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The Politics of Health Reform

There will be two national elections before the new health overhaul is substantially implemented (in 2014) and a third election the year it is supposed to be implemented.

Question: Will the voters reward office holders who supported the Affordable Care Act (ACA), or will they vote for their opponents? In thinking about this question, forget all the public opinion polls. Can you predict the outcome based on what you know about political science alone?

My prediction:  Supporters of the new law are going to get creamed. As I explained at my own blog the other day, there are four reasons: The law violates two bedrock principles of coalition politics that have been successful for the past 80 years; it abandons core Democratic constituencies; and it ignores the fundamentals of the politics of the health care sector.

Franklin Roosevelt’s First Principle of Successful Coalition Politics: Create benefits for people who are concentrated and organized, paid for by people who are disbursed and disorganized.

The ACA  violates this principle in spades. The main beneficiaries are many (but not all) of the new law are 32 million to 34 million newly insured people who otherwise would have been uninsured. Far from being organized and focused, most people in this group do not even know who they are. Indeed, it is probably fair to say that never in American history have so many benefits been conferred on so many people who never even asked for them!

Another group of potential winners are those with pre-existing conditions. But if the low take-up rate for the newly created risk pools is any indication, people who are potentially in this group aren’t rushing to embrace the new law either. Odds are, most of them are very uncertain about how they will fare.

People who are going to pay for the reform, by contrast, are organized, focused and aware that they are in the target zone.  If you work for a tanning salon, if you make wheelchairs, if you are a health insurance agent, etc., you may not know your exact burden, but you know that the law was not written for your benefit.

The administration also hurts its cause when it singles out the wealthy as deserving of special pain. If they talked about taxing capital gains and dividends, many people might wonder what that meant. But by repeating over and over again that there is a $250,000 income threshold, (and by vilifying everyone who exceeds it), almost everybody who is in the crosshairs knows full well he is in the crosshairs.

My bet: the organized and the focused will have disproportionate impact on election day.

Franklin Roosevelt’s Second Principle of Successful Coalition Politics: Benefits should be visible and overt; the cost of those benefits should be hidden and covert.

The idea behind Roosevelt’s National Industrial Recovery Act (NIRA) was politically brilliant. Following Mussolini’s model of Italian fascism, each industry was to be allowed to collude and act like a cartel — restricting output and raising prices. The winners (the producers) had a good idea of what they could expect to gain, while the losers (the consumers) had no idea.

By contrast, most of the benefits of the ACA are distant and abstract. The costs are upfront and real. Granted, the administration is trying to get everyone focused on the measly benefits that are being dribbled out in the first few years. Its problem: there just aren’t enough 26-year-old voters who really need to sign up on mom and dad’s health plan.

By the way, we’ve been through this before — in health care! The Medicare Catastrophic Care Act of 1988 imposed costs that were upfront and clear in return for benefits that were distant and vague.  Congress came back the next year and repealed the whole thing.

Democratic Constituencies: Organized Labor, the Poor, the Elderly and Especially the Poor/Elderly. I keep forgetting to mention that the Obama White House and the Democratic Congressional leadership did a brilliant job of getting almost every special interest in Washington, D.C., to sign on to its health bill. This meant getting the American Medical Association to sell out doctors, AARP to sell out seniors, the trade unions to sell out their members, etc., etc., etc.  Indeed, I believe historians will rank this frenzy of backstabbing and betrayal as one of the great legislative accomplishments in American history.

Of course, this feat can survive election day only if the people being sold out don’t know they have been sold out. Yet people have a strange knack for figuring out what’s in their self interest.

The surprise in all of this was the willingness of Democrats to abandon their core constituencies:

Note that no one has ever voted for any of this! Democrats didn’t think they were voting for this when they nominated Barack Obama. General election voters didn’t think they were voting for any of this either when they elected him president. November will be the first time voters will have a chance to say what they think.

The Politics of the Health Care Sector: Doctors, Hospitals and Drug Companies. People generally like their doctors. They tend to think fondly of their local hospital. Very few people feel warm fuzzies about drug companies located — where? Some place in New Jersey?

