DECEMBER UPDATE: CLICK HERE FOR SHOCKING SENATE RESULTS!!
ATLANTA— The dreaded beast of a health care bill is heading to the House floor this Saturday, if naughty Nancy gets her way. Mrs. Pelosi is breaking her pledges left and right, this time by refusing to post certain aspects of the bill 72 hours before the vote. Driven by the prospect of a short-sited, narrow-minded ideological win over tea-party goers and “Nazis” the world over, Mrs. Pelosi is blissfully looking past the dramatic Democratic defeats on Tuesday and looking towards supposed “victory” this Saturday. She may well have convinced herself that her beleaguered Democratic caucus will walk the plank on her behalf. Party first; country second, she reckons.
What will this Saturday’s vote result in? I’m probably 70 to 30 in thinking this monstrosity will narrowly pass the House. What a shame.
But if it doesn’t pass the House, Democrats should blame Mrs. Pelosi. Armed with an overwhelming Democratic majority placed there by Americans tired of “politics as usual,” Mrs. Pelosi has decided to use politics as usual to arm-twist and force through a bill written almost entirely by liberal House committee heads. She has failed to reconcile in any convincing way with her own party moderates and has basically refused to bring Republicans on board.
Because of her methods, even Nancy Pelosi herself is forced to admit the vote will be close. In my view, this is completely absurd. How can you think it is helpful to write a bill that will affect each and every American, while completely shunning the views of over one-half of the American populace? It is ridiculous, arrogant and tragic. A bill of this magnitude and this much importance should necessarily be bipartisan. There should be no serious concerns over whether it would pass the House.
If we had true leadership in the Congress and in the White House, this wouldn’t be the case.
In my view, this woman is insane. This bill is insane.
Here’s to hoping the thing fails on the House floor on Saturday.
TennesseePaul
Stephen VanNuys
Brooklyn Daniel
The Freedom Thinker
Well, of course it is a dreaded beast of a healthcare bill to some, and a long overdue means to address a very dysfunctional and ruinously costly healthcare market to others. Public opinion is evenly split on this action.
As for the 72-hour posting, I think the test is whether the final bill is amended in any material way from the mark-up version that has been posted for about a week. If anything subservsive is amended in at the last minute, then Pelosi should be hoisted from her proverbial petard. But if not, then it should be conceded that she fulfilled the essence of her pledge. Substance over form.
A “dreaded beast of a healthcare bill” at least stands on some merit. A “very dysfunctional and ruinously costly healthcare market” has substantially less merit. As their are many more debatable things such as the meanings of “dysfunctional” and “ruinously costly”. While the fact that conservatives dread 1,000 page government bills that completely (at the point of a gun) change an industry is much harder to debate. Although I won’t deny that to liberals the non-debatable part is that they probably see this as a “long overdue means to address” something with government force.
I just read this in an email my CEO forwarded to me thought it was funny.
“Let me get this straight. We’re going to pass a health care plan written by a committee whose head says he doesn’t understand it, passed by a Congress that hasn’t read it but exempts themselves from it, signed by a president that also hasn’t read it, and who smokes, with funding administered by a treasury chief who didn’t pay his taxes, overseen by a surgeon general who is obese, and financed by a country that’s nearly broke. What possibly could go wrong?”
lol
Nicely stated. Although I think you should include a statement about how well the H1N1 vaccine program has been handled by the same gov that wants to take over healthcare for everyone but congressmen and their families.
Very true, there, Lordrobot.
IMO, a “very dysfunctional and ruinously costly healthcare market” has every bit as much merit as the concerns about the Democrats’ healthcare bill. The facts are clear that the US spends 50% more per capita on healthcare than any other nation, and that, without something to ‘bend the curve,’ healthcare will rise from 16% of our economy now to more than 20% within a decade. I think we all understand that rapidly escalating obligations under Medicare and Medicaid are the greatest threat to the government’s long term fiscal stability. And in the private sector, the ability of employers to shoulder the out of control burden of insuring employees is coming to an end. I employee 900 people in my company, and I can surely attest to that.
