You gotta love someone who tells me I follow ideology blindly and then sends over editorials from the WSJ and Forbes (cross-posted on Yahoo Finance, no less).

My links were to the text of the legislation, the non-partisan CBO, and Fox News (yep, guilty as charged).

Yeah, and if you actually read that WSJ article, it has little to do with Tim’s post here.  It merely deals with comparative effectiveness research, while listing proponents’ support and opponents’ objections.   And it doesn’t come out looking that bad really.

The last paragraph does sound a fearful note on the public option, though.  Regarding the public option’s innovative payment rates, it asks “Would it keep a tight rein on costs and ration care?”  Hello, insurance companies do that RIGHT NOW, and the nearly 50 million people have the severest of rationings: 0% health coverage.  Plus, as Tim pointed out, the health insurance exchange will have plenty of private options, so if you’re that concerned the government would ration your care, simply don’t go with the public option.

The 2nd article’s most pertinent section argues that many would lose their current coverage, but the CBO’s assessment is different,
> says Yahoo News : “Republicans often cite Lewin Group analysis to make their point that millions of people would lose their current health coverage if the proposed overhaul became law. But the CBO disputed the group's conclusions.”

If the public Option is SINGLE-PAYER, (which I sincerely hope it is, because I'm ready to get off the capitalist rollercoaster ride) The insurance companies won't be able to compete with our lower prices for service.  Private doctors will have to accept the money the government pays or hope people have the money to continue paying insurance to afford them.

That is what I believe they are hollering about.

Get Obama back to Single-Payer

"WINDOW TREATMENT" 
our windows are sick- just like us
 they need HR676-       just like us
Let's give them a LARGE dose. hang up a HUGE sign that says HR676, and on our car windows too if we can. "HEAL" our windows to HEAL US!!

"The insurance companies won't be able to compete with our lower prices for service."--

President Obama says that is not the case.  He says UPS and Fed Ex are fine.  It's the post office that is in the red.

If you are right, he is wrong.  If he is right, not exactly a great selling point for government-provided healthcare, is it?

I agree something should be done, but I worry about the funding.  Maybe they should attack this problem by capping lawsuits (lawyers get a pretty big cut and doctors pay over 100,000 a year in their premiums) and allow health insurance companies to sell policies across state lines.  This would cut funding.  I don't really care whether Uncle Sam foots the bill but he should be attacking the cost of it.  The last thing we need is another entitlement fund that has no money.  Social security is already broke (the government hasn't stream lined this or run it effectively.  What to do:(

I am so tired of the "fear" tactics in place of "truth" on the daily regular news, that I don't even care to turn it on at the end of the day anymore...they are the ones who have access to getting the truth out and they are simply spreading the word....and fear - like sex sells and sadly, that  seems to be the means they are using to get the attention of the average American...Far more accurate information on the internet at such sites as this to name a few...sadly those out there hollering "I don't want the Federal Government messing with my Medicare"....(duh)...are not using the internet to get thier information.....

Yes, both sides are using tactics and we have no practical or logical middle ground.  Whether it is Republicans saying "Death panels" or Democrats saying "it won't affect current health care policy's", we are continually be bombarded by extremist lies from all sides.  Both sides are just as bad.  To bad we don't have a logical bipartisan group to get information from.

Mike, I have to disagree with the assessment that both sides are just as bad.  Someone saying, "it won't affect current health care policy" where a majority of the time it won't is not equivalent "death panels" which are not, will not, won't ever be part of the reform.

One is an exaggeration which will be true for a majority (but not all) of listeners, one is an outright fabrication which is not true for anyone on Planet Earth.  Let's not lose perspective here.

How about the Left lying and villifying senior citizens and other concerned citizens for exercising their Freedom of Speech when they know all the polls show significantly greater percentage don't support the plan?  They've been called frauds, Nazis, right-wing nuts, insurance industry swills, etc by the media and some of the Dems.

Pretty Nasty.  I guess we will all be the Judge as to who is worse.

Also, per www.factcheck.org the following:

Obama promised once again that a health care overhaul "will be paid for." But congressional budget experts say the bills they've seen so far would add hundreds of billions of dollars to the deficit over the next decade.

He said the plan "that I put forward" would cover at least 97 percent of all Americans. Actually, the plan he campaigned on would cover far less than that, and only one of the bills now being considered in Congress would do that.

He said the "average American family is paying thousands" as part of their premiums to cover uncompensated care for the uninsured, implying that expanded coverage will slash insurance costs. But the nonpartisan Kaiser Family Foundation puts the cost per family figure at $200.

Obama claimed his budget "reduced federal spending over the next 10 years by $2.2 trillion" compared with where it was headed before. Not true. Even figures from his own budget experts don't support that. The Congressional Budget Office projects a $2.7 trillion increase, not a $2.2 trillion cut.

The president said that the United States spends $6,000 more on average than other countries on health care. Actually, U.S. per capita spending is about $2,500 more than the next highest-spending country. Obama's figure was a White House-calculated per-family estimate. 

Lastly, are we guranteed that in trying to control costs that the government panel will not be setting standards that result in a denial of available alternatives that are presently available? 

Canada and Britain ration care this way.  How do we know for sure?  At least I can sue a private entity, but the government is difficult to sue (if not impossible) due to soverign immunity.

