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If Reform Fails

If conservatives manage to kill health care reform legislation, what will happen next?

I really don’t want to go there.

First, I’m convinced that conservatives won’t be able to repeal the Affordable Care Act (ACA). Democrats will hold onto the Senate, and President Obama still has a veto. If necessary, he will use it to protect the bill. Meanwhile, the majority of the public either favors the legislation or want to “wait and see” how well it works. Most voters would be utterly disgusted if Congress returns to the health care debate this fall. It was ugly the first time around; virtually no one wants to watch re-runs on C-Span. In the months ahead, Americans hope that their elected representatives will do just three things: create jobs, create jobs, and create jobs.

Secondly, if conservatives somehow succeed in crippling the reform bill, we will find ourselves back in a world of laissez-faire health care where medical spending continues to spiral by 4.5% to 9% a year (just as it has for the past ten years), thanks to a combination of climbing prices and rising utilization.

Here, I’m not talking about how much insurance premiums rose: reimbursements that private insurers, Medicare and Medicaid paid out to hospitals, doctors and patients over the past ten years have been climbing by 4.5% to over 9% annually.

In some years, Medicare reimbursements were growing faster; in other years, payouts by private insurers levitated. Over the same span, Kaiser reports that premiums for a family plan rose by an average of 13.1% a year.

Without the Affordable Care Act (ACA), payouts for drugs, devices, hospital services and physicians’ services are expected to accelerate over the next ten years, rising by an average of more than 6% a year. Without reform, roughly one-third of our health care dollars will still be squandered on unnecessary treatments, redundant tests, over-priced products, preventable hospitalizations and avoidable medical errors. Employers will continue to shift costs to employees (or just get out of the health benefits business altogether), and more and more Americans will find themselves priced out of the health care market.

Rather than joining the rest of the developed world by offering affordable, comprehensive care to all of our citizens, the U.S. will find itself becoming part of the “developing world”–where only the very wealthy have access to good care.

I don’t believe that will happen. We are on the path to reform. It will be a long, rocky road, but there is no turning back. The alternative is just too bleak.

The Liberal Dream

That said, why am I even addressing the possibility that conservatives will form a death panel and pull the plug on the ACA?

Because some irrepressibly optimistic progressives have begun to suggest that if reform’s opponents prevail, the story might have a happy ending. And I am worried that these liberals may encourage other progressives to step back, and let conservatives have their way. After all, many on the Left found the Affordable Care Act disappointing—a half measure, not what they hoped Obama would deliver. Some are willing to let it slip away.

Just a few days ago, in a piece in AolNews titled “Obamacare Critics: Be Careful What You Wish For,” New American Foundation fellow Micah Weinberg made the argument that a victory for the conservatives could lead us to what some liberals still yearn for: a single-payer system.

“If this round of reform fails . . . . we’ll have to do something entirely different. But don’t hold your breath waiting for a system that relies even more heavily on the private market for health insurance.

“In fact, the most likely thing that we will do is move toward a system like Medicare that is financed by the government.“It turns out that Medicare is extremely popular among seniors of all political persuasions, even tea partying ones. After all, the thing the town hall screamers were the most upset about was the idea that the program would be changed to institute ‘death panels.’ This was a vicious smear that could not have been further from the truth. But it shows just how little appetite there is for changing the Medicare program in any way, even among members of the conservative right.

“So people of all political stripes love to love Medicare, and they love to hate insurance companies. It stands to reason, therefore, that if we have to start over, we’ll build on what is popular rather than heading even further in an unpopular direction.

“Conservative Republicans are free to continue their quest to undermine health care reform. But they should be careful what they wish for, because through their actions they may be the very people who finally lead this country to . . . a single-payer health care system.”

Employer-Based Insurance vs. Medicare

What Weinberg forgets is that while seniors love Medicare, a great many Americans under 65 love—or at least like—their employer-based insurance, if for only one reason: their employer pays for it.

And when employers pick up most of the tab, this is good news for all taxpayers. When middle-class and low-income employees working at large companies have good insurance, we don’t have to worry about funding subsidies to help them buy coverage. (Granted, wages are lower because employers provide benefits—in that sense the employee pays for his health insurance. But as I explain below, if single-payer replaced employer-based insurance, salaries would not automatically rise to equal the value of the lost perks.)

Typically, employers pay 85% of health insurance premiums according to the Kaiser Family Foundation. In addition, as this Kaiser Issue Brief points out, the average large-employer PPO plan is more generous than Medicare.

Even when you include Medicare’s relatively new prescription drug benefit, Kaiser observes, the average value of Medicare benefits in 2007 ($10,610) lagged the value of the typical plan offered by a large employer ($12, 160). “Medicare is less generous, on average, than the comparison employer plans because it has higher cost-sharing for inpatient care under Part A (particularly for relatively short hospital stays), no out-of-pocket limit on services provided under Part B, and less generous drug coverage under the standard Part D benefits. . . .”

In 2010, for example, if a Medicare patient is hospitalized he must meet a deductible of $1,100 before Medicare kicks in to pay for the first 60 days of hospitalization. If he remains in the hospital longer than 60 days, the patient faces a co-pay of $275 per day—up into day 90—and $550 per day for days 91 through 150. After 150 days, the patient is responsible for all hospital charges, and there is no cap on how much he will be asked to pay, out of pocket, in a given year. Medicare part B covers physicians’ services, but seniors must pay premiums of $110.50 to $353.60 per month (depending on income), and Medicare pays only 80% of the approved costs for these services.

As Kaiser explains: “individual Medicare also pays a smaller share of total costs associated with covered benefits, on average, than either the typical large employer PPO or the Federal Employee Health Benefit Plan’s standard option). In 2007, Medicare paid 74 percent of costs associated with covered benefits for an individual with average health care costs ($14,270), while the typical large employer PPO paid 85 percent of total costs.

Indeed, when they turn 65, many Americans are surprised to discover that Medicare doesn’t reimburse for everything their employer-based insurance covered—routine eye exams, for example, are not included in the package. Many seniors are even more startled by co-pays and deductibles that can be hefty, particularly if they’re hospitalized.

To compare job-based insurance to Medicare, think of it this way: 60 percent of seniors lay out as much as $279 a month to pay for supplemental coverage such as MediGap in order to fill the cracks in Medicare. That’s $3,448 a year—just to bring Medicare up to the level of a good employer plan.

Make no mistake: I’m not suggesting that seniors don’t like Medicare; They do. At least the 60% who have supplemental coverage (because either they or their former employer can afford it) are pretty content.

But younger Americans who are lucky enough to work for a large company where they have employer-based insurance are fond of their coverage, too. They won’t want to give it up–especially if someone explains that insurance modeled on traditional Medicare would cover less, while costing them more.

Before Dreaming of Single-Payer . . .

If a single-payer plan set out to match the benefits that large employers now offer, it would cost taxpayers a bundle.

