Fighting Like Hell for Healthcare Now

At Upper Senate Park on the grounds of the US Capitol yesterday, on a hot, humid DC summer day, 10,000 people from across the country rallied for healthcare reform with a real public option.

They flew in from as far as Washington state, Montana, New Mexico and Nebraska; bussed in from Ohio, Pennsylvania, West Virginia, New York and New Jersey; and made the trip from Florida, North Carolina, Tennessee, Missouri and Illinois.

It was a vibrant crowd, showing the colors of unions that turned out in force: CWA red, UFCW yellow, AFSCME green, SEIU purple, LiUNA orange, IBEW lime, and SIU blue.

They were there not only to rally but to lobby. They understood the urgency with nearly 50 million people uninsured and millions more underinsured and an illness away from bankruptcy. They understood the opposition as the industry lobbyists fight tooth and nail to protect their profits. And they understood the need for citizens to make the case for real reform each and every day until we win.

Maddie, a resident caregiver for children with developmental disabilities in Vineland, NJ, made the bus trip down with AFSCME Local 2215.

"We have a lot of people -- even in the bus that we brought down today -- they have children that are sick. One lady has a daughter who has a rare disease -- she doesn't have any healthcare," she said. "It's more important than getting a raise, or making extra money. We fight health issues every day of our life... The private companies aren't necessarily gonna give us that healthcare, the public option makes sure it's for all. I just hope my brothers and sisters make a statement today and do what we came here to do -- convince Congress."

Ronald, a splicer for Verizon, came from Wilmington, Delaware with CWA local 13100.

"There's a lot of work that needs to be done. Everybody needs to rally together and get this," he said. "We're in America -- strongest nation in the world. We shouldn't be going through this -- with all these people not being able to take care of their family members .... We vote these guys in to do a job -- not to leave their state, come down here to DC, and then all of a sudden they flip the script, they have their own agendas."

Congressman Charles Rangel told the crowd that their efforts were historic, drawing a parallel to the March on Washington.

"Civil rights without the right to health -- you can't use it much," he said. "Remember this day the same way we remember the day that we marched down here with Dr. Martin Luther King. No one knew how important that march was....One day you'll tell your kids and your grandkids that have healthcare, 'Enjoy that, but don't take it for granted because [I] came to Washington on a hot, June day'...."

Senator Charles Schumer -- who has taken a leading role in speaking out for a public plan option (in contrast to weak substitutes like Democratic Senator Kent Conrad's regional coops) -- also fired up the crowd. He called for a public option that isn't "diluted" and told the people to "hold [Congress'] feet to the fire" in this "long, hard fight."

Actress Edie Falco -- a breast cancer survivor -- talked about her past as an unemployed actress who needed to make the same tough choices so many people are forced to make today.

"It's bad enough the emotional impact of not having a job, but to get sick on top of that, and worry every day that [you're] not getting better, figuring out what you're gonna have to do without so you can afford a doctor's visit," she said. "I'm far more familiar with that than I am with my situation these last number of years. I'm here on behalf of all the people who are still in that situation, working hard, doing their jobs, and not being able to take care of themselves or their families."

The rally lasted for about an hour and a half, then folks headed to lobby their legislators or attend town meetings. Pennsylvania -- which had 2,000 people who came down in 36 buses or carpools -- packed the main floor of the Capitol City Brewing Company and its balconies with hundreds of rank and file union members. (There were definitely more than 700 people -- the official capacity of the establishment.) There was word that Senator Arlen Specter was on his way, and with his plans for reelection hinging on Democrats who were unsure about his position on the public plan option and the Employee Free Choice Act, there was quite a buzz.

He kept getting delayed, however, and most were predicting he wouldn't show. In the meantime, Congresswoman Allison Schwartz stopped in to pledge her continued support for this cause. So did Sen. Specter's rumored challenger in a Democratic primary, Congressman Joe Sestak.

Rep. Sestak told the crowd that while his opposition to the Iraq War is often reported as the reason he ran for Congress in 2006, his primary motivation was the debt he feels to the nation for the healthcare he and his family received while he was in the military.

Four years ago his daughter was diagnosed with a malignant brain tumor and given just months to give. But she received the best possible treatment and she is now eight years old. Her roommate her first day in the hospital -- a two year old boy with acute leukemia -- didn't have insurance and treatment was much more difficult to obtain. That was when Sestak began to focus on healthcare for all Americans. He said he's in this fight as "payback to the citizens of this nation" who provided the care his family needed.

The crowd began to disperse as people gave up on Sen. Specter. But about three hours after the meeting began, he showed -- having been delayed, it turns out, by the White House meeting on immigration.

For some minutes before the Senator spoke, the crowd chanted repeatedly, "Healthcare is a right. Stand with us and fight." So when Senator Specter finally stepped to the mic he said, "I compliment you on your tenacity.... And I think Sen. Schumer has the right idea about having a public component which has a level playing field with the private sector."

While it's good news that Sen. Specter called for the public option that Senator Schumer hours earlier said can't be "diluted", we know this is far from a done deal.

It would be good to see President Obama tap into the grassroots energy that brought so many to Washington yesterday. Congress now begins a recess that runs through Fourth of July weekend, and Pres. Obama should barnstorm around the country for the robust public option he wants. With his approval rating remaining high, and 72 percent of the country wanting a public plan, he can tap real momentum which could decide this debate.

Too many craven Democrats are still talking compromise in an effort to win 60 votes. We don't need a few out-of-touch Republicans. What we need is real health care reform that includes the public option, and it can be done with just 51 votes thanks to the arcane "reconciliation" rule in the Senate.

But to win this, it might take the President coming out and fighting like hell -- just like the good people who came to Washington to make their voices heard yesterday.

Comments (148)

1. GREG K.: ....Ronald, a splicer for Verizon, came from Wilmington, Delaware with CWA local 13100....said. "We're in America -- strongest nation in the world. We shouldn't be going through this -- "

   Can splicer Ronald grasp why we're the "strongest nation in the world"? Could it be because we're the least socialized and least-coddled (by Big Brother) of the developed economies?

   Can splicer Ronald recognize the self-evident connection between high illegal immigration and more uninsured? Not exactly splicing science!

   Posted by Happy at 06/26/2009 @ 3:21pm

2. I'm with Happy! I don't want single payer insurance-I can't afford $600 a month. This is just another program for George Sorrus & AmeriCorps, and ACORN to suck money out of Americans. And, his community organizers are voting on the CAP&TAP energy bill that raises our electricity up by 90%-can you afford $600 a month for single payer insurance, plus $200 a month more for electricity, t hen $7 a galon for gas, and he is taxing our soda drinks, our oceans and seas and t hen opening up all the borders?? And brings down 19 missles?????? TAX, TAX, TAX and nore TAXES---and more illegals sucking our Social Security??? Whats left for our children?? Nothing! All small business are closing uo shop,c redit cards up to 30%, all banks have sharia law put into their bank laws, this country is becoming a Russia, COmmunism!!!!!! I say NO, NO, NO to single payer insurance, and NO, NO to CAP & TAX (85% goes to ENRON?? AND ACORN??????? No Thank you!!!

   Posted by saxton at 06/26/2009 @ 3:47pm

3. My medicare part A and B cost me 289.00 for three months my Anthem blue cross blue shield cost me 689.00 per month, because the CEO has to get 15.8 million a year. I have a relative, who is employed by Unum whose sole job is to deny claims. I live on the Canadian border and most of the people here have to go to Canada for their health care. Why are Harry and Louise going to win this one again? Why has health/drug money so polluted and corrupted our political process? Why do politicians leave the senate/congress and become health care lobbyist, Tozan, Brau, Daschle? How did the stench of corrupt money so corrupt our political process? Why do professional doctors leave medecine to go into the health insurance business?

   Posted by julien38 at 06/26/2009 @ 4:23pm

4. The Obamanation that makes desolation and the Demoncrats just can't stop themselves from destroying America like good Regressives! The $787,000,000,000. Porkbarrel politics bill has do nothing to stem the loss of jobs, now at 9,000,000. or create the 2.5 million new jobs in addition to those lost! NOW;

   "Fifteen states have depleted their unemployment insurance funds so far, forcing them to borrow from the U.S. Treasury. A record 30 of the country's 50 states are expected to have to borrow up to $17 billion by next year, said Rick McHugh of the National Employment Law Project, a nonpartisan advocacy group.

   "We are setting the stage for big pressures for states to restrict eligibility and benefit levels," McHugh said. "Those type of restrictive actions undercut the (Depression-era program's) economic and social stability purposes."

   The state-run unemployment insurance programs normally are financed with payroll taxes paid by employers on each worker. But the funds' tax revenues are falling at the same time benefit demands are rising.

   Nine million Americans are receiving jobless benefits, triple the number who got checks at the beginning of the year."

   So NO,NO,NO,NO don't you dare saddle the remaining tax payers and states looking at $142,000,000,000. state total debts with MORE unpayable bankrupt goofy ideas like socialistic healthcare! Businesses and markets need rebuilding and people need employment!

   Posted by BigPasture at 06/26/2009 @ 4:43pm

5. Businesses and markets need rebuilding and people need employment!

   Posted by BigPasture at 06/26/2009 @ 4:43pm,

   rio,

   you repeatedly voted for the people who allowed their banker buddies to squeeze america dry.

   Posted by frosty zoom at 06/26/2009 @ 5:01pm

6. Posted by frosty zoom at 06/26/2009 @ 5:01pm | ignore this person | warn this person

   Never voted for the Demoncrats or Barney or Dodd who were all elected by Wall Street and the Big Bankers?

   Posted by BigPasture at 06/26/2009 @ 6:13pm

7. You do not have to be a brain surgeon to see that government-run health care will bode ill for doctors and medicine, says Dr. David McKalip of the Association of American Physicians and Surgeons.

   But McKalip, who happens to be a St. Petersburg, Fla.-based neurosurgeon, predicts an eventual mass exodus of doctors out of medicine if Congress passes a health care reform bill that contains a mandatory government insurance option.

   "I think you'll see an incremental change where doctors will be squeezed so hard, they will simply start migrating out of medicine," McKalip said at a unique virtual town meeting broadcast on the Internet Thursday evening.

   "The older doctors, 55 or 50 they will leave early. The other ones who are mid-career, mid-generation, young 40s – Well, I'm already supplementing my income in other ways so that I can support my family. I'll practice as long as I can, but I can't practice by paying to work."

   "Unfortunately what's coming is a government takeover of medicine," McKalip said. "The goal is to ration care. Whenever the government takes over medicine, they always ration care. When you bring this up to the proponents, they always say that ‘Rationing happens anyway, we just want the government to do it.' They never deny that there will be rationing."

   Doctors will be forced to ration for the government, he said.

   "They will be forced by being paid less if they don't comply with certain bureaucratic protocol set up in a committee," he said. "They will be forced if they don't do what the hospital tells them to do – because there is a big plan to move all the money into the hands of the hospitals, so that doctors will have to do what they are told, and as it turns out, the hospitals are doing what the government tells them to do."

   Posted by BigPasture at 06/26/2009 @ 6:34pm

8. Posted by BigPasture at 06/26/2009 @ 6:34pm

   Dr. David McKalip is also in private practice and profits by skimming off paying, insured patients and leaving the unprofitable patients for the state to pick-up. So, I'm sure he is deeply troubled by any system that makes that no longer possible.

   Posted by srjenkins at 06/26/2009 @ 6:53pm

9. Posted by BigPasture at 06/26/2009 @ 6:34pm

   Let me provide a little more detail. Let's use a vascular neurosurgeon for an example.

   If you put one in an academic institution, they can make anywhere between $200,000 for just out of fellowship junior attending physician to capping somewhere around $750,000 for your big name attending. A vascular neurosurgeon in private practice starts at around $750,000.

   What's the difference? Academic neurosurgical departments have to provide a whole suite of services, which includes unprofitable practices like pediatric neurosurgery. So, effectively, the lower salaries of some physicians relative to those working in private practice in the same specialty are being used to subsidize these other, unprofitable practices.

   Private practice, on the other hand, only focuses on the money. They are already rationing their care because they don't take anyone that isn't worth it - from their point of view. They frequently cover multiple hospitals and do bread and butter cases because complex cases take more time and often pay less money.

   You also notice that good private hospitals, such as Mayo or Geisinger, follow the academic model and pay physicians the same or lower salaries despite differences in compensation by specialty. This eliminates gouging, questionable referrals and all the other problems plaguing medicine these days.

   Further, despite what he is telling you, it is quite possible to survive on $200,000. I'll try not to shed too many tears for Dr. McKalip.

   Posted by srjenkins at 06/26/2009 @ 7:14pm

10. How to bankrupt America

    Step 1-implement a govt guaranteed healthcare program with "subsidies" for those who cannot afford it.

    Step 2-when the plan goes bankrupt, the govt will either dramatically raise everyones taxes or just print more money (as Obama has admitted below).

    The current pending legislation in Congress:

    <People buying in to the Exchange -- those with incomes up to $43,000 for individuals or $88,000 for families of four -- would get subsidies, called "affordability credits," to purchase coverage.

    Holohan told the House Ways and Means Committee in testimony Wednesday that because it would attract sicker than average people "the public plan could have somewhat higher premiums as a result."

    Would the public plan be subsidized by the federal government?

    Obama acknowledged in his press conference Tuesday that "there can be some legitimate concerns on the part of private insurers that if any public plan is simply being subsidized by taxpayers endlessly, that over time they can't compete with the government just printing money.">

    http://www.msnbc.msn.com/id/31545920/ns/politics-capitol_hill/

    Posted by antisocialist at 06/26/2009 @ 7:15pm

11. New discussion: Online Journalism. Does this graph represent The Nation? Discuss amongst yourselves, my fellow fucktardians.

    http://www.popbitch.com/home/2009/06/23/online-journalism/

    Posted by srjenkins at 06/26/2009 @ 7:27pm

12. There is excellent health care now for the few at the top of the economic heap, but for the general population it is essentially take your chances. There are floors in hospitals where there are suits of rooms reserved for the wealthy. They don't mix with the general population, yet those suits are subsidized by the general population. Most medical schools are also heavily subsidized by tax dollar, yet very little of that cutting edge stuff ever finds its way down into the general population. Most life saving drugs are researched by public dollars here and abroad. Most medical schools are heavily subsidized by tax dollars. I don't care if I have to stand in line for a tummy tuck or a but enhancement, but I would like medical assistance for my buddy who recently died because he couldn't afford his diabetic medication. NO, He was not over weight and he was among the working poor. Neurosurgeons who don't want to work for close to a million a year can lobby for pharma or join the gluttons on Wall street.

    Posted by julien38 at 06/26/2009 @ 7:49pm

13. Where are the dung heap dwellers Harry and Louise? I just saw a commercial with a fraudulent Canadian citizen wit a brain tumor tell me I didn't want the Canadian model. I live on the Canadian border and most of us have to go to Canada for decent health care and affordable medication.Even the local Wal Mart can't compete with them.

    Posted by julien38 at 06/26/2009 @ 7:57pm

14. No government controlled healthcare!

    No government controlled education or "accountability" or testing, especially no teaching of the nonsensical atheist claim of "evolution"!

    No government controlled "coast guard", private corporations like Blackwater could do it better!

    No government controlled stoplights, speed limits or or oppressive, pinko commie traffic regulations of any kind!