Simply-will we have rationing of care or not?  I know many think we have that now, but that is not my question.

Thanks.

I guess both sides are messed up.  When you want to sell something you have to present your beliefs or fulfill the wants of others.  IO know not to apply the general lable to all of either party but I don't get why we can't just address the problem with common sense.  I am not asking for some big entitlement program like SS.  Just pass some laws that don't cost us anything.  Throwing money on problems, name calling and more government are not solutions.  I am disappointed in myself for voting after seeing someone I thought could change things be so much like his predecessor.  Where is Ross Perot?

James,

Factcheck.org is a great site, but they keep failing to mention that the $239 billion remainder in the House bill goes to patching the Medicare sustainable growth rate.  This is not a reform but a long-standing policy that sounds wasteful and probably should change but was going to continue this year regardless of reform.

So, yes, Dems are wrong to say the House bill would not add to the deficit, but the more important point is that its reforms will not.  The nuance required to explain that wouldn't really make for a good primetime soundbyte.

http://wonkroom.thinkprogress.org/2009/07/20/sgr-house/

Paul,

I'm not sure we need the public option to draw down costs.  Everytime the government gets involved costs go up! 

Just cap lawsuits (would cut phsician rates), prosecute fraud (eliminate free loaders who want more and help insurance companies who are not the problem but victim of fraud) and set policy for unfair cancellations.

i'm getting sick of both parties just throwing money at problems.  it doesn't work!

Paul,

I copied the article and sent it to www.factcheck.org.  I figured they should respond to that.  I'll let you know if I et a response.

We have gone through this on varioius articles and posts, so I will just hit these:

1.  It depends whether you are getting it through your employer or not.

2.  MY healthcare plan rewards me for healthy living by giving me a lower payment if I don't smoke, and other things.  You are flatly wrong.

4.  The CBO clearly states that 3 million people will lose the insurance provided through their employer.  Timothy Foley has agreed with that.  See the other threads on articles of this topic.  The net result will be that by 2016 other folks will insist on being employed where it is offered and their will be a net gain of 3 million.  But that is small comfort to the folks who lose it and aren't in that 2016 pack.

5. "Those who are doing everything in their power to discredit the president for trying to get a public health plan passed have no real ideas of their own, or we would have seen them by now. Keeping the status quo with what we now have is NOT an option any of us could or should continue to live with." 

This has been refruted so frequently that it is wearisome to have to point out yet again the plans that have been proposed and rejected out of hand by the majority party.

You may be right.  What about folks who get kicked off of their planns because the insurance company says they have capped?  Shouldn't we step in with policy of some kind.  Fair policies wouldn't cost a thing.  We could still keep the market free but address a BIG problem!

MIke,

Yes we should.  Agreed.

James, Mike,

The value of the free market is contingent on its ability to deliver the best goods & services to people for the most affordable price.  The "free" insurance market is clearly not doing that now, with its de facto monopolies.

The whole logic of a public option is that it would address this lack of competition and drive down insurance costs, or at least be an affordable option itself.  Removing it wouldn't save $ (as Tim has pointed out, the CBO actually says it would make reform more expensive).  We would just be subsidizing more expensive plans.

It's the subsidies & expansion of Medicaid that are the main costs.  So, the question is: can we achieve the same level of affordability with regulation alone?  It seems hard to say yes, since the direct subsidies in the House bill are pretty generous.  They would probably still be needed even with something like a price cap (which is not under serious consideration right now anyway and would likely get fought as hard or harder than a public option).

Paul,

Good comments, but I am still concerned when we view the TennCare model and how closely it relates to HR 3200 in comparison. 

I fear that choice of healthcare insurance  will be eliminated because the government will be injecting a subsidized product with falsely lower premiums into the free market.  Then, when the government eventually becomes the only provider, it will then possess a grossly intrusive power into the lives of its citizens.  Britain's government run system has already priced human life, as I am sure private insurance companies do as well, but here lies the difference, there are legal avenues to fight private health system decisions while it would be next to impossible to fight a federal, single source, grossly bureaucratic and governmentally controlled system.  In addition to this, health care will then have the great potential of becoming a political football rather than what it ought to be, a system focused on the healthcare of the patient.  Literally, it may come to a point where we would have to write our congressman for their assistance in attaining a medical procedure and then, depending upon your political affiliation, how much you have donated to the party, or if you have been a good little citizen and not made waves, you may or may not get it.  I am sure this scenario sends shivers down your spine as it does mine but you have to admit this is a real possibility.  Remember, absolute power corrupts absolutely. 

The only way to fix this problem is through free market economies.  Let's not throw the baby out with the bath water and keep what is good with our present system and fix what is suppressing what can make the system better.  People will vote with their wallets and create/demand efficiencies and cost control.  Let's shop for healthcare products as we do for car insurance and let's do it not only on a national but an international level.  We can not allow the government, as it does now, to close the system by not allowing healthcare insurance to be purchased on the open market.  Open up the borders to insurance while having the government provide a safety net for its citizens that are truly indigent and those who can not provide for themselves.

I have no confidence in a government running my healthcare that also produced the "doughnut hole", the post office and cash for clunkers.  I do not believe the government can do a better job in making my healthcare decisions than I can.  Let's not manage by minority and skew our system by what is wrong but instead build upon what works and make it better. 

