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Re: Re: Re: The utterly insane mandate (Reply to this comment)
by voxpoptart
And it's poor reading on your part to believe that I *do* present it as no big deal.
You suggest the paperwork challenge is something novel under the sun, and I disagree, specifically, about that. Have you ever dealt with the paperwork from private health insurance, for goodness sakes? Half the administrators in American hospitals are employed specifically to deal with it, and it still can drag out preposterously. We're not exactly inventing brand new nightmares.
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Dec 20 '09
5:03 am PST
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Re: Re: The utterly insane mandate (Reply to this comment)
by Ahab1973
Except you can elect not to own a car. Your life is pretty much here to stay as long as you are.
I think this will bury the people who need it most in more red tape than most of them have ever seen. I had to apply for government assistance to pay a hospital bill once and the paperwork was nuts. And I never heard anything else about it. I don't know if they paid it or not. Being under threat from the government, people will not be able to have that kind of uncertainty.
It certainly is different from anything we've seen before and it's intellectually dishonest to present it as no big deal.
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Dec 19 '09
6:38 am PST
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Re: The utterly insane mandate (Reply to this comment)
by voxpoptart
It's not different in structure or philosophy from, if you own a car, the requirement to buy collision liability insurance. This would be a lot more expensive, and I think the decision to mandate *private, for-profit* insurance (instead of providing a nonprofit alternative) is both corrupt and politically stupid. But there's no reason to think the paperwork challenge would be anything new, and the precedent has already been set.
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Dec 15 '09
6:16 am PST
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The utterly insane mandate (Reply to this comment)
by Ahab1973
"4) Everyone will be required to have health insurance. People making less than 4 times the poverty income (so, $80,000 for a family of four) will receive subsidies. Nothing will ensure that the subsidies will help them buy *good* plans, but everyone will buy a plan."
1. So where's the guarantee that subsidy will be easy to obtain and will always be there? My guess is you'll have to apply for it and the government will be able to turn you down just like they can for any other kind of government assistance.
2. Once they find that they can mandate health insurance on the grounds that your failure to do so affects the economy and other people, what will stop the floodgates from opening on this sort of thing on all kinds of other issues? This will be a precedent that most people are just not thinking about. And it's a scary one.
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Dec 14 '09
4:25 pm PST
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Re: Good summary.... (Reply to this comment)
by voxpoptart
Rather than commenting I have decided to write my own (unbalanced) rant
Excellent choice! I shall check it out next time i have the functioning brain cells.
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Sep 10 '09
9:40 pm PDT
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Re: Re: Re: The Gang of Six is the Problem ... (Reply to this comment)
by voxpoptart
(I would write my own piece on this issue but I'm afraid my head will explode from the exercise of sifting through the stupidity from the Republican noise machine.)
No, no: make *their* heads explode. Aim before you fire.
Rep. Anthony Weiner of NY had a rather simple but succient solution which involves allowing those under 65 to buy into Medicare coverage if they can't get insurance through their employer.
Nice, although those of us who can get employer insurance will suddenly be annoyed.
cheers,
- Brian
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Sep 10 '09
9:39 pm PDT
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Good summary.... (Reply to this comment)
by vicfar
and really balanced. Rather than commenting I have decided to write my own (unbalanced) rant.
Cheers V.
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Sep 10 '09
3:07 pm PDT
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Re: Re: The Gang of Six is the Problem ... (Reply to this comment)
by MiDoyle
Brian:
Sorry if I came on too strong. I was having a "Howard Dean" moment. Now there's a healthcare advocate I believe in. I'd vote for him...if given the chance.
(I would write my own piece on this issue but I'm afraid my head will explode from the exercise of sifting through the stupidity from the Republican noise machine.)
Rep. Anthony Weiner of NY had a rather simple but succient solution which involves allowing those under 65 to buy into Medicare coverage if they can't get insurance through their employer. It's simple, it's efficient and costs less. It would force the insurers to compete on price, which they cannot do. Medicare has a 4% administration cost versus private insurer's 30% or more. It has no advertising and no CEO to pay, no investors to please. And, it works pretty well.
He also noted that people should ask themselves "what do insurer's do, what services do they provide that the government can't?"
Cheers
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Sep 08 '09
12:09 pm PDT
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Re: The Gang of Six is the Problem ... (Reply to this comment)
by voxpoptart
First, a clarification: I wrote this piece because I hate public debates built on lies. The piece isn't pro- or anti- Obama's likely reform plans; it's more of a fact sheet. I think his plans are wildly inadequate, and I suggest that gently here and there, but it's not the piece's purpose. Please feel invited to write an Epinion that *does* make your strong case.
the Senate is where things (including somewhat good bills) go to die. Why we're allowing six clowns from low population states with no experience outside of taking huge amounts of money from the heathcare industry decide this bill is insane
"We" aren't allowing it. Obama is allowing it - correction, Obama has actively intervened to make sure it will happen. He's been meeting leaders of the insurance industry in the White House over and over, crafting concessions to their interests; he's been aiding Max Baucus's fundraising, while treating genuine progressives as trouble-makers who need to be quashed.
