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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there is everything need to live a happy life and the myth also plays a very important role in life.
thanks-
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.
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.
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!
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!
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!
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?
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.
Ms Mahar:
assuming you read your thread here, what is your comment(s) re the link below from the OC Register who is running a series of interviews with CEOs of companies directly affected by this coming legislation?
http://www.ocregister.com/opinion/care-245680-health-companies.html
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.
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!!!
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.”
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?
“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?
“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.
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?
” .. 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.
Congrats on your business Nate.
“Lets start with the Liverpool Care Pathyway, how is it decided what patients are put on it and which are not?”
http://en.wikipedia.org/wiki/Liverpool_Care_Pathway_for_the_dying_patient
Right Nate, only you and your perverted thought process would call it a death panel.
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.
“Alfie Kohn is a fool.”
Who knew gathering scientific studies on a topic (competition & rewards) and publishing them was foolish?
Karl did.
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.
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?
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?
Thanks, now I know this is useless. Alfie Kohn is a fool.
Way to go.
///////////////
Dr. Berwick on pay for performance (audio from IHI):
http://www.ihi.org/IHI/Programs/IHIOpenSchool/On+Call+Does+Pay+for+Performance+Work.htm?player=wmp
Don refers to Alfie Kohn in his talk.
“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?
“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.
Dr. Berwick on pay for performance (audio from IHI):
http://www.ihi.org/IHI/Programs/IHIOpenSchool/On+Call+Does+Pay+for+Performance+Work.htm?player=wmp
Don refers to Alfie Kohn in his talk.
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.
” .. 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?
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.
” .. 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.
“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.
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.
“[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.
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.
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.
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 bett