60 replies »

1. I think there needs to be a system with a knowledgeable Layperson, a Health care expert, and a Judge to review merit.

2. how is this a free country, if one has to prostitute oneself to corporate america to obtain health care for one’s family. that enforced dependence is frankly a form of slavery. what has become of the american dream. and i’m not talking about people who want to follow festivals selling tie-dyed t-shirts. there are plenty of potential small businesspeople who would be able to support themselves with their enterprise if they didn’t have to make sure they have two million dollars in the bank in case of a health emergency in the family, and because they have an aging parent. you simply are not ‘free’ if being self-employed is not an option. i’m frankly astounded that conservatives — many of whose parents made started out as small businesspeople raising families — are not raising cain about this.
   anyone who thinks it’s reasonable to expect people to *choose* between doing what they want to do for a living and insuring their family is no less than a sociopath and no more than a corporate whore him- or herself who wants to drag the rest of this country down with them.

3. Thank you for the many comments.
   On malpractice, take a look at Texas: caps on torts has not capped over-treatment (or over-spending.)
   Dan M: Thanks for the kind words.
   I don’t think we’ll end up with incremental compromises. On the Sunday morning shows (this morning) the REpublicans made it pretty clear that they are not intersested in compromise. Mitch McConnell stated that no Republican would vote for reform– even if the Democrats offered to add tort reform to the bill.
   The Republicans don’t want to cover 30 million people.
   Peter–I agree with much of what you say. But if we don’t embrace this first step toward reform, we won’t get anything for at least 3, probably 7 years. By that time, universal coverage will be unaffordable–whether by single-payer or some other means.
   Single payer savings just aren’t as great as some say. The Commonweaelth fund estimates that a government plan would cost a family about $2,000 less than a private sector plan: $11,000 instead of $13,000 in today’s dollars. That’s probably about right. Note that most other developed countries do NOT have single-payer– only Canada and the UK. And they pay much less than we do, while receiving care that is, on balance, better.
   If we vote for the current plan, a few years from now I’m pretty confident that we will have a public option. If that proves a huge success, we might gradually move to single-payer. That’s the only way we’ll get there–and I still would prefer a hybrid private/public plan with non-profit insurers competing with the government plan.
   What would you do if Jed Bush–or one of Bush’s daughters–is elected president at some point in the future– and the conservatives re-take Congress? Imagine what they would do to a government health care plan. . .And you would have no other options. (This is what happened in the UK when Margaret Thatcher took over.)
   To really put a lid on health care inflation, we have to stop overpaying for products and healht care services, and we need to stop paying for unncessary tests and procedures while also greatly reducing the number of medical errors that add to costs. That’s all in the Senate and House bills–under Medicare reforms.
   Medicare is already cutting fees for diagnostic testing and cardiologists–beginning this year.
   Medicare reform is already beginning and if we have reform legislation, it will pave the way for rational cost-saving throughout the system.
   Bottom line: Barry wrote: “We also need an electorate willing to reward politicians with re-election if they cast votes that require short term pain and sacrifice (higher taxes or less than unlimited end of life care, for example) from us in exchange for a more cost-effective, affordable and sustainable healthcare system over the long term.”
   I really think everyone should think about this. We’re at a point of no return. Either we begin to try to cover everyone and control spending (which means letting Medicare lead the way by cutting reimbursements and raising co-pays for UNnecessary and Unproven tests and procedures) — or in another 9 years, health care premiums will double.
   That means that the middle class and most of the upper-middle class will not be able to afford insurance–or much health care.
   No doubt some low-cost providers will pop up to help us out (probably primarily foreign-born foreign-trained physicians who now take care of our poor). But it will be very, very hard to find a low-cost hospital. Or affordable surgery.
   We wil wind up with a sharply tiered health care system–much like the systems in some developing countries–where only the very wealthy will receive care.
   I imagine the government will try to continue to take care of the elderly- after all, they have paid into Medicare for so many years. But as Medicare adds to the deficit, our economy will suffer.
   If we actually choose that path (I don’t believe that we will) we will wind up a second-tier economic power with third-world health care.

