August 10, 2009

Why aren't we hearing more from doctors about why we need the proposed health care reform?

Asks David Kurtz at TPM:
So where are the family practice docs, the public health docs, the rural practitioners, those who staff the inner city clinics? I'm not suggesting they're purposely sitting on the sidelines, but they do seem to have been sidelined in this debate. Can we hear more from them? Have I just missed it?
Yeah, and where are all the horror stories about people suffering and dying because of the current healthcare setup? You'd think there'd be all sorts of compelling anecdotes offered up to sway public opinion about the need for a big change. Quite aside from whether the proposed changes would solve the problems, I do think we should have been shown a vivid picture of the need for change.

What is the meaning of the absence of a vivid picture? I can only think of 3 answers: 1. The problem isn't there, 2. the Democrats are woefully inadequate politicians, and 3. some combination of #1 and #2.

161 comments:

TosaGuy said...

The Dems are too busy trashing opponents of the bill instead of creating support for it. That works when then opponents are painted as Washington politicans or Wall Street types, but it crashes and burns when the targets are regular citizens....even if in the eyes of some they get a little too animated.

Methadras said...

Any doctor that comes out against healthcare 'reform' might as well paint a target on his forehead. They are keeping their heads down for fear of intimidation, being ostracized, or blackballed. Many of them that I know are also taking a wait and see attitude and do not want to voice their opinion for fear of retribution against their practices or essentially being silenced if they work for a provider.

Kirby Olson said...

The absence of details is Orwellian.

Rialby said...

Several reasons - Methadras nailed the first one - who wants to be targeted? 2 - doctors don't tend to be all that political - this is why they got science degrees not political science degrees. 3- doctors have real jobs that require real work and lots of paper work; they do not typically have the time to spend becoming spokesmen/women against Obamacare.

Skyler said...

Ann, you voted for this platform. I'm glad you seem to be questioning it, but the time to question it was in November.

We're doomed.

Original Mike said...

I'm pretty sure my primary is for it, given the admiration he has expressed for the Cuban health care system.

Maguro said...

As I recall, the last time the Dems gave us a healthcare sob story (something about a kid in Maryland?) it was kind of underwhelming.

Maybe they've lost confidence in their ability to create heartbreaking narratives for the soap opera crowd.

madawaskan said...

On the front page of Yahoo a couple of minutes ago they were delineating some of the biggest reasons for waste or excessive expenditures in our current health care system.

One of the things listed was- infections that originated from doctors not washing their hands-it goes on.....

The province of Quebec not too long ago gained world wide notoriety for this....nationalized health care didn't solve it for them.

Canadian hospitals are failing to control infections resistant to antibiotics. These kill 8000 patients and cost healthcare systems at least $C100m (£40m; $80m; 63m) a year. The Canadian Broadcasting Corporation, in a news investigation, has said that the incidence of methicillin resistant Staphylococcus aureus (MRSA) has increased 10-fold in less than a decade (www.cbc.ca/news, 21 March). It also said that since 2003 Clostridium difficile has killed more than 600 people in Quebec province alone.

If cases of necrotising fasciitis, the third most common hospital infection, are added, more than 250, 000 Canadians are getting ill from preventable infections every year,
says the corporation.


Link

Again, Canada has only 33 million citizens to worry about, we have 305 million and others- let's nationalize this thing....it's a Pelosian of an idea.

Bissage said...

Why are front-line doctors keeping quiet?

It’s all about the timing. They’re still hoping to negotiate their way out of having to report their substandard patients for mandatory sterilization.

That will be the endgame and they’ll need something to bargain with.

After all, loyalty is a valuable thing; you just don’t give it away for nothing.

traditionalguy said...

You will find the evidence supporting the Crisis in the healthcare story right next to the evidence supporting the climate change Crisis. Such evidence only exists in Disneyworld Sci-Fi movies. It just aint there folks! Cinderella's pumpkin is still only a pumpkin, and her charming Prince is just a pretend Prince using her like a hollywood extra in a crowd scene.

Methadras said...

I'm wondering why at this point no one has stood up and asked why the government just doesn't set up a specific plan to cover these "47 million uninsured" only instead of trying to carpet bomb this plan into our lives.

NKVD said...

A couple of things - ask any doctor, privately, one on one, and they will tell you that this plan stinks and they didn't spend all those years in school just to become minions of the state.

Others, like my primary care physician, just retire. He's done. Moved on. Fifty nine years old and he refuses to have the government dictate how he can treat his patients.

As for necrotising fasciitis, Obama's plan is all for that. Democrats are fasciitisists.

Old Dad said...

Most Docs I know went into medicine to A. Practice, B. Make a good/great buck. for the last 20-30 years, they've seen their autonomy and incomes eroded to faceless bureaucracies in Washington and within the big carriers. The smart business heads among them have been creative--self-insuring, teaming to muscle the insurance companies, sharing Medicaid overhead. The last thing they want is to give the Feds any more power. They got hammered by Medicare, remember? And you think they want more of that?

peter hoh said...

I agree that this has not been handled well by the Democrats.

I remain skeptical about any bill that tries to do too much, and of course I haven't read it. I'm not here to defend it.

Andrew Sullivan has received some compelling anecdotes from readers. Most galling was the one from a woman whose insurance company refused paying for her newborn's care, as the newborn had "pre-existing conditions."

Original Mike said...

I'm wondering why at this point no one has stood up and asked why the government just doesn't set up a specific plan to cover these "47 million uninsured" only instead of trying to carpet bomb this plan into our lives.

You want their stated answer (they need the "savings" they plan to extract from Medicare to pay for it) or the real reason (this is their stepping stone to single payer)?

Alex said...

Skyler - stop attacking Ann. She knows she made a mistake voting for "big guy" and is repentant. Have mercy!

Robert Cook said...

Here is one group of medical professionals who support a single payer program:

http://www.pnhp.org/

The debate has seemed largely one-sided because the media has not given significant coverage to serious voices for health care reform, particularly advocates of single payer. The media has chosen to focus on and promulgate the fear-mongering propaganda of nitwits such as Ms. Palin, mendacious tools such as Newt Gingrich, and other entities who serve the interests of the entrenched players in the health care industry. The media serves the powerful, and it does not fit their paradigm to depict the grim reality in which many Americans exist. Aside from this, the media is always terrible, by and large, at presenting nuanced reporting and analysis of any debates over public issues--as we see in their terrible coverage of Presidential campaigns and their junior high school level focus on who's up and who's down and who embarrased themselves and who appeared "presidential."

And, yes, the Democrats are terrible at getting a focused message across, or even in standing united behind a coherent plan. That they did not come out, from top down, for single payer from the beginning was a clear sign that we would have a confused "debate" about the issue, at best, and little or no reform in the end.

We must recognize there really is no party in Washington that serves the interests of the populace--a few anomalous individuals excepted. We have merely the more and the less bellicose wings of the Corporate Party.

Alex said...

Andrew Sullivan has received some compelling anecdotes from readers. Most galling was the one from a woman whose insurance company refused paying for her newborn's care, as the newborn had "pre-existing conditions."

Except there is no evidence to believe such cases don't happen even more frequently under single-payer systems. I hear FAR more horror stories from the UK then the US.

Hector Owen said...

On CNN just a couple of minutes ago [plummy announcer voice]: "Why are so many Americans hooked on pharmaceuticals? And could they be leading to worse drugs, like heroin?"

CNN always gets the talking points. So if this is a new talking point, that pharmaceutical drugs are bad, that opens an avenue for ObamaCare to cut costs. Putting pressure on the drug companies by making use of any drug less acceptable. It's the logical next step in the War On Drugs.

Lipitor, gateway to heroin!

NKVD said...

Democrats need to hire Cookie - he is further to the left than Stalin and crazy as a loon. He can get their message out.

Naderites are always the best possible hire for any job.

Cookie - you still killin' indians and stuff? Did you sell your slaves yet? Why do you continue to take up space in our evil country? Take your hatred of the USA to France or somewhere that it will be appreciated.

AJ Lynch said...

When you have a hammer, you look for a nail.

When you are a DEM and you have a big fat checkbook supplied by the taxpayers, you look for ways to spend it on the "needy".

Triangle Man said...

The doctors have been brought to the table along with the insurance companies, the medical technology companies, and Pharma.

The biggest mistake the dems made (so far) is to talk about "health care reform", when what they are aiming for is universal health insurance coverage.

Alex said...

The biggest mistake the dems made (so far) is to talk about "health care reform", when what they are aiming for is universal health insurance coverage.

But the bigger story is that Obama wants "anyone who created the mess to shut up". He wants no opposition, period. Our republic hangs in the balance.

tim maguire said...

peter hoh said...

Andrew Sullivan has received some compelling anecdotes from readers. Most galling was the one from a woman whose insurance company refused paying for her newborn's care, as the newborn had "pre-existing conditions."


And did Sullivan confirm this story before running with it? I bet he didn't.

Methadras said...

Alex said...