Granted, thanks to lower administrative costs, a public plan’s premiums should be at least 5 percent to 7 percent lower than premiums for a comparable private plan. (These numbers come from a Commonwealth Fund brief that offers a very positive assessment of how much a public plan could save.) When compared to a “public option,” that competes with private insurance, a single payer plan should yield even greater savings because hospital and doctors would be dealing with only one payer, slashing their paperwork and administrative costs.

But, over time, those administrative savings wouldn’t be enough to pay for the generous benefits that large companies offer. Don’t forget that the price of the services and products that hospitals, doctors, drug makers and device makers provide has been climbing by an average of nearly 5% to 11% a year, year after year, for two decades. The one-time savings in administrative costs (however big it is), won’t compensate for continuous, compounded increases in the underlying cost of medical products and services.

The only way that a single payer system could afford the level of coverage that large employers offer is if we rein in runaway health care inflation by wringing some of the waste out of our system. And, assuming that we’re going to eliminate waste in an intelligent way, using a scalpel, not a meat cleaver, this will take time. The Affordable Care Act set out to change how we reimburse for care by moving away from fee-for-service, paying health care providers for value (better outcomes at a lower price), not volume. This means persuading patients—and physicians—that more care is not necessarily better care.

Financial carrots and sticks also can encourage hospitals to take a closer look at the medical errors that, according to a recent study conducted by Millman, Inc. for the Society of Actuaries (SOA), added $19.5 billion to the nation’s health care bill in 2008. Not all errors are preventable, but many are. The most expensive error on the SOA list—pressure ulcers (a.k.a. bedsores) often can be avoided. Yet in 2008 374,964 ulcers, at a cost of $10,288 each, boosted the nation’s health care tab by $3.858 billion. (See the Institute for Health Care Improvement on prevention programs that have dramatically reduced the incidence of pressure ulcers in a number of hospitals.)

Who Would Make Up for the $$$ Employers Now Pour Into Health care?

Keep in mind that if we switched to a single-payer system, large companies would no longer pay 85% of their employee’s premium. Low-income and middle income families who now have job-based insurance would qualify for subsidies, but taxpayers would have to foot the bill. More affluent employees (individual earning over $43, 320 or a family of four taking home more than $88,200)–would not receive a government subsidy.

As noted, single-payer insurance would enjoy lower administrative costs, but even so, next year, comprehensive f family coverage that is comparable to what large employers now offer would cost more than $10,000. (By then, a private plan that offers good coverage for a family will fetch close to $14,000.)

But wait—if employers no longer provided benefits, wouldn’t Congress insist that they raise wages-, or pay higher taxes into an insurance pool to help fund the cost of universal coverage? Yes, but it’s doubtful that either wage hikes or taxes would equal what employers now lay out for insurance.

First, what an employer now spends on premiums is tax deductible as a business expense. The value of that tax deduction varies, but let’s say that a company contributes $9,000 to each employee’s insurance premiums (this was the average contribution in 2007), and that, after taking the deduction, insurance costs the company $9,000 minus “X” (with X equaling the value of the tax write-off) per employee).

If single-payer replaced employer-based insurance, would most employers be willing or able to raise each employee’s wages by $9,000—or contribute $9,000 to the pool? Probably not. Employers would argue, not unreasonably, that in the past they were spending only $9,000 minus X, and they were hard-pressed to do that. They cannot afford more.

Secondly, when an employer invests in his own employees’ insurance, he buys something that is of value to his business: employee loyalty. His workers are less likely to move to a competitor if he offers generous insurance. This saves him the time and money that it takes to train new workers. Turnover is expensive. Under a single-payer system, if a business pays taxes into a national insurance pool, it gets nothing in return. This is another reason why employers would be reluctant to toss even “$9,000 minus X” into a pool that would fund universal coverage. Many in Congress would sympathize with their reasoning.

As for raising wages –if the 1990s taught us anything about labor economics, it is that employers will not hike salaries for most workers unless they absolutely must. Even while earnings grew and productivity rose, in the 1990s the average worker did not see his wages climb. Corporations paid out dividends to shareholders, bought other companies, invested in their own business, bought back their stock and hiked executive salaries. They did everything—except share higher profits with workers—until the final years of the decade. Even then, workers’ wages did not begin to catch up with the gains corporations and their investors enjoyed.

Today, with real unemployment well over 10 percent, businesses are not worried about losing workers. In the past two years, when companies such as GM or Dow Jones cut back on insurance benefits, they did not hand out raises.

Under a single-payer system, I am sure Congress would expect businesses to make a contribution to the pool that funds government subsidies, but you can be quite certain that employers would not wind up paying 85% of the cost of coverage—not even 85% of the cost for the 133 million employees that large companies now insure.

Who will pick up the difference? Tax-payers and more affluent Americans who don’t qualify for government subsidies.

Why Medicare E (for Everyone) Just Isn’t Affordable Now

Do we want to try to drop the entire U.S. population into a single-payer system that resembles Medicare sometime over the next few years? No. Keep in mind that our entire health care system is broken. Medicare, like other payers, squanders roughly one-third of its dollars on treatments and products that provide little or no benefit to the patient. Our for-profit medical-industrial complex is set up to maximize the amount we spend on drugs, hospitals, tests and procedures. If we attempted to roll out a single-payer plan next year, the only way we could afford to cover everyone is if took an axe to the waste, rationing care, slashing physicians’ fees and closing hospitals. This is not rational reform.

As it stands, we’re planning on shepherding some 32 million uninsured Americans into what we euphemistically call our health care “system” in 2014. This is because we have no choice. Those Americans have been left out in the cold for too long. They need our help. And we have to start somewhere.

The good news is that the cost of covering the uninsured, along with the climbing cost of Medicare, will push policy-makers to start demanding value for our health care dollars. Already, Medicare has begun insisting on higher quality, lower cost, patient-centered care (refusing to pay for preventable hospital readmissions, for instance).

Medicare director Don Berwick will be setting an example that private insurers will follow. As president of the Institute for Health Care Improvement (IHI), Berwick has had great success in showing hospitals, doctors and nurses that they can make their own work environment more efficient, and their work more satisfying if they collaborate to provide better, safer care at a lower cost. Reform shouldn’t have to be imposed on caregivers. It can happen from the inside. Berwick understands this better than anyone. Between now and 2014, we can prepare for reform, but it will take more than three years to make the deep structural changes needed.

If Liberals Want a Public Option, They Should Protect Reform Legislation

Congress is not going to pass a single-payer bill at this point in time. For one, legislators know that the vast majority of the 133 million employees who work at large companies where their employer pays 85% of premiums are quite attached to that perk. Why wouldn’t they want to hold onto it? On average, benefits are better than Medicare’s, and cost sharing is lower.

Why should the rest of us care whether those 133 million hang on to a sweet deal? Because society as a whole benefits as long as those corporations continue funding 85% of the cost of insurance for their workers–including millions of middle-income and low-income Americans. (Under the rules of employer-based insurance, all employees must receive the same deal.) And according to a Kaiser survey, despite the economic downturn, employers remain surprisingly committed to providing benefits: 95 percent of those with 50 or more employees offer insurance. Although they are increasing co-pays, only 2% say they are very likely to drop benefits. This gives us some breathing room, time to bring down health care inflation, before Americans decide whether they want a single plan for everyone.

