Exactly!

You can collect premiums on those who make enough to do so. There have been times in my life where Medicare was better than what I can buy. I would be willing to pay a fair premium for it.

shoulda heard what LBJ went through to get Medicare for us. He basically had to trick the head of the AMA at a press conference! He knew how to get it done and didn't care about "everybody's feelings". He knew the special interests would push hard, so he cheated. Good for him! Good for us!

With a stretch of imagination, one may see that "shutting down" insurance companies (I assume in a sense of forcing them to be non-profit as in all other industrial countries with private insurers) can help, but hospitals? Don't think so.

Hi Lee,

The greatest number of retirees in the history of the United States is entering retirement..The "baby-boomers" {those born after 1946 up until 1964} will be illegible for Social Security benefits and Medicare..will the government health care program be able to accommodate the millions of "boomers"?  Rumor has it, the Bush Administration spent the Social Security fund on financing the Wars in Iraq and Afghanistan...

I agree in part, with lowering the age requirement but what I'd really like to see, is the end to AGE DISCRIMINATION and include ALL the uninsured..!!  How will the government pay for it..??  The same way THEY paid for the Bailouts and the Stimulous packages..just PRINT some more money..!!!...it not backed by Gold, so go figure..right..?

I'd like to correct a couple of myths about Medicare and about the public vs. private option.

Medicare is not free to those who have it.  We have paid into the hospitalization portion for years as part of our FICA (social security) tax.  We also pay a monthly premium (currently about $96 a month) for the out-patient part of it, if we want that.   The two of them pay 80% of our costs.  If we want all of our costs covered, we buy a private supplemental plan to pay the other 20%.   My premiums add up to $190 a month.

If they allow people to buy into Medicare, or if they create another public plan, they will be charging them a reasonable premium, and that's how it will be paid for, same way private plans are paid for.  It's not a giveaway.  The only reason Medicare is struggling is that it currently insures the unhealthiest portion of the population. We've all been paying into it, but costs have gone up so much, and our generation is so unhealthy, it's not enough.

I believe that if younger, healthier people could buy into it, it would strengthen the overall program.  I don't know why they're thinking of inventing another plan.  

The second myth is that private insurance companies don't "negotiate" provider fees.  

Let me tell you what is apparently a BIG SECRET: private companies began reducing our fees 15 years ago, when Managed Care came down the pike.  All but just a couple of them pay less than Medicare, at least to psychologists (nobody negotiates.  They just tell us what they'll pay us, and if we don't agree, we aren't in their networks.  THat's what networks are all about: lowering provider fees.  That's really ALL they are about.)  Our average fee is about $5-$10 less per hour than it was 15 years ago (while inflation is probably around 30% for those 15 years, @ 2% a year).  So in other words, we are now making about 35-40% less, in real terms,  than we were 15 years ago, and that doesn't include all the Managed Care restrictions on how many office visits they'll pay for, etc.  Nevermind that we have mortgages, too.

Meanwhile, healthcare costs have more than doubled in those 15 years.  So guess what, folks. It's not because of doctor fees, which have gone down in a big way.  It's because CEO salaries have mushroomed while they have been lowering our fees.  And the administrative work to keep us under their thumb (preauthorizations, contracts, not paying claims and having to then receive and review them a second time, or third time, and all the phone calls that go into finally getting paid....) that's why their administrative costs are so much higher than the government plans.  Oh, and don't forget the lobbying fees (currently 1.5 million a day or more), and the campaign contributions, and the perks and bonuses, etc.

Healthcare for profit was a dumb idea.  Managed care was an even dumber idea.  The idea was to let the private companies reduce costs, since they are so much more efficient than Uncle Sam, right?  Well, it hasn't played out that way.  

The CEO of Aetna makes over $24,000,000 a year.  So imagine my outrage when I recently received a contract from them wanting to reduce my fee by $4 from last year to barely above what it was 15 years ago.  Without even reducing his salary to an even $24,000,000, the CEO could cover last year's fee for 20 sessions for 3000 psychologists nationwide.  And he'd still make over $24,000,000 a year.  You would think he could even allow us a raise.   I mean, giving us a $5 an hour raise, he would still make more than $23,000,000.   I don't think he'd even notice.  But I would notice. 

The automechanic I take my car to hasn't been reducing his fees to keep down with mine.  Nor has the grocer, or the plumber, or the gas station, etc.  

rant, rant, rant, rant......(but it makes me MAD folks)....private companies do not deserve another chance, in my opinion.  The only way we will get things under control is a government plan, a PUBLIC OPTION!  If they don't have that competition, they'll keep right on paying their CEOs in the millions and millions, every single year....

..if you want to pay for those CEO salaries, you'll have plenty of private plans to choose from.  If you want to protest and boycott them, then you can buy into a public (government) not-for-profit plan that will, guaranteed, give you more bang for your buck.

And you'll make us providers who have been hanging in there very happy.

One of the ironies of Medicare is that the current generation of retirees relies on the current workforce to fund the program. That's why it's becoming unsustainable.

Not only would younger, healthier workers paying more into the system help to bolster the program financially up front, it would provide a healthier more productive base which may not need the same degree of care later in life.

There is also the regressivity of Social Security which currently taxes only the first $107K in wage earnings. Imagine, if you make $107K, your Social Security tax is 12.4% - $6,634. If you're the CEO of Aetna, you pay the same amount - $6,634 - .03% of your wages.

Medicare taxes are unbounded but flat at 2.9%. Imagine a progressive roll upward on that .

With all those untaxed earnings, there's plenty to keep Social Security and Medicare afloat.

