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Myths and Facts About Health Reform Part II

Lobbyists representing the many who profit from our $2.6 trillion health care industry spent millions in the war over healthcare reform. Yet National Journal Contributing Editor Eliza Newlin Carney suggests that “it’s unclear whether all that lobbying, advertising and check-writing yielded much.”

No question, the reform legislation that finally passed falls short of many reformers’ hopes. The public option is gone. Private sector insurers will scoop up all of the new business.  Meanwhile, by agreeing to support reform—and make some financial concessions—Pharma bought protection from generic competition, plus  a promise that it can continue to set prices, without worrying about Medicare trying to bargain for discounts.

Nevertheless, as I argued in part one of this post, Carney has a point. Lobbyists lost on many issues. Under the legislation, insurers who offer Medicare Advantage  are going to lose their windfall payments. Some relied on that corporate welfare to stay in the black.  In addition, insurers who cover large groups will have to pay out 85% of premiums to physicians, hospitals and patients, keeping only 15%. This rule kicks in next year, and makes raising premiums far less attractive. If an insurer lifts premiums by 10%, it will have to increase pay-outs by 8 ½%. Meanwhile a 10% hike means that it the company likely to lose market share, particularly in the more transparent new exchanges that open up in 2014.

Insurers will gain millions of new customers, but the majority will be expensive. Some patients suffering from pre-existing condition will need extensive care, and many others will come from low-income families who, as a rule, are not as healthy as more affluent Americans.  Moreover, between now and 2014, it’s likely that Congress will bring back the public option.

Drug-makers also will face new challenges. As I explained in part one there are various ways that Medicare can cut its drug bill without bargaining with drug-makers. The legislation also contains  additional funding for comparative effectiveness research;; this spells trouble for an industry that is not accustomed to head-to-head comparisons. When the research is published, insurers, physicians, journalists and patients will pay attention. Already, the mainstream media has begun questioning the value of two of Pharma’s most profitable products: statins (a.k.a. cholesterol-lowering drugs) and the newest, most expensive cancer drugs.

Lobbyists also worked to protect health care providers, with mixed results. Those who represented primary care physicians and others near the bottom of the providers’ income ladder (gerontologists, pediatricians and family practitioners) won a 10% raise from Medicare. The 10% hike begins next year, and continues every year for the next 5 years. Primary care physicians and pediatricians who care for Medicaid patients also will enjoy a well-deserved raise: going forward they will be paid Medicare rates—which typically are 30% higher than what the government pays doctors who care for the poor.

But better-paid specialists are likely to see their fees sliced for some services. Some physicians are particularly concerned that an Independent Payment Advisory Board (IPAB) will have the authority to recommend changes to the fee schedule Medicare uses when paying doctors. IPAB’s changes will go into effect unless Congress votes against them and the president agrees with Congress.  If the President disagrees, the changes automatically become law—unless Congress can find 60 votes to overcome the presidential veto.  (IPAB begins its work in 2014, though it won’t begin to recommend changes in payments to hospitals until 2020.)

Providers who take fees from drug-makers and device-makers and then recommend their products could find themselves in an awkward position. The final legislation requires pharmaceutical and medical device companies to report all payments over $10 to physicians and teaching hospitals. This data will be made public on a searchable website.

Reform also includes new regulations for hospitals. Those that report an excessive number of preventable readmissions will find that Medicare no longer pays for patients who bounce back. (Private insurers will no doubt follow Medicare’s example).  Hospitals also will have to go public with their infection rates. And every three years, they will have to justify their tax-exempt status. (Here, I’m just skimming the surface of what reform means for hospitals; I’ll be writing a post about this in the near future.)

All in all, a close look at the details of the final bill suggests that the lobbyists representing hospitals and doctors did relatively little to undermine reform.

Politicians Weakened the Legislation

Carney’s thesis is that politicians did the damage:
“Partisan rifts and fickle political winds have done more to derail proposed health care changes than any lobbying campaign. . . That stands in contrast to President Clinton’s failed health reform plan 16 years ago, which ran aground in part because of deft insurance industry lobbying.”

I tend to agree.

One would prefer to think that lobbyists are responsible for the legislation’s limits. But I’m afraid that our elected representatives–and the conservative grassroots voters who made their voices heard—deserve most of the credit. Maybe this battle really was driven by “ideas” rather than money—however tattered some of those so-called ideas might be.

Admittedly, it’s hard to separate the lobbyists form the politicians they fund. But lobbyists didn’t fund the tea-baggers. Sure, some of the protests were staged. And a GOP consultancy created the brand name and used the bus tours that became the Tea Party Express as a vehicle to promote Our Country Deserves Better.

But Lobbyists don’t pay millions of Americans to watch Fox News, or listen to Limbaugh. (In fact, only about 3 million viewers tune in to Fox, and no one knows how many are addicted to Limbaugh. We don’t have an accurate count on how many protesters traveled to Washington carrying signs reading “Compassion is Voluntary, Not Compulsory,”  or “The Only Thing We Have to Fear is Obama Himself.”  But moderate Democrats in Congress perceive vocal conservative voters as a major force in this country. And in some states, they are. Moderates have reason to fear them. George Bush is no longer in the White House, but many  right-wingers are still bitter that President Obama won.

A Divided Electorate

It’s worth remembering that only 43 percent of all white voters chose Barack Obama in November of 2008; 55 percent picked McCain. As Timothy Noah noted at the time the lack of support from white voters wasn’t necessarily about race: No Democratic presidential candidate has won a majority of white votes since Lyndon Johnson. (Jimmy Carter came close—losing the white vote by only 4 points, and Bill Clinton narrowed the gap to two percent.)

The history of presidential voting patterns over the past 45 years suggests that Obama lost the white vote, not because of the color of his skin (or at least not only for that reason), but because he was perceived as a liberal Democrat. Conservative white Republicans just don’t like Democrats, and they’ve been making that clear at the polls ever since LBJ lost the South when he signed the 1964 Civil Rights Act and the 1965 Voting Rights Act into law.

That these were the events that caused Dixiecrats to desert Democrats does suggest that the divide does have something to do with race.  But, for the purposes of this discussion, the more important point is that in January of 2009 Barack Obama became the president of an extraordinarily polarized nation. And this is what made it impossible to pass health care legislation that many reformers would have preferred: a bill that included a public option, gave Medicare the right to negotiate for lower drug prices, imposed stiff penalties on individuals who decide to wait until they’re sick before applying for insurance, and insisted on federal regulation of private insurers.

Yes, lobbyists contributed millions to the battle over reform–they have the money.  But Xtreme Conservatives own the hearts and the minds of a significant slice of the American public. That is what made the difference. Carney quotes Richard Kirsch, national campaign manager for Health Care for America NOW, a liberal coalition that spent millions to support comprehensive reform: “I think the larger political narrative, and what’s going on in the grassroots around the country, is much more important than any traditional lobbying.”

Kirsch should know. As campaign manager for HCA, he watched his organization spend millions to promote reform. And yet, Carney contends that liberal lobbyists like the industry lobbyists, failed to get full value for their dollars: “Some of the biggest spenders were progressive advocates such as organizers at Health Care for America NOW, who found themselves playing defense by August, when conservative activists crowded town hall meetings to shout down comprehensive reform. Having been surprised and swamped by industry opposition during the Clinton health care debate, such groups lobbied early and aggressively for the Obama plan this time around. But they lost control of the narrative.”

“Ralph Neas, CEO of the National Coalition on Health Care Action Fund told Carney ” I don’t believe we’ve done a good enough job explaining to the American people how health care reform will help every family. Too many people think that health care reform is getting taxed to pay for those who don’t have health care insurance.”

I agree. But I don’t blame groups such as  Health Care for America NOW or the National Coalition for failing to persuade Americans that they will benefit from reform. The opposition was spreading easily-framed lies:

  • “You will be paying for healthcare for illegal immigrants.”
  • “Death Panels will decide when Grandma dies.”
  • “Seniors Will Lose Medicare Benefits”
  • “Doctors Will Stop Taking Medicare Patients”

Lies fit nicely into one-liners. The truth is usually much more complicated and far more nuanced. If you’re going to tell the whole truth, you are forced to qualify what you say. This usually takes more than one sentence. Try explaining palliative care (a.k.a “Death Panels”) in eleven words.

