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The White House Healthcare Summit – Democrats 0 Republicans 0

Laszewski

There is politics and there is policy.

On the policy front what we saw today was the same exchange of the old talking points we have watched for a longtime. No progress was made toward any kind of health care bill. That is no surprise–this was never going to be the place to
fashion any kind of compromise.

At the end the President asked the Republicans if it was worth it to spend another month or six weeks trying to come to some agreement. I am glad he did that. I am not optimistic but a “yes” from the Republicans would be the right answer for the country.

On the political front this was a win for Republicans because it was a draw. Granted, they have a very thin health care agenda but all they had to do was hold their own over the course of the day. Politically, if not on policy, they did that. No minds were changed in the room and likely none out in the country. The left will still say get on with passing this, those on right will say kill it, and the majority of critical swing voters will still be concerned that the Democratic bills are going too far too fast in the face of the Great Recession. This is the biggest reason I don’t hold out a lot of hope there will be a lot of Republican willingness to come to the table–at least before the November elections.

Ironically, this “bipartisan summit” may have just increased the political cynicism in the country because it went off so predictably.

Most importantly, I don’t see the President and the Democratic leadership having accomplished their real goal: To “stiffen the spines” of the moderate Democratic votes they need to ram their health care agenda through using reconciliation rules.

A week from now, I expect the polls will still show only about the same 40% approval rating for the Democratic health care agenda and the moderate Democrats won’t have the political cover they need to vote for a reconciliation strategy.

Unless the President gets a positive response from the Republicans on his offer to spend a few weeks trying for a bipartisan bill, it will be on to “Plan B” for the Democrats.

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86 replies »

  1. Does anyone remember when you paid for insurance and then never saw a bill for going to the doctor…you paid for your insurance and that was all. You maybe had to pay extra for a private room when you were in the hospital but that was it. You and your doctor decided what was best in the way of treatment. But rising costs made insurance rates go up and people complained…next came some hair brain idea about HMO’s and PPO’s. Now I have to check to see if my doctor is on the “list” and if I need a “specialist” I have to go see a doctor (general practitioner) who does not specialize in that problem first to be “refered” to the doctor I wanted to go see in the first place. Oh and now I have to pay a co-pay to not one doctor but two. And then if the insurance company deems that the costs are too high they’ll only pay a certain amount then I get a bill for the rest! So now instead of insurance I’m just prepaying a discounted rate…God forbid the doctor prescribe a name brand drug…I pay the highest co-pay and if he has to prescribe more than 30 pills per month I can expect to pay the highest copay for the first 30 pills then full price for the next…so a 60 dollar perscription can end up costing me over $400! All because the insurance company’s “experts” think I should only have 30 pills or I need to use some generic that I’ve tried and doesn’t work as well.
    TRUE REFORM would be if you have insurance they should charge reasonable rates and cover whatever the Dr. prescibes as a reasonable treatment. If people do not have insurance then they need to pay for treatment out of pocket by setting up a payment plan with the doctor or treatment facility that they can both agree to. People do not have to go broke paying for medical care but at the same time they should not get it for free! They should also not expect those of us that fork over a third of our takehome pay for insurance to pay for their care either. I pay my bills. The last time I had surgery…insurance paid their part then I paid what I could each month till it was paid in full. Personally insurance should have paid my entire bill not just what they wanted to. But thanks to the inventers of our current healthcare system they won’t.
    True Reform will not come out of the current crap Mr. Obama wants rushed through and passed…it has to many tack on’s and pork. The middle class will foot the bill and suffer the most. Doctors have to take an oath to “DO NO HARM”….I think our President and Congress needs to take the same oath before tampering with something none of them will be affected by. ARE there any Medical Doctors in congress? I don’t think so. Untill then they need to focus on costs and capping them. Flat fees for operations, flat fees for new drugs, flat fees for drugs that have been around 10 or more years. That way there are no surprises when you open the bill from the hospital… No more $100 band-aids or $50 ibuprofen tablets…etc. Then people could set up repayment plans based on income not the dictates of the insurance or medical industry. Everyone is out to make a profit…but they do not have to overinflate costs to the extent they do. Just like if a ibuprofen cost $.03 ($10.00 bottle of 300) yes charge $.06 or $.10 for that tablet not $50… you’re still making a profit but you are not taking advantage of the most needy….get the picture!

  2. jd I would further argue, not in a yelling manner though, that the equal protection clause was meant specifically to prevent the vote buying we see today. The Cornhusker kickback and Louisana Purchase undermine democracy at its core.

  3. jd in regards to the success of socialist vs libertarian states which of these 10, 20 or 40 successful countries would you say are improving on their standard of living? Liberalism doesn’t kill a nation overnight, it slowly strangles it over generations. Take Greece for example, they are clearly without doubt on their way to collapse, Debt exceeds GDP, every indicator is they must make changes…and Unions are protesting in the Street for Status Quo.
    The fall of Rome didn’t happen over night and it was a great empire up till the end, that doesn’t change what killed it though, and that which did kill it wasn’t what made it great.
    “A free people can choose that in a Democracy.”
    Is it still a democracy if 51% vote to confiscate the wealth of the other 49%? While technically a Democracy when votes are out right bought you can no longer call it freedom.

  4. Does anyone ever learn anything in these debates? I think Margalit has evolved some the longer she has posted. Not sure anyone else has.
    There have been dozens of howlers in this thread, and if I were unemployed I might even have the desire to engage them all. As it is, I’ll just point out again that the failure of both private and public insurance to control costs is primarily a failure to control the cost of health care. Obvious, yes, but it bears repeating. Both fail for similar reasons that come down to public attitudes and expectations (and lack of knowledge), which provides an opportunity for industries and their interest groups to press the advantage to grab a larger and larger share of the national income.
    Nobody, not Nate or Peter or Mr. Laszewski or President Obama, will be able to solve our health care cost problem until we are able to reset public expectations and break the power of the provider/supplier lobbies. It is clear from examples across the world that this can be done using a single payer or multiple private or quasi-private payers. The coverage vehicle in this sense doesn’t matter. What matters is the politics, the culture and whether power is able to serve the public interest.
    Which brings me to one political point: it was asked whether any non-liberal nation has been successful (which I’ll interpret to mean: is there any non-socialist nation in the top quartile for standard of living). The United States absolutely must be considered socialist or a capitalist-socialist hybrid: Social Security, public education system, Americorps, Medicare, Medicaid, VA, food stamps, huge funding for basic research at govt and non-govt institutions, modestly progressive tax system designed to redistribute wealth, etc. The US government spends as much on health care per capita as nations with single payer universal health care systems.
    There are no non-socialist nations in the top 10, or top 20, or top 40 nations. Nor will there be. In simpler times, when the bonds of family and community were strong, things could be taken care of at that level in a way they cannot be taken care of in our fluid, free society. Huge, complex, socially free societies fall apart when government doesn’t step in to smooth the rough patches, ensure safety and protect people from some aspects of failure when they strike out on their own or are left on their own. If that weren’t the case, and Libertarian ideals worked, don’t you think you’d see a single example of it? Even with the US, the states that are the least Libertarian tend to have the highest economic success.
    I don’t mean that we don’t see Libertarian elements in successful societies. Certainly, we do, and protecting certain kinds of freedom and responsibility can be very effective and valuable in their own right. But there is no “Libertarian” society today because those ideals are as stupid in their understanding of human nature as Communist ideals.
    The best way to kill Libertarianism is for a modern nation to embark on the project of becoming a purely Libertarian political system. It won’t survive first contact with the real world, just as Communism didn’t. We’re all going to live with massive government involvement to structure the economy for the rest of our lives, just as we have lived with it for our entire lives up to now. The questions to ask have to do with the best way to make government work, and yes, that means people are making decisions that impinge on the freedoms of others. A free people can choose that in a Democracy. And they have. And they will continue to do so. No amount of yelling will change that.