4. Dear Maggie, I can not agree more with You.
   I believe that we, the people who are getting screw up by previous 20 or more years by republicans governing, we must be more vocal and instead paying attention to pools, start writing about OUR needs and ideas on HEALTH CARE !!!
   Whe we have (in this big country) just few big Health Insurances III. Maybe it is time to start looking for health care insurances in different directions. If Blue Cross is rising their members 39% , why not change provider???? why stay with dthose who are killing their own Members, by charging so much and giving so little??? We have thousands doctors who will do their job for less and help all of US with smmaller payments.Maybe it is start to turn back from corrupted doctors and look for those who truly want to help those who need them. Another thing is “ILLEGALLS WHO GET FREE RIDE ON ALMOST ANYTHING.cALIFORNIA PROBLEM IS AESPECJALY, BECAUSE JUST THAT!!!! It is time to get in office a new blood, and get those with experience-corrupted OUT from office and vote for TERM LIMITS on Congres and Senat. How people in a such old age are running OUR COUNTRY. Some are complaining that we can not put in office someone with no experience, well!!! most in Congres are with more then 15 years of, and what they are doing??? screwing US on everything.They have a lot of experience doing just that!!!

5. “We need to replace it with some people with integrity who can actually accept the job and act for “We the people.””
   We also need an electorate willing to reward politicians with re-election if they cast votes that require short term pain and sacrifice (higher taxes or less than unlimited end of life care, for example) from us in exchange for a more cost-effective, affordable and sustainable healthcare system over the long term. When I ask my favorite health reform question, what’s your contribution, “we the people” need to offer a credible answer.

6. As an analogy, Congress is much like Phineas Gage, the famous case of the pre-frontal cortex injury in the 1800s where he lost executive function of the brain, but could still express right vs wrong. However, any decisions he made were made absolutely and only for immediate self-gratification and not based on any future outcomes potentials. As a sitting TBI Congress, we will not rehabilitate it. We need to replace it with some people with integrity who can actually accept the job and act for “We the people.” I doubt it matters much which party. We just need honest, straight-spoken people with functional frontal lobes.

7. They will be playing musical chairs…I guess… 🙂

8. “there will be disappointment (38%) and anger (20%) aimed at both parties. This will surely translate into repercussions come November….”
   Which third party will they be able to vote for then?

9. it was a CNN poll out yesterday

10. What poll are you looking at Nate? The one I saw was from Kaiser and they did ask very specific questions, not just “do you want reform?”.
    To Peter’s point, that is true, Kaiser did not attach a price tag to anything, so maybe if they did, folks would have replied differently.
    What the Kaiser poll shows very clearly is that if Dems fail to pass reform, along the current lines, there will be disappointment (38%) and anger (20%) aimed at both parties. This will surely translate into repercussions come November….

11. Margalit, how did this lil tidbit fail to get mentioned?
    “. An overwhelming majority of Americans, 73%, prefer that Congress either start from scratch (48%) or stop work completely on health care reform (25%). Obama’s Health Plan contains essentially the same policies as the bill passed by the Senate, with the addition of price controls for health insurance premiums.
    CNN buries the lede in its article accompanying the release of its findings, never mentioning that an overwhelming majority (73%) of the American public disapprove of passing a bill similar to the one before Congress, including four in ten Democrats who want the President and Congress to start over. CNN does manage to state that “nearly three quarters” of Americans want some kind of reform, including in that figure the 48% who want Congress to start over in that grouping in a somewhat dishonest fashion…”

12. And step down extra hard on the hopelessly ill littering the sidewalk.
    For all your grandiose talk, none of you are up to the battle with the medical establishment effective cost controls would require.

13. great there goes even that chance at a smile….you will stop at nothing to ruin insurance companies will you? Just for that I’m going to go deny some claims for no reason but I am having a bad day.