Early in the debate, Congressional Republicans were voicing these exact same concerns. Democrats were all about increasing access, and Republicans were all about reining in the runaway cost of healthcare. Sad to say, the partisanship in Washington has squandered this great opportunity to address the cost issue.
The bottom line is that partisanship has caused our national attention to be divided between “pass the Democrats’ bill” and “stop the Democrats’ bill.” Meanwhile, the raging cancer of the current system carries on, now with no end in sight. Once again, shameless politics has triumphed over intelligently addressing the real problems we face.
It’s dysfunctional because we spend so much on it? Isn’t that our choice? So, by this logic is anybody that buys a high end car like a BWM or Porsche or something dysfunctional??? And that type of thing sould be illegalized. This is called oppression…
I don’t agree that the issue has been partisanship. The Republican’s for what they are worth have made some good suggestions and some not so good suggestions. However, the other side of the aisle has ignored cost (proposing a 1 trillion dollar cost bill) and making it all about health care as a right (a dispicable lie) and increased access. They have not focused at all on cost saying that some how they will save costs. This doesn’t surprise me. Just look at the inefficiency in nearly every government system from education, DOT, DMV, Medicare, Medicaid, IRS, etc. etc.
As a business man, have you heard the story of the underpants gnomes. This is what the government is doing. They have a product like the underpants gnomes. Underpants, they do something with this product, and they make or in the governments case save money. Just like the Dot.com’s of the 90′s. You have to have a better business plan then Idea, ???, and $$$. You have to first answer the question of what your going to do to actually make money or save money. The Dem’s aren’t answering this question with anything other then snake medicine oil.
If as you point out your concern is cost then your enemy should be Dems. This is what we’re trying to stop. Spending. Republican’s have proposed some good spending cut ideas and some not so good ideas. At least they are focused on cost. There is nothing wrong with trying to stop 1 trillion in spending which is actually going to cause COSTS to go UP. I’m a CFO for a health care facility and trust me. If more people go on a government plan like Medicare Medicaid YOUR cost for insurance for you employees WILL go up. However, maybe you just dump them to the government system and cut those costs. In that case I feel sorry for the quality of care they will recieve. Try to find a specialist or surgeon that takes medicare and medicaid. Your going to be in a LONG waiting line.
The Center Square. Please, in the future, distinquish between Health Care and Medical Care. They are two very different things. Entirely different. A doctor cannot change a persons eating habits. Habits which lead to obesity. Obesity, which leads to a slew of medical problems and shortened life span.
Center Square: Thanks for dropping by. In your second post, you hit on something important. This should have been America’s moment to pass substantive health reform. You are correct that health care costs are spiraling out of control and that overwhelming majorities of Americans from the left and from the right want reform to address this.
But where we have gone wrong in this debate is not that Republicans have started playing partisan politics. It’s that Obama let Congressional Committees write the bills, and the Democrats in Congress used seniority to select Committee Heads, and the only Democrats with any seniority are the ones from left wing districts and left-leaning states. So, liberals were constructing the bills in Congress (with the exception of the Senate Finance Committee).
As we know, liberals are the most fringe of the fringe political groups in this country, representing only 20 percent of the ideology makeup of the country, while conservatives and moderates make up so much more.
So it is not any surprise to me that the bills the liberals wrote are incredibly unpopular (well under 50% according to CNN and Rasmussen) and are driving off moderates and conservatives, and causing independents to vote overwhelmingly Republican in the elections last Tuesday.
For some crazy reason, liberals are mad at Republicans for not hopping on board with these health reform plans. But there is basically nothing in these health reform plans that conservatives (40 percent of the population) want. In fact, the vast majority of this stuff conservatives specifically DO NOT want. So of course conservatives are opposed and of course Republicans are unanimously opposed.
Obama and the liberal Dems misread their mandate from last year. Their mandate was to govern with moderation after 8 years of ideological strife under the GW Bush.
Instead, they have governed with a similar, narrow-minded ideological focus and they have done so from the fringe-left flank (never a good place to be in American politics).