  5. “You live in a fantasy world that is determined by factually unsupported extreme rightist ideology.”
    Typical Wendell, wild claims and not one example to back it up. Argue any point I made Wendell….you can’t, you can’t even man up and debate a single thing I said. Grow a pair then post buddy.
    “If you aren’t hung as an enemy of the people.”
    Didn’t I read in the Liverpool Care Pathways that hanging was the preferred treatment for old age and many other age related conditions?
    “But pretending that certain markets such as the market for medical services lend themselves to competition when they in fact do not, have not and cannot for the most part, is foolish and an impediment to rationale discussion of alternatives.”
    ya ya and man made global warming will melt the glaciers in 50 years, and islands will be under water, and this year will be a horrible hurrican season, and ALL THE SCIENTIST agree. It is exactly your ignorance of the ability for medical services to be competitivly purchased that you try to hard to deny it. It is this same ignorance of what is possible that your ideology always fails. You ignore the viable solutins asimpossible and implement the impossible as viable…and are shocked when it never works out.
    You can’t expect poor people to provide for their own hosuing so we’ll just round them all up into projects….wow can’t imagine why that failed.
    You can’t hold parents and their kids accountable for showing up to school and getting an education so we’ll just socially promote them…uuugggg why didn’t that work it made so much sense on paper.
    poor people can’t saveup money to buy houses so we’ll let people with no money and poor credit buy houses to….why in the world would they default we gave it to them for nothing
    I could go on all day. Each of these problems had an obvious solution that was viable, liberals and Wendells, couldn’t see the obvious so they instead went with the obvious to fail….and low and behold fail they did.
    Nothing in healthcare is beyond competition, only small minded liberalism prevents it.

  6. It’s time Americans aggressively voice their support for a bipartisan approach. Call your congressman today and demand that the Healthy Americans Act (Wyden Bennett) get its hearing!

  7. archon41: Nate is the contributor here who raises ideological irrelevancies. Not only that but socio-economic systems are complicated. If one wants to characterize portions of the USA healthcare system as competitively determined versus administered, that has some meaning.
    But those characteristics are largely devoid ideological content which almost never serves any positive role in any case. Those characteristics represent mechanisms for pricing and bridging supply and demand.
    I suspect that anyone without a special political or ideological axe to grind but otherwise across the political spectrum would prefer see to supply and demand for services or products met by a competitively-determined market.
    But pretending that certain markets such as the market for medical services lend themselves to competition when they in fact do not, have not and cannot for the most part, is foolish and an impediment to rationale discussion of alternatives. Much better to identify those segments of the market that can set by competitive forces and therefore make policy choices that permit or encourage that.

  8. And here we have, writ large, a demonstration of why attempts at “bipartisanship,” “dialogue” and “compromise” are futile. If you aren’t on board with the agenda, you are a sociopath, and need to STFU.
    Don’t worry, Nate, you’ll get your fair share of monopsonized health care, equal, uniform and precision cut. If you aren’t hung as an enemy of the people.

  9. “You cant regulate a free market system.”
    Healthy free markets are, by definition, regulated, at least according to Adam Smith. For example, automotive market has always been regulated: you can’t sell a car unless it meets several regulations. The food market is regulated: you cannot sell food that does not meet certain quality regulations. Most markets are similarly regulated. We have anti trust laws.
    Basically the government’s job is to make sure the consumer is not being sold dangerous stuff and that sellers don’t collude to set unfair prices.
    So why is it that it becomes a Stalinist horror story when the government proposes to regulate the minimum quality of health insurance plans? If anything, the government is guilty of doing too little too late.
    And Nate, why are talking about Mao and Pot and Stalin when we are discussing liberal views which have nothing to do with rabid Communism? Should we discuss Fascism whenever “the good of the country” is mentioned with utter disregard for the good of the citizens?

  10. Nate: You live in a fantasy world that is determined by factually unsupported extreme rightist ideology. Your praise of capitalism and condemnation of other social systems are laughable. I doubt you even know how to define capitalism and its characteristics, both good and bad.
    Still unclear what it is that you do for a living, but you should stick to reporting on the details of that rather than extrapolating from your specific occupational experience to grand theories about society or economics.
    At least those details add something positive to this weblog. The rest is utter nonsense and uses up electrons that could otherwise be used more productively.

  11. “This president is great at pointing at problems but his greatest problem his is that is an idealogue.”
    Not that GW Bush was or the GOP is of course. He’s only one man, not king and not god. He can’t even control his own party, let alone Congressional leaders elected by their state voters. Do you want a king?
    “And the governments emergence and evasive policies into our economy have caused nothing but harm.”
    You might want to look at how a lack of government regualtion in the financial industry brought us this latest crisis. The “government” that started all this “evasive policies” (I think you mean invasive) was a Republican, Alan (hands off regualtion)Greenspan, a Republican, GW (free market) Bush, and a Republican, Henry M. (700 Billion bailout) Paulson, Jr. Do you think that extensions of unemplyment insurance, COBRA subsidies and taxpayer money sent to local communties for projects “have caused nothing but harm”?
    “You realize Reagan believed in trickle down economics.”
    If he believed in it he actually legislated “trickle up” economics.
    “But just talk to a few people in finance.”
    You mean the ones who got bailed out and their bonuses secured by “government”?

  12. “but that is because industrial capitalism has been killed off by purely financial capitalism, which does not ever “trickle down” anything but debt.”
    There are 12-20 million illegal immigrants that would disagree with this. NOTHING in the history of man has brought more people out of poverty then capitalism and free markets. No soical engineering or liberal feel good program even scratches the surfce of the success of freedom. Wealth redistribution, as history has shown time and again, brings everyone down instead of raising everyone up.
    technically Moa, Pol Pot, and Stalin “helped” people. The problem is the tens of millions that died to accomplish it. Liberalism has the same success, for every person it marginally helps it destroys many times that. The problem isn’t that communism, facism, liberalism, or even free markets kill people, people will die under any system no matter what, the problem is Liberalism like communism and socialism removes the opportunity for individuals to determine their own destiny. Liberalism sentences people to death. It sentences entire generations to it actually. See public housing and education.

  13. You realize Reagan believed in trickle down economics.
    And of course you also realize that socialism is just trickle down economics from a shallow water pot?
    Id venture that you dont truly understand the trickle down theory. Few do.
    You asked for a non liberal country that had been mildly successful.
    Youre living in one.
    The name of the problem is corruption among the government. Ya know how that happens? BIG GOVERNMENT!

