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How to Get Enough Votes in the Senate

Picture 66 When Hillary Clinton was running for President, she set forth a more modest agenda for health care reform than her competitor, Barack Obama. Maybe she understood better, based on her experience, how difficult it is to get a comprehensive bill through Congress in this field.

What is possible now that the President has lost the 60-vote majority in the Senate? I think the thing to remember is that he was having trouble even holding together the 60 votes he used to have. He had to agree to an assortment of give-aways — to Nebraska, to Louisiana, to the labor unions — to get the votes he needed. In part, that proved to be the undoing, as Massachusetts voters watched this sausage being made and sent a message through the election of Scott Brown that they didn’t like what they had been seeing.

Now, it may be that the Republicans will act to kill anything that might come along. I don’t think so. I think they are willing to be part of a bill, but it has to be a bill for which they can claim credit among their constituencies. What might it be?

Insurance reform: People, irrespective of party and political leanings, despise the practices of insurance companies that limit or take away coverage. The use of pre-existing conditions to deny coverage, lifetime limits of coverage, and rescission of policies are nasty and unfair. These practices remain as sources of insecurity among Americans, even those with insurance. There should be near-universal support to change them.

Tort reform: I think that most people feel that, while people should have a right to sue for medical malpractice, the process that exists today is inefficient and arbitrary for both plaintiffs and defendants. Any doctor will tell you that fear of such suits also leads to the practice of defensive medicine, driving up costs for all of society. Tort reform does not require limitations on payments. It could be accomplished with the establishment of specialized courts and procedures that would add greater certainty to outcomes and reduce the tensions and abuses associated with the system. This should not be a partisan issue.

Payment reform: Nobody likes the results of a system that systematically underpays primary care doctors and leads them to a life of 18-minute appointments and a role as triage doctors, a way station to referrals to higher paid specialists. If Congress were to order Medicare and state Medicaid plans to take the lead in establishing reimbursement rates for PCPs that reflected their value to families and patients, we would be on the way to a more rational system of care. Likewise, if physicians were paid for care delivered by telephone and electronically, millions of unnecessary and time-consuming office visits could be eliminated. If these steps were taken for Medicare and Medicaid, private insurers would follow.

Transparency: A national mandate for public disclosure of the rates paid by insurers to providers would help drive greater rationality in payment methodologies in the states. Disclosure of clinical outcomes in clinically important arenas would provide impetus to improvement in patient safety and quality. How can this be a partisan issue?

Now what about access? I fear that expansion of insurance coverage is the third rail in this debate. Why? Because it requires revenue to support the subsidies that would be required, and tax increases are really hard to achieve. The President made this issue more radioactive than necessary by proclaiming at the start that you could get access, choice, and lower costs all in one neatly wrapped package. Everybody in the field knew that you could not. This then resulted in sleight-of-hand revenue measures that became the undoing of the bill as Christmas tree ornaments were added to undo the effect on particular states or interest groups.

As I have stated here, a fair approach to generate the revenues for expanded access is to eliminate or reduce the pre-tax treatment of insurance premiums. Doing so would use the progressive income tax system in a way that would apply a larger percentage of these costs to more wealthy people. Could this approach gain a bi-partisan consensus? It could not gain support even among the Democratic majority, so I am guessing not. And the Republicans seem to express no interest at all in mandates for greater access. Maybe we have to accept as a reality the idea that expanded access is a casualty in this debate. I hope not, but I don’t yet see an answer to this that can get 50 votes, much less 60.

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33 replies »

  1. Your blog brings me a good deal of enjoyable. Incredibly glad to have the opportunity to meet you. Take ralax and give your self a surprise, and we will reside extra content.

  2. Every time someone tells you they need something in order to make you more safe, get ready, you are about to lose some freedom.People identify with a desire for increased participation, communication, and transparency.”A government big enough to give you everything you want is.Every one have to be on they all give themselves high scores! It’s amazing what a great job our government is doing.