Or, consider this question: Under reform, will your premiums go up? This depends on whether you have employer-based insurance, what state you live in, and how many sick people were excluded from your state’s insurance pool in the past. I plan to write a post addressing that question. If I’m going to give HealthBeat readers accurate information, I’ll probably have to write at least 500 to 800 words. And spend two or three hours researching the answer to make sure I get it right.

Meanwhile, a great many opponents of reform have already given you the answer: “Your premiums will rise.”

That’s nice and concise. But it isn’t true.

In the months and years ahead, the lobbying and the lying will continue. Some in the health care industry will be trying to change certain planks in the reform bill. But the big effort will come from conservatives who hope to take back Washington, “break Obama,” and roll back reform.

As Carney observes: “with the midterms fast approaching, health care lobbying expenses are already starting to morph into campaign messages.” Indeed, the Wall Street Journal has already reported that the U.S. Chamber of Congress plans to spent $50 million on the election in an effort to unseat vulnerable Democrats who voted for reform.

“Carney quotes Henry J. Aaron, a senior fellow at the Brookings Institution: “ The way the bill is drafted, health care is certain to be the number one or two domestic political issue for the next five to six years. It just won’t go away.”

If you’re inclined to engage in the battle, find out where legislators in your district stand on reform, and work for a candidate who shares your views.  If you can, try to explain what the bill will mean to friends, family and neighbors.  But don’t attempt to match conservative bumper stickers with your own one-liners. That’s a contest you’ll never win. The truth is complicated, particularly in this case: the strength of the bill lies in the details.

If you want to help combat the campaign of misinformation try explaining just one of those details, in full. You might point out that the legislation addresses the shortage of primary care doctors: they will be getting 10 percent pay hikes, each year, from 2011 to 2016. Reform also includes generous scholarships and loan-forgiveness programs for med students who choose primary care.  Or you might describe how, beginning next year, insurers who try to raise premiums will be able to keep only 15 percent of the increase, making premium hikes far less profitable.

As I continue my “Myths and Facts About Reform” series, I’ll delve into more of the often-overlooked details that make this a pretty good bill. Despite what you may have heard, the lobbyists representing our medical-industrial complex did not win.

Maggie Mahar is an award winning journalist and author. A frequent contributor to THCB, her work has appeared in the New York Times, Barron’s and Institutional Investor. She is the author of  “Money-Driven Medicine: The Real Reason Why Healthcare Costs So Much,” an examination of the economic forces driving the health care system. A fellow at the Century Foundation, Maggie is also the author the increasingly influential HealthBeat blog, one of our favorite health care reads, where this piece first appeared.

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77 replies »

  1. While I am at it let me take this opportunity to share a little secert with Anonymous, is that your first name or last name, on how to be a know it all. The secert is to only raise your hand when you know the answer.
    Shocking isn’t it, when its written out it pretty darn obvious but you would be amazed how few people actually think of it.
    So before I say insurance companies do this, or the law says that I either have personal experience, from doing it every day, or use this internet thing to look it up. Some might call it cheating, and I’ll be the first to admit if you asked me questions I would get a lot of them wrong but people set the bar so low it really is that easy.
    Look through the post and see how many I don’t comment in, want to know what they all have in common, I don’t know the subject well enough to throw my two cents in.
    I know it doesn’t work for everyone, Maggie couldn’t write her own blog and post here if she only talked about stuff she knew for more then 3 hours. Ezra Klien would probably still be in school if he couldn’t make up stuff to fill his pages. But its a rule that works for.

  2. As much good as it would do him, Obama would never let some one obviously smarter and better looking then him in his spot light, his selections of amin staff show this. Besides healthcare he could use just as much help with that pitching arm and playing b ball, woouldn’t take more then a couple months to make a man out of him.

  3. While Nate has his less than endearing qualities with some of his comments, I have to say I agree with him as much as I disagree with him, which is more than I can say about the Obama administration, which is more and more Bush II. And why would someone like Nate honestly be interested in helping shape policy that is as rigid and inflexible as any politician can formulate? I know you are being sarcastic, anonymous commenter above, but, it is the minions like you who just think that demeaning and ridiculing dissent that has some respectable position will get the majority of the public to just love and respect your point of view.
    Hey, the German people thought highly of Hitler, Pol Pot had his allies, and even Bush was and still is highly respected by a sizeable circle. Don’t like the comparisons? Well, I don’t like this alleged health care reform bill, fashioned by the ilk that is being exposed as the greedy, selfish, clueless, uninvested in true public welfare scumbags that will be gone when the full impact is felt in 2014.
    So readers, watch out who is telling you truths, and who is just hiding behind anonymity and lack of interest in your well being as they can’t really tell you what is real about this legislation.
    By the way, I have told Mr Holt who I am, so while I use an alias, I do tell the blog authors the truth. I just can’t trust the trolls for the Democrats all the details, because, McCarthism really does still exist in this decade, it just hides behind the smile of insincerity and lust for power. Obama is no different, nor is Pelosi, Reid, and all their lackeys.
    What is next, blinded supporters? Dissenters are racists! No, I am biased, as I despise liars and people out to screw the public for their pathetic and damaging self interests. Some may see that as realists and survivalists. I have no party loyalty, only public loyalty. Get a possessed Democrat, or even Republican, to try to admit that attached to a polygraph. Watch out, the pens may hit you in the face!
    November will be a fun month!

  4. Open Letter To the Obama Administration and Congress
    You can stop fussing and worrying about healthcare insurance and costs! One person you apparently haven’t sought out has all the answers you’ll ever need!
    I am writing to recommend that you seek his advice. He has the answers you are seeking—to relevant questions and irrelevant questions alike. Just ask him.
    He’ll tell you how things are really done in the real world of health insurance, and what you really should do to solve the problem of runaway healthcare costs. Just ask him.
    I would recommend him unabashedly but in the interest in full disclosure I must point out a few flaws in his personality and style. There must be one or two people—perhaps his mother and father—who find him charming, warm, cuddly and even pleasant to be with, but most find him arrogant, obnoxious, rude, insulting, and unable to participate in civil discourse.
    He is known to publicly call those who differ with him “idiots,” “stupid” and other charming terms of endearment. Of course, he is correct in doing so. Just ask him.
    His most redeeming quality—and the principal reason you should seek his advice—is that he has all the answers! And his answers and opinions are always based upon what he loosely calls facts—whether they really are facts or merely his opinions!
    You probably are drooling a bit at the prospect of recruiting such talent and I would certainly like to help you do so. But I have one minor problem—I don’t know his full name! I know him only by the name he uses when posting to The Health Care Blog — it is Nate. While he has never posted his last name it must be something like “Hubris” because it fits him to the proverbial “T.”
    I suspect any number of government agents can contact him by visiting THCB and looking for his ever-argumentative, rude postings. Oh yes, they’ll know they have found the real “Nate” by reading his postings. He can’t spell.
    I can’t wait until you invite him to join your administration. I’ll then know that all our healthcare problems will be resolved in short order!

  5. To Nate per above comment:
    Per the HHS position, reinforces the adage “blind faith” or blind loyalty. Who wants to see the truth when all it will do is confuse, and god forbid, encourage independent thinking?
    Whether it be Democrats or Republicans, you think either party wants independent, thoughtful discourse? Per this post the thread has challenged, do supporters like Ms Mahar want to show they thought things out before commenting and embracing political canned opinion? No!
    The important question is, who is objective and unbiased to see through the lies and manipulations of data, and who just wants to keep their eyes closed and cling to wishful but useless thinking? Not people I want to consider allies and of value!

  6. with this post from Maggie this really shouldn’t surprise anyone;
    The economic report released last week by Health and Human Services, which indicated that President Barack Obama’s health care “reform” law would actually increase the cost of health care and impose higher costs on consumers, had been submitted to the office of HHS Secretary Kathleen Sebelius more than a week before the Congressional votes on the bill, according to career HHS sources, who added that Sebelius’s staff refused to review the document before the vote was taken.
    “The reason we were given was that they did not want to influence the vote,” says an HHS source. “Which is actually the point of having a review like this, you would think.”
    who needs truth as long as the cause is pure right?