Cheers,

Chip

Thanks for the thoughts Chip,

The opening the borders idea is interesting, and I'd like to hear some more perspectives on that.  But I don't think it's unreasonable to target certain unacceptable practices that and say: it's illegal to do this, or to directly create a mechanism that would fight such practices (so the public option to fight price-guaging).

The CBO is on record saying only about 10 million we even choose the public option, and that's for the original bill.  The public option has since been weakened and may have even fewer customers.  There is little reason to fear a government takeover from this plan.  It was designed to retain so much of the current system that single-payer purists are pulling their hair out.  As Tim has pointed out (http://healthcare.change.org/blog/view/grading_the_public_option), even the originator of the public option idea specifically designed it to be one option amongst many.

And has been oft mentioned, the government insurance we do have in this country, Medicare is better at delivering health care to its beneficiaries than private insurance!  People love their Medicare. 

http://www.nationaljournal.com/njonline/mp_20090629_2600.php

Paul good ideas.  I hope congress is reading this blog. 

As I wrote in a response below I do believe that there must be some safety nets for those that need it and this can be a part of doing business here in the US but the possibility of a monopoly government run health care  system is too uncomfortable a thought for me.  The majority of government programs that I have been associated with have proven less than adequate compared to the private sector.

On a personal note, I have dealt with Medicare and I did not have a good experience concerning my mother in a nursing home for a surgery that she needed and Medicare balked on.  So the message is, we can do better in many arenas while we wrap our arms around the swirling health care issues.  A government run health care system with no options or retort is not the answer.  Choices and options have always proved to be the best catalyst in providing the most efficient and effective service to the customer.

Just to be clear, it's not "The Congress."  It's 6 Senators.  This hasn't even gone before the full committee yet and although they're clearly floating a trial balloon, we don't know how bad it is yet.  (Although note I don't in any way want to indicate it will be good -- it won't)

More on the Senate Finance Committee, and Fortune's laugh-a-minute reprise of the talking points from 1994 which, as Barbara point out, better describe the situation we have NOW than the proposals in Congress, later today...

Phree, the public option has not been deleted. The house bill does have the option, and the senate is still arguing. The problem in the senate is the blue-dog dem's., who are spineless jellyfish, and need to grow a pair! They have a firm majority, but are still letting the minority win! Harry Reid is a gutless wonder. Max Baccus, the chair of the Sen. finance committee, has taken $6million from insurance co's., and needs to be replaced. They need to hear from us! When they come back to their constituencies, we need to bombard them with calls, visits, and emails. This has to be a grassroots movement, and we need to do it now!

The public option will place the US government in another aspect of our lives.  80% (number could go either way) of Americans are happy with their health care.  The government has a poor track record on big entitlement programs (social security and medicare are both almost bankrupt) .  Place this in an equation where things are working for most of America and most are left with:

Why pay more for less?

Where will the government get the extra doctors etc. to prevent rationing of health care?

The government likes to throw a heap of cash on the fire and it smothers the problem for a little while.  Then eventually that lump of cash catches fire and we are all worse off.

Maybe the single payer option is not addressing the problem.  Maybe the government should be attacking the lawyers, their fees and the costs passed onto our doctors (would probaby cut premiums in half).  Hey that's a cut in $400 a month I could deal with:)

They capped malpractice awards in TX & CA, but that didn't dent costs.  And that doesn't get at the core of the market dysfunction: concentration/lack of choice.

Medicare actually operates at a lower overhead than private insurers (since they're not beholden to pricey execs & Wall St. investors), AND people with their Medicare report greater satisfaction & access to care than those with private insurance: http://www.nationaljournal.com/njonline/mp_20090629_2600.php

As for extra doctors, the house bill includes incentives to encourage more to enter medicine.

« Climate Change Update - Falling Dominoes Government Run Health Care - "Anecdotal" or Indicators of a Systemic Problem? » Busting Medicare's "Low Overhead Advantage" Myth July 2nd, 2009 | Author: Bruce McQuain

One of the favorite arguments of the government health care crowd is the supposed Medicare low overhead argument - i.e. Medicare is more efficient than private insurance because its overhead is so much lower than private administrative costs.

It goes like this:

But the administration of Medicare is a miracle of low overhead and a model, despite all the fraud and abuse, of what government can do right. Three percent of Medicare's premiums go for administrative costs. By contrast, 10 to 20 percent of private-insurance premiums go for administrative costs. Roll that figure around on your tongue. When you swallow and digest it, you'll understand that any hope of significantly reducing health-care costs depends on a public option.

Right now, the Medicare average is 3% and private insurance averages 12%. But Tom Bevan points out, some of that difference is an apples and oranges comparison:

But here's the catch: because Medicare is devoted to serving a population that is elderly, and therefore in need of greater levels of medical care, it generates significantly higher expenditures than private insurance plans, thus making administrative costs smaller as a percentage of total costs. This creates the appearance that Medicare is a model of administrative efficiency. What Jon Alter sees as a "miracle" is really just a statistical sleight of hand.

Furthermore, Book notes that private insurers have a number of additional expenditures which fall into the category of "administrative costs" (like state health insurance premium taxes of 2-4%, marketing costs, etc) that Medicare does not have, further inflating the apparent differences in cost.