  14. Yes, Obama is great at talking something to death. Thats really all hes got going for him in more ways than just a few.
    I dont understand why He repeats himself over and over concerning the problems with the HC system. How can you be alive and not ‘know’ what they are? This president is great at pointing at problems but his greatest problem his is that is an idealogue. And the governments emergence and evasive policies into our economy have caused nothing but harm. But just talk to a few people in finance.
    You cant regulate a free market system. Why? Because you cannot predict free markets responses to regulations. And unless youre a psychic or God you cannot. Obama has left the credit card companies with nothing but the opportunity to find even more deceptives to get more money out of americans which at the end of the day hurts more than it helps.
    I think Obamas banking ventures and automotive ventures and yes, even Health Care Reform is nothing more than what the little boy does when he thinks mom and dad wont get what a good idea he has in mind until he just goes and does whatever is in his mind without first asking. Then when mom and dad see what a great idea it is theyll see after the fact they woulda been wrong to say no.
    Thats what Obama is entourage are. Children. Children that think big government and a more socialistic approach is the best thing and when Americans see what a good idea it is we’ll do like the mom and dad…feel foolish more thinking it was a bad idea.
    Every intervention this administration has made into our lives has left us with short term and long term difficulties even more severe than the ones they were first trying to circumvent.
    Obama puts ideals and ideas above this country and its people. Thats why hes dangerous and a horrible president.
    Hes not on fire about Healthcare because he just genuinely loves the american people. What Obama is genuinely in love are his personal beliefs about government and society.
    Next time someone runs on the promise of the hope of change. Maybe people will look more closely at the facts
    and not turn a blind eye to the facts as they did concerning this mans past and his affiliations.
    Birds of a feather and all that…

  15. “Who exactly has Liberalism ever helped?”
    I of course could write an essay in response, but I think you know what the contents would be. Unfortunately, we can not run RCTs to prove the point, but I would like you to give me one example of a non-liberal country in this whole wide world that is even mildly successful.
    And please remember that our country has been at the front line of liberalization from the day they put it in writing that all men are created equal.
    I do agree with you that we are being forced to contemplate more social support lately, but that is because industrial capitalism has been killed off by purely financial capitalism, which does not ever “trickle down” anything but debt. So maybe the solution is somewhere deeper than just health care.

  16. “For me the entire country is the entire country – 100% of its citizens.”
    You mean like how Medicare raised senior poverty from 13% to 19%? All the people in public housing who liberalism helped? Liberalism claimed to help people but hasn’t. Who exactly has Liberalism ever helped?

  17. “…it really is in the best interest of the entire country if you let [liberalism] die and we learn from its failures.”
    How do you define “the entire country”, Nate? Is it the 80% than can survive? Maybe the 1% that gets richer and richer every day? For me the entire country is the entire country – 100% of its citizens. So maybe you want to rephrase that and say that it is in the best interest of a large portion of the country.
    At that point I will argue that you cannot really have a successful country where large segments are doomed to all sorts of deprivations. These are not just “bums” any more. These are hard working folks, and it’s getting worse.
    I don’t feel warm and fuzzy at the prospect of Medicare, Medicaid and Social Security going away, leaving millions of elderly, sick and poor to fend for themselves in abject poverty. What exactly are we trying to achieve here? Arab Emirate status?
    Let’s look at it from a different angle. If some inner workings of the food industry would cause 45 million Americans to be unable to afford the purchase of basic food, like bread, do you think the government should intervene? And by intervene I don’t mean suggestions of eating cake, or dropping dead quickly.

  18. “I am saying that with all the fraudulent schemes out there, people are leery about unknown small players.”
    I need a theme song, if I had one then people wouldn’t be leery. Wonder if I could get a grant to buy and market a theme song, surly there must be some government program for theme songs.
    I don’t see nearly the leerynees you claim Margalit. Sitting down in front of them and shacking their hand seems to resolve a lot of that, unlike some faceless insurance company 2-3 states away you can barely get on the phone let alone to come to your office. There is also that worthless broker the left loves to hate that supposedly does nothing but leach off the system. When they say they know me and have been doing business with me for years then people don’t seem to have concerns about my leerinspiring nature.
    For being 600% more expensive and so inefficient, compared to Medicare as Liberals like to claim, when we administered Medicare Supplements the seniors loved us. They could come sit down in our office and talk, they would get the same person on the phone when they called, and we knew them by name not number. Geanted we got paid nicely for it, them seniors know how to cook, we could have opened a confectionary store with all the sweets we would get around holidays.

  19. “but I have seen numerous allowable schedules.”
    You know you can create a comparison between any two numbers correct? A private fee schedule is always some percent of Medicare. That doesn’t mean it was created based on Medicare. You can look at every single allowable schedule in the world and that still wouldn’t support your argument. You can only look at the actual contract to see if it is based on 125% of Medicare.
    “the private sector seems unable to provide care for all its constituents.”
    ? The private sector is the sum of those that buy policies not the sum of everyone under age 65. Is VA broken becuase people are uninsured? How about Indian Health Affairs? Care for the poor has been a responsibility of Medicaid since early 1960s. It has been broken since roughly 5 years after it passed.
    Private Insurance is self sustainable, it can’t fail as it corrects itself by raising rates to cover its risk every year. It can only collapse if artificial restraints are placed on it, like being required to write policies on people after they are sick and haven’t been paying premium or being required by law to allow people to lie on their policies.
    Further government has been shifting Medicaid liability to private insurance for years and now allowing them to charge for it. They have also been shifting Medicare cost to private insurance. So once again you are completly wrong, Private insurance, far from being broken, is the only thing keeping Medicare and Medicaid alive. If Medicare and Medicaid could not transfer cost to private insurance they would have already collapsed.
    The liberal opinion is both must be addressed but not for the reason you claim. All three pillars of liberalism are on the verge of collapse; Medicare, Medicaid, Social Security. If liberals can’t find 100 trillion+ to shore these up it will be the death of your dogma. The average person can name pretty easily segments of our economy where you can raise 100 trilion over the next decade or two;
    Healthcare
    Energy
    Banking
    What are liberals main “reform” efforts these days?
    Healthcare Reform
    Cap and Trade
    Finance Reform
    What a shock all are comprised of MAJOR new taxes and regualtion and questionable benefits. The only failure happening here is the failure of Liberalism, I know it is scary for you Margalit but it really is in the best interest of the entire country if you let it die and we learn from its failures.
    Without reform private insurance will still be here in 20 years. Without reform Social Security, Medicare and Medicaid won’t.

  20. Nate, I am not saying that smaller companies, like yours, are not offering better value than the giants. I am saying that with all the fraudulent schemes out there, people are leery about unknown small players. Why did those two Ohio companies go bankrupt, and what happened to their customers?
    As to the fee schedules, we will have to agree to disagree. Obviously your experience is different than mine. I did not negotiate any contracts, but I have seen numerous allowable schedules.
    So Medicare is broken in the sense that its costs are escalating. Private insurance is similarly broken (the sum total, not your company). However, unlike Medicare, in addition to escalating costs, the private sector seems unable to provide care for all its constituents. In the liberal opinion, both failures must be addressed simultaneously, and if one should have precedence, then universal coverage should come first. I think this is where we differ.

  21. “Patients or employers are the ones selecting the insurer, and they are less likely to pick ACME insurance even if the price is slightly lower.”
    And you base this on how many thousands of policies you have sold? Why do you make statements like this? You have to know you have no basis of knowledge to even begin to form an opinion let alone state emphatically they won’t buy ACME. Ohio has had 3 insurers go out of business this year, 2 of which were only a couple years old. Both had business and that business was gained SOLELY on the grounds of cheaper rates. There are new insurance companies formed every year and they compete SOLELY on rates. Insurance is a commodity, like life and auto and all other insurance you buy based on price. There is very little to sell insurance on besides rate, your comment is completely inaccurate.
    “it usually takes the form of 1.25 Medicare, or something like that, and then applied to each and single 90000.”
    How many contracts have you signed? Personally I have done thousands and when you include the other networks we use over a million. Short answer, um no. Long answer Medicare has the most convoluted fee schedule money can design, people go out of their way to avoid linking anything to Medicare because you then need to spend the time to calculate Medicare allowable. Conversion factors seldom have any relation to Medicare. When we came up with our conversation factors Medicare was never consulted once, we looked at what other PPOs were able to get, estimated what we could get away with at our size then came up with numbers we could get the doctor to take.
    “The brightest lights are going to be shining on Medicare’s business in the coming years. It will have to change.”
    Then why not fix Medicare and prove they can fix Medicare before they destroy the rest of it? If someone has never once in their life succeeded at something why would you continually trust them with more and more responsibility? That makes as much sense as trusting the med student that can’t find a vein to do your open heart surgery. They can’t give an injection, diagnosis a cold, or treat a sprain but sure they can do open heart surgery, there bound to get something right sooner or later.