  3. A man flew a plane into a building today to make a statement about the affairs of this county, and while a sad and terminal comment by him, imagine if he did it into the Capitol of this country and wrote a manifesto about the state of health care. Whoa, wouldn’t people pay a lot more attention to this if this was his agenda.
    Well, certainly I am NOT advocating for this, but, maybe any reader who reads this might want to think about this perspective. Health care reform is not going to be effective and responsible being lead by a bunch of self serving, greedy, irresponsible, and clueless ALLEGED representatives for us all. I really hope readers pause and think about that last sentence.
    That is what politicians are, in 2010. They do not give a damn about the average american. If you think they do, you are the a–hole who re-elects them every 2 to 6 years. And if you are complaining about them now, look in the mirror! ‘Cause you are the problem!
    Man, you have to appreciate a slap in the face once in a while. It wakes you up and sobers you up!
    Republicans. Democrats. Idiots. Morons. Substitute whatever word fits for you. I am done my perusing here for now. If the author is paying attention to my commenting here, and really cares about health care matters, you might think about what I am saying. You might not give a damn either.
    You know what, though. I see patients. I listen to what they say about the state of health care. And, the ones who know better are voters.
    If there is a God, or a higher power who is invested, I hope he slams the idiots. And, I won’t know better. But, I’ll enjoy the outcome.
    To all readers who agree with me, thanks!

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  5. Oh, come on Matt and other extremist positions. This is about moderate positions, not the Democrats “let’s get legislation put out now so we can get voters to keep us in office” or Republicans “let’s satisfy minority big business so they can fund our minority status and return us to office”.
    Both parties suck, and why can’t average, moderate americans see this is a one party system, republocrats, who in the end know they need each other to keep their minority system in check to screw the majority.
    God, why can’t people see the truth!? Politicians have no real interest in helping health care problems, and I am sick of reading the special interest commentators who repeat endlessly at this site selling their personal gains. This site is not about health care reform in the end, just sound bites and personal interests.
    As I have said before, and for my last comment here, where are real doctors who know what is going on and when are you going to take a real stand and advocate for your patients and our profession?
    TAKE THE F-O-R OUT OF PROFIT IN HEALTH CARE AND WATCH THE ROACHES OF SPECIAL INTEREST SCATTER TO OTHER GREEDY OPPORTUNITIES. IT IS THAT SIMPLE, BUT NO ONE WHO REALLY CARES IN DC WILL TAKE A STAND AND SAY SO!!!
    What does that say about the so called “representatives” you vote for repeatedly. Selfish, ignorant citizens elect selfish, ignorant leaders. Good luck, you so called invested and caring commenters!

  6. Health care spending is out of control because people do not own the constitution anymore. It is owned by financial backers of elections, usually large businesses.
    But here’s the thing. Why don’t the people just start writing a bill themselves rather than just criticizing everthing that is done in Washington. Is that too much too ask. We are all people that live in real communities and see what really goes on. We can come up with solutions ourselves.. We should stop being such babies and just do start putting specific ideas together ourselves.
    I am so sick of so called experts throwing in so much junk into the debate that it becomes hard to follow. The Republicans love this confusion because then most Americans get disoriented and disenfranchised. Then it just gets easier for them to say stuff like, this is socialism or keep goverment out of health care. It’s not that they don’t want positive change, it’s just that Republican politicians just want to keep them confused about it so they can’t figure out what’s actually good for them. Let’s all just make one or two points and start putting it all together in a simpler way.
    Every other industrialized country takes pretty good care of its people and the U.S is the one with the enlightened founding fathers who put together such a divine fundamental document that laid the foundation for the greatness of this country in the moral principles that were put into law in the form of a constitution. Let’s just bring a collective morality back and use that to put some good ideas down.
    Can I start please?
    How about this, how can we encourage obese Americans not to pile up their breakfast plates with pounds of sausage and bacon? It tastes so good.. yes, but it is costing me money because they eventually have to get treated for very expensive procedures either for their heart, for colon cancer, for diabetes, or some other condition. It costs money to us all if people eat without feeling like their are no consequences. Well Im hear to say there are consequnces that we all have to pay for when people eat this stuff. It costs everyone money.
    Other industrialized nations are ready for stuff like Universal Health Care or a Public pool option that provides insurance as a safety net. This nation is not ready for those things, because we are not a healthy nation, and unhealthiness is very very expensive. That’s why private insurance won’t touch a lot of pre existing condtions. What CEO can get away with saying to the company, let’s put our shareholders needs to the side for now and simply focus on the greater good. I’m sure the CEO and Board of Directors are not that bad of people, but they have a job to do. So yes, government does play a role and that is why. If we ask Capitalism to manage our health care, the private companies will keep buying eachother out untill there are only a few left and the nature of completition that makes capitalism thrive will not be able to perform its duties of keeping costs down and quality up. Do you really want only a few really big companies to run every industry? Why do you think goverment is around? They are suppose to be the moral collective conciousness that protects its people. So for those of you saying Obama is a socialist and stuff like that. it is so stupid. Not enough goverment intervention is why the banks failed and non goverment interference is what allowed them to get so big that our economy could not allow them to fail. If the banks had been smaller they could have dissolved for all we care. But they were so big, that the taxpayers had to keep them afloat. Capitalism works as long as politicians do their job to protect the citizens as stated in the Constitution. It is written in the constitution, life, liberty, and the pursuit of happiness. How can these three elements actually manifest if you tell someone that they have a pre-existing condition and corporate owned insurance says no to covering you. That is not what the founders of this country had in mind. I think even a supporter of Republican politicians could agree with that.