14. Geewiz –
    My only concern with scrapping and starting over is that I can’t see a way we end up anywhere different than where we are today. There are firm ideological differences with little inclination to compromise. If we’re going to be in the same place a year later why waste the year?
    David Brooks had a nice piece in yesterday’s New York Times discussing the calamities of educated, thoughtful healthcare strategy colliding with politics. The result is the House and Senate bills we see before us.
    I predict we’ll see compromise in small, incremental reforms so that both sides can claim victory. Coverage won’t be substantially expanded and costs will not be reasonably controlled. The administration will have to get on to other things (the economy and security) and we’ll bop along dumbly for another 4-5 years until Medicare’s appetite for the Federal budget becomes so extreme that we have to either dramatically raise taxes or cut spending on popular programs (like Medicare, Social Security and Defense).
    Then we’ll have to try to re-engineer the rudder on the Titanic at moments before iceberg impact.

15. “Now Peter that isn’t fair at all the Republican plan passing would make me smile for at minimum a week or two.”
    A week, really.
    GOP Plan:
    Sec. 103. No annual or lifetime spending caps.
    without—
    10 (2) cutting Medicare benefits for seniors;
    I believe two things you oppose.

16. Then why not, as has been suggested, scrap it and start over? There is obviously no rush if Obama and team are talking 2014 anyway. Would be nice to have a plan the CBO can price (they say there is not enough info in the President’s plan to price it) so that the plan actually improves care and reduces costs.

17. It’s hard to see a point in congress anymore I agree. All they do is fight with each other. All these plans are getting us nowhere. As a current nursing student it is really frightening to think where we will be in 5-10 years and how I will have to be dealing with patients.

18. Thereby the desire to scrap it and start with a whole new and hopefully functional, cost-saving, humanitarian plan.

19. what is reform?
    Without first defining what it is how do people know if they want it? It’s like asking do you want to be successful, of course most people do, until you define success that doesn’t mean anything though.
    Conservitives want reform as well, they just don’t want liberal reform that is sure to fail. This is a perfect example of the dishonesty in your argument. You ask a generic and meaningless question then use that as proof people support your bill. BS, no one wants your reform except the far left of the country which is less then 20%.
    If you asked who wants government rationed care 80% of Americans would say no, that is a far more honest poll question then who wants reform.
    Now Peter that isn’t fair at all the Republican plan passing would make me smile for at minimum a week or two. Isn’t that enough of a reason right there to pass it?

20. Margalit, Nate has a point. The public can always agree to changes they think will not cost them anything. They didn’t like the Democratic Plan because they perceived it to cost them something, while the Republican plan won’t cost them anything (at least up front) it also won’t do anything.

21. I believe the desired reform is NOT what is being carried to the four yard line right now. Reform would mean fixing a lot of the portability and cost issues, not a 2000-page tome that gives any government more power and authority over us. I’d love some reforms if they are functional and sensible. The trouble is, I see little or no sense in Congress anymore – just arrogance.

22. “Perhaps Peter would like to identify a state in which negigence, proximate cause and damages are not required elements of proof in a malpractice action.”
    My point, if you missed it, was I have not seen any proof that tort “reform” has led to reduced utilization. Maybe you could provide some.
    But if all three elements are present then I guess it’s one of those non-frivolous cases isn’t it.
    “There’s no rhyme nor reason to it”
    To what, 2 wrongs? If we are told that the cost of insurance is simply the cost of care outside the insurer’s control plus a measly 5%, how would outside insurance companies, looking at the same actuarial figures be able to offer the same benefits for less? If they could offer it for significantly less then is there more beef in the profit than we are led to believe? The monopoly, present here in NC as BCBS, is a political monopoly where no health legislation passes unless it gets the thumbs up from BCBS. They ran a political campaign, despite their non-profit status, against the Democratic health “reform” package. People in NC don’t trust BCBS and were able to stop it from getting “For Profit” status, but the victories are few.
    “You will note that Peter has precious little to say about how the President’s Proposal will reduce provider costs or generate adequate funding for existing liabilities.”
    achone, you haven’t been paying attention. I ended up opposing the Democrtic Plan because it did not address system costs. I am also an advocate of single-pay, which would control provider cost inputs (your bane), control user utilization and require NO insurance companies so we could save that modest 5%. It would also reduce paperwork and marketing costs and ensure all providers would get paid, no cost shifting and a mandate. The resulting reduced cost of healthcare would fund reduced liabilities. Not surprisingly it would allow state to state portability and release employers from the burden of providing healthcare coverage, a boost for small businesses. But I can only lead the horse to water.