  22. Looks like “universal single payer” is the default modality here. If anyone is still interested in the President’s Proposal, I wish they would explain to me the rationality of subsidizing, for the uninsured, the purchase of insurance from the private insurers who are feasting on hapless consumers (cue, in your mind’s eye, Goya’s hideous giant devouring a human torso.) How on earth are they going to manage copays, deductibles, and gaps in coverage? Is there some ideological fastidiousness here about creating “second class patients”? You’ve already done that with Medicare. You would like for me to participate in funding broader benefits than those available under Medicare, perhaps? And what about these obscene insurer profits and “administrative costs”? Surely tax dollars can be put to use more effectively, with greater practical relief to the beneficiaries.

  23. The problem with your Anthem strategy, Nate, is that the business is not conducted just between providers and payers. Patients or employers are the ones selecting the insurer, and they are less likely to pick ACME insurance even if the price is slightly lower. Name recognition and viability and financial stability are big factors in that choice. Maybe that’s wrong, but it is what it is. So basically the whole thing is a chicken-and-egg sort of thing. As much as a provider may dislike Anthem, if they stand to lose half their patients if they don’t take Anthem, they will bite the bullet, complain and sign the contract.
    This is why I agree with you that these giant insurers need to be broken down, just like the giant hospitals need to be.
    As to the payments, the x.xx offered for the 90000s, it usually takes the form of 1.25 Medicare, or something like that, and then applied to each and single 90000. And when contract time comes around next, and the newest Medicare fee schedule is up, the game starts afresh. These are the allowables we are talking about. What the provider bills out is much higher and only relevant if you are uninsured.
    As to other professions, yes teaching is a horrible mess and an example of why we shouldn’t do anything across the board and “on the cheap”. However, in the service market, a good lawyer makes more than a lousy one and a good plumber gets more business than a crappy one.
    You can always figure out ways why nothing can change and why we are doomed to failure, but the entire premise of Change is to affect Change. Which means changing how Medicare reimburses providers and changing how it deals with fraud and changing all the wasteful ways it squanders our money. The brightest lights are going to be shining on Medicare’s business in the coming years. It will have to change.

  24. Obviously Congress doesnt want to change-their intent to fight each other rather than do some good for the public. Most of them have dated solutions that dont work as they are relatively untroubled about the problems in the country-after all unless they feel our pain they can be as indifferent as they chose to be- and are. Its up to us to foster change for Congres is too neurotic to do much for anyone but themselves

  25. I don’t know if the Republican Senators at the summit are sociopathic, but I do know this: they are FORMER doctors as being a Senator is a full time position, so they do not practice medicine at this point in their lives. So, their perpective is PAST perspective, not current. And, their loyalty is evident per comments to party needs, not public needs.
    In my opinion, it is time for medicine as a DISCIPLINE to find a way to mark when a doctor is not actively practicing clinical care, so his/her credentials reflect that to the public, maybe like “pMD” for Prior Medical Doctor.
    Me, some people should be defined as “daMD” for DUMB ASS! Sorry, I know this is a rude comment, but, it is what it is to me. They are not advocates for what physicians should be advocating.

  26. “If Anthem owns half the lives in a particular state, you have to take whatever they give you.”
    This is where I must point out that for being bright enough to get a medical degree most doctors aren’t bright enough for basic business logic. What doctors did in the past was agree to aggressive rates from Anthem then try to gauge the smaller people. This created an excessive price disparity between B(lues)UCA and everyone else that drove more business to BUCA which gave them greater pricing power. Business 101 would have told providers my enemies enemy is my friend. They would go to the small players and give us contract 5-10% higher then BUCA. Those players could not compete with BUCA and take business away from them and decrease their pricing power.
    Sorry I’m not going to pity providers for their own poor business decision, that is how a free market works, you make a mistake you pay a price. We are actually seeing aggressive moves from providers, mostly hospitals, to strengthen the competition to BUCA. It won’t happen over night but easily in under 5 years.
    Mt technology is as good as BUCA, my disease management and care programs are better, and my service is better, the ONLY reason people choose BUCA over the smaller players is the discrepancy in discounts. Lie with dogs don’t complain about the fleas.
    “For every other profession, payment is somewhat tied to outcomes and quality and mastery.”
    Margalit you must be joking. You really mean to argue public education is tied to quality and mastery? How about politics? Just about anything union? When I go to the DMV all those workers are the best out there?
    Read Barry’s link but disagree with what you’re taking away from it. Just because I use RBRVS doesn’t mean my allowables are tied to Medicare. We might use the same RVUs but what we pay per RVU have no relation to each other. In our PPO contracts we would agree with the physician or other provider to pay a dollar amount per class of RVUs, 90000s get $x.xx while your 80000s get $y.yy. When Medicare changes what they pay per unit that doesn’t allow us to break our contract and start paying less per RVU. It’s the same as AWP and why that lawsuit was such a joke, all AWP and RVU are is arbitrary values assigned to a service. It’s the value you assign to that arbitrary unit that matters and private insurance and Medicare are not that closely linked.
    So that’s your defense for the failures of Medicare, tell me to learn some facts? You sold me, I’m now a believer, based on Wendell’s overwhelming logic I believe Congress will for the first time successfully run a healthcare program, deliver all the benefits they promise, and do it cheaper then what they claim. Further never again will Congress make empty promises to physicians or the public only to break them 5-10 years later. Wow Wendell I only wish you had enlightened me earlier.
    Please excuse me while I go out and prophesize the Hope and Change….Margalit can I borrow some of your signs?

  27. Accept it Mr Laszewski and followers of this guru who has been in DC too long.
    We will have long overdue major US health care reform very soon.
    It will be accomplished through reconcilitation because the Republicans and some fringe Democrats have the audacity/immorality to say we need to “start all over”
    As Chris Dodd said,yes,it’s complex and all connected, but expanded COVERAGE is the lynchpin of reform
    Sorry Mr Laszewski – US History is about to be made.
    We will figure out fair and ethical methods of controlling costs about which you seem to obsess.
    Dr. Rick Lippin
    Southampton,Pa

  28. To invite two sociopathic uncaring Republican doctor-politicians to the summit was an ethical low point for the nation and the US medical profession.
    Dr. Rick Lippin
    Southampton,Pa

  29. Not only is the means of price setting that Mr. Carol cites accurate but most primary care physicians bill for only 10 of the over 7000 billing codes. The balance of the codes are for any conceivable procedure, mostly, but not exclusively performed by specialists. From this perspective the pricing is 100% administered and in large part (the conversion factor into monetary units is set by Congress for Medicare at least) is set by the service providers themselves.
    Not done nefariously, but the outcome, particularly over decades, is predictable and renders the current level of reimbursement.
    The AMA website among other sources has a straightforward description of the RUC and of the RBRVS process.