Make no mistake: I’m not disparaging the liberal dream. I’m just saying that it won’t happen in the next few years.

First, we need to realign the financial incentives in our health care system .The reform legislation lays out the blueprint for providing higher quality, more affordable care, but reform will be a process that takes place over time.

As I have suggested in the past, my guess is that sometime before 2014 a public option will be added to the current reform scheme. Under the new regulations, some for-profit insurers are bound to throw in the towel, and I suspect that we will need a public plan to take up the slack in the Exchanges. Ultimately, I expect that a public plan will be open to everyone. When reform legislation included that option beginning in 2014, legislators suggested that employees of large companies would be eligible to join a few years later. If a public plan manages to provide high quality coverage at a reasonable price, more and more families will pick the government plan.

This is the best route to a public health care : let Americans choose it.

But all of this will happen only if we press ahead with reform. Liberals must put their heads down, get behind the Affordable Care Act, and push—as hard as they can.

The alternative is not the status quo—it is something far worse. The situation is deteriorating as I write. Our health care system is heading for a wall. Without reform, even Medicare will run out of money, and you and I will just have to hope against hope that we and our loved ones don’t get sick.

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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35 replies »

  1. “You are providing a most clear example of what economists refer to as the “parable of the broken window”, named after an anecdote related by the French economist Frederic Bastiat (1801-1850).”
    James, why do you equate providing necessary healthcare to vandalism? You’d be much closer to the mark if you said the theory falsely shows we benefit economically from our broken food policies contributing to chronic illness because it increases money circulation.

  2. “progressively higher income tax rates that rise with income are an efficient way to generate tax revenue.”
    And a efficient way to buy the votes of those not paying those higher taxes but reaping the benefits. It is also a highly efficient way to build a subservant class of economic slaves.
    “In the lower group, almost any additional income goes to one type of necessity or another”
    If your talking about latin america, africa or other developing nations. In developed nations that additional income goes to cable tv, cell phones, smoking or drinking, or $100 sneakers.
    ” highest income group necessities have long been covered in most cases, so incremental income generates less usefulness”
    Stasrting business, creating jobs, investing, in a communist society are all less useful. In a free nation they are vital, far more vital then a cell phone, cable TV, or smking and alchol.
    “a comprehensive reform proposal was formulated and enacted that on net represents an improvement in existing legislation/practices, i.e. benefits the public overall.”
    It benefits no one but the entitlement minded liberals that passed it. 45 years of liberal reform have accomplished nothing but increasing cost and decreasing access. The public overall has been terribly harmed by failed liberal healthcare reform. That is why every time far left wing liberals pass reform it is with lies and midnight votes and bills no one has read.
    “No question that such a scheme removes substantial cost burdens to businesses of all sizes.”
    Nothing but liberal propoganda, we have versions of single payor already in the US and they are some of the most inefficient systems in the country. Single payor is nothing but a socialist pipe dream for those that can’t grasp history.
    “I am sure there are many other areas of confluence of policies that lower costs/improve service to the USA public and traditional Republican interests.”
    Finally Wendell gets something right but I can assure you he won’t want to discuss them.
    How about Tort reform Wendell? Republicans and the rest fo the country know it will lower cost and improve service yet you liberals keep blocking it.
    How about AHPs they proposed for 15 years to lower cost and imrpove service for small business, again blocked by liberals.
    Cutting manadets, also blocked by liberals. It seems the entire problem with healthcare cost lies squarely on the sholders of Liberals who pass terrible unfunded programs them block all efforts to correct them.

  3. “What about the negative macro-economic effects of any tax?”
    I agree that taxation of any kind should be considered relative to its economic effect. However,
    ” .. This is why Obama is raising taxes only on the wealthy ..”
    Although I cannot find the context for this quotation above, progressively higher income tax rates that rise with income are an efficient way to generate tax revenue.
    This is primarily due to the fact that the marginal utility of additional income for someone, say in the tax group that reports $250,000 in adjusted gross income and higher, is lower than the marginal utility of someone in the group with adjusted gross income of $30,000 or less.
    In the lower group, almost any additional income goes to one type of necessity or another, the marginal propensity to consume is generally close to 100% if not always 100%.
    In the highest income group necessities have long been covered in most cases, so incremental income generates less usefulness and the marginal propensity to consume is lower.
    This is not the venue to discuss tax policy per se however. Ms. Mahar’s posting here does a good job at addressing the issue raised by the title of the posting: What happens if this, that or the other feature of the Affordable Care Act is foiled by the new Congress, i.e. one in which extreme right-wing Republicans are elected in greater numbers.
    There is any number of criticisms that some like the “james”, “James”, “J.S.” above provide that have a legitimate basis, but his prime assertion “the ACP sucks” is both wrong and misses the point.
    The point is that a comprehensive reform proposal was formulated and enacted that on net represents an improvement in existing legislation/practices, i.e. benefits the public overall.
    This, despite the fact that mainstream media was and continues to be filled with lies, distortions, misrepresentations and so on about how the healthcare system in the USA is structured and what there is to learn from healthcare systems elsewhere.
    Republican legislators could in fact stay true to traditional Republican policies, if they made the slightest effort to consider facts, rather than spout ideologically-based nonsense.
    My usual example in this regard is the institution of single payer/insurer (or equivalent) for medical service financing. No question that such a scheme removes substantial cost burdens to businesses of all sizes. Were Republicans to acknowledge that fact, they could easily become strong advocates for it and thereby do good to both the general public and to a traditional Republican constituency.
    Another policy area is facilitation of medical tourism by making the insurance reimbursement for interventions performed outside the USA as easy as reimbursement for the same done in the USA. That is a concrete way – with potentially material positive impact – of encouraging competitive-determination of pricing for expensive medical services. This under that assumption that encouraging “free-market economic principles” is a key traditional Republican tenet.
    I am sure there are many other areas of confluence of policies that lower costs/improve service to the USA public and traditional Republican interests.

  4. James, the flaw in your application of the specter of opportunity costs to discount broken windows parables is it assumes opportunities are magically weighed and ranked in some cosmic objective scale, extant since the creation (or big bang, or whatever origins myth you subscribe to).
    I feel it my duty to let you in on something: they’re not.
    The comprehensive economic value achieved by totting up opportunity costs depends as much on the presumptions – the beliefs, if you will – of the totter as does the value yielded by repairing broken windows.
    I’m quite aware of the shortcomings of, and exaggerated claims for, broken windows policies. I also know that invocation of “opportunity costs!” is not sufficient to dismiss the position against which your economics lesson is arrayed.