Yet in the health bill, doctors get taken to the cleaners. Hospitals get massacred. And drug companies make out like bandits. Former Medicare Trustee Thomas R. Saving and his colleague Andrew J. Rettenmaier compared spending projections in the 2010 and 2009 Trustees reports. The difference, shown in the chart below, mainly reflects the effects of the Affordable Care Act. As the chart shows:

  • Spending on hospitals (Medicare Part A) will be only 80% of where it would have been by the end of the decade; and it will be less than half of the previous projection by 2080.
  • Spending on doctors (Medicare Part B) will be almost 10% below previous projections by the end of the decade and more than 40% below by 2080.
  • Spending on pharmaceuticals, by contrast, barely changes — even after 70 years

2010-10-18-THCB Graphic-medicare-spending-from-the-2010-Trustees-Report_FOR_SHOW

Of course, the drug companies promised millions to help Democrats get re-elected.

Will that work?  We’ll see.

John C. Goodman, PhD, is president and CEO of the National Center for Policy Analysis. He is also the Kellye Wright Fellow in health care. The mission of the Wright Fellowship is to promote a more patient-centered, consumer-driven health care system. Dr. Goodman’s Health Policy Blog is considered among the top conservative health care blogs on the internet where pro-free enterprise, private sector solutions to health care problems are discussed by top health policy experts from all sides of the political spectrum.

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44 replies »

  1. Good Article… The change in the U.S health care bill has lead to rising health insurance costs in the U.S & has consequently necessitated travel to other destinations to avail medical services. India, proven by the increasing number of medical tourists every year, is becoming the most popular destination for medical tours & Chennai, in particular, is rapidly following suit, with its vast network of state-of-the-art hospitals & highly skilled, compassionate medical professionals at much cheaper rates.

  2. how does aarp no what their member want when then never ask. they just tell us this is their opinion and that they represent their member. they don’t represent me and many of my friends are against the health bill. aarp just comes out and says all their members are in agreement with this. not true how do we get the word to aarp that they do not speak for all their members?

  3. Its a very nice article.I have read all the points.There was actual political division,however, between centrist Democrats and progressive Democrats, who wanted more liberal provisions in the plan such as a public option.System can not be fixed unless honest politians stand up against drug cos.,doctors, hospitals and HMOs.

  4. Ahem, 59 seats in the house and 6 in the senate and they are still counting. Biggest mid-term election swing since 1948.
    Is’nt it time to acknowledge Mr Goodman’s salient points were correct?

  5. One thing is certain health care has become political.
    Not sure whether Winston Churchill would agree to his famous quote being used in that way.

  6. Wow, I like that! “…praise the lunacy of Maggie Mahar.” And it is lunacy, if not simply bold deception and manipulation to fool the masses. Unfortunately, a solid portion of them are easily fooled, but, we owe it to anyone who will listen to both sides to put it out there! Well, as an independent, and moderate thinker and active citizen, we can only hope that voting in Republicans this election cycle will just hasten the clash of the alleged titans, and they will eliminate each other so real representation can emerge by 2012, 2014. Yeah, if you haven’t figured it out by now, I hate conservatives and liberals. Polarity has no place in real public discourse and attempts at resolution.
    Is anyone else out there truly in the middle, and tired of being squeezed by these extremist zealots who, in the end, don’t give a rat’s ass about the public!?

  7. Peter,
    As usual, nothing in your comments relates either to the original post or my comments in reference to it. As always you blather on about single payer and parise the lunacy of Maggie Mahar. I suppose in the land of the blind a one eyed man can be king. I stand corrected taske off your single payer monocle.

  8. “explain how conservatives could pass their healthcare laws in 06 and 07 when Democrats controlled Congress?”
    02, 03, 04, 05, and if fact Republicans controlled the house from 1995 to 2005. 10 years and nothing for it. They could have even solved immigration if they wanted.
    “is a marginal professional athlete who makes $250,000 a year for his three year career rich?”
    For those 3 years yes. We don’t tax people on what they could or should have made or if they’re “marginal, but on what they make. They also get tax write-offs for being professional athletes. My opinion is athletes are over paid at $250k.
    “Is the owner of a family business who struggles for 40 years making minimial profit then sells to retire rich if they sell it for $250,000?”
    I didn’t know there was a “struggle” clause in the tax code. He has options when he sells:
    http://smallbusiness.dnb.com/buying-exiting-businesses/selling-a-business/1447-1.html
    He also didn’t get taxed on personal stuff he put through the business.
    By the way Nate, under health reform he can deduct 100% of his healthcare costs – courtesy of other taxpayers who can’t.
    “read this”
    I can’t, bad link.