  7. No to higher taxes.
    No to bigger government.
    No to government intrusion.
    No to abortion that might comes of this.
    No to the return of the welfare state.
    No to “free” anything.
    Down with the New-deal.
    Government is not the solution, it is the problem.
    Let’s not kid ourselves. There is a fundamental disagreement between the parties on the role of the government. Which leads to my other point: healthcare reform will have to be done with out the aid of republicans.

  8. “Ok, I’ll bite: If we’re truly on the cusp of a health care cost meltdown”
    Ok, I’ll ask you the same question about the deficit, are we truly on the “cusp”? Why all the right wing/Tea Party screaming now – in a Democratic presidency? When the “left” was talking deficit in the Bush years Republicans were poopooing it as ok when measured against GDP, no Tea Parties then. But I guess it’s different when funding connected private war contractors or wealthy campaign donors through tax cuts.
    Right now healthcare is only a meltdown when YOU can’t get healthcare due to price, and I’ve agreed that not enough people are hurting yet for much reform to take place. Don’t look at my situation as the norm. But if projections continue to come true it will steal funds from all other sectors of the economy that need our dollars as well to grow and employ people, and many more people who should be able to contribute to coverage won’t be able to.
    “why the fanatical insistence on linking cost control with “increased access”?”
    How else would you increase access, except with government subsidies? Look at every other product in the marketplace – lower costs/price = greater affordability/access to. Unless you are growing the wage scale to cover for escalating costs, but healthcare is outpacing inflation by leaps and bounds and real wages/profits can’t keep up. We’re talking about access to necessary healthcare here not Cadillacs. In most all other sectors of the economy people can choose less expensive options and still participate in the economy, but in healthcare there is only one price – the high one, and just trading for a HDHP to lower cost is like putting the purchase of a Mercedes on a longer pay plan, it doesn’t solve the cost issue.
    “Looks like “bait and switch” to me”
    No one will ever stop the rich from getting what they want, if that’s who you think I’m trying to bait and switch. I never said we can have unlimited access and cost control at the same time. Public systems need cost control more than private systems because they serve more people and there’s no where to dump the ones you can’t serve. You will however get more cost effective healthcare available to more people, oops, that’s “communist” isn’t it, but if that’s communism then you’d better tell that to all those Medicare comrades.

  9. Ok, I’ll bite: If we’re truly on the cusp of a health care cost meltdown, why the fanatical insistence on linking cost control with “increased access”? Looks like “bait and switch” to me, with the former acting as “cover” for the latter.

  10. “and now you think “healthcare dollars” should be a “shared resource”
    Actually I thought that prior to my “going naked”, just not in a system designed to extract every last dollar from it’s citizens and the U.S. treasury. I’m also in favor of a mandate as well, not just the one the insurance industry salivates over if it can per$uade enough politicians that it’s their entitlement.
    And yes, la vengeance est un plat qui se mange froid. But I’m not naive enough to think (or care) my little posts will have any effect on BCBS, and I’ve already taken steps to cover my own healthcare without insurance getting my profit dollars.