  30. archon14: mono + opsōnein = single to buy = single buyer. You are looking in the wrong place. The counterpart of better-known monopoly mono + polein – single to sell = single seller.
    Nate: Please learn a few relevant facts about economics before writing once in a while.
    “all this utopia”
    It is called an administered market not utopia. The market for medical services will largely continue to be an administered one. At least the diagnostic part will be. Procedures that lend themselves to a “factory method” for performance can increasingly be offered in a competition-determined marketplace.

  31. Margalit, I have no doubt you believe what you are saying about the willingness of doctors to treat Medicare patients, but you are quite mistaken. I reside on the outskirts of a fairly large metropolitan area with an extensive medical community. Not so very long ago, I broke my upper arm. I was bound up in the ER, and referred to the orthopedist “on call.” I contacted his office the next morning, and was told he had been on vacation for a week and wouldn’t be returning for another week. So, I sat down with the yellow pages and starting making calls. Over a period of several hours, I heard a multitude of variants of “Dr. So and So isn’t accepting new Medicare patients.” My arm was swelling and turning blue, and I was getting a little desperate, so I contacted the ER physician to see if she had any ideas. She didn’t. I kept calling individual orthopedists, unaware that a number of them were part of the same practice. Late that afternoon, one finally agreed to see me. He was part of the same group to which the doctor on vacation belonged. I suspect the only reason he accepted me for treatment was concern that I would go back to the hospital and blab that the ortho “on call” was on vacation. Later, I questioned a physical therapist associated with the orthopedic group, and he told me the group decided several years ago to withdraw from both Medicare and Workers Compensation practice. Too much “hassle” for too little pay, as he put it. Yeah, I heard that duffer who claims to be Obama’s personal physician warble about how much better Medicare is than private insurance. What a flack.

  32. Yes, Barry, but the reform bill has several provisions for changing the status quo and for starters CMS is proposing to equalize the office visit reimbursements between specialists and PCPs.
    BTW, Nate, you should click on Barry’s link. AAFP says that about 85% of private payers tie reimbursements to Medicare. Maybe the AAFP is more credible than I am… 🙂

  33. If I recall correctly, medicare had limited the number of Patients a Doctor Could treat and so the urgent Care Facilites and walk ins are seeing more of these Patients.They are (Medicare Patients) methodically being exploited for (monitary gain)testing and then Threatened to be turned away because of Government reimbursement rates? Death Panels or Good Business?What ever lets us sleep at night.
    I don’t think this industry realize that this Group (Elderly) is their Bread and Butter.
    I may not be accurate in my observations.However, I think that Insurance and the providers carry the Blame for Medicare’s problem as much as Government. Facilities and Insurance has erronously collected for Medical Errors and Hospital Acquired infections for decades. Government has been complicit in allowing it. No wonder Medicare is in trouble.
    The simple solution would indeed to be to put the patients down at a Certain Age. Its apparent that they are falling thru the cracks from Fractured Medical Care system and I see NO Point in feeding Insurance Companies, Hospitals and their related Representatives for services to maximize Financial Gain.When your dying!
    Sounds cold and Callious? The fundamental premise of Insurance and providers although more refined in covering up actual motivations. Often times lead to the same outcomes. Dead Broke!

  34. if you can manage it lets get technical Wendell. Besides the concept of governement even dictating labor prices you have the way in which they do it. I don’t have any problem with the reimbursement per code for most provide labor, it is all the labor that shouldn’t be done. Government has never tried to seperate good care from bad, they just pay less for all care, this is extremly counter productive.
    Next up global budgets. If one type of provider or speciality or new area of medicine is to be paid more then an existing one must be paid less. There is no logic to support this, its a perverse outcome of flawed ideology.
    Please feel free to defend global budgeting, broken promises of past and unit price controls, share with us all this utopia of yours where it all works

  35. “Maybe if government sets all rates it will result in a more equitable distribution of income amongst physicians. Primary Care has only to gain from this.”
    Margalit – Medicare sets physician payment rates based on a concept called RBRVS which stands for Resource Based Relative Value Scale. A 29 member group called the Relative Value Scale Update Committee (RUC) updates these payment rates each year. The committee is dominated by specialists which accounts for why primary care reimbursement has been historically shortchanged. For a more detailed discussion of the RUC see: http://www.aafp.org/fpm/2008/0200/p36.html

  36. Nate, the system we have in place now is as unfair to physicians as it is to patients. Doctors don’t decide what to charge for their labor. Insurers decide what they are willing to pay. And please don’t say that the doctor doesn’t have to accept it. If Anthem owns half the lives in a particular state, you have to take whatever they give you.
    This system also favors large physician groups and organizations. So basically, if you are a “not so brilliant” doctor and you are part of a group, you will get better reimbursement than if you are a magnificent doctor in a small office across the street. The same inequities exist based on geography and hospital affiliation.
    For every other profession, payment is somewhat tied to outcomes and quality and mastery. It’s not exactly so for physicians.
    I am NOT saying that physicians should not have high incomes. Every profession that requires so many years of training and has such enormous responsibilities should be equally well reimbursed. However, just like everything else in the healthcare system, physician reimbursement, the way it is now, makes no sense and is wasteful in many cases.
    The prime example is Primary Care, which is being taken for granted, disrespected and underpaid, and we all pay the price in health and wealth for this short sighted, market inflicted, indignity.

  37. People such as Wendell should be branded with a S for single payor, then if the time ever does come that government dictates prices and we have a physician shortage we know who to treat last….if at all

  38. “Private insurance fee schedules are calculated based on Medicare fee schedules. When Medicare makes a change, all fee schedules follow”
    Not true and not even close to true Margalit
    You don’t seem to know what a fact is Wendell. Further I never said physicians aren’t over paid and couldn’t get by on a lot less. That argument or opinion has nothing to do with your historically ignorant comment that physicains should advocate single payor in the naive belief congress will negiotate fair rates.
    It is unamerican to tell someone they can only make $x for their labor, it is even worse when that person went to school for 8 years under the belief they would be making 2-3 times X. If the free market dictates physicians earn less then that is the American way, but it is wrong for some congressperson to wake up one day and dictate the value of ones labor. Physicians made the mistake of trading in their freedom once, I doubt they would be senseless enough to do it again.
    “You should stick to the specifics of what you do for a living rather than making inflammatory statements without factual basis.”
    FYI I specifically pay doctors for a living thus the schooling I just handed you

  39. To MDasHell:
    You listen to the rebuttals and attacks on MDs like you and I, these people really come across as expecting us to be priests and accept the alleged vow of poverty they demand so they can be treated without any hardship or sacrifice on their part, except accepting some pitiful payment so it can validate their time.
    And that is a big part to what sucks in the health care process these days. Patients don’t get it in the end, by in large. And I really know some of these repeat “offenders” in these threads want to push the adage “repeat the lie enough and it becomes the truth”.
    And, in the end, too many MDs are either scared or lazy to set the limits that need set.
    You’d think people would step back and wonder why less doctors are accepting Medicare now, and if this disgusting legislation passes as the Democrats push it like parents shove vegetables in the face of a child, how many doctors will stay in the profession?
    In the end, the people who scream the loudest “do as I say” are so disgusting when they don’t practice their shouting. Pay attention to this, other readers.
    We are not priests, we are doctors. We get paid for the sacrifices we make to learn this craft. Get your priest to treat your gallbladders, your COPD, your depression, your chest pain.
    Or, maybe he’ll refer you?!

