David : Actually I agree with your recommendations with respect to tort reform and --implicitly-- for other kinds of reforms , for example, limits on malpractice lawsuits. When I say "public option" or any number of other things, my assumption, generally unstated, is for systems redesign. Not just individual parts of health care ( or other issues, as the case may be.) For all my gripes with Gingrich, and admitting that he is in the pockets of more than one health care outfit, I think Newt is on the right track, comprehensive systems redesign. Otherwise there is always something else to fix, always some new problem that is sure to surface. Back when I was eligible for the Oregon health plan there was nothing better. That was way back in 2000 / 2001 when, after my medical problems in Arizona I relocated here and had zilch for income Creep back above the poverty line and you are cut off completely. But it was once helluva good plan and covers the waterfront --your choice of doctors or dentists. Anyway, why shouldn't all Americans have that kind of coverage, granting that any such plan ought to be means tested ? What is gained when a significant % of the population is in poor health ? The losses to all of society are major if you add it all up. The Oregon plan is sufficiently good that Arizona and some other states ( like Massachusetts ) used it as the model for their own health plans. Billy ========================================= In a message dated 3/24/2010 8:20:25 P.M. Pacific Daylight Time, [email protected] writes:
I have heard "government is the last refuge of the incompetent," although Asimov said it was Violence and Boise Penrose said it was "public office." So I really have no good source for that other than dear old dad (RIP). You can see that in the Louisiana DMV or the Texas DMV or the Dallas VA Hospital. I wish that I could trust and believe that government bureaucrats were professional, but the CIA leaked like a sieve under Bush and hasn't been quite as forthcoming under Obama, so I do not have great trust in the professionalism of the bureaucrats, other than that I trust them to be professional in a partisan manner. Which is tantamount to "not at all." Same thing for the EPA, DHHS, DHS, and countless other agencies. Obama has said that he is in favor of a single payer system (as has Barney Frank). The public option is the halfway house to single payer (as Barney Frank has claimed). I don't believe that he (either one) will stop there (at the public option). I don't believe that the Democratic Party will stop there. So I'm leery of the whole notion in the "camel's nose under the tent" sort of way. Most of this is trying to legislate a free lunch, or at least a lunch at medical reimbursement levels which Congress needs to fix so that doctors will continue to accept Medicare patients. I guess that means that the doctors are greedy, too, but my brother in law is a doctor and his student loans were astronomical. So is his malpractice insurance because he actually delivers babies. They have to be well paid or they will never pay those 8 to 12 years worth of loans off, and never pay those premiums for OB malpractice. But no, we cannot have tort reform, we can only screw the doctors. If he were to give up delivering babies, he would get to keep a lot more money, but the people of south central Arkansas would have to drive to Little Rock (2 hour drive) to have their babies delivered. Or deliver them somewhere on US 79 or US 165/US 167 in an EMS vehicle. I know that back in 2001, Aetna paid my doctor $75 for an office visit (plus my $25 co-pay) while Medicare paid $25 to my mother's doctor for her office visits. The doctor got another $2.50 or so from Aetna, and less than $10 from mom (I may have that backwards, I was paying the bills off in 2002-don't remember and really don't want to remember). The doctors barely cover their costs with Medicare patients. There ain't no such thing as a free lunch. (TANSTAAFL.) David "A pleasant natural environment is a good - a luxury good, philosophical good, a moral goody-good, a good time for all. Whatever, we want it. If we want something, we should pay for it, with our labor or our cash. We shouldn't beg it, steal it, sit around wishing for it, or euchre the government into taking it by force."--P. J. O’Rourke On 3/24/2010 1:58 AM, [email protected]_ (mailto:[email protected]) wrote: David: I have no idea what public employees you have had the most dealings with in your life but most ( not all, but most ) of the ones I have had dealings with have been conscientious and have sought to do good work. You have a point, entirely valid, about the BHO admin, but I'm thinking about the people, professionals, who will actually carry out the work of the plan. To REPEAT, this particular plan SUX. I do not like it. My argument is essentially hypothetical since it is about public option. But , while you make some points, at no place do you address the problems which public option is most designed to remedy. Should an exec at Aetna, or any other company , be paid $ 15,000,000 when their actions or inaction means that an average stiff must pay $ 500 per day for a hospital room, $ 5000 for a medial procedure that costs a doctor and his assistants $ 1000 to perform, or $ 50,000 over the course of a decade for prescription drugs ? Sure, aspire to wealth, it is legal and is useful in a hundred ways. But NOT when that kind of reward level means that I get shafted when I need surgery, or