I think we're in basic agreement here, and we're both Matt Taibbi fans (check MiDoyle's link, folks!). Personally I'm making the phone calls and donations to try to make the public option happen: to encourage the 40 progressives who've promised to vote against any bill *without* a public option.
nothing will really change.
That said, i think the bill i describe in the piece might really happen, and it's not "nothing". I'm not convinced it would do more good than harm -- harm in the form of costing a lot of tax money, harm by pressuring the poor to buy insurance that won't really help them, harm especially in that it can only happen by defeating those dirty hippie liberals (e.g. me) yet again -- but it would do some good.
Unless of course they get rid of the lifetime cap of invidual medical payments, and hire fake regulators who won't bother to enforce the new regulations of the industry. Then the bill's crap.
Obama has been a terrible leader
Depends. If his purpose, as a leader, has been to establish the Democrats as the dominant fund-raisers in America, he's done quite well so far. Although i think he's putting their majority at risk with his cautious acceptance of right-wing frames, and if the Dems lose a lot of seats, we'll see how fast the money dries up.
A single payer universal health care plan would transform peoples lives and reinvent the economy. No more fear of losing healthcare. No more staying in a job just for healthcare. No more worry about pre-existing conditions or starting your own business.
And a truly strong public option -- one anyone could choose to buy into, a la the Wyden-Bennett bill -- would achieve the same thing even while leaving the insurance industries in place. I don't think it'll happen either. But if the progressives hold their ground, Obama _might_ (just might) get desperate enough to try.
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Sep 08 '09
10:21 am PDT
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Re: Re: Re: Careful...... (Reply to this comment)
by voxpoptart
I assume that doctors are concerned with human life, in general. Medicine can be a way to get rich, but it's much harder than going into finance, and the most obvious motives for choosing medicine instead are good ones. As for the greed angle, I agreed with you that I'd implied too strong a role for it, which is why I edited my piece.
But it's easy for even the best of us to come to think well of practices that pay us money. When doctors have incentive to order more tests/procedures, as is the case with most (not all) American hospitals, they have incentive to believe that those tests and procedures are necessary. To _truly_ believe it; I'm not implying corruption. But it's not necessarily in the interest of the U.S. as a whole for them to believe that way.
On the other hand, everyone who wants their child well-educated really does need to hire a private history tutor. That's just established fact, and would only benefit me by accident.
cheers,
- Brian
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Sep 08 '09
10:02 am PDT
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The Gang of Six is the Problem ... (Reply to this comment)
by MiDoyle
Brian:
You've done a nice job with this explanation.
Unfortunately, none of this will likely happen... the Senate is where things (including somewhat good bills) go to die. Why we're allowing six clowns from low population states with no experience outside of taking huge amounts of money from the heathcare industry decide this bill is insane.
The House has(had) a decent bill, but the Democrats will shoot themselves in the foot (already have), have given away the main component that would change Amwerica (a public single payer system) and nothing will really change.
Obama has been a terrible leader on this point and the result is that the fear that Republicans tap into so readily has taken root as reality. The Republicans have no desire to change the status quo for Americans, and the corporate Democrats are just as bad. The Blue dogs are a joke. We are a very f***ed up country.
The healthcare rationale in America is pretty simple. If you have a job and can pay, you might get some kind of healthcare plan (more money equals better choices and access). If you lose the job, you're SOL.
Matt Tiabi has a piece in Rolling Stone that explains what's happened pretty well:
http://www.rollingstone.com/politics/story/29988909/sick_and_wrong/1
Without the public option, we have nothing to cheer about. A single payer universal health care plan would transform peoples lives and reinvent the economy. No more fear of losing healthcare. No more staying in a job just for healthcare. No more worry about pre-existing conditions or starting your own business. And, with the administrative and salary costs of the for-profit insurers, it would save money. no more billing and claims battles. It makes perfect sense which is why it will never happen.
I doubt we'll get anything beyond a semi-crappy bill that will do nothing to address the problems outside of requiring people to get insurance.
Cheers
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Sep 08 '09
9:58 am PDT
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Re: Re: Careful...... (Reply to this comment)
by millinocket
Although the way _my_ Operation: Mindcrime lyric sheet has it, Dr. X seems remarkably unconcerned with malpractice charges or indeed with causing deaths.
I know you're kidding, but one of the things that bothers me about this whole debate is that people seem to be willing to believe that all doctors, everywhere, are far more concerned with money than with medicine. And if that means bankrupting patients or causing harm, they'll do so without hesitation. That just isn't true, and it's grossly unfair to the people who are willing to take on the tremendous responsibility of taking care of people's health. Trust me, a whole lot of them aren't making huge bucks and they do actually care.