    No government controlled appliance safety regs or rules about high voltage!

    Posted by winyahn at 06/26/2009 @ 9:12pm

15. Single payer would not be socialized medicine.

    In fact it could cover everyone now covered and the rest that aren't for the same money we're paying out now. The difference? It's the 31% of the health care dollar that is currently being spent on "administrative" costs. That's another word for the private health insurance industry.

    Single payer would simply cut the middle man out of the equation and let people still choose doctors and hospitals.

    The current system and it's trajectories can't fly. The numbers are totally unsustainable.

    Most of what you hear about single payer from the media is lies and propaganda that is funded and promoted by the PR people in the pay of health insurance companies.

    In any free and open forum where the can get equal time in a debate with PR advocates (professional bullshitters) from the health insurance industry, the single payer experts kick ass.

    The facts clearly and obviously support single payer.

    The health insurance industry provides no medical services. It is worse than parasitic, it is toxic.

    Whether it gets done this year or in five years or three years or ten years; we will wind up with single payer because it is the most logical and efficient way of getting everyone quality care.

    Pure unmitigated greed is not a good way to run health care. It's killing us financially and literally.

    Obviously, every year the status quo can maintain itself is billions of more dollars they can suck out of the lifes blood of our economy...and they are willing to spend billions in PR and lobbying and "contributions" to campaigns to keep people afraid, ignorant, confused ans even terrified of anything that might mean positive change.

    Again, the scam is unsustainable, the nation is broke. They are killing the goose.

    Posted by Nick Lento at 06/26/2009 @ 9:45pm

16. Posted by winyahn at 06/26/2009 @ 9:12pm

    Read Gibbon's Decline and Fall. Relying on mercenaries is the best way to lose any freedom you might have.

    Posted by srjenkins at 06/26/2009 @ 9:51pm

17. Posted by Nick Lento at 06/26/2009 @ 9:45pm

    There is no right to healthcare...it is a service.

    Posted by antisocialist at 06/26/2009 @ 10:11pm

18. <Fighting Like Hell for Healthcare Now>

    We absolutely need to fight with all we have to keep the govt out of our healthcare services.

    Posted by antisocialist at 06/26/2009 @ 10:18pm

19. Obama has to do what's right and hold the line on compromise just to keep people happy. He's trying too hard to get along and be bi-partisen and it isn't working. With 75% support for public health care coverage even if it fails then every single Congressman who voted against health care reform should be voted out. The only reason to vote against health care reform is to protect the insurance companies profits. The "House Cleaning" is clearly not over. Those who vote against health care reform are voting against the best interests of the people of this country and they have to go. Call it voter imposed term limits, 2010 and 2012 will be here mighty soon and then it can be accomplished as it should be.

    Posted by ROinReno at 06/26/2009 @ 10:19pm

20. In fact it could cover everyone now covered and the rest that aren't for the same money we're paying out now. The difference? It's the 31% of the health care dollar that is currently being spent on "administrative" costs. That's another word for the private health insurance industryPosted by Nick Lento at 06/26/2009 @ 9:45pm | ignore this person | warn this person

    Administrative cost; cloak word for malpractice insurance and punitive and exemplary damages gouged out of the system by super rich lawyers of the ABA the largest contributor and supporter of the Demoncrats in every election since....can't remember back over 40yrs!

    Posted by BigPasture at 06/26/2009 @ 11:49pm

21. to "antisocialist" who says there is no "right" to health care I say you are in a small minority.

    In one sense it's already a "right" in that no one is refused emergency room treatment and hospitalization in acute situations.

    Sadly, that's the most ineffective/stupid way to get health care and the most expensive. It's a complete waste of money and single payer universal health care would save all that money.

    You don't have the votes to turn America into a third world nation in which we let the poor die in the streets as most folks don't want us to become Somalia.

    Believe it or not, doing the morally correct thing here is actually going to cut your taxes and make us a much more productive and healthy nation.

    Further, we are also a nation in which there are hundreds of millions of armed people. In your America where no one has any rights and it's a chaotic war of all against all; there would be anarchy and warlordism; maybe that's your idea of "Youtopia" because you think you're the toughest and meanest guy on the block.....but I suspect that we would ALL find that America hellish.

    People taking care of each other is normal and leads to security, wealth and health for all.

    Free enterprise is not threatened by social justice; on the contrary a healthy educated population that sees itself as a unified nation is actually going to be MORE prosperous and more successful on the world stage.

    You aren't going to be allowed to bring America back into the 18th century....it ain't happening. :-)

    Posted by Nick Lento at 06/26/2009 @ 11:58pm

22. uh, oh..

    looks like larry's got some competition in the insurance business:

    "N.Y. Fed to Trim AIG Debt, Receive $25 Billion Stake in Two Subsidiaries

    By Brady Dennis

    Washington Post Staff Writer

    Friday, June 26, 2009

    American International Group announced yesterday that it has reached a deal to reduce its debt to the Federal Reserve Bank of New York by $25 billion.

    The troubled insurance giant, which has received multiple federal bailouts since September, said that it would give the New York Fed preferred stakes in two of the company's crown jewels -- Asian-based American International Assurance, or AIA, and American Life Insurance Co., or Alico, which operates in more than 50 countries.

    Under the agreement, AIG will split off AIA and Alico into separate company-owned entities called "special purpose vehicles," or SPVs. The New York Fed will receive preferred shares now valued at $25 billion -- $16 billion in AIA and $9 billion in Alico -- and in exchange will forgive an equal amount of AIG debt."

    Posted by frosty zoom at 06/27/2009 @ 12:08am

23. Actually Big Pasture...malpractice insurance and claims are not part of that 31%, that's the administrative costs of collecting money from patients/businesses that pay premiums and then processing it and then paying claims....less insurance company profits.

    If you've ever dealt with an insurance company you know the lengths they'll go to to avoid paying a claim.

    Doctors and hospitals hire many thousands of staff people to do battle with the thousands of insurance company bureaucrats to get paid, it's an insane stupid waste of money for all.

    As for malpractice, yes, it's a problem. The ultimate answer if to get rid of incompetent doctors and to train more and better ones and to improve procedures.

    Tort reform in that there is wayyyyy to much money being scammed by the LAWYERS on BOTH sides is a good idea, let's find ways to cut out the middleman there as much as possible.

    Meanwhile read THIS: http://www.medicalnewstoday.com/articles/11856.php

    >>>An average of 195,000 people in the USA died due to potentially preventable, in-hospital medical errors in each of the years 2000, 2001 and 2002, according to a new study of 37 million patient records that was released today by HealthGrades, the healthcare quality company.<<<

    If one of those dead victims was your child, parent of spouse I suspect that you would be singing a different tune.

    It's not about one "ism" vs another my friend. It's about simple benevolent common sense vs short sighted greed and malicious stupidity.

    The free markets work best in an environment where people are free and health and secure about the basic fundamentals of life like health care, housin and education.

    Being selfish and greedy and scared is an unfit way for humans to live; it leads to poverty and war.

    Be intelligent. U Cn doit!

    Posted by Nick Lento at 06/27/2009 @ 12:13am

24. Further, despite what he is telling you, it is quite possible to survive on $200,000. I'll try not to shed too many tears for Dr. McKalip.

    Posted by srjenkins at 06/26/2009 @ 7:14pm

    Spoken like someone who's not a neurosurgeon.

    Posted by plainbruce at 06/27/2009 @ 12:46am

25. Speaking to Happy, being the strongest nation in the world is something that is purely subjective and speaks to too much zealotry in America. But if by strength you mean militarism, we attained the strength by ignoring the needs of the domestic population and funneling money disproportionately toward killing others, instead of saving lives and building schools. Furthermore, the essence of Socialism is a good one, it means working together for individual goals, it doesn't mean you can't make choices or you can't wear your Nikes or shop at the Gap. America is not one of the least Socialized states I would argue, America is simply one of the least Socialized considering it's own citizenry; Business however is another matter, corporate Socialism is alive and well. Rugged individualism is used to dupe the people, and fleece of them of basic social services, enriching those at the top. Businesses engage of collective efforts to squeeze more profits out of the people and improve their bottom line, so what is wrong with us regular folk banding together. Happy, think before you write.

    Posted by Jetfly83 at 06/27/2009 @ 07:01am

26. Posted by plainbruce at 06/27/2009 @ 12:46am

    I know you meant this as some kind of fucktard comment, but it also happens to be true. Why would a neurosurgeon argue against their own interests?

    This is exactly why people need to get better informed so that after they hear about high costs of malpractice insurance, length and costs of physician training, performing surgeries at a loss (which private practice physicians never do), rationing and all the other teeth grinding about holding down John Galt from physicians, they can get a better sense of the other issues they don't talk about.

    One of those issues is how the business model of private physicians rests on providing a narrow, profitable service that takes advantage of the way health insurance is currently provided and garners them incomes that are twice as high as state employed physicians in the same speciality.

    You want to know why health care is so high? Maybe looking at how that is possible might give us a clue, and a physician like Dr. McKalip isn't going to make that point. Nor are physicians going to talk about physician kickbacks for referrals, junk science and all the physician-centered problems in health care.

    So, yes, spoken most unlike a neurosurgeon or any physician for that matter.

    Posted by srjenkins at 06/27/2009 @ 07:39am

27. Of course the insurance and drug companies are going to fight like hell to deny public option health care. Look at the massive profits they stand to loose. the drug industry never has a bad day on Wall street.

    Posted by julien38 at 06/27/2009 @ 08:12am

28. Posted by srjenkins at 06/27/2009 @ 07:39am

    Speaking of fucktard comments, you can toss this entire ignorant rant in the circular file.

    "Why would a neurosurgeon argue against their own interests?"

    So, are physicians lobbying for single-payer insurance arguing against their own interests?

    "performing surgeries at a loss (which private practice physicians never do)"

    I wasn't aware you were informed of the practice habits of ALL private practice physicians. BTW, those private physicians who accept Medicare/Medicaid oftentimes are practicing at a loss. That is one reason why they charge insurance and self-pay patients so much more.

    "One of those issues is how the business model of private physicians rests on providing a narrow, profitable service that takes advantage of the way health insurance is currently provided and garners them incomes that are twice as high as state employed physicians in the same speciality.

    You want to know why health care is so high? Maybe looking at how that is possible might give us a clue..."

    First of all, academic and private physicians in the same area receive the same compensation from the same insurances. So part of the difference is related to higher productivity of private physicians as they don't have the additional (unpaid) responsibilities of teaching, research, etc. Further, private physicians understand that medicine is a business (something that many liberals ignore) and must stay profitable to stay in business. They also understand that the more surgeries performed equals more reimbursement which translates to higher salaries. This is actually a good thing because it encourages physicians to do more,something that will be necessary in the age of rationing that will be forth-coming in Obamacare.

    Posted by plainbruce at 06/27/2009 @ 08:37am

29. Unfortunately, Obama's plan will result in decreased reimbursement, which in turn will lead to decreased productivity. Those physicians who don't want the headaches of a state-run program will likely retire if old enough or find a new line of work, as Dr. McKalip stated.

    BTW, as I look at this, I'm curious. Do you also begrudge the academic physicians who make $750,000/yr or is it just the private physicians who make the same amount?

    Posted by plainbruce at 06/27/2009 @ 08:41am

30. Posted by plainbruce at 06/27/2009 @ 08:37am

    "So, are physicians lobbying for single-payer insurance arguing against their own interests?"

    How many physicians are arguing for single-payer insurance? What kinds of practice do those physicians have? For physicians in unprofitable practices or certifiable altruists, their own interests lies in single-payer. For everyone else, the answer to your question is yes.

    "BTW, those private physicians who accept Medicare/Medicaid oftentimes are practicing at a loss. That is one reason why they charge insurance and self-pay patients so much more."

    In what way is this is different from academic environments? Care to offer an estimate of how many private practice take Medicare/Medicaid? Of those, how many do you think have figured out some other way to make money off of it, whether it means getting a cut from the hospital fees or some other compensation?

    "First of all, academic and private physicians in the same area receive the same compensation from the same insurances."

    You are ignoring the whole patient payer mix. You are also ignoring the fact that physician fees are not the only compensation arrangements.

    For example, if I were taking stroke call, the physician fees are next to zero. So, hospitals offer some physician compensation in order to get people to provide stroke coverage because they make money from the hospital stay.

    Posted by srjenkins at 06/27/2009 @ 09:19am

31. Posted by plainbruce at 06/27/2009 @ 08:37am

    "So part of the difference is related to higher productivity of private physicians as they don't have the additional (unpaid) responsibilities of teaching, research, etc."

    This is a legitimate point. However, you and I both know that what private practice physicians do is spend a lot of time running around to different hospitals doing surgeries for paying patients. Academic physicians, on the other hand, work at institutions with much higher patient volumes and decidely worse payer mixes after private practices is done cherry picking patients. The argument that they are working twice as hard and therefore deserve twice the compensation is bullshit, and you know it.

    "Further, private physicians understand that medicine is a business (something that many liberals ignore) and must stay profitable to stay in business."

    Remarkably, places like Mayo treated medicine as a social good and put patient care above profitability - and they provide better care at a lower cost while still covering their expenses. Treating medicine as a business is precisely the problem in modern medicine because your goal becomes to make a profit over treating a patient.

    "They also understand that the more surgeries performed equals more reimbursement which translates to higher salaries."

    Actually, it's eat what you kill that causes it. Even if an academic bills millions in physician fees and still gets a million or two in collections - they still make their salary with a bonus. They don't clear everything they earn. That's part of what translates into higher salaries for private practices because they own the practice.

    ...age of rationing...

    There's rationing in every system. This is just code for you don't like this kind of rationing.

    Posted by srjenkins at 06/27/2009 @ 09:28am

32. Posted by plainbruce at 06/27/2009 @ 08:41am

    Doubtful. I'm also not sure that "productivity" is the right way to measure what a physician does. It's like saying we should increase teacher's "productivity" by increasing classroom sizes - despite the fact that there is a threshold where more students leads to negative returns for learning. Same goes for patients and patient care.

    "Do you also begrudge the academic physicians who make $750,000/yr or is it just the private physicians who make the same amount?"

    I don't begrudge the salaries at all. If you are an experienced neurosurgeon working 18 hour days and making life and death decisions every day, $750,000 may be far too little.

    What bothers me is all those physicians that rake in $750,000+ that work cake hours, treat their practice as a "business", while making patient care decisions based on whether it is profitable or not and short-changing other aspects of the practice that are as important to patient care but not billable. There is a whole class of physician that is basically living as parasites on the current system. These people are not a rarity, and the worst examples I know of are in private practice.

    Posted by srjenkins at 06/27/2009 @ 09:40am

33. A Big BINGO for srjenkins...

    ...for this gem: >>>"Remarkably, places like Mayo treated medicine as a social good and put patient care above profitability - and they provide better care at a lower cost while still covering their expenses. Treating medicine as a business is precisely the problem in modern medicine because your goal becomes to make a profit over treating a patient. "<<<

    Theoretically, either a single payer or a purely commercial model would bit work out to the same high level of affordable care if every individual in the system was a compassionate altruist.

    We, as a nation...and as a species, are not anywhere near that state of human evolution. That's why we do need laws, governments, rules and regulations....because we HAVE evolved to the point where there is a generalized social/political contract that expresses a collective wisdom that we are all better off when we take care of each other in fair and decent and humane ways. That's what the constitution is all about.