However, when you make an apples to apples comparison, Medicare comes out much worse than private insurance:

But, as you might expect, when you compare administrative costs on a per-person basis, Medicare is dramatically less efficient than private insurance plans. As you can see here, between 2001-2005, Medicare's administrative costs on a per-person basis were 24.8% higher, on average, than private insurers.

So, contrary to claims of Alter, Krugman, and President Obama, moving tens of millions of Americans into a government run health care option won't generate any costs savings through lower administrative costs. Just the opposite.

Make sure you click through and check out the real Medicare administrative costs as compared to private industry.

Then there's waste fraud and abuse. Did you happen to catch that little hand wave at "fraud and abuse" in the first quote touting Medicare's efficiency? What, pray tell, is one of the primary jobs of an administive system? Would you imagine it to be the elimination of fraud and abuse - or said another way, to ensure that the company pays legitimate claims and avoids fraudulent and unnecessary payments?

How efficient is a system which is awash in both fraud and abuse? And, without profit, what incentive do they have to eliminate it?

John Stossel takes that part of the "Medicare efficiency" myth apart:

But there's a bigger point - the connection between "low" administrative costs and staggeringly HIGH levels of fraud and waste. As Michael Cannon at the Cato Institute and Regina Herzlinger at Harvard Business School have pointed out, much of the 10 to 20 percent of private insurance administrative costs goes to preventing fraud. Private insurers, you see, care about whether or not they lose money. Medicare, with its unlimited claim on the public purse, does not. It's only taxpayer money, after all.

The results are predictable, but breathtaking nonetheless: an estimated $68 billion (with a B) in outright Medicare fraud every year (About $3 billion in Miami-Dade county ALONE.) On top of that, according to well-respected Dartmouth researchers, roughly a third of Medicare's total $400 billion annual spending goes to procedures which were medically unnecessary.

That's, on average, 68 billion every year. Imagine a private insurance company surviving with loss figures like that. But as Stossel points out, without an incentive to eliminate fraud and abuse, it continues year after year after year, with politicians and Medicare administrators tut-tutting but never really doing anything about it.

That is the reality of Medicare's efficiency. It is also the probable model any future health care insurance run by the government. Efficiency is an illusion brought about by a statistical sleight of hand and ignoring the systemic waste, fraud and abuse of Medicare.

~McQ

http://www.qando.net/?p=3362

That's interesting stuff.  I checked out both articles, along with their source, Robert Book of the Heritage Foundation, who seems to rely on numbers from the Lewin Group in his assessment of the Public Option, making it dubious.  This does not mean he is wrong about Medicare, but it’s the Public Option we’re really talking about here: and the CBO has already gone on record saying it WOULD in fact save $150 billion over 10 years.  (I didn’t see McQuain, Stossel, or Book address this, so I’m inclined to go with the non-partisan CBO on this).

Besides, Book’s assessment of Medicare is far from unimpeachable.  This Columbia prof had this to say about Book's analysis:

"Don't forget about the denominator, as we always tell our students.

The next step, I'd think, is to compare costs for different groups of potential patients, characterized by age, health status, and socioeconomic and demographic background variables.

But that's not what Book does--instead he just compares average administrative costs per patient: $509 per primary beneficiary for Medicare, $453 for private insurers. But this can't be right: of course, Medicare patients, who are older, sicker, and are going to the doctor and hospital more often, will have higher administrative costs! It seems silly to jump all over the first set of unadjusted numbers and then take the second set of unadjusted numbers at face value."

http://www.stat.columbia.edu/~cook/movabletype/archives/2009/07/does_medicare_a.html

Additionally, Jacob Haker has pointed out that a closer comparison does exist:

“The Congressional Budget Office (CBO) has found that administrative costs under the public Medicare plan are less than 2 percent of expenditures, compared with approximately 11 percent of spending by private plans under Medicare Advantage. This is a near perfect ‘apples to apples’ comparison of administrative costs, because the public Medicare plan and Medicare Advantage plans are operating under similar rules and treating the same population…

As is well known, Medicare Advantage plans are substantially overpaid relative to what it would have cost to provide coverage to the same enrollee in the public Medicare plan…”

http://institute.ourfuture.org/files/Jacob_Hacker_Public_Plan_Choice.pdf

That sounds like it has more to do with premiums than administrative costs, but it shows what private insurers’ efficiency is all about: charge as high as you can, pay for as few services as possible.

In the end, it seems that administrative costs is only one aspect of the larger question: what % of revenue goes to actually covering claims (the actual point of coverage) in public vs. private?  Given that private insurers are for-profit and have to pay out to Wall St. investors, I would be curious to see the numbers on that.

The Internet is wonderful!  We live in a day and age where it changes everything in government and everything else:)

I've read a CBO report but couldn't find the one that included overhead/administration costs.  It is going to be pretty expensive.  I believe we can ameliorate the situation by policy.  There are headlines eking out that the Canadian health care system is imploding (Canada's administrator for the program Dr. Robert Ouellet, the current president of the CMA) http://www.healthzone.ca/health/newsfeatures/article/681882!

Why can't we learn from other countries?  We are smarter than that!  It's like going to war without checking out all the options (Have you heard of this before?)  Diplomacy first. 

Throw out the single payer system idea, period!  Let's get with some good laws and legislation while saving money(we can't afford it anyway)! 