But the bigger story is that Obama wants "anyone who created the mess to shut up". He wants no opposition, period. Our republic hangs in the balance.


Now he wants to brown shirt his opposition. Our Republic doesn't hang in the balance when the leftists are playing tug-of-war with it and trying to drag it to the left.

Kirby Olson said...

A lot of Cuban doctors have left Cuba to strike it rich in the USA. You'd think they would have something to say about it.

Here's some of the apparent details (the whole 1000-page slog is somewhere online). I didn't annotate this. Someone sent it to me, and it had a lot more details, but I'm trying to be mindful of the patience of the readers:

Pg 22 of the HC Bill MANDATES the Government will audit books of all employers that self insure.

Pg 30 Sec 123 - There will be a government committee that decides treatments/ benefits.

Pg 29 lines 4-16 - Rationing??

Pg 42 - The Health Choices Commissioner will choose your benefits for you.

Pg 50 - Health care will be provided to all, including illegal immigrants from citizen's taxes.

Pg 58 - Government will have real-time access to individual finances and National ID Healthcard will be
issued.

Pg 59 lines 21-24 - Government will have direct access to your bank accounts for electronic funds transfer.

Pg 65 section 164 - Subsidized plan for retirees and their families in unions and community organizations
(sounds like pay-off to unions and organizations like ACORN)

Pg 72 lines 8-14 - Creation of health care exchange to bring private plans under government control

Pg 84 section 203 - mandates all benefit packages for private plans in the exchange

Pg 85 line 7 - specifies benefit levels for all plans, leading to probability of rationing, especially for seniors

Pg 91 lines 4-7 - mandates linguistic appropriate services, which would include for illegals

Pg 95 lines 8-18 - will use groups such as ACORN and Americorps to sign up individuals

Roger J. said...

This may come as a great surprise, but Doctors are not monolithic in their thinking. There are some specialties, like pediatrics, that tend to have more liberal practitioners; then there are the proctologists who tend to be conservative but love liberals because they will always have a job pulling liberal heads out of liberal asses. So pediatricians versus proctologists: the debate in a nutshell. you heard it hear first--please flag me at whitehouse.gov

Alex said...

Now he wants to brown shirt his opposition. Our Republic doesn't hang in the balance when the leftists are playing tug-of-war with it and trying to drag it to the left.

"hang in the balance" is an expression. I didn't mean that we are currently "in balance". Hope I cleared that up.

Synova said...

"Most galling was the one from a woman whose insurance company refused paying for her newborn's care, as the newborn had "pre-existing conditions.""

Do you recall if the child had a medical problem other than being a newborn?

Pregnancy is tricky for insurance if you don't have the insurance before you get pregnant. If you're pregnant then it's a pre-existing condition... and as many people have pointed out, if you could get insurance after you got sick, who'd pay for it when they were healthy? Or... if you could get insurance after you were pregnant who'd be stupid enough to pay for it when you weren't? It utterly defeats the process of pooling resources "just in case" something happens.

The way it went when I had kids was that the baby care was part of the mother's labor and delivery until it left the hospital for the first time. Then, being brought back to the hospital it would be its own self, insurance wise. So if the pregnancy was a pre-existing condition that initial baby care would be included in that pre-existing condition.

When I've heard of this causing difficulties it was because the mother had medical coverage and for some reason the baby did not, so if the baby had stayed in the hospital all would be well but because the mother and baby were released to go home even knowing the baby had issues and would be right back, the insurance for the mother wouldn't pay.

It's easy enough to see how that might happen. Life never conforms to the rules. There's always going to be something that doesn't happen the right way in the right order and causes problems.

Thing is... government is the *worst* at this, or I never spent months trying to get the State Department to stop telling me what I was *supposed* to have done and start telling me what to do to NOW. (I despise the State Department.)

John Althouse Cohen said...

Why aren't we hearing more horror stories about Medicare?

Republican said...

I work as a consultant in the medical field, directly with ER physicians and hospital staff.

None support "reform", because it is not necessary.

Synova said...

There's the California hospitals closing partly due to Medicare story...

But I think we don't hear a whole lot about Medicare horror stories other than doctors or hospitals saying it doesn't pay *them* enough and they aren't free to refuse it (usually, I guess) because people who don't think it is adequate buy supplemental coverage.

Hoosier Daddy said...

Why aren't we hearing more horror stories about Medicare?

Isn't the pending insolvency of Medicare in 2019 not scary enough for you?

Hoosier Daddy said...

But I think we don't hear a whole lot about Medicare horror stories other than doctors or hospitals saying it doesn't pay *them* enough and they aren't free to refuse it (usually, I guess)

Doctor's can opt out of accepting Medicare. They just have to inform prospective patients up front.

I don't think its so much as Medicare doesn't pay them enough as much as it doesn't pay as much as the private insurer.

John Lynch said...

The school system doesn't exist to employ teachers, and the medical system doesn't exist to employ doctors. It's there to fix people, and it's the people getting fixed that we should be most concerned about. Is a system better or worse for the patient? The end.

Shanna said...

But the bigger story is that Obama wants "anyone who created the mess to shut up". He wants no opposition, period. Our republic hangs in the balance.

Obviously, doctors, pharmaceutical companies, insurance companies, etc… all created the mess. Therefore we shouldn’t talk to any of them. It’s poli sci majors to the rescue!!! Because they know a ton more about healthcare than people who work in the industry.

Martha said...

Doctors are beginning to organize. My husband who is an internist has been contacted by a Congressman and asked if he would sign a petition to appear as an ad in The Wall Street Journal and The New York Times ---physician leaders against ObamaCare.

Alex said...

Obviously, doctors, pharmaceutical companies, insurance companies, etc… all created the mess. Therefore we shouldn’t talk to any of them. It’s poli sci majors to the rescue!!! Because they know a ton more about healthcare than people who work in the industry.

Yeah - why are poli-sci majors more qualified to fix health care then people with medical degrees and nursing certifications? Why do we worship politicians so much?

peter hoh said...

Synova, here is the link to the letterregarding the newborn denied coverage. The letter is not specific enough to answer all your questions.

A friend of mine is a pastor. Their statewide organization has commitments to pay for their retired pastors' health coverage, but costs are escalating faster than they can deal with. A combination of factors, including longer life spans, rising costs, and declining church membership combine to put them in a difficult spot. Not every business has to contend with flat or declining revenue, but all who provide health insurance to their employees (and the few who provide it for their retirees) will continue to face the other two issues.

I'm not sure what the solution is, but I wish we could have a rational discussion about it.

Big Mike said...

I'd like to hear more about the amount of paperwork that a doctor has to generate for a Medicare or Medicaid patient versus the amount he or she has to generate for a BC/BS patient. That might give us a hard data point to start from in evaluating HR 3200.

Lem said...

"..there is no health care crisis in this country."

Daniel Patrick Moynihan.

Where have the Moynihans gone?

Robert Cook said...

"I work as a consultant in the medical field, directly with ER physicians and hospital staff.

None support "reform", because it is not necessary."


This may be your experience, but my mother, a retired nurse who worked for years in hospitals, and who is a staunch Republican who has never voted for a Democrat and who--much as it pains me to admit this--actually takes Fox News seriously as a news organ and does not see it as the propaganda arm of the Corporate Party that it is--supports single payer, universal health care for all Americans. This is based on no political calculus on her part but purely on her experience in the trenches of the health care industry. Her experiences dealing with my father's medical crises in his last couple of years of life merely put the period at the end of the sentence of her support for single payer.

Florida said...

I've reported this post as "fishy" to Reichsmarshall Douglass at flag@whitehouse.gov

Your name, email address and your new co-conspirator's name (Meade) is now part of the federal records being kept by political operatives in the White House.

peter hoh said...

I am aware of a health care agency that stopped doing pediatric care altogether because reimbursements were lower than expenses.

traditionalguy said...

Robert Cook has shown up just in time to speak for the Marxists today. He assures us that the "profit making" Corporations and Professionals are just not on the side of the people who always vote out of existence any property rights to a profit, and that the American Constitutional government is only a tool for these evil "profit makers". Go to Cuba Robert, they need more of your distilled wisdom since the first 60 years of it has strangely failed them. The fact that Russia and China finally gave up on Marxism and turned to profit making market economics is only more evidence of tools everywhere. Only a Robert Cook could calmy call Sarah Palin a nitwit, while he shares such wisdom with us today.

Alex said...

I am aware of a health care agency that stopped doing pediatric care altogether because reimbursements were lower than expenses.

Cite? You are just making shit up.

Hoosier Daddy said...

Synova, here is the link to the letterregarding the newborn denied coverage. The letter is not specific enough to answer all your questions.

Well I take anything from Sully with a grain of salt. I'd also like to see the specific policy language that was used to deny the claim.

Otherwise I call horseshit.

madawaskan said...

John Althouse Cohen-

Have you not been listening to your own President Obama-

President Obama:

And it's about the fact that the biggest driving force behind our federal deficit is the skyrocketing cost of Medicare and Medicaid.