  5. WRONG
    ” .. This is why Obama is raising taxes only on the wealthy ..”
    What about the negative macro-economic effects of any tax?
    Provide URLs that 100% dispute that position. It cannot be done, IMHO.
    Looking forward to those URLs being posted — or an admission of error. Like E. Warren and Himmelstein making wild claims that NYTimes even could not accept.
    http://www.nytimes.com/2009/11/25/health/policy/25bankruptcy.html

  6. BI-PARTISANSHIP: OBAMA-CARE IS A MESS
    Well, OWE-bama has both parties together now — both say ACA has been a LIE, LIE, LIE.
    ROTFLOL
    —-
    This article from The Politico might be on interest:
    http://www.politico.com/news/stories/0810/41271.html
    It notes that DEMOCRATS are being advised to back away from claims that this legislation will save money. It also claims that DEMOCRATS are realizing that the public has not developed a liking for this legislation.

  7. The biggest “lie” that is being propagated here is that “droves of people” will flock to health care positions once this deform legislation is entrenched. (those quotes not of Ms Mahars but certainly can be inferred from her above comments)
    Yeah, and let’s take a look at who will madly rush to work for a floundering, oversupervised setting: those who either have no other options, or, those who are looking to prey on the patient population until better opportunities come along. So, basically we are looking at underqualified or insidiously intended candidates. Lovely. Just the type of professionals we want providing care.
    Because, let’s face it, no one with the ability who has responsible insight and judgment is going to commit to a system that is destined to do more damage than good.
    But, as I keep reminding all you silent readers, believe the Maggie Mahars, these slick salespeople for the Democrat agenda, or, you can give some consideration to those who do the work and see the train coming. And this one will not only hit you, it will derail to try to take out those who thought themselves safe away from the tracks.
    How can you listen to Obama, Pelosi, and Reid, when they truly live by the adage “do as I say, not as I do”?
    Oh, I forgot, Maggie here is just echoing this!!!
    And, don’t look to the equally flawed and delinquent dialogue and agenda of the Republicants in positions of authority at this time. They had their chance from 2000-2006 and did squat! Just vote all the incumbents of more than 10 years out in November; send that message we as an electorate do have sizeable power, and watch those with even half a brain at least listen a bit to their constituents!!!

  8. Excerpts from Maggie’s reply:
    “Under reform, we’re doubling the capacity of communitiy clinics. Millions of new jobs for nurses, doctors, technicians as we begin to provide preventive care.”
    “Under reform, the 37 million people who are now uninsured will be going to doctors and hospitals more often. Many new jobs in the medical profession.”
    “Maybe eyeglasses to all of the children in the U.S. who will now get free annual eye exams? Maybe dental equipment to the dentists who will be examining their teeth (again, free under reform for all kids.)”
    “I could go on. All in all, health care reform will create more jobs than are lost.”
    Maggie:
    You are providing a most clear example of what economists refer to as the “parable of the broken window”, named after an anecdote related by the French economist Frederic Bastiat (1801-1850).
    You can read about it and Bastiat here:
    http://en.wikipedia.org/wiki/Parable_of_the_broken_window
    http://en.wikipedia.org/wiki/Fr%C3%A9d%C3%A9ric_Bastiat
    In a nutshell, Bastiat points to those who shallowly conclude that a shopkeeper who has to replace an accidentally broken window is stimulating the economy. It is a conclusion likely in error because they can only see the public benefits (work for the glazier, etc.). But, the analysis is flawed because they can’t see the “opportunity costs” of the funds that went to redo the window.
    To do one thing meant NOT doing something else and the something else may have provided far greater benefit.
    The money to pay for these health care benefits is a classic broken window parable, in that you point to the benefits — but blithely IGNORE that the money to pay these benefits has to come from somewhere. Right now, we are borrowing it. At some point, we have to pay it back. There is an opportunity cost for both the borrowing (investment funds removed from the private capital markets) and for the taxation (I can’t spend it if you take it).
    The only way you can claim more jobs created than lost from a piece of legislation is to examine the opportunity costs. For example, the stimulus bill showed a long-range LOSS of economic benefit when the opportunity costs associated with paying back the borrowing kicked in.
    There are some forms of government spending, at tolerable levels of taxation, that may provide economic and/or employment benefits that surpass the opportunity costs. However, loading a B-52 Bomber with greenbacks and dumping it over Detroit also provided economic stimulus and create jobs — but ONLY if you don’t factor in the opportunity costs for the cash you shoved out the bomb bay door.
    So, if you are going to claim that there is a net economic and/or employment benefit, please, please, please cite a source — and make it one that factors in the opportunity costs. Otherwise you will make everyone who ever read an economics textbook in their life roll their eyes.
    And, remember, we were also assured that health care reform was going to bend the cost curve. But, now you are claiming we will hire all these new medical people and create oodles of new jobs. So, we are going to hire lots more warm bodies AND spend less?
    Let’s think that one through a bit more…
    Remember: TANSTAAFL!
    http://en.wikipedia.org/wiki/There_ain%27t_no_such_thing_as_a_free_lunch

  9. This article from The Politico might be on interest:
    http://www.politico.com/news/stories/0810/41271.html
    It notes that DEMOCRATS are being advised to back away from claims that this legislation will save money. It also claims that DEMOCRATS are realizing that the public has not developed a liking for this legislation.
    Excerpts:
    “Key White House allies are dramatically shifting their attempts to defend health care legislation, abandoning claims that it will reduce costs and the deficit and instead stressing a promise to “improve it.””
    “The confidential presentation, available in full here and provided to POLITICO by a source on the call, suggests that Democrats are acknowledging the failure of their predictions that the health care legislation would grow more popular after its passage, as its benefits became clear and rhetoric cooled. Instead, the presentation is designed to win over a skeptical public and to defend the legislation — in particular, the individual mandate — from a push for repeal.”
    “The presentation concedes that groups typically supportive of Democratic causes — people under 40, non-college-educated women and Hispanic voters — have not been won over by the plan. Indeed, it stresses repeatedly, many are unaware that the legislation has passed, an astonishing shortcoming in the White House’s all-out communications effort.”
    “The presentation’s final page of “Don’ts” counsels against claiming “the law will reduce costs and [the] deficit.”
    It appears that Maggie hasn’t gotten the new talking points yet and is still working off the old ones.

  10. “According to the CBO, a public option would realize significantly savings: “According to the CBO, this plan’s premiums would be 5 percent to 7 percent lower, on average, than the premiums of private plans offered in the exchanges.”
    When repeating anything the CBO says it is important to remember they specifically and admitly don’t assume real world probability. They are given the assumptions to make then asked to calculate the outcome.
    Under that principal I could ask them to calculate the cost to the member of private insurance vs public option if Philanthropist martions paid the full premium for private insurance. Title of their study would be private insurance can provide free insurance for everyone.
    People like Maggie tend to ignore that aspect of their analysis for obvious political reasons. Study sort of loses its punch when you open it up and see the assumptions are improbable. Same as when Maggie cites certain pools favorable to her agenda then you find out they sample dems at 40% compared to Repubs at 25%. When you build in bias you can always get the result you want.
    “Argue for or against the current reforms, but please don’t characterize the status quo as laissez faire.”
    Very common liberal stalking horse, Over at Managed Care Matters they based an argument on the failure of the free market to control insurance premiums. You try to correct them they just delete the comment of course. Something Maggie is also famous for.
    Very few if any markets are as heavily regualted as healthcare and liberals still try to justify additional reform as making up for failed free markets. Prior to 1965 you might be able to argue it was mostly free, since then it has been central management all the way, and thus the continual decline.