    As it turns out, we are happier, healthier AND wealthier when we act as a common community as opposed to as a collection of disconnected cut throat "individuals".

    Single payer represents a material manifestation of common human decency. It is good. Cooperation is good. Sharing is good. Being respectful of the value of human life is good.

    The system we have now has multiple and myriad layers of perverse incentives that financially reward people for being selfish, lying, manipulative greedy scumbags. The cumulative effect effect of such a system is that everyone screws everyone as it is a battle of "all against all". That dynamic is what causes just about all of our economic and environmental problems too....all of these issues are connected.

    Posted by Nick Lento at 06/27/2009 @ 11:59am

34. "How many physicians are arguing for single-payer insurance? What kinds of practice do those physicians have? For physicians in unprofitable practices or certifiable altruists, their own interests lies in single-payer. For everyone else, the answer to your question is yes."

    First of all, this is BS. They are ALL arguing against their own self-interests. When socialized medicine kicks in (and it will), reimbursement will undoubtably decrease, regardless of specialty. FYI, tens of thousands (or so I'm told by the Nation) are stupidly in favor of just such a thing. There is even a website dedicated to physicians for single-payor.

    Posted by plainbruce at 06/27/2009 @ 12:30pm

35. "You are ignoring the whole patient payer mix. You are also ignoring the fact that physician fees are not the only compensation arrangements. "

    I did not mean to give the impression that I was ignoring payor mix. I wasn't. This is a natural part of physicians going it on their own and starting a business.

    And lets be very clear about this one point. MEDICINE IS A BUSINESS. There is no other way around it. To pretend otherwise is disingenuous. Physicians have bills and expenditures just like every other business. Problems arise when third-parties intrude and attempt to decrease reimbursement without regard to a physicians costs. This is why doctors will start limiting their payor mix, usually governement payors. You hear it every time government start talking about making cuts. Who will it affect the most? The patients because doctors can't continue to accept new Medicare patients with an ever-decreasing reimbursement without taking an even bigger hit. This doesn't apply to specialists only. It affects PCPs also. As an example, I charge ~$37 to give an antibiotic shot. Do you know what Medicare pays? 9$. Now, how do you stay in business with reimbursement like that?

    Posted by plainbruce at 06/27/2009 @ 12:54pm

36. It will be interesting to see how the seniors will feel about having a government goon decide who is worth treating and who just gets a pain killer - our president is one cold sob.

    Before we subhumans are enlisted in a sub-standard health care system, ask the politicians if they will join the same system or keep their gold-plated-we-are-better-than-you-so-screw-you-system. I wonder if Ted Kennedy would fair as well under the mandated system as he is now.

    Posted by pyeatte at 06/27/2009 @ 1:00pm

37. It's morally wrong to leave 100 million Americans un or underinsured, 1 illness away from financial ruin. And it's wrong to burden small business with the outrageous insurance costs also -- found a cool site; Balkingpoints ; incredible satellite view of earth

    Posted by reg373 at 06/27/2009 @ 1:13pm

38. I urge everyone to read the analysis done by Betsy McCaughey of the proposed Kennedy healthcare bill. You can also read the entire bill posted online if you want to wade through all the legal verbage.

    Everyone will suffer except for the excluded special people - politicians, tort lawyers etc. Yes, there will be no tort reform, stated publicly by the manupulator-in-chief. So, the tort lawyers will be fed while rest of us will be abused - enjoy.

    Between screwing the American people with cap-and tax and unjust public health punishment, I wonder how much will be tolerated before we degenerate into a terrible revolution? You know what happens in revolutions...people who cause them...

    Posted by pyeatte at 06/27/2009 @ 1:22pm

39. "For example, if I were taking stroke call, the physician fees are next to zero. So, hospitals offer some physician compensation in order to get people to provide stroke coverage because they make money from the hospital stay."

    You have me confused with "physician fees." Actually, physician REIMBURSEMENT is next to zero if not zero for hospital call (not just neurpsurgery, but many specialties). Tired of giving services for free, physicians negotiated with hospitals to get some form of payment. Hospitals pay it in order to continue offerring those services for the community.

    (I should specify that I'm largely referring to private physicians in community hospitals. Academic hospitals already have coverage with residents, etc.)

    Posted by plainbruce at 06/27/2009 @ 1:29pm

40. We, as a nation...and as a species, are not anywhere near that state of human evolution. That's why we do need laws, governments, rules and regulations....because we HAVE evolved to the point where there is a generalized social/political contract that expresses a collective wisdom that we are all better off when we take care of each other in fair and decent and humane ways. That's what the constitution is all about.

    As it turns out, we are happier, healthier AND wealthier when we act as a common community as opposed to as a collection of disconnected cut throat "individuals".

    Single payer represents a material manifestation of common human decency. It is good. Cooperation is good. Sharing is good. Being respectful of the value of human life is good.

    The system we have now has multiple and myriad layers of perverse incentives that financially reward people for being selfish, lying, manipulative greedy scumbags. The cumulative effect effect of such a system is that everyone screws everyone as it is a battle of "all against all". That dynamic is what causes just about all of our economic and environmental problems too....all of these issues are connected.

    Posted by Nick Lento at 06/27/2009 @ 11:59am

    What a great example of Socialist BS.

    Nick's bottom line is that only through the "collective" aka socialist/mother govt can people achieve any sense of community and common good.

    Marx, Engels, Mao, and the rest of your heroes would be proud of you comrade.

    Posted by antisocialist at 06/27/2009 @ 1:29pm

41. The former Trotskyites and followers of David Horowitz, Peter Collier and Martin Peretz, seem to be the standard opposition to The Nation's thoughtful articles. We acknowledge them for there zeal, but admonish them for their misleading attacks on progressive ideals.

    Posted by Scott_ffolliott at 06/27/2009 @ 1:59pm

42. Posted by srjenkins at 06/27/2009 @ 09:40am

    You seem awfully pre-occupied with how much physicians earn and how they earn it. Frankly, and with all due respect, it's none of your business. Not everyone wants to be or has the stomach for "academic" medicine. It is the physician's right to determine how he wants to run his practice--to determine who to treat and when. Let us not forget that this came about a long time ago because government reimbursement was pathetic and insulting in many cases (not to mention the prohibitive paperwork). If it was on par with private payors to begin with, private physicians would likely have continued to see those patients. Again, appropriate compensation for physicians actually encourages and incentivizes them to do more. As a result, productivity goes up. That is what we want--more patients seen and treated. As a natural consequence, those physicians earn more. However, government and folks such as yourself see that as a problem and attempts to decrease "costs" by actually decreasing reimbursement. Government can't afford to pay physicians their fees and consequently DE-incentivizes them. That brings us back to Dr. McKalip's prediction of physicians retiring early, cutting back, or leaving medicine altogether.

    Posted by plainbruce at 06/27/2009 @ 2:07pm

43. It's funny. I had a somewhat similar conversation with Frosty a while ago. He was griping about the amount of money a couple of neurosurgeons (I think) were being paid by the Canadian health system. I think it was around $500,000/yr, maybe more. He stopped griping when I pointed out that there was a net loss of physicians from Canada in the preceding 30 years and that was what it cost just to recruit those neurosurgeons to practice there.

    Posted by plainbruce at 06/27/2009 @ 2:14pm

44. Posted by plainbruce at 06/27/2009 @ 2:07pm:

    Not to mention the cost of "malpractice" insurance which will be paid by who? The government? Funny how no one wants to discuss the 800 lb gorrilla in the middle of the room - that of tort reform that will not happen. You can certainly tell this plan was written by politicians and lawyers.

    Posted by pyeatte at 06/27/2009 @ 3:11pm

45. That brings us back to Dr. McKalip's prediction of physicians retiring early, cutting back, or leaving medicine altogether.

    Posted by plainbruce at 06/27/2009 @ 2:07pm

    My older one starts med school in a little more than a months....and while I didn't discourage him, I didn't encourage him nor share in his excitement of gaining acceptance.

    For bright young Americans, the medical profession under UHC/single-payer, will lose even more of its appeal since under the biggest Big Brother of all, doctors can fully expect some type of caps on compensation, severe rationing of facilities/equipments and care, and the inability to escape to another state.

    Us consumers with some money, will be taking lots of medical `vacations' as our way of dealing with the hurry-up-and-wait socialized medicine.

    Posted by Happy at 06/27/2009 @ 3:16pm

46. Posted by Happy at 06/27/2009 @ 3:16pm:

    I agree. Mexico will be the new medical vacation. Ironic, isn't it. Maybe this is Gods way of showing he has a sense of humor.

    Posted by pyeatte at 06/27/2009 @ 3:24pm

47. I agree. Mexico will be the new medical vacation. Ironic, isn't it. Maybe this is Gods way of showing he has a sense of humor.

    Posted by pyeatte at 06/27/2009 @ 3:24pm

    You know, I suspect many bright and freedom-loving doctors, the newer ones and/or those reaching the traditional experience curve to start private practices, may start setting up shops in Mexico and other points nearby, to treat clients for cash....that would be great for those of us who would prefer US-trained physicians vs. South-of-border trained.

    In fact, when my son reaches that status, perhaps I'll seed him to do just that!

    Posted by Happy at 06/27/2009 @ 3:35pm

48. It appears that Ms. McCaughey has some incentive to go negative:

    Igor Volsky: Wonk Room: Pay To Play? McCaughey Received $11K In BioTech Stock Days Before Penning Health Scare Op-Ed: Ideology may not be the only factor driving Betsy McCaughey's propaganda campaign against two health care provisions in the stimulus bill. As Health Care Renewal points out, "not noted in Betsy McCaughey's op-ed article was that she is currently on the board of directors of Cantel Medical, a device company, and formerly on the board of Genta, a biotechnology company." In fact, according to a Statement of Changes in Beneficial Ownership Securities from the Securities and Exchange Commission, McCaughey received 750 Shares of stock options just days before writing the Bloomberg op-ed. Then, the total worth of the shares was approximately $11,250:

    Posted by wearyvoter at 06/27/2009 @ 3:55pm

49. Posted by Happy at 06/27/2009 @ 3:16pm

    Good luck to your oldest. It's an incredibly challenging, rewarding, and at times frustrating career. Hopefully, there will be a better system (than what the dems are cooking up) waiting for him when he graduates. Only then will it be more challenge and reward than frustrating.

    Posted by plainbruce at 06/27/2009 @ 5:40pm

50. Posted by pyeatte at 06/27/2009 @ 3:24pm

    No, no, no. I'm thinking Aruba. Or Caymans. Some island in the Caribbean would be better than Mexico. A nip here, tuck there and wash away the pain with a cool, fruity cocktail on the beach.

    :)

    Posted by plainbruce at 06/27/2009 @ 5:43pm

51. Posted by plainbruce at 06/27/2009 @ 5:43pm:

    I would not object to Aruba.

    Posted by pyeatte at 06/27/2009 @ 6:22pm

52. We absolutely need to fight with all we have to keep the sick away from our healthcare services. Posted by antisocialist at 06/26/2009 @ 10:18pm |

    Posted by snowball777 at 06/27/2009 @ 7:08pm

53. Posted by plainbruce at 06/27/2009 @ 12:30pm

    If you don't profit from the current system - say pediatric phyisicans, then you are not invested in maintaining it. The fundamental flaw with your argument here is that you are treating medicine as a single entity rather than dealing with the reality that different payment schemes are going to impact different practices differently. Some will benefit from single payer.

    I agree that single payer will reduce physician compensation. That's part of the point of doing it.

    Posted by plainbruce at 06/27/2009 @ 12:54pm

    "This is a natural part of physicians going it on their own and starting a business."

    It's also a system problem with a public/private system. Private physicians cherry pick patients, and the public and physicians working in a public setting are left holding the bag.

    "This is why doctors will start limiting their payor mix, usually governement payors."

    Oh, it's not just doctors. It's also private hospitals. It is also not just government patients, but HMOs and even some PPOs. Again, this creates a cascading problem where the state and public hospitals pick up the slack.

    "Actually, physician REIMBURSEMENT is next to zero if not zero for hospital call..."

    I'm talking about a neurologist or neurointerventionalist actually coming in to treat stroke - not just taking call. The physician gets chump change for doing the work.

    "As an example, I charge ~$37 to give an antibiotic shot. Do you know what Medicare pays? 9$."

    The question is what is the cost for you to provide the shot. If it's $1, that's a good margin - irrespective of what you charge for it.

    Posted by srjenkins at 06/27/2009 @ 7:54pm

54. Posted by plainbruce at 06/27/2009 @ 2:07pm

    "Frankly, and with all due respect, it's none of your business."

    You make it my business whenever your "business" is predicated on profiting from a certain kind of patient and leaving the others for the state to pick up with my tax dollars.

    "It is the physician's right to determine how he wants to run his practice--to determine who to treat and when."

    Are physicians not licensed by the state? Then, the only rights you have regarding practice are the one's the state gives you. You certainly don't have the right to cherry pick paying patients. If the state is going to be stuck with the non-paying patients, then why not socialize it and see if it can be made viable. You don't have the right to be a physician or to practice medicine as you see fit - as any practicing physician knows. So, what's with all this nonsense about your rights? You don't have any - just like every other "business".

    "Let us not forget that this came about a long time ago because government reimbursement was pathetic and insulting in many cases (not to mention the prohibitive paperwork)."

    Let's not forget that without government reimbursement, our elderly population wouldn't be using your services. They'd be dead.

    "Again, appropriate compensation for physicians actually encourages and incentivizes them to do more. As a result, productivity goes up. That is what we want--more patients seen and treated."

    I want better health outcomes. I personally don't care if that means more physicians making less and doing less work. I certainly don't see a focus on maximizing the bottom line, number of patients seen, operations performed as good metrics for health care. There's obviously a point of negative returns that you are outright ignoring here.

    Posted by srjenkins at 06/27/2009 @ 8:08pm

55. The Health Care Industry vs. Health Reform http://www.prwatch.org/node/8422

    Posted by Scott_ffolliott at 06/27/2009 @ 8:09pm

56. Posted by plainbruce at 06/27/2009 @ 2:14pm

    I think I have demonstratably shown I have much more knowledge about the business side of our health care system than Frosty or frankly, many physicians. So, please spare me the "I'm an authority" line.

    Posted by pyeatte at 06/27/2009 @ 3:11pm

    "Malpractice" with quotes? Granted there are frivolous lawsuits but there are also physicians practicing that have no business seeing patients. It's one thing to make mistakes. But, there is no ongoing system for measuring competence, and there should be.

    That said, the cost of malpractice insurance is something that needs to be addressed. But, it isn't an issue that has much relevance for single payer.

    Posted by Happy at 06/27/2009 @ 3:35pm

    You are describing health care tourism. As with most things in life, you get what you pay for. If you want to go that route you better do due diligence on the physician and be comfortable with things that wouldn't fly in the United States, like resterilized equipment. If you cannot afford it in the United States, it's a better option that not getting it done at all for conditions that must be treated.