  11. archon41, you say “lurid.” Where you thinking ‘lurid’ like this? —
    “LOS ANGELES (AP) — The Obama administration on Monday asked California’s largest for-profit health insurer to justify plans to hike customers’ premiums by as much as 39 percent, a move that could affect some 800,000 customers.
    “In a letter to the president of Anthem Blue Cross, Health and Human Services Secretary Kathleen Sebelius said she was very disturbed to learn of the planned increases, calling them “extraordinary.”
    “I believe Anthem Blue Cross has a responsibility to provide a detailed justification for these rate increases to the public,” Sebelius wrote. She said the company should also make public what percentage of customers’ premiums go to medical care versus administrative costs.
    “In a statement, Anthem Blue Cross of California blamed the weak economy and rising health care costs for the rate hike, while pledging to reply to Sebelius’ query promptly.”
    archon41, is this kind of untenable price increase which suggests a so-called ‘insurance death spiral’ (common term for rising premium costs causing health policy holders to opt-out, leaving the sick and thus driving up prices further) qualify as a “catastrophic” (your term) increase that could lead to a “collapse”?
    Just trying to understand your point of view.

  12. So, Peter, you got into a spat with BCBS over a $1,500 bill, decided to “go naked,” and now you think “healthcare dollars” should be a “shared resource,” heh.
    These lurid predictions of a catastrophic collapse of the “system” are but a revenge fantasy.

  13. “Ah, yes, what might have been, had only Harry and Nancy been content to focus on overtreatment, waste and “overutilization.”
    archon, I too wanted that, but I assume you would prefer to have the patient spend more of their money to control this and not to impede the ability of providers to push their need for billings. I’ll also assume you have ample healthcare coverage (employer provided?) so that you won’t have to consider any choke on your “overutilization”. So this is really all about “them” not you? We already have that “focus” of a reduced access system in place for the un/under-insured. Imposing universal government controlled budgets forces providers to limit access by need, not by cash, and recognizes that healthcare dollars should be a considered a shared scarce resource.
    “But that wouldn’t have harvested many votes, would it?”
    Well if Republicans had come forward with some co-operation instead of a strategy of Obama kill, maybe all politicians would have had more of a backbone to reduce system costs/revenue/profits.

  14. ironic that one thing that could get bipartisan Congressional support is also one of the most damaging ideas being considered. Eliminating pre-ex without a strong individual mandate with a penalty equal to the cost of insurance would double rates in a couple years.
    It was bad ideas just like this passed years ago that created the present day problem.

  15. It’s interesting that the social driver for reform for many is to increase access, yet it’s always someone elses’s ox that gets gored. I think Paul is right that some modest “reform” could include bipartisan support for elimination of pre-existing conditions for insurance eligibility, but probably not much else. The mandate is for change that doesn’t cost money but in this case only the contingency lawyers have something to lose.

  16. I suppose you have studied on the issue of whether the common and statutory laws of the various states lie within the constitutional reach of the federal government. There are limits to doctrines such as “preemption.”

  17. Yes, there should be health courts (HC), or some other mechanism to screen out innocent defendants, like me, from cases where there is some reasonable basis to proceed. This is a more necessary provision of tort reform than caps on non-economic damages, which I have reluctantly supported in the past. The health court, or similar panel, would issue a judgment on whether a case against a defendant should be dismissed or proceed. If the plaintiff wants to sue, despite the HC’s recommendation to dismiss, than the jury should be informed of the HC’s decision and the plaintiff should pay legal costs, if the defense prevails at trial. In this way, the HC’s would be empowered and could not be casually ignored by a litigant who might otherwise ‘roll the dice’. See http://www.MDWhistleblower.blogspot.com under Legal Quality.

  18. Perhaps it wasn’t a real bright idea to make cost control a hostage to patronage politics.

  19. Gary,
    The difference between war spending and Medicare spending is just a matter of which comes first. The war spending has already occurred. Had we not had the wars we might have the economic solvency to embark on Healthcare deform. We no longer do.
    If we print our own money it will devalue the currency and each dollar will buy less and less of everything.
    The part I wrote earlier but deleted is that there will be a severe economic collapse and reset with cutting Medicare simply because of the shock to the cash flow in the economy. Yet the balance sheet will be better. Somewhere sometime there must be and will be a reckoning with reality.