  9. Hmm, the dialogue gets more heated as November 2 approaches, just coincidence? Maybe there are issues at hand that are costly beyond party control? Like, if not repeal this entirely, then pass admendments to this farce legislation that could hit some people in their wallets, who aren’t patients or doctors?
    The lack of transparency in passing this monstrosity is the loudest foul deed this Congress could possibly commit. And any responsible and invested participant should know this.
    Mandating people have to buy insurance. Why is it only extremist liberals find this refreshing? By the way, are any of you supporters paying attention to the “issues” going on in Greece and France of late?
    Oh, not in your time zone, so not relevant!?

  10. “You conservatives had 8 years to show what you could do to bring health care costs down under Bush and what did you do?”
    LindaB care to explain how conservatives could pass their healthcare laws in 06 and 07 when Democrats controlled Congress? Maybe your not aware that Congress writes and passes bills before they get to the President?
    rbar is a marginal professional athlete who makes $250,000 a year for his three year career rich? Is the owner of a family business who struggles for 40 years making minimial profit then sells to retire rich if they sell it for $250,000?
    Peter….any chance you might know who controls spending? Figure that out, read this, http://www.freerepublic.com/focus/f-bloggers/2327185/posts, then tell us who has a spending problem.

  11. What does the ‘Louisiana Purchase’ remotely have to do with this post or discussion?
    At the time it was also controversial for some of the same reasons as obamacare. It too was thought to be an overreach by the federal government, and possibly un-constitutional. There was also great concern about the overall cost, and the bond debt to European bankers that was required to finance the purchase.
    The more things change, the more they stay the same…
    In the end it’s all about money, and you forget that at your own peril.

  12. Group Guy,
    “If you took of your rose colored glasses…”
    I have no rose colored glasses about healthcare (or anything else) and the botched attempt by Democrats to “reform” it. We don’t have healthcare reform, I only wish, we do have insurance coverage reform (subsidies) that do not reduce costs – just as I said, neither has 50 years of insurance industry domination of the health coverage market.
    “The story of the last two years is as simple as it is dramatic. It is the epic story of an administration with a highly ideological agenda encountering a rising resistance from the American people over the major question in dispute: the size and reach and power of government and, even more fundamentally, the nature of the American social contract.”
    Too bad Americans can only look back two years, and how very fortunate for Republicans (and the Tea Party) they have such a short memory as to how we got to this point in the financial mess, and how Bush and Republicans left us with so much debt. I was not in favor of any of the bailouts, but ask the big banks and their investors if they were, ask homeowners and real estate investors if they would be happy if Fannie, Freddie and AIG went bankrupt and they would be stuck with a literal collapse of the real estate market. Ask voters if they don’t want their congressman and senator to bring federal tax dollars home to their states, ask Tea Party and Republican seniors supporters if they would be happy with cuts (and higher fees) for Medicare and Social Security. I say to them be careful what you wish for, because nothing is without consequence. It’s easy to oppose the bailouts after they’ve been made and you’ve been made whole at the expense of the (peasant) taxpayer.
    As for, “when the peasants get organized.”; if only this was about the “plight” of the peasants. It’s not and you know it, it’s about control of government by the wealthy and corporations and protection of their assets from taxation, that’s where revolutions come from. Your so called “peasants” have been on the loosing side for the last 20 years – as Warren Buffet said, “If this is about class warfare, my class is winning”.
    “and I at least have the stones to put my profile on my posts unlike so many anonymous posters like you”
    Well, I have no affiliation, and my name is actually my name. I guess you feel I should post my home address and phone number. If you’d been reading this blog long enough you’d know I support government run single-pay. But where are all the “stones” of the rich guys secretly funding unlimited ads against Obama supposedly for the down-trodden peasants?

  13. Agree Exhasted MD otherwise the healthcare debates would have been on cspan as promised by the most transparent president ever,right?
    Of course transparency has risk so does democracy. Truth is I could care less if my views offend someones delicate PC sensibilities.
    Also agree that most of the posts here in blue do not dissent with the opinions posted here and that is why I occasionally comment.