  40. But, to a large degree, government IS controlling physicians’ income. Private insurance fee schedules are calculated based on Medicare fee schedules. When Medicare makes a change, all fee schedules follow, and small practices don’t have much bargaining power at all. There was a rural hospital CEO that posted here not too long ago, and his payment rates from private insurers were LOWER than Medicare in most cases, and only slightly higher for the rest.
    There was also a post recently about Maryland, where the State sets all hospital rates and it seems that those hospitals are doing rather well.
    I really don’t see the insurmountable problem here….
    Maybe if government sets all rates it will result in a more equitable distribution of income amongst physicians. Primary Care has only to gain from this.

  41. You’re a little too erudite for me, today, Wendell. I haven’t a clue as to the import of “monopsony.” Doesn’t look like a proper Greek derivative to me–no “psonos” in my Liddell & Scott. My question was purely rhetorical, anyway, set forth to highlight the vigor with which the medical community is defending its financial turf. As for the AMA, it is my understanding that the membership is not only opposed to “single payer,” but also the “public option,” unless it comes with a mix of public and private insurer payers. Some confusion there, it would seem. We will have to disagree on the number of doctors willing to let the government control their income.

  42. MD as HELL. What patients you or other physicians see is a function of (1) ethics regarding your professional responsibility and (2) local demand/supply conditions.
    If your facility has excess capacity and if your marginal costs are lower than the marginal revenue that Medicare patients bring in, you will see Medicare patients.

  43. Nate: You might want to look at Canada or any other system outside the USA. Providers of medical services have accommodated themselves to an arrangement where their compensation is well below that in the USA with zero negative consequences for patients.
    The privileged position of physicians in the USA is a function of suppliers having substantial power vis-a-vis customers, i.e. patients.
    The fear of the income or other consequences of single payer/insurer financing is vastly overblown, in part because too many physicians believe their privileged position is somehow god-given rather than a function of government policy that overwhelmingly represents their interests as opposed to those of patients.
    Assertions by physicians that Medicare reimbursement rates force them to offer services below cost is patently absurd.
    You should stick to the specifics of what you do for a living rather than making inflammatory statements without factual basis.

  44. MD as HELL,
    First, the cuts will be repealed. They always are.
    Second, some permanent solution is necessary and while I don’t think there should be any cuts in your line of business, I would like to see some serious cuts in fees for wasteful procedures and even some that are not so wasteful but grossly overpriced.
    Third, when you write what you write above, you also sound like a vendor. Not that there’s anything wrong with that…..

  45. I run an urgent care. We see lots of MediCare patients who, for a variety of reasons, are seeing us instead of their regular doctor. On Monday, March first, without a repeal of this fee cut of 21%, we will see no MediCare patients.
    They probably will choke the ER. People will have to wait. Bring a book and food if you go to the ER.

  46. Does this sound familiar to anyone?
    “In 1964 hearings had been held by both the House and Senate on Social Security amendments, including compulsory medical insurance as well as an increase in Social Security benefits. The House and Senate passed different versions of the bill increasing benefits, with the medical insurance provisions omitted from the House bill but included as an amendment to the Senate bill. When the conference committee appointed to reconcile the two bills ended in deadlock over the Medicare issue, conferees decided to forgo the Social Security benefit increase passed by both the House and the Senate in a deliberate effort to give Medicare another chance in the following year. As Rep. Byrnes (R., Wisc.) put it, “The amendments to the old-age survivors disability insurance sections of this bill could have been passed last fall if the word had not come down, and the insistence made that ‘Oh, no, you have to tie all of these together because of the fear that the medical part of this program could not stand on its own merits'” (U.S. Cong. Rec.-House 7 April 1965: 7219). The administration’s insistence on this linkage was central to its transaction-cost-increasing strategy.”
    “Payroll-tax increases extending to 1987 were specified in the bill, thereby lowering the apparent present cost to workers of the health insurance provisions. The planned pay-as-you-go financing, disguised by the bogus Medicare “trust fund,” further concealed the full cost of the proposed program.”
    Until November 1964 Wilbur Mills as chairman of the House Ways and Means Committee…As a southern Democrat…First, he insisted that there not be any open public hearings on Medicare in 1965: the 1965 Ways and Means Committee hearings were held in executive session.
    This was just yesterday
    “Stripped of most ideological discussion by Mills’s edict, the hearings were a pretty dull affair.”
    Peter will love this, insurance companies where evil coniving SOBs 45 years ago as well.
    “Walter J. McNerney, President of the Blue Cross Association recommended that, under Medicare, “it would be desirable … to have one carrier, perhaps with the Secretary [of HEW] authorized after consulting with the hospitals to contract with this carrier.”
    Read the whole thing, no one that knows their history would support what is being called reform today with any expectations it would do anything it promised or cost a fraction of what they claim.
    http://www.cato.org/pubs/journal/cj16n3-3.html

  47. “It would make sense if most supported the scheme and worked cooperatively with the financier, i.e. the federal government for an equitable level of payment to them,”
    Wendell you apparently have never read a history book or learned how to do research. Ever hear the old adage fool me once shame on you, fool me twice shame on me?
    Medicare 1965 gained physician support by adding a section that specifically said providers would be paid a fair amount. Fast forward a couple years, Medicare cost blows through projections, Congress repeals that section and reduces reimbursements. By this time all other insurers of seniors had been driven out of business leaving only Medicare. Providers were forced to accept the new lower IMPOSED reimbursement or give up their entire pratice over 65.
    Here we are 2010 and Wendell thinks it would make sense to try it again. Sure what could possibly go wrong, not like Congress would screw them twice that would be wrong.

  48. “Anyone have any idea why the AMA and like associations decline to support “single payer”?”
    The AMA supposedly represents specialists and primary care physicians in rural practices. I do not know what its position is on single payer/insurer, but the primary reason why some physicians are opposed to that financing scheme is because they fear what they perceive as a monopsony, despite the fact that single payer/insurer is a financing, not a buying scheme.
    Needless to say a single financier would have extraordinary power to negotiate payment to medical service providers. That is one reason why compensation to physicians outside the USA is considerable lower than in the USA. No question that physician income would face potential decline under such a scheme.
    There are many physicians who support single payer/insurer. It would make sense if most supported the scheme and worked cooperatively with the financier, i.e. the federal government for an equitable level of payment to them, but also to the payers – the 300 million USA residents who heretofore are the last participants in the system to receive consideration.

  49. Obama so clearly cut to the heart of issues that finally Eric Cantor, who was trying mightily to keep even with Obama, just up and said the one thing that could matter to the big group of swing voters in the center.
    It was such a great moment, when real discussion (Obama and Cantor were actually discussing for a while) took over.
    Here’s what Cantor asserted, and whether it is true:
    http://findingourdream.blogspot.com/2010/02/eric-cantor-fingers-key-sticking-point.html

  50. “Fine. Pass the bill. Hold an election. ”
    Who said there is no consensus???
    That’s exactly what the President said yesterday….

  51. i’ve a commentary that suggests fixing the economy and education system first, in order to provide an able bodied America the time and energy fix its health care woes. you may read more here.
    “Where should we place our focus in this hour of discontent? Would you tell the homeless man to eat healthier or the working mom to get more exercise? To do so would be to miss the immediacy of their condition. …”
    http://www.loveforthetruth.com/2010/02/26/termites-in-the-crust-of-the-health-care-pie/

  52. Nate, I liked Paul Ryan’s speech and he is making very good points. I tend to agree with him that this bill, as it is now, will cost us money. I think the President agreed in principle that it will cost money. At least Ryan seemed to actually know what he was talking about, unlike other folks there who obviously haven’t even bothered to have a staffer summarize the bill for them.
    I don’t think this bill is perfect, far from it, but it is a step in the right direction. Too small of a step in my opinion. I do agree with the notion promoted by the Dems yesterday that these things hang together and it is not possible to have incremental half measures. Senator Schumer said it best in that respect.