This year should have been about true health care reform. The system is out control.
And it would have been if Dems had read their mandate correctly and studied Clinton’s health reform failure in 1993 closely. They would have recognized the way to pass health reform without frightening more than half the country is to do so incrementally and in an overtly bipartisan way.
In short, they should have split up health reform and tackled it in a series of separate bills, over the course of a couple of years.
Had they done this, they would have been political geniouses and a more permanent Democratic reallignment may have emerged.
Instead, the Democratic leadership in the House followed the Rahm Emanuel path: they scraped together a single, comprehensive, left-wing bill while trying to create a sense of crisis and it has exploded in their faces.
The truth is, Center Square, that the Democrats’ bill is not going to address any of the concerns you have mentioned above. It is going to force costs higher, put more pressure on the federal deficit, and reduce the quality of care for most Americans.
This bill WILL make American health care worse.
If this thing passses, you can take my statement to bank.
I agree with most of this, although I think a couple of the particulars are off track. Liberals and conservatives equally define the extremes of American politics. And all the independent polling shows that as many people favor this legislation as oppose it. And I do think the bill addresses some serious concerns about access to healthcare and fixing some of the worst abuses of the private insurance market (e.g., pre-existing conditions). They didn’t manufacture the crisis; that is utterly real. So, it’s not ALL bad. Just a whole lotta bad.
Where I do agree with you completely is that Obama erred horrifically in letting the Pelosi wing of the party take the lead on this legislation. What the heck was he thinking??? But it also is true that the Republicans never did respect the Democratic majority. What the Republicans should have done is accepted the political will of American voters for a quasi-universal coverage option, including even a public option, BUT used their leverage to demand in return that REAL cost containment be in the bill.
After all, that is how politics work best in this country: when Democrats can find a way to meet very real needs (which Republicans have been largely unwilling to do, including in this instance), and Republicans make sure that the mechanisms are fiscally responsible (which Democrats have failed to do too many times to count).
The problem didn’t start when the Congressional Democrats went “liberal,” though. Nor did it start when the Republicans went “conservative.” It started in November 2008, when we the people (ONCE AGAIN, DAMMIT) decided to send nothing but partisan liberals and conservatives to Congress. The die was cast that day.
Everyone: Vote for thoughtful, moderate leaders. Stop drinking your liberal- or conservative-flavored Kool-Aid. Please. We are running out of chances.
hen Democrats can find a way to meet very real needs (which Republicans have been largely unwilling to do, including in this instance)
I’d disagree with the idea that only Democrats look to solve real problems. This appears to be nothing but partisan drivel.
I am a doctor. Sure you set up a program to feed insurance companies under threat of jail time and IRS fines. Congress can get in bed with whomever they want. There aren’t enough doctors willing to work for peanuts or under the rules of no tort reform. So say good-bye to most of the doctors who are already in short supply. The vast majority of doctors that have let medicine over the past 10 years have left due to a lack of tort reform, a takeover of insurance companies, increasing paperwork, and reduction in reimbursements. With this bill you give doctors all negatives and zero positives.
So when your family needs serious medical attention, good luck finding a doctor who will take your cut rate insurance. You can have all the insurance you want, but if the insurance company won’t pay the doctor’s bill, then doctors won’t do business with them. In fact, I will not do surgery unless the patient posts a bond. So I don’t really care how much the insurance decides to pay me. I will get paid my fee regardless. No gov agency is going to tell me that I have to advance credit to a patient with the new cut rate insurance.
I am an American trained doctor with 9 years of medical training before I started in private practice. Maybe you can find some Pakistani doctor to take your cut rate insurance. It won’t be me. I will get paid my full fee. The gov. doesn’t allow any billion exceptions if you want me to save your life, I will get paid for saving it because I have your bond and really don’t care what your cut rate insurance is willing to pay you.
