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So what happens now?

By | January 19, 2010, 6:08 AM PST

The expected election of a Palin-ezoic Republican to Ted Kennedy’s Senate seat marks a turning point in the national debate on health care.

(To the right, Republican Scott Brown as a Cosmopolitan model in 1982.)

It’s great fun for the pundits, but the stark reality remains obscured.

American businesses pay more for less health care than their trading rivals. This subsidizes giant, powerful industries, but it leaves tens of millions facing a neo-Haitian situation, unable to insure against immense risks, and subject to bankruptcy in the event of accident or disease.

Last year’s Harvard study, showing we suffer a 9-11 nearly 15 times each year from premature death due to a lack of coverage, was merely another Inconvenient Truth in the Fox-o-sphere.

Rather than spur compromise, it sparked angry rejectionism, with Democrats unable to cobble together the super-majority needed to overcome it.

This, in turn, is bringing out the inner Tea Partier in Democratic activists. The middle ground is now seen as the yellow line on a country road, a political deadline for whoever stands there.

This is either the beginning of the end for President Obama and the Democrats or the end of the beginning. They can face the reality and full responsibility for failure or they can raise high the standard of political war, becoming just as unyielding as those on the other side.

But what happens now for health care? Some elements of reform, like meaningful use of health IT and efforts to treat the insured not as risks but as a bundle of defined services, are baked in.

The insurance contracts that went into force this month replace the old PPO-HMO choice with a more defined benefit structure, where wellness costs are paid for but strict limits are placed on illness payouts.

The result is that the financial risk of dire illness is being transferred from the insurers to the insured.

  • There are no guarantees that, if you get sick in an expensive way, your costs will be covered.
  • There remains no control over risk rating, meaning you may be unable to get coverage if you have a preexisting condition.
  • There remain no incentives for hospitals and clinics to control costs.
  • There remains no way for individuals and small businesses to get the kinds of deals large businesses get from the insurance industry.
  • Decisions on what must be covered remain in the hands of state bureaucrats.
  • Even rich people may have trouble getting emergency care as services are cut due to a flood of poor uninsured.

It’s a bad deal and there is no compromise coming. Industries primed to face a new reality find instead the old one.

So don’t get sick, and if you do die quickly. The can is getting kicked down the road while players on all sides, and at all levels, point fingers.

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Dana Blankenhorn

About Dana Blankenhorn

Dana Blankenhorn was a contributing editor for SmartPlanet from 2009 to 2010.

Dana Blankenhorn

Dana Blankenhorn

Contributing Editor, Healthcare

Dana Blankenhorn has written for the Chicago Tribune, Advertising Age's "NetMarketing" supplement and founded the Interactive Age Daily for CMP Media. He holds degrees from Rice and Northwestern universities. He is based in Atlanta.

Follow him on Twitter.

Dana Blankenhorn

Dana Blankenhorn

Dana Blankenhorn has been a technology reporter since 1982, a business reporter since 1978, and a writer for as long as he can remember. His Schwab IRA has a few tech stocks in it, most notably some Intel and Applied Materials bought over 10 years ago. But the vast majority of his tiny fortune (emphasis on the word tiny) is invested in mutual funds. He presently writes for no one else but ZDNet, SmartPlanet and himself. But if you've got an opportunity let him know. If he takes the gig he"ll first add it to this disclosure page.

He writes for SmartPlanet and is not an employee of CBS.

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0 Votes
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RE: So what happens now?
I'm sorry to say, but I believe that real "reform" is dead in the water. The unwieldy mess that we're likely to get, if we get anything, is nothing for anyone to be proud of.

My optimism has been replaced by cynicism. RIP Progress -- it was good to know you.
Posted by Den2010
19th Jan 2010
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Perhaps the problem is...
...that what is now in Congress is not healthcare "reform", but an attempt at a healthcare-based "takeover" of over 1/7th of the US economy, orchestrated entirely by back-room deals. The transparency promised by the President lasted less than 36 hours after his inauguration. Take whatever cheap shots you will at Scott Brown, but the fact remains that the Democrats are very close to losing what they've assumed was their crown jewel of entitled Senate seats. In the last minute, they have had to pull all the stops out to try to save a race in the bluest of states that for generations has required little more than a phone-in. This race might as well have been between a block of wood and a brick; it's less about Brown and Coakley than it is about the rampant corruption that has made everyone outside of the extreme-left echo chamber already forget about the Bush years no matter how much they cry "we inherited it".