  7. Even though it has been accepted that only 5 to 10 percent of cancerous cells are inherited, several cases of women suffering from breast cancer have inherited them form there family.

  8. what idiots. even 0.000001% is an increase and disproves maggie’s claim that those saying cost will increase are liars. Are you really that stupid or just that partisian?
    Maggie made a very specific and very measureable claim. HHS disagrees as does everyone else that has more then three hours of knowledge on the subject. How much more simplistic can it be.
    On top of that is E MD’s point that they already have increase cost, it took them 5 years before they admitted Medicare was over budget. It doesn’t get better with time, the increase will just get worse as all their poor calcualtions and mistakes come to light.

  9. So today it is 1%, and in the next few months the decimal point is off by one spot to the left, and it becomes 10%, and later, who knows?
    You supporters of this health care intrusion will stop at nothing to shout down any and all detractors, even when it is becoming known that the lies can be revealed.
    What are you going to do next, CALL US RACISTS!?
    Oh yeah, you’ve already done that. So, projection has failed, rationalization is quickly becoming undone, so now on to displacement and denial.
    Such effective defense mechanisms, eh? Yeah, for narcissists and antisocials! Oh, who compose most of the House and Senate chambers!!!

  10. Nate left out this quote from the article.
    “The report found that the president’s law missed the mark, although not by much. The overhaul will increase national health care spending by $311 billion from 2010-2019, or nine-tenths of 1 percent. To put that in perspective, total health care spending during the decade is estimated to surpass $35 trillion.”
    “Administration officials argue the increase is a bargain price for guaranteeing coverage to 95 percent of Americans. They also point out that the law will decrease the federal deficit by $143 billion over the 10-year period.”
    I guess Republicans would rather have done nothing and guarantee costs rising to 20% GDP and beyond, but at least that wouldn’t be “socialism”.
    Nate, I thought you’d be in favor of this part as you’re always telling us Medicare will go broke. Let those seniors pay more of their share instead of expecting the “socialist” governement to give them healthcare they didn’t “earn”.
    “In addition to flagging provider cuts as potentially unsustainable, the report projected that reductions in payments to private Medicare Advantage plans would trigger an exodus from the popular alternative. Enrollment would plummet by about 50 percent. Seniors leaving the private plans would still have health insurance under traditional Medicare, but many might face higher out-of-pocket costs.”

  11. I’m sorry, Nate, but I couldn’t find anything in that article specifically saying that premiums will be rising.
    It says that general costs will be rising by less than 1% over the next decade, while the deficit is actually reduced, which doesn’t seem too bad for covering millions of new folks.
    Am I missing something in the article?

  12. “WASHINGTON – President Barack Obama’s health care overhaul law will increase the nation’s health care tab instead of bringing costs down, government economic forecasters concluded Thursday in a sobering assessment of the sweeping legislation.”
    ///////////
    OH MY GOD!
    Obama’s wrong?
    Did (hot place) freeze over?

  13. “Meanwhile, a great many opponents of reform have already given you the answer: “Your premiums will rise.”
    That’s nice and concise. But it isn’t true.”
    http://news.yahoo.com/s/ap/20100423/ap_on_bi_ge/us_health_care_law_costs
    “WASHINGTON – President Barack Obama’s health care overhaul law will increase the nation’s health care tab instead of bringing costs down, government economic forecasters concluded Thursday in a sobering assessment of the sweeping legislation.”
    “A report by economic experts at the Health and Human Services Department”
    “But the analysis also found that the law falls short of the president’s twin goal of controlling runaway costs. It also warned that Medicare cuts may be unrealistic and unsustainable, driving about 15 percent of hospitals into the red and “possibly jeopardizing access” to care for seniors.”
    OK Maggie when even Obama’s HHS says cost will rise who is the one telling lies? What is most telling of all is how you are completly unable to admit you were wrong no matter how obvious and well proven.

  14. Hey, Ms Mahar, read Dr Palestrant’s column today, April 22, re the events to be in Massachusetts? What pearls of wisdom to you have for readers who depend on physicians for care? I know you’ll find some pathetic, rationalizing, dismissive comment that you’ll think will soothe and comfort the masses who follow your lead like blind mice. Well, when the public with brains and reason find out the truth of the coming storm of health care deform, you will be exposed for what you preach!
    Hey colleagues, you need to start paying attention that we are being told we took an oath of poverty, and it is being sold by people who have no clue to what is really behind the practice of health care. And we treat a public that will believe anything, as their mantra is American Idol, fast food, and anything in print on the internet if the headlines are in big enough bold print.
    And just look where the church is headed these days!
    By the way, no one commented on my earlier comment of the 7 ways to improve health care without this disgusting legislative orifice attack? I guess you can’t argue with the truth, eh?

  15. ” .. Right Nate, only you and your perverted thought process would call it a death panel.”
    If you need government to help — you are beyond help. And at their mercy (LOL).
    New Orleans was just one example.

  16. ALFIE KOHN IS A FOOL
    Another Harvard soft-side academic — like MESS-iah and Elizabeth Warren — who think the public can be conned by ginned-up statistics (“statistics, damned statistics, and LIES”).
    http://nyti.ms/ax4BW4
    ” .. How many personal bankruptcies might be avoided is unpredictable, as it is not clear how often medical debt plays a back-breaking role ..
    ” .. Last summer, Harvard researchers published a headline-grabbing paper that concluded that illness or medical bills contributed to 62 percent of bankruptcies in 2007, up from about half in 2001. More than three-fourths of those with medical debt had health insurance.
    “But the researchers’ methodology has been criticized as defining medical bankruptcy too broadly and for the ideological leanings of its authors, some of whom are outspoken advocates for nationalized health care ..”
    Like how LIAR Albert Gore Jr. just got caught —
    http://www.noteviljustwrong.com/
    Nov. 2 — the reckoning.
    Nov. 6, 2012 — Obama is retired (Thank God!).
    ////////////////////
    “Alfie Kohn is a fool.”
    Who knew gathering scientific studies on a topic (competition & rewards) and publishing them was foolish?
    Karl did.

  17. “Alfie Kohn is a fool.”
    Who knew gathering scientific studies on a topic (competition & rewards) and publishing them was foolish?
    Karl did.

  18. Maggie’s PhD is in English, not Finance. She’s never worked as an economist or financial analyst, just like MESS-iah. Stop picking on her.

  19. what goes through your or Maggie’s mind when you start typing? How do you write about stuff you don’t understand and just make stuff up? Do you really think reading 3 hours about something on the internet makes you knowledgable?

  20. Peter why do I bother trying to educate you when you dont even try?
    “family’s insurance business?”
    I own EBC by myself, bought it myself, work it myself. I also help my parents with theirs ontop of running my own business. How did I earn it Peter, by working my ass off since I was 15 1/2 large portion of that time 2 jobs at a time. Starting my own business once before, with little success. Working for others and being hired to start businesses for others. That is earning Peter, any other ignorant questions?
    “That’s just an intentionally uninformed LIE!”
    How is it uninformed? comming from you that is a ittle ironic, Mr. say anything off the top of your head with no basis of knowledge to support it, i.e. see your other post. Lets start with the Liverpool Care Pathyway, how is it decided what patients are put on it and which are not? That should sgut you up for a few hours.
    “Dominating the “opinions” of all those people is their worst fear that this HC reform WILL lower or at least curb premium increases and that something other than industry standard procedure will actually accomplish something.”
    Again Peter your being a blabbering idiot with out any idea what your saying. It wasn’t BUCA sitting in the room it was reinsurers, the very people that are responsbile for holding cost down, they don’t benefit like BUCA from increasing cost. Self Funded carriers don’t make more money when premiums increase. Don’t you ever wish you knew what you were talking about PRIOR to typing?

  21. “Nothing else, you mean besides reference to the 20 years experience, the conference in DC with the reg writers, the 20 carriers in the room.”
    Dominating the “opinions” of all those people is their worst fear that this HC reform WILL lower or at least curb premium increases and that something other than industry standard procedure will actually accomplish something. They believe it will fail because they want it to and will try their best to see that that happens. I actually can’t agree with Maggie that premiums will not continue to increase – the industry is just too well politically connected and self sustaining to bend to this mild “reform”. This bill, for what I’ve seen, is just good for those who will receive subsidies – a boon to insurance.
    “Rationing in these countries is not done by need or even if the person earned it, it is arbiratary and unfair.”
    That’s just an intentionally uninformed LIE!
    “The rationing I do is based solely on if the person earned it or not.”
    Nate, how did you “earn” walking into your family’s insurance business?