  20. Well…
    Today, the ideas about reforming the system are broken as the system itself, perhaps even more broken.
    The health bill was a carefully worked out compromise among all the parties involved. It was also complete and utter crap. What does that say about the parties involved?
    JD Klienke is author who’s research and opinion I appreciate. On this blog, he recently wrote: “The only constant in health care that I’ve actually witnessed, since I was first sentenced to the industry in 1989, is – well – every fundamental thing about health care. Oh – and constant anxiety about change that never actually happens.” (https://thehealthcareblog.com/the_health_care_blog/2009/10/health-care-reform-lite-.html)
    Essentially saying “there’s nothing new about this present failed effort and I’m used to that, so let’s go on with it”.
    EXCEPT, BIG Except — what hasn’t changed is the whole edifice is *heading towards destruction*. Yeah, it’s still heading South. None of paltry, half-assholed efforts did anything, just like you wouldn’t expect them to. The rottenness of the reform was essay on the rottenness of the system.
    Things are “normal” – but normal means a bomb that’s still ticking, normal means increasing proportion of lives ruined by health emergencies, an overall economy further distorted by the irrationalities of even more bloated system.
    Let’s see, we have a system which is the worst of all possible worlds. It’s psuedo-market economy in which private, for profit actors take actions whose ultimate profitability is determined by government action. We have an ideological system that sees “reform” as creating “accountability” by demanding each individual actually manage the overall risks involved in health and which thus mainly generates a vast array of parasitical enterprises sucking the tit of the array of perverse incentives created by the ideology of “responsibility”. As the average individual is crushed more by health care demands, the reformers only thinks about doing more to incentivize this individual towards better behavior as well as charging the individual for all the clever ideas the system comes up with. What amazing is the experts who didn’t understand that is this is not working, that their effort aren’t good and that people have good reasons for not appreciating all the carefully worked-out compromises. How many experts understand what a huge red flag mandatory purchase of private insurance is to the average person?
    The thing about pushing decisions and responsibility down to the individual is that it makes the single individual compete with large entities like insurance companies, hospitals and drug companies. We’ve seen that regulation and aggregation doesn’t change the asymmetries involves.
    We have you, the experts writing this blog. I write pages about perverse incentives but I’m sure Klienke could write books about it. He has. I read it.
    But the experts somehow, after all this, think we’ll muddle through one more round of the usual bullshit compromises. As Health Care moves toward 25% of GDP, this monster seems well capable pf sinking our already rather fragile and unstable overall economy.
    The Ptolomaic astronomical system of the European Middle Ages was based on the fiction that the Sun revolved around the Earth. To hold up this fiction, Ptolomaic astronomers had a system of nested spheres they claimed the Sun lay within. When a certain number of spheres was not sufficient to explain the Sun’s motion, they simply added more. The American health care non-system is based on the fiction that market can provide a framework for rational decisions about a collective good – social health. As this market fails again and again, more rubegolberian extensions are added to it. Fairly soon the whole process seems destined to fall apart – but the people who’ve lobbying for extra extension, “personal health accounts” and similar monstrousities, should share the blame as fully as the folks who are managing the present system.
    ——————-
    As far how real change can happen? Well, perhaps reformers should be working on making things worse as quickly as possible. Why wait? The best policy would be to bankrupt all the big player today, every last one of them and then start on a new policy. Single payer? Total privatization? Each could probably work if they didn’t have the present baggage. Certainly, I favor socialize medicine. No sugar coating, this is what needs to happen (however unlikely it is to happen, until things fail utterly).
    I don’t know what else to say … the immediate future just doesn’t look pretty

  21. “The fact that anyone would think it is ok to throw old people under the bus when it comes to their health care”
    The current slated federal budget is set to spend $7 on seniors (65 or older) compared to every $1 it spends for programs on children (18 or younger). Giving an overwhelming majority of resources to the elderly instead of the young is a recipe for disaster in the medium-longer term yet the Boomers are clamoring that they don’t get enough benefits from the gov’t right now.