I'd bet a million bucks that Obama will not agree to a mandate without a public option. I just know it.

What was that, a prayer to big government?

One more point, NYC Weboy (I'm not as annoyed as this probably sounds--not at you, anyway):  When insurance companies pay their CEOs from 9 to 24 MILLION per year, there are inflated costs.   And I beg to differ on the higher administrative costs.  I deal with them every day, and most of it is unnecessary nonsense.  I haven't had a "Preauthorization" denied in 14 years, even without progress notes.  They are nothing but sillliness and a waste of everyone's time.   The silly contracts we're supposed to fill out for "credentialling" and the months we wait to be "credentialled" are nothing but excuses to keep us out of their networks as long as possible, and pay us as little as possible when we get in.  United Health Care, for one, lowered our fee by $20 an hour 13 years ago, and hasn't given us a raise since.  Talk about low-balling.  That means, when inflation is taken into account, they're paying us more than 50% less than they were 15 years ago.

Nobody has said the public plan will operate as a losing proposition.

I do agree with you that people who work at a healthy lifestyle and keep their weight within normal range should be able to pay less for their premium.  It would go a long way, I think, toward motivating people.   

Oh but if only that fantasy worked out in reality.  A healthy lifestyle is damned near impossible in lower income brackets.  A healthy lifestyle AT BEST lowers risk - contrary to what various people and groups love to imply about it totally preventing various things. Weight alone doesn't CAUSE anything either nor is it SOLELY caused by poor diet and/or inadequate exercise.  For example, Polycystic Ovarian Syndrome (commonly known as PCOS) is found in around 10% of women of childbearing age and the most common form - that involving insulin resistance - typically results in a very swift, rather large and particularly stubborn weight loss that happens without change in diet, that doesn't need for the person to be overeating or eating unhealthily and with insulin resistance even cutting back to the point of anorexia and developing similar exercise habits are often just enough to merely slow or stop the weight gain.  Yet despite all this - and the documentation showing it to be true and to be common - in the US, PCOS is treated almost exclusively as an "infertility problem"...unless you're in the group where the insulin resistance goes on to become Type 2 diabetes or the weight and insulin resistance become Metabolic Syndrome both of which are common complications of untreated PCOS with insulin resistance and a reason why it should be treated at first symptoms along with why weight gain isn't always just a lifestyle thing.

So... what, Pamela, bring Medicaid's coverage of the poor into Medicare? How would that work? Add more levels of complexity to fee for service, and bring in a population that's quite possibly in more need of care?

As you note, the problem with Medicaid now is that it is wildly underfunded, poorly administered, and badly run. I'd add that it doesn't even do what it purports to - that is, make sure that everyone in poverty has coverage and access to basic care.

The more sensible solution, at this point, seems to me to be what the current House legislation proposes: bring Medicaid back to federal control, fund it properly, and make sure not just everyone below the poverty line is covered, but go over the poverty line to 150 or 200%. That, by the way, is a very large percentage of why the House bills are so expensive, and is probably the real story of why health care "reform" - such as it is - is failing in Congress and probably will get scaled back. "Please don't expand Medicaid" is probably the most painful thing a progressive person could argue for, since without that, we're leaving people in poverty with pretty much nothing, and it's entirely unrealistic to suggest that Medicare, at least as its currently constituted could be expanded to everyone in poverty, never mind expansively over the poverty line. I sympathize with your points about poor reimbursement, and I, too, think, good sense favors a move to some sort of single payer (though not, as many progressives suggest, some version of "Medicare for all" because whatever we move to should abandon fee for service first and foremost); but as with many activist proposals, I think the problem is how we get from where we are to anything like what you or I might envision. We have to deal, like it or not, with what we have mnow, and with a public that does not understand many of these issues and fears massive change. Given that, working with the progrmas we have - reforming Medicare, expanding and propoerly funding Medicaid, and making good reforms to pribvate insurance, are doable things that would make a difference. A public option would help... but I don't think it's the holy grail of healthcare reform.

I'm with you!  Fee for service doesn't work!  I wish providers were all paid a base salary, and then on top of that got incentive pay for doing something creative to lower costs!  Right now,  with fees so low, people have to come up with ways to keep seeing patients if they want to make a decent living.

Colin Campbell, who wrote The China Study (which isn't mostly about China), said on Charlie Rose that he mentioned to a colleague that his diabetic patients could get off their meds if they'd change their diets.  His colleague responded, "What are you trying to do?  Ruin my business? My diabetic patients come in once a month for a checkup."

I don't know that we'll ever completely get rid of Medicaid, but it is a bear of a system.  In our state, if Medicaid would simply allow all providers to see Medicaid patients (instead of putting us through months of "policy and procedure" nightmares and requiring physician "supervision") then the low fees would be spread around and all of us would have a small percentage of our patients who were low fee.  Now the Medicaid providers get a reputation for being the low fee provider, and they get all of the low fee patients, and can't make a living.  So they quit.  It doesn't do any good to insure all these kids if there isn't anyone who can see them.

I didn't know that the House was considering bringing Medicaid back under the feds.  That would go a long toward making it more reasonable.  The feds, IMHO, are much better at doing things than the states are.

I'd like to get rid of the age discrimination altogether. A public plan should be THE public plan. If you're getting a 100% subsidy because you're indigent or elderly or getting a partial subsidy to buy into the public plan, it should be the same plan. No more Medicare or Medicaid. Take the burden off the States.

If you're getting federal benefits, then you're getting the public plan. Real simple. Good way to make sure it's a high-quality plan.