  22. “Your idea of minimum is ER care.”
    Now Margalit you know what happens when you assume. My idea of minimum is Medicaid that people need to earn. Thanks for letting me state my own beleifs.
    “Mine is the federal employee standard.”
    problem is you can’t find any sustainable way to deliver that. It’s easy to have impossible dreams, reality requires you actually deliver. You will never find a way to accomplish that.
    “without engaging in moral judgment of the poor by the wealthy.”
    Yet you have no problem with the wealthy standing in moral judgement from the poor, why is that? I’m the one that works 80 hours a week and I need to justify my life and spending. The poor, many of whom don’t work even forty hours you don’t hold at all accountable. That is the crux of our disagreement.

  23. Despite all this verbage and the bloated new law, what I actually do will remain the same: Talk with and examine a patient who chose to come see me about a matter, plan a course of action with him/her, execute the plan and follow-up to see if the desired outcome has or is occurring.
    Sometimes I am doing a sports physical so a student can participate in North Carolina school sports. Sometimes I am doing CPR or directing care of a multi-crunch car wreck victim or victims. Usually I am taking care of either the worried well or people who routinely get their care in the ED, necessary or not, insured or not.
    None of this will be meaningfully changed for all the fuss and expense of this new iteration of Federal mismanagement. Only the paper-pushing (figuratively) will change, again.
    I actually feel I give the care away but charge a lot for all the documentation and accountability. Few professionals have had to relearn their business more times than physicians.
    As my children become independent of my financial support I will need to generate less income. I have no illusions that I can ever retire, but I do not have to work my a** off, either. Besides, why retire and become useless?
    So one huge myth is that this has reformed anything at all.

  24. ” .. therefore those that live in poverty or close to it are somehow undeserving bums.”
    Madam, we are our brother’s keeper.
    It is not a blank check. Even Europe is cutting treatments — de facto rationing, de facto “death panels.”
    With 40% of medical costs due to SMOKING, dope, booze, over-eating and “extreme living” — why do the innocent have to pay for the stupid? Try to justify that, MGA.
    And contrary to that fool T.R. Reid, Taiwan’s single-payer plan nearly went BANKRUPT in the beginning. Similar to the now-bankrupt Tennessee and Oregon state-level plans (next: Mass.). And Taiwan is a better-run country!
    Open borders? How long until bankruptcy would happen?
    No lifetime cap? Nice theory — in Michigan, that has resulted in 40% higher costs, the highest cost insurance in the USA.
    Heck — why don’t the Kennedys prove how generous they are, by turning over their $3,000,000,000.00 cash pile to the poor?
    MGA — why don’t you go after the Kennedys? And let the working-class shop-keepers alone for a while?

  25. Nate, beyond insurance policies and all the gory details, it boils down to two things.
    You think people should get health care commensurate with their income and assets. I agree, with the caveat that there should be a minimum of care provided by the state to everybody.
    Your idea of minimum is ER care. Mine is the federal employee standard.
    At the heart of our disagreement is your belief that hard work and wealth are cause and effect, therefore those that live in poverty or close to it are somehow undeserving bums.
    I happen to believe that luck and circumstances play a huge role in one’s financial status and we as a society have a duty to take care of each other without engaging in moral judgment of the poor by the wealthy.

  26. ” .. You hate the rationing in those “liberal/socialist” countries but you ration care every day, somehow thinking that if private insurance does it, it’s honest and just. And at the same time you’re tearing down single-pay countries your using Canada’s health system to save your clients’ money – how dishonest is that?”
    At least with private firms — you can bring litigation.
    Ever tried to sue the government? Good luck, Charlie.
    As for lifetime caps — President O-Bumbler obviously never lived in Michigan, as well took finance.
    In Michigan, auto insurance is mandatory — and no lifetime cap. Only state of 50 with such a law.
    Result: HIGHEST COSTS in USA, except La. (great!).
    http://www.automobile.com/cheapest-states-for-car-insurance-in-2010.html
    President O-Bumbler has replaced Jimmy Carter as the MOST-NAIVE president in modern history, a soon-to-be one-termer, whose questionable acts will take years to fix. He makes GWB seem like Einstein.
    All the race-cards and verbal canards in the world will NOT save President O-Bumbler from history’s judgment. He’s a talker, not a leader.

  27. “I would submit that what the opponents to the current administration are doing and saying is beyond the pale of civilized discourse in a democracy.”
    What they are doing and saying about Obama doesn’t begin to compare to what the left said and did about Bush. The vile hatred isn’t even close.
    “The point is what would have happened without reform as compared to what will happen with reform.”
    With reform as now passed rates will rise considerably faster then they would have without reforming passing. We know this becuase cost controls were outlawed, insurance is force to cover sick people below cost, and other aspects of the bill. We known for certain because we have already seen the increase in carriers premium to cover aspects of the bill.
    The point is when Maggie pens a piece claiming the very real increase in premium directly contributed to this reform isn’t real and those that claim it is are liars she needs rebukked. It amazes me how someone can publish a piece attacking people then be hurt and offended when they are attacked back. Don’t write 3 paragraphs calling people liars when your full of ^&(*#. That is the point.
    “If you substitute “politicians” for “liberals”, then I think you have a winner.”
    Bev your write that was to broad, but politicians is not nearly broad enough. There is a group of liberals, the Ezra Kliens, Maggie Mahars, Friedman, Dodd etc that have no clue what they are talking about, spend 1-3 hours reading each other discuss something then claim to be experts, that are hit men for the ideology. Anyone pointing out facts that don’t support the cause get attacked by these folks. Labeling them just liberals was like you said unfair to millions of liberals who suffer the beleif:) but don’t kill for it.
    I’l try to come up with some wity label for this kabala before my next retort.
    “That’s always been the “right’s” attack method,”
    Peter, did you not read Maggie’s piece that I was responding to? Its hard to respond to an article about liars without useing the word liar.
    “nothing else in the argument matters,”
    Did you read anything Peter? Nothing else, you mean besides reference to the 20 years experience, the conference in DC with the reg writers, the 20 carriers in the room. Compare my argument, full of facts and supporting sources to Maggie’s. Where does Maggie get her support for the claim cost won’t increase.
    It’s almost funny if it wasn;t annoying and a waste of time that you attack me for what Maggie did Peter, I think they call that projecting.
    “You hate the rationing in those “liberal/socialist” countries but you ration care every day, somehow thinking that if private insurance does it, it’s honest and just.”
    Rationing in these countries is not done by need or even if the person earned it, it is arbiratary and unfair.
    The rationing I do is based solely on if the person earned it or not. If someone labored to make the money to buy the insurance that covers the treatment they get it. I don’t have any say at all in who gets what. Someone people might not like the idea that some people have more money then others and thus can buy more care but that is a far more honest, transparent, and fair method then saying some politician will decide.
    “And at the same time you’re tearing down single-pay countries”
    I’m flattered you think I am powerful enough to collapse foreign health health systems but I am way to modest to think I can do that. Pointing out the flaws in a system and making suggestions on how it can be improved is not an indictment of the entire system nor even advocation for its demise. I don’t like the way our current political sytsem works, that doesn’t mean I am an anarchist.
    “But I guess making arbitrary health decisions every day for which you’re not held publically accountable”
    Now your just being a dumb ass. First it is illegal under ERISA to make arbitrary decisions. Second do you really think when we deny a claim for some reason the patient, privider, group, and sometimes even the State or Feds don’t hold us accountable. Why do you talk so much when you know so little? If you spent half the time you waste typing this crap into actually educating yourself both you and the internet would be 1000 times better off.