  53. “The ordinary citzen, however, sees “spreading the health care” as a subset of “spreading the wealth.” He sees this administration has an obsession with redistribution of income.”
    Amen. The entire Democratic agenda comes down to “take more money away from the people who earn it and give it to those who don’t, because there are more of them.”
    Fine. Pass the bill. Hold an election.

  54. The way Peter carrys on sometimes, one would hardly realize he agrees with me that the greater good will be better served if the pending legislation goes down in flames.

  55. “Pacific Research Institute”
    http://www.sourcewatch.org/index.php?title=Pacific_Research_Institute
    archon, got a more credible “think tank”?
    Care to post the link to PWC report. If the impact is so large then why aren’t tort “reform” states showing much, much lower medical/insurance costs? Why has this had no impact in Miami/Dade FL and McAllen TX?
    How much more tort reform do you want, no liability at all? I bet we could build cheaper bridges, cars, office buildings etc. with no legal liability for malpractice.
    “Also, how can the liberals support a bill which screws American taxpayers”
    I didn’t like the bill, too much corporate give-aways. But you know the entire healthcare industry is “screwing taxpayers”. But if you support a system where no one gets elected without corporate campaign donations then this is the result – happy?

  56. Actually, Paulo, I don’t see why improving Medicaid isn’t preferable to this scheme for equality of health insurance.
    Anyone have any idea why the AMA and like associations decline to support “single payer”? Anyone? Bueller?

  57. archon41, I have personally nothing to gain from the proposed legislation, other than knowledge that my descendants, friends, and neighbors will have guaranteed access to health care regardless of which state they decide to live in.
    You can argue all you want about paying taxes and being fed up with government. But at the end of the day, neither you nor I nor anybody else can buy an individual 50-year health insurance policy in the private marketplace. This means that the ONLY way to guarantee future access to health care for individuals is for government to step in and either 1) create and fund high-risk pools or 2) make everyone participate in a health insurance pool (through mandates/subsidies like in the Senate plan or through taxes/vouchers like in the Paul Ryan or Ron Wyden plans).
    You probably prefer 1). I prefer 2). It’s an honest disagreement. Elections will determine the outcome.

  58. I’m sorry, but Republicans look like the fools that they are. President Obama did his usual excellent job in this kind of setting. How he can tolerate the nonsense from the Republicans for 7 hours is beyond me.
    I did not watch enough to see or hear commentary from Congressional Democrats, aside briefly from Senator Reid. Hearing the idiocy from Senator Alexander at the beginning, then later from Senator Coburn was too much to stomach.

  59. Peter
    Tort Reform is not a minor detail, and from your numbers it looks like the Trial Lawyers are getting a pretty good “bang for their buck”.
    FYI
    PricewaterhouseCoopers calculates that medical liability concerns increase annual health care spending by $124 billion in 2006 dollars. The additional cost of liability-based health care costs adds 3.4 million Americans to the rolls of the uninsured. (“Jackpot Justice: The True Cost of America’s Tort System,” Pacific Research Institute, March 27, 2007)
    Also, how can the liberals support a bill which screws American taxpayers (no reimportation)to the benefit of Big Pharma, which has an 8-12% profit margin? That is exactly the kind of back room deal Obama campaigned against(and won the Independent vote).

  60. “He turns on CNN, and hears an endless stream of conspiracy theory about “right wing special interests” subverting the legislative process. He wonders when the SEIU, the UAW, the public employees unions, the trial lawyers, the ACLU and Acorn ceased to become “special interests.”
    Lobby Money (1998 – 2009) by sector:
    Finance, Insurance & Real Estate – $3,924,511,526
    Health – $3,834,499,942
    Labor – $391,923,247
    Lawyers & Lobbyists – $313,181,442
    http://www.opensecrets.org/lobby/top.php?showYear=a&indexType=c
    Ya, it’s a bloodbath out there for finance, insurance, real estate and health against those well financed unions and lawyers. Obviously archon you’re in a different reality.

  61. Yes, the people who are unenthusiastic about “progressive” visions of HCR see this issue as part of a much broader picture. Most of the people who post here have tunnel vision. They are deeply involved in some aspect of the health care system, and a number of them hope to profit financially by passage of the pending measures. The ordinary citzen, however, sees “spreading the health care” as a subset of “spreading the wealth.” He sees this administration has an obsession with redistribution of income. It hides behind many guises: HCR, Cap and Trade, “Stimulus,” Card Check, etc., etc., etc. Ordinary Citizen feels he has already been spread as thin as a wafer in funding the welfare state. Now he is being asked to bleed for “the uninsured.” He knows it won’t stop there. He is even being asked to bleed for people who have to settle for a Big Mac instead of a nice plate of boiled cabbage and tofu because of lack of convenient access to Whole Foods (No,I’m not making this up.) He turns on CNN, and hears an endless stream of conspiracy theory about “right wing special interests” subverting the legislative process. He wonders when the SEIU, the UAW, the public employees unions, the trial lawyers, the ACLU and Acorn ceased to become “special interests.” He hears the siren-toned pitch that all this is really for his middle class benefit, and knows it is partisan flapdoodle. He has had it.

  62. It’s funny how people can watch the same exact thing and see different pictures.
    The President indeed spoke more than anybody in the room, but being the only person elected by the entire nation, he represents more people than anybody in the room. By far.
    The Democrats’ sob stories were a bit too much and entirely aimed at the cameras, just like the Republicans’ piles of papers that seem to magically appear in front of every speaker.
    Other than that very few people addressed the actual issues showing an understanding of what was supposed to be debated. I thought there was a slightly higher number of Dems seriously engaged than Republicans, but I was genuinely surprised to see that some Republicans seemed only a few inches away from agreement with the core proposals and there is no substantive reason why a compromise cannot be reached.
    If Dr. Coburn is holding out only because there is no provision for “undercover patients” to fight fraud, by all means add it in. Of course that would make the piles of paper even higher, but it’s a small price to pay.

  63. And you wonder why health care reform cannot pass?
    8 health care lobbyists for each member of Congress
    The Center for Public Integrity has posted a searchable database of what they say are the 1,750 companies and organizations that have hired 4,525 lobbyists to influence health care reform legislation. The Center states:
    “Despite the recession, 2009 was a boom year for influence peddling overall with business and advocacy groups shelling out $3.47 billion for lobbyists to represent them on all kinds of issues, according to the nonprofit group Center for Responsive Politics.
    Much of that money went to fight the health reform battle, according to Center for Public Integrity data. Businesses and organizations that lobbied on health reform spent more than $1.2 billion on their overall lobby efforts. The exact amount they spent on health reform is difficult to quantify because most health care lobbyists also worked on other issues, and lobby disclosure rules do not require businesses to report how much they paid on each issue.
    From an industry perspective, it was money well spent. A close look at the health reform bills that passed the House and Senate show lobbyists were apparently effective at blocking provisions like a robust government-run insurance program, and blunting the effect of cost-cutting measures on health care companies.”