I don't understand why they still want to differentiate. At the least, healthier people enrolled in the same program as the elderly and chronically ill would lend to the economic sustainability.

Hi Bruno--

To be clear, once the public option is up and running, it doesn't have access to any more subsidies than Aetna or WellPoint would.  Plans in the Exchange would receive subsidies for those under a certain income, but all plans would have the same chance at being subsidized -- it's up to the choice of the customer.  As a direct result, it's not receiving unfair tax subsidies.

And it certainly doesn't cost $1 trillion!  The $1 trillion is for the full 1,018 pages, not just the 12 for the public option.

Thanks Tim!

Well, I am all for this exchange. I hope it will be part of the reform.

Thanks again!
Bruno

Bruno, can you explain to me why it's even important to save the insurance companies?  They've been ripping us off for years.  Why is it important that they continue?

I agree, we should ban all insurance companies, including auto and life insurance.

Pamela, I am all for having private insurance companies provided that there are clear minimum requirements for coverage (even if there are preconditions) and nobody could be turned down or denied coverage. The borders should be opened so that the companies would have to compete across the whole USA. It would be up to them to decide if they want to concentrate on a few states only. If there is a public option, that would be even better but I think implementing the above suggestions would create enough competiton.

Why should that work? Well, if the same basic coverage has to be provided by each insurance company then how else can they compete than with a lower price for this coverage and/or better service. They will be offering additional coverage beyond the basics and also support prevention because that will save them from future claims.

Fred, I’ll tell you another thing conservatives only want: the low-wage workers that lack the legal opportunity for entry such as the 12 Million undocumented immigrant workers living in the U.S.  Despite the high demand for them, there are no employment visas; in fact there is a huge backlog.  Anyway, I just wanted to point out that fact and also the fact that the family immigration system has not been updated in more than 20 years!

Danetta, I respect the frustration you have with Medicaid as it is curently constructed... but the kind of reform under consideration - whee Medicaid would become a federal program with universal standards, reimbursements and greater Administrative reach would, I think, address a lot of the problems you suggest. I think it's unrealistic to think Medicare can be stretched well beyond its current focus on the lederly, to poor populations that vary widely in terms of health, need for care, access, and issues to address (Medicare, for instance, currently doesn't deal at all with pregnancy or reproductive health). Medicaid needs reform because it is so crucial to  serving a population that is poorly served and needs more support. If changes don't happen, then I agree... it's time tow work to end Medicaid as we know it. But before that... let's try and see if we can get a better program first.

Sorry if I wasn't clear enough.  I hate Medicaid because I've HAD it.  To get it, I had to go from "might be able to work if she could get - and keep - timely access to appropriate care (which even those that said it knew what a fantasy that idea was with the current system)" which meant getting rated disabled and going into a particularly dire level of poverty as a childless person only to find out that Medicaid - even in pre-Governator CA - was dang near worthless on what I needed it the most for due to things like lack of providers, quality of providers or simply because of what MNP Medicaid doesn't cover that regular Medicaid will.  Maybe Federalizing the program and some of the other proposed reforms will fix stuff like this.  I certainly hope so, but I'm not willing to hold my breath after what I've endured and the tone of the health reform "debate" even with the optimism of my now local Congressional Representative, Jim McDermott.

Medicare, I know is hideous in SOME respects.  It's what I have now. It seems to totally forget things like that the program covers people due to disability which means that it'll also be covering people of childbearing age (so as a result things like women's health and prenatal care SHOULD be covered) and there's that damned discriminatory bit about the mental health care coinsurance payments and coverage that's only now slowly being phased out despite the fact that - once again, the program covers people due to disability and a leading (off the top of my head top 3) cause of SSI/SSDI disability is mental illness. Still, it's BY FAR better than anything else I've ever had - with the exception of access to a good charity care program.  The doctors are better and the access to care is better than private insurance. This, IMHO, says volumes about the current more popular proposals to "reform" health care by means of insurance. 

If we could get a working public insurance option, which I think could easily be based on Medicare - IF they'd fix a few basics like the two things above - it could put the insurance companies out of business by pointing out their cruelty and inhumanity.  Then again, if we could get a working assistance program (which would require doing things like taking an accurate assessment of poverty, something the Federal Poverty Line sorely fails to do) and a truly functional Medicaid system, maybe we could buy the time to hold a reasonable debate and know we fixed this bugger correctly from the get go.  Or that might just drag out these flipping mudslinging contests.  Still, something MUST be done.  How many more lives have to be wasted to death or disability just because it's easier to ignore this elephant under the carpet and let people, their families and ultimately the nation suffer than to fix the health care mess?  It's not right to let people be forced into disability, to be allowed to die because needed care is denied, to be forced into bankruptcy, etc - yet these are commonplace in our system.  I don't see anything other than a public option that'd fix this.

But maybe I'm just jaded since the current system so repeatedly failed me or flat out bit me in the butt.

1.      First, I also want to say to the Pres. “stay firm.”  I join Rev Bookburn in urging the President to stand firm against the obstructionists.  Let's get it done.

2.      Look what deregulation did to the banks-

3.      I agree that, “Healthcare for profit was a dumb idea.”

4.      I am definitely worried about the fact that we would now be mandated to buy insurance without a strong not-for-profit alternative, meaning we would be forced to buy insurance that has no price control.

5.      I agree that we need a single, universal risk pool that is equitably funded and would most easily be accomplished through progressive taxes. So why would we continue to support the intrusion of the wasteful private insurers that do no more than take away our choice of hospitals, physicians and other professionals? You are so right on Martin. 