  28. Nate, you throw out the word “liar” almost more often than you fling “liberal” at us in your responses. The use of those two words (used in hate) don’t bolster your argument, it makes you look like an idiot. That’s always been the “right’s” attack method, just use “liberal” and nothing else in the argument matters, because that’s all that’s needed for a conclusion.
    Where did you read that I said that reduced Medicare benefits and access were not going to happen or that we should “lie” to Medicare recipients? As Margarlit says, they’re happening now without reform. You hate the rationing in those “liberal/socialist” countries but you ration care every day, somehow thinking that if private insurance does it, it’s honest and just. And at the same time you’re tearing down single-pay countries your using Canada’s health system to save your clients’ money – how dishonest is that?
    “The inteligent way to ration peter is to eliminate that which should never be done, not postponing that which should. Sever back pain should be handeled in weeks, exoctic bio engineered drugs that prolong life for weeks should never be paid for with limited public funds. Do you see the difference?”
    You don’t define “severe” back pain. As for your limited “intelligent” way I guess your the great “OZ” who can easily determine what should not be postponed and what should never be done. But I guess making arbitrary health decisions every day for which you’re not held publically accountable makes it easy for you to claim supreme knowledge and insight.

  29. “[Liberals] Attach (sic) anyone that disagrees, no matter how right that disagreement is, and always protect the message.”
    Whoa, Nate!! I don’t think even you can honestly say that sentence applies only to liberals. Come, now.
    If you substitute “politicians” for “liberals”, then I think you have a winner.

  30. Nate, The point isn’t that premiums will go up or that there will be a shortage of physicians. The point is what would have happened without reform as compared to what will happen with reform. Both are not happy paths. Question is which one is preferable.
    You can of course argue that this is the wrong reform and that would be a legitimate argument. I think it is the best that could be achieved under the circumstances. You probably disagree.
    That’s why we have elections.
    The problem here is that the debate got out of hand. Just because people disagree with the actions of elected officials does not mean these actions are undemocratic and demonic.
    I disagreed with almost everything the former President Bush was engaged in and I expect to disagree with the next Republican administration as well, so you engage in civilized debate and eventually cast your ballot for what you believe in. I would submit that what the opponents to the current administration are doing and saying is beyond the pale of civilized discourse in a democracy.

  31. jacob
    The fact that cancer stem cells (CSCs) may have unique biological properties more likely to fuel cancer, or unfavorable factors in the neighboring cells surrounding the tumor, such as mutated genes, proteins that encourage cell growth, it is important to look at the “forest” and not just the “trees.” There are many pathways to altered cellular (forest) function (hence all the different “trees” which correlate in different situations). Cell functional analysis measures what happens at the end (the effects on the forest), rather than the status of the individual trees.

  32. Maggie:
    The 12 year exclusivity that Pharma demanded on their biologics just builds on their workaround of the Waxman-Hatch Act; gain 30 more months of exclusivity by just claiming that their patent was infringed. It really doesn’t have to be infringed mind you, they just have to claim it and its 30 more months of the money train!
    This doesn’t even take into account the backroom deals between the innovator and the generic firms.
    If you dont believe me, check out the booming generic sales of the patent expired Piperacillin/Tazobactam injection (Zosyn). You wont find any because the Wyeth lawyers have stopped the generic from being shipped. There truly is generic product ready to be used across the U.S that sits in a warehouse in Germany. In the mean time we pay a premium for Zosyn injection and remain Pharma’s stooges.
    This bill makes it even better for the Biologics innovator and more difficult for the maker of the biosimilar product to be substituted at the pharmacy level down the road. Heaven help you if you develop MS or rheumatoid arthritis because these drugs will cost you $30,000 to $100,000 per year.

  33. Here is a really crazy idea Peter….
    How about honesty? I know as a liberal the concept is appaling to you but if your going to ration care, take away some one’s benefits, or drastically change something as important as healthcare is it asking you liberals to much to be honest about it?
    Medicare benefits are going to be reduced and it is going to be harder to find doctors, that is fact. Instead of being upfront about this fact, explaining to seniors why it is happening, and most importantly what they need to do about it individuals like yourself and Maggie will insist it isn’t true, then go even further and call anyone that brings that fact to life a lier.
    As a senior I might not like, or even hate, the idea of Medicare changing but if I rely on the dental and vision benefits in my MA plan I sure would like to know if they are going to be here in 12 months or 48. To have people like Maggie label me a liar for wanting to know what my insurance is going to look like is partisian evil.
    Maybe it is mylife experience that makes me so different then people like you and Maggiw Peter, having spent more then 3 hours on the subject and all, but when I make changes to people’s health plan I am required by law to notify them. I can’t just eliminate benefits and let them be surprised down the road. To be it just sounds like the right thing to do, being honest and all.
    I notice you also left his part out from the beginning;
    “to deal with her severe back pain.”
    Even under a rationed system something like this usually is left to wait 6 months. There is more then enough waste and inefficieny in heathcare that we can eliminate instead of dragging out needed surgery.
    The inteligent way to ration peter is to eliminate that which should never be done, not postponing that which should. Sever back pain should be handeled in weeks, exoctic bio engineered drugs that prolong life for weeks should never be paid for with limited public funds. Do you see the difference?
    One thing that sunk into everyone at this conference, that took more then 3 hours, was how little liberals understand about insurance and healthcare. As an ideology you really just don’t get it, it’s always about the politics with you, then move on to the next thing. Attach anyone that disagrees, no matter how right that disagreement is, and always protect the message.
    We are already seeing carriers increase trend to pay for reform and specifically covering overage dependents, yet people like Maggie can claim it isn’t happening and call people liers for reporting the truth they see, and people defend her. Just amazing. 3 hours she might spend on something this weekend and she knows more then people with the quotes in hand presenting them to small employers and trying to figure out what to do next. Don’t belive the lieing quote in your hand Maggie and her three hours said it isn’t real. Who do we believe Maggie or our bank accounts that have less money in them?????

  34. “She must now find at least £10,000 for private surgery, or wait until the autumn for the NHS operation to remove a cyst on her spine.”
    Sounds life threatening. Oh my, “autumn”,how terrible. I wonder how much the breast cancer treatments (that made her a surviver) cost her? I wonder how much the back surgery will cost her? Nate, I find these anecdotes by you odd since you keep telling us how Medicare is going broke and those European “socialists” are on an unsustainable path, but then castigate them when they attempt to control costs. You then also warn us that under this new legislation seniors will loose benefits. Which do you want, continued un-limited treatment for seniors when they want it for any reason, or cost constraint?

  35. ” .. I highly respect Maggie Mahar and her books. I have a post that may tie in with Mahar’s discussion. Enjoy:
    http://publichealthbugle.com/?p=1507
    Yes, she does a good job as a POLITICIAN without (1) hard-facts and (2) math skills. Just like Elizabeth Warren, David Himmelstein, Nancy Pelosi, and B.H. Obama. No wonder the IMF announced today that it was concerned about the world’s democracies, imprisoning its citizens with DEBT.
    http://www.washingtonpost.com/wp-dyn/content/article/2010/04/20/AR2010042001694.html?hpid=topnews
    As for your Web site — are you paid by the word? Sure seems like it.

  36. Destroying bad seeds
    Scientists have found a microRNA that blocks the development of breast-cancer stem cells
    Cancer stem cells are thought to be the ‘bad seeds’ of cancer. They are the only cells capable of giving rise to new tumours and are resistant to chemotherapy. Destroying cancer stem cells could potentially block cancer development. Erwei Song at Sun Yat-sen University in Guangzhou, Judy Lieberman at Harvard Medical School and co-workers1 showed that breast-cancer stem cells could be blocked from self-renewal and differentiation through the interference of let-7 microRNAs.

  37. The weak link_HIT in its current form is unexpectedly lethal. Maggie has not considered this nor have many others.
    HIT gear is being recalled in Canada.
    At least the Canadian government does not subject its unsuspecting citizens to HIT experiments as is thought to be OK in the USA and by Maggy.