So let me be clear: if we do not control these costs, we will not be able to control our deficit. If we do not reform health care, your premiums and out-of-pocket costs will continue to skyrocket. If we do not act, 14,000 Americans will continue to lose their health insurance every single day.


[President Obama Health Care Speech July 22nd Transcript ABC News]

NKVD said...

Cookie's mother killed Indians! Cookie's father is probably his mommy's owner! COOKIE!!! No wonder you hate yourself - you are a loathsome child of a Rethuglican! GO KILL YOURSELF NOW!!!

madawaskan said...

Also I started scanning the draft of the proposed bill and I have not dived into the details but from the Headers it looks like marriage counseling will be part of this universal health care coverage.

OldGrouchy Doug Wright said...

Well, Obama 08 worked out so well, when will the Obama 2012 stickers come out?

Lem said...

You would think not having health insurance would an incentive to getting a job.

peter hoh said...

Alex, how exactly do I cite a relative who told me what happened at work? You are invited to be skeptical, but I think I have earned a level of trust at this blog that allows me to tell an anecdote.

Hoosier, of course you should take any letter that Sullivan or anyone else publishes with a grain of salt. It does not strike me as out of the range of possibility, though I allow that it might seem impossible to you.

madawaskan said...

Looks like some of the docs are in for some "training"-

SEC. 2251. CULTURAL AND LINGUISTIC COMPETENCY TRAINING FOR HEALTH CARE PROFESSIONALS.

Section 741 (42 U.S.C. 293e) is amended--
(1) in the section heading, by striking `Grants for Health Professions Education' and inserting `Cultural and Linguistic Competency Training for Health Care Professionals';
(2) by redesignating subsection (b) as subsection (h); and
(3) by striking subsection (a) and inserting the following:
`(a) Program- The Secretary shall establish a cultural and linguistic competency training program for health care professionals, including nurse professionals, consisting of awarding grants and contracts under subsection (b).

peter hoh said...

Lem, any number of people don't start their own businesses because of health insurance concerns. Also, if hiring people means taking them into your health insurance pool, there is a disincentive to hire new employees.

madawaskan said...

Ooooh-

SEC. 2242. NURSING WORKFORCE DIVERSITY GRANTS.

Subsection (b) of section 821 (42 U.S.C. 296m) is amended--
(1) in the heading, by striking `Guidance' and inserting `Consultation'; and
(2) by striking `shall take into consideration' and all that follows through `consult with nursing associations' and inserting `shall, as appropriate, consult with nursing associations'.
SEC. 2243. COORDINATION OF DIVERSITY AND CULTURAL COMPETENCY PROGRAMS.

Title VII (42 U.S.C. 292 et seq.) is amended by inserting after section 739 the following:

AJ Lynch said...

Peter Hoh:

Dependent people like the ones you described generally don't start businesses anyway.

Risk-takers start businesses not people who let every little stumbling block or obstacle deter them from their goal.

AJ Lynch said...

Kirby:

They will want your bank account number so they can grab your money?

Jeez, even the IRS does not ask for that.

peter hoh said...

Alex, here's the Louisiana State Medical Society complaining that proposed changes would put reimbursement levels below cost of delivering those services:

Cuts in reimbursement will drop them below their actual costs and force them to leave the program.

madawaskan said...

peter -

Go read the bill there is a complete section on how they can tax a business up to 10% of their revenue or $500,000 for "non-compliance" by either the current employer or proceeding noncompliant employer....

Either way the money has to come from some where.

They also can tax individuals an additional 2.5% tax for not having acceptable health coverage.

peter hoh said...

AJ, everyone who does not start a business because they weigh the costs is a dependent person?

Really?

AJ Lynch said...

Kirby:

Illegal immigrants will be covered? And it will be paid by the taxes paid by citizens?

Well I guess we will all just start using phony names when we get medical treatment right? Pretend you are an illegal immigrant and get a free ride.

peter hoh said...

Madawaskan, I'm sure Alex will call bullshit, but I know a doctor who thinks that good marriage counseling is a very cost effective way to reduce medical costs.

AJ Lynch said...

Peter:

My point is entrepreneurial spirits won't let this type of obstacle stand in their way of starting a business.

Your anecdote sounds like a cocktail party pipedream you might hear from the biggest slouch at the party.

Synova said...

Peter, the letter doesn't sound unreasonable (except for the good-for-nothing husband not making the irate calls to the insurance company instead of his wife). What is unreasonable is the assumption that Obamacare (or Pelosicare, or whatever) would not have the same sorts of problems, and if not *that* one then not something else.

Military medical care is entirely "free" and universally available (to those in the military) and there are still stories about how some fellow got screwed by the system.

Insurance coverage works best when everything goes according to plan... no one moves, or changes jobs or ends up with something unexpected happening, no one puts the wrong information on a form or misses a form or send you home with your baby when it would be best (insurance-wise) to stay or has you stay when it's best (insurance-wise) to release you and then readmit your child.

Those sorts of problems insurance companies won't go away because the government has become an insurance company.

And I'd like to have a discussion about this TOO and I'd like to see our Congress make the small, obvious, improvements to reduce health care costs... which when it comes to *babies* is HUGELY about the insurance the doctors have to buy in case they are sued.

madawaskan said...

peter-

Actually I was just coming back to amend that-

I think they only pay for it if it is used to identify, or diagnose mental illness-I knew I probably should have dove into it a little further.

peter hoh said...

Madawaskan, I'm sure the chiropractors have lobbied to be included, too.

Joseph said...

The problem isn't that lots of Americans are suffering and dying because of the health care system. Some are suffering and dying and I think that should motivate us but most people have perfectly adequate coverage. The problem is more banal--Americans that have coverage pay twice as much for it as people in other countries pay for perfectly adequate coverage. And there is no apparent end in sight to that trend.

Smilin' Jack said...

Why aren't we hearing more from doctors about why we need the proposed health care reform?

Because they work for the insurance companies. They're on the other side.

The days when a doctor's job was to provide medical care to his patients is long past. Now their job is to prevent their patients from getting care, or failing that to treat them as quickly and cheaply as possible. That's what keeps costs down, profits up, and their bosses at the HMO happy. Obama's plan offers them nothing but a pay cut.

peter hoh said...

AJ, the other way it can play out is that I could start a business while covered by my wife's insurance, but that all changes if I start to hire full-time employees.

Synova said...

"The days when a doctor's job was to provide medical care to his patients is long past. Now their job is to prevent their patients from getting care, or failing that to treat them as quickly and cheaply as possible. That's what keeps costs down, profits up, and their bosses at the HMO happy. Obama's plan offers them nothing but a pay cut."

BECAUSE... Obama's plan requires doctors to treat patients and quickly and cheaply as possible to keep costs down.

With the "pay cut" that you see in store for the doctors I wonder... does Obama plan to chain them to their examining tables?

Pogo said...

"Yeah, and where are all the horror stories about people suffering and dying because of the current healthcare setup? You'd think there'd be all sorts of compelling anecdotes...

What is the meaning of the absence of a vivid picture? I can only think of 3 answers
"

There's a 4th reason:
It's not reported because no one wants the story to be told.

A story that targets Medicare itself? Won't happen.

Besides, no one gives a shit what doctors say, except where they agree with the left-liberal agenda.

Hell, I couldn't get an article published against national health care in JAMA or anywhere else even though no such article had appeared since 1967. The editor of JAMA called me up and screamed at me on the phone about my paper (because it castigated her paper). Had to got to Heritage Foundation to get it printed at all.

You are told exactly what you are permitted to hear.


P.S. Hoosier: Docs lose $100 on every Medicare patient they see, therefore most practices now cap their Medicare patient load at less than 20%

Synova said...

Obama even SAID that you know... it was the famous bit about the Red Pill or the Blue Pill.

Costs are going to be reduced by giving patients the cheaper pill, the cheaper care.

He SAID that.

I don't recall which pill sent Neo to deal with unpleasant reality and which pill let him reenter comforting fantasy, but I suspect that Obama missed the Matrix reference all together and suggested that the "Blue" pill was the better one.

dailydino said...

I have heard many MDs who are against this bill and I work with many of them.

Most of the MDs I've talked to about it are most concerend about what migh happen to the tech base of medicine when an anti-capitalist stystem is in place.

Roger J. said...

JAC: the horror story about medicare is not the caliber of service; it is the fact that it is a government run program that failed to control costs and that will run out of money in the very near future necessitating yet another tax increase. You may not consider that a horror story--but if you think medicare will be around in in its current form when you turn 70, take another look. That money you paying every month out of your paycheck is going to pay for my current medicare costs and that of a burgeoning older america--an older america made possible, BTW, with a supposedly terrible health care system.

Anyone can come up with anecdotal evidence--and it just is useless as an analytical tool.

Pogo said...

There are plenty of socialist MDs who want a single payer. The state of California is full of 'em. California is also broke, which is a closely related phenomenon.