  14. Transparency is not really respected and without risks, or else everyone would have their name in blue, eh, Group Guy?! Maybe when you are critical and candid and then get tossed from the building, you’ll think a little bit more before being so free to “have the stones to put my profile on my posts.”
    Ask Juan Williams what happens when you speak freely and honestly! It’s not right, but, when people in power are not really interested in discourse and dissent, in respectable manners mind you, they not only don’t give a fecal breath what you think, they remove you from the scene real fast.
    So, at sites like this, people who are transparent have little to lose should they dissent, because in the end, they inherently know there is nothing to lose if they do dissent.
    And, do most of the blue names really dissent with the opinions here in the end?

  15. Peter,
    If you took of your rose colored glasses perhaps you would see that John’s operative point is that the American people are about to unleash their anger on Nov 2, 2010 because they are not pleased with the change congress has enacted. Or as Charles Krauthammer so eloquently put it,
    http://www.investors.com/NewsAndAnalysis/Article.aspx?id=551158&p=2
    The story of the last two years is as simple as it is dramatic. It is the epic story of an administration with a highly ideological agenda encountering a rising resistance from the American people over the major question in dispute: the size and reach and power of government and, even more fundamentally, the nature of the American social contract.
    An adjudication of the question will be rendered on Nov. 2. For the day, the American peasantry will be presiding.
    Just remember what happens to the intelligentsia during revolutions Peter when the peasants get organized.
    I proudly represent real employers and their team members in benefit matters Peter and I at least have the stones to put my profile on my posts unlike so many anonymous posters like you who limit their interaction to the comments section while those in the arena exercise their rights to speak freely.

  16. OWE-BAMA DON’T PAY
    Bart – This quote comes to mind with your posts:
    “Democracy is the theory that the common people know what they want and deserve to get it good and hard.”

    What OWE-bama and Pelosi don’t get — “debt is real. It’s not a flaky theory.”
    Google “Louisana Purchase” and try to understand debt. Good luck.

  17. Bart – This quote comes to mind with your posts:
    “Democracy is the theory that the common people know what they want and deserve to get it good and hard.”

  18. I’M FROM THE GOVERNMENT, AND I’M HERE TO HELP
    “Yes Group Guy, it’s comforting to know that we can trust the insurance industry to save us from high health care costs ..”
    Why .. of course. Let’s let Bwarney Fwrank and Pelosi fix everything .. like how they f’d FANNIE/FREDDIE.
    Think OWEbama can do anything but blather? Sure — and pigs are flying over D.C.

  19. Yes Group Guy, it’s comforting to know that we can trust the insurance industry to save us from high health care costs as they have been so effective in doing over the past 50 years.

  20. ” .. do you have any idea about income distribution in the US when you doubt that a person making 250K a year is rich?”
    Sure — they’re gub-mint officials in Calif. (LOL)
    Do you have any idea how much the WORKING “rich” pay in taxes?
    Here —
    http://www.ntu.org/tax-basics/who-pays-income-taxes.html
    Yes, numbers are scary, especially to law school people.
    Well, just try — then read Chapter 9 of the U.S. Bankruptcy Code. That’s where OweBama and Newt are taking the USA.
    Have an OweBama-bankrupt day!

  21. This is an excellent post John and I suspect your conclusions are spot on with what we will see in the November election. I base this on speaking with real voters every day while interacting with them during open enrollment meetings. Here are a few specific examples.
    1. Americans are just discovering that beginning in 2011 they can no longer pay for OTC meds with their HSA. Since Americans take many medicines including OTC every day it has been accurately estimated that this provision of Obamacare will raise costs to the tune of 40% for many Americans.
    http://biggovernment.com/jberlau/2010/03/25/seeing-red-at-reconciliation-over-medicine-cabinet-tax/
    2. Child rates are exploding in group health plans due to the lack of a pre-existing exclusion in Obamacare. Consumers seeking shelter in the individual market are discovering they cannot buy child only coverage anymore because insurers have ceased to underwrite new business. So a two income family in America where both parents work with coverage through their employer who is being responsible and covering their children under a group plan no longer have the option of gaining relief by covering their healthy children in the individual market. I covered this yesterday in my own blog which has links to all the news reports where HHS Secretary Sebellius seems shocked their is no market for business that will be inherently unprofitable.
    http://thegroupguy.blogspot.com/2010/10/failure-of-central-planning-via-hhs.html
    The reality check for politicans is coming on November 2, 2010. Post up then and tell John how wrong he is if you have the courage.