my mother gets robbed at surgical knifepoint, or Uncle Harry needs to shell out 25% of his income on drugs that a pharmaceutical company sells at a 250% mark up. Sometimes capitalism is legal robbery. Mostly I like the capitalist system. But in all cases ? Not a chance. Billy ================================================ In a message dated 3/23/2010 9:53:37 P.M. Pacific Daylight Time, [email protected]_ (mailto:[email protected]) writes: Billy, With the way this administration is working, I'm reminded of the Gang That Couldn't Shoot Straight. I don't trust any administration with this. See how wonderfully solvent Medicare and Social Security are. OOPS!!! Heck, just look at the new deficit figures. And by the way, Government pay now leads private sector pay in applications programming. So I could go get a government job and make more money (couldn't look myself in the mirror any more, but hey). The Toll Road argument is specious, the state owns both. Some highways are toll until they are paid for: The Dallas-Fort Worth Turnpike, which is now the Tom Landry Highway (I-30) and free. Under the control of the state of Texas for the whole time. It wasn't ever private and then went public. It was public from the beginning. Citing the Huffington Post and a web site run by a pro-Obamacare group is not persuasive to me. Not without hearing the old class warfare "evil Capitalist Oppressors" memes in my head while doing so. Frankly, executive pay like that is something to shoot for. I don't really understand why it is wrong for the head of Aetna to make big bucks, but OK for the head of GE to make big bucks. Oh, that's right, the head of GE donated to Obama. I forgot. I guess that all medical care should be charity driven. But government will soon set pay guidelines and everything will be "fair." Just like the old Soviet Union. David "A pleasant natural environment is a good - a luxury good, philosophical good, a moral goody-good, a good time for all. Whatever, we want it. If we want something, we should pay for it, with our labor or our cash. We shouldn't beg it, steal it, sit around wishing for it, or euchre the government into taking it by force."--P. J. O’Rourke On 3/23/2010 10:33 PM, [email protected]_ (mailto:[email protected]) wrote: David : Seems to me that criticism of private insurance companies in the medical sector --this has nothing to do with homeowner insurance, or automobiles, or anything else-- is entirely justifiable. Generally I favor market solutions to just about anything, but here is a case , financial institutions is another, where the market clearly has broken down and the best available solution is the public sector. The argument that a public option would destroy private insurance companies is false as I see it, for much the same reason that toll roads and toll bridges continue to exist despite the existence of the Interstate or , for that matter, other public highways or bridges. Consider these remarks from : Donald Cohen, Executive Director, Center on Policy Initiatives in the Huffington Post for March 23, 2010, originally from last year. " Since health insurance costs are rising at nearly twice the inflation rate, there couldn't be a more important time to eliminate non-essential overhead through healthy competition. Families and employers are being crushed under the burden of increased health care costs. Since the year 2000, employer-sponsored health coverage premiums have increased by 87 percent. It's no wonder, though, that the Health Insurers are frantically trying to head off competing with a public plan. Private insurance overhead and profits eat up 20% and more of health care premiums while Medicare overhead (and no profit) is closer to 3%. There is big money to be made in health insurance. The top 7 "for profit" health insurers made a combined $12.6 billion in 2007-- an increase of 170.2% from 2003. The same year, the _average CEO compensation package _ (http://www.insurancecompanyrules.org/pages/insurance_company_ceo_compensation_2006_2007) for these health insurance companies was $14.3 million. Pay packages ranged from $3.7 million to $25.8 million. " I simply cannot work up much or any sympathy for any business which is usurious in essence Moreover from what I have read elsewhere, insurance company profits grew even more than usual in 2009 despite the recession for the simple reason that several million people dropped their private plans because they could no longer afford them, and many of this pool of people were those with higher costs due to health issues. In such a case inflation of profits is immoral. There was also a Sanjay Gupta piece on CNN which showed the obscene prices for medical equipment that are commonplace in the "industry." And you thought that military toilet seats at $ 1000 were bad, that kind of pricing occurs up and down the line for everything from catheters to bedpans, Clearly hospitals, if not also doctors, don't give a damn about such pricing ( even if some do ) and are more than willing to require people to pay through the nose. Even if families are bankrupted in the process. In what way is that good ? The article below explains "public option" for anyone unclear on the concept. I am anything but anti-capitalist, but I am very much anti-gouging and do not regard the government as evil by design. So, when a government option can do a better job, OK with me. Today about 17% of GDP goes to health care, twice the rate in 90% of modern nations This