AJ Lynch said...

Synova:

Come on, Linda Douglass was a psychology major not poli sci. :)

Kirby Olson said...

Here's a few more snippets from 1,007 page bill. You'd think that doctors would especially object to the last dictum (p. 253):

Pg. 195 - officers and employees of government health care will have access to all citizens financial and
personal records

Pg 203 lines 14-15 - "The tax imposed under this section shall not be treated as tax."
(Therefore the administration can claim they haven't imposed taxes for this.)

Pg. 239 lines 14-24 - physician services will be reduced for Medicaid.

Pg 241 lines 6-8 - no matter the speciality, doctors will be paid the same

Pg 253 lines 10-18 - government will set value of doctor's time, professional judgement, etc

madawaskan said...

This is about the fourth or maybe fifth new committee they are going to have-

Telehealth Advisory Committee-
`(1) IN GENERAL- The Secretary shall appoint a Telehealth Advisory Committee (in this subsection referred to as the `Advisory Committee') to make recommendations to the Secretary on policies of the Centers for Medicare & Medicaid Services regarding telehealth services as established under section 1834(m), including the appropriate addition or deletion of services (and HCPCS codes) to those specified in paragraphs (4)(F)(i) and (4)(F)(ii) of such section and for authorized payment under paragraph (1) of such section.

madawaskan said...

Then this thing keeps referring to Chapter 34 Taxes on Certain Insurance Policies.

Be damned if I know how to find Chapter 34.

madawaskan said...

peter hoh-

Heh.

Hey somehow I don't think chiropractors made the cut.

So there's that.

Kirby Olson said...

Here's the whole darned thing. Apologies if someone has already posted it. It's 1,007 pages in length. The devil is in the details as they say. Hidden real deep in places, just like the bail-out bill. I doubt if anybody will read this thing in its entirety, but it's about to be law:

http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.pdf

Alex said...

I doubt if anybody will read this thing in its entirety, but it's about to be law

Over my carcass.

Der Hahn said...

Highlighting private insurance horror stories conflicts with two parts of the Obama message.

Obama sez you can keep your coverage if you like it but if private insurance is horrible, why not outlaw it?

Obama sez there are 'millions of uninsured' and more every day, so where are all these horror stories coming from?

bagoh20 said...

I'm sure there are plenty of sad stories out there: real, imagined and combos. It does not prove anything since they exist in all systems.

More useful are statistical comparisons that adjust for real differences in populations and methods. What I have seen, overwhelmingly argues against single payer. It's also important to remember that other systems around the world owe much of their "success" to ours anyway due to the extremely high ratio of medical advancements created by our system. In effect, we are subsidizing them in both the technology and the ongoing cost since we pay the major portion of the cost of these advancement even after they are adopted worldwide via the higher prices paid here.

Americans are not the only ones who will "pay" for nationalized medicine.

madawaskan said...

Kirby-

Ya that's the thing I am trying to navigate the damn thing is labrynthian and I think refers to other bills just like it-so-

if you ractually try to read the thing-it makes you sick.

Catch-22.

BJM said...

Hector said: On CNN just a couple of minutes ago [plummy announcer voice]: "Why are so many Americans hooked on pharmaceuticals? And could they be leading to worse drugs, like heroin?"

And then they cut to a Viagra ad, right?

Methadras said...

Alex said...

"hang in the balance" is an expression. I didn't mean that we are currently "in balance". Hope I cleared that up.


Cleared. I understood what you were saying and meant. I was trying to embellish on top of what you had said.

Pogo said...

John Althouse Cohen said...
"Why aren't we hearing more horror stories about Medicare?"

You simply have no idea how much national health care is going to stick its nose into every damned aspect of your life.

But we have raised entire generations of people who don't give a shit about their freedoms, so they don't fear soft fascism in the least, but welcome it.

Kirby Olson said...

Madawaskan, that's funny. However, actually reading the bill will not be covered under the plan. If you read it and get sick, you are on your own, because illnesses created by the present administration' texts will get you signed up for the reeducation camp, which is free and compulsory.

Pogo said...

Plus, if they'll punch a black guy for protesting these changes, and nothing is said on national news about it, consider how force will get you to comply when you want to protest in the future.

Face it, you're screwed.
Fascism is here, the kind with a sorta happy face.

Methadras said...

Pogo said...

Face it, you're screwed.
Fascism is here, the kind with a sorta happy face.


The hopey-changey face?

ricpic said...

Our lives are in the hands of the twentysomething wonks and wonkettes who cobbled together this bill and are so wet behind the ears that they actually believe in the mercy of the state.

madawaskan said...

Kirby-

Ha! Oh goody camp....

Ugh-

One last thing and then I think I am done trying to figure it out.

Don't they say you can keep your current plan?

They have one section of the bill that seems to say that they can tax individuals 2.5% more for having unacceptable plans,{I can't find what is considered unacceptable} and then they have this section-

(b) GRACE PERIOD FOR CURRENT EMPLOYMENT-
BASED HEALTHPLANS.—

(1) GRACEPERIOD.—

(A) IN GENERAL.—The Commissioner
shall establish a grace period whereby, for plan years beginning after the end of the 5-year period beginning with Y1, an employment-based health plan in operation as of the day before the first day of Y1 must meet the same requirements as apply to a qualified health benefits plan under section 101, including the essential benefit package requirement under section 121.


[So if you can keep your current plan, why is there a five year grace period before it has to conform to the requirments of sections 101 and 121? And, I'm not sure what section 101 and 121 require.]

sydney said...

Well, I'm a family physician on the front lines, and I can tell you the Democrat version of healthcare reform scares me.

I was expecting Medicare to implode in about another 9-10 years from demographic pressure, but with the current plan and its emphasis on expanding government largesse, the implosion of Medicare will occur much sooner - within a year of enactment. There isn't enough money in the system to pay people to care baby boomer Medicare enrollees, let alone the enrollees in a "public plan."

Even worse, the bill is stuffed with details that will serve to increase physician office overhead and decrease productivity. Mandated electronic medical records that meet government specifications (i.e. that are easily data mined by the government payer) are costly and make documentation of visits longer. You don't hear that from the cheerleaders for electronic records, but ask a roomful of average doctors who have suffered through electronic records implementation and they'll tell you it takes them longer to get through their day. Also, proving that you've met the government's standards of "best practice" will take more time and more staff. There are only so many hours in the day, and I would rather use them taking care of patients that proving to some third party that I've done my job.

I'm looking at alternative options like concierge medicine or working overseas. Those are two things I would never have dreamed of considering a year ago.

My practice will not survive a single government payer. It won't even survive a Medicare pay cut.

There are plenty of other doctors who feel the same way I do. We just aren't represented any longer by organized medicine.

Pogo said...

"My practice will not survive a single government payer. It won't even survive a Medicare pay cut."


Hey, sydney!
Looks like I'll be on the boat outta here with you.

Stephanie said...

Concierge will be outlawed via the "approved coverage" provision.

When they don't have enough docs to do this, are they going to mandate retired doctors come out of retirement??? You do owe the government something for all those interest subsidised loans... even if you did pay them off.

Matt said...

sydney

The key really is to bring down costs, increase choice and get everyone covered.
I'm not sure that is a bad goal.
What would you do if you could design a better health care plan? Or at least make what we have now better and more appealing to you?

NKVD said...

Matt, have you been huffing unicorn droppings or something? Once you finish up getting an education, go out and work in the real world. Your cluelessness might slowly diminish.

NKVD said...
This comment has been removed by the author.
Kirby Olson said...

He's turning the country into Zimbabwe, exactly as predicted, and right on schedule.

I wish other doctors would weigh in as Syd did.

I really thought there might be something in all this, something I didn't get. Syd confirmed that that ain't so.

Matt said...

NKVD
What's up with the rude comment? I'm simply asking what plan a doctor opposed to Universal Healtcare would accept to make Health care better. Medical costs in this country are not cheap. Most agree the system needs to change and cost needs to come down - while still maintaining good care.
I'm not slamming anyone for having an opposite view.
I'm simply asking a question in a civil conversational way. I have doctor friends who want a Universal system. Some want a single payer system. But they have articulated their point. So I want a different perspective.

NKVD said...

Ok, how about this - try reading about how much the government spends on Medicare, currently, and then look at their idiotic predictions about how they can cover an addition 46 million (their made up number) patients in a revenue neutral way.

You would have to be huffing something to think such a thing is possible, in a non-rationed way.

Heck, just scroll through the comments, for pete's sake, even your leftist fellow travellers will occasionally stumble across a nugget of truth.

As for rudeness, go fuck yourself, you commie bitch.

Hey, you from Joisey?

Hoosier Daddy said...

Ok, how about this - try reading about how much the government spends on Medicare

The 2009 budget estimate for Medicare is $413 billon. That pays for 42 million Medicare beneficiaries.

So when Obama says we're going to cover an additional 47 million with a public option plan for $100 billion a year I call bullshit.

sydney said...