  38. can’t wait for this….
    “A WOMAN has been denied an operation on the NHS after paying for a private consultation to deal with her severe back pain.
    Jenny Whitehead, a breast cancer survivor, paid £250 for an appointment with the orthopaedic surgeon after being told she would have to wait five months to see him on the NHS. He told her he would add her to his NHS waiting list for surgery.
    She was barred from the list, however, and sent back to her GP. She must now find at least £10,000 for private surgery, or wait until the autumn for the NHS operation to remove a cyst on her spine.
    “When I paid £250 to see the specialist privately I had no idea I would be sacrificing my right to surgery on the NHS. I feel victimised,” she said.”
    “Bradford and Airedale NHS trust said it was looking into the case “as a matter of urgency” but added: “Anyone who chooses to pay for a private outpatient consultation cannot receive NHS treatment unless they are then referred on to an NHS pathway by their consultant.”
    Don’t worry grandma you can wait 5 months to diagnosis that pain, maggie promised you wont die
    Pathway is starting to take on some scary conotations if your british

  39. not to be a women hating misogynist but someone’s got to do it.
    “The opposition was spreading easily-framed lies:”
    Glass houses Maggie, you have to know when you write this BS I am going to correct you and point you out for the fool you are.
    “Seniors Will Lose Medicare Benefits”
    The additional benefits paid for by the excessive payments as you call them will be eliminated, everyone knows this. Vision, Dental, hearing, and lower premiums will not longer be offered by MA plans when the government stops paying for them. Lost benefits, true statement, you’re a liar
    “You will be paying for healthcare for illegal immigrants.”
    We already pay for healthcare for illegals and nothing in the bill stops that. Illegals will still get free care from ERs and nothing stops illegals from buying coverage in the exchanges. Maggie is a liar x2
    “Doctors Will Stop Taking Medicare Patients”
    The number of doctors no longer accepting Medicare patients grows every month. Maggie is a liar x3
    “Death Panels will decide when Grandma dies.”
    Liverpool Care Pathways, Maggie your pants are now officially on fire
    Now for a more educated debunking of Maggie and why you should never believe a word she says;
    “Or, consider this question: Under reform, will your premiums go up?
    If I’m going to give HealthBeat readers accurate information, I’ll probably have to write at least 500 to 800 words. And spend two or three hours researching the answer to make sure I get it right.”
    WOW MAGGIE 2-3 ENTIRE HOURS! You are an expert.
    “Meanwhile, a great many opponents of reform have already given you the answer: “Your premiums will rise.” “That’s nice and concise. But it isn’t true.”
    So these opponents are people like me, last week I spent 3 days in DC talking to other people that do this every day for 20-30 years. Also there was the House and Senate staffers who write the regs. The reg writers tell us they are going to eliminate lifetime and annual caps, require preventive care be covered at 100% and force plans to cover dependents till age 27. Not being complete idiots us opponents who have been doing this for 20 years know that when you cover more expenses, are force to cover more sick people, and remove caps on spending cost will increase.
    I have tried to be a better person, bev, margalit, et all I really tried. But sometimes you just can’t help it.
    Maggie Mahar you are a raging freaking moron. Your stupidity and dishonesty knows no limit. If your really going to deny this bill will increase premiums and insist on calling those that point that fact out as liars then you need branded as the twit you are. You need a major T branded on your forehead. They had a breakout session of carriers at this conference, that lasted well over 203 hours Mrs. Expert, and EVERY SINGLE ONE said premiums were going to skyrocket. You’re a joke, so hyper partisan you can’t even recognize common sense.
    “In the months and years ahead, the lobbying and the lying will continue.”
    Apparently every time Maggie pens a word

  40. MATTHEW
    Someone going to write about how much private research money has been lost, during Obama’s on-the-job training exercise (a.k.a., “reform”)?
    Who the heck would invest a dollar, knowing MESS-iah would either (1) screw it up or (2) GRAB your earnings. And, of course, LYING about his questionable acts.
    The USA, having shouldered 50% of global the medical-research burden (where were you, Europe?), has seen a tremendous rise in lifespan.
    Now — with MESS-iah’s SCREW-UP — will that great progress end?
    Of course. The STEAL-O-CRATS could screw-up a two-car funeral procession, they are so incompetent and envious of the success of others.
    NOV. 2 — REPEAL — FIX THE PROBLEM.

  41. P.R. TROLL
    Last comment to Mr. Wendell, since his commentary is otherwise irrelevant to anything ..
    Mr. Wendell, you should quit posting your business URL, in a FEEBLE attempt to gain free PR.
    Have you no shame? Or is it customers?
    Obviously, both.
    NOV. 2 — THE RECKONING — HARVARD LIARS EXPOSED

  42. I wonder where Maggie will get her care. What is in it for her that she spends so much time on this?
    The ultimate reform will be when doctors go cash and carry and let the patient deal with the insurance company. That would be perfect.
    Will reform get rid of the myriad of forms I fill out for the Dept. of Labor or the DOT or the FMLA or Worker’s comp? Will worker’s comp even be part of this? How about chiropractors or dentists? How about all the mental health BS that masquerades for care? How will all the management companies, now taking their cut off the top, be treated by the state government? you know the 9-5 M-F do-gooders who are never around when the s**t hits the fan.
    Why will anyone ever feel they need to be personnally responsible for anything ever again?

  43. Last comment to Mr. Bama, since his commentary is otherwise irrelevant to anything. You should use your own name rather than use a pen name to hide behind, assuming that you sincerely believe that your commentary has some merit.
    It doesn’t. You know that, so you won’t.

  44. YOU FIRST
    “Mao Bama: Go away. Your commentary, not to mention your pen name, is offensive and stupid.”
    Wendell: Go away. Your commentary, not to mention your pen name, is offensive and stupid .. I still recommend that your commentary be deleted given its lack of any value to the discussion and due to the intentional offensiveness aimed at others who write or comment here.
    W, great job, showing how little you know. Excellent job — I can’t imagine anyone using anything you post. Congratulations — outstanding work. Jejune and retromitigent at the same time. You and Obama must be soul-mates.

  45. Mao Bama: Go away. Your commentary, not to mention your pen name, is offensive and stupid. Find some other weblog to harass since that is all you appear capable of doing. I still recommend that your commentary be deleted given its lack of any value to the discussion and due to the intentional offensiveness aimed at others who write or comment here. Perhaps it is aimed specifically at Ms. Mahar’s writings, but it should not be tolerated in any case.

  46. Thanks for this post. I have a hard time finding good content
    related to this subject when searching most of the time.
    I also run a blog similar to yours and here’s part of one of my
    recent posts…
    “The political grounds involve the Constitution of the U.S. The document that Obama tries to sidestep every-time he makes executive decisions, but it is the same document he promised at the Inaugural to defend and protect. This document said exactly and spelled out exactly how the federal government is supposed to do, and the concept of universal healthcare was never mentioned. I support a strict and literal understanding of this document. If it is not included, then, it can not be done. Therefore, he is violating the Constitution by pushing for it and supporting it. He violates the terms of this document by promoting something that is unconstitutional and harmful to the American people. ”
    Check it out and let me know what you think…
    http://american-national-health-insurance.com
    Thanks,
    Michael

  47. STOP IT
    Maggie’s PhD is in English, not Finance. She’s never worked as an economist or financial analyst, just like MESS-iah. Stop picking on her.
    Ditto MESS-iah. Look at all the management problems that have already been reported with his MESS-terpiece. That’s just a start.
    On Nov. 2 — this MESS gets fixed.
    OK — pitch the sexism-card and race-card. And it was Bush’s fault, too. (God, that BS has gotten over-used and tedious. Thank Satan for Pelosi’s bottomless pit of TAX-money — LOL)
    /////////////
    ” .. On primary care comp, your analysis makes it sound like they get 10% per year increases for each of the next five years. If you read Sec. 5501 (p 1413 of the Senate Bill), “Expanding Access to Primary Care Services and General Surgical Services, “Incentive Payment Program for Primary Services”, it looks for all the world like a one time upward adjustment for all E&M services rendered in CY’s 2011-2015 which goes away after that.

  48. Maggie,
    On primary care comp, your analysis makes it sound like they get 10% per year increases for each of the next five years. If you read Sec. 5501 (p 1413 of the Senate Bill), “Expanding Access to Primary Care Services and General Surgical Services, “Incentive Payment Program for Primary Services”, it looks for all the world like a one time upward adjustment for all E&M services rendered in CY’s 2011-2015 which goes away after that. It is carefully hedged only to apply to their E+M codes and only if 60% or more of their practice is those codes, which will effectively bypass a lot of rural primes, as well as people who billed for a lot of diagnostic tests to get their incomes up. Finally, the Medicaid parity on primary care appears to last only for two years.
    Am I reading the bill wrong? I couldn’t find anything about primary care pay raises in the Reconciliation Bill. Sorry to trouble you with this.