  22. Too tired to comment on the OP. But Ken, do you have any idea about income distribution in the US when you doubt that a person making 250K a year is rich?

  23. John, you need to complemented for writing a well thought out post on such a difficult and divisive topic.
    This could have been really legislation, until the special interests and political ideology hijacked it. While people complained about the HMO’s, our healthcare system works, and works well.
    Yes, costs are too high. That was mostly due to lack of competition and legal issues.
    When the gov’t decides winners and losers, such as the wealthy and unions, we all lose in the end. Sicne when is $250,000 rich today?
    If the Obamacare legislation was so good, Dems would be running on it, not running from it.

  24. ” .. Nowadays, you’ll find far more Hitler slurs thrown at the left than the right. It’s like a campaign.”
    Why .. of course. When the watermelons (green outside, Commie-red on the inside) win, the taxpayers are brilliant, kind and angelic.
    And when they lose — Nov. 2, hurry up — the taxpayers are stupid, greedy fools.
    USA taxpayers are so much smarter than the OweBama/Harvard Law crew, it isn’t funny. They know when they are being LIED to.

  25. Exactly, LindaB, “not so easy to really fix it”, and yet by your rhetoric we should just accept this legislation without dissent or pause? And having a better plan in 2011 ensures it will as good in 2017?
    Legislators pass a bill the size of what, 2500 pages, and freely admit they did not read it? And you are ok with this attitude?
    If you answer yes to that last question, not only are you part of the problem, you deserve the problems this legislation will create as time progresses!
    Wow, ignorance is not just prevalent, it metastisizes!!!
    And, by the way, while HSA’s are not applicable to the population at large, this legislation will basically outlaw it for the sizeable population that could benefit from using it. Your Democratic agenda is very obvious, and, you gotta love people who promote that they care, when the law is careless!!!
    Read the links, with some objective and unbiased ablility. Otherwise, wait for when the choir bites you when you least expect it!!!

  26. You make some good points about the delay in getting the most important benefits implemented, but you are way way off on the rest — for example —
    The surprise in all of this was the willingness of Democrats to abandon their core constituencies:
    “Labor union members will now see their health plans taxed.” — not all labor unions. The number of union plans that may be subject to tax is relatively small.
    “People in Medicaid will have to compete with 16 million new enrollees in a medical marketplace that will have only a handful of new doctors and a significant reduction in Disproportionate Share payments for safety net hospitals. –” You fail to note the substantial amount of money that is being directed toward community clinics and safety net providers, and training of new physicians to help with the Medicaid expansion.
    “Seniors as a group will bear more than half the cost of reform, as Medicare payment rates fall below Medicaid’s before the decade is out.
    Members of Medicare Advantage plans — elderly, low income, disproportionately minority (the very profile of a Democratic voter!) — will lose a third or more of their benefits by 2017 in many U.S. cities.” That is just BS. I’m one of those beneficiaries and my plan is actually better for 2011 than it was in 2010. MA will continue to be in the market, and plans are already figuring out how to stay profitable. The savings will come out of the insurers’ hides and hopefully the government and state regulators will have the guts to keep them honest.
    BOTTOM LINE? I see you are part of an organization that promotes HSAs and CDHPs. They are NOT the answer to the health care crisis. You conservatives had 8 years to show what you could do to bring health care costs down under Bush and what did you do? Passed the Prescription DRug Act, which was NOT paid for, and will add a trillion to the deficit in the next ten years. Easy to criticize health reform, isn’t it? Not so easy to really fix it.

  27. I am not from the US, so my perspective may be wrong. But if I understand anything about human psychology,especially that of poor people, then I can say that even when people are disorganized they know what is in their interest. I am certain the uninsured/ underinsured know exactly who they are. The question is will this benefit be good enough for them to change their voting decission.

  28. Maybe this is not the best place for this link, but, having read it twice and felt the paragraph in the middle is so applicable to this site and the push for electronic medical records without regard for consequences, I’ll note it here, include the link, and hope those who are open minded and interested in ideas, not quick fixes first, will read it:
    Breee Barton is the author of the piece in USAToday:
    “Welcome to life in 2010. We’ve never been more connected to the people around us. We’ve never been more disconnected, either.”
    http://www.usatoday.com/news/opinion/forum/2010-10-20-column20_ST1_N.htm
    Trust me, when people start putting their faith and expectations that computers and technology will answer the questions and solve the problems, there will only be more aggravation and heartache when the human interaction is pushed further away. Computer access is only part of diagnosis and treatment, our nature is to seek out instanteous gratification, and only those who reframe problem solving and solution seeking make progress. And trust me further when I say a sizeable portion of the Medicaid population alone are not interested in reframing!
    That is not an indictment of a population, but an observation that might have a healthy intervention for the better, but, not by this legislation!!!