23. It is not meaningless in the debased political environment in which health care reform is being debated. It means that the majority still wants to see reform and it means that reelection considerations need to be “slightly” different than what conservatives are peddling in the media.
    It is very likely that Dems will lose seats in November no matter what they do with healthcare. It is very likely that Dems will lose a hell of a lot more seats than anticipated if they drop the reform ball on the four yard line.

24. “Well, well, well…. Guess what? Folks still want health care reform and they will be disappointed if it doesn’t pass.”
    Little girls still want ponies and guys want to date super models. Ask them if they want to wake up to feed them every day, walk them, and comb them every day for the next 15 years or lose weight, learn another language, and do what ever it is to attract a super model and the interest plummets.
    It is a meaningless poll and even less meaningful to comment on it, it says nothing! Now ask if they would be willing to have their taxes double for guaranteed coverage, or would they accept rationing, etc etc and then you have something to talk about. The left doesn’t want to do that though becuse it kills their narritive. People don’t want the reform the left proposes so you pimp generic polls.

25. The government cannot give anything to anyone without taking it from someone else first.

26. Perhaps Peter would like to identify a state in which negigence, proximate cause and damages are not required elements of proof in a malpractice action.
    I believe there has been some talk of standardizing health insurance forms. One minute these guys are complaining about insurers exploiting their state “monopolies” to gouge the public, and the next about their eagerness to sell substandard insurance across state lines. There’s no rhyme nor reason to it: just a ritual “talking points” dance.
    You will note that Peter has precious little to say about how the President’s Proposal will reduce provider costs or generate adequate funding for existing liabilities. It’s all about funding for new entitlements. “Comparative Effectiveness”: I’m sure those doctors in McAllen are already quaking in their designer boots.

27. I’d add to the above that an Electronic Medical Record is critical. In the ER we still see people pop in with some complaint, saying they need a workup, only to later find out they have had 3 CT Scans and 4 MRIs for exactly the same issue in the last 2-months. A big part of stopping abuse is knowing what the patient’s are doing before they get to us.

28. “but that doesn’t cut costs, it just cuts benefits.”
    Actually, portability can cut costs because it does increase competition rather than locking in selected few companies to a single state. And, where it has been used (eg: Texas) it maintained benefits at exactly the same level. It just allowed people to move from Waco to Lubbock without losing coverage.
    “Medicare needs to do more on fraud but that would mean more employees and changes to how it’s obligated by statute to pay within 30 days and probably a more rigorous provider approval process.”
    If structured correctly, the gains in recovery for fraud would easily pay for the employees, plus generate more funds. Having worked with a fraud and abuse unit, I can attest that all one needs to do to cover costs plus generate profit is set up a correct screening approach so time is spent on where the money is.
    Related to tort reform, 1/3rd of medical costs are still done to cover risk, without actual need for the tests, etc. One state’s action won’t solve it. There needs to be a system with a knowledgeable Layperson, a Healthcare expert, and a Judge to review merit. Once the medical establishment trusts that system, costs for “cover my ___” medicine will drop, but not until then.
    And as for Medicare Funds…
    The media has reported for decades that the funds are “raided” by the Congress for other projects, and I have never heard a single congress person say, “We never did that.”
    Think insurance is expensive now? Wait until it is Free. The Congress will take most funds targeted for coverage and use it on other, unrelated projects. Until Congress is changed and we get some people with honesty and integrity, we won’t be able to afford anything.

