matthew, convince me.

  30. “The only thing that Medicare did was to prevent seniors going destitute due to medical costs (which it has done)”
    This is incorrect Matt, prior to Medicare 85% of seniors had sufficent assets to pay for all the health care they needed in their life time. If you look at the number of seniors on Medicaid it isn’t any better. That was the lie Liberals told to pass Medicare, protect grandma if she ever gets seriousally ill, Medicare does the exact opposite, benefits cease after 60-90 days then they are dumped into Medicaid.
    The politicians told us they would fix the system, Would you like me to link to Kennedy’s speech about how proud he was of HMOs, how they lower cost 30% and increase quality and they would save the world? Or are you agreeing Kennedy isn’t sensible? Which if that is what you are saying, he supported HR 3200 so why should we beleive he finally got it right?

  31. GroupGuy & Nate. You continue to spout rubbish. No one sensible (Enthoven, Fuchs, me) ever thought that Medicare, The HMO Act, COBRA or HIPAA were ever going to fix the US system. The only thing that Medicare did was to prevent seniors going destitute due to medical costs (which it has done) & make the health care industry rich.
    Nothing in Gingrich’s 6 points will put a cap on overall system costs.
    Finally, crapping on about passing a right wing non-bill while we have solid Dem majorities in Congress and in the White House is either wishful thinking or deliberately obstructionist. The alternative to the trivially minor reform we have up on deck now will be doing nothing. Is that what you want? Be brave boys and say so.
    And yse, I have a proposal, but admittedly not one that anyone right now is favoring.
    And the result will be something you really won’t like around 2016

  32. Times up Matthew. You have to choose between the lesser of two evils.
    1. Do you continue to pontificate from your liberal pedestal and vilify “the looney fringe” who have significant policy disagreements about the sustainability of the current proposals which re-engineer healthcare in a manner which does nothing to bend the cost curve down and will bust the budget in a manner that will make your current assessment and Joe Padua’s seem like wishful thinking, or;
    2. Do you actually have proposals that would bend the cost curve down and avoid the calamity of 2016 impossibility of economics you have described?
    I make this point because our elected officials live in the real world and there are many smart people who post on these pages who seem incapable of comprehending the legitimate objections of real Americans who possess valid concerns about current reform proposals which are highly suspect in terms of their ability to achieve specific policy objectives regarding cost stabilization much less reduction.
    It would be helpful to see more rational posts aimed at #2 instead of emotional appeals rooted more in worldviews than in pragmatism.
    American’s clearly believe the cures being proposed are worse than the underlying disease as all the polls show. And if Health 2.0 is to advance it will only do so based on rational buyin from providers who must understand the economic justification for investing in HIT which is not crystal clear to many providers today despite the $20B pissed away in the spendulous package which has only served to freeze investment while the provider community waits for meaningful use to be meaningfully defined. Your turn.

  33. nice job avoiding the history. Medicare was suppose to solve the HC problem for seniors in 1965.
    HMOs were suppose to fix everything in 1973
    COBRA was suppose to fix losing insurance when you left your job in 1986.
    HIPAA was suppose to fix keeping your insurance and pre-ex in 1996.
    That is 4 major reform bills that were suppose to fix the problem but instead failed miserably and drove cost up. This doesn’t include several minor federal fixes and thousands of state fixes that failed to deliver the results they promised and drove up cost.
    Matt you now want us to believe once again if we don’t pass some major reform the system will collapse? I think history proves that if we do pass reform the system will collapse. Your projections are flawed from the start, the increase in insurance the past 5-10 years was because of the passage of COBRA and HIPAA and the fallout from Teddy’s HMOs. The systems have dealt with those and can now start reducing cost. The only thing that can stop this correction is more government interferance. Just like the new deal prolonged the depression it is government reform that has prolonged the spike in Health Care.
    Viva La No HR 3200!
    before peter misreads this and starts running at the mouth, there is plenty of things that can be fixed in our systems, they just don’t involve a larger role for the government that created this mess. I know how you liberals love to claim the right has no ideas when we don’t support your failed ideas. We just have better ideas that actually work.

  34. Something needs to be done to make sure that physicians are of good quality and are using their skills for healing instead of lining their pockets at the expense of hurting people. Otherwise there won’t be anyone left in 2016 healthy enough to vote on anything.
    There also is a great need for better availability of the information on HOW to locate the quality care physicians and to know how to tell the difference between a doctor that wants to HEAL and one that is just going through the motions. The need is for everyone that is not “wealthy” to have this necessary information.
    In addition to my own bad experiences attempting to gain quality care, as well as others whom I know and thousands of others seen on the internet, I’ve recently been emailed a link to a new blog with a story far worse than my own, and he/she has apparently only begun to tell their tale. There was a bit in his/her tale that reminded me of several known situations, so perhaps it might spark some recognition and contribute to any venue of improvement: .
    Something must be done.

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