    Posted by srjenkins at 06/27/2009 @ 8:19pm

57. The wealthy and upper middle class will still be able to get their Blue Cross Blue Shield Primo coverage. A lot of people will not opt for the "public option" because it is well, too public, that means poor. I had a choice of coverage and chose the cheapest HMO, which was originally called "Harvard Community Health." When I started the co-pay was one dollar!!! It is now ten dollars. Still it is very cheap. It was, by the way, union negotiated. Most of the people going there are Black and Hispanic, ie poor. Or working poor, or lower middle class or whatever. I don't mind one bit. Many would not choose it, though, because of that reason. No private room in the hospital, and so forth. So public option will not drive out the insurance companies, it will simply make health insurance affordable to those who cannot afford the expensive policies. It is an OPTION. You don't have to choose it. I think that businesses and corporations, certainly, will continue to offer their workers options. Everyone is not going to pick public. I agree with the President that we need a uniquely American solution and that solution is not single payer, but choice, as long as one choice is a public, affordable one. If we can cover 20 million more Americans, that is a good start. We can expand or adjust. The point is to make a beginning in this. I am also fighting like hell for the public option. Joined DFA, signed petitions, called and e-mailed all Senators and the White House dozens of times. You have to become active. If you are, thanks.

    Posted by jonnirae at 06/27/2009 @ 8:43pm

58. The accusation that anything that takes into account common human decency is "socialist" is sheer nonsense.

    We ALREADY treat everyone who shows up at an ER....and it's a waste of billions of dollars because most of those people could have been treated far far more cheaply by simply giving them access to preventive care.

    Unless you are ready to simply let all the uninsured die in the streets, we ALREADY have a perverse form of socialized medicine that actually makes MORE money for hospitals and doctors because the taxpayers and premium payers wind up paying MORE money that it would cost to prevent the ER visits....and the weeks that these poor dying people end up spending dying in ICU units.

    So unless you're willing to just let 50 million people suffer and die in the streets, we already have socialized medicine.

    Further, at the current rates of increase, virtually NO ONE except the super rich will be able to afford insurance in 20 years.

    Further, the existing insurance companies suck up 31% of every dollar spent on health care and provide NO actual treatment!!! That's money better spent on doctors and nurses etc.

    I have to wonder how many of the anonymous posters here actually are paid shills of the insurance industry?

    Posted by Nick Lento at 06/27/2009 @ 9:17pm

59. All of the questions and points made against single payer are factually addressed here...

    http://www.pnhp.org/facts/singlepayer_faq.php

    The fact is that none of you anonymous folks have the guts to attach your real names to what you are saying here. If you really believed the pro insurance company propaganda that wants to maintain the status quo....you would be proud of who you are and happy to use your real names on line. As it is you are ashamed and frightened to do so....and I don't blame you.

    Posted by Nick Lento at 06/27/2009 @ 9:26pm

60. "As an example, I charge ~$37 to give an antibiotic shot. Do you know what Medicare pays? 9$." The question is what is the cost for you to provide the shot. If it's $1, that's a good margin - irrespective of what you charge for it. Posted by srjenkins at 06/27/2009 @ 7:54pm | Posted by plainbruce at 06/27/2009 @ 12:54pm |

    Is that $730/hr for just the shot (which takes about 3 minutes of the doc's time)?

    How much do the actual meds cost?

    Does it include the $100 office visit before you're willing to give them the shot (as in most medical offices)?

    Would you support a system where I could get and self-administer anti-bug meds (thus ending your state-enforced monopoly on basic healthcare)?

    Posted by snowball777 at 06/27/2009 @ 9:29pm

61. Thanks to Scott_ffolliott who posted this url!

    The Health Care Industry vs. Health Reform http://www.prwatch.org/node/8422

    You really HAVE to read the whole thing. One of the top PR execs for the insurance industry actually comes clean and confesses that they are (essentially) professional liars who sell their souls for money.

    I wonder how many of them troll sites like this and inject fear mongering comments that distort the truth and make people afraid of any kind of reform that would cost them and their employers their lavish lifestyles?

    If you kill someone for money you are a murderer. In a moral sense how similar is such an assassin to someone who takes money to promote a system that causes the deaths and suffering of many thousands of people?

    At least the hit man isn't kidding himself about what he's doing.

    Posted by Nick Lento at 06/27/2009 @ 9:49pm

62. Posted by Nick Lento at 06/27/2009 @ 9:26pm

    Yikes. While I've been giving plainbruce a hard time about his objections to single payer, which I think are dictated by his worldview and being a bit loose with the facts, single payer has its problems too. I went into them in-depth in a previous discussion:

    http://www.thenation.com/blogs/actnow/445721/wewantthepublicoption

    Some points are whether or not there will be reduced capacity to provide healthcare under single payer that will negatively impact citizen health. In economic terms, this would be called deadweight loss. Can you address this point?

    What about the need to subsidize medical education? What about unintended consequences? There are plenty of problems in single payer. The problem is that most conservatives are so wrapped up in their personal ideology that they don't ask good questions about how single payer stacks up against alternatives.

    Feel free to read the previous discussion here: http://www.thenation.com/blogs/actnow/445721/wewantthepublicoption

    Posted by srjenkins at 06/27/2009 @ 10:21pm

63. I think I have demonstratably shown I have much more knowledge about the business side of our health care system than Frosty or frankly, many physicians. So, please spare me the "I'm an authority" line.

    Posted by srjenkins at 06/27/2009 @ 8:19pm

    ??? I found the parallels between the two conversations interesting and humorous. You, apparently, did not.

    Posted by plainbruce at 06/27/2009 @ 10:30pm

64. Posted by snowball777 at 06/27/2009 @ 9:29pm

    $37 covers the cost of the medicine, syringe, salary of the file clerk who has to find/return your chart, salary of the nurse who draws up and administers the shot, physicians salary, rent, water, electricity, gas, phones, security, insurance. You get the idea.

    Posted by plainbruce at 06/27/2009 @ 10:40pm

65. srjenkins

    I honestly don't know where to begin with many of your responses. I did find it interesting that you seemed to sweep aside my statement that this problem began with government medicine and its under-reimbursement policies. Fix that and much of the issue goes away. If you're not willing to pay physicians their going rate, then don't complain when they refuse your "payment plan." Point of fact, we began accepting Medicare patients two years ago when they had become one of the better payors in our area (albeit more of a regression in payment by the private insurers than any significant increase on the part of Medicare). I have a colleague who refused Aetna for several years because of poor reimbursement. It works both ways. I also notice that you seem unconcerned the burden that under-reimbursement by government places on private payers (insurance, HMOs, and self-pay). Part of the reason they pay more is BECAUSE government is paying less.

    "Let's not forget that without government reimbursement, our elderly population wouldn't be using your services. They'd be dead."

    That's not entirely accurate. Prior to the advent of Medicare, over 90% of the elderly paid for private health insurance.

    Posted by plainbruce at 06/27/2009 @ 11:33pm

66. $37 covers the cost of the medicine, syringe, salary of the file clerk who has to find/return your chart, salary of the nurse who draws up and administers the shot, physicians salary, rent, water, electricity, gas, phones, security, insurance. You get the idea.

    Posted by plainbruce at 06/27/2009 @ 10:40pm

    Unfortunately Dr Bruce, they don't. Nor do people like Snowball want to have their income reduced they way they want yours reduced. That is the great hypocrisy of these leftists.

    Posted by antisocialist at 06/27/2009 @ 11:41pm

67. Posted by snowball777 at 06/27/2009 @ 9:29pm

    $37 covers the cost of the medicine, syringe, salary of the file clerk who has to find/return your chart, salary of the nurse who draws up and administers the shot, physicians salary, rent, water, electricity, gas, phones, security, insurance. You get the idea.

    Posted by plainbruce at 06/27/2009 @ 10:40pm

    I echo what anti just posted. Most Libs have no idea what `overhead' and fixed costs are. They actually think 31% of insurance co. revenues are `wasted', as if the Gubbers can run sungle-payer without any `waste'.......the Libs undoubtedly think half the expenses of keeping the doors open for a doctor's practice is wasted.

    SRJ also seems to think, if ones' license is issued by some Gubber faction, the licensee must serve anyone! Try calling a licensed tradesman, say a plumber, and force him to replace your wax ring for $20. That pretty astounding stance by SRJ, tells a lot!

    Posted by Happy at 06/27/2009 @ 11:57pm

68. "You make it my business whenever your "business" is predicated on profiting from a certain kind of patient and leaving the others for the state to pick up with my tax dollars..."

    First, sorry, but you have no right how to tell a physician to run his practice. You may not agree with it, but your opinion on the matter is irrelevant. Since there are no laws restricting him from doing this, the law is on my side.

    Secondly, this is kind of circuitous logic. You complain that physicians refuse govenment insurance because of poor reimbursement. Then, gripe that physicians in state hospitals get stuck with all the patients that have less profitable government insurance/reimbursement? Either way, it doesn't really matter if that patient is treated by a private physician or state institution. You're still going to pay for it.

    Thirdly, and what I find most frightening particularly in this country of the free, is that you believe you should be able to control someone simply because it somehow might affect your taxes. It's this kind of thinking that gave us seatbelt laws, helmet laws, carseat laws, etc. It is also what is leading our elected suppressors in Congress to consider additional "fees" (i.e. taxes) on unhealthy items. Frankly, it is micromanaging of the worst sort (trying to control behavior) and definitely NOT what the intended purpose of our government was or is.

    Posted by plainbruce at 06/28/2009 @ 12:02am

69. There is probably a better way to argue the above, but at 1:00am the mind is getting a little sludge-y.

    Posted by plainbruce at 06/28/2009 @ 12:05am

70. Posted by antisocialist at 06/27/2009 @ 11:41pm

    Posted by Happy at 06/27/2009 @ 11:57pm

    Amen and amen.

    Posted by plainbruce at 06/28/2009 @ 12:07am

71. (to srjenkins)......what I find most frightening particularly in this country of the free, is that you believe you should be able to control someone simply because it somehow might affect your taxes. It's this kind of thinking that gave us seatbelt laws, helmet laws, carseat laws, etc. It is also what is leading our elected suppressors in Congress to consider additional "fees" (i.e. taxes) on unhealthy items. Frankly, it is micromanaging of the worst sort (trying to control behavior) and definitely NOT what the intended purpose of our government was or is.

    Posted by plainbruce at 06/28/2009 @ 12:02am

    Our nat'l anthem needs to change, in honor of BHO and the Libs....strike out "And the Land of the Free" and change to "Once the Land of the Free".

    Posted by Happy at 06/28/2009 @ 12:10am

72. The fact is that none of you anonymous folks have the guts to attach your real names to what you are saying here. If you really believed the pro insurance company propaganda that wants to maintain the status quo....you would be proud of who you are and happy to use your real names on line. As it is you are ashamed and frightened to do so....and I don't blame you.

    Posted by Nick Lento at 06/27/2009 @ 9:26pm

    Does that go for all of the anonymous pro-socialized medicine crowd as well?

    Posted by plainbruce at 06/28/2009 @ 12:14am

73. "If you don't profit from the current system - say pediatric phyisicans, then you are not invested in maintaining it. The fundamental flaw with your argument here is that you are treating medicine as a single entity rather than dealing with the reality that different payment schemes are going to impact different practices differently. Some will benefit from single payer."

    I admit I'm generalizing, but not by much. Pediatricians, GPs, FPs, and internists have difficulty staying profitable in the current system which includes the government payor. I'm not sure how that gets better by switching to a system that will under-reimburse on a much larger scale than what we have currently. The last stat I saw was a 6% overall reduction in pay for PCPs with a public insurance option. That does not include the 20% cut in Medicare reimbursement scheduled for Jan. 2010.

    "I agree that single payer will reduce physician compensation. That's part of the point of doing it."

    Do you see how that could present a problem?

    Posted by plainbruce at 06/28/2009 @ 12:23am

74. Posted by Happy at 06/27/2009 @ 3:35pm

    You are describing health care tourism. As with most things in life, you get what you pay for. If you want to go that route you better do due diligence on the physician and be comfortable with things that wouldn't fly in the United States, like resterilized equipment. If you cannot afford it in the United States, it's a better option that not getting it done at all for conditions that must be treated.

    Posted by srjenkins at 06/27/2009 @ 8:19pm

    What I describe, health care tourism, is a perfect answer to problems that WILL crop up for a lot of folks who develop conditions that aren't critical or of an emergency nature, say replacing a hip joint or a better set of false teeth, and who will be put on waiting list months out (under socialized/single-payer).

    Given a few years' time, I have faith that the market will create quite a few pockets of highly qualified medical centers catering to folks who do not wish to suffer on a waiting list. These could be in the US or out-of-the-US. I tend to think most will be forced to be out-of-US in order to keep costs reasonable enough for most, say 50% of Americans, to be able to afford out-of-pocket.

    For malpractice or just bad luck, us health care tourists, can buy an insurance policy specific to whatever operation or procedure needed...like travel insurance.......or the doctors can provide some simplified `guarantee' that they themselves, can buy cheaply. Reasonable sums topped out at say, $1 million for high-risk procedures.

    Posted by Happy at 06/28/2009 @ 12:23am

75. Looks as though if Dr. Bruce flubbed a surgery, it wouldn't be a sponge or a pair of forceps sewn into the patient, it would be a calculator.

    This guy smells phony from a mile away.

    There's a good reason why top flight physicians don't laboriously scrutinize their own bookwork unless they've been seriously embezzled by an office manager or two.

    Posted by Sorelish at 06/28/2009 @ 12:26am

76. (srjenkins:) "I agree that single payer will reduce physician compensation. That's part of the point of doing it."

    Do you see how that could present a problem?

    Posted by plainbruce at 06/28/2009 @ 12:23am

    The Libs don't see a problem....just as they don't see any problem w/slamming all high-income individuals with punitive taxes.

    They don't believe in the `Going Galt' alternative.....

    Speaking as someone who dropped out of the corp. world due in part, to avoid the high marginal tax on a two-income professional couple. I'm far HAPPIER even while making ~$100k less per year on fixed salaries....investment income is far more exciting and only subject to a 15% tax rate....and NO FICA, NO MEDICARE!

    Posted by Happy at 06/28/2009 @ 12:28am

77. "I'm talking about a neurologist or neurointerventionalist actually coming in to treat stroke - not just taking call. The physician gets chump change for doing the work."

    When I refer to "call," I was assuming not only admitting the patient, but providing continuing coverage/treatment. At any rate, I think we're on the same side of this issue (?)

    "Are physicians not licensed by the state? Then, the only rights you have regarding practice are the one's the state gives you. You certainly don't have the right to cherry pick paying patients. If the state is going to be stuck with the non-paying patients, then why not socialize it and see if it can be made viable. You don't have the right to be a physician or to practice medicine as you see fit - as any practicing physician knows. So, what's with all this nonsense about your rights? You don't have any - just like every other "business". "

    Wow. I don't know that you could be more wrong. Happy made a good point earlier, but on top of that, while doctors are licensed by the state, they simply have to adhere to the usual and customary laws. The state doesn't micromanage. Physicians most certainly have every right to pick and choose which insurances (government or private) they will accept. Not only that, but physicians can accept/refuse/discharge patients at their leisure and for any reason, excepting the usual discrimination "biggies." And, yes, Americans have the right to become a physicians if they are able.

    Posted by plainbruce at 06/28/2009 @ 12:53am

78. Posted by Happy at 06/28/2009 @ 12:28am

    Agree again. Obama will be double-dipping on the physicians if he gets his way. Not only will he decrease reimbursement, but he will raise their taxes right along with it.