This is like someone wanting to buy a new car even though they don't have the money.  The old car runs but isn't the greatest.  In my house, I take it to the repair shop.  I don't continually work on budget lines that are unrealistic.  Why?

We don't need CBO reports, because this whole thing is spun up and unrealistic (not in the budget and doesn't work anyway).  Pragmatically speaking, government should be the reason government was created (we were all taught why in school).

The CBO "figures do not include certain costs that the government would incur to administer the proposed changes and the impact of the bill's provisions on other federal programs, and they do not reflect any modifications or amendments made after the bill was introduced. Nevertheless, this analysis reflects the major net budgetary effects of H.R. 3200."  http://cboblog.cbo.gov/?p=332

Doesn't include administrative costs?  That sounds odd - it kinda defeats the purpose of a cost estimate.

That said, will the costs of administering the public option outweigh its $150 billion savings?  Even if it breaks even, it still delivers an important measure into the system for the multiple reasons already listed elsewhere. 

not really.  We can do better without it.

Support please?

And as for admin costs, they are hard to ascertain with certainty at this point, and the CBO can’t make guesses at non-hard data (this is why they couldn’t score any of the savings that should come from many reforms, so it cuts BOTH ways).  But even without admin costs, as that post says, the CBO's  "analysis reflects the major net budgetary effects of H.R. 3200."

And again, the $150 billion savings have to be reckoned with.

Medicare, Medicaid and Social Security work perfectly fine. Ask any of us who are currently receiving these benefits. The largest problem right now is the documented fraud from hospitals, doctors and individuals to get more money than they should be entitled to from Medicare. What we need is very stringently enforced regulations to prevent this.

We all paid into the system for years, and now, those who can no longer work, either because of age or disability can now have some kind of income. It's not great, but it helps.

I, too, pay for taxes for education that I no longer use, but guess what, my community is all the better because it is filled with young people who are receiving a good education. Yeah, I want my taxes for that. I do not want my taxes used to kill people in unjust wars, and truthfully, that is where most of our taxes are going.

You are right, though; I do not want a "crummy public plan" either. I want an exceptional, cost effective, all-encompassing plan that will help the millions of people who desperately need insurance, and whom the insurance companies have chose to ignore.

Every single civilized society needs some kind of government programs to protect the young, the elderly, the sick and disabled. It is naive to assume that any private company or organization is going to offer the social services required to help all those who are incapable of working. It is naive to assume that private industry is going to put the needs of the public before their profits.

This is why 70% of the American public want a public health plan option, and a good one, and why they do not trust the insurance companies to give them adequate health care.

Barbara,

Studies have shown that there is as much as 30% waste in the Medicare system.  If the bank lost 30% of your savings would you say the bank is "working perfectly"?

According to the Association of American Physicians 25% of doctors refuse to treat Medicare patients.  This is largely due to the hassle of having to deal with Medicare and the red tape. Is your solution really "enforced regulations"?  How about discovering why it is such a hassle and getting rid of the red tape? 

Do you really believe public education is good? Have you checked the drop out rates lately?  Some cities are up to 50%.  And some schools are cranking out students who are functionally illiterate. 

We both want a good healtch care plan - but this isn't it!  Our politicians have yet to figure out how to effectively manage any program.  You are right - our sick, disabled and elderly deserve much better than this!

The answer is to come up with simple, clear and understandable plan that anyone can follow and execute without having to hire a lawyer to interpret.

If the people in our society don't demand better then our society will get exactly what they deserve.  You and I must stand up and first recognize that this is a real problem and then insist that our representatives get it fixed. Now! 

Here is something to think about... Will our Senators be under the same plan that you and I are going to be forced to participate in?

The answer is no.  Why is that?  Maybe they need to live under the same plan as the people they represent. That might be just enough incentive for them to get it right.

To be clear:

1.)  "Will our Senators be under the same plan that you and I are going to be forced to participate in?"

In the Senate HELP bill, the answer is yes.  All members of Congress would be required to be in the public plan.

2.)  "Studies have shown that there is as much as 30% waste in the Medicare system."

The study is the Dartmouth College Atlas program, and the finding is for the public and private health care system combined.  This is not to argue that Medicare works perfectly, but that the problem is the health care system as a whole.  Over the past 39 years, Medicare costs have risen an average of 8.8% per year.  But private insurance premiums have 9.9%.

http://www.cms.hhs.gov/NationalHealthExpendData/downloads/tables.pdf

Mike says: "Will our Senators be under the same plan that you and I are going to be forced to participate in?

The answer is no.  Why is that?  Maybe they need to live under the same plan as the people they represent. That might be just enough incentive for them to get it right."

Although no one is forcing anyone to do anything, I entirely agree, Mike, all Americans should all be insured under one plan, Senators, Congressional Representatives, and Presidents alike.

Unfortunately, you have some mis-information. The 30% waste is due to the administrative costs of PRIVATE insurance, not Medicare.

Numerous polls have shown that 59 percent of American physicians now favor national health insurance covering everyone.

Most doctors much prefer dealing with Medicare, even though reimbursement can be lower than with private insurance, because there is so much LESS red tape with Medicare. Have you ever seen a Medicare bill? Very simple and straightforward.

Medicare works well, and does not exclude anyone for pre-existing conditions.

It is private insurance that denies care, drops people after they become ill causing medical bankruptcies, and pays its executives millions of dollars a year.