People are also coming to the realization that as long as "health care reform", "cap-n-tax", the dozen or so other taxes that Congress is currently considering, and other anti-business legislation is hanging in the wind, the economy is going to remain stagnant. (It's difficult to cogitate and execute a business plan when you haven't a clue as to what your capital and labor costs are going to be in the short-term, much less the long-term) It really won't matter if we technically aren't in a "recession" anymore if real unemployment is still hovering around 15%. As much as people need "health care reform", they need jobs and income even more.

So after your little political dig, you actually do ask a good question. What does happen now?

Well, it's entirely likely that even if Coakley wins, the bill may be dead. Democrats facing races in November cannot ignore the fact that they nearly lost their most assumed seat in the living heart of the northeast liberal establishment. Already, we've seen many Democrats fall on their swords by announcing retirement. But many more like their life in DC too much to commit suicide over this, and will back off to save their seats no matter how much arm-twisting the leadership applies. If the Democrats lose in Massachusetts over this, what chance do they have in Peoria?

The reality is that America is still a far more conservative country than the elites realize. Too many know that the Pelosi-Reid "Reform" was always orchestrated as just a big step towards a single-payer system similar to Canada or Britain. And regardless of whatever Paul Krugman says, we know that those systems are a mess.

People want real "reform". Not a "takeover". And nothing more constructive is likely to happen until Congress scraps the current embarrassing mess and starts over.
Posted by JohnMcGrew@...
19th Jan 2010
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RE: So what happens now?
While it is true that there is much to be done to reform our health care system, this bill is not it. While 45000 people a year die from lack of insurance, 99000 die each year from medical errors. The bills being proposed just add more bureaucracy and further remove the public and medical professionals from the decisionmaking in which they should be participating, from what they put in their bodies to what treatments are available when one does get sick. It is the rejection out of hand on partisan grounds of all Republican ideas (not that they are all good) submitted, and the media's participation by reporting as if the Republicans never offered any, which evidences that this is not about fixing a broken system. Yes the Republicans squandered 8 years of opportunity to help get things down the right path, but that is no excuse to let the Dems kill the economy by taxing it into the ground. As I wrote to my Senators, "when you show me that you can run the 65% of our healthcare system that is already under government control (Medicare, Medicaid, Tri-care, etc.) in the black without all the pervasive waste, fraud etc. and deliver a high level of care to those in the system, I will support handing the rest over to you. Until then, clean up your house first before you go invading others." We aren't going to fix anything by passing this bill. Just moving the money around.
Posted by WinstonV
19th Jan 2010
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The charges against the bill
JohnMcGrew@. and WinstonV

I think your charges against the bill are groundless. It's not a
government takeover. It's federal regulation. Taxes have yet to go up
-- let alone are we being "taxed into the ground." Tax rates here are
lower than in countries that are beating us economically.

Ideology is blinding conservatives to reality. I don't condemn that
as some do. I think it's natural. Ideology worked so well,
politically, until if failed the country under the last
Administration.

Rather than acknowledge any responsibility and adjust, those who
believe in the ideology just deny reality and act like George W Bush
never happened.

I think this Massachusetts election is a turning point. Democrats are
as sick of what's going on as Republicans are, and Democrats are
likely to change their strategy as a result.

But not toward "meaningful compromise" as Republicans define it. More
toward kicking elephants where they've been getting kicked. Not
useful in a policy sense, but now necessary in a political one.

Remember. After Humphrey Democrats came up with McGovern, and after
Carter Mondale. Parties take time to adjust to changed ideological
circumstances. It's something that has not faced Republicans in two
generations -- their response to defeat since 1968 has been to become
more like themselves, and it always worked. (Ford's loss begat
Reagan, and Bush's Dole.)