 6.      NYC Weboy makes a good point, "Not only would younger, healthier workers paying more into the system help to bolster the program financially up front, it would provide a healthier more productive base which may not need the same degree of care later in life."

7.     Another good point, "rather than layering yet another public funded and managed care system onto the VA, Medicaid and Medicare, a better solution would be to begin to unify all those systems into a more coherent whole, which gradually draws in additional participants. The larger point is that a public plan simply shouldn't be the "make or break" element of overall insurance reform; it's a necessary part of achieving full insurance... but ultimately, Medicaid and Medicare reform, along with stronger regulations for private insurers would do more, right now, to improve what we have." Thank you NYB!

    8.      Lastly, I do agree that people who work at a healthy lifestyle and keep their weight within normal range should be able to pay less for their premium.     

“weight should be treated at first symptoms - weight gain isn't always just a lifestyle thing. A healthy lifestyle is damned near impossible in lower income brackets.  A healthy lifestyle AT BEST lowers risk - contrary to what various people and groups love to imply about it totally preventing various things,” Thanks Danetta!

I like everything being said save one thing, premium price breaks for a "healthy" lifestyle. I have friends who are vegan and eat only live foods, friends who are ovo-lacto vegetarians, most, like myself, are omnivores. Who is making the healthiest choice and should get a break? Is there a penalty for too many pizzas or trips to the KFC? Some of my friends snowboard and ski, some exercise only at the gym, some climb cliffs, some skydive. There are variations in risk of injury, does that make some active lives less healthy? Millions in Europe drink more wine and beer than Americans and have health care systems and life expectancies higher on the WHO scale. Yet, I know people who think that one drink is one too many and is unhealthy.

I know thin people who exercise, diet, and have high cholesterol and overweight people with low blood pressure. I know guys who smoke a cigar once a week at the poker table. I was subjected to a childhood of second-hand smoke and bad sunburns - that makes me a worse risk than someone who didn't. Should I be charged more for my parents' choices?

Should we charge more for gamblers who might need more mental health coverage? I don't get casinos and lotteries, but I know lots who go regularly and buy tickets. What's a fair loss before we say there's a problem that merits higher premiums? Where does it end?

At some point, we have to stop judging each other and simply help. That's what the insurers do. They look for something that casts aspersions on someone's health care habits and they pull the rug out even if it doesn't relate to the situation at hand.

Exactly Harold.  Health insurance isn't like car insurance (which really should be DRIVER insurance but that's a whole other story) where what one does or doesn't do clearly and directly relates to one's risk as a driver.  Don't maintain the car on schedule? Car has a higher chance of a mechanical failure that could cause or contribute to an accident. Drive when tired, drunk, on intoxicating medications, distracted, etc.? You've got a higher risk of an accident. This is all well PROVEN.

What establishes risk factor and WHY for health care is to good degree still guess work.  Is it being overweight that makes a person high risk or is it specifically something they do or don't eat or a lack of exercise?  If it's one of the latter, then thin people are equally at risk.  If we're speaking specifically of being overweight due to certain hormonal conditions or metabolic ones (like PCOS, diabetes or metabolic syndrome), then sure I'll admit it's been proven connected to risk factors to things like coronary disease - but at this point, we're also talking about GENETIC conditions. If we charge people higher premiums for being overweight due to their medical conditions at this point - without answering the chicken or egg question behind weight and these conditions which so far seems unanswerable - we've effectively penalized what could be millions for illnesses and disabilities. This makes us as evil as the insurance companies about which we complain.

Then too, you're right about things like how one stays thin.  Anorexia and anorexic habits do damage to the body.  HOW I fought my PCOS weight may easily be behind WHY I have gastroparesis - but since no one wanted to do anything other than tell me to "admit to my eating problems, then eat less and exercise more", I had no other directions and no one tested me for PCOS until I'd had its symptoms well over 10 years. What about the damages from diet pills?  Liposuction?  Surgical removal of ribs? Or even less extreme questions like yours - vegan, vegetarian, semi-vegetarian, no red meat, Mediterranean diet (with or without or with how much wine) what IS the right diet?  For that matter who REALLY knows what the right weight is?

I have two remarks regarding some of the suggestion above:

1. Combining Medicaid and Medicare plus adding the public option would create a much too big conglomerate of agencies and administrators. Where would be the competition?

2. Discrimination according to weight, eating habits or whatever is not doable and unfair (see comments on this blog). In order to encourage a healthy lifestyle the insurance companies would subsidize ex. family sport, fitness abonements, yoga courses, etc.

Bruno, I've seen you repeatedly make what are more or less defensive comments for the insurance companies.  If the free market or a relatively free market were our health care path to freedom, how is it ALSO what got us INTO this mess?  It's not just a question for you but one I ask of anyone who defends insurance companies and any variant of "we must protect the free market" in the course of the health care debate.  The "free market", left relatively unfettered, was able to deny rather basic types of care until mandated by either the states or the feds, it's been able to deny insurance coverage (and thus access to care) for anything from a pre-existing condition (which generally means a genetic condition - i.e. a disability) to a risk factor (like taking something as silly as an allergy medication), to making ridiculous and unexplainable profits - often by very subtle tweaks of existing patents (such as a time release version of something on the market).  Health care - as it stands - is one of the last frontiers of the wild west.

Danetta, I am not supporting an unregulated market. We have enough evidence by now that a market without any bounds is not sustainable. However, I support competition within giudelines set by law.