Matt,

I would opt for a system that increased risk pools for insurance companies beyond state boundaries or aggregates of employers so people could buy affordable insurance. Also would make it possible to buy a basic insurance policy that was free of state mandates.

I would opt for a system that encouraged patient participation in cost decisions. Right now, insurers and the government bear the immediate cost of these decisions, patients and doctors don't. We only feel it later in higher premiums, higher co-pays or aggravating pre-authorization requests for drugs.

I would elminate direct to consumer advertising of any drug that is not paid for in full by the customer. (Perhaps there could be a stipulation that any insurance company is free to deny coverage for any drug that is advertised directly to the patient.) Direct to consumer advertising is a perfect marketing set up. From a sales perspective, there may never have been anything created that is more beautiful and perfect. They get to sell a product to a customer who doesn't have to pay for it directly. (He does eventually pay for it in higher co-pays and premiums, but he never makes the connection between his choice of higher priced prescription options and his personal cost. It's just seen as greedy behavior by insurance company CEO's.)There is just too much of a disconnect between his behavior and its consequences.

I would not design a plan that assumes cost savings will come from preventive care, electronic medical records, or "quality assurance." These all cost money. They don't save it. (Preventive care saves lives, not clear that quality assurance does, though it might. Electronic medical records have even cost lives in some large provider implementations.)

I would like to see tort reform attached to any effort for healthcare reform. Every doctor has the fear of being sued for missing something- whether it's the radiologist reading a mammogram or chest xray or the gastroenterologist looking at a colon, the emergency room physician evaluating chest pain or the family physician evaluating a sprained ankle. There are a lot of biopsies, xrays, scans, hospitalizations, and expensive blood tests done in the name of ruling out the remotest possiblity.

None of the above are in the current reform package. The current "reform" seems intent on pursuing avenues that will only increase cost without doing anything to reign it in - except maybe pay doctors and hospitals less and charge taxpayers more.

Dust Bunny Queen said...

I'm simply asking what plan a doctor opposed to Universal Healtcare would accept to make Health care better

Tort reform!!!

The cost of medical practice is eaten up with very expensive liability/nal practice insurance. Doctors perform defensive medicine in that they do unnecessary tests, expensive tests and procedures, and repetitious tests just so they can attempt not to be sued.

The cost to the patients would go down down down and the medical professionals would be more productive.

In addition the amount of Government mandated paperwork is ludicrous for Medicare and Medicaid. It would do nothing but get worse under a new massive Government plan. The staff needed just to process the paperwork is 2 to 4 times what is needed in a "real world" business environment.

Do those two things and the costs will come down. Of course Obama and the fascists on the left won't attempt to really make the system better. That would mean that they lose their death grip on our lives and the free market would be working

Methadras said...

Kirby Olson said...

Here's the whole darned thing. Apologies if someone has already posted it. It's 1,007 pages in length. The devil is in the details as they say. Hidden real deep in places, just like the bail-out bill. I doubt if anybody will read this thing in its entirety, but it's about to be law:

http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.pdf


I have it and I've read it. Twice now. I've challenged Garage Mahal, the 3rd Althouse stooge on it and he still hides like a bitch under his mothers skirt.

Matt said...

sydney
Thank you for articulating your views. Most surveys I have seen show more doctors than not want a National Healthcare program.
They say it will ultimately bring costs down and become more efficient. So I wanted your view.

I agree with what you say about what it is that is driving costs so high.

Methadras said...

madawaskan said...

[So if you can keep your current plan, why is there a five year grace period before it has to conform to the requirments of sections 101 and 121? And, I'm not sure what section 101 and 121 require.]


The grandfathering section in section 102 is fairly explicit about the 5 year grace period. After that 5 years you have to take the public option because any private options will essentially have to take the public option process. If your employer has a private option, they have a 5 year transition period to the public option. However, what isn't addressed is what do you do when your employer decides that he wants to take the public option now? Well, then you are stuck. Either way you are being wedged into a public option. This is something that morons like Jeremy, AlphaLiberal, and Garage Mahal (The three stooges of Althouse) seem to neglect or simply don't understand.

chuck b. said...

"the Democrats are woefully inadequate politicians"

And the Republicans--what are they?

Methadras said...

Stephanie said...

Concierge will be outlawed via the "approved coverage" provision.


Of course it will. Just like it is in Canada where private practice is outlawed. And it will be outlawed here in 5 years via section 102.

NKVD said...

Woefully inadequate losers.

OldGrouchy Doug Wright said...

Please, so many of the comments made on this post are very interesting and on point. However, we're all talking around the primary issue regarding Obama's Health care.

Obama and the Dems want more control over our society. It's truly an issue of Statist versus individual liberties.

There have been strong examples of state control over society in the UK, Canada, Germany and elsewhere. However, all that will pale in contrast to what the current US administration and its Congressional allies have planned. I don't really know where Obama's plan are headed yet believe he truly does feel he knows better than the rest of us, as does Barney Frank, Rangel, Pelosi, Hoyer, and Reid.

So, explain, criticize, object all you wish, yet prepare for the end results of Obama's plans and reflect on how this result can be avoided. I'm not certain we can outlast Obama's efforts while hoping we can.

Elmer Stoup said...

Believe doctors are fearful of the consequences of crossing the Admininstration.

Methadras said...

Matt said...

sydney

The key really is to bring down costs, increase choice and get everyone covered.
I'm not sure that is a bad goal.


That may be the goal, but that isn't the reality. If that was the case, then Medicare would have been a storied success and used as a model template for expanding it beyond it's charter.

How do you expect to bring costs down when you will have a monopoly on the healthcare system via government? When government itself will be the arbiter of costs, when it shoves out any competitor as it tries to drive costs down through government mandate. The system will collapse because government intervention in any price fixing scheme (because that's what it is) can't be tolerated by the market. But oh, the government is now the market or will become the market. So at that point you will have total control of all prices which will affect the costs of the care that you receive and how it's apportioned to you or to your family and if you meet or exceed based on all sorts of identifiers (race, age, smoker, non-smoker, drug users, etc. etc.) as a recipe for how care is metered out, then I wonder if you will be worried about the costs being driven down then.

In essence you will end up with a system for the lowest common denominator, for the lowest cost, with the lowest level of care, for the most amount of dollar spent by the tax payer because while you think government will artificially shove down prices, that bubble will percolate up to the taxpayer in the form of higher taxes to offset those costs. Then what do you end up with? Well, the Canadian/English hybrid system attending to 310 million citizens with no way out of course.

What would you do if you could design a better health care plan? Or at least make what we have now better and more appealing to you?

Let anyone keep the system they want. Let the government develop a system for only those alleged 47 million they say are uninsured instead of canvasing the entire nation with this debacle. Start it out on that level. Let's see how it works and then let's take a look at the costs and outcomes involved with that. Let's see how well government can deal with it on that scale. Outside of that, it's a total racket designed to have government use the excuse of healthcare to inject itself even deeper into your life. If you really want that, then I suggest you find another country that can accommodate you.

Richard said...

Keep your laws off my body.

storkdoc said...

Matt

Every doctor I know is opposed to this plan. So I don't know what poll you read where it said more docs are in favor of it than not.

We should start small like Sydney said. Tort reform, allow insurance to cross state lines. Decouple insurance from working. Make it actual insurance. So it covers unexpected things like a broken bone, pregnancy and appendicitis.

Make everyone pay out of pocket for their routine visits. The cost of those visits might come down. No need to tangle with the insurance company for payment for an office visit.

If you visit the ER for something that my mother could tell you how to treat, you'd be responsible for that cost.

madawaskan said...

Methadras-

Ya, they are just plain lying aren't they?

They've developed all kinds of ways to make everyone go public...

That's sure what it looks like on first scan.

I hate how I can still be *shocked* by the audacity of it.

Either that or Obama doesn't even know that section....damn likely the answer isn't what Mickey Kaus thinks it is....

madawaskan said...

Well hell they have a giant loophole for themselves...the military, and Indian reservations...

Elliott A said...

@Hoosier Daddy- The difference in cost between the 47 million on public option and those on medicare is that medicare patients are OLD! They use health care all the time. Nearly everyone that dies a slow death is on Medicare and this costs a ton. On the other hand, a third of the uninsured are healthy young people, another third are illegals,(also young) and the last third are not well deliniated, but are not old or they would be on Medicare. If you do the math, you get 100B divided by 47 M = 2127 per year per person. Very reasonable figure for younger people. There would still be copays for them if they actually use the insurance.

Do I trust the gov't to properly run anything? No. However, the insurance companies are criminals and there are too many people getting free care driving up the costs for everyone else. We need to get hospitals and doctors out of the business of providing free care, and get insurance companies to have some enforcible guidelines, and some competition The above mentioned across state line exchanges).

Methadras said...