    Unfortunately, if and when that happens, I will likely curtail my hours if not retire completely as Dr. McKalip predicted, albeit not with the investment income of one of our esteemed posters here ;) Fortunately, my beautiful and successful wife has already told me that she wouldn't mind having a "kept man" around the house.

    I guess I'd better get caught up on my "handsome" sleep. Must keep the wife happy.

    Posted by plainbruce at 06/28/2009 @ 01:11am

79. I don't understand you people. The US has the most expensive and inefficient health care of all civilized countries because it allowed the insurance industry, Big Pharma and a subset of specialist MDs and fot-profit hospitals to game the system.

    Of course they dislike it. They've been parasitising the country for too long.

    This is not about the "single payer". It is about the corrupt alliance between the special interests (the insurance lobby, the AMA etc) and the politicos.

    Posted by cuckatoo at 06/28/2009 @ 01:43am

80. Posted by plainbruce at 06/27/2009 @ 10:30pm

    Making the association seems to be trying to paint us both as naive. I cannot speak for Frosty nor did I read that discussion. However, I can assure you I am not naive on this topic.

    Posted by plainbruce at 06/27/2009 @ 11:33pm

    I ignore the under-reimbursement issue for the obvious reason that the cost of healthcare to the taxpayer using the current system is not viable.

    "If you're not willing to pay physicians their going rate, then don't complain when they refuse your "payment plan."

    As soon as you agree to not complain about "going out of business" because your going rate is price gouging. Physician "rates" are based on maximizing profits from insurers. They are not based on the actual cost of providing a service combined with a reasonable profit - like every other "business".

    "Point of fact, we began accepting Medicare patients two years..."

    You and I both know that private insurance, since the downturn, has reduced their payments to the point where Medicare patients have looked attractive, particularly for marginal practices that need the volume. Again, this shows that rates are also dictated by volume and economic environment.

    "I also notice that you seem unconcerned the burden that under-reimbursement by government places on private payers (insurance, HMOs, and self-pay)."

    Private insurers can also choose not to pay your "rate". The fact that their business model allows physicians to gouge them to a certain degree is not my problem.

    "Part of the reason they pay more is BECAUSE government is paying less."

    Exactly, which undermines your whole "rate", argument. This is basically an admission that your rate is based on whatever you'd like your margins to be rather than actual margins determined by the market.

    Posted by srjenkins at 06/28/2009 @ 07:04am

81. Posted by plainbruce at 06/27/2009 @ 11:33pm

    "That's not entirely accurate. Prior to the advent of Medicare, over 90% of the elderly paid for private health insurance."

    Is that 90% of the elderly that used physician services? Or 90% of the population? The latter, frankly, is absurd. The former not particularly interesting.

    Posted by Happy at 06/27/2009 @ 11:57pm

    I understand overhead and fixed costs. The problem is that physicians fees are not based on costs but are based on trying to game the system to achieve the margins they want. Name me another "business" that works that way - practically all of them that suck from the governments teat like aviation manufacturing?

    Bottom line is that physicians play a lot of games to reduce the number of competitors by limiting the number of "board licensed" physicians and by licensure. If it is important to license physicians, then it is important to regulate practices as well. That's why organizations like JCAHO exist. Doctor's are so regulated and subject to best practice lawsuits that talking about the physicians "right" to do what they want is playing rather loose with the facts.

    "Since there are no laws restricting him from doing this, the law is on my side."

    The old, "status quo" argument. Hey, the law allows me to charge whatever exorbitant price I want without being called out for price gouging (because they simply don't bother to pay the "rate"), cherry pick patients so that there are network effects that I see in my tax bill, whine about my compensation - even though doctors are among the best compensated people in our society and so forth. Apparently, it's the responsibility of others to sit back and pay the taxes while they continue to screw over the system and make it ever less viable.

    Yes, I do disagree.

    Posted by srjenkins at 06/28/2009 @ 07:24am

82. Unfortunately Dr Bruce, they don't. Nor do people like Snowball want to have their income reduced they way they want yours reduced. That is the great hypocrisy of these leftists. Posted by antisocialist at 06/27/2009 @ 11:41pm |

    Go drink some acai juice and pray your anencephaly cures itself.

    Posted by snowball777 at 06/28/2009 @ 07:35am

83. Posted by plainbruce at 06/28/2009 @ 12:02am

    My main issue is the problem of network effects.

    "Either way, it doesn't really matter if that patient is treated by a private physician or state institution. You're still going to pay for it."

    This is the crux. This is ONLY true under single payer - because then there is only one buyer for the services, the taxpayer. If private industry (meaning, insurance companies taking only mostly healthy people and works the margins so the healthy cover those that get sick - profitably and private practice physicians only take people with private insurance) takes the profitable portion of the healthcare market, and leaves the unprofitable for the state.

    So, your state is only true from a patient care perspective. There, it doesn't much matter. In terms of the finances, the demographics matter a great deal.

    "Thirdly, and what I find most frightening particularly in this country of the free, is that you believe you should be able to control someone simply because it somehow might affect your taxes."

    Ever consider how you putting your hand in my pocket takes away my freedom? You are aware that most people have to spend time making money, and most make a lot less than doctors? So, no. I'm not particularly concerned about any freedoms or rights that are predicated on taking money out of my wallet. You don't have a right or the freedom to use the government to take my money for your livelihood.

    "It's this kind of thinking that gave us seatbelt laws, helmet laws, carseat laws, etc."

    No, it's this type of thinking that led to the Boston Tea Party. You don't have the right to make a living off my back. The only reason why you do is because most people don't understand the healthcare system well enough to know that's what you are doing.

    Posted by srjenkins at 06/28/2009 @ 07:36am

84. Posted by Happy at 06/27/2009 @ 11:57pm |

    "I echo what anti just posted."

    We'll feign surprise.

    "Most Libs have no idea what `overhead' and fixed costs are. They actually think 31% of insurance co. revenues are `wasted', as if the Gubbers can run sungle-payer without any `waste'"

    My sister-in-law is an admin at an OT office so you could say I know the overhead personally.

    She tells me about the lunacy of dealing with hundreds of different insurance plans, each of which will deny coverage on any mistake in interpretation of 'treatment codes' (or any other spurious reason that allows them to delay payment).

    A good deal of the 31% overhead...is eating the cost of services rendered to covered people that are denied by the insurance company.

    "the Libs undoubtedly think half the expenses of keeping the doors open for a doctor's practice is wasted."

    No, I think most if not all of the money collected by health insurance companies is wasted.

    In truth, I have no problem with doctors being paid what they deserve, and I'm willing to have my taxes raised to make that an option for the American public, but I'm tired of middlemen who believe that they are entitles to something for inserting themselves between the skilled and the needy.

    Posted by snowball777 at 06/28/2009 @ 07:48am

85. I am American who has been living in Europe since 1991. I would like to come back to the US, but my wife and I can't because of the high cost of health care. So remain in Germany.

    I am witness to the Health Care gangsters which have taken over America. At 68 years old, I have seen a good reliable health care system with resonably priced insurance degrade into a Mafia run organization. Lets start back in 1994. The passage of Medicare. I was working for an electrical contracter in california as a young man. We did electrical work in hospital construction. When Medicare was passed, the cost of materials of electrical equipment, plugs, circuits, etc, went through the roof. I mean the price increased in some cases by 1000 percent. A 100 dollar equipment cart went to 1000 dollars. The electrical componets needed to be special for hospitals so that meant expensive. I don't have actual statistics, but I imagine after Medicare, the cost of building a hospital increased by 500 percent.

    Next we had the incorpation of Doctor offices. Seminares were set up all over America to teach Doctors the advantages of Incorporation and how to make money charging for procedure instead of time. Charging for procedure means that everything a doctor does in his office is billed as a procedure. As example, I went to a doctor in Danville, California for a regular check up. He notice that I smashed my fingernail and told me he could take care of that. He did in 4 seconds with a puncture device of some kind. It drilled small holes in my nail and relieved the pressure. As I left, I went to pay my bill. The doctors visit was 60 dollars and the "nail procedure" was 150 dollars for a total of 210. Welcome to procedure billing. Instead of billing for time, you bill for procedure.

    Posted by erdingtown at 06/28/2009 @ 07:58am

86. continued:

    Now every doctor, hospital, lab physio bills for procedures.

    Next we had the HMO. Because of procedure billing the cost of health care really went up. The answer, HMO. Great concept! For profit companies which manage their profits by managing your health. Again insurance costs up about 300 percent

    It has been downhill since. The entire system needs to be redesigned. Stop talking about how bad the system is in Canada or the UK. Start talking about how good it is in France or Germany or Czech Republic for that matter. I don't have to wait for anything. Hospitals are clean without staph infections. Procedures are the best. Even if you have to pay cash, a MRi IN Germany cost about 200 euors if you have to pay for it. compared to 5000 dollars which my daughter had to pay last year in Texas. You get a choise of classic medicine, homopathy, alternative, chinese medicine. Some of it is paid by the state insurance system. If you want more personal care and better coverage you can take out private insurance. We are satisfied with the state which also covers perscription drugs. The cost of drugs in europe even if you pay them yourself are a quarter of the cost in the United States.To solve the health care problem, you have to re-invent the system and take the greed out. By the way, I have a choise of any doctor I want to go to. However, I must wait for about an hour in the office to be seen because he takes the private insured first. Big Deal! The politians in washington don't know what they are talking about. The need to analysied the French or German System. By the way, the cost of hospital stays are about 100 euros per day which is paid for by insurance. We must pay for food which in many cases is fantastic.

    Posted by erdingtown at 06/28/2009 @ 08:08am

87. Posted by plainbruce at 06/28/2009 @ 12:23am

    You are only looking at one side of the equation. What most "businesses" do when they are faced with reduced revenue is cut costs. But, you never see physicians talking about cutting costs or developing ways of distributing these costs better. It's always complaining about the compensation and threatening to go home and take their ball with them. To which I say, if you cannot find a way to make it in the "business", then perhaps you should be doing something else.

    "Do you see how that could present a problem?"

    Of course, it's a problem. But, it has to be done. It can also be mitigated by programs subsidizing medical education. It may also have unintended positive effects, such as more physicians completing fellowships to become specialists in areas where more money can be made.

    What I would like to see from you is your ideas about how to handle the costs of health care. You talk about poor compensation, but it is a fact that medical charges have been rising much faster than other prices. How do you propose to solve this problem?

    Posted by Happy at 06/28/2009 @ 12:23am

    Health care tourism will essentially create rationing elsewhere. As a U.S. citizen, I'm more concerned about dealing with U.S. problems, but I think your "solution" is going to encounter resistance when the local populations wonder why foreigners get such good treatment while they don't have basic medical services.

    I think the problem in your analysis is that you assume deep rationing. You could deal with this problem by creating a greater capacity for providing healthcare and reducing the focus on "doing something" so it can be billed. There are also advantages from volume pricing, standardized procedures, and so forth that will squeeze excess out.

    Posted by srjenkins at 06/28/2009 @ 08:18am

88. Posted by plainbruce at 06/28/2009 @ 12:53am

    I think this varies. I've heard of people getting paid just to take call, those that get paid only if they come in or both. Obviously, if you come in, you bill for your time and what you are doing - not that you'll get paid anything for it.

    You are awful free with the term "right". I understand "rights" to have two justifications: (1) inherent in being human (human rights) and (2) those "rights" provided for by the state (right to free speech in the U.S.). I don't see a "right" to a particular occupation being justified on either of these grounds.

    Yet, physicians are subject to regulation, just as the insurance industry is subject to regulation. If the government decides that it will be the sole insurer, you can decide to do something else rather than agree to accept them as an insurer.

    You can certainly also take advantage of the current system, legally, by taking paying patients and leaving the public picking up the check on their tax bill. But, you don't have any "right" to complain when I lobby government to get their (and by extension your) hand out of my pocket.

    The rest I've addressed above.

    Posted by srjenkins at 06/28/2009 @ 08:37am

89. Posted by erdingtown at 06/28/2009 @ 08:08am

    Thank you for posting. I think this pretty much addresses all the rationing/you won't be able to find any healthcare, government controlling my practice, compensation whining and so forth that has characterized this discussion.

    So, if you want to work in private practice. So long as your existence isn't made possible by skimming patients and my tax dollars, I'm all for it. If government has to pick-up the check, then let's just socialize the bulk of the system rather than let private industry suck on government's teat. That's the essence of my position.

    Posted by srjenkins at 06/28/2009 @ 08:43am

90. "The second big distortion is that most doctors in America work on a fee-for-service basis; the more pills they prescribe, or tests they order, or procedures they perform, the more money they get--even though there is abundant clinical evidence that more spending does not reliably lead to better outcomes. Private providers everywhere are vulnerable to this perverse incentive, but in America, where most health care is delivered by the private sector rather than by salaried public-sector staff, the problem is worse than anywhere else...One thing that should be unleashed immediately is antitrust: on a local level many hospitals and doctors work as price-fixing cabals."

    http://www.economist.com/printedition/ displayStory.cfm?Story_ID=13900898

    Posted by srjenkins at 06/28/2009 @ 09:06am

91. "We absolutely need to fight with all we have to keep the govt out of our healthcare services."

    if this is true, then i suppose you already lost that fight about 45 years ago.

    "There is no right to healthcare...it is a service."

    this is a non-sequitur.

    but people who cannot afford, or for whatever reason do not have, insurance, do get sick, correct?

    and when they get sick, they use health facilities anyways, correct?

    and the taxpayers ultimately pay for that usage, correct?

    so WE ALREADY ARE PAYING MORE FOR other people's lack of insurance.

    is this what your fighting for, antisocialist???

    Posted by darladoon at 06/28/2009 @ 10:12am

92. and if people w/out health insurance DON'T use health facilities, and perish and/or die, is this what antisocialist is fighting for, as well?

    or is he more concerned with debating a non-sequitur?

    because antisocialist is such a strict constitutionalist, and expert in international law, one wonders why he doesn't fight for gay rights.

    Posted by darladoon at 06/28/2009 @ 10:26am

93. Anybody who defends the private insurance companies is either nuts or works for them. BlueCross/BlueShield of Massachusetts has more health insurance administrators, which covers about 3 million people, than administrators in all of Canada which covers over 30 million people. You insurance company apologists are so full of it!

    Posted by antigop at 06/28/2009 @ 11:52am

94. SRJ: "Health care tourism will essentially create rationing elsewhere.....I think your "solution" is going to encounter resistance when the local populations wonder why foreigners get such good treatment while they don't have basic medical services."

    I'm talking about American doctors setting up shop to treat anyone able to pay what their price. I'd think the Aruba or Mexico Gubbers would love to have the foreign exchange that comes w/such `medical tourism'. Not quite the maquiladora (twin-plant) industrial concerns, but bear similarities including the hiring of numerous local, non-doctor support staff.

    Canadians medical touring into the US....has that created "resistance" from Americans that "don't have basic medical services"?

    SRJ: "I think the problem in your analysis is that you assume deep rationing....There are also advantages from volume pricing, standardized procedures, and so forth that will squeeze excess out."

    For elective or non-emergency procedures, I do assume "deep rationing" as the long-term stable state even if that won't happen immediately upon implementation of UHC/single-payer. Canada is the clear example. It will take a while for US doctors, med students, med school applicants to digest what all this will mean to their future or if they wish to pursue an alternate one.