29. “If people want reform, then they need to establish portability between and within states,”
    With one national plan from one insurance company? I’m assuming that means insurance companies able to do business across state lines. How would that cut system costs? For sure it would allow insurance companies to offer bare bones plans in a race to the price bottom, but that doesn’t cut costs, it just cuts benefits.
    “investigate and manage fraud,”
    I agree that Medicare needs to do more on fraud but that would mean more employees and changes to how it’s obligated by statute to pay within 30 days and probably a more rigorous provider approval process. I think there’d be opposition (lobbying) from providers for these measures.
    “do tort reform and set up expert panels to judge actual merit of the 90% rate of inappropriate law suits against docs and hospitals,”
    Ah yes, unless you’re one of the plaintiffs. Many states already have malpractice legislation. Florida for instance does where you must prove 1.negligence
    2.proximate (immediate) cause AND 3.damages. Failure to prove any one of these elements, and your case dies. Miami-Dade is at the top of the most expensive places in the U.S. to get medical care, can you prove a connection to malpractice awards and medical utilization/costs?
    Here’s the situation in Virginia:
    http://legalmedicine.blogspot.com/2009/11/end-of-frivolous-lawsuits.html
    “limit futile care (which eats up tons of end-of-life Medicare dollars)”
    I think you’re right on this one, but writing the rules is difficult – remember “Death Panels”.
    “educate docs to actualy present reality to end-of-life patients and their families,”
    Actually part of the ‘Obama” plan addressed living wills and end of life issues in an attempt to have the patient control this and not their emotional family or the docs.
    “and … by the way … the benefits for Medicare won’t be there for me if the Govermnet keeps robbing the Medicare funds to protect brown tree snakes, pay foreign coiuntries to be our “friends,” and fund some questionable so-called arts.”
    I don’t think Medicare funds pay for those things, but you don’t think the government should fund this:
    http://www.fort.usgs.gov/Resources/Education/BTS/
    Actually if all medical costs keep rising the way they have been then I doubt you’ll be able to afford anything, even private insurance.

30. Not impressed with the Republical plan either. If people want reform, then they need to establish portability between and within states, investigate and manage fraud, do tort reform and set up expert panels to judge actual merit of the 90% rate of inappropriate law suits against docs and hospitals, limit futile care (which eats up tons of end-of-life Medicare dollars), educate docs to actualy present reality to end-of-life patients and their families, and … by the way … the benefits for Medicare won’t be there for me if the Govermnet keeps robbing the Medicare funds to protect brown tree snakes, pay foreign coiuntries to be our “friends,” and fund some questionable so-called arts.

31. “Look at how well Congress has handled Medicare and Social Security. Funds come in, are looted and go elsewhere, and the programs face bankruptcy.”
    Geewiz, not sure if you know but the GOP “Plan” explicity says no cuts to Medicare and also calls for abandonment of Comparitive Effectiveness. How would you ensure that Medicare benefits are there for you when you need them? Would you want all the healthcare you want when you are over 65, or would you support some controls on benefits?
    You might also want to read this on SS:
    http://www.ppionline.org/ppi_ci.cfm?knlgAreaID=450020&subsecID=900194&contentID=254807

32. So it is okay to take people’s money, give it to a bureaucracy managed by a Congress who cannot control their own lust for power and money, and see what happens? Look at how well Congress has handled Medicare and Social Security. Funds come in, are looted and go elsewhere, and the programs face bankruptcy. What makes anyone think the future of healthcare taxes will face any different pathway?

33. Maggie –
    Thank you for taking the time to consider my point of view and having the intellectual honesty to state what you believe in.
    I have been disappointed that the conversation around this important issue has remained far too rhetorical, as if human beings in America weren’t involved.
    When things like comparative effectiveness research, individual mandates and individual caps all get demonized as a “massive governmental takeover” of the system, the conversation ignores that people face bankruptcy and access (i.e., rationing) issues to preserve the right to “whatever we want, whenever we want” for many.
    If we decide as a nation that largely preserving the status quo is OK, fine. But the opposition shouldn’t get away with a polyanna approach that acts as if there aren’t real consequences for not addressing major problems that require significant changes to fix.
    Mr. Grassley, look straight into the camera and say, “I think it’s more acceptable to limit access to care, thereby increasing the burden of illness and chronic disease, on a small portion of our population, than requiring all Americans to be insured, even through the private sector.” Then, at least, you’re being as honest as Ms. Mahar
    Again, I appreciate you having the fortitude to state your opinions on the personal, human impacts of the decisions we face. Too often the discussion seems like a conversation about some abstract, collective idea in which individual, personal impacts either don’t exist or don’t matter.
    We shall see.