Elliot. Unfortunately, the 47 million uninsured is a big fat lie and Obama and his leftist, 5th columnist cadre are willing to spend 20% of GDP on them at our expense and you really want government to step in so everything becomes 'fair' while in the same breath you call insurance companies criminals? There is a recourse for insurance companies that behave badly. It's called a lawsuit. What is the recourse when that insurance company is your government and they are magically exempt, hmmm?

Dogwood said...

Another anecdote regarding Medicare/Medicaid.

A friend of mine owns a pharmacy and several years back she dropped all Medicare/Medicaid patients.

She did so for two reasons.

First, the programs did not reimburse her for the full cost of the drugs. This was made worse by the fact that she had carved out a niche serving HIV/AIDS patients. Those medications were very expensive and as the government reimbursement rate kept getting cut, the economic viability of serving those patients disappeared entirely.

Secondly, she told me that it took six months to get reimbursed for Medicare/Medicaid patients.

So you can imagine the cash flow nightmares she began to experience as Medicare/Medicaid patients became a larger part of her practice.

In the end, she dropped them all. Today, she serves those with cash and those with health insurance.

If the House bill becomes law, I suspect she will simply close her pharmacy and find something else to do.

Elliott A said...

@Methadras- I am ambivalent because the insurance companies ARE criminals. I am a health care provider, I KNOW. Also, most states do not have an effective means of enforcing insurance company wrongdoing. They routinely try to cheat people out of benefits and get away with it. It is most difficult to sue what you cannot prove. If they steal $50.00 from 500,000 different people, it is 25 million dollars, but they each can only sue for 50. If an employer is never shown the entire contract ( as if most are capable of understanding it ) he doesn't know what little surprises they buried inside. I come across many uninsured people, almost all young and healthy. Uninsured by choice. They still get treatment in the OR after they crash their car. We pay. I am all for the exchanges without the public option, perhaps I wasn't clear. I don't trust the gov't at all. Just want some competition for the monopolistic insurance companies.

CapitalistMD said...

I am a doctor (Ob/Gyn). The problem in healthcare is not lack of care - I deliver plenty on care for which I never see a dime - but lack of insurance. Almost every hospital requires physicians to take ER call and take care of whatever comes in the door. The Democrats are misrepresenting the problem. Most of the doctors I know are adamantly opposed to this plan. It would increase cost to the system, increase gov. control, push doctors out of medicine (cut pay but not help with tort reform). True reform should increase competition, transparency and individual responsibility. Too much regulation and gov control is the problem now. I love my work but if anything like HR 3200 goes through, my days are numbered.

Pogo said...

The biggest problem with nationalized health care in the US is that it will be impossible to undo, even if (or more likely *when*, I argue) it stinks like a freshman wrestler's gym locker at the end of the season.

But to socialists, that's a feature, not a bug.

Thus you are voting to imprison your great-grandchildren in a system that by then will be totally bankrupt and change inevitable but very very painful.

And they will think of us, rightly, as complete assholes.

onparkstreet said...

Docs are generally pretty apolitical - it's the personality type. The docs I work with (and me) just want to do our work.

However.

I'm hearing a lot of negativity and grumbling, even from Obama supporting docs. They see a big unwieldy confusing mess. Plus, the proposed Medicare cuts will devastate my specialty - we are already operating on the thinnest of margins.

@ Pogo - I was thinking about putting together an article, too, but you are basically telling me forget sending anything like that to JAMA or the like? Does Heritage consider unsolicited papers from docs :)

Matt said...
This comment has been removed by the author.
peter hoh said...

This thread defies most. It is becoming more civil and making more sense as moves past the 100 count.

Matt said...

Methadras

The plan[s] as they are written now do not call for a monopoly of healthcare by the government. They instead are trying to address the uninsured. Everyone can keep their doctors and their plans. Now, personally, I would like to see a Single Payer plan - but that won't happen.


storkdoc

I live in CA. Many doctors are left of center. That said every poll I have see shows more doctors supporting some kind of reform that includes Universal health care.

I agree being skeptical of government is healthy. But you can't tell me the Insurance companies and Big Pharma are better? They're crooks.

Health care reform is the key. What shape it takes is to be seen.
But we will have something by the end of the year. And it won't be communism. In fact I think it will be pretty much what we have now only a few more people will be covered.

Pogo
Without Medicare health costs would be a disaster for many child of a elderly parents.

onparkstreet said...

With all due respect to your points Matt, I am skeptical of those surveys. I think if you dig deeper, you may find a different picture. I could be wrong.

Also, medical schools tend to teach students that single payer, or some other government plan, is better than the current model. Students may not hear the alternative as much. It may not be championed as much in the academic environment. This is speculation based on my anecdotal experience in academia and I could be wrong.

Finally, even if big Pharma and Insurance companies are terrible, with a more free market plan, there is a theoretical 'out'. Once you place the main decision making in the hands of government, there is no more 'out', if you see my point. Always remember, when you think of ceding more power to the government, don't think of the best case scenario with the best civil servants. Think of the worst and see if the system can still provide good care.

I am deeply skeptical.

JAL said...

Cook: Her experiences dealing with my father's medical crises in his last couple of years of life merely put the period at the end of the sentence of her support for single payer.

Was Robert Cook's father on Medicare?

I am also a nurse and nurses are not particularly well informed about the economics of the insurance situations of their patients.

We *did* know that the hospital charged what seemed to be exhorbitant amounts for those blue "chux" they used to put under patients.

But then that's how they paid the nurses, maintenance men, unit secretaries, housekeeping ....

Methadras said...

Matt said...

Methadras

The plan[s] as they are written now do not call for a monopoly of healthcare by the government. They instead are trying to address the uninsured. Everyone can keep their doctors and their plans. Now, personally, I would like to see a Single Payer plan - but that won't happen.


Hmmm. That was interesting. It looks like you deleted your previous comment about calling insurance companies criminals because you think they steal money and how you know that because you are some kind of provider. Not to mention you used that lame canard of doctors attending to emergency room calls (because they have to by law) to anyone that comes into the emergency room and using the uninsured young person in a car accident as a means to create a false dilemma where we as tax payers pay for them. Not sure why you deleted that statement unless you were worried about being called out on it.

First of all, if I'm uninsured and I suffer a catastrophic injury that requires emergency room care I will still get a bill. Unless of course I'm an illegal that stopped by the emergency room for a sniffle, a fever, or some other lame reason because of my illegal status. Again, I would get a bill and I would have to pay, if I don't pay then I go to collections, I get sued, and I have to deal with the repercussions of that. Hospitals and emergency rooms increase their costs to cover those delayed collections or ones they never get, not to mention the costs of illegals sapping the system for what it is worth. If you live in California you should know this. If you don't, go pay a visit and take a look. Furthermore, this cost transference gets passed on to those with insurance who have their insurance make up the difference, so you have a medical provider cost shifting to an insurer and that insurer pushes it to me in the form of higher premiums, hospital costs, and emergency rooms costs. It isn't a criminal act on the insurance companies, it is wealth redistribution from one provider to another and this is the false premise you don't understand.

Now to address your current statement. You haven't read the bill and therefore you don't understand the implications of the sections involved. A 5 year grandfather clause means only one thing and one thing only, that in 5 years you will either be on the government plan, aka single payer, or you will be fined. If you have insurance via an employer, they have 5 years to move over or be fined. What part of that don't you understand in that in 5 years of the implementation of the signing of the act into law the government will become the sole provider of health care?

If they are trying to address the uninsured, then why don't they simply set up a system that allows the uninsured to go to them without compulsion, set up a legal vehicle to make that happen in the form of Medicare/Medicaid plus or something like that and leave the rest of us alone? Why are they trying to blanket 300 million citizens with a one size fits all solution to a problem that only allegedly afflicts 47 million?

You are a clueless fraud if not a lame sockpuppet. You simply don't understand what the hell you are talking about.

JAL said...

Thanks to all the physicians who have checked in on this discussion. And those of you who are reading the bill, also.

Your insights are welcome.

I intend to, sigh, download it tomorrow.

Maybe my legislators can reimburse me for reading it for them?

garage mahal said...

EVERY doctor I know is against this plan. Except the lobby for them for the past 162 yrs, the AMA.

onparkstreet said...

Many doctors (I think the majority, actually) do not belong to the AMA. I certainly don't. Most docs I know just throw their membership flyers into the circular file.

Also, docs belong to the AMA for a variety of reasons and it doesn't actually represent the main lobby. Most docs use their specialty associations as the main lobbying group, so cardiologists use their own association, pathologists their own, etc.

Finally, the AMA has been inundated by angry members becasue of their cut a deal mentality.

I am sure you knew that, Garage Mahal.

onparkstreet said...

Inundated by calls, etc, from angry members, eh, you know what I meant.

Good try, though.

JAL said...

Matt said... (7:33 PM)
sydney
Thank you for articulating your views. Most surveys I have seen show more doctors than not want a National Healthcare program.
They say it will ultimately bring costs down and become more efficient.


Were we reading the same article? The tone of the article you reference is pure class warfare-ism. When the argument is based on how ruthless and rich insurance companies and CEOs are, the radar starts beeping loudly. (Can one do an ad hominem on organizations?)