Why change a winning formula?
Posted by DanaBlankenhorn
19th Jan 2010
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RE: So what happens now?
Nice picture of Scott Brown, Dana. Thank you for sharing.
Please find a similar shot of Sarah Palin from her college
days. If that gets out, she'll be our next President.
Posted by dc.martin@...
19th Jan 2010
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Status Quo remains
Although there is still time for more changes to the bill, I am not impressed with what is being done. While the bill fixes some problems, it may make things worse for everyone else.

The worst part of this is that the status quo does not really change. The problem that should be fixed is the access to health care and not adding layers of administrators between the doctor and the patient.
Posted by sboverie@...
19th Jan 2010
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Last time I was in a journalism class, I recall...
...that it was imperative that an honest journalist understand the arguments of both side of the story. Come on Dana, you're smarter than that. Are you honestly going to post here that all of the criticisms of this bill are "groundless"?

Are you honestly going to defend the backroom deals with the AMA, Insurance industry, Nebraska, or the recent deal with the AFL-CIO that will see to it that two citizens with the same job, pay, and benefits will be taxed differently based simply upon union (read: political) affiliation?

Are you honestly going to go on the record stating that ANY of the math on this bill makes sense? Fiscally it is a joke. They've even given up repeating the lie that this is going to be saving money somehow down the road. Nobody, even the party leadership buys that anymore.

It is an attempt at a "government takeover". But don't believe me. Just listen to the leaders in the fight for this bill:

Russ Feingold (D., Wis.): "I would love to see it, and I believe the goal here is to create whatever legislation we have in a way that could be developed into something like a single-payer system.

Gov. Kathleen Sebelius, Secretary of Health and Human Services: "I'm all for a single-payer system eventually. I think what we have to do, though, is work with what we've got to close the gap.

Rep. Barney Frank (D., Mass.): "I think if we get a good public option, it could lead to single-payer, and that's the best way to reach single-payer."

White House Chief of Staff Rahm Emanuel: "The objective is what's important. It's not the means."

Rep. Jan Schakowsky (D., Ill.): "This is not a principled fight. This is a fight about strategy for getting there, and I believe we will!"

Paul Krugman: "Politically, it's hard to do in one step. You have to convince people to give up the insurance--forget about mollifying the insurance companies; that's not going to happen. But you're going to have to convince people to completely give up the insurance they have, whereas something that lets people keep the insurance they have but then offers the option of a public plan may evolve into single-payer, but you can do it politically."

Seems pretty clear to me. Single payer is the ultimate goal. The object of the current bill is to get it passed, and then tweak the unworkable morass until it finally evolves into the single-payer system that they really want.

Taxes will go up. They have to unless they plan on printing dollars or getting loans from the Chinese Communists forever. You might be dumb enough to think that your taxes won't be going up, but they will.

You might be right about one thing; The Democrats are going to need a new strategy fast. But it's not likely going to be the scenario you envision. It's more likely to be like 1994 when the Democrats surrendered a 40-year monopoly on Congress to the GOP. The only question I have is how long with it take the GOP to squander that again.

Either way, how pathetic will it be that the Democrats surrender the seat of "The Lion of the Senate" and the Obama agenda gets derailed by the election of a 1982 Cosmo centerfold model?
Posted by JohnMcGrew@...
19th Jan 2010
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JohnMcGrew@
The charge you originally made -- that this is a "government
takeover" -- is groundless. It's not. And your note here indicates an
understanding of that.

You say it's the first step toward a government takeover. You don't
accuse the current bill of being that. Single payer advocates will
keep pressing their case, just as those who want hands off the
industry completely will keep pressing theirs.

If Democrats don't change strategy -- and they didn't after the
previous reform effort failed -- then they will lose all power in
Washington quite quickly. I agree with you on that.

I am guessing these Democrats aren't that stupid. But, again, I could
be wrong.

I think losing Kennedy's seat to a Cosmo model is humiliating. IT's a
great Republican victory. I don't pretend otherwise.