Mike, I'm afraid someone has you hood-winked.

Tim says:

"In the Senate HELP bill, the answer is yes.  All members of Congress would be required to be in the public plan."

Tim: when?

The Senate HELP bill does not contain a timeline as the House bill does.  The Gateways begin to be formed 60 days after the passage of the bills.  They begin to receive start-up dollars right away and plans within it can begin to negotiate rates once they're qualified.  That includes the "community health insurance option" -- the Senate HELP version of the public plan.

There's a target date to have that up by January 1, 2012, but not a specific mandate or reason it can't be set up before then.  Like most new agencies, when it's up, it's up.

And when it's up, MOCs are required to enroll, per the Republican-offered amendment that both Dodd and Kennedy voted for.  MOCs are the sole exceptions to section 3106 (a) (2) which states, "Nothing in this section shall be construed to require an individual to participate in a community health insurance option, or to impose any penalty for non-participation."

So, let's cut the 30% waste figure in half.  We are still talking about 15% waste!  If you fail to recognize that there is a problem - it will not get resolved.  In fact, you are defending the same old way of doing things. 

Why do you say I'm hood-winked?  Because I haven't drank the kool-aid?  The system is broken - both public and private - Democrat and Republican.  If nobody admits it and focuses on the real problems and not a political agenda it is a sad day for America.

Tim: Thanks.

Mike: I think you and I probably agree about many things...one of them would be: "The system is broken--both public and private--Democratic and Republican." And like you, I'm trying in my own way to "focus on the real problems and not a political agenda."

We need to look for points of agreement. I bet one might be that IF any real healthcare reform passes, it must apply to members of Congress and the Administration first and foremost. Wonder how many Americans would disagree with that? 

Tim - with all due respect.  I rest my case. Section 3106 (a)(2) is a meaningless clause from the standpoint of financial participation.  Your taxes and my taxes are still going to support it whether we "participate" or not.

Do you know what would be great... If someone took the time to enumerate the problems that this plan proposed fixing and how it was going to do it.  You know - the details.  Betcha can't do it.  Please prove me wrong.

Mike's request to "enumerate the problems that this plan proposed fixing and how it was going to do it" reminds me of one of my favorite episodes of the TV show "Friends"... the trivia contest episode where the guys bet the girls their apartment.

Monica: You guys are dead, I am so good at lighting rounds.
Chandler: I majored in lightning rounds. All right, we're gonna destroy you.
Monica: Huh, wanna bet?
Chandler: Well, I'm confused as to what we've been doing so far...

Hah!!  Tim - that is very funny!  I think we do agree on most things. 

I guess I am jaded.  I have started and managed businesses for many years and without a detailed plan you are normally doomed.  Even with a detailed plan you may still be doomed.  But if you don't have a plan it is impossible to get everyone moving in the same direction - at least without a lot of pain and suffering.

Enjoyed the quote from Friends.

I think you all are onto something.  Instead of listening to some folks blame the insurers, lets look at the real problem even the insurers hate, FRAUD!  There is the cost problem, people trying to cheat entitlement programs.  Maybe we should enact serious penalty laws against fraud and stealing from the taxpayer.

Thank you all for turning on the lights:)

Yes, I'm having real regrets about joining AARP when they e-mail me their stupid action alerts.

Well Carla, your statistics are faulty(there are about 8 million people there), but otherwise, it onlybothers me that there are some pretty looney Democrats from the states in question.

This is FAR LESS nasty than what the grass roots protestors are called by this government.  When the government attacks it's own people for non-violent protest, lying about them and maligning them for expressing their honest concerns and opinions, we are degenerating fast.  Now a "snitch" line so citizens can report on other citizens.  And being prepared to try and pass legislation that is overwhelmingly being rejected by the American people.............So much for the Constitution.

WE should start over and put all options on the table for full discussion and debate.  We deserve to have reform done well. 

Are you kidding?  Only a moron would be happy to take a pay cut.  I just got my license renewed at the DMV and the wait was horrendous.  They didn't have signs telling people which line was the right line and after waiting for 30 minutes people would have to switch lines.  They didn't tell you that credit cards were not accepted until you got to the window - many people had to leave to get cash. People had been sitting in chairs for hours waiting to be called.  The DMV was complete chaos.  There is a 50% drop out rate in many cities.  You and I must be living on different planets.

Turk, I know sarcasm when I hear it.

Like I said - "Are you kidding?"  Carla - that generally means something like "you can't be serious".  I got your sarcasm too.

Hi Carla,

I have worked with Medicare when my mom fell and broke her hip in a nursing home.  They were not going to repair her hip and treat it with pain medication and leave her in a wheel chair.  If she had not had health advocates that is where she would have been until she died.  This is what scares me about a public system.  Medicare, at least at this point, is still a system that can be challenged but if the government becomes the only provider and there are no checks and balances we will cross the line where our lives will be decided by what is the most cost effective and take the human out of the human equation of life. Do you really want to contact your Senator to get that hip replacement you think you need?

Don't suggest it can't happen here because it can and let's build upon what works, change what doesn't.

I have seen government in action for 28 years and we are the envy of the world for health care.  I am not willing to change the entire system for the sake of "change". 

Oh come now, Turk.  Greed is alive and well and -- guess what -- it makes a killing off of Medicare.

