“Congressional Democrats and the Obama administration blatantly ignored the voices of the American people and rammed through a hyperpartisan piece of legislation that will have a disastrous effect on our nation’s health care system,” Mr. Price said shortly after Mr. Obama signed the bill in 2010....My link goes to a NYT article that warns us that Price has the vantage point of a doctor and needs "a broader perspective" that looks after the "needs of Medicare beneficiaries, Medicaid patients and taxpayers who finance those programs." We're also told that Price is "a strong conservative," "a member of the Tea Party Caucus," but "no bomb thrower": "He works within the system and has led two groups that promote conservative policies in the House."
The legislation Mr. Price has proposed, the Empowering Patients First Act, would repeal the Affordable Care Act and offer age-adjusted tax credits for the purchase of individual and family health insurance policies. The bill would create incentives for people to contribute to health savings accounts; offer grants to states to subsidize insurance for “high-risk populations”; allow insurers licensed in one state to sell policies to residents of others; and authorize business and professional groups to provide coverage to members through “association health plans.”...
We're told that Price has a 100% rating from the National Right to Life Committee.
And: "Gay rights groups have also been critical of Mr. Price." Why? The only evidence of hostility to gay people is that when the Supreme Court found a constitutional right to same-sex marriage, Price called it "a sad day for marriage" and "a further judicial destruction of our entire system of checks and balances." I'd like to hope that his opinion — about the meaning of marriage and the importance of judicial restraint — has nothing to do with anything health-related.
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93 comments:
The only solution to our abominable health care delivery system is to get the for-profit insurers out of the game. Create a Medicare-For-All system.
Medicare isn't free. They take money out of my Social Security check to pay for my Medicare.
Sounds like a good choice. An MD and plenty of background on ACA policy. If they're going to do anything about Obamacare they need someone who knows what he's doing.
The only solution to our abominable health care delivery system is to get the for-profit insurers out of the game. Create a Medicare-For-All system.
Because VA care is the best health care in the country.
Mr Cook, may I ask how old you are?
Robert Cook - LOL - that's the last thing we need.
So if health insurance companies make so much money, why hasn't some enterprising capitalist started a health insurance company that only makes "(so much money) - X"? That would be an easy way to make a fortune!!
When P J O'Rourke was still funny, he said that if you think health care is expensive now, wait 'til it's free.
"I'd like to hope that his opinion — about the meaning of marriage and the importance of judicial restraint — has nothing to do with anything health-related." Why do you hope that?
One group they need to pay attention to is the small business owner-independent contractor-self employed contingent.
The way the mechanics of the system work now is absurd considering the people on the exchanges are there because they don't have salaried or government jobs.
Trying to figure out how much you are going to make next year, deciding whether to take the tax credit or pay for insurance you have to struggle to afford, trying to "prove" your income before the 1099s legally have to be out, The fear that you'll have to pay back the tax credits if you make more than you thought you would. The expense of the policies.
The whole way you sign up for the year is designed for the employer market.
There are lots of things Obamacare needs to fix it, but the exchanges need to be better designed.
Robert Cook said...
The only solution to our abominable health care delivery system is to get the for-profit insurers out of the game.
The solution is to get all insurance out of the vast majority of our healthcare spending. Health insurance should be for the major, unexpected expenses, such as cancer, heart attack, stroke, or serious auto accident.
I would support public financing for vaccines and treatment of communicable diseases, such as TB.
I don't care if insurance companies make a profit. I want free market based care. I don't want idiots in Government and admitted liars like Jonathan Gruber writing healthcare policy.
I want choice and competition in the marketplace. I want health savings accounts. Medicare for all is single payer. It places every American on the government dole. I have no issue helping the elderly and lower income with subsidized healthcare. When you place every American on welfare/medicare/single payer - (whatever socialist scheme you want to call it-) you remove funding to help those who really need it.
My link goes to a NYT article that warns us that Price has the vantage point of a doctor and needs "a broader perspective" that looks after the "needs of Medicare beneficiaries, Medicaid patients and taxpayers who finance those programs."
Shorter version: Why can't Trump just nominate a lawyer for this position? Who needs medical knowledge, anyway?
Robert Cook said...
The only solution to our abominable health care delivery system is to get the for-profit insurers out of the game. Create a Medicare-For-All system.