But I suspect that will get through and we can avoid another 1994. I
think it's triangulation that got the country into this mess.

I also don't think Republicans want to be forced to get 60 votes for
everything either, so if they do take control of the Senate this fall
you can expect the filibuster to disappear in the next edition of the
Senate's rules.

We'll see.
Posted by DanaBlankenhorn
19th Jan 2010
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It IS the first step of an eventual takover...
...and those quoted above leave little to the imagination of that fact. As far as they are concerned, it doesn't matter that this bill is mediocre. In fact, that is the point. The plan is to force an industry-wide change that is so unworkable that the industry will either end up bankrupt, or the public will become so desperate that they will beg for a single-payer solution as the only seemingly viable alternative. Game over.

The irony is that if this bill passes in it's current form, I myself will end up being one of uninsured! My current high-deductible insurance policy will effectively be outlawed since it does not provide all of the "freebies" that the President has been promising. It will far cheaper for me to drop my insurance and pay the 2.5% "uninsurance penalty". I can then bank the difference to cover out-of-pocket expenses as I do now. (My HSA account is likely to be eliminated) If anyone in my family gets sick, I'll just go get insurance then, which I'll be able to since pre-existing conditions will no longer be a problem. If and when we're healthy again, we'll drop the insurance. This is basically what has happened in states that has experimented with this approach, like Washington State in the '90s.

Of course, I won't be alone in doing this. Millions of others who don't work for big employers or the government will do the math I've done and do the same. And there won't be enough rich people paying surtaxes on "Cadillac Plans" to make up the difference. The Chinese Communists aren't likely to fund this for very long either.

Either way, single-payer is inevitable. After my mortgage, health care is my #2 monthly expense. Hopefully by then, my house will be paid for and since working will be so unprofitable, I'll retire and let what is left of the middle class to pay for my health care.

On a superficial economic basis, it's almost as though I should be rooting for it. And yet I don't, because I know better. It will be a disaster economically for the whole nation.

And a Brown win would hardly a great GOP victory, beyond putting the brakes on the Obama agenda. It's basically a victory by default, which is basically all the GOP is capable of. It's sad to think that all they have going for them at the moment is that their agenda is only slightly less pathetic and offensive than the Democrats. Either way, I'll be enjoying the gains in my portfolio as the economy breathes a giant sigh of relief.
Posted by JohnMcGrew@...
19th Jan 2010
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Go JohnMcGrew!
While Dana argues using political dirty tricks (the Brown picture, as an example), McGrew discusses with talent.

Dana asked a very good question. So what do we do now?

Well, the 45 million uninsured was a total lie to begin with. So, why not continue with what we have now? The real number of uninsured "Americans" was, according to estimates and some studies, closer to 10-12 million.

The clear reason for democrats to pass "healthcare reform" was for the government to take over 1/6th of the economy. With that takeover, their grip on power and politics would be guaranteed for many generations to come. That's why they were willing to commit political suicide with the passage of the bill. They understand that once people become adapted to a government program, that it's very hard to undo it. That's what's happened with Social Security and with Medicare/Medicaid. People who depend on those programs feel as if it's a guaranteed right for them.

So what happens now? Well, my personal wish would be for any democratic leaders who feel disillusioned or enraged to go ahead and resign and go back to a regular job in the regular economy. Either that or go jump off the highest bridge they can find.

The best thing that could happen is for the democrats bill to die altogether. Perhaps then businesses all over the country can breathe a sigh of relief and go back to considering growing their businesses and hiring more people. The economy was being hindered while the people in congress were "threatening" to make life more miserable by enacting higher taxes and increasing government control over the economy.

Good riddance to the bill, and good riddance to democrat control over our lives.
Posted by adornoe@...
19th Jan 2010
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Democrats desperately need to lose this one...
The liberal Democrats care absolute zero about the masses, and if you believe otherwise then you've been drinking far too much of their Kool-Aid. Nancy Pelosi and Harry Reid have no interest in anything other than that which lines their pocketbooks, and unfortunately, some of the more severe Republicans have the exact same problem. All too many politicians in Washington are infected with that disease, and until we the people throw them out of office, we'll continue to get exactly what we elect - garbage government.