From the article: "No amount of cost-cutting can save enough money to support a for-profit system. The only solution is a universal, government-run healthcare system. Surveys suggest that a majority of Americans and doctors desire this."

Oh really? The article author references NO SURVEYS. Which ones? When? Where? Who? What was asked? How was it asked?

Not to cast aspertions, but the author is the author of The House of God, for cryin' out loud. He's had issues for decades.

dick said...

One of the things that bothers me with this is that after 5 years your plan has to meet the moving standards that the govt sets up. You also cannot add to people to your plan. Any bets on how many of the insurance plans will meet the standards the govt sets up? What happens if you have a kid. How can you add the kid to your plan when it specifically says you can't add people to your plan.

IMNSHO this whole thing is just a total disaster waiting to happen. How soon can we get rid of this admin and Congress.

AlphaLiberal said...

It's very telling that all the fallacious horror stories from the Right Wing already exist today under the existing helath care care system that they so rabidly defend.

Death panels? Check.
Waiting lists? Check.
Rationing? Check.
Denial of health care. Check. Check and check.

All of these things conservatives embrace when coming from a private system. When their fevered imagination conjures images of it happening in a public health care system FREAK OUT!

No, I don't expect anyone from the right to sanely address that.

Pogo said...

AL, there will always be rationing because our desires outstrip our resources.

Liberty demands that the choices remain individual.

Over time, state and federal government have gained tighter and tighter control of insurance products so that choice has become increasingly restricted, and power given over to insurance companies.

Now we face ceding all choice to the state, from which there is no escape. Insurance company control is bad enough, as liberal posters here document all too well, but it requires a massive self-delusion to believe that giving over your choice from an insurer to the feds represents anything more than a frying-pan-into-the-fire further loss of freedom.

If there must be rationing, and there must, I want to make my own decisions, not be forced to come hat in hand to the Medicare Czar and plead for the life of my elderly wife who 'doesn't meet therapeutic criteria' (i.e. is too old to treat).

All the horror stories arise from similar arrangements in other nations, easy enough to find.

The vote for loss of liberty is not only unAmerican, it's anti-American, turning us from free citizens into coerced subjects.

CapitalistMD said...

Most doctors are not part of the AMA or at least not active in it. The AMA is controlled by doctors in academic medicine and primary care doctors. It is much more liberal than physicians as a group. More that half of the state medical associations have come out against Obamacare and HR 3200.

Pogo said...

@onparkstreet,

From 2000 to 2005, I repeatedly approached around 10-12 internal medicine journals with articles about the economics of health care. I have had other things published, even book chapters, but was unable to get any takers.

I complained to JAMA that their chief editor reviewed my paper about the follies of national health care, yet she had written the very article I was complaining about. One day I got a call and it was her, yelling at me.

Seriously, I thought it was a deranged mental patient (I was at the time doing medical exams on an inpatient psych ward).

"Who are you to blah blah blah" she said. After her rant I said that JAMA had not had a fully researched article on the topic since 1967 (only editorials from the AMA), and her unhinged response was proof she was unable to be unbiased about my article ...which sent her into another tirade. 20 minutes of that nutjob yelling on the phone. Very strange.

Even my own clinic's journal rejected it, after getting so far as 4 revisions. A final reviewer said my article, which rejected national health care, was "outrageous" and should never be printed.

I believe that I understood then how the left had completely taken control of the media, even including the sciences (see global warming).

I suppose you could try again, but we live in a land that worships the state, so I dunno.

Hoosier Daddy said...

Do I trust the gov't to properly run anything? No. However, the insurance companies are criminals and there are too many people getting free care driving up the costs for everyone else. We need to get hospitals and doctors out of the business of providing free care, and get insurance companies to have some enforcible guidelines, and some competition The above mentioned across state line exchanges).


The whole insurance companies are criminals is really becoming tiresome. Sorry doc but I work in the insurance industry and I can assure you there isn't a back room where the claims examiners are gleefully denying claims on a whim. The exclusiions provisions outline quite clearly what will not be covered.

Yes there are a lot of people who get free care, what 1/3 of them illegals who will be covered under this public option? That's peachy. Bad enough we're spending billions overseas on foreigners now I get the pleasure of paying for their health care here too.

Let me assure you that the health insurers are the most regulated with the most state mandated provisions of the entire industry. The difference between P&C insurance and health insurance in terms of what the state mandates is absolutely staggering. I can assure you that if your homeowners or auto insurance were required to cover basic maintenance they'd be unaffordable too.

Shanna said...

Anytime you have to "grandfather" something in, you are in the process of getting rid of it. Do people really not understand this?

Grandfather is a HUGE red flag.

NKVD said...

Matt said that the plan will be implemented and it won't be communist.

Well, that's good enough for me! Start taking our money and our rights...

Robert Cook said...

"Was Robert Cook's father on Medicare?"

Yes, he was, and he and my mother were very happy with it. This is my point: if not for Medicare--a government funded health plan--my father's medical expenses in his last couple of years would have bankrupted my parents.

NKVD said...

Cook thinks he knows who his father is! Now that's some funny shit right there. I am pretty sure he is Nader's love child.

Hoosier Daddy said...

Yes, he was, and he and my mother were very happy with it. This is my point: if not for Medicare--a TAXPAYER funded health plan--my father's medical expenses in his last couple of years would have bankrupted my parents.

I know many liberals think the government just shits money but I felt compelled to state the obvious.

Pogo said...

Instead, your father's medical expenses in his last couple of years have bankrupted Medicare.

Pogo said...

It's called rent-seeking, Mr. Cook.

NKVD said...

The funny thing is Cook hates this country and all that is stands for. Yet he was willing to let this evil country pay for his father's medical bills. God, you are such a flaming hypocrite, Cookie. Be a man for a change - step up. Or move to Cuba, where things are done right.

Pogo said...

Ah, Cuba, where nutrition was so poor in the late '90s that people went blind, and now they can't afford toilet paper.

But they gots them some sweeet single payer national health care!!1!

Bruce Hayden said...

I was a bit surprised today to see President Obama claiming that he would cut down on Medicare costs by banning excess testing. And how would he identify excess testing? Apparently by some "peer" review panel - except he didn't explain how he could get peers out of their medical practices long enough to sit on such panels.

And, most importantly, he didn't mention the big root cause of the "excess testing" - his contingency fee tort attorney supporters. Yes, the same guys who funded his run for the Presidency, and who did so partially from their medical malpractice wins.

A couple of the docs and others above have pointed out that Medicare (and esp. Medicaid, etc.) are reimbursing at or below costs, and there is no reason that they can extract any more out of cutting reimbursement levels any more.

Part of the problem for awhile has been that those with private insurance have been supporting Medicare, Medicaid, etc. patients for awhile now, and that is a good part of why medical costs are exceeding inflation - private insurance not only has to cover their increased costs, but also that of government plans too, through cross-subsidization.

But, with that problem, how does Obama, et al. intend to cut costs, with everyone being pushed into government plans where reimbursements are continually being crammed down, with the pool of those paying for that cramm down being pushed out of their private insurance? This is never addressed by the proponents of ObamaCare, etc.

Robert Cook said...

"Yes, he was, and he and my mother were very happy with it. This is my point: if not for Medicare--a TAXPAYER funded health plan--my father's medical expenses in his last couple of years would have bankrupted my parents.

"I know many liberals think the government just shits money but I felt compelled to state the obvious."--Hoosier Daddy

Thank you for your statement of the obvious...redundant as it was. Of course "government funded" means taxpayer funded...who thinks otherwise? Taxpayers pay for our roads and highways and bridges and reservoirs and dams and waterworks and fire departments and police departments and our military and so on and on. Are these "socialist" enterprises? (If so...so what?) Could we find better ways to funds these enterprises in the private market? No one who endorses single payer thinks it represents "free" healthcare; rather, we know it is healthcare that is made possible through our shared underwriting of the costs.

I'm very happy that my taxes--along with my parents'--helped fund medical care available to my father in his last years; I'm very happy my taxes help fund medical care for the parents of all of you here, and for any others who need it. I would much rather my taxes be spent providing health care to all Americans than buying munitions to murder human beings around the world. That so many find no reason for pause in the astronomical costs of our military expenditures and who object to our funds going to help our fellow citizens--and ourselves--astounds me.

I think we're living in a society that is becoming increasing psychotic, a psychosis of ignorance, greed and brutality.

BJM said...

Shanna @6:53 Exactly, they are brazen enough to put it in plain language.

Of course the ultimate goal of single payer is to grandfather out Grandfather.

Methadras said...

Robert Cook said...

Thank you for your statement of the obvious...redundant as it was. Of course "government funded" means taxpayer funded...who thinks otherwise? Taxpayers pay for our roads and highways and bridges and reservoirs and dams and waterworks and fire departments and police departments and our military and so on and on.