  29. To the extent that the American electorate can become educated (I’m not holding my breath) on what Obamacare contains, then politicians will be punished. Otherwise, never underestimate a politician’s ability to pull the wool over the eyes of the average American voter.

  30. The state of Texas Medical Board needs to hand over Robert Robinson medical MRI’s they took of his upper extremity and neck. The Texas Attorney General Open Records needs to force the Texas Workers Comp to hand over Roberts Two MRI’s one before the botch surgery and the one taken after the botch surgery under Dr. Gary Gartsman in Houston Tx at St Lukes Hospital. Now this is one of many issues that real people have in our health care, crap like this and what is more despising is having people working in these type of Government agency’s that allow this crap to go on in our Health care . TIME FOR A CHANG

  31. “I suspect this is because for a long time the right was associated with fascism”.
    While this statement is true of the European Right, it is not true of the historical origins or current reality of the US right. The US right wing has been generally understood to map to European classical liberal and Whig parties. Fascism is another form of collectivism, albeit a toxic one. The US right has, historically, been the least collectivist party in the US.

  32. How was the NRA was ‘fascist’ when it guaranteed trade union rights, permitted the regulation of working standards, and promoted collective bargaining. Fascism is generally the unison of gov’t aligned closely with corporate interests and those things aren’t in the interests of ‘corporations.’ NRA was many things but labeled it ‘fascist’ is a stretch at best and more likely a misclassifcation but political history/theory aren’t strengths of the American public as a whole.

  33. “Of course, the drug companies promised millions to help Democrats get re-elected.
    Will that work? We’ll see.”
    http://www.opensecrets.org/industries/indus.php?ind=H04
    As usual is the case, Goodman is either misconstruing facts or flat out wrong. In this case, it is both. Pharma typically is a heavy and reliable GOP donor as the charts indicate. Like most GOP donors, they hedged their bets a bit to make it more 50/50 with the Democrats full in control after the ’08 elections by clear majorities in the Senate and House.
    “The idea behind Roosevelt’s National Industrial Recovery Act (NIRA) was politically brilliant.”
    Really? It cost Roosevelt a bit in the ’34 elections and there were alot of Southern Democrats who were conservative and opposed much of the NRA because they felt the executive was taking over directing many functions that were clearly the provision of the Congress (I know crazy that Congress would actually stand up to the Executive Branch).
    This lead to the formation of the Southern Coalition between Democrats in the South and some GOP members. Hell, the Supreme Court found aspects of the NRA unconstitutional in ’35 and Roosevelt was no shoo-in to win the ’36 election because parts of the NRA were so unpopular and many people (both Democrats and GOP members) thought FDR had overstepped his bounds.

  34. Frank, it wasn’t an Obama and Mussolini link she was referring to, but a comment that Roosevelt imitated Mussolini and was “brilliant” in doing so.
    As for the association of Democrats with fascism, this has been a sustained effort on the part of the right for several years. Jonah Goldberg made a splash doing this, and it has gotten more pronounced since then. I suspect this is because for a long time the right was associated with fascism (and the left with communism), but right wing folks like Frank chafed under parallels drawn with Hitler and Mussolini, so decided to reinvent themselves and turn the tables. Nowadays, you’ll find far more Hitler slurs thrown at the left than the right. It’s like a campaign.

  35. Well, that was quite the frenzy of attempted evisceration. Some of that wild stabbing even hits the mark.
    However, mostly it misses. On the one hand, we have the comment that people have a “knack for figuring out what is in their self interest.” And yet the large subsidies for health insurance to the working poor are going to be given to people who, “far from being organized and focused, most people in this group do not even know who they are. Indeed, it is probably fair to say that never in American history have so many benefits been conferred on so many people who never even asked for them!”
    Remarkable how that knack disappears when convenient.
    And the whole piece is like this. On the one hand, we have costs that are too high, but on the other hand when Medicare costs are projected to go down relative to current trend (not in absolute terms), that is a betrayal and will harm seniors (rather than result in any reduced inefficiencies and waste which we all agree are needed).