Solving healthcare is going to require fundamental economic reforms that change the very nature of how companies do business, or we can forget about any meaningful changes to the system. As long as the dollar remains more important than the people to the CEO's of this world, we're screwed. Capitalism may be the best kind of economics, but not without some level of control over just how rich any one person or company can get. If you can't get your head around that concept, think of it as freedom vs. responsibility. You can't have the former without the latter, or you end up with the kind of problems and chaos we have today, as there's just no limit on greed. If WE don't stand up and tell Washington that the greed is going to have to go the way of the dinosaur, we're all in for some serious fiscal pain.

If you don't like them apples, then you're probably a hopeless liberal democrat without a clue... or an elite Republican with more connections and dollars than common sense and ethics...
Posted by sgmunson
19th Jan 2010
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Eduardo in florida
I just know one thing about healthcare after serving the military for 9 years. I don't have any and i cannot afford private policies if i want good coverage them i need 2 jobs or one that has a good medical coverage and inexpensive. where is this country going to? with so much money spend annualy by the goverment and noone can come up with a good answer, sooneer or later we will bw thw haiti of the western hemisphere.
Posted by dominicano51
19th Jan 2010
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RE: So what happens now?
You know why I like your articles so much Dana, because as a conservative I can admit I didn't vote for Bush in '04 and can even appologize for my vote in 2000. You however cannot get past the pollution in your own head that we need this conundrum in this country. Your party is always right!! Well the people of an ultra liberal democratic state have just spoken and if it takes a cosmo republican to stop the insanity so be it. The people have spoken. Now its time to relieve congress of radicals such as Pelosi, Reid, Waters and Boxer and of course my hometown favorite Tim Ryan !!!
Posted by partman1969@...
20th Jan 2010
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So now that we?re done mocking Dana?
?let's answer his question: So what happens now?

Here's what I'll be sending to my representatives, now that we?ve got their attention:

Now that the attempted federal takeover of health care is over, it's time to discus actual "reform". These are the items I'd like to see addressed as a start:

A) Tax employer-provided and private plans equally. Either make privately purchased plans fully tax-deductible (favored by Republicans) or start taxing benefits provided by employers (favored by Democrats). Personally, I don't care which. Either way, the current treatment is unfair to those who are self-employed or work for employers who do not offer health benefits or otherwise wish to purchase their insurance independently.

B) Encourage instead of discourage the adoption of efficient high-deductible plans and health savings accounts. Allow people to fend for themselves.

C) Increase competition by nullifying laws that prohibit insurance companies from competing across state lines.

D) Repeal government mandates that require policies to contain expensive coverage that many consumers do not want. (for example, I don?t want in-vitro treatments or maternity care)

E) Require that health providers make costs transparent so that consumers understand what health-care treatments cost and can make intelligent consumer decisions. No more "secret" prices that you can only find out after you?ve already consumed the service.

F) Two words: "Tort reform". I know too many doctors who pay as much for insurance as they take home in pay.

G) Two more words: "Reform Medicare". Medicare advocates like to argue that they spend a fraction of what the private insurance industry does on overhead. Unfortunately, they also pay several times what the private industry does on fraud, waste, and abuse. When the government demonstrates that it can handle running the systems that it already runs, then perhaps people will be more willing to discuss expanding the role of Medicare to other issues, such as the "uninsured" and "uninsurable".

These are just starting points. But they are points where there bi-partisan progress can be made as opposed to the backroom dealmaking and the "our way or the highway" shut-out represented in the current plan that the public has unanimously rejected.

Get to work.
Posted by JohnMcGrew@...
20th Jan 2010
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RE: So what happens now?
Yeah, what Mr. McGrew says! (intelligent, common sense)
Posted by partman1969@...
20th Jan 2010
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Stupid question, but
What is wrong with "socialized" medicine? This has been a war cry since the early 60's. When I was in the military I had coverage for health that would be called socialized medicine.