  22. How do you get the votes? Bribe a Republican Senator, just like the Democrats did for Lousiana and Nebraska.
    Like that would be hard for a Republican to be enticed?
    My feelings? Why do you write a post asking such a dumbass question in the first place!? Maybe it is time for the health care reform advocates to ask the real question: why do liberals think their agenda is the only agenda for this country? And why did we as moderates have to listen to conservatives in the first half of the last decade treat us like their agenda was the only agenda for this country.
    Maybe, just maybe, it is time for moderates, who are the true majority of American, to take back control and put these extremist minorities in the place where they belong: in the trash!
    Health care is not going to be solved by politicians and the lobbyists/special interests who have no interest in real and responsible change in the end. And this debate is beyond old, it is annoying and disruptive to people who really want change for the better. This site per most of the posters is just getting old to responsible and invested providers like me.
    You know what blogs are coming to? The terrible adage of “tell the lie enough and it becomes the truth.”
    Well, this is one reader who has learned that just because it is in print, it does not infer truth and accuracy. Maybe readers have to remind themselves of this little tidbit of truth, eh!?

  23. “So Mary (and archon41) it’s not about controlling costs it’s about feeding revenue at taxpayer expense? Tell the hospitals and specialists to get real about their “costs”.”
    I agree with Peter. Feeding the investor at the expense of the Patient is what it is all about! Making mincemeat out of the Patient while the investors demands suck the life out of Quality Care.
    I agree with MD as Hell to a small degree except Medicare is not Going to go Broke. We Print our own Money! When we spend trillions of Dollars on two Wars and Ignore those costs.How is Health Care different?
    Then we discuss the myriad of Issues Confronting Health Care. We fold so quickly because of Costs! Its Not the actual and real Costs that lays the excessive burden on the system. It is inflationary Pricing and bloated staffing designed to cajole investors that draws away from quality of Care and Patient Safety. We have to wonder just how misplaced our values are when the cost of wars are acceptable and the cost of life is intolerable.

  24. Ah, yes, what might have been, had only Harry and Nancy been content to focus on overtreatment, waste and “overutilization.” But that wouldn’t have harvested many votes, would it?

  25. “According to Richard Foster, the chief actuary for the Centers for Medicare and Medicaid Services, the Medicare cuts in the Bill will effectively destroy Medicare services for Seniors due to the fact physicians and hospitals will be forced to drop Medicare patients because the Medicare reimbursement rates will be lower than the cost of providing their care. Mr. Foster adds that other planned Medicare cuts would damage doctors and hospitals:”
    So Mary (and archon41) it’s not about controlling costs it’s about feeding revenue at taxpayer expense? Tell the hospitals and specialists to get real about their “costs”.

  26. Mary, you haven’t told the half of it. I wish some of the posters here would sit down with the Yellow Pages, turn to “orthopedists,” and try to find one accepting new Medicare patients.

  27. Medicare is destined to go broke. Seniors either get thrown off the bus or it corrodes and grinds to a halt, leaving them with no bus. Seniors had better pan ahead and be ready to take care of themselves.
    The days of everyone going on dialysis are going to end. The days of home health aid coming in to bathe and feed people are doming to an end. The days of limitless and futile end of life care are coming to an end.
    There will be no death panels. There will simply be spending priorities that leave all these things out. Spend your own money if you wish.
    I pity the party in power. They are going to take it in the neck. Over time the power will shift back and forth in classic bear market fashion. The party in power will not like being in power and getting blamed for things that are out of their control. But such is the nature of the news cycle. You get the credit for things not of your doing as well.
    This post is a rerun. There is no burning national clamor for health care reform. People want their own costs cut, but thats as far as it goes.

  28. The fact that anyone would think it is ok to throw old people under the bus when it comes to their health care while at the same time giving Unions tax breaks that no one else will get is just plain despicable if not evil. According to Richard Foster, the chief actuary for the Centers for Medicare and Medicaid Services, the Medicare cuts in the Bill will effectively destroy Medicare services for Seniors due to the fact physicians and hospitals will be forced to drop Medicare patients because the Medicare reimbursement rates will be lower than the cost of providing their care. Mr. Foster adds that other planned Medicare cuts would damage doctors and hospitals: “Over time, a sustained reduction in payment updates, based on productivity expectations that are difficult to attain, would cause Medicare payment rates to grow more slowly than, and in a way that was unrelated to, the providers’ costs of furnishing services to beneficiaries.” ref. http://online.wsj.com/article/SB10001424052748703652104574652563562216036.html?mod=WSJ_Opinion_AboveLEFTTop#articleTabs=article. The bottom line is, the catastrophic cuts to Medicare in the Democrats Bill translates into another holocaust for Seniors and the people know it.