I thought that I was clear in my comment that all the insurance companies would have to cover the same basic needs and could not discriminate anybody for any reason. What are the basic needs? Of course this will give rise to fierce discussions again but why not look at other countries (ex.Switzerland) and come up with similar rules (there are not only cows but also "normal" people like in the US.  :-)). After all the purpose of an insurance is to distribute the risk. There is the lucky smoker who lives into his 90s and there is the not so lucky non-smoker who gets lung cancer with 35. This is life, and therefore we have insurances.

But let's not forget what Tim said in his article above: the public option is only a relatively small (but important) part of the whole health care reform!

Bruno, I didn't say you personally used the word "unfettered" only "free market".  Thing is, "free market" no matter how free or loosely regulated is how we got INTO this mess.  I see no reason to further trust it to get us OUT of this mess, with or without regulation.  Clearly a "free market" even WITH regulation is NOT suited as a solution to health care.  Free markets haven't got the interest of the public enough in their interest to make decisions in the best interest of society or of individuals.  If they did, we wouldn't have page after page, book after book, site after site, and even several movies of stories of health care horror stories about stuff like denied and/or delayed care resulting in worsened illnesses, injury, disability and even death.  We wouldn't have had to argue vehemently to get laws passed to REQUIRE insurance companies to cover basic things - and to cover them equally - like women's health, mental health, and preventive medicine as basic as stuff like testing for diabetes or immunization of children.  We wouldn't be needing the current reform to do away with inequalities like that women can be charged 1.5 times what men are charged. 

And I know a lot about how health insurance works.  Not only have I managed benefits, but I've HAD to learn to get insurance companies to do what I was paying them to do instead of just denying care and taking my money.  No one should need to learn contract law just to get someone (even an insurance company) to do what they've contracted to do - yet that's commonplace in health insurance.

Stuff like these things are why I am so adamant about a public option being a necessity not an option and about health insurance being the problem not the cure.

Free market health care has not yet been tried. How about a few market reforms before enacting a huge new government program?

Haven't been tried?!?  What planet is that on? They HAVE been tried HERE to the detriment of society and to the result of disability and even death of millions.  Had it not been for regulations, the results would be worse.

Please explain. Health care was much less regulated before the McCarran-Ferguson Act and the HMO Act. And you wouldn't believe it but it was cheaper too!

All medical costs were lower, then. It was a question of arresting the unsustainable growth of medical costs - that's why the legislation was pushed through, as an attempt at market reform. It was failed regulation.

To say that free-market health care has not been attempted is either disingenuous or deliberately inflammatory. Administrations under both Roosevelts, Truman, Kennedy, Johnson, Nixon, and Clinton and the concurrent Congresses wrestled with market regulation and access. The first real inroad was Medicare under Johnson. Prior to that, the open market was all there was and people still wanted something different.

Neither free-market nor regulated free-market approaches have limited the growth of costs. There remains the economic fact that a society will get what it wants, get the economic allocation of resources through whatever means it needs to employ. The question is: what's next? We can't look backward to what didn't work before.

What's the next set of reforms that will deliver the goods as the people want them delivered? That's the whole point of the economy and the basis for any discussion of reform.

Thank you Harold.  The whole thing about "if we'd just sit back and REALLY let the free markets do their thing" - when applied to this or any other problematic section of our economy, if taken with a view at history (like, for example, looking back one hundred or so years to why we started regulating the free market back around the time of Upton Sinclair's The Jungle despite cries of "yellow journalism and all sorts of other smear tactics), starts to make the claim look more and more like a spoiled child throwing a tantrum because his/her way either hasn't been gotten yet or didn't work as they thought it would.  Even Einstein said that doing the same thing over and over again but expecting different results is the very definition of insanity - to roughly paraphrase the quote.  This seems to be exactly what the "free market" types want us to do with health reform via insurance.

Actually, the current Democratic reforms have the feature of being exactly like previous reforms: Employer-based health insurance, mandates of all kinds, increasing government control and influence (and thus waste and corruption), and even further severing the link between price paid by customers and what is charged by providers. This behavior of our government, always doing the same thing over and over again, indeed is totally insane and promises to bankrupt our health care system, our government, and our economy.

Which is why I support only what has gone well, single-payer. I want to sever the link between insurance and care, employers and insurance, and I want universal coverage.

As to waste and corruption, it is the profit motive which drives it. Whether we're talking about fraud committed by practitioners, contractors padding work, corporations buying legislators, the root is not our desire or ability to govern, it is pure greed. What possesses anyone to think that the cure corruption is the same as the cause of corruption?

All systems are flawed because all systems are created by people. The system with the least degree of corruption is the best one can hope for. The desire for representative government to allocate resources according to the desires of the people for their own, common well-being is morally superior and infinitely more trustworthy than any motive for private gain beyond well-being.

I'll put my faith in the wisdom of those who struggled against corporate machines and greed.

"The government is us; we are the government, you and I." T. Roosevelt

"Let us never forget that government is ourselves and not an alien power over us. The ultimate rulers of our democracy are not a President and senators and congressmen and government officials, but the voters of this country." F. Roosevelt

"What I am interested in is having the government of the United States more concerned about human rights than about property rights. Property is an instrument of humanity; humanity isn't an instrument of property." W. Wilson

At least you're being honest, Harold. Single payer would be more efficient for a time, but eventually the inefficiency would overtake the system and there would be long waiting lists and needless death. Moreover, doctors would be told what they should earn, not based on the demand for their services but on the whims of a government panel. The same would happen to every aspect of health care. I'm not interested in having a health care system like Canada or the UK, so that's why I oppose single payer and any attempt to get there, like a public option. But I can see why you would like it better, it makes sense on some level, just not on the level of individual rights, which is pretty important.