  11. Maggie,
    The CBO report that you quote is an analysis of an obscure proposal by Rep. Pete Stark. This is a proposal to tie the public option to Medicare payments. This has no chance of ever passing this Congress, let alone next Congress.
    The only “public plan” that ever had a chance of passing was the competitive public plan proposed by Harry Reid in the Senate, where the public plan had to compete with private insurance on provider payments. This plan was analysed by CBO. It didn’t reduce the deficit and had premiums that where higher than average. CBO estimated that this public plan would attract sicker and older patients and therefore have higher costs.
    Switzerland and other countries have lower health care costs because they have mechanisms in place to set prices, not because they have public insurance. It doesn’t matter if the insurance is private or public. The discussion we should be having is about whether it is appropriate or not to fix prices. And if so, how does it get done (government agency, medical board, collective bargaining between insurers and providers, etc.). Arguing private-vs-public is not useful.

  12. By the way, in Switzerland, there are 84 health insurers competing for business with the top six controlling 80% of the market. Importantly, there is no government run plan. Everyone, including the elderly, has private health insurance. While the insurers are not allowed to earn profits on the basic benefits package, if they were, it is highly unlikely that overall healthcare costs in Switzerland would be more than nominally higher than they are now.

  13. “According to the CBO, a public option would realize significantly savings: “According to the CBO, this plan’s premiums would be 5 percent to 7 percent lower, on average, than the premiums of private plans offered in the exchanges.”
    Maggie – CBO is, I think, making an assumption that a public option would be cheaper based on a combination of somewhat lower administrative costs and lower reimbursement rates – either Medicare or Medicare +5%. It ignores Nate’s point about the differences in the amounts lost to fraud which, if not a nine percentage point gap, is probably still considerable. More importantly, CBO apparently makes the implicit assumption that the people who sign up for a public option would have comparable risk scores to those who opt for a private plan. This is far from certain. In Switzerland, even though all insurers must offer the same benefits package and everyone pays providers the same rate for a given procedure in a given canton, premiums can vary by as much as 20% within a canton. The reason is differences in the risk profile of the members. While Switzerland uses risk adjustment payments to mitigate this, the system is far less than perfect and, at the end of the day, overpays for the healthy and underpays for the sick which creates an incentive to maximize the number of health members and minimize the number of sick members.
    In the U.S., an insurance broker I know in CA tells me that one of the reasons Kaiser can’t provide health insurance for much less than its competitors despite salaried doctors, the use of electronic records and the ownership of its hospitals is that its members are, on average, older and sicker than those of its competitors. When the brokers get small and mid-sized employer groups with an above average number of older and sicker employees, they tend to steer them to Kaiser as the insurer of last resort. Like a lot of other analysis coming out of the CBO, their analysis of the potential savings from a public health insurance option is simple, straightforward and wrong or, at best, incomplete.

  14. “Secondly, if conservatives somehow succeed in crippling the reform bill, we will find ourselves back in a world of laissez-faire health care where medical spending continues to spiral by 4.5% to 9% a year (just as it has for the past ten years), thanks to a combination of climbing prices and rising utilization.”
    Uh, please tell me what part of the current health care system even faintly resembles “laissez-faire”. Is it the part that contains both Medicaid and Medicare? The part that contains extensive state and federal law and regulation of the insurance industry? Is it the part that limits limits providers via scope of practice laws, licensing regulations, certificates of need, and restriction on multi-state practicing? The part that includes the current tort system?
    We haven’t had anything like a free-market system in health care since at least LBJ.
    Argue for or against the current reforms, but please don’t characterize the status quo as laissez faire. It is simply not so, unless the term has been completely altered from that used in standard economic discourse.
    For the record, this is what “laissez faire” means, referencing Wikipedia’s first paragraph of the term:
    “In economics, laissez-faire… describes an environment in which transactions between private parties are free from state intervention, including restrictive regulations, taxes, tariffs and enforced monopolies.”
    http://en.wikipedia.org/wiki/Laissez-faire
    Does that square with ANY aspect of the current health care system?

  15. propeneity & ciphertext
    Propensity– Health IT works very well in other countries–one reason their health care costs are so much lower.
    ciphertext–
    If wealthy people want to leave the U.S., no one is stopping them.
    But where could they go where total taxes (income, VAT, inheritance etc.) are lower than in the U.S.?
    There are places of course-in Africa, less desirable regions in Asia . . .But no where in the developed world, aside from a few tax-haven islands that become pretty boring over the long haul. . .

  16. Brad–
    Under reform, we’re doubling the capacity of communitiy clinics. Millions of new jobs for nurses, doctors, technicians as we begin to provide preventive care.
    Under reform, the 37 million people who are now uninsured will be going to doctors and hospitals more often. Many new jobs in the medical profession.
    Insurers will need fewer underwriters–you’re absolutely right. People who now make a living denying people insurance because their sick will have to find something else to do. That’s not terrible.
    Some people who now sell insurance will have to find something else to sell.
    Maybe eyeglasses to all of the children in the U.S. who will now get free annual eye exams? Maybe dental equipment to the dentists who will be examining their teeth (again, free under reform for all kids.)
    I could go on. All in all, health care reform will create more jobs than are lost.