trend has gotten worse with, ironically, more competition, or presumably more competition, from the time about 20 years ago when it stood at about 10 %. The nation cannot afford more of this nonsense and anything that will stop this is long overdue. Billy --------------------------------------------------------------------- OpenCongress blog What is the Public Option? August 20, 2009 - by Donny Shaw The public option as proposed in the _House health care bill_ (http://www.opencongress.org/bill/111-h3200/show) , is a government-run health insurance plan, like Medicare, that would compete along side private insurers in a new Health Insurance Exchange that the bill would set up. The exchange is basically a place where people who aren’t on Medicare or Medicaid and don’t have insurance through their employers would go to comparison shop for a health plan. One of the plans available on the exchange would be the public option. Like all plans on the exchange, the public plan would have to meet certain minimum standards for care – minimum services that must be covered, mental health benefits parity, a fair grievance and appeals mechanism, etc. The public option and the private insurers on the exchange could still offer different levels of care – from catastrophic-only to comprehensive – but plans would be relatively standardized by type so that comparison shopping is easier for consumers. The exchange would be available to the public as a website and a toll-free hotline, and would be focused on making information about the plans more transparent. Conservatives argue that the government-run public option plan would drive private insurers out of business because, not being burdened by the need to generate profit, they could offer the same level of care at a lower price. They fear that this would happen to such an extent that eventually there would not be any private insurers left. Liberals on the other hand see the competitive advantage of a public plan as a way to bring costs down throughout the industry, thereby increasing the number of affordable health insurance choices for consumers. Without the public option there will be no real change to the current system that has kept health insurance out of reach for millions of Americans, they argue. Who’s right? The Congressional Budget Office (CBO), a politically independent, non-partisan government agency whose job is to provide economic data to Congress on the bills they propose, has done some _analysis_ (http://www.cbo.gov/ftpdocs/104xx/doc10430/House_Tri-Committee-Rangel.pdf) (.pdf) of the public option’s likely effects. This is as close as we can get to an unbiased, scientific take. Based on how the CBO sees the public option working, it’s safe to say that even if the conservatives are right and the goal is to crowd out the private insurers, as written into the bill, it’s not going to have that effect: Another significant feature of the insurance exchanges is that they would include a public plan that largely pays Medicare-based rates for medical goods and services. CBO estimates that the premiums for that plan would generally be lower than the premiums of the private plans against which it would be competing. Because all plans offered in the exchanges would vary their premiums to reflect the costs incurred in each area, the difference in premiums between private plans and the public plan would vary geographicallyâ⠂¬â€but on average the public plan would be about 10 percent cheaper than a typical private plan offered in the exchanges. That difference in premiums is itself the net effect of differences in the major factors that affect all insurance plans’ premiums, including their payment rates to providers, their administrative costs, the degree of benefit management they apply to control spending, and the pool of enrollees they attract (the effects of which would be partly offset by the risk-adjustment provisions described above). _______________________________________________ Centroids mailing list: [email protected]_ (mailto:[email protected]) _http://radicalcentrism.com/mailman/listinfo/centroids_radicalcentrism.com_ (http://radicalcentrism.com/mailman/listinfo/centroids_radicalcentrism.com) Archives at _http://radicalcentrism.org/pipermail/centroids_radicalcentrism.com/_ (http://radicalcentrism.org/pipermail/centroids_radicalcentrism.com/) _______________________________________________ Centroids mailing list: [email protected]_ (mailto:[email protected]) _http://radicalcentrism.com/mailman/listinfo/centroids_radicalcentrism.com_ (http://radicalcentrism.com/mailman/listinfo/centroids_radicalcentrism.com) Archives at _http://radicalcentrism.org/pipermail/centroids_radicalcentrism.com/_ (http://radicalcentrism.org/pipermail/centroids_radicalcentrism.com/) _______________________________________________ Centroids mailing list: [email protected]_ (mailto:[email protected]) _http://radicalcentrism.com/mailman/listinfo/centroids_radicalcentrism.com_ (http://radicalcentrism.com/mailman/listinfo/centroids_radicalcentrism.com) Archives at _http://radicalcentrism.org/pipermail/centroids_radicalcentrism.com/_ (http://radicalcentrism.org/pipermail/centroids_radicalcentrism.com/) _______________________________________________ Centroids mailing list: [email protected] http://radicalcentrism.com/mailman/listinfo/centroids_radicalcentrism.com Archives at http://radicalcentrism.org/pipermail/centroids_radicalcentrism.com/
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