Nothing being discussed is remotely like the UK system.  Quit being disenguous and blatently misleading.  It MIGHT be roughly comparable to the Canadian system on some levels, I will give you that.

Still, if "individual rights" is the be all, end all deciding factor, how is an insurance company deciding who gets to have what tests when, what treatments when and what medications at what amounts when along with what the providers get to be paid for providing those things AT ALL different speaking in reasonable, LOGICAL terms from any other organization - like a "public option", "public health" or overtly socialized medicine (which, BTW, is NOT even being discussed currently)? Had I received the tests and treatments I needed from my then insurance companies when I *should* have gotten them, not decades later when I finally got them through Medicare, I likely could have delayed or even avoided disability - even my doctors admit this.  There have been myriad stories on the news about people who've died because of denied health care where their insurance companies decided things like proven treatments were suddenly still experimental. Your argument is about a half step from Palin's claim of death panels and similar fringe (and equally false) claims of stuff like "communism".

It's not disingenuous to claim that a "public option" would be the first step to single payer. It's not any more misleading than saying "you get to keep your health insurance" under Obama's plan. Both statements have an element of truth.

And I'm sorry that you got such a bad deal from an insurance company. The free market reforms I am talking about would diminish the power of insurance companies so that they function more like an auto or life insurance company, with competition and clearly defined roles. Right now most people have "comprehensive" insurance and that is the main reason why health care costs are spinning out of control. When a 3rd party is paying your medical bills you have less control over your health care decisions and will be less satisfied with the experience.

Socialized medicine is definitely the current plan under discussion. You will be forced to buy health insurance whether you want it or not, and pay into a program that covers everyone else. That's not very different from a socialized system like that of Canada.

If that is honestly what you believe, you're part of the group that Obama was talking about "calling out" for spreading "misinformation".  Socialism and socialized have NOTHING to do with the current reforms. A mandate to purchase coverage is a far cry from socialized or socialism.  On the contrary, socialized or socialism would have coverage provided for the people, not purchased by the people on the grounds of a mandate. Mandating a person carry health insurance is no more socialist than mandating they carry car insurance.  I can't imagine it's going to be any more effective at getting us to 100% coverage either.

Here's a good place to start for a proper understanding of socialism: http://dictionary.reference.com/browse/socialism

Wikipedia is also decent (and does a good job of explaining the range of socialism): http://en.wikipedia.org/wiki/Socialism

But there's NOTHING remotely socialist about a mandate - nor a public option.  Not any more so than there is about Medicare or our nation's safety net.  And I'd still assert that if a "free market" were going to fix this, it would have done so by now along with that insurance to a large degree IS the problem with health care.

A mandate to buy health insurance is pretty serious. It's the government telling you how to live. Most people associate that with socialism, because that's how life is in most socialist countries, the government tells you what to do. Yes it's a democratic government in our case but that's not much reason for comfort, IMHO.

If you want to ignore the multitude of ways health care is regulated and controlled by government already, particularly State governments, suit yourself. There are ways to improve health care while preserving and increasing individual freedom at the same time. Unfortunately the president's proposal is not one of them.

Instead, the plan is to have everyone pay in, and the government will figure out how to cut costs and then do it. They don't say exactly how, just that there will be various "incentives" and "penalties". It sounds to me a lot like this passage from that Wikipedia article:

"Some socialists advocate complete nationalization of the means of production, distribution, and exchange; others advocate state control of capital within the framework of a market economy"

Control. That is what this is all about.

You're still wrong about it being socialism. Telling you that you MUST buy something is NOT socialism.  It's authoritarianism or fascism.  Socialism would be the government running the insurance companies or directly controlling/approving them somehow and then us having no choices other than which government run or approved company we were going to use for purchase of our insurance coverage. Authoritarianism or fascism is "all live people MUST have health insurance or they WILL suffere a penalty such as paying the $3,800 fine Baucus proposes".  Authoritarianism and fascism are things that can exist in ANY type of system. 

But at this point, we've wandered far off the topic of "what is the public option" and way, way into "political science 101" that quite clearly the American public needs much better education about. So at this point it's way past time to drop the discussion.

This would be the same "individual mandate" that was the requirement of free-marketer Mitt Romney for the Massachusetts plan, otherwise he wouldn't support it.  It's also the top demand of AHIP -- they won't consent to additional regulations unless the individual mandate is part of health reform.

Mark, when it's the top policy request of a man who ran for the Republican nomination for president and the leading insurance industry, I have a hard time pinning this one on the usual imaginary socialists.  Unless you're saying the conservative movement is inherently a socialistic one, of course.

Thankfully I don't look to Mitt Romney or AHIP for a strong defense of conservative principles.

In fact, I look to Massachusetts's experience as evidence that a mandate will not do anything to contain costs:

http://www.boston.com/news/health/articles/2009/08/22/bay_state_health_insurance_premiums_highest_in_country/

I would like to know the multitude of ways health care is regulated and controlled by government already, particularly State governments.

There are ways to improve health care while preserving and increasing individual freedom at the same time. Take a look at the president's proposal.

http://my.barackobama.com/page/content/hcsignon/?returnlink=false&source=20090909_signon_invite

"Socialized medicine is definitely in the bill under discussion" ....ha ha, just because you subjectively without definition apply "socialism" to everthing that scares you, doesn't mean you're right.

Socialism, SCHMocialism, Fascism, SMASHISM, why don't you fear mongers grow up and start contributing some facts and reality to the conversation!