  49. You know, the more allegedly complex a problem is presented, the sheer simplicity of it becomes apparent. Also, this columnist is another living example of the adage “tell the lie enough and it becomes the truth!!”
    You want to fix health care and the massive costs it presents? Let’s start with the really complex and intricate factors (sarcasm seriously submitted in that last statement):
    1. Take insurers out of the shield of ERISA, and for the sake of space, learn about it yourself if you don’t already know what that acronym stands for. It stands, for me, the insidious effort of insurers to hide behind this protection to get away with the intrusions and disruptions they got away with for the past 20 years or more.
    2. Tobacco becomes a substantial negative in applying for health care benefits. It is simple: you smoke, you pay more, and if you get caught lying you claim you don’t, you are dropped, and added to a blacklist. Would have the added benefit of ending new smokers to the future, eh Marlboro Man?
    3. Physicians in every state have to enroll in a well monitored CME program for the specialty one practices in, and then take an exam every 4 or 5 years to show competency in not just clinical areas, but ethical and advocacy roles for the communities one practices in as well.
    4. Same goes for other health care specialties; sorry, not having MD after your name doesn’t mean DATM–Doesn’t Apply To Me.
    5. This one will cause lots of howling, but, it is reality we are dealing with here, so deal with it!! : Terminal illnesses do not get full court presses, and families advocating for care beyond reasonable doubt need to be stuffed. We are humans, we die, we are not meant to live for 100 years, and the technology does not trump reality. A lot of you may spasm and convulse reading that last sentence, let’s just hope it is not because reading the sentence triggers your brain tumors!
    6. Medical Technology and Pharmaceutical Industries need to come to terms that health care innovations are not based first on profit margins, but on serving the public and gaining some financial benefit where it is realistic and fair. In other words, take the F-O-R out of profit in health care. Said before, so no stunning revelation for the regular readers, eh?!
    7. Finally, take politicians out of the equation of making changes in health care needs. If not, then I want my colleagues in medicine to be able to go to Washington once a year and write and pass a law that affects politicians only. Think we could be creative in causing some gastrointestinal discomfort!?
    It really starts with the simple, and yet you all want to pontificate and be eloquent and elusive in your agendas, eh? Come on, this legislation is about money and power, and gee, how do I figure that?! It was written by our current batch of corrupt, careless, and indifferent politicians. And we got to see Democrats do not give fecal concerns for the public like their predecessors, the Republicans.
    Are those gasps of surprise I see in my crystal ball? Yeah, I see it because all the hot air being expelled is like the steam rising from a manure pile in the winter. That was a lot of fun to write. Bet not so much fun to read. I’d say sorry, but, we all know that would be a lie.
    Cheers. Getting drunk would be more fun and productive!

  50. FUNNY
    “Time will show if Maggie’s predictions hold.”
    That will happen, right after Obama admits he has no executive experience.
    And Maggie, Elizabeth Warren, David Himmelstein, and Alan P. pass the Certified Financial Analyst exams.
    And Nancy Pelosi finds that bottomless pit of money to fund all her wacky Euro-Socialist ideas.

  51. The HIT vendors have been hailed as saviors of health care in the Bill as linked with ARRA’s HITECH. The Ponzi program will come to a grinding halt as what has happened in the UK. Criminal conduct by the HIT industry has deceived the USA.

  52. HAND OVER WALLET
    To paraphrase Harry Truman — when someone says they are going help you, go home and lock the meat freezer.
    When politicians and their puppets say they “have the facts” — that is when the LYING has started.
    Medicare passed bi-partisan in the U.S. Senate 70-24 after nearly eight years of Congressional debate.
    Obama’s political “MESS-terpiece” may lead to the loss of 50 U.S. House seats by his political party. Was it due to Harvard Law LIES like this, in “The New York Times?”
    http://nyti.ms/ax4BW4
    ” .. How many personal bankruptcies might be avoided is unpredictable, as it is not clear how often medical debt plays a back-breaking role ..
    ” .. Last summer, Harvard researchers published a headline-grabbing paper that concluded that illness or medical bills contributed to 62 percent of bankruptcies in 2007, up from about half in 2001. More than three-fourths of those with medical debt had health insurance.
    “But the researchers’ methodology has been criticized as defining medical bankruptcy too broadly and for the ideological leanings of its authors, some of whom are outspoken advocates for nationalized health care ..”
    When the politicians say they have “the facts” from Harvard, et. al — put your hand over your wallet. They want your money.
    There will be a reckoning for all this Harvard LYING.

  53. “In addition, insurers who cover large groups will have to pay out 85% of premiums to physicians, hospitals and patients, keeping only 15%.”
    Any idea what a “large group” is? This “pretty good bill” which to actual myth busters is called a law, doesn’t have the decency to describe what a large group is and also fails to address the fact that self insured plans (you know the kind most groups over 200 employees fall into) are technically not subject to this 85/15 rule since the medical claims are not insured by an insurance company.
    I will suggest again, this 15% will include the least possible amount of customer service (kinda like medicare and medicaid). What a great way to control medical costs: remove all incentive by insurance carriers affected by this rule to do any medical cost management or steer the insureds to cost effective treatments. Genius!
    Also very reassuring to hear from you that it will be a mere four years before the public is learned enough about this law to appreciate how good it is for them. I know I usually like to pay for something for about four years before I figure out what’s in it for me. Good thing too, since most of the good things are not available for four years anyway. Also comforting that you predict by then, and without a shred of support, that unemployment will not be as high as it is today. Ever consider for a moment that employers have not been hiring or replacing employees because of this impending law and all the other uncertianty created by this administration and legislature. I suggest (using your same standard of not a shred of support) there will be millions of people on unemployment paying the price for $2,000 penalties and uncertianties generated by this still unknown law and worse unknown regulations to follow.

  54. “how often the private equity boys are wrong”
    Within a week of writing my post on the survival of nonprofit community hospitals, two large safety net hospital systems sold out to private equity firms.
    Cerberus Capital Management–Caritas Christi Health System with six nonprofit community hospitals
    Blackstone Group’s Vanguard Health Systems–Detroit Medical Center & its eight hospitals
    Vanguard paid a $1 billion dividend to its PEU owners, while HCA returned $1.75 billion to KKR and company. Both borrowed to finance dividend payments.
    http://blogs.wsj.com/deals/2010/01/29/is-hcas-big-dividend-justified/tab/article/
    Detroit groups are challenging the Vanguard deal:
    http://www.crainsdetroit.com/article/20100331/FREE/100339977#

  55. Greg, Alan P. and Alan P. (on private equity), Joe
    Greg– Thank you. And yes, they’ll keep spinning myths.
    But we’ll keep debunking them. And eventually– sometime between now and 2014, I hope, the public will
    slowly but surely come to understand what is actually in the bill.
    Alan– I guess you have not read the pages and pages of testimony and posts that P. Orszag has written about health care reform. He knows the MedPac reports (several hundreds of pages each) cold. He knows the Dartmouth research cold. The remark was, in part, facetious, in part true– the only way to find out which of the MedPac recommendations works– and where — (some things will work in some regions, some in others) is to try them out. Demonstration projects and pilots.
    As I noted in my earlier reply, CBO projections on employer-based insurance are, at best, wild guesses. No one knows– too many variables, too many unknowns (about the economy, for one, in 2014).
    Alan P. —
    I covered Wall Street for enough years to know how often the private equity boys are wrong.
    And the fact that the mainstream media is already reporting that insurers are trying to book administrative spending as medical spending shows that insurers are not going to be able to get away with much.
    They’re close to being the most hated industry in the U.S. EVERYONE– the media, government, bloggers, states–will have their eyes on them. Any politicians can win votes simply by voting for legislation that tightens insurance company regulation.
    Joe– Pharma will see many patents expire in the next couple of years. Rocky times for the industry between now and 2014. And, as I noted, no assurances from the White House that they won’t be asked to make more concessions going forward. Drug prices will come down, one way or another–see part 1 of this post.

