Billy,
And the Massachusetts plan went broke. Doesn't that say anything about
the sustainability of such plans? TANSTAAFL. RomneyCare has done a
belly-flop. So will it work at the national level, or will it just be
even a bigger mess? (With the smallest number of business people ever
appointed to cabinet and mid-level positions since they've been keeping
track (1900), I vote for a bigger mess.)
What restrictions in the Oregon plan keep it afloat while Massachusetts
went under? Are those restrictions in the "public option" that was
floated in the House? If not, then it is heading for a RomneyCare
belly-flop.
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 11:36 PM, [email protected] wrote:
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] 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]
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] 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 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, 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 (.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€Âbut 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).
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