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

"In 2006, Medicare spent fifteen thousand dollars per enrollee [in McAllen, TX], almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns."

Sounds like the Medicare-taking doctors are doing all right for themselves to me!

Rather dramatically undercut that nearly 75% of doctors still take Medicare, I would say.

Don't let the facts get in the way of a good stump speech, though.

There's nothing misleading here. I included the full quote. More people in employer-based coverage means more people in employer-based coverage.

That means fewer people in the Exchange.

And that means fewer people choosing the public option which is one of many options in the Exchange, running the full private gamut from Aetna to UnitedHealth.

NO ONE GETS FORCED INTO THE PUBLIC OPTION.  PERIOD.  It is one option out of many, and it's open to very few people.

Tim,

I don't see how you are missing the obvious.  The CBO states that 3 million people WILL lose their employer-provided healthcare.  SOME employers will do the math and it will make sense for them. 

The fact that the government option is one choice does mean noone will be forced to take the public option unless it is the best deal. 

It does mean, however, that if you were one of the 3 million and WANTED TO KEEP what you had and your employer dumped the insurance, then you would be faced with choosing from the exchange.  Once there, if economically the government option was the only one that you could afford, you will have de facto been forced into the public option.

So technically your statement is true, but if I am one of the people that fits into this scenario, I am not interested in technical truths.  The practical reality is that some might be forced by circumstance into the public option.

Do you agree?

Nope.  Everyone gets the same subsidies.  Everything's affordable.  And the CBO projects the public option costs no more than 10% less.  If true, I have a hard time saying someone choosing between a $1,000 plan and a $900 plan was forced to choose the $900 plan.  It's just not credible.

Everything is calibrated to a percentage of your income.  The choice is yours.  NO ONE GETS FORCED.  PERIOD.

Tim,

Then why do we need the government option if it is not going to increase access for some by reducing costs?  Increased competition and interstate purchasing in addition to the rest of the Bill stripped of a public option would essentially achieve the same result if the $100 is meaningless.

There are 16 clauses in the bill that refer to automatic enrollment.  The bill is very poorly written in perhaps the worst legalese I have ever seen.  There are hundreds of cross references that can be interpreted in many different ways.

The clause you may referring to is Section 1206. Special Enrollment Period and Automatic Enrollment Process.  It is written in such a way that the "Secretary" has sweeping power to automatically enroll individuals and they cannot decline. 

It seems to violate the principles of the Constitution to "secure the blessings of liberty".  The argument could be made that the Congress has not been granted to power to do what they are proposing in this bill by the Constitution. 

Mr. Grayson, what do you think of Selective Service?  Does it violate the Constitution.

There are various auto-enrollement provisions.  There are no provisions for auto-enrollment into the public option.  It's not in the bill.  Period.  And the Senate HELP bill expressly forbids it.

Mr. Grayson, what do you think of Selective Service?  Does it violate the Constitution?

There are various auto-enrollement provisions.  There are no provisions for auto-enrollment into the public option.  It's not in the bill.  Period.  And the Senate HELP bill expressly forbids it.

Those powers to draft are given under the right to declare war and raise armies and malitias.  A clear power of Congress.  You look too youthful to remember the last time this country drafted an army. I remember getting my draft notice and reporting to Selective Service.  My best friend fled to Canada and there were riots on campuses across this great nation.  I was there and I served my country by going to war.  56,000 died.  Just because you can doesn't mean you should.

The rush to get this done appears to be driven largely by ego and not by the principles of effective management. If the plan is unclear and you have failed to get buy-in from all of the stakeholders it is doomed to failure before it even starts.  Lyndon Johnson made that mistake with Vietnam and George Bush made that mistake with Iraq.

When everyone is on board and the plan is clear success is almost assured.  Roosevelt was highly successful because he only went to war when it was clear to the nation that it was something we had to do. 

Roosevelt was also successful with the original Social Security bill in 1935.  It was only 64 pages long and was a work of art compared to the current bill.  The average citizen could read it and understand it.  The precise details of the plan were clearly spelled out.  This is the kind of legislation Congress needs to create.  See http://www.ssa.gov/history/pdf/fdrbill.pdf and compare it to the current bill.  Night and day.

I didn't mention one aspect of the Social Security bill of 1935.  It's stated purpose was, "To alleviate the hazards of old age, unemployment, illness, and dependency".  It was actually a brilliant plan that formed a cohesive team with each state to solve the problems.  The individual states would implement the plan based on the needs of their population.

History has proven that centralized national systems do not work well.  The Social Security system was initially designed as a decentralized system and worked well for many years.  It was only when it was changed and made more centralized that problems began to surface.

I am against this bill, not because it is not needed, but because it attempts to be implemented in a fashion that has been proven by history to fail.  There needs to be strong state involvement for local populations based on their needs.  It needs to be much better than it is.  The American Citizen deserves better than this.

Roosevelt ruined the country with Social Security!  The compromise towards "social" programs is killing us today (no coincidence that the term is in the title of the program).  He caused the Depression to last longer than was needed with all his band aids and many of us will suffer for it.  Hm, he didn't spend his generation's funds on the program but some future generation(like ours).  The juxtaposition is evident. 

I hope our president doesn't make the same mistakes.  I liked him at first, but now he has lost touch and is certainly becoming a band aid type politician.  I hope he has learned from others.