  64. The politics and policies that go into health care reform, whether we are talking about insurance reforms or broader reforms, are not only extraordinarily complex on their own, but are made more so by the personal and philosophical nature of the related issues…
    Health care reform is not just about health or care. It has come to represent and encompass all the political lightening rods: abortion, immigration, big government vs smaller government, free markets vs regulation, taxes, scoring, and states rights.
    The closer we get to an election, the hotter these issues get. And We The People get burned.

  65. Your assessment is accruate, it was a political show with both sides dragging out the same old story and debating “facts” The Democrats enjoyed bashing the abusive insurance companies and rolling out horror stories and the Republicans through malpractice reform would solve the health care crisis.
    My favorite was the Harry Reid story where he said coverage was denied because a birth defect was a pre-exiting condition – something is missing in that story, but most enlightening was he railed against the insurance company not paying the $90,000 bill but never questioned why the bill was $90,000 in the first place. They don’t get it.
    My blow by blow on the Summit is at:
    http://www.quinnscommentary.com/category/healthcare

  66. “A week from now, I expect the polls will still show only about the same 40% approval rating for the Democratic health care agenda”
    And a majority of Americans supporting the Public Option.
    And a majority of Americans supporting and end to abuse health insurance practices.
    And a majority of Americand supporting requiring employers to provide health insurance.
    It’s a funny thing, when you ask Americans if they support or oppose the key provisions of what’s in the legislation, they support it.

  67. These stories failed to mention that Obama talked more than all of the Republicans combined and the Democrats had 3 times the time the Republicans did. No one ever claimed that there would be equal opportunity to raise issues only to suppress them.
    When questioned about it Obama took the arrogant approach saying he is the president so he can talk too much.
    Every time the Republicans tried to raise an issue the Democrats spun the subject to something else.
    Ried again lied saying that Reconciliation he was on TV earlier this week saying it is going to be used, then denying it was ever discussed.
    It will be interesting to see how the media spins this meeting.

  68. However worthy the objectives of health reform, we’re basically going to put a lot of this on the credit card. Would the IMF buy this health reform package if it were coming from, say, Greece? Would an objective party see the capacity to make sacrifices and exercise fiscal restraint (e.g. keeping all the promises about raising taxes and cutting Medicare spending, etc.) as required in the bills the Dems want to pass. There are zero credible cost controls on any of this, or for that matter, on our existing commitments (e.g. Medicare or Medicaid), which represent huge unfunded future liabilities.
    I just don’t trust them/us to do this. . .

  69. Both Dems and Reps have lost sight of the main problem: lowering health care costs. Until that problem is addressed, legislation can not succeed.
    One point made during the summit is that existing entitlement programs are in trouble. Medicare, for example, will go bust in eight years. Doing nothing is not an option. However, I don’t see any proposal that addresses that issue. They just sweep the shortfall in with the deficit.
    Why not do something simple, like expand existing programs to cover the poor? In other words, lessen the requirements for Medicaid? One advantage of Medicare/Medicaid is the lower overhead (administrative) costs. CMS overhead costs are much lower than that of commercial insurance companies.
    The Massachusetts Health Connector, which is often seen as a model, is really sleight of hand. It introduced new bureaucracies – with their own substantial costs. The result is that a relatively small number of people benefit – those that could marginally afford insurance before. The same thing could have been accomplished by simply loosening the requirements on existing programs (Medicare, Medicaid, Mass Health). Instead there is a costly new program in place that is largely redundant with existing programs.

  70. Exhausted, apologies. I glossed over the second half of your post and see you were indeed an equal opportunity basher. Wish I could delete.

  71. ExhaustedMD, really? You’re right that some Democrats who complained about reconciliation 4 years ago are defending it now. It’s just as true that some Republicans who defended reconciliation, indeed, who defended the “nuclear option” of doing away with the filibuster entirely, are now complaining that using reconciliation amounts to railroading the legislation and is horrible, undemocratic, etc. Ignoring that makes you look like a partisan hack.

  72. *The Republicans want to reduce health care costs by eliminating unecessary expenses and defensive medicine; lower costs will reduce health insurance premiums and, therefore, make health insurance affordable for more people.*
    Hmm, at the start of the reform plan, the White House wanted to eliminate unnecessary expenses too. Notice how that was removed by the congressional sausage machine. If the Republicans had started the ball rolling, their sausage machine would have removed it instead and spat out a plan similar to the Democrats’ plan.
    As far as I can, no bill at all would be the best of a number of bad outcomes.

  73. The two sides are fairly close on substance and objectives. They differ on approach:
    The Democrats want to expand coverage by regulating insurance rates and mandating individuals to buy insurance and pay for it by cutting Medicare spending and increasing taxes.
    The Republicans want to reduce health care costs by eliminating unecessary expenses and defensive medicine; lower costs will reduce health insurance premiums and, therefore, make health insurance affordable for more people.
    I do not understand why Congress cannot compromise and produce legislation that provides for some of what each side wants. The American people would win with half a loaf for each side instead of nothing for anybody.

  74. The title of your article is incomplete..should be:
    The White House Healthcare Summit – Democrats 0 Republicans 0 American People 0 (but they get the bill for the summit)

  75. Go to Youtube and find the video of the Democratic Senators from 2005 who spoke out against Republican attempts to use renconciliation at that time.
    Interesting, the same assholes who are promoting this process for their own agenda now. And watch the spin they will try to minimize the sheer incredibility when more people watch it and say “what the f—!?”
    They are all corrupt. And, it is pathetic how the Republicans spin it now to say how hypocritical the Democrats are. Well, aren’t the Republicans equally hypocritical for trying it in the first place?
    Democrats. Republicans. Incumbents. Assholes. All interchangeable terms to me. Hey, is any one else noticing this too?
    And Obama, he spoke of change and hope. Surrounding himself with the entrenched idiots who have been digging this hole for the past 30 years? And how people equate him with Reagan. Yeah, the perverse circle is complete!

  76. Ah, yes, my pulse quickened and a frisson flashed down my leg at the radiant grandeur of his rhetoric. Grade A “uplift.” Turning to substance, the Prez said it all in his summation, when he identified the “uninsured” and “pre existing conditions” as the “core problem.” His heart really isn’t in restoring solvancy as to existing obligations and controlling provider excesses. This, basically, was to provide an opportunity for his followers to trot out a parade of horribles before the cameras. It changes nothing. As for “reconciliation,” bring it on.

  77. Bob, are you sure that’s not just wishful thinking? I didn’t hear anything indicating a “Plan B”. The President’s closing remarks, I thought were pretty straightforward. Either the Republicans play ball or the Democrats will go it alone and let the elections decide who is right and who is wrong.
    BTW, this is the only option available to Dems if they want to limit the damage in November.
    President Obama’s closing remarks (from WaPo transcription):
    “What I do know is this. If we saw movement, significant movement, not — not just gestures, then you wouldn’t need to start over because essentially everybody here knows what the issues are. And procedurally, it could get done fairly quickly.
    We cannot have another year-long debate about this. So the question that I’m going to ask myself and I ask of all of you is, is there enough serious effort that in a month’s time or a few weeks’ time or six weeks’ time we could actually resolve something?
    And if we can’t, then I think we’ve got to go ahead and some make decisions, and then that’s what elections are for. We have honest disagreements about — about the vision for the country and we’ll go ahead and test those out over the next several months till November. All right?”
    No “Plan B” here…..

  78. it was a very good debate. President Obama is such a good leader and I am glad that he is helping us to become a better people. People need to stop just looking at the color of his skin and help him make this country and our quality of life better.

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