I would also direct you to this comparison of average cost of individual health insurance plans in all 50 states. Why would more competition across state lines not help solve the twin problems of cost and access?

http://mjperry.blogspot.com/2009/08/competition-cure.html

When I had to shop for private insurance a decade ago, Blue Cross Blue Shield denied me because I wrote "Neck Pain" and "Motrin" on my application. They then sent me a letter saying they'd be glad to insure me for over $1000 a month! I was scared and freaked out about this at the time. I found an "agent" to get me insurance, and he helped me to complete my app so that I had to lie to get accepted. He shopped cross the country for me and found me a plan out of Texas. This was the same as other plans I've had since, high deductable, only half of charges covered and a little under $300 a month. It's not worth it. This is not some new thing, buying across state lines. The other insurance I had after this one was out of state too. Coop and trigger are no things in this debate.

Having already written on the question Mark O asks, I refer you all to the following...

http://healthcare.change.org/blog/view/why_health_insurance_dergulation_aint_enough

As much as the First Church of Deregulation holds it an article of faith that the mandates and regulations at the state level have a causal relationship to cost, the data does not support the argument.

The new thing is letting people figure out what they want covered and what they don't want covered, and finding an insurance company to meet their needs. Right now most people only have a few choices, employers often have only one choice, and in the end most states are dominated by a few monopolies. More choice, more competition, all will help to bring down the cost of health insurance and help at least somewhat to bring down the cost of actual health care. We need to go after the entrenched interests of doctors and hospitals too, but nobody's talking about that.

Let's not start name calling either. I have no financial interest in scaring anyone or misleading anyone. My concern is about the consequences, intended or unintended, of government-run health insurance and health care.

Tim, I can see we just talked right past each other. I will have to look closer at the links in that blog post you put up, but you can't tell me that the heavy regulation in states like Massachusetts and New Jersey has had no effect on the cost of health care there.

Everything is interconnected. If one state mandates a certain treatment, hospitals across that state will divert resources to that treatment. People in neighboring states will be affected. There are so many effects of all these regulations and it's all a huge distortion from what the market would look like absent regulations. And in most other sectors of our economy, the market does a pretty good job of distributing goods and services to a wide and varied population.

It does affect cost, in a relatively slight way.  It does not affect cost as much as regional variation in health care spending.  Comparing the map of who has cheaper insurance to the map of regional variation in Medicare spending (where all regulations apply equally) prompts a number of questions -- although hardly a 1:1 correlation either, it matches up more to the map of lower insurance premiums than does # of state mandates and estimated value of said mandate.

http://www.rwjf.org/qualityequality/interactive.jsp?id=38

Take the example of Minnesota, which has the most regulation of any state.  It does not have the highest premium -- it's 13th below average on the chart you link to.  It is also in the lowest band of costs per Medicare recipient.

"Gain is fine but wealth is finite - one can only have more if another has less."

That's just plainly false. Wealth is created every day.

Wealth is collected, converted, traded - it is not created. It is the finitude of wealth that creates the fundamental problems of economics: human desires are infinite, resources are not.

Simple example: A person acquires a newly built house. He is considered to be in possession of wealth. However, the materials in that house could have been converted to other uses - there is the opportunity cost of having a house instead of something else. Moreover, the land on which the house is built could have been used for something else. There is also the fact that the acquisition of the house came at the cost of some other wealth previously possessed by the owner, say cash, which represents wealth converted through labor and capital processes.

There was a choice in the allocation of resources which resulted in a house on a piece of property as being the thing which would get someone to yield the most of some other type of wealth.

This planet is a closed system. We might like to believe that we can simply keep converting materials and printing up more and more representations of our materials conversions to trade for other pieces of converted materials, but we can't.

The best we can do is entice people to give up more of their wealth to us for the things that we do to things.

The market system which helped people decide how to spend their resources helped bring about a more efficient allocation of those resources: As the price of one thing (say, wood siding on a new house) went up, the money was diverted to other uses (say, vinyl siding). When the process is complete, people are indeed in possession of wealth, and since they have coverted their money (a store of wealth) into a final product, they are better off, otherwise they would have held onto their money. Trade between any two people, groups, or countries leads to a division of labor and greater wealth for both groups. Sending your kids to school costs money but brings greater opportunity and wealth. Wealth increases in a market system, but tends to decline in socialist systems. Disagree?

Yes, I do disagree.  Education isn't a guarantee of squat except employment of school employees, builders of the school, etc. It's quite easy - and common - to get an education and still end up in poverty.  Ask any number of people. I personally have a BA with a dual major, multiple IT certifications in stuff like CISCO and Sun Solaris and yet I *still* sit here in poverty thanks to our dysfunctional health care "system".  On top of all that, I have the indignity of a student loan to pay off just to remind me of the promise made by people like you that if I would only "go get an education, I would avoid poverty, be a member of the middle class and have a decent chance at wealth".

Go take your falsehoods and false information elsewhere.  Been down that road already.  I know where it leads.  Back into the tar pit of poverty from which I came - only with a bigger weight to hold me down than the one I had originally.

i become more and more convinced that profit should not be a part of our healthcare.

SINGLE PAYER NOW

Insurance companies are just middlemen who do not offer any value to the situation.

Mark O. You make claims that have no basis in fact. It's just fear mongering plain and simple.

For example, you say that a single payer system would lead to more death. Where do you get your data if other countries have better mortality rates than ours? That means they live longer! Ha!