    How has "volume pricing/standardized procedures" worked out for MediCare & MediCaid? Seen what has happened to Big Pharma, say Pfizer, stocks vs. the generics like TEVA? You think volume pricing to the extent of a single-payer, helps R&D?

    For other examples, how has "volume pricing/standardized procedures" worked out for big ticket defense procurements? Is the VA the perfect medical `system'? Is the US Postal Service the best there is? How's the airport security system?

    Posted by Happy at 06/28/2009 @ 1:44pm

95. Ever wonder why Medicare Advantage, which is private insurance coverage to Medicare patients,costs 13% more than government-run insurance plans?Overhead for government run Medicare runs about 3%.Do the math.

    Private insurance is profit-driven.Investors own almost all of the specialized hospitals, most free standing facilities and 20% of the non-public hospitals.The focus of these facilities is on expensive treatments rather than prevention.

    In other countries that spend less and manage to cover all of their citizens ,the focus is more on prevention rather than high priced specialists. We have more specialists than primary doctors.Our specialists make more and prescribe more tests and are invested in the health care biz themselves.Its called "vested interest".Mix this with politicians who depend on lobbyists contributions and you have a recipe for commercialized health care systems instead of health care systems who focus on wellness, prevention and high quality treatment aka "socialized medicine". One systems' focus is profit , theirs is professional. Guess which one has the healthiest citizens?

    Posted by selvia at 06/28/2009 @ 3:11pm

96. In truth, I have no problem with doctors being paid what they deserve, and I'm willing to have my taxes raised to make that an option for the American public, but I'm tired of middlemen who believe that they are entitles to something for inserting themselves between the skilled and the needy.

    Posted by snowball777 at 06/28/2009 @ 07:48am

    Posted by srjenkins at 06/28/2009 @ 08:37am

    why don't you people be consistent then and make the case for complete socialization of the country. Why should medical services be singled out because you don't like the rates, or the supposed inefficiencies?

    Snowball says he's willing to pay more taxes for socialist healthcare, but evidently doesn't want anyone attacking his own means of production and income.

    You read all of these pro socialized medicine posts and they simply refuse to be honest that they want more socialism in America, except for their own work.

    Posted by antisocialist at 06/28/2009 @ 3:14pm

97. because antisocialist is such a strict constitutionalist, and expert in international law, one wonders why he doesn't fight for gay rights.

    Posted by darladoon at 06/28/2009 @ 10:26am

    for the very same reason I don't fight for the rights of adulterers and pedophiles. But you already knew that.

    Posted by antisocialist at 06/28/2009 @ 3:17pm

98. Bottom line:

    Single payer is a major part of the massive systemic reform that is required to fix our broken health care system.

    It is currently being driven purely by extortionale greed and fear. It's as if the insurance companies and the doctors and pharma and the supply and equipment folk are saying, you will either pay anything we demand or you and your families will suffer and die.

    Reading this blog and the comments (most of whom come from people who are cashing in on the status quo) onl;y makes it clear that single payer is a required part of the mix.

    Sadly, we live in a nation in which bribery is legalized and it seems highly improbable that the evils of the system will be extirpated any time soon.

    The problem with being a parasite is that you kill the host. The system we have now will die sooner or later because it is simply unsustainable.

    Just like a cancer, that grows fat and "happy" it believes that the con job will continue forever....sorry, that ain't happening.

    This isn't China or Iran or Korea at some point average Americans will figure out on a massive scale that just about everything they've been fed by the dominant corporate establishment was/is a pack of lies.

    Posted by Nick Lento at 06/28/2009 @ 4:08pm

99. This isn't China or Iran or Korea at some point average Americans will figure out on a massive scale that just about everything they've been fed by the dominant corporate establishment was/is a pack of lies.

    Posted by Nick Lento at 06/28/2009 @ 4:08pm

    So you think folks in China/Iran/N.Korea has been fed a pack of truth by their dominant Gubber establishment....brilliant, like all Libs!

    Posted by Happy at 06/28/2009 @ 4:26pm

100. Posted by Happy at 06/28/2009 @ 1:44pm

     "I'm talking about American doctors setting up shop to treat anyone able to pay what their price."

     It's possible. However, the examples I have read about have focused more on foreigners using indigenous services. It is also not too hard to imagine other unintended consequences like the poor donating organs for food or other morally problematic issues.

     "...Americans that "don't have basic medical services"?

     Americans can always stop by the emergency room for treatment. Even rural America has health care that is much more accessible than say the people living in rural India. If you have a scarce resource like health care and a large population like India, any significant foreign use is going to raise concerns.

     "For elective or non-emergency procedures, I do assume "deep rationing"..."

     Based on what? The rationing will simply be different than the rationing currently happening.

     "How has "volume pricing/standardized procedures" worked out for MediCare & MediCaid?"

     As I've touched on above, the problem is pay per service and the way the public private system works and is exploited. In terms of providing health care, Medicare and Medicaid provide health coverage to those that wouldn't otherwise receive it. If you have thoughts on a better system, please feel free to share it.

     "For other examples, how has "volume pricing/standardized procedures" worked out for..."

     Look at the history of any universal service, Happy. Universal service, whether it is education, railroads, telegraph, telephone, electricity, roads, etc. all lend themselves to natural monopolies and government subsidy at some level of government.

     So, the only question we need to get clear on is whether health care is a universal service. I think it is.

     Posted by srjenkins at 06/28/2009 @ 4:26pm

101. Posted by antisocialist at 06/28/2009 @ 3:14pm

     "...why don't you people be consistent then and make the case for complete socialization of the country..."

     The answer to this revolves around the universal service question as well. You acknowledge that there is a need to socialize defense. I agree because it is a universal service.

     But, there is no need to socialize manufacturing, retail trade, agriculture (although you can argue that we have socialized agriculture), trade & transportation (beyond the roads everyone uses), warehousing, information (beyond that produced by the government), financial institutions, leisure/hospitality industries, etc. because these are not universal services or that they are universal services that can be obtained without government involvement.

     However, I don't think health care, education, postal service and the like would be universally available without government involvement. The founders recognized the universal service issue because they specifically provided for establishment of post office and so forth in the Constitution itself.

     The Supreme Court has also supports this view. In United States vs. Butler: "While, therefore, the power to tax is not unlimited, its confines are set in the clause which confers it, and not in those of Sec. 8 which bestow and define the legislative powers of the Congress. It results that the power of Congress to authorize expenditure of public moneys for public purposes is not limited by the direct grants of legislative power found in the Constitution."

     http://caselaw.lp.findlaw.com/data/ constitution/article01/26.html#1

     So, I think we can see that wanting single payer doesn't necessary collapse into a "I want to socialize everything". So, unless you can address this point, it's just red herring.

     Posted by srjenkins at 06/28/2009 @ 4:53pm

102. So, I think we can see that wanting single payer doesn't necessary collapse into a "I want to socialize everything". So, unless you can address this point, it's just red herring.

     Posted by srjenkins at 06/28/2009 @ 4:53pm

     I disagree.

     The argument becomes how one views medical services.

     You see them as a universal service (whatever that means). For me, it is no different than any other service I may choose to utilize.

     Defense is an entity all on it's own because without it, the nation ceases to exist.

     Fire and police services are as they should be, locally determined and funded. They would far more fit your "universal service" definition than healthcare does.

     I've commented previously that the majority of healthcare costs are avoidable. Our costs are based upon Americans making poor lifestyle choices rather than what doctors, hospitals, or drug companies charge. We are the worst in the world when it comes to type 2 diabetes which is fully preventable, naturally curable without drugs, and almost always due to lifestyle choices.

     From diabetes we get the outrageous number of people on kidney dialysis, another huge cost driver to the healthcare system.

     but the UHC/single payer mindset would rather continue looking at how to treat the consequence of poor decision making rather than the root problem. And that answer for the left is always to throw tax dollars at an issue. That is mental laziness and reflective of a citizenry that refuses to think and accept personal responsibility.

     Posted by antisocialist at 06/28/2009 @ 5:10pm

103. Posted by antisocialist at 06/28/2009 @ 3:14pm |

     "why don't you people be consistent then and make the case for complete socialization of the country. Why should medical services be singled out because you don't like the rates, or the supposed inefficiencies?"

     Because markets work just fine when they aren't applied to 'products' like healthcare which may or may not be something that people can 'negotiate' a fair deal on.

     I'm fairly confident that people who choose an option other than bankrupting themselves if they could, but when you need chemo to keep feeding your kids, that's waht you'll do...well, everyone but Anti, who talks a good game about his 'time to go', but went to the hospital when he had a heart-attack.

     "Snowball says he's willing to pay more taxes for socialist healthcare, but evidently doesn't want anyone attacking his own means of production and income."

     And yet, I deal with socially conservative loons who insist that violence is caused by my works rather than poor parenting on the part of many and idiotic ratings agencies (ESRB) who limit sales of videogames because people are too lazy to talk to their kids about what they want to play.

     "You read all of these pro socialized medicine posts and they simply refuse to be honest that they want more socialism in America, except for their own work."

     Only when I believe that a governmental solution will work better than a market solution that has most obviously failed (at least from the perspective of the sick, anyway...it's going like gangbusters for the vampiric side of the equation).

     We're not dishonest; you've just failed to pin the tail on the donkey, again, but thanks for attempting to play both sides of the conversation.

     Posted by snowball777 at 06/28/2009 @ 5:30pm

104. Universal service, whether it is education, railroads, telegraph, telephone, electricity, roads, etc. all lend themselves to natural monopolies and government subsidy at some level of government.

     So, the only question we need to get clear on is whether health care is a universal service. I think it is.

     Posted by srjenkins at 06/28/2009 @ 4:26pm

     You confuse universal "service" w/universal needs. There is a universal need for education in the US but is the "service" so "universal"? Are the costs "universal"-as in uniform per-student expenditures? How about teacher pay....where Cali teachers are paid more than 30% above the national norm and delivering the second-lowest results?

     Railroads....there isn't a single one that runs throughout the country. They `loan' each other their tracks and the rates they charge, is highly dependent on alternate transport modes competing...be they barges along the Mississippi or interstate highways.

     My point is, today, very very few endeavors "lend themselves to natural monopolies and government subsidy at some level of government." That certainly goes for medical care where it's both highly specialized and remains the most personal in nature...and where for the large part, one's own life style and priorities, account for one's need for this service.

     Why should a frugal family that eats very healthy, say Frosty or Anti, fork over their tax dollars to Joe Slob who eats junk, watches 5 hours of TV a day, is 60-lbs. overweight and only visits the doctor when his condition becomes dangerous?

     Health care sob stories are a regular diet for our modern MSM....now, how many of them dig down into the lives led by such media darlings?

     We live the life we choose! For the true hard-luck cases, the Gubbers can subsidize their needs!

     Those

     Posted by Happy at 06/28/2009 @ 5:36pm

105. Posted by antisocialist at 06/28/2009 @ 5:10pm |

     "I disagree. The argument becomes how one views medical services. You see them as a universal service (whatever that means). For me, it is no different than any other service I may choose to utilize."

     Choose to pray that your metastatic melanoma gets better...choose to not be Type-1 diabetic...and don't even start with the snake-oil acai berry pitch: you're just a low-grade speed dealer, no better than teens selling p-shooters (ephedrine) in gym class.

     "Defense is an entity all on it's own because without it, the nation ceases to exist."

     And yet there are many nations, all with defense budgets that are dwarfed by ours, still existing.

     "Fire and police services are as they should be, locally determined and funded. They would far more fit your 'universal service' definition than healthcare does."

     911 is a joke in your town...

     "I've commented previously that the majority of healthcare costs are avoidable..."

     On this we agree, but that's an argument for how much coverage we give to 'easy' ways out like statins instead of exercise, and you still haven't addressed people who can't 'choose' not to have cancer etc

     "but the UHC/single payer mindset would rather continue looking at how to treat the consequence of poor decision making rather than the root problem."

     Not true. Universal access would make preventive medecine and information more readily available.

     "And that answer for the left is always to throw tax dollars at an issue. That is mental laziness and reflective of a citizenry that refuses to think and accept personal responsibility."

     Perhaps you'd fare better if you'd stop tossing out invalid generalizations and address the obvious holes in your arguments.

     Posted by snowball777 at 06/28/2009 @ 5:39pm

106. Posted by Happy at 06/28/2009 @ 5:36pm |

     "How about teacher pay....where Cali teachers are paid more than 30% above the national norm and delivering the second-lowest results?"

     30% higher pay...50% higher cost-of-living index and they deal with much higher density than certain states that most folks wouldn't move to on a bet.

     "Why should a frugal family that eats very healthy, say Frosty or Anti, fork over their tax dollars to Joe Slob who eats junk, watches 5 hours of TV a day, is 60-lbs. overweight and only visits the doctor when his condition becomes dangerous?"

     "Health care sob stories are a regular diet for our modern MSM....now, how many of them dig down into the lives led by such media darlings?"

     I'm sure people are lining up to get boutique cancers that can only be treated here in the US because there's a market for them...please.

     "We live the life we choose! For the true hard-luck cases, the Gubbers can subsidize their needs!"

     People don't 'choose' to get mesothelioma from the asbestos in the building where they work, or from chromium-6 leeched into their aquifers, or from radio-isotopes spewed into the air from San Onofre, or when some drunk driver runs into their motorcycle.

     Posted by snowball777 at 06/28/2009 @ 5:45pm

107. People don't 'choose' to get mesothelioma from the asbestos in the building where they work, or from chromium-6 leeched into their aquifers, or from radio-isotopes spewed into the air from San Onofre, or when some drunk driver runs into their motorcycle.

     Posted by snowball777 at 06/28/2009 @ 5:45pm

     You're pretty wordy but poor arguments....easy to gloss over.

     Both Anti and I said "lifestyle"...really, go read what I wrote about Joe Slob!

     Plenty of money being made out of your pals, the lawyers, for the very few true asbestosis cases and the like.....smokers too.

     Posted by Happy at 06/28/2009 @ 5:58pm

108. snow: "50% higher cost-of-living index and they deal with much higher density than certain states that most folks wouldn't move to on a bet."

     Any proof of "50% higher"? And, perhaps Cali has the 2nd highest "density" to explain its 2nd worst student performance?

     Didn't think so! You're mostly mouth!

     Posted by Happy at 06/28/2009 @ 6:00pm

109. Posted by Happy at 06/28/2009 @ 5:58pm |

     Gloss all you want, foolio; we know you can't argue your way out of a wet paper-bag.

     It won't change the fact that your "it's all your lifestyle" argument is a giant crock of fertilizer.

     Posted by snowball777 at 06/28/2009 @ 6:03pm

110. Posted by Happy at 06/28/2009 @ 6:00pm |

     "50% higher cost-of-living index and they deal with much higher density than certain states that most folks wouldn't move to on a bet."

     "Any proof of '50% higher'?"

     http://www.cincinnatichamber.com/ pdf/eco/accra.pdf

     Houston, TX, 2008: Composite: 90.7% of average, Housing: 75.8%

     San Francisco, CA, 2008: Composite: 172.1%, Housing: 292.9%

     "And, perhaps Cali has the 2nd highest 'density' to explain its 2nd worst student performance?"

     Population density: cows don't count.

     Prop 13 gutting the funding for the schools didn't help either, if you were unlucky enough to live in the hood.