  29. Perhaps you and Matthew should have a go at this from the perspective of the many who have placed retirement savings into mutual funds which specialize in health related enterprises. Would you doubt that they include the halt, the lame and the blind? Are their interests and expectations to be set at naught? Yet you would force upon them the burden of funding the medical needs of those judged, by traditional underwriting standards, uninsurable. This violates the core principle of insurance. But you would have it that the insurers, by their “nasty” practices, are violating asome duty owed to the greater good. Where in out history do you find a basis for this extraordinary notion, if not in the ideology loath to speak iits name?
    Has it not occurred to you that the quid pro quo negotiated with the insurers–the “individual mandate” and premium subsidies in exchange for funding the needs of the uninsurable–is but a shabby maneuver designed to make HCR appear “deficit neutral”? To impose the enormous cost of this benefit directly on the public through the mechanism of insurance?
    It is precisely for this sort of radicalism that Middle America has rejected you.

  30. Paul, while I agree that your listed initiatives are all positive changes to the system, I am afraid that if applied on their own the net result will be even higher health care costs than if we do nothing at all.
    Reforming insurance by only demanding guaranteed issue without requiring the young and healthy to join the pool will drive premiums up significantly.
    Reforming payment by increasing PCP reimbursement without reducing specialty and hospital reimbursement and without an effort to bundle services will just add costs. One way to cap these costs would be for some Federal agency to set allowable charges for hospitals and surgery centers. I don’t think there will be bi-partisan support for that.
    Transparency is always good and tort reform done right may have some marginal positive effects.
    It’s the square peg and the round hole thing again.

  31. This article shows the complicated twist and turns of Health Care. Democrats that opposed Health Insurance reform.Held out to be bought by their own Party with taxpayer dollars. Republicans have always commented of the ineffectual workings of Government. When you vote them in; they become part of the problem and show us how useless Government is to the American People.
    The only difference between these Parties,in my view. Is democrats raise taxes to pay for new Programs and Republicans will create unfunded programs spending until they have to raise taxes. At this point Health Insurance reforms are on the chopping block and special Interest has won by shear influence and a abundance of funds.
    Tort reform is interesting idea that eliminates any and all responsibility for Mal Practice. If anyone that has gone after a Institution or a Profession, will tell you. It is nearly impossible to sue anyone for wrong doing. I’m sure some one could tell us what percentage of lawsuits actually get to the Court House Steps. For the most part only the most egregious claims are awarded.However,in retrospect of their extreme injuries. They cannot afford to pay for circumstances not of their making.So the profession says its not my problem. So we pass it onto the Patient? The process may need to be reformed ,but the Health Industry needs to own up to their responsibilities. If You cause Harm to a patient than step up and pay for services that are not covered by insurance. Stop the Practices of making consumers pay for your mistakes.Why should a Patient with a Hip replacement have to pay for two more corrective surgeries of the same Hip?
    Everyone Knows that Most Doctors do not Like Medicare’s payment process and /or the min payments. Still the Demographic groups using Medicare are frequent visitors of Health Care providers.This demographic has the greatest risk of a revolving door, medical error, and (HAI’s) Hospital Acquired Infections.
    Transparency in clinical Outcomes would be welcomed.However I think we have a growing problems that have simply been hidden in the shadows for Decades. We need transparency in infection rates across this Country.HA_MRSA Kills some 19,000 people each year according to the institute of Medicine. Most Patients are unaware of the virulent strains of Hospital Staph Infections. Some 94,000 people Die from various Hospital Staph infections. Ranging from methicillin resistant Staph, C Diff,Vancomycin Resistance, and Flesh eating Bacteria to name a few.
    Transparency and Public Reporting must begin with Hospital Acquired Infections.
    Simply because Best Practices are being ignored and enforcement is not applied by the institutions.

  32. No to higher taxes that will destroy jobs. No to government mandates to buy inferior insurance people don’t want or need. No to catastrophic cuts to Medicare. No to tax breaks for Unions that no one else gets. No to dirty back room deals to buy votes. No to all the lies used to sell Health Care Reform like the lie Obama told about keeping your insurance and doctor.(LOL) NO TO OBAMACARE!!!

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