  17. pcp, Paolo, Wendell
    pcp–
    I tracked down the provision you’re talking about.
    This is something that Congress has been talking about for a long time. It’s a much-needed law to help capture the many small businesses that deal mainly in cash– and don’t report their full income.
    (About a year ago, I went to a Park Avenue doctor in Manhattan who doesn’t take credit cards–or insurance. “We have never taken credit cards” her book-keeper explained. I had to write a check for the full amount, then bill my insurer. I asked the book-keeper: Does this mean she doesn’t report her full income? The book-keeper looked away. This was a very expensive specialist, and well-established. )
    Back to the tax rule: If a business shows that it is spending significantly more than it reports as income,–and is still in business– clearly something weird is going on. This is why the IRS wants the information.
    Wendell’s right: it’s not such a big deal. Any decently run business should have a list of vendors and keep a record of payments. If now, how do you do your books?
    Tax experts explain: “Start getting w-9s from everybody including corporations: you must have a current address and valid Tax Payer Identification Numbers (EIN or SSN) for any vendor you routinely pay more than $600 per year for goods or services-starting in 2011. A Form w-9 is the recommended method for obtaining this information; it is available in PDF format from the IRS.gov website (pdfs can be printed out using adobe acrobat reader which can be downloaded for free from the adobe.com website).
    “Be sure your accounting program lists purchases by vendor and amount paid as you will also need this information to properly prepare the 1099s in 2012.”
    Once you set up your accounting program to accomodate the law, this won’t be a big deal. And having an accounting program will make running a business a lot easier.
    Paola–
    You’re mistaken. According to the CBO, a public option would realize significantl savings: “According to the CBO, this plan’s premiums would be 5 percent to 7 percent lower, on average, than the premiums of private plans offered in the exchanges.
    “The proposal would reduce federal budget deficits through 2019 by about $53 billion,” CBO says. And because the public plan is saving more money as time goes on, if you extend that out to 2020, the savings to the government are $68 billion. That implies a savings of $200 billion or so in the second decade.” See CBO post here http://cboblog.cbo.gov/?p=1196
    Wendell–
    Thanks for commenting. Always nice to talk to someone who is actually interested in the issues, even if we don’t agree on everything.
    You’re right the tax break for empolyer-based insurance is a middle-class–and working class–entitlement. Over time, I suspesct we’ll move away from employer based insurance and this tax break will fade.
    But we can’t suddenly do away with the tax break. We in the middle of a serious recession. Consumer spending is down. If you suddenly hike taxes on the working-class and middle-class (by doing away with the tax break), they’ll spend even less.
    This is why Obama is raising taxes only on the wealthy. After you adjust for inflation, the middle-class and working class have seen only a tiny increase in wages over the past 20-plus years.
    You say that it’s not a question of whether a company is willing to contribute $9,000 per employee (or whatever it now spends on insurance) to a pool–it’s a necessity.
    First, the employer now spends $9,000 minus his tax deduction.
    Where would he get the extra money? Again, we’re in a recession. Many businesses can’t afford what they’re now spending on health insurance. Consumer spending has kept this economoy afloat for more than two decades. (Shop till you drop). Now consumers are saving (which is good for consumers, but terrible for business.) Real unemployment is over 10%. People aren’t buying–and if they are, they’re buying imported good which are cheaper becaue the cost of living is so much cheaper in China, etc.
    (IF we slap tariffs on those goods, we hurt low-income consuemrs in the U.S. And other countries would put steep tariffs on our goods.)
    U.S. businesses are hurting in many sectors, and it will get worse before it gets better. . .
    Finally, on single payer: if it’s more efficient and more affordable, why don’t countries in Continental Europe use single payer?
    Virtually all of them use a hybrid private sector/public sector system. The difference is that insurers are usually non-profit and tightly regulated.
    Single payer works well if, and only if, you have an intellilgent, honest, caring government running it.
    You probably remember what happened to the UK system when Margaret Thatcher took over the govt. The conservatives took a hatchet to the system. Health care in the UK is still underfunded, though gradually, they’ve been putting more money into it. (They have to ration care by age, etc., because Thatcher decided to starve the beast.)
    Consider the last 30 years in the U.S. How often have we had very intelligent, honest and caring govt in D.C.? (Here I’m thinking of both Congress and the administration.)
    What if Jed Bush became president? Suddenly, end-of-life care would mean do everything possible–even for the brain-dead. And very likely, insurance would no longer cover birth control. The poor would get sub-standard care–just as they do in Florida.
    I’m really not joking. Sometimes the American people elect truly terrible governments. When that happens, I’d like to have non-profit private sector alternatives–insurers like Geisinger and Kaiser Permanente competing with a public option.

  18. “track payments…” Ever hear of accounting software?
    Everyone runs quickbooks on their smartphone like Wendell does right? If you have a couple hundred sales people running around the country racking up recpeits I hate to see how much the license fees are going to cost.

  19. “”collect tax IDs” Simply tell a vendor that it will not be paid without the id. Problem solved.”
    Really is that all Wendell, then you go down to McDonalds and place an order then tell the 18 year old cashier your not going to pay until she gives you the franchise TIN.
    Next time you run into staples for some copy paper try the same thing.
    Every time you get gas this month make sure you refuse to pay until you get their TIN.

  20. People are upset because the unemployment rate is over 9.5% and unemployment claims are steadily rising. If you think it’s bad now, wait until Health Care Reform goes in full effect in 2014. Millions of people who sell and work in health insurance sales and in the medical care field will be unemployed and uninsured. The loss of income taxes and state taxes to the Federal gov’t and State gov’t’s will put this country over the edge into total financial chaos.

  21. jacksmith, You are a piece of work.
    Maggie, Get used to deform failing. It already has.

  22. “For a small practice to collect tax IDs on every vendor they use, track payments (even if made by check), forward the info to accountant, etc. is a very large burden.”
    Don’t mean to belabor this, but will.
    “collect tax IDs” Simply tell a vendor that it will not be paid without the id. Problem solved.
    “track payments…” Ever hear of accounting software?

  23. ” Meanwhile, the majority of the public either favors the legislation or want to “wait and see” how well it works.”
    http://i2.cdn.turner.com/cnn/2010/images/08/19/rel11g.pdf
    Maggie CNN came out yesterday and said your full of it as well. 56% oppose, unless you redefined what majority means the internet has caught you in another one of your made up propoganda pieces spinning away for legislation the real majority want no part of.

  24. wow are you detached Wendell, are you a politician when not posting here? For example the way the bill is written if you have sales people that travel and pick up lunch they will need to collect the restruants TIN and have the accounts track if all sales people combined spend more then $600 at that place. Imagine the gardener or handy man who runs to the hardware store EVERY day, all those needed recorded.
    Wendell is a great example of why people who have never worked shouldn’t be allowed to pass laws on those that do. Talk to small businesses and see what they say the effect of this regualtion will be.
    ” but one that instills fear in many medical service providers. That fear is unsubstantiated,”
    Really Wendell, unsubstantaited? So you saying the government never has and never would pass a major healthbill taking over coverage for part of the population, lets say those over 65 for arguemnt sake, and in that bill promise to pay fair reimbursement. Then once they have control over those lives and no competition repeal that portion and start cutting reimbursement without regard for cost? That would never happen, providers have no reason at all to fear that?

  25. Health care reform is unlikely to ever be completely repealed. No politician from either party is going to put forward a proposal after 2013 that reintroduces medical underwriting. And without medical underwriting, you have to have some form of mandate/incentive for people to buy insurance and some form of subsidies for those who can’t afford it. Most people realize this, even 2012 Presidential front-runner Mitt Romney.
    Likewise, proposals to introduce a public option are going to go nowhere. As shown by the CBO, there is nothing that a competitive public option would do to lower costs.
    Expect a lot of noise and a lot of grandiose plans from the wings of both parties, but very little of substance will get done. Our energies would be better spent figuring out ways to lower costs with the system we have in place.

  26. “Must be the editorial pages, because I have missed this.”
    It’s been in both the editorials and the news analysis sections. I haven’t seen it anywhere else, so I’m trying to find out if it’s correct.
    “Hardly a burden to anyone however.”
    Sorry, completely wrong. For a small practice to collect tax IDs on every vendor they use, track payments (even if made by check), forward the info to accountant, etc. is a very large burden.