Other countries do not have better mortality rates than ours. Especially for chronic illness such as cancer.

see, states his own set of facts to suit him.

http://en.wikipedia.org/wiki/List_of_countries_by_death_rate

How does that wikipedia article suit anyone? I'm talking about cancer survival rates.

you said "a single payer system will just lead to more death"

I have PROVEN YOU WRONG

Take it like a man.

How have you proven me wrong? That wikipedia article lists the UK and Sweden as having higher death rates than the U.S., and Canada as lower. Since there are a million factors which contribute to death rates, how does your wikipedia article prove anything?

The most pertinent stat in terms of the health care system is in preventable deaths:

http://blog.worldvillage.com/health/which_country_ranks_high_in_focusing_preventable_deaths.html

http://www.modernhealthcare.com/article/20090520/REG/305209995

http://www.safepatientproject.org/safepatientproject.org/pdf/safepatientproject.org-ToDelayIsDeadly.pdf

Here, the US lags behind many other systems of various market structures. What it indicates is that the US market has failed to create the care system we need; single-payer, socialist, not-for-profit, and more highly regulated systems with lower wages do not negate the creation of better systems.

If the government is the only one paying doctors, how will anyone know what the "normal market rate" is for their services? In other countries their salaries are set by a central planning board. Not exactly a market process.

I know one thing market rate is NOT.  Market rate is NOT the $382 for a "follow up visit" that lasted all of 10 minutes - if you also include the time spent by the PA to take my history and vitals (which was most of the appointment) - with a neurologist.  I really don't give the northbound end of a rat flying back to the south for the winter how you figure it, $382 for 10 minutes even allowing for only 5 patients per hour and 2 weeks vacation per year works out to well over $3M/year - that's a lot of money to explain.  Even with "the cost of med school" and even if he had been paying all of his own overhead (which I'd bet he wasn't since he worked for a clinic system) - even with malpractice and real estate (another cost that I'd bet he didn't personally pay).  Thing is, I know it was HIS rate, because another neurologist from the same clinic charged less than that - and neither collected anywhere near what they charged from Medicare.  Both, as based on level of competence, were grossly overcharging too.

So even under the CURRENT system, who's figuring "market rate"?  Clearly NOT the doctors.

There needs to be oversight to determine what a fair and reasonable fee is for each service. This is based on equipment used, time it's used, and how it is used to diagnose the patients. We need solid clear data. Other countries are way ahead of us on this and we spend one and half times more on healthcare because of innefficiencies and the 30% of the health insurance dollar that goes to overhead and CEO bonuses. Nobody likes 1/3 waste in our healthcare system. The more I find out about this stuff, the more I think we need to get profit out of our healthcare once and for all.

How would you like it if some oversight board in Washington DC told you how much you could make at your job? What if your boss wanted to give you a raise but the "data" used by the "oversight" process determined that the raise was not "fair and reasonable" and thus your raise was denied? Would you be comforted by the fact that the whole process was ostensibly fair and democratic? I doubt it.

Mark O. I've already had that done to me by many employers. "I'm sorry, but you are at current market rate. To keep you equitable with others in your industry, you do not qualify for a raise."

There is already a "standard" out there used by Human Resources managers to determine fair salaries.

GAAAAHHH!!!!!

There's a world of difference between the government setting prices and not getting what you want out of your employment, which is voluntary.

oh, I see. So it's okay if corporate human resources sets fair wage standards.

but not okay for a regulated government agency to do the same thing.

now I see who Mark O. Loves, BIG CORPORATIONS

Don't forget small corporations, startups, sole proprietorships, independent contractors, professional trades, for-profits, non-profits, and any number of VOLUNTARY relationships outside of government which form the basis of wealth and economic prosperity. Yes that is what I prefer.

Harold, I agree that it's complicated, but sometimes the answer to a complex question turns out to be a simple one. I agree that because of our traditionally based insurance model, it has become a hodge podge of efficient and inefficient models out there. Unfortunately, many providers don't take the time to review and analyse their internal processes and waste. I was a part of this process once in a medical group, as a part of a restrucuring. I think that if any provider wants to be profitable, they should do this ever few years to make sure they are still efficient and not wasting. They have to be responsible for their internal waste and bottom line, but it may be up to a board of physicians and experts to determine a fair price for services. If these fees do not cover their waste, they have to cut it to survive.

Also, other countries who have single payer systems SAVE 30% over the U.S. because they don't have profit in their healthcare.

Hi Harold, it was hard for me to see you are for single payer, for some reason. Glad to hear it! Actually, if I'm not mistaken (Tim, correct me if I'm wrong) but I think Medicare reform is a part of healthcare reform. And part of the medicare reform is increasing doctor's fee schedules. The other good thing is reducing or removing the donut hole where seniors get stuck with a sort of deductable at some point, until they meet a certain amount.

As far as doctors suffering, I don't think that's the case. The New England Journal of medicine did a poll recently, and 63% of doctors were for the public option, and an additional 10% were strictly for Single Payer.

Have you heard about the Mad as Hell Doctors touring the country extolling the virtues of single payer? I love these guys!

http://www.madashelldoctors.com/

We never should have allowed Max Baucus to get away with having the single payer reps escorted from the "open healthcare forum" by security like common criminals. Did you see that? I wish the media would play that clip.

I've been following the madashelldoctors.com blog for a few months. I think the AMA is deliberatley squelching the debate and silencing the majority of doctors. That sad part is that they're doing it with the help of our own government. It's rule by an oligarchic minority which far too many voters consider "centrism".

Harold, it's so true, the country showed what's mainstream last November, but now the "powers" are trying to move the goalposts and say we are "far left" and the GOP and blue dogs are centrists.

UGH