     "Didn't think so! You're mostly mouth!"

     Guess again...chucklehead.

     Posted by snowball777 at 06/28/2009 @ 6:09pm

111. well, everyone but Anti, who talks a good game about his 'time to go', but went to the hospital when he had a heart-attack.

     Posted by snowball777 at 06/28/2009 @ 5:30pm

     You're wrong. I did not go to the hospital when I had my heart attack. I instead relied upon prayer, rest, and green tea.

     I went to see a doctor friend 2 weeks later because of the insistence of one of my sons and his wife who is a nurse.

     Posted by antisocialist at 06/28/2009 @ 6:20pm

112. Posted by antisocialist at 06/28/2009 @ 6:20pm |

     My apology for my mis-statement, but you didn't make that clear when you brought it up before and had presented those facts in reverse order leading me to believe that you took a ride in an ambulance involuntarily.

     Treating a cardiac issue with a diuretic...which is likely to leave you dehydrated and with a screwy elecrolyte balance...that's...novel, anti-oxidants or no.

     Posted by snowball777 at 06/28/2009 @ 6:32pm

113. Prop 13 gutting the funding for the schools didn't help either, if you were unlucky enough to live in the hood.

     "Didn't think so! You're mostly mouth!"

     Guess again...chucklehead.

     Posted by snowball777 at 06/28/2009 @ 6:09pm

     this is a repeated false argument that you spin.

     Prop 13 never gutted school funding.

     <State expenditures for K-12 education, adjusted for inflation and population growth, grew almost 99 percent between FY 1977-78 and FY 2002-03, while health and welfare expenditures grew over 48 percent (see page 49).>

     http://tinyurl.com/lsevwo

     As shown on this table, spending went up after prop 13, not down and boy did it go up. No other state is even close to California in our total public education budget.

     http://nces.ed.gov/programs/digest/d08/tables/dt08_176.asp

     and from the California K-12 website

     <Total funding for K-12 education is projected to be $68.5 billion in 2008-09. Of this amount, $65.1 billion is state, federal and local property tax funding accounted for in the State Budget.

     This proposed budget was constructed first by computing the workload budget funding level. From the workload budget, adjustments are made to reflect specific policy reductions, including budget balancing reductions. As a result of these budget balancing reductions, the budget reflects an $865.1 million decrease from the revised 2007-08 total of $66 billion.

     K-12 PER-PUPIL SPENDING

     Total per-pupil expenditures from all sources are projected to be $11,935 in 2007-08 and $11,626 in 2008-09, including funds provided for prior year settle-up obligations (see Figure K12-01).>

     The next highest state is NY at 49 billion.

     Posted by antisocialist at 06/28/2009 @ 6:51pm

114. BTW Snow,

     There is a good reason we should be reducing the state education budget; there are fewer kids in the schools. We have a declining school population the last few years.

     <As a result of a steady decline in birth rates throughout the 1990s, attendance growth in public schools is declining (see Figure K12-04). For the 2007-08, K-12 average daily attendance (ADA) is estimated to be 5,923,000, a decrease of 29,000 from the 2006-07 fiscal year. For 2008-09, the Administration estimates K-12 ADA will decrease by an additional 31,000 to 5,892,000.>

     http://www.ose.ca.gov/budget/documents/k122008.pdf

     What they leave out is that the overall population is declining in California as people get fed up with the high taxes and regulation and go elsewhere.

     Posted by antisocialist at 06/28/2009 @ 7:00pm

115. Posted by antisocialist at 06/28/2009 @ 6:51pm |

     "State expenditures for K-12 education, adjusted for inflation and population growth, grew almost 99 percent between FY 1977-78 and FY 2002-03"

     Yes, when the cost of housing in CA more than doubles (~ 2.8x), and the population doubles, you need to pay people more in order to get them to be teachers in your state and pay more people...welcome to the real world.

     http://mysite.verizon.net/ vzeqrguz/housingbubble/san_francisco.html

     1978: 19M 2008: 36M

     Our spending has definitely gone up since the mid-90s (right as I was leaving high-school; I'm starting to take this personally), but our revenues have been handicapped by Prop 13 ever since they dropped 57% in 1978 so we've passed bond measure after bond measure, but that doesn't make for a balanced budget, just higher debt, which your sources contend are somehow magically spent on students?

     If teachers put their materials on a 20% interest credit card (as many have to do), would you consider the interest charges as 'per student expenditures' too?

     "No other state is even close to California in our total public education budget."

     What state has anywhere near the same number of students? We have 44% more students than the next closest state, TX.

     "Total per-pupil expenditures from all sources are projected to be $11,935 in 2007-08 and $11,626 in 2008-09, including funds provided for prior year settle-up obligations "

     Projected...but actually...

     2005-06: CA: $8,486 (29th) US Avg: $9,100

     And why are they 'settling up' obligations? Because they failed to meet them.

     "The next highest state is NY at 49 billion."

     NY has 2.7M students; we have 6.7M.

     Posted by snowball777 at 06/28/2009 @ 7:37pm

116. What they leave out is that the overall population is declining in California as people get fed up with the high taxes and regulation and go elsewhere. Posted by antisocialist at 06/28/2009 @ 7:00pm |

     Unfortunately, we'll need a lot more people to return from whence they came to get from class size averages of 21 down to the US average of 15, but Bush-o-nomics is making a dent as we speak.

     Posted by snowball777 at 06/28/2009 @ 8:09pm

117. Posted by antisocialist at 06/28/2009 @ 5:10pm

     "I've commented previously that the majority of healthcare costs are avoidable."

     But, it is also true that diseases like cancer can strike anyone, be devastating on every level and are unavoidable. Same goes for broad classes of standard emergency room use. For these people, is it necessary to provide health care or not?

     I think most people think providing some level of health care is an essential, universally needed service and not providing healthcare has moral implications I don't think most are willing to accept.

     Posted by Happy at 06/28/2009 @ 5:36pm

     The above is also relevant to your comments.

     You are also not looking at history. To talk about the current state of railroad service, given our investment in automotive infrastructure, downplays the importance of this institution in our nation's history and its fostering by the federal government as a means of public transport. I'm glad you also brought in waterway development because that is another clear example. Automotive highways are another.

     I basically agree with your criticism that healthy people should not be picking up the check for those that make lifestyle choices that make them sicker and more likely to use healthcare services - which in a universal health care context would mean the costs would be distributed evenly over the population. I don't see any problem in passing along more of the costs to them to make this more fair.

     Posted by antisocialist at 06/28/2009 @ 6:20pm

     I think it is safe to say most people would not want to follow your example. While I have as much skepticism about medicine as I have about government, I recognize that both can occasionally be useful.

     Posted by srjenkins at 06/28/2009 @ 8:17pm

118. Posted by antisocialist at 06/28/2009 @ 7:00pm

     "What they leave out is that the overall population is declining in California as people get fed up with the high taxes and regulation and go elsewhere."

     Current Census estimates put California at 13 largest growing state in terms of percentage and 2nd largest (behind New York) in total population growth by 2030.

     http://www.census.gov/population/www/ projections/projectionsagesex.html (Table 1)

     While California has had some outmigration, this has been to faster growing adjacent states such as Nevada, and one of the possible explanations is a general trend of inland retiree migration, although economic factors are also cited.

     http://www.census.gov/prod/2003pubs/censr-8.pdf

     Posted by srjenkins at 06/28/2009 @ 8:37pm

119. Mr Happy (I assume it's a male since most women aren't this thick skulled) quotes me out of context and then does a 180 re what I said.....

     here's the whole post.

     >>>>>>>This isn't China or Iran or Korea at some point average Americans will figure out on a massive scale that just about everything they've been fed by the dominant corporate establishment was/is a pack of lies.

     Posted by Nick Lento at 06/28/2009 @ 4:08pm

     So you think folks in China/Iran/N.Korea has been fed a pack of truth by their dominant Gubber establishment....brilliant, like all Libs!<<<<<<<

     Go back an re -read my original post "Happy". My point was that the peoples of those countries are being lied to and they don't have many choices/freedoms with which to respond.

     We still have a modicum of democracy in America. 70% of us disagree with your view that the current system is just fine.

     The only scenario in which your "I've got mine and screw everyone else" might work is if we stopped treating anyone who was poor/ununisured and just let them die. We don't live in your reality yet.

     As it is "Happy" (I doubt that you are very ;-) we are wasting so much money on ER care and on insurance companies that universal coverage through a single payer would actually be cheaper!

     Yes "Happy" doing the right and decent thing is actually more efficient and effective. Your world/values lead to a Hobbsean "war of all against all".....a kind of mad max/somalian hellhole.

     This whole debate really comes down to values. What we have now aren't free markets but fixed dirty corrupt monopolies/cartels that legally bribe government officials into designing policies that maintain a pathological status quo.

     People just want systems that manifest common human decency. You seem to have a problem with that.

     Posted by Nick Lento at 06/28/2009 @ 9:09pm

120. Single payer is just one facet/element of what it would take to radically cut our health care costs and still provide high quality services for all for less money that we're spending now.....and to actually see DECLINES in health care spending.

     As has been mentioned, a large part of what makes people sick in the USA is "lifestyle". The thing is that most of the "poor choices" people make are very very very profitable to various sectors of our economy.

     The advertising and PR industries spend billions of dollars brainwashing people into making those poor choices and the food industry constructs food that is designed to be addictive.

     Most cancers would simply never happen if we had truly clean food, air and water.

     We live in a society in which many milions of people hate their lives and their "consciousnesses" so much that they drink alcohol and take all manner of legal and illegal drugs to escape their barren/painful inner worlds.

     We wage "wars" on drugs that create more criminals and more drug dependencies.

     We adopt anti-abortion policies that create more abortions.

     Most of our medical practice should be primary care directed toward prevention in a wholistic framework...as it is our medical system profits from rampant illness. The incentives are mostly perverse.

     Even if by some miracle, a truly public option were passed this year.....the insurance industry would be about sabotaging it (or co-opting it...same thing) from day one.

     Again, single payer is required but it is no panacea. We need systemic change that isn't "socialism" or "capitalism". Free enterprise and free markets are good, so long as they are intelligently regulated.

     It's all connected folks. ;-)

     We shall evolve, or perish. I remain optimistic.

     Peace!

     Posted by Nick Lento at 06/28/2009 @ 9:27pm

121. http://www.pnhp.org/facts/singlepayer_faq.php#socialized

     Anyone care to dispute any of the facts asserted herein???

     >>>>How much of the health care dollar is publicly financed?

     Over sixty percent (60.5 percent) of health spending in the U.S. is funded by government. Official figures for 2005 peg government's share of total health expenditure at 45.4 percent, but this excludes two items:

     1. Tax subsidies for private insurance, which cost the federal treasury $188.6 billion in 2004. These predominantly benefit wealthy taxpayers.

     2. Government purchases of private health insurance for public employees such as police officers and teachers. Government paid private insurers $120.2 billion for such coverage in 2005: 24.7 percent of the total spending by U.S. employers for private insurance.

     So, government's true share amounted to 9.7 percent of gross domestic product in 2005, 60.5 percent of total health spending, or $4,048 per capita (out of total expenditure of $6,697).

     By contrast, government health spending in Canada and the U.K. was 6.9 percent and 7.2 percent of gross domestic product respectively (or $2,337 and $2,371 per capita). Government health spending per capita in the U.S. exceeds total (public plus private) per capita health spending in every country except Norway, Switzerland and Luxembourg.

     (Source: Himmelstein and Woolhandler, "Competition in a publicly funded healthcare system" BMJ 2007; 335:1126-1129 [1 December] and Woolhandler and Himmelstein, Health Affairs, 2002, 21(4), 88, "Paying for National Health Insurance - And Not Getting It.")<<<<<

     Posted by Nick Lento at 06/28/2009 @ 9:32pm

122. Houston, TX, 2008: Composite: 90.7% of average, Housing: 75.8%

     San Francisco, CA, 2008: Composite: 172.1%, Housing: 292.9%

     Posted by snowball777 at 06/28/2009 @ 6:09pm

     That's the extent of your `proof' that Cali's cost-of-living is 50% greater than average? Do you know what % of total living cost the housing component needs to be to back up your `proof'?

     Oh, well, math and logic....may not be necessary for video game programmers!

     Posted by Happy at 06/28/2009 @ 9:51pm

123. I don't see any problem in passing along more of the costs to them to make this more fair.

     Posted by antisocialist at 06/28/2009 @ 6:20pm

     I doubt ANYONE here would "see any problem in passing along more of the costs to them to make this more fair". What's the real problem then? Details like.....health tax on sodas? $4 per pack on cigaretts? $1 per lb tax on butter and french pastries? What about those of us who partake in these UNhealthy, over-rich `stuff' in total moderation?

     What if they are low-income...the typical profile of the UNinsured who just by chance of all chances, also leads in poor life style choices?

     Providing UHC to all, like welfare, will encourage many to stay on the path of taking shitty care of their bodies for the simple reason that they know their care will be essentially FREE!

     One fair way to "pass along" some of the costs of UHC, is for all able-bodied to work for it. Say a minimum of 10~15% of their pay. Since most of the folks w/out care don't pay income taxes, this will become their All-In tax to offset part of their care....if they have dependents, make that 15~20%.....targeting soda or liquor cast way too wide a net even though it will cut down consumption.

     Posted by Happy at 06/28/2009 @ 10:07pm

124. Go back an re -read my original post "Happy". My point was that the peoples of those countries are being lied to and they don't have many choices/freedoms with which to respond.

     ....As it is "Happy" (I doubt that you are very ;-) we are wasting so much money on ER care and on insurance companies that universal coverage through a single payer would actually be cheaper!

     Posted by Nick Lento at 06/28/2009 @ 9:09pm

     OK, I re-read and your point, such as it were, was not what you rephrased at 9:09pm: that Americans are being conned. Insurance companies are heavily regulated and their books are public...they make a profit and that, I understand, is BAD from your POV. Me, I'm HAPPY they are profitable and provide jobs for many and $$ return to their investors/owners.

     Are we really "wasting so much money on ER care"? Are you saying the money spent in ER for the poor are wasted?

     As I understand it, the poor who use ER for non-life threatening services are NOT treated ahead of the gunshot or heart attack victims....sure, the ER staff maybe kept busier than what the normal true emergency case load might be, and may even need to have an additional staff on hand....but serving the indigents shouldn't bear the same overhead load as what the 24/7 ERs are meant for. By that I mean, the severely injured car wreck victim, and the 9 indigents coming in for some fever or ear ache during a shift, shouldn't all bear 1/10 of the costs!

     Maybe we should staff each and every ER, 24/7, with a primary physician who will handle, ironically, NON-emergency care! Bet that wouldn't cost $1.6 Trillion over 10 years. And, each non-emergency patient coming in, pays $50, a meaningful enough sum without it being unduly difficult to produce.

     Posted by Happy at 06/28/2009 @ 10:43pm

125. Posted by Happy at 06/28/2009 @ 10:07pm

     I assume this post was for me.

     "What about those of us who partake in these UNhealthy, over-rich `stuff' in total moderation?"

     I was thinking more along the lines of passing along higher costs at the point of service, offering lifestyle classes to avoid those extra costs (same as is done for automobile driving) or promoting good lifestyle choices through social suasion (limited only by your imagination and could include anything like a small tax relief offered for those who only used preventative health care the preceding year to creating and promoting the use of bicycle paths).