  36. ” .. haven’t seen “brilliant” and Mussolini mentioned in the same context in a very long time….”
    Odd. OWE-bama and FASCISM have been jointly mentioned daily for months.
    Time to start actually believing in free speech ..

  37. “Note that no one has ever voted for any of this! Democrats didn’t think they were voting for this when they nominated Barack Obama.”
    “Of course, the drug companies promised millions to help Democrats get re-elected.”
    The above quotes typify the right wing blarney you can always expect from the clown who fired Bruce Bartlett for daring to say Bush wasn’t conservative.

  38. Someone once quoted, ‘the stand you take on a position depends on where you sit’… in other words we all have agendas– be it pundits or physicians or me. And these bedrocks you quote, are more akin to the coda for magicians and crooks, aka misdirection. Look over here, while I take something from you over there. Let’s face it the entire system is broken.
    I am not a big fan of government driven approaches and neither am I a fan of corporate driven solutions. Neither has our best interest at heart and why the county is up in arms about HC reform, instead we should be up in arms for spending money on wars that were a waste of our money and policies of greed that have driven this country to the brink or moral corruption.
    But all of us have an agenda, and until you put your own agenda out on a ledge, you cannot see the best for the Country or the world. Our politicians are not working in the best interest of the USA they are looking out for their next re-election. Neither party deserves to get re-elected as they are either Democrats running scared or Republicans who are obstructionists. I’ll bet if we call this a War on Health, the politicians would rally.
    So let’s clarify some misconceptions- one the uninsured are already affecting the system. They are either showing up to an overburdened ED or they are deferring their treatment until they are really sick. Who does this hurt, well the disbursed, the disorganized, the centralized and the organized, and mostly those of us that are already insured be we middle class, employed or rich, in other words many of us. Because our insurance premiums are higher covering for those that are not covered or our hospital costs are higher because hospitals charge more to cover for unreimbursed expenditures.
    What we really need is a system that incentivizes wellness and prevention and not post illness or diagnosis. Most states for example require car insurance or you cannot drive, why is the HC reform any different? Why are you all agog over requiring HC insurance. Most states require some form of preventive maintenance (smog tests, annual inspections) to catch problems before they affect the greater whole. But for some reason we cannot see or do this for ourselves.
    Instead we all sit on our comfy couches watching TV/ internet, eating unhealthy food products and ultimately ending up sicker than we should, because of poor choices. I for one do not want to pay for someone elses poor choices and neither do I want to pay for the uninsured at a much higher cost, because they do not have access to primary care or wellness programs.
    The exhausted physician, you have an agenda, and I get that, but this informed patient is telling you to become more efficient(learn to use a computer /EHR), work in hospitals that are leaner, help us reduce pharmaceutical dependence and reduce costs in the process. Let’s look out for the disbursed and the disorganized because they are costing us anyway in more ways than we can imagine.

  39. And you know what, the majority of people who will attack this posting are interested first and foremost on what is in the best interests of the Democratic Party, not the public, not the core principles of doing what is right and responsible, and certainly not what is in the best interests of the patient-physician relationship. And I can say this without any doubt I am most likely right, because this Congress never really had an interest in the direct opinions of who was most impacted by this legislation: patients and physicians.
    So, let’s see who will be upfront and put out their disclaimer why they disagree so passionately with this post, and who will just write paragraphs of verbal nonsense and then expect readers to just believe them.
    Here is my disclaimer: I took an oath over 20 years ago to treat people and do what is right and responsible, and the rest that will be more good than bad will follow. I am a registered independent, and never vote a party line in any election. And, I have no financial interests in any medical care organization or system, I have been for the most part a salaried physician for different health care systems in my career, and have never earned more than $150K in a year.
    And, I know bs when I see it, and this legislation is not a joke, but foul, disgusting, intrusive garbage. I hope it sinks as many political careers as it can, and I will shed no tear for anyone who voted for it and is not reelected, but moreso, not for any incumbent in office more than 12 years. They as a collective group have failed in representing the American public, and if there is a god or force looking out for the better good, November 3rd is the beginning of hope.
    I can’t wait to read what follows this comment!!! I think this is a great post, thank you for writing it!

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