This is the typical canard of a shallow thinking leftist. It's in the governments best interest to provide money for these services because they allow the revenue stream to flow from citizen to the coffers of the treasury. It's a circular requirement flowing from government to citizen. We provide the services, you pay up in taxes. Don't like the taxes, well then will the services go away? No, because the confiscatory nature of our tax structure will seize your assets, assess fines and penalties and see you bankrupt before it lets that happen and through that fear and intimidation those services still flow. Stunning how the subtlety of it is just like a protection racket isn't it?

Eisenhower enacted the federal highway/free system for commerce, but also for allowing the military to be able to travel from point A to point B or land aircraft on them if necessary. It's a federal system and he enacted it without regard to whether the citizens wanted it or not because as commander-in-chief he deemed it was necessary for the best interests of the nation. So please stop using this argument as a bludgeon to for why we pay taxes and what we get for them. It's lame, it's stupid and only demonstrates your total lack of understanding on the subject.

Are these "socialist" enterprises? (If so...so what?)

No. They are authoritarian enterprises because of the flow of power from the government to the governed. We do not live in a collectivist society do we? The entire premise of this country is based on individual liberties, individual freedoms, and individual rights. If you can find anywhere in the Constitution were government is setup as a collectivist state or anywhere in the Bill of Rights where our rights are enumerated as collectivist, I'd love to see it. Another lame canard by a shallow thinking leftist.

Could we find better ways to funds these enterprises in the private market?

Why must there be a necessity to fund these enterprises at all? Afterall, it's the federal government that is asking the people to swallow a jagged bitter pill and pony up for a new entitlement program that will drain 20% of GDP and in 5 years after its enactment effectively drive every citizen into a single payer system without a vote, a say so, or proper representation. That doesn't neglect the fact that there is even a necessity to foist an entire intrusive healthcare system onto an entire citizenry when the argument is made that only 47 million allegedly uninsured citizens are the ones we are trying to help.

No one who endorses single payer thinks it represents "free" healthcare;

Tell that to the 40% of the population that don't even pay income taxes leaving the other 60% to foot the bill. For that 40% not only will it be free but they will be laughing all the way to the doctor for everything that the plan will cover. Oh wait, we don't know what that is going to be do we. Do you? If I didn't pay income tax I would be stupid not to endorse single payer.

So when every moron decides they want to go to the doctor for a headache or for the sniffles or for a sore foot or just out of loneliness which will start to drain the system dry, then you will see the, uh oh, rationing begin. Even your Fraud-in-Chief said that he will want to limit tests? Oh really? I have cancer or I think I might, so Mr. Barely, which tests do you think I need and if you fuck it up and miss something, what will be my legal recourse. Oh guess what? Under a single payer system, there won't be one. Surprise. Do I really need to go on or do you understand yet what you are kneeling in adoration for?

continued below...

Methadras said...

rather, we know it is healthcare that is made possible through our shared underwriting of the costs.

Total bullshit. Costs will be passed to taxpayers that actually pay. Those are the people that will underwrite this whole thing while government once again drives a gigantic legislative wedge into the lives of every American under the guise of helping 47 million allegedly uninsured Americans. And what will happen when we decide not to pay?

I'm very happy that my taxes--along with my parents'--helped fund medical care available to my father in his last years; I'm very happy my taxes help fund medical care for the parents of all of you here, and for any others who need it. I would much rather my taxes be spent providing health care to all Americans than buying munitions to murder human beings around the world.

Where the fuck did I leave my violin at? Damn, I can never find it when I need it most. Hey, Cook, need a tissue? I know I do after this bit of maudlin blubbering. You are a great American wanting to help your fellow citizen out, but what if others don't want to? Are you going to force them to at the barrel of a gun or by taking everything they have to enforce your flights of whimsical socialist/communist fantasies just to ausage your collectivist envy and white guilt? Another excellent canard though.

That so many find no reason for pause in the astronomical costs of our military expenditures and who object to our funds going to help our fellow citizens--and ourselves--astounds me.

Military spending is what percentage of GDP again? Idiot.

I think we're living in a society that is becoming increasing psychotic, a psychosis of ignorance, greed and brutality.

And one which will need a fantastical single payer health care system to help correct your perception of that psychosis? Is your version of health care going to medicate out ignorance, greed, and brutality from the rubber stamp of a health care commissioner? It's phony morons like you that fancy themselves progressive(s) and so forward thinking with their aspired high ideas and flights of fancy that have put us in this position. You've received your marching order that now, all of a sudden the great health care crisis is at a crescendo and we should all kneel at its altar and pray for its passing into law. Now all of a sudden health care is the looming crisis that is breaking the back of us all and it's half-wits like you and the rest of your leftist 5th columnist ilk waiting right there to save us all. Two words, fuck you. I don't need your help and I don't need you to be my advocate on my behalf to help government interject itself into my life any more than it already is. Government is already a guest in my house that I can't seem to kick out for freeloading on the back of my hard work and my hard earned labor. You want to be the fucking hero, then give up everything you have for the cause brother, you faux indignant, sanctimonious prick.

Robert Cook said...

"You are a great American wanting to help your fellow citizen out, but what if others don't want to?"

They can just suck it up, just as I have to suck it up that my tax dollars are going to kill and torture people around the world, and to hold untried others--many others--for indefinite and possibly life terms in prisons known and unknown.

Your overheated rant fails to note that a majority of Americans do want some form of government funded healthcare, so you can excise from your mind the false idea that any such plan--which I don't, unfortunately, expect to see--would be a case of the government forcing an authoritarian program down the throats of an unwilling public.

Methadras said...

Robert Cook said...

"You are a great American wanting to help your fellow citizen out, but what if others don't want to?"

They can just suck it up,

Oh, so you really don’t want people to have a choice. At least you are honest. Deviously evil, but honest. You see this type of authoritarian/totalitarian collectivist attitude is what is wrong with your thinking, but you don’t care because after all, if a ship is sinking you don’t even want the rats to jump ship.

just as I have to suck it up that my tax dollars are going to kill and torture people around the world, and to hold untried others--many others--for indefinite and possibly life terms in prisons known and unknown.
And this relates to healthcare how? Do you usually try to shape shift arguments by putting up the lamest of strawmen as a means to control the point of the topic at hand? One has nothing to do with the other outside of illustrating what a deeply flawed and demented mind you have. But I’ll play your stupid subject changing game. First of all we had no say so in whom we went to war with outside of the very vocal protestations of your comrades who sympathized with sub-human bombs that kill innocent men, women, and children to further their religious/political endeavors. Then you have you throw out the tired old charge of torture and indefinite containment of these nameless and faceless ‘people’. They attacked us, not the other way around. When a President decides to fight back, you don’t get the privilege to call for a national referendum on it. It’s Constitutional, healthcare is not. Nice canard, complete and total failure on your part of trying to make a morally equivalent point.

What you perpetually seem to neglect, because you are very stupid, is that you get to voice your opinion now on an idea about how this country will intrude itself into our lives via a debacle called healthcare. You have the right to speak loudly and freely for or against it, just like you do for or against the war. The distinction is, is that your representatives are coming to you to hear your opinions on a piece of legislation that will declare a war on our economy and prosperity.

Continued because of a 4096 character limit... wtf?

Methadras said...
This comment has been removed by the author.
Methadras said...

Your overheated rant fails to note that a majority of Americans do want some form of government funded healthcare, so you can excise from your mind the false idea that any such plan--which I don't, unfortunately, expect to see--would be a case of the government forcing an authoritarian program down the throats of an unwilling public.

And yet out of everything I said, you only challenged and I use that term very loosely because you are really just one stupid man, one of my statements because you have no other leg to stand on. You neither know the legislation nor do you care to know. Those that want it in alleged overwhelming numbers are so stupid they would vote for a ham sandwich and yet are savvy enough to supposedly understand this healthcare package? And you are marginally smarter than they are. You just want what you want because your moronic ideology only leads you to apply envy, jealousy, and emotionally ladened rationale for the fantasy you think will bring about your utopia faster. You’ve signed on to an ideology that is a lie, is based on a lie and frankly is evil. And in willingly accepting and adopting this evil ideology, you wish to foist that evil onto the rest of us. You can’t even formulate the most basic of arguments without resorting to emotionally/envy based rhetoric of your collectivist thought processes. It’s pathetic. It really is. You and those that think like you are a stain on humanity. Your vile and evil ideology is a repugnant devaluing of human decency cloaking in the cloth of compassion. I wish that people like you would leave this country to real men and woman who know what freedom, liberty, and constitutionally based rights are so we can have a government that is lean, mean, as unintrusive as possible and yet still carry out its Constitutional duties. Right now we have an obese, top heavy, bloating pig of a government and they want an even bigger piece of my hard earned pie and useful idiots like you are standing in the wings like drooling yes men willing to give it to them for a promise they can never keep. Do you not even see the folly of your thinking or are you so blinded by your inner hatred for this country that you would willingly see it burn to the ground to be remade in the image of your choosing? You disgust me.