I'm sure, statistically, that the US test numbers are higher than other countries. But I do have personal knowledge that not every health care facility is contributing to those numbers. And I do think it's important to look outside the health care and insurance industries when trying to assess the root causes of our health care woes. It isn't a good system, I agree - but I also don't want to see people get so caught up in what's wrong that they forget that in the end, no matter what system is in place, the doctors and nurses need to be there to run it and take care of all of us. If you cast them all aside like so much greedy trash - where will we be then?
Sue
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Sep 08 '09
9:14 am PDT
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Re: Careful...... (Reply to this comment)
by voxpoptart
this statement is not true... I know with absolute certainty that there are functioning clinics outside of Mayo where this is not the structure, and never has been. In fact, there are doctors and nurses in the trenches who sometimes have to fight for the tests they want performed - and do indeed have to prove that they are both necessary and reasonable.
According to those who have studied the issue: yes, it is true, statistically, that American doctors perform far more tests and procedures than those in other advanced countries. "E.g. the Mayo Clinic" means "for example": there are certainly other U.S. hospitals that discourage over-treatment, and I'm delighted to hear that you've experience with them. But granting the obvious caveat that I didn't personally conduct the studies (people who knew what the hell they were doing did), the overall numbers seem clear.
reasons for tests being ordered that are not about greed. Do you know how much malpractice insurance costs? Do you know how many of those suits are based on claims like "well, it wouldn't have happened if there Dr. X had ordered a PET scan for my sprained ankle
Agreed, that's also a distinctly American reason: our malpractice system is unique and quite awful, and doctors are indeed properly frightened of it. I will edit the piece to add that reason. Thanks for the reminder!
(Although the way _my_ Operation: Mindcrime lyric sheet has it, Dr. X seems remarkably unconcerned with malpractice charges or indeed with causing deaths.)
cheers,
- Brian
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Sep 07 '09
4:02 pm PDT
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Careful...... (Reply to this comment)
by millinocket
American doctors, who are paid per test and per procedure, order far more tests than doctors elsewhere in the world
Not to be argumentative, for I have little in-depth knowlege of the bills being considered or debated, but this statement is not true. I'm sure it is the case in some places, but I know with absolute certainty that there are functioning clinics outside of Mayo where this is not the structure, and never has been. In fact, there are doctors and nurses in the trenches who sometimes have to fight for the tests they want performed - and do indeed have to prove that they are both necessary and reasonable.
It would also be a good idea to look at reasons for tests being ordered that are not about greed (yes, I do know that it happens, but anyone who knows or has a decent doctor will tell you that it isn't universal). Do you know how much malpractice insurance costs? Do you know how much that number increases if a suit is filed, even if it has no merit? Do you know how many of those suits are based on claims like "well, it wouldn't have happened if there Dr. X had ordered a PET scan for my sprained ankle just to rule out the possibility that it was caused by an insanely rare tumor rather than falling out of my Hummer, which is of course what I told the doctor happened but so what"?
Health care is a beast with more layers than an onion, and it's important to look at what drives the "ills" that drive the costs.
Oh, terrific piece, btw - I always like to see your name on my alerts!
Sue
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Sep 07 '09
3:31 pm PDT
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Re: An succinct and interesting summary. (Reply to this comment)
by voxpoptart
the proposed reform does nothing to address (one) and (two), which are arguable the biggest cost drivers
Arguably, as you say. Of the seven I listed, the "fat person" reason is almost certainly the 7th-most significant, though it's getting the most attention. I don't have the expertise to rank the other six, and I'm not sure anyone has the expertise to truly quantify the importance of preventive medicine or poverty. They're all important.
there is little to prevent consumers from requesting (or agreeing to) expensive treatments and procedures - driving the general costs up
In my opinion, that shouldn't be the consumer's job, because the consumer can't know enough. If you're scared of dying, or of endless grinding pain, you'll probably pay whatever you're told it takes to be well, and worry about the debt later. The cost control needs to be done by the medical experts, and right now, most of their incentives go exactly the wrong direction. Thanks for your comment!
cheers,
- Brian
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Sep 07 '09
2:08 pm PDT
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Re: Very clear (Reply to this comment)
by voxpoptart
If you mean they should report me instead of, like, Chuck Todd or Diane Sawyer - someone who's supposed to report things that really happen - hey, I'll accept the compliment. I'm not mean or rabid enough to take the place of Beck or Limbaugh: their gifts will never be mine.
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Sep 07 '09
2:00 pm PDT
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An succinct and interesting summary. (Reply to this comment)
by asafono
Good point that the proposed reform does nothing to address (one) and (two), which are arguable the biggest cost drivers.
What I don't see any attempt to create appropriate incentives for people to use their health dollars wisely. Unless the reformed health plans have co-insurance and hefty out-of-pocket minimums (minima), there is little to prevent consumers from requesting (or agreeing to) expensive treatments and procedures - driving the general costs up.
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Sep 07 '09
6:37 am PDT
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Very clear (Reply to this comment)
by rmthunter
The news outlets should be reporting what you said, rather than, say, Glenn Beck or Rush Limbaugh.
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Sep 07 '09
6:19 am PDT
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