34. Well, well, well…. Guess what? Folks still want health care reform and they will be disappointed if it doesn’t pass.
    http://www.kff.org/kaiserpolls/posr022310nr.cfm
    I hate to say it, but “I told you so…”

35. Mark maybe you can define your meaning of better job then? They are better at controling cost only because they have the power of law. That allows them to control their cost not the actual incured cost. Congress dictates they are reducing reimbursements by 100 billion. Most people don’t consider that controling. Further it only works becuase there is a private system to absorb those cost.
    I wont rehas it here but you are 100% on your overhead claim and have no idea what you are talking about. Your 5% versus 25-30% has no validity at all.
    “(which does not provide any coverage for the poor).”
    Again Mark no clue what you are saying, you lack even a basic understnading of the market. Who do you think runs most Medicaid programs? What do you call SCHIP, those are all private insurance plans paid with subsidies. Have you ever heard of the working poor? Millions of whom have insurance.
    You didn’t get a single fact right in your entire post.

36. I should have specified the differences between Medicare and Medicaid when I said they are doing a better job than private insurance.
    Medicare does a better job of controlling costs than private insurance (consistently lower year on year cost increases). It also has much lower overhead (5% vs the 25-30% for private insurance). Most people are happy with the service and the coverage.
    Medicaid, OTOH, as has been pointed out is a state run program, not a federal program and the results vary quite a bit from one state to the next (this is a good argument for a federal program). It is successful as a safety net program providing some health services to the poor that private insurance will not cover at all (due to affordability or per-existing conditions). It should cover more people for more health problems but that is a matter of funding and management. I think it is fair to say that even with its faults Medicaid does a better job than private insurance (which does not provide any coverage for the poor).

37. bev M.D. you were further ahead when you ignored me, businessweek was wrong, the study they used to write the story was wrong, as documented by countless people including ABC. The Harvard “researcher” is a single payor advocate and hack scientist who doesn’t know how to set up a study.
    Let me repeat sice you seem to have missed it;
    Moreover, Harvard’s definition of “medical” expenses includes situations that aren’t necessarily medical in common parlance, e.g., a gambling problem, or the death of a family member. If your main wage-earning spouse gets hit by a bus and dies, and you have to file, that’s included as a “medical bankruptcy.”
    would you like to apologise or just go back to not commenting?

38. Hello Nate;
    Re medical costs as a primary driver of bankruptcy, see this quote from Business Week:
    “Medical problems caused 62% of all personal bankruptcies filed in the U.S. in 2007, according to a study by Harvard researchers. And in a finding that surprised even the researchers, 78% of those filers had medical insurance at the start of their illness, including 60.3% who had private coverage, not Medicare or Medicaid.”
    http://www.businessweek.com/bwdaily/dnflash/content/jun2009/db2009064_666715.htm
    Now perhaps that has been eclipsed for just this year by job losses, but neither you nor the original commenter specified a given year. For at least 2007, he was correct and you were not.
    I wouldn’t have bothered to play Gotcha if you didn’t do the same to others. Get your own facts straight.

39. This Obama outline – I can’t really call it a bill nor can the CBO score it – is not bipartisan. It is hyperpartisan. Why not challenge the Republicans by putting Real Tort Reform in the Bill along with some other of their ideas. Perhaps the Chinese menu style compromise – One from Column A, One from Column B. I know the public would welcome such a show of real compromise. Reid’s compromising with Pelosi is not bipartisan.

40. I’ll take it, archon. There must be some oversight on what providers charge, particularly hospitals. It won’t hurt to break up those big hospital conglomerates either, particularly the ones that are right next to each other.

41. I’m sure it’s occurred to some of you that, by using private insurance as a loss transferring mechanism, you will be forcing, in many instances, the less affluent into helping the more affluent to stave off bankruptcy.
    If you can create a federal agency to exercise oversight of insurer rating, why can’t you create one to exercise oversight of provider rates? That’s what you would have done under “single payer,” no? The seeds sprinkled on the ground may or may not produce effective mechanisms. Does anyone really believe abuses result from earnest ignorance of “best practices”? Why not take the bull by the horns and create an agency to which payers can appeal questionable charges? (I’ll credit Margalit with this, whether she wants it or not.)
    Some interesting language from the Proposal: “The President’s Proposal modifies these statutory provisions that currently limit random medical review and place statutory limitations on the application of Medicare prepayment review.” Who knew?