And one more thing. Don’t think you will even get close to a lawsuit with me. Before surgery you will be signing every disclaimer known to mankind. And try to remember that your deal with your insurance company about pre-existing conditions has nothing to do with me. The price of my surgery goes way up if I have to fix a mess of another surgeon and fix ups will include a virtually unlimited disclaimer explaining the hazards of surgery and the compounded risks of altered anatomy. In short, good luck beating me out of my fee or in court on a malpractice claim. Sure it will be a lot of paperwork, but so was the 1900 page health care bill. So what’s another 1900 pages of contract which you can take to your lawyer in advance of surgery. Let him make the decision as to whether you see me or the guy from Pakistan. Then you can sue him for legal malpractice or your estate can.
Why would anyone write a bill that would include zero input by doctors? My response… who cares. Your doctor doesn’t care anymore.
LordRobot, pretty cynical view. I hate to say it, but I’m pretty close to being right there with you in terms of what this will mean for doctors and for American medical care in the upcoming years. Check this post out from a couple of days ago.
http://americanmissive.com/2009/10/30/health-care-disaster-top-4-predictions-for-nancy-pelosis-awful-and-ideological-health-care-bill/
I forgot to mention that I am also a lawyer. At some very basic level everything that gov does creates a series of impediments to survival. Medicare and Medicaid created a system where a doctor that was a medicare provider had to abide all the federal rules which included Stark rules, and price fixing. A doctor could not charge any patient less of a fee than they did any medicare patient or faces charges of medicare fraud for every medicare patient they had seen. So in the last several years medicare has embarked on expanding their criminal investigations of doctors for exactly this kind of thing which they call medicare fraud. So doctors are pretty hardened to medicare and have pretty much abandoned medicaid. These are your examples of gov medicine. Thus, the only doctors that could adjust prices below medicare were doctors that were not medicare providers.
So the great billing scheme erupted. We bill medicare $5000 for a triple bypass and they pay 1250 dollars. So all bills to patients are higher than the medicare reimbursement rate but are never paid. When insurance companies adopted the medicare reimbursement schedule, they told doctors to go after patients if they wanted to collect their fee. But most doctors don’t want to sue patients. Further the insurance contract has nothing to do with the doctor but is between the patient and the ins co. So the doctor can’t sue the insurance company unless he tries to adopt the third party beneficiary approach which has not been successful generally. Of course this could be altered by the doctor’s paperwork between the patient and himself. But this still pits the doctor against the patient.
The simple reality is supply and demand. There aren’t enough primary care doctors to handle all the future newly insured and with the cut rate ins. nobody is going to care. Besides, pre-existing conditions as I alluded to alter the anatomy and risks of surgery. I would just refer those out to the universities and let them absorb the risk and losses.
So cut rate insurance isn’t going to change anything. The only think that will change if IRS will hound citizens to purchase insurance and will do their usual pile on of interest and penalties and jail time for offenders. Nobody is paying attention to the fundamental right to refuse medial care which in broad legal sense may include not buying health insurance. I think it would make an interesting Constitutional challenge. Plus there is something about a gov forcing citizens to buy something that may be unconstitutional on its face. Yes the gov can tax you so if they tax you and then force you to have ins. then they might get away with it but this system is set up differently to force you to buy something and if you don’t then you have to pay taxes.
Further, this is a soak the rich plan and soak corporations. I can promise you that corporation will spin off numbers and migrate to China faster than you can say union.
I don’t see the senate passing this thing. The congress under pelosi has the odball thought process of the 9th Circuit in California. The senate will not touch this thing until next year, which is an election year. So good luck.
Meanwhile, I think the congress will be blasted out of power by conservatives. This bill will virtually guarantee that unemployment will rise in anticipation to 14%. Large corps will reduce payrolls, substitute independent contractors for employees and do a lot of dancing before they waste a lot of money on supporting a system that will just reduce their global competitiveness.
Most of my friends in high incomes are cutting way back on showing income. Look at Warren Buffett. You think he bought a railroad because it is a great business? He is planning to cash out and needs something that can be heavily depreciated. Rail can be a bottomless pit to bury income.