     Vice taxes have been used in the past, but I favor a positive approach. You can elect to get into fights that send you to the emergency room or not use the bike paths - but creating incentives and opportunity will work to help more people decide to make better choices for themselves.

     "What if they are low-income...the typical profile of the UNinsured who just by chance of all chances, also leads in poor life style choices?"

     This is true. But, I think the approach above doesn't represent an undue burden and can achieve real results, even though this group has a higher portion of the costs.

     "One fair way to "pass along" some of the costs of UHC, is for all able-bodied to work for it."

     Now who's the socialist? =) The problem is there is a whole host of people that are doing work that doesn't count. What would you do with all the stay-at-home mothers/fathers, people taking care of elderly parents, people who's primary work consists of doing volunteer work or people taking care of terminally ill spouses? I'm not sure I like the idea of government dictating how people should be living their lives beyond social suasion or cost/tax incentives.

     Posted by srjenkins at 06/29/2009 @ 12:20am

126. That's the extent of your `proof' that Cali's cost-of-living is 50% greater than average? Do you know what % of total living cost the housing component needs to be to back up your `proof'? Oh, well, math and logic....may not be necessary for video game programmers! Posted by Happy at 06/28/2009 @ 9:51pm |

     1) The composite number includes it and is 72% higher.

     2) The housing component is 70% of my cost-of-living.

     3) As I do video compression and cryptography, I can run rings around you with whatever math or logic you'd like, Dippy.

     Posted by snowball777 at 06/29/2009 @ 12:29am

127. Excerpt from Finnish online publication ovimagazine.com.

     http://ovimagazine.com/art/4566

     The Real Solution to Healthcare Reform by Bohdan Yuri 2009-06-26

     "…Those that can afford it don't really care.

     True change - begin by cutting Congress's health care benefits.

     … may be the only way to force Congress into changing the moral character of this pseudo "debate... That is the REAL SOLUTION to this problem. Throw Congress into the world of the uninsured --- perhaps that sting will make them act."

     Posted by onekoleso at 06/29/2009 @ 01:42am

128. Posted by onekoleso at 06/29/2009 @ 01:42am |

     Wouldn't that just make them take "Cadillac Plans" in exchange for votes...like Chuck Rangel's homes, but with low premiums and no deductible?

     Posted by snowball777 at 06/29/2009 @ 08:07am

129. 10,000 people showed up !!!!

     I heard a news report where attendance was described as being "in the hundreds".

     Technically, that may be an accurate, but misleading description.

     But then, most of the media is biased on this issue and most others. I don't know why republicans criticize the media.

     Posted by mextex at 06/29/2009 @ 09:12am

130. What if they are low-income...the typical profile of the UNinsured who just by chance of all chances, also leads in poor life style choices? Posted by Happy at 06/28/2009 @ 10:07pm |

     What about differentials across states?

     http://www.statemaster.com/ graph/hea_obe_rat-health-obesity-rate

     Obesity: MS (26% worst) TX (3rd at 24%) CA (19th at 20.1%) CO (20%...best)

     http://awesome.good.is/transparency/ 013/UpInSmoke/

     Smoking: KY (28.1%...worst) TX(18.1%...19th) CA (14.1%...49th) UT (9.8%...best)

     http://www.statemaster.com/graph/ hea_alc_con_bin_dri-health- alcohol-consumption-binge-drinkers

     Alcohol: WI: 21.8%...worst TX: 15.6%...23rd CA: 14.7%...28th UT/WV: 2.8%...best

     You may have me convinced, cons...I may not want to subsidize the fat, drunken smokers of WI, KY, and MS.

     Posted by snowball777 at 06/29/2009 @ 09:25am

131. Posted by pyeatte at 06/27/2009 @ 3:24pm

     No, no, no. I'm thinking Aruba. Or Caymans. Some island in the Caribbean would be better than Mexico. A nip here, tuck there and wash away the pain with a cool, fruity cocktail on the beach.

     :)

     Posted by plainbruce at 06/27/2009 @ 5:43pm

     Have your son come and visit me in the islands...I will be running a group of Tikki style bars to cater to the Medicotoursts coming to get what the US used to provide by that time..inovative great health care...

     ask at any one of my bars for Edwardo..that will be me..present your paid medical bill and receive a free drink on me...

     Remember Bruce, Happy and the rest of us who still believe what the FF dreamed and we are living it..

     Those who believe they have defeated your arguement and defend the single payer system...also believe the POST OFFICE is a model of success.

     Enough said there.

     Posted by YourJomamma at 06/29/2009 @ 10:06am

132. Jomamma, care to point me to which private carrier could deliver my letter for less than a dollar? Or, want to provide a discussion on the role of the post office in the development of this country?

     Oh yeah. There isn't a private carrier capable of handling the volume and your understanding of the post office extends to how well they service your business needs - which is not the only (or even a good) criteria for evaluation.

     But, thanks for the reminder that I'm wasting my time. The "keep your chin up my fellow cons and just believe in the rightness of the cause despite the facts" is exactly why you people are going to be in the political desert for the foreseeable future. One day you are going to wake up to the fact that facts matter.

     Posted by srjenkins at 06/29/2009 @ 10:42am

133. Posted by srjenkins at 06/29/2009 @ 10:42am |

     Sshhhh...if they all head south of the border, we won't have to ration care.

     Posted by snowball777 at 06/29/2009 @ 11:28am

134. "Ever consider how you putting your hand in my pocket takes away my freedom? You are aware that most people have to spend time making money, and most make a lot less than doctors? So, no. I'm not particularly concerned about any freedoms or rights that are predicated on taking money out of my wallet. You don't have a right or the freedom to use the government to take my money for your livelihood."

     I just got back and this is the first post I came across. Don't look now but you're starting to sound like a conservative. I find it ironic and somewhat humorous that a socialist (at least that's how it sounds) is complaining about goverment's hand in his pocket when HE is the one that put it there.

     Have YOU ever thought about how having your hand in MY wallet takes away MY freedom? You just made an argument against medicaid/medicare/school lunch programs/welfare programs of all types.

     There have been a lot of posts since I last checked so I'll have to come back later.

     Posted by plainbruce at 06/29/2009 @ 1:01pm

135. "Ever consider how you putting your hand in my pocket takes away my freedom? You are aware that most people have to spend time making money, and most make a lot less than doctors? So, no. I'm not particularly concerned about any freedoms or rights that are predicated on taking money out of my wallet. You don't have a right or the freedom to use the government to take my money for your livelihood."

     I just got back and this is the first post I came across. Don't look now but you're starting to sound like a conservative. I find it ironic and somewhat humorous that a socialist (at least that's how it sounds) is complaining about goverment's hand in his pocket when HE is the one that put it there.

     Have YOU ever thought about how having your hand in MY wallet takes away MY freedom? You just made an argument against medicaid/medicare/school lunch programs/welfare programs of all types.

     There have been a lot of posts since I last checked so I'll have to come back later.

     Posted by plainbruce at 06/29/2009 @ 1:05pm

136. As most here lick their chops over Obamacare, sure to benefit many and enrich some, a tiny bit of a reminder, on whose `pockets' are being targeted....no surprise, that's a lot of pockets:

     White House Won't Rule Out Benefits Tax

     By Michael D. Shear

     Washington Post Staff Writer

     Monday, June 29, 2009

     President Obama's top political adviser declined yesterday to rule out the possibility that the White House would agree to a tax hike on health insurance plans that would hit middle-income Americans.

     Speaking on ABC's "This Week," David Axelrod declined to repeat Obama's "firm pledge" during the campaign that families making under $250,000 would not see "any form of tax increase, not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes."

     Instead, Axelrod said the president has no interest in "drawing lines in the sand" on the issue of how to pay for the costly health reform plan making its way through Congress....

     Axelrod insisted that Obama is "very cognizant of protecting people -- middle-class people, hardworking people, who are trying to get along in a very difficult economy."....

     He also repeated Obama's preference for a cap on the deductions that people making over $250,000 can take on their taxes as a way to pay for health-care changes....

     Posted by Happy at 06/29/2009 @ 3:48pm

137. Time to throw ALL the republicans OUT of office!!!

     Posted by Tiger2Lover at 06/29/2009 @ 5:39pm

138. Time to throw ALL the republicans OUT of office!!!

     Posted by Tiger2Lover at 06/29/2009 @ 5:39pm

     don't blame Republicsans because you aren't getting all of the socialism you want. Republicans don't have any control of Congress or the White House.

     Posted by antisocialist at 06/29/2009 @ 5:43pm

139. Posted by plainbruce at 06/29/2009 @ 1:05pm

     Libertarian socialism is neither conservative or liberal. It just means an acceptance of the fact that, frequently, individual freedom is increased through social ownership.

     The problem is the role of government. Ideally, health care would be provided by communities for themselves without government involvement. Coop health care is something that both The Heritage Foundation and the Democrats supporting cooperative health care can agree on.

     In my view, cooperative health care doesn't currently have a chance. It will either be captured by private industry, government playing at being a coop or it won't work. So, I think an intermediate step of federal government single payer is necessary to change the game, even though it also runs the risk of government capture.

     The bottom line is that the current system is broken. If we are going to have cooperative health care, then we need to build infrastructure to support that and in the mean time, single payer or at least a government option can deal with access and cost issues.

     I'm about as pragmatic on this issue as anyone can be.

     " I find it ironic and somewhat humorous that a socialist..."

     The questions are: (1) What are they there for? (2) Are there alternatives? For certain problems - such as national defense (narrowly defined), universal education, or universal health care coverage, federal, state and local government may have a role to play, particularly when the alternatives are not there. For certain issues, like making sure you have a livelihood, there are alternatives, so government reaching into my pocket isn't warranted.

     I don't like government involvement. But, unfortunately, it occasionally seems necessary.

     http://www.heritage.org/Research/Healthcare/wm2493.cfm

     Posted by srjenkins at 06/29/2009 @ 8:08pm

140. This discussion is somewhat interesting.

     http://www.fivethirtyeight.com/2009/06/wyden-not.html

     I also liked the physician example of economic rent.

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

     Posted by srjenkins at 06/29/2009 @ 8:14pm

141. Jomamma, care to point me to which private carrier could deliver my letter for less than a dollar? Or, want to provide a discussion on the role of the post office in the development of this country?

     Posted by srjenkins at 06/29/2009 @ 10:42am

     Again, not quite true. The post office can't deliver mail for less than a dollar either. We spend billions to keep the system up and running, they continue to increase the price of a stamp and they're STILL in debt up to their eyeballs and will be closing ~10% of their offices.

     Posted by plainbruce at 06/29/2009 @ 8:17pm

142. Again, not quite true. The post office can't deliver mail for less than a dollar either. We spend billions to keep the system up and running, they continue to increase the price of a stamp and they're STILL in debt up to their eyeballs and will be closing ~10% of their offices.

     Posted by plainbruce at 06/29/2009 @ 8:17pm

     Despite all the increases, a stamp is just $.44.

     Even if the PO's deficit equaled its operating budget, that's still only $.88.

     What a bargain.

     Posted by Malcontent at 06/29/2009 @ 10:02pm

143. I wish I had more time to read through the other posts upthread, but I have too much work to catch up on tonight. However, I did see this one since it was at the end, so I thought I'd comment.

     "Libertarian socialism is neither conservative or liberal. It just means an acceptance of the fact that, frequently, individual freedom is increased through social ownership."

     Contrast that with your earlier statement:

     "Ever consider how you putting your hand in my pocket takes away my freedom? You are aware that most people have to spend time making money, and most make a lot less than doctors? So, no. I'm not particularly concerned about any freedoms or rights that are predicated on taking money out of my wallet. You don't have a right or the freedom to use the government to take my money for your livelihood."

     You can't have it both ways. Just because the government isn't taking it out of YOUR pocket doesn't mean that someone else's liberty isn't being affected. Apparently you feel comfortable infringing on another's freedom as long as it's not your wallet being "relieved" of its contents.

     "The questions are: (1) What are they there for? (2) Are there alternatives?"

     No, the question is what does the Constitution specifically allow? National defense, postal roads are named among others. There's nothing about health care. Secondly, there are many alternatives to socialized medicine. We haven't even scratched the surface of the possibilities.

     Posted by plainbruce at 06/29/2009 @ 11:27pm

144. Posted by plainbruce at 06/29/2009 @ 11:27pm

     I addressed this issue in my post at 06/28/2009 @ 4:53pm. Hamilton's broad interpretation is the law. I further differentiate it by using the concept of universal service. Consult the findlaw site for further discussion.

     "We haven't even scratched the surface of the possibilities."

     What exactly do you propose besides more money? The fee for service model is broken. The current model is broken. Conservatives like to complain about government involvement, but I've yet to see anything offered up that has a realistic possibility of working besides single payer. I'm all ears.

     Posted by srjenkins at 06/30/2009 @ 12:48am

145. Sshhhh...if they all head south of the border, we won't have to ration care.

     Posted by snowball777 at 06/29/2009 @ 11:28am

     That's true..for if those who pay for your health care head south, so does your meal ticket.

     Ssssh..if they all head south, you won't have anyone left to steal away their fruits of their labors, as guys like me take it and the ability to produce with us....sshhhh...socialism only works up and until you run out of other peoples money...

     SSSHHH

     Now, if all the illegals head south, then maybe we don't have to ration health care immediatley, but it will be rationed..

     Posted by YourJomamma at 06/30/2009 @ 02:02am

146. Posted by YourJomamma at 06/30/2009 @ 02:02am

     Your John Galt fantasies are amusing.

     Posted by srjenkins at 06/30/2009 @ 09:34am

147. Canada Sees Boom in Private Health Care Business

     By Molly Line

     FOXNews.com

     Tuesday, June 30, 2009

     Private for-profit clinics are a booming business in Canada -- a country often touted as a successful example of a universal health system.

     Facing long waits and substandard care, private clinics are proving that Canadians are willing to pay for treatment.

     "Any wait time was an enormous frustration for me and also pain. I just couldn't live my life the way I wanted to," says Canadian patient Christine Crossman, who was told she could wait up to a year for an MRI after injuring her hip during an exercise class. Warned she would have to wait for the scan, and then wait even longer for surgery, Crossman opted for a private clinic.

     As the Obama administration prepares to launch its legislative effort to create a national health care system, many experts on both sides of the debate site Canada as a successful model.

     But the Canadian system is not without its problems. Critics lament the shortage of doctors as patients flood the system, resulting in long waits for some treatment.

     "No question, it was worth the money," said Crossman, who paid several hundred dollars and waited just a few days.

     Health care delivery in Canada falls largely under provincial jurisdiction, complicating matters.

     Private for-profit clinics are permitted in some provinces and not allowed in others. Under the Canada Health Act, privately run facilities cannot charge citizens for services covered by government insurance.

     But a 2005 Supreme Court ruling in Quebec opened the door for patients facing unreasonable wait times to pay-out-of-pocket for private treatment....

     Posted by Happy at 06/30/2009 @ 8:31pm

148. Posted by Happy at 06/30/2009 @ 8:31pm

     ahh the old blanket statements with no statistics to back them up. these countries run costumer satisfaction studies and they are always very high across the board. ancedotal evidence is an oxymoron. show me a number then we can talk.

     Posted by nathantankus at 07/02/2009 @ 03:05am