If socialized medicine is bad then what about police and fire departments? These are also socialist institutions. Public schools are also socialist institutions and have been treated badly.

John McGrew, you put out several points that are good and some that need more detail. This is good for starting a rational discussion. Your item C, increase competition needs to define what the insurance companies are competing for. If they are competing for providing good medical coverage for low premiums, then I agree but if it is to make bigger profits then this status quo which is not working for enough people.
Posted by sboverie@...
20th Jan 2010
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sboverie, I could go on for hours on what is wrong...
...with "socialized medicine. Suffice it to say that very few things the government does well, and practically none that are done better than those with a profit motive. For example, are you honestly going to argue that our very expensive public schools produce a good product for the money?

At the most simple, I'd say that socialist programs are doomed at both ends of the equation; Since to the end consumer, the cost of the product or service provided appears to be free, there is no reason for them to restrain their consumption of the socialized product or service. On the other end, since there is no profit to be sought, the providers of the socialized product or service has no incentive to produce the product or service efficiently, since they get paid the same either way. In fact, there is a disincentive to produce efficiently. Since there are always limited resources to provide the product or service and demand is nearly infinite, by definitions there will be shortages. Inevitably, the government resorts to rationing as a mechanism to decide who gets how much and when.

If you want more, I suggest googling "what's wrong with socialized medicine" and you will find no shortages of examples.

As for "Item C", what I want the insurance companies to compete for customers. Since states limit competition to companies within the state, and then mandate the coverage that those companies must provide, consumers are often denied cheaper coverage that can be obtained out of state.

And as for "profit": I would not ever do business with a company that was not profitable. If a company is unprofitable, it then means that they likely will not have the resources necessary when I am in need, and will likely have to ration care. Given your socialist tendencies, you probably find this ironic, but that is exactly what happens with socialist systems, which are non-profit by definition.
Posted by JohnMcGrew@...
20th Jan 2010
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RE: So what happens now?
Pigs to earn money just Girbi also took out or what happened at those companies now let's see what to do

Sohbet

Chat
Posted by tahsin29
20th Jan 2010
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Ideology
The problem with JohnMcGrew is he argues everything from the point of
view of ideology.

Mexico gets more bang for its medical bucks than we do. You know some
Americans have been moving there for the medical care, because they
can't afford the co-pays and deductibles here? It's crazy.

But that's "socialism." Can't have anything that smacks of
"socialism." Arguing that way is exactly like Stalin arguing against
capitalism.

There is no such thing as perfection. Those who think the last decade
was perfect are deluding themselves, and trying to delude us.

We need a new political thesis based on muddling through, based on
using what works elsewhere and not being blinded by our own ideology,
and based on the wisdom that comes form the bottom-up.

JohnMcGrew represents the past. Ideology uber alles.

We should do what works. Canada pays 11% of its GDP for medical care
and covers everyone. Other countries pay less. And they get more.

IF that makes me a damned socialist, fine. But it doesn't. It makes
me practical. IT makes me a realist, not an ideologue. It makes me a
capitalist, not a Soviet.

I like flexibility. I love capitalism. But I also know that
capitalism, when treated as ideology, leads to excess. This is
knowledge from the 19th century. Chester Alan Arthur understood it --
that's why he created the first regulatory agency, the ICC. Following
on the Mugwump legacy of the murdered James Garfield.

I am not for building a bridge back to the Gilded Age, especially
after we just escaped a Depression in service to that ideology by the
skin of our teeth.

I do not want the United States of America to become Argentina. So
I'm not listening to Sarah Evita Peron. I'm rejecting that ideology
and the ideologues who support it.

I'm looking for practical answers.

The economy is now growing again, by the way. No thanks to the GOP
idiots that opposed TARP because it was "socialism."

Socialism, schmocialism.
Posted by DanaBlankenhorn
20th Jan 2010
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The pot calls the kettle black.
Scroll to the very top and notice that the guy who says that "The
problem with JohnMcGrew is he argues everything from the point of
view of ideology." started this whole discussion by posting a
picture of a candidate for Congress as a centerfold as a cheap attempt
at discreditation.