  27. “Full of sound and fury, signifying nothing!”
    Keep on riding those coattails of this current White House administration and their blind constituients. People who care are keeping the complete cluelessness of this legislation front and center. I can’t speak for any other dissenter, but I thank you for these pontifications you continue to spout.
    Sincerely,
    ExhaustedMD

  28. “The Wall Street Journal has been making a big deal about the ACA requiring businesses to file a 1099 for all vendors with whom they spend over $600 during the year.”
    Must be the editorial pages, because I have missed this. Hardly a burden to anyone however. Often a necessity to force contractors (i.e. as opposed to employees) to fully acknowledge income.
    Good analysis from Ms. Mahar, but any changes to the new healthcare law are unlikely even if Republicans gain some net seats in Congress this year – an outcome that I find unlikely, but it could certainly happen.
    “If single-payer replaced employer-based insurance, would most employers be willing or able to raise each employee’s wages by $9,000—or contribute $9,000 to the pool?”
    Not a question of willingness, but of necessity. It is a matter of redirecting existing cash flows through any entity that provides a healthcare insurance benefit.
    The tax-advantaged status of healthcare benefits paid by employers has to go away at some point. When permitted by the IRS during WWII, then confirmed in the 1950s, the impact of this tax preference was minor, but it has grown into a monster because Congresses have been too cowardly to act on it.
    It is a middle-class entitlement, much like the tax-deductibility of mortgage interest. Conceptually okay, but in practice it causes too much distortion and stands as a roadblock to needed reform.
    The essential argument regarding single payer/insurer is that it is significantly cheaper to society as a whole and it greatly simplifies financing of medical services and the administration thereof. It also gives the federal government additional leverage over spending – a good thing for the public, but one that instills fear in many medical service providers. That fear is unsubstantiated, but exists and continues to represent a significant impediment to consideration of single payer/insurer.
    In any case, through economic forces alone the financing of medical services will evolve towards single payer/insurer over time.

  29. ” Meanwhile, the majority of the public either favors the legislation or want to “wait and see” how well it works.”
    Complete lie, American public strongly favors repeal.
    http://www.gallup.com/poll/4708/Healthcare-System.aspx
    http://www.freerepublic.com/focus/f-news/2479555/posts
    http://www.usatoday.com/news/washington/2010-03-29-health-poll_N.htm
    “Granted, thanks to lower administrative costs, a public plan’s premiums should be at least 5 percent to 7 percent lower than premiums for a comparable private plan.”
    More lies. Are you going to pretend you don’t know public plans have a 10% fraud rate compared to 1% for private plans. That 9% in additional loses to fraud negates your entire admin savinsg which are suspect to start with.
    “Private for profit health insurance plans cost more. But provide dangerous and poorer quality patient care.”
    Really Jack? How does an insurance company that also pays medicare, provide worse care when people are seeing thre same providers and having their bills paid by the same company? Or haven’t you thought it through that far?
    ” What happens when those who can afford to pay for the entitlements, decide that they no longer want to pay for the entitlements?”
    Exactly you would think people would learn from CA, NY, and NJ, when you overtax the minority that actually produces they will eventually get up and leave. Sooner or later you hit 100% tax rate if you keep raising it every couple years.
    “Any radical reform “movement” requires “moving” people’s minds from where they are to where they could be. Education.”
    Propoganda, white washing, covering up, mislead, distort, you do many things Maggie educate is not one of them.
    “As any good teacher knows, not everyone can learn,”
    Contrary to the liberals and NEA not every teacher can teach either.
    “This gives us breathing room and means that reformers can focus on those who have been left out in the cold”
    Odd choice of words and not at all accurate, for it is these very reforms you bow to that has thrown these people to the cold and locked them out. Why did Liberals block AHPs for 15 years Maggie? AHPs would have given small businesses all the same benefits, buying power, and leverage as these large company plans you praise. Ah that’s right becuase protecting Unions was more important then these small people having affordable insurance. Why can’t liberals clean up Medicare and Medicaid before they screw up the rest of the system?
    The truth is since Liberals first proposed nationialized healthcare in 1904 it has never been about good affordable healthcare, it is all about the money and power.
    “Do you know if this is accurate, and if it is, why in the world was it included in this bill?”
    PCP see prior paragraph, money and power, Liberals need more money to spend and they think they can catch billions in unreported income by expanding 1099 filings.

  30. Ms. Mahar:
    The Wall Street Journal has been making a big deal about the ACA requiring businesses to file a 1099 for all vendors with whom they spend over $600 during the year. This would be an enormous expense for small businesses, including most primary care docs. Do you know if this is accurate, and if it is, why in the world was it included in this bill?
    Thanks

  31. James–
    First, I’m sorry my posts are boring you.
    Unfortunately, our health care system (and its problems) are very complicated. So reform is complicated
    Any radical reform “movement” requires “moving” people’s minds from where they are to where they could be. Education. In the case of health care reform, we’re talking about heavy lifting. .
    I’ve been a teacher for many years, and during that time, I have learned that education is all about repetition. (This is why teachers burn out.)
    Your comment suggests that you still don’t understand what I’m writing about.
    So I must continue to repeat: in different ways, from different angles, using different examples.
    If you’re bored, think about how I must feel!
    Eventually, you may understand how the ACA cuts waste and saves money. Or you won’t.
    As any good teacher knows, not everyone can learn, but it’s impt. to keep trying because there are always surprised. And those are the most important students–the ones who justify the whole enterprise.
    And today, when the vast majority of Americans have no idea of what is actually in the legislation, it’s impossible to know who is open to understanding the bill and who isn’t. All I can do is try to explain it to everyone.
    Secondly, it strikes me that people who identify themselves as “members of the professional left” are saying that they constitute the “elite” among Lefties.
    I’ve been on the left for many, many years. But I would never identify myself as a “professional leftie”.)
    If you consider yourself part of that elite, it’s not surprising that you don’t have much sympathy for the the many middle-income and low-income workers atlarge companies who enjoy generous health care benefits with relatively low co-pays and deductibles– the administrative assistants, the people in the mail room–In total , they outnumber the executives.
    In these employer-sponsored plans, people with pre-existing condtion cannot be denied care, and cannot be asked to pay more because of the pre-existing condition. Their insurance cannot be cancelled if they become sick. They’re pretty safe.
    They don’t even pay taxes on those benefits– this is a gilded freebie!
    One could be jealous of them —or one could realize that it’s a good thing that a fairly large segment of the population has this coverage, with large corporations paying a disproportionate share of the cost.
    This gives us breathing room and means that reformers can focus on those who have been left out in the cold–the many who don’t have good employer-based coverage. (Some work for smaller companies that offer “insurance” but it just isn’t very good or isn’t affordable.)
    Taxpayers are better able to help this group because many large companies are doing a pretty good job of covering their workers.
    As I suggest at the end of the post, once we have covered those who are uninsured and seriously underinsuredm we can expand a public plan, and employees at large companies will be able to decide of they want to join.
    Finally, I’m sure this comment seems, to you, “endless, long-winged and sterile.”
    I have said many of these things before.
    But some other reader may benefit. That is why I so often respond to comments, even if the the person I’m responding to really didn’t offer an argument, or evidence.

  32. At some point, it will no longer be economically feasible to entertain entitlements, such as this, when there is no productive capacity left to provide the entitlements. Who pays for the entitlements? Certainly not the “entitled”, for if that were the case, we wouldn’t have a requirement for “entitlements” to begin with. What happens when those who can afford to pay for the entitlements, decide that they no longer want to pay for the entitlements? Do you hold them captive in the U.S.? Force them to surrender their private property (money) prior to leaving the U.S.?