Mr Labbe, sorry but I strongly disagree.  Did you read the original bill?  It was only 64 pages and extremely well written.  My family was hit hard during the Great Depression and lost their farm. My grandmother and grandfather died with dignity due to the program.  It was the least the country could do for my grandmother who sent 4 boys to fight during World War II while working in the fields to keep food on the table for the rest of the family.  You can read the original bill at http://www.ssa.gov/history/pdf/fdrbill.pdf. 

Did you know the fund actually had money it at one time?  Then, Lyndon Johnson raided it to pay for Vietnam and it opened the door to all of his successors - both Democrat and Republican.  Our Congressional elite failed to make the tough decision and now it is perhaps too late.  Hind sight is always 100%.  If we were allowed to put our money into private accounts we would have a pretty sizable nest egg by now - even if a portion was contributed to the destitute. It is the theft of my hard earned money that makes me mad!

Why do you say Social Security caused the Depression to last longer?  It wasn't implemented until 1935 when the Depression was in full swing. I don't think the people who were starving and standing in bread lines would agree with you. To say it made it last longer is strickly hypothetical.

I for one think we have a pretty great country and it is far from ruined.  I look forward to the next election in 2010 and hope that we clean house and elect representatives who are citizens first, effective managers and decision makers second and financial conservatives.  The principles of balancing your checkbook and having enough capital have proven that it cannot be violated.  Not in 1930 and not in 2008.

This is good.  Let me define my input a little better.

I did not live during the depression (Baby Boomer), but often was surrounded by anti Roosevelt sentiment.  We worked for everything.  If we didn't have enough, we worked two jobs.split wood etc.  Dad often said, if I get in trouble (ie. jail), I'm on my own.  All were expected to move out or go to college at 18.  We never took handouts...

Anyways, there was a phrase that was used, "Roosevelt runined the country"  I believe this country is the greatest on earth, sure, i'm a 20 year vetern.  I'm also a pull yourself up by your own bootstraps type person.  This gives SS not such great marks.  

Anyways, some things are ruined (not everything and not most things...general label problem).  Work ethics and government are two grave concerns of mine.  I won't delve into the first.  We have too many government programs!  Government shouldn't be in the business of handouts and entitlements.  It kills the countries vigor and stamina and I worry when things get really tough, the population will just roll over and give up.  This health care/welfare program is another nail in the coffin.

P.S. I'm glad people benefit from SS but this country made it for almost two centuries without it.

Edward - talking about demands... 

I demand to see where 40 years of social security money that I have paid into my "account" shows up.  Congress makes Bernie Madoff look like a rookie. What was supposed to be held in a "trust" has been spent for other things. 

Chip - interesting info about TennCare.  My biggest objection to any government run system is that there is no incentive for innovation.  Government run agencies don't have to stay ahead of the competition or satisfy their customers.

As an example, I had to renew my driver's license a couple of weeks ago and the process took 2 hours.  The lines were so long they went outside where we stood for 45 minutes.  There was a pregnanent woman, an elderly woman with a walker, another with a cane and several with small children.  It was a hot day and you could tell it was brutal on them.

When the "officer" in charge of the facility walked out of the door I stopped him and asked him if this was normal.  He said, "Oh yeah, pretty much every day."  I then asked what he was doing to fix it, pointing out that some standing in line were suffering.  He said, "I believe the commission chairman is working on it.  We don't have enough people to handle the processing.  It isn't in the budget."  There was not a hint of personal responsibility.

As I got to the counter I began to see people being turned away after waiting in line for two hours because they did not have cash.  There were no signs outside or inside telling anyone they needed cash, except for on the  counter next to clerk.  There was no incentive for anyone to even place simple signs that would have reduced the size of the line and saved people a major headache.  It wasn't anyone's "job" to do so.  It was a pathetically managed operation.

In a competitive free market (the key word here is competitive), if you don't take good care of your customer you will soon find them beating a path to your competitor and you'll be out of business.  This is totally non-existent in a government run entity of any kind.  There is a lack of innovation and a perpetuation of the bureaucracy.

Could not agree more Mike.  I am a vet and have had to deal with federal related veteran issues with the VA.  It is like moving a mountain to get anything done.  There is no incentive to do better, as a matter of fact, I felt I was seen an a inconvenience rather than a customer, let alone a verteran who served my country for 28 years.  (See my previous post regarding bureaucracies.) This is what will occur if a government controlled option becomes the rule. If one has choices, without government contrived limitations, people have options and can take their business elsewhere.   

I see that we as a society need to have a safety net for those that are vulnerable and TRULY destitute.  (Lifeline verses Lifestyle) and those people should be targeted for assistance but otherwise let people vote with their wallets and allow the market to self correct.  I also see a need to address those with pre-existing conditions but any type of monopoly, government or otherwise, will not be in the best interest of health care or what this whole issue is suppose to be about.....the patient.

Cheers 

Mike, we are on the same page.  Let the free market bring out the best in products and services.  People vote with their wallets instead of a government deciding for us.  We are both vets, maybe that is what gives us a "Trust but verify" mentality. 

Mike, on a personal note, thank you for your service.  Sounds like you were in Viet Nam. You served when serving was not vogue.  You went when others fled......Thank you.

Chip