Also notice that he doesn't ever discuss the specifics of anything I
say; just delivers broad, cheap shots. It was all pretty much the way
that Coakley, Kerry, and finally Obama responded to Brown. The
country's pretty tired of that, Dana.
Posted by JohnMcGrew@...
20th Jan 2010
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Thesis,antithesis and synthesis
I am not a socialist, I am not conservative and I am not liberal. I am not trapped by the strict viewpoints of any idiology. I am willing to listen to other's opinion and integrate that into what I understand.

I asked a question about what is wrong with socialism but I did not get an answer. Personally, I think "socialism" is not being properly defined in these discussions. If we do not agree to the definition then we can not discuss the good and bad of it.

We are a bitterly divided people. We find more reasons to disagree than we do to agree. The increasing animosity between idiologies is hurting much more than it helps. Abraham Lincoln is quoted as saying "A house divided shall not stand" and our coins have the motto "E pluibus unum" meaning out of many, one.

If we are to find solutions we need to find more things that we do agree with and understand we need input from conservatives, liberals, socialist, anarchists and everyone. Opposing viewpoints are healthy and help the people make better decisions.

In the battle between thesis and antithesis it looks like there is no common ground. But, thesis and antithesis can be united in synthesis. Let go of being rigidly polorized. If you see things in black and white then you are in the dark, lighten up and you will see more colors.
Posted by sboverie@...
21st Jan 2010
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sboverie, in #17 I thought I was pretty clear in answering your question.
Abraham Lincoln is quoted as saying "A house divided shall not stand" and our coins have the motto "E pluibus unum" meaning out of many, one.

Good quote. However, Lincoln would not have suggested that people be coerced into being one. That is what socialism is and does. People who come together to solve common problems of their own free will are far more successful and productive than those who are coerced into doing so.

I am not as ideologically rigid as you might suspect, but there is one aspect of my being that I will never be willing to sacrifice or compromise on, and that is my "freedom". Socialism is the antithesis of freedom. There's little point to lightening up to see more colors, if the only colors you will be permitted to see are the ones dictated by someone else.
Posted by JohnMcGrew@...
21st Jan 2010
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Thanks John McGrew
We agree that freedom is very precious. Any form of government can become tyrannical and there are non governmental collectives that are as dangerous.

Socialism and fascism have bad, well deserved, reputations. The problem is conflating socialism with the population coming together to solve a problem. The biggest objection to having the government supply access to health care is that it is a form of socialism. My objection to the status quo is that it is enabling a plutarchic system where the corporations coerce their rules on everyone else.

The quote by Abraham Lincoln was made before the Civil war, the civil war was to bring the South back into the Union.

You did make several suggestions on health care access and that is better than most other posters. Dana did bring up some other problems with people with pre-existing conditions and also that there needs to be encentives for the health care to control costs. Tort reform can help reduce malpractice insurance to help reduce medical costs.

This is the kind of dialog the American people need to make and then tell their congress critters what needs to be done. Congress is more of a reactive body and it will make many assumptions of what the people want. The government should serve the people and not vice versa.
Posted by sboverie@...
21st Jan 2010
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RE: So what happens now?
John McGrew,

If socialized medicine is so bad why are the two medical systems with the highest customer satisfaction in the USA the VA system, which is completely socialized with government hospitals, doctors and nurses, and Medicare?
Posted by riverat1
21st Jan 2010
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As long as you can overlook the mold and rats...
...you'd probably be okay with the VA. I'd be interested in where you found that the VA has the "highest customer satisfaction". Not long ago, the VA's premier facility, the Walter Reed Army Hospital was the subject of Congressional scrutiny:

From USAToday: "The chairman of a House panel holding hearings today on the care of wounded veterans at Walter Reed Army Hospital said problems at the facility are only the "tip of the iceberg" of poor treatment that extends throughout the military health care system.

"This is the wrong way to treat our troops and serious reforms need to happen immediately," said Rep. John Tierney, D-Mass., in opening hearings in the hospital's auditorium.