It is all about supply and demand. The gov is just trying to shift the costs of medicare and medicaid in the form of a new tax. But the inefficient mess it will create will raise the cost of medicine across the board with a huge resurgence of medmal premiums. Mark my words, med mal ins. premiums will start creeping up just on the strength of this stupid congressional blunder that will knock out as many as 10% of doctors in the next six months. Doctors are not fertilizer for a society, to the contrary, they are absolutely indispensable; congressional members are not.
What troubles me most about this is that as a group, doctors are like gentle lambs that for the most part enjoy being doctors until they get a frivolous suit, or get chopped up by medicare and threatened with criminal charges. They take all this stuff very personally and suits ruin doctors lives. But this may be a catalyst for doctors to stick together and abandon the AMA and form organizations that represent the interests of doctors, not the AMA’s interest in renting billing codes to the federal gov.
I wish to comment on two of lordroberts’ points.
“So when your family needs serious medical attention, good luck finding a doctor who will take your cut rate insurance.” Let’s not forget that this legislation, while sprawling to many other purposes, is aimed first and foremost at those who lack such access in the first place. Just as Medicaid now may not provide access to the best our healthcare system has to offer, it does gives access to basic services, so too this bill will provide basic access to many millions who currently lack it.
“It is all about supply and demand.” In healthcare, it is not. The market for medical services is a well documented anomaly. Additional supply of services invariably creates additional demand, driving up the cost for all of us. Free market supply-and-demand principles require perfect information. In this case, the gap between the information of the provider and the consumer has proved too great to conform to free market principles.
That’s not to say that I disagree with everything here. It’s just that it is a very complex subject, and I think people on all sides have come to recycle generalizations and apply ideology without really gauging the depths of the issues.
>In healthcare, it is not. The market for medical services is a well documented anomaly. Additional supply of services invariably creates additional demand, driving up the cost for all of us. Free market supply-and-demand principles require perfect information. In this case, the gap between the information of the provider and the consumer has proved too great to conform to free market principles.
Thanks for dropping back by Center Square. Interesting point here. I have read articles that have alluded to this, but nothing that precisely states a free market set of principles cannot apply to health care.
When I hear a statement like this, I always think, well- what is the alternative? In a free market, the consumer negotiates with the provider over the price for a good or service, using the leverage of competition to acquire the good or service at the price they think is most reasonable.
I think these principles should still apply to basic, non-emergency forms of health care. Routine check-ups, prescription drugs, etc. etc. Clearly, such principles don’t apply when someone is in the midst of cardiac arrest- but that should be why we have insurance, for chatastrophic illness.
The alternative to a free market (I assume) is to say that there is some central bureaucracy that should mediate between provider and consumer to dictate prices or and to say what forms of care should or should not be given. That mentality seems to have informed the writers of the house bill, with their creation of various bureaucracies to oversee health insurance, etc. But where that falls apart for me is that these central groups will be too far removed from consumer and provider to understand true needs or to guage the implications of their decisions. Central planners are notoriously ineffective at predicting demand patterns or at nimbly changing to movements in the market.
My guess is central bureaucracies will stifle creativity and medical innovation and slowly over time, more and more Americans will seek different types of advanced care in foreign countries (depending on the type of care and what types of care central planners in other countries have allowed their health insurance to cover and thus allowed for their internal markets to create in response to demand).
Anyway, this is a meandering thought, but I’m curious for you to say what you believe the alternative is to market-based principles.
I still believe market-based principles should still apply to bulk of medical care in this country. That’s why I support the Republican initiatives to focus on high-deductible plans and HSA’s- people spending their own money will seek out lower-priced services. I think it will also allow doctor’s to charge what they think is a reasonable and fair rate in order for them to stay in business.
What we are about to get in terms of ever more pervasive central planning of reimbursement rates will force many doctors out of practice and will scare future talented young people from joining the practice. It will stunt innovation and lower overall quality of care for most Americans.
And in following up to my thoughts here, I assume you are probably talking about advanced forms of care that are made in response to complex medical issues (i.e. greater supply of expensive, advanced care leads to greater demand).