42. On the bankruptcy question, I have to admit I am skeptical of the Harvard study. The primary authors are long time proponents of a single payor system, and their research usually ends up supporting that position. I gather even they have backtracked somewhat on their findings, from medical expenses “causing” to “being one of the causes” in bankruptcy. Another study (from AEI, who I’m sure has their own agenda)is similarly (but more factually) skeptical: http://www.american.com/archive/2009/august/the-medical-bankruptcy-myth
    Like most things, the “truth” is probably in the middle – the impact of medical expenses on bankruptcy rates is perhaps not as bad as some claim, but it certainly can’t be ignored.
    Of course, I’d be interested to see how many of the bankruptcies were caused by people already on public programs (e.g., seniors who end up in the nursing home)….the Obama proposal won’t change that.

43. Maggie – thanks for your comments. I was lumping Medicare & Medicaid together because Mark was, and agree they are very different (as my comments noted).
    Three things in response to your response:
    First, I think it is difficult to get a real read on Medicare cost control versus private insurance, for several reasons. One is that Medicare has the huge advantage of essentially dictating prices, which not only helps “control” their cost increases but also pushes those costs onto private insurance payers. The second is that private insurers themselves vary in their cost control effectiveness, both between carriers and between market segments within a carrier. E.g., inflation for large employers is very commonly several points lower than for smaller employers (and not out of any antipathy for smaller employers!). Reasons for this are not entirely clear, but hypotheses include more stable risk pools and more ability to carry out more effective cost management programs.
    Second, Medicare’s design is essentially rooted in 1960’s Blue Cross(Part A) and Blue Shield (Part B) designs, which have all but disappeared from the private market. Most notably, that design did not include major medical coverage, which addresses more catastrophic events. So, yes, private insurance does have “holes,” but ones more aimed at deliberate cost-sharing.
    Third, I would be interested in seeing the basis for your statement “Most people on Medicare are happier with Medicare than they were with the insurance they received from their employer.” I don’t know that I’ve seen such data, and interpreting such data would be compounded because employer coverage varies so widely. One reason that Medicare HMOs (now Medicare Advantage) came about was that people in HMOs and other private plans wanted an equivalent type of coverage, especially for preventive care. One would also have to distinguish satisfaction with traditional Medicare from Medicare Advantage, as the latter looks very much like private coverage, and to tease out if how much they were contributing versus how much they pay for Medicare impacts satisfaction. It’s all possible to do — I just haven’t seen the studies.
    Thanks.

44. This is what passes for science with Maggie and the left, remember this when you read anything they say;
    “A good part of the problem is definitional. The Harvard report claims to measure the extent to which medical costs are “the cause” of bankruptcies. In reality its survey asked if these costs were “a reason” – potentially one of many – for such bankruptcies.
    Beyond those who gave medical costs as “a reason,” the Harvard researchers chose to add in any bankruptcy filers who had at least $1,000 in unreimbursed medical expenses in the previous two years. Given deductibles and copays, that’s a heck of a lot of people.
    Moreover, Harvard’s definition of “medical” expenses includes situations that aren’t necessarily medical in common parlance, e.g., a gambling problem, or the death of a family member. If your main wage-earning spouse gets hit by a bus and dies, and you have to file, that’s included as a “medical bankruptcy.”
    When I asked the lead author, Dr. David Himmelstein, about his definitions of medical bankruptcy back in 2005, he said, “It’s a judgment call,” and added that any death, for example, “to our mind is a medical event.”

45. Ms.Margalit,
    A penny saved is a twopence earned.
    Variant: A penny saved is a penny earned.
    Saving is another form of earning. – Ben Franklin
    Just because Ms. Mahar and you do not consider investment income as earnings, does not make it so. Just ask the IRS.
    64 out of 300+ million Americans voted for Obama, fewer for the other jokers. 22% does not make a majority and this country operates under a representative republic not a true democracy.
    Tangetial points, but since Ms. Mahar, who I could argue knows even less about the healthcare system (or earnings) than Obama is given permission to post here, I guess it’s ok to go a bit off subject. Thanks for listening. LD