The newspaper reported on moldy walls, rats and roaches at the outpatient facility where soldiers are sent after their initial treatment at the main hospital. The series also examined the frustrations of wounded soldiers from the Iraq and Afghan wars who face a bureaucratic nightmare in seeking medical help.

"Rats and cockroaches don't burrow and infest overnight," Tierney said. "Mold and holes in ceilings don't occur in a week. And complaints of bureaucratic indifference have been reported for years."

And this was at the "premier" facility. I can't wait until these people are providing my care too. Can you?

As for Medicare: The problem with Medicare is not quality of care, since almost all Medicare treatment is provided by private practice physicians and hospitals. Since most Medicare patients are oblivious to payment side of the equation, I'm certain that they are quite satisfied with their care.

The problem with Medicare is that (like Social Security) it is not economically sustainable. The pool of people eligible for benefits is growing as the pool of people paying Medicare "premiums" (technically, it's a "insurance" program) is diminishing. Barring radical reform, Medicare will likely be bankrupt before the end of this decade.

The government's main response to this has been to further cut payments to providers, frequently below the cost of providing care. Insured and cash-paying patients have been subsidizing the Medicare patients. The result of this has been more and more providers no longer accepting Medicare assignments. As more doctors and facilities refuse to take Medicare patients, that means more patients seeking care from a diminishing pool of providers willing to accept them. Sooner or later, the quality of care is going to suffer, and/or simply will become unavailable.
Posted by JohnMcGrew@...
21st Jan 2010
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RE: So what happens now?
Walter Reed has nothing to do with the VA. It is an Army hospital. The Veterans Administration is a separate entity from the Defense Department. If you care to take the time you can find reports about VA patient satisfaction online.

Medicare does have its problems but putting patients through hoops to get coverage is not one of them. Since it only covers those 65 and older (for the most part) it has the most expensive segment of our population to cover. I'd be happy if I could take the money my employer spends on health insurance on my behalf and buy into medicare. If people of any age were eligible it would spread the costs over a larger group and ease a lot of the problems.

The real question I have about our health care is why does the US spend twice as much per capita annually than any other industrialized nation with universal health coverage? We don't get twice as good care. It's mostly pretty comparable between us and the western European countries. I don't think it's reasonable to consider health care a free market. When you need it the most is often the time when you have the least time and the fewest options for obtaining it. Did you know that more than half of the personal bankruptcies in the US are due to medical bills and more than half of those bankruptcies for medical bills are for people that had medical insurance. That's the real crime as I see it.
Posted by riverat1
21st Jan 2010
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Why are we so expensive?
Just a few reasons off the top of my head:

A) Health care in the US is not a "free market". The government already purchases over 50% of it.

B) Most consumers are insulated from and unaware of the real costs because they don't actually pay the bills; insurers and the government does.

C) Because of this, there is no incentive to shop for care. In fact, it's almost impossible to. (See suggestion "E" in post 14) How expensive would other goods and services we buy be if we didn't know the price until after we've consumed it and got the bill?

D) Government mandates and regulation forcing us to purchase care we would reject if the money for it actually come out of our own pockets.

E) Other country contain costs by rationing care. They set a fixed amount for care, and once that limit is reached, the waiting lists start.

F) Most people confuse "insurance" with "payment plans". How expensive would your auto insurance be if it covered regular maintenance, new tires, and oil changes all for a $10 co-pay?

G) Most people rely upon employers for their insurance. This is an artifact of the tax code going back to WWII. Relatively few take the time or effort to understand what is and is not covered until it's too late. All they want is their cheap co-pay.

H) We have the best care in the world. Bar none. Very few American's go to Canada for their care (other than to buy drugs). Thousands of Canadiens come here.
Posted by JohnMcGrew@...
21st Jan 2010
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Oh, and finally...
...liability. Depending on the studies you'd like to believe, at least 15% to 25% of our costs goes to defend lawsuits, and "defensive medicine" to prevent them. (Suggestion "F")

Check out John Edward's bio to understand why.
Posted by JohnMcGrew@...
21st Jan 2010
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