I find that reasoning strange. The introduction of advanced, expensive products in most industries frequently leads to increased demand, which in turn leads to economies of scale, more entrants into the market to supply the good, and over time reduces costs and reduces prices. This happens all the time in the technology industry (iPods, flat screen TVs, etc.).
I really fail to see why this simply cannot happen in health care.
I think the system is so whacked out with regulation, medical malpractice lawsuits, etc. that it has distorted the markets. i think we need to target these things to change the incentive structures in health care.
I’m glad for you to prove me wrong here, but I just fail to see where this does not apply.
Here is a fantastic article which examines in depth the non-free market characteristics of healthcare: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
It is a bit long, but it is well worth the time spent to read it.
As for what does work when a free market does not exist, that’s a good question, and my principle frustration with bills emerging from Congress. They will do a good job of addressing access problems (uninsured Americans, etc.), but a less good job of addressing cost problems.
What I believe will ultimately be the most effective solution to address costs will be that we, the actual consumer, end up bearing more direct financial responsibility for our care. We need to see greater levesl of co-pay, coinsurance and deductibles. We need those who demand the care not be shielded so pervasively from the costs of care. When the price charged by every doctor, every lab, every radiology service, every hospital visit is challenged by consumers, I think it can have a systemic effect. Today, we just write the check for the small co-pay without thinking about it much.
When you think about it, that principle is already proven, albeit perversely: uninsured Americans, bearing the entire burden of their medical costs, access the healthcare system with far lesser frequency than their insured counterparts. A correlation between self-pay and utilization/over-utilization is strongly suggested.
Whether this bill puts us on that path is uncertain. Sadly, it it does not directly put us on that path, a great missed opportunity. I do hope by challenging the insurance industry, this bill will point us in that direction, but it is just that, a hope.
Wow, Center Square, we agree whole-heartedly here, in terms of what you believe is the most effective solution to our problems.
Where I disagree with you is that I believe strongly that this bill in front of Congress does not get to this issue at all. In fact, it takes us further away from it by furthering this illusion that we can all have health insurance, that health insurance can cover all our problems, and that it should all cost a whole lot less. There are just terrible incentives built into such a mentality, as you seem to recognize.
Anyway – will have to read the article you posted. Thanks for sharing, and for your continued discussion of this very critical topic.
The “good” news, if we can call it that, is that the bad incentives intrinsic to an insurance-based approach are with us now. We are already have that in both the private insurance and Medicare realms now. So, I don’t think we will see any material worsening of such ill-effects. We just missed a great opportunity to fix them.
How do we get the consumer to have a stake in healthcare finances, so that the oceanic forces of consumer expectations fix the healthcare market? We have to fix the “moral hazard” and “adverse selection” failures of the private insurance market, and fix tax policy to stop subsidizing private insurance.
Something like this:
(1) Overcome the moral hazard problem inherent in the current insurance market by having consumers pay the first $2500 of ALL medical costs each year; then self-pay at a significant share, e.g., 40%, to a deductible of, say, $25,000; and then insurance picks up all costs thereafter. If need be, develop government safety net programs to insure the higher out of pocket fee structure does not reduce access for the indigent and working poor.
(2) Overcome the adverse selection problem inherent in the current insurance market by legislating that minimum qualifying insurance is mandatory. E.g., young people who carry no insurance, and then dump the cost on the rest of us when they get injured and go on to file bankruptcy. Use a public option if the private market does not provide qualifying coverage.
(3) Legislate that all insurance benefits received by individuals from a third party (employer or government) are taxable income, while all medical expenses incurred by individuals are tax deductible without having to first reach a threshhold. Today, employers can deduct all premiums paid, but employees do not have to report that benefit as income — a massive government intervention in the private sector (that somehow escapes the outrage of many conservatives).
Do those three things — along with a handful of common sense add-ons, such as forbidding pre-existing condition exclusions and allowing full insurance portability — and I bet we’d have a pretty decent bill.
Alas.
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