  33. It will fail because it is too dependent on HIT, which itself raises expenses, increases adverse events, and wastes the time and disrupts the cognition of health care professionals.

  34. maggie- that is the best defense of the signature piece of liberal legislation since the New Deal?
    proof that critics about the bill are being proven right, even more than they feared… and the law is not even 6 months old.
    perhaps your scare tactics about claims of costs- which are not remotely contained, only worsened by the ACA- are of the same veracity that “if we pass the stimulus, unemployment will not go above 8%”.
    or “75% of the oil is gone”
    or “guantanamo will be closed within 1 yr.”
    or, most sadly laughably, “recovery summer”
    makes us unwashed masses of the professional left more than a little skeptical…
    the ACA sucks.
    repeal it.
    give americans more options and choices for their health care.
    protect, not gut, a woman’s right to choose.
    respectfully, your endless, longwinded digital orations have become hackneyed and sterile.

  35. I’M PROUD OF YOU LABOR!. Keep standing up. The lives and health of all the American people and the World are in serious jeopardy.
    Further, unemployment healthcare benefits are critically needed. But they should be provided through the Medicare program at cost, less the 65% government premium subsidy provided now to private for profit health insurance.
    Congress should stop wasting hundreds of millions of dollars of taxpayer money on private for profit health insurance subsidies. Subsidies that cost the taxpayer 10x as much or more than Medicare does. Private for profit health insurance plans cost more. But provide dangerous and poorer quality patient care.
    It’s over. Tell congress to get the healthcare Merchants of death and injury out of the American peoples lives for good. 2010 is about THE PUBLIC OPTION!
    And that CORRUPT! UNDEMOCRATIC! filibuster must GO! NOW!
    Alan Grayson Honors The Dead http://www.youtube.com/watch?v=TV9TRoYMtjs&feature=player_embedded
    Alan Grayson on Healthcare http://www.youtube.com/watch?v=oPpQ2MNaSDo&feature=player_embedded
    Ron Sparks HealthCareReform http://youtu.be/kqlBFRJh4Cw
    John Garamendi – The Public Option http://www.youtube.com/watch?v=EyBTEke68aQ&feature=player_embedded
    I want to commend all of you for working so hard and being so strong at helping the whitehouse and congress begin to address our U.S. and Global healthcare crisis. You have been AWESOME! my fellow Americans and peoples of the World. America and the World is better and safer for it. My greatest pride is the knowledge that I am one of you. And that you really get it. You really understand the importance of it all.
    There are some potentially very good things in the healthcare legislation. Especially with the reconciliation fix’s. The Democrats, Bernie Sanders and the Whitehouse did a GREAT! job of fighting to produce the best healthcare legislation that they could. They have earned all our strong support. And we should give it to them.
    But it was your relentless pressure and hard work that made the difference. Whatever good comes from this healthcare legislation, America and the peoples of the World will have each of you to thank. You were smart, creative, courageous and relentless. You fought together for the best legislation possible. And when you had to, you fought alone. No matter who stumbled and fell you continued to push and forge ahead. Fighting for the lives and health of the American people and the World. YOU SHOULD BE PROUD OF YOUR-SELVES 🙂
    It may come to pass that future generations will look back on us and say that we were ALL Americas Greatest Generations. And that healthcare reform was our finest hour. You should be proud of our leaders President Obama, Speaker Pelosi, Majority Leader Reid and the many other Democratic and independent fighters for the people in congress. They proved them-self worthy of the leadership of a GREAT! PEOPLE.
    But we are not done yet. This was just the beginning of healthcare reform, not the end. WE THE PEOPLE OF THE UNITED STATES, ARE NOT! divided on healthcare legislation. The vast majority of you have been consistently crystal clear that this legislation does not go far enough. You want a strong Government-run Public Option CHOICE!! available to everyone on day one. And you want it NOW!
    YOU MUST NOT ALLOW AN INDIVIDUAL MANDATE TO STAND WITHOUT A STRONG GOVERNMENT-RUN PUBLIC OPTION CHOICE! AVAILABLE TO EVERYONE.
    WE THE PEOPLE have been crystal clear that we want an end to dependence on for-profit healthcare and the for-profit proxies called private for non-profit healthcare. The American people want the CHOICE! of a strong Government-run Public Option to replace their need or dependence on healthcare providers whose primary motivation is profit. Rather than providing the highest quality, easiest accessible and most affordable medically necessary healthcare possible. This is what the rest of the developed World has. And the American people want it too. They want healthcare ASSURANCE! Not, for-profit health insurance. And they want it NOW!
    Now is the time to continue the push for a strong Government-run Public Option CHOICE! available to everyone that wants it on day one. Rationally it’s clear what we have to do to get this done. SUPPORT THE DEMOCRATS that supported you with a Public Option choice, and REMOVE as many republicans as you can. Not one republican in congress was willing to step across the isle to support a strong Government-run Public Option CHOICE!! available to everyone on day one. NOT ONE! Let no candidate prevail this November that does not support a Strong Government-run Public Option.
    47,000 AMERICANS die each year from lack of healthcare. 120,000 die from treatable illness that don’t die in other developed countries. Hundreds of thousands of you are dieing from medical accidents in a rush to profit. And Millions of you are injured. Millions more are driven into bankruptcy. All for the privilege of paying two to three times as much as any other people in the developed world for healthcare. HOGWASH!
    Additionally, tens of thousands of you and your children were killed and millions sickened and injured from a terror attack with H1N1 (swine flu). Released on the American people and the World by the for-profit healthcare industry. All in an attempt to panic and frighten you into accepting the oxymoronic criminal enterprise of private for-profit healthcare (The most costly, deadly, dangerous, and disgraceful product sold in America). H1N1 is still sickening people and killing them. Especially children, the young and the middle aged. And there will be a third wave. These are the terrorist you need to worry about the most. Even the so-called international terrorist would not do something so INSANE! But greed driven medical profiteers would and did.
    Apparently as far as republicans in GOVERNMENT are concerned, YOU! my fellow Americans – CAN JUST DROP DEAD! Including their own family members. Fools!… Hundreds of thousands of you, and possibly millions of you will die from the long-term effects of your infection and poisoning with H1N1.
    So my fellow Human Beings. Rest-up, Take good care of the basics (Balanced nutrition, hydration, exercise, rest and POSITIVE emotional supports). Then wade back into the FIGHT! for a strong Government-run Public Option CHOICE! available to everyone on day one. Drug re-importation, Abolishment or strong restrictions on patents for biologic and prescription drugs. And government controlled and negotiated drug and medical cost. You must take back control of your healthcare system from the Medical Industrial Complex. You MUST do it NOW! This is a matter of National and Global security. There can be NO MORE EXCUSES.
    God Bless You My Fellow Human Beings. I’m glad to know of you. And proud to be one of you.
    See you on the battle field.
    Sincerely
    jacksmith – WorkingClass 🙂

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