  56. Stephen. Anonymous, Alan P., Hub
    We already have stacks of comparative effective research done by the int’l Cochrane collaboration. There is no need to reinvent the wheel and start from scratch.
    Medical evidence that we already have raises many questions about risks vs. benefits of statins, for instance.
    Insurers won’t be able to raise premiums without permission from state regulators. As Mass and Rhode Island have already shown, that won’t be easy.
    I would predict that a number of for-profit health insurers will go out of business over the next few years, or be taken over by other insurers. Private insuers are way over-paying many hospitals — 15% to 20% more than it should cost them to care for patients according to the Medicare Payment Advisory Commission.
    This is an area where insurers may begin to cut back especially if publicity (in California, most recently, and in Mass. calls public’s attention to the way brand-name hospitals are shakng down insurers–leading to higher premiums for all of us. See Joe Paduda’s recent post on Managed Care Matters outlining what has been happening in California.
    Anonymous–
    If you read all the way to the end of the post, you would find this paragraph: “onsider this question: Under reform, will your premiums go up? This depends on whether you have employer-based insurance, what state you live in, and how many sick people were excluded from your state’s insurance pool in the past. I plan to write a post addressing that question. If I’m going to give HealthBeat readers accurate information, I’ll probably have to write at least 500 to 800 words. And spend two or three hours researching the answer to make sure I get it right.”
    In other words, I’m saying that premiums will go up for some people, not for others. Some increases will be small. Others will be larger. To explain, in detail, I’ll probably need 500 to 800 words.
    Finally, to a large degree I’m talking about whether premiums will go up BECAUSE OF REFORM– because we’re covering an extra 32 million people. Without reform, we could expect premiums to rise an average of 8% or more each year–as they have for the last 10 years–because doctors and hospitals are doing more–more tests, treatments,and surgeries, using more advanced technologies, which are always more expenisve than (though not always better than) older medical technologies. In addition, the prices of drugs and devices go up each year.
    Will health care reform rein in the rising volume and blunt price increases? To some degree– though it will take some years to see the results of changes in how Medicare (and insurers) pay for care and what they pay for . . .
    I’ll be writing a post on HealthBeat addressing the question: “Will my premiums rise under Reform” soon.
    Alan P.
    No one knows how many employers may stop offering insurance. (As CBO would be the first to say, it is “guesstimating.)
    What we do know is that under the final reconciliation bill: “penalty on large employers who do not provide health insurance and whose employees receive public subsidies is significantly increased—from $750 to $2,000 per full-time equivalent (FTE). The penalty for employers who offer insurance but who have employees who receive premium assistance because they cannot afford the employer-offered insurance (with affordability now defined at 9.5 percent of income) is increased to $3,000 for each such employee. The first thirty FTEs of an employer, however, will be disregarded for calculating penalties, to ease the transition to large-employer status for growing businesses.”
    The penalties are stiff enough to make large employers think twice. Moreover, if they drop insurance they will have to pay the penalties PLUS give raises to employees who earn to much to qualify for govt subsidies so that they can buy insurance. These employees will expect a raise if their employer cuts back on benefits. Insofar as these are valued employees, he will have to provide raises–or lose them to the many large companies that will continue to offer insurance. (I’m assuming that, by 2014, unemployment will not be as high as it is today, and employers will once again have to worry about losing their best employees.)
    Bottom line– I doubt that we’ll see a major shift away from employer-based insurance unless and until we have a public option that offers less expensive, high quality comprehensive insurance (less expensive because of much lower administrative costs.) Then employees may Want to move away from employer-based insurance to a public option.
    Smaller employers, on the other hand may cut back on insurance. Often the insurance they provide isn’t that good and their employees will be better off in the exchanges.
    Hub– Thank you.
    On the question of pilots and demonstrations. . . While writing these Myth vs. Fact posts I’ve found that no one seems to have all of the information on any topic in one place. Typically, I wind up with 30 sources–finding 3 facts here, 7 facts there, etc. (In writing the posts I’m doing my best to get as much info as possible on a given topic in one post, while fact-checking to make absolutely sure that it’s true.)
    So here are links to a few sources that each do a good job of detailing some of the pilots and demonstration projects:
    http://e-caremanagement.com/pilots-demonstrations-innovation-in-the-ppaca-healthcare-reform-legislation
    http://www.nhpco.org/i4a/pages/index.cfm?pageid=5853
    http://www.geron.org/HCRprovisions.pdf
    http://chealthblog.connected-health.org/2010/04/05/the-healthcare-reform-bill-results-in-opportunity-for-connected-health/
    (Often, you’ll find pilots and demonstration projects mixed in with descriptions of other provisions in teh legislation, but they’ll be labeled “pilot” or “demonstration”)
    What’s different about these pilots is that, under the legislation, if a pilot is successful, Medicare can expand it to the rest of the country without having to go through Congress. (In the past, Congress has blocked implementation of some successful pilots because they saved money–which means they took a bite out of someone’s revenue stream.)

  57. There are facts behind the Obama team’s new myths. Take Peter Orszag’s admission at the Economic Club of Washington that he has no idea how to pay for quality but will “throw stuff against the wall and see what sticks.”
    Then there are CBO projections on the number of Americans with employer coverage, lower in 2019 than 1998 despite tens of millions more population.
    The rhetoric of both Reds & Blues is vapid.

  58. Obama noted that the health care legislation bears resemblance to health reform bills proposed by republicans in the past, so distortions were necessary to perpetuate the narrative that reform would ruin the health care system and harm the country. New myths have emerged, distorting what the country will supposedly look like after implementation of the the health care bill. Each of the old myths have been beautifully debunked by the likes of Maggie Mahar and the new ones will simply be more distortions in attempt to mislead the American people. Good job! Maggie!

  59. As for PPACA, the 85% medical cost expenditure by insurers relies on a robust operational definition of medical vs. administrative costs. Insurers already are trying to reclassify administrative costs as “medical.”
    A new industry will form around insurance company database mining, just as educational testing ballooned under NCLB. At The Brookings Institution Peter Orszag called for health care to move in the direction of econometrics, i.e. clinical modeling.
    http://peureport.blogspot.com/2010/04/peter-orzag-health-care-power-grab.html
    Quants turned junk securitizations into “no fail” Triple A rated products. Those “knowledge managers” will turn their eye from financial modeling to health care.
    Private equity underwriters (PEU’s) of all stripes have their eyes on health care. They see 30% annual returns where Maggie sees nothing. Cerberus Capital Management purchased the largest nonprofit community hospital system in New England. The sellout comes three years into Massachusetts health care reform. Caritas Christi won’t even leave a well funded foundation in their for-profit wake.
    The big money boys have their eye on the PPACA prize. Time will show if Maggie’s predictions hold.

  60. The deal that Pharma made on Specialty Pharmaceuticals (for MS, rheumatoid arthritis, etc.) will be sure to drive up costs. Why should they get any more patent exclusivity than anyone else?

  61. I look forward to the future section that backs up your “truth” that health premiums will not rise, since I have a very hard time seeing that future. I agree it is hard to summarize, but your statement that health premiums will not rise is just the exact of the claim that health premiums will rise. At least cite your assumptions so I know where you are coming from. Also, clarify whether are you saying that premiums will not rise for anyone, or if only some segments (young, old, individual, small group?) of the population will not have any premium increases.

  62. You are right. It is hard to write an eleven word description of “death panels” that resonates with the general public. The closest I got is: “Death panels are local professionals convened at the request of patient, patient family, or healthcare provider to help them consider end-of-life issues.” (22) The easiest one is: “Death panels are local ethics committees that take no votes, write no orders for any patient.” (16) But, only people who have had an experience with ethics consultation in a hospital can understand this one.
    I look froward to more of your clear exposition of myths and facts. I would like to include some info in my blog http://www.hubslist.org about the “250 pilot projects and demonstrations” in this bill that some readers consider a potentially real positive benefit to how we deliver care. Do you know where there is a summary of that info?

  63. I don’t see any mention of the Trail Lawyer’s Lobby? I guess this didn’t really have an impact on the reform legislation?
    According to the math, there is still a financial benefit (and likely need) for insurers to raise premiums. The effect of market forces acting to deter this remains to be seen, and will be largely dependent on the success of the alternatives.
    Pharma actually did pretty well considering the cost-cutting alternatives of generics and across the board bargaining. Relying on CER to help to curb these costs is a long way off, these trials take years (even decades) to accumulate data.

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