Take a look at the health care systems current ran by the US government and get back to me when you find one that is effective, efficient, and provides top quality services. VA? Bureau of Indian Affairs? US Military? Anyone? Bueller?
Doctors have the highest accident rate in general aviation.
Expertise doesn't transfer but the feeling is that it does.
I'm girding my loins for the onslaught of sob stories, akin to the ones we got to pass this behemoth in the first place.
Remember all the people who were in the hospital with cancer who couldn't get insurance, and how sad that was.
And then...remember all the people who lost their insurance policies when Obamacare kicked in and nobody felt sorry for them because the echo chamber said they should be glad to lose that insurance because it was bad insurance?
How arrogant the powers-that-be were.
It was all so....benevolent. It was all so, "we know how to take care of you better than you know yourself".
And now they are back to finding people who "need" Obamacare even though they voted for Trump. People with sad tales (and they are sad) of preexisting conditions. But not a moment's consideration for the people who can't afford these policies, and certainly won't be able to swing the deductible year after year! How many people in this country have $20,000 sitting around to pay for 2 years of deductibles?
I'd love to know what Elizabeth Warren's bogus bankruptcy study would say about whether people can really afford their house payments after a medical condition under her party's creation.
But we won't hear that. We'll hear the other sad stories and be asked to have a heart.
Health care is pretty much uninsurable; the insurance companies have to limit their liability in any case, so you die if you get sick enough for long enough.
It does drive up care costs, though, as all third party payments do.
Veterinarians discovered pet health insurance as a way to raise rates enormously.
In the 50s doctors tailored their bill to the patient and it worked okay.
I have an idea. Why not give the guy a chance?
As for his opinions on whether it is OK for nine people in black robes to redefine marriage for everyone, so what? If his views lead to improper lawmaking or other abuse of his powers, I am pretty confident he will be brought up short or dismissed. If his views do not lead to that, then they're just another opinion.
I notice the left collectively vilify for-profit insurance.
If you leftist progressive socialists are going to vilify profit in one industry, you must vilify ALL profit in every industry. Should the government take-over all for-profit business? Where does it end?
rhhardin said...
Doctors have the highest accident rate in general aviation.
Surgeons with money to burn buying planes and flying into mountains.
People who tell you The Canadian system is wonderful - these are people who have never been sick.
" I'd like to hope that his opinion — about the meaning of marriage and the importance of judicial restraint — has nothing to do with anything health-related." Conservatives tend to think that the folks should pay for their own birth control, abortions, and sex change operations-- which do not deserve consideration as "health care", insofar as these thwart or subvert the body's natural, healthy processes. Let's treat the sick, instead of politicizing medicine.
What does gay marriage have to do with his job?
His job is to flush PaulKrugmanCare down the toilet.
Ignorance is Bliss said: Health insurance should be for the major, unexpected expenses, such as cancer, heart attack, stroke, or serious auto accident.
I would support public financing for vaccines and treatment of communicable diseases, such as TB. Agreed!
This is the very problem we have had in the medical insurance industry in the last 40 years. It has gradually morphed from being actual INSURANCE to being a monstrosity that covers everything. When it pays for everyday ordinary maintenance care the costs of that care becomes more expensive.
It used to be, back in the olden days, when I was a child that you went to the doctor when you were sick. Paid cash or negotiated a payment arrangement with the doctor. It cost hardly anything to see the doctor and people really went only when they needed it. Not for every itty bitty thing. If you were in need of hospitalization, surgery and were fortunate enough to have a company insurance plan or your own major medical coverage, then the insurance would kick in.
Because there wasn't widespread overuse of the system, the costs were relatively low. When people are spending their own money, they are more circumspect and frugal. Now because they can bill the insurance companies for obscene amounts for the most routine procedures, the costs have gone up up up.
The definition of insurance is that it covers risk. Major and catastrophic risk. In the original use of insurance in historical times was to cover loss of cargo. It didn't insure the scraping of the barnacles on the ship. Just the loss of cargo.
Think about your car insurance. It covers loss, damage and even some medical caused by the "accident". It doesn't cover oil changes, tire rotation or detailed cleaning of your car. If it did....how expensive would that be? A lot.
Health care reform can't really be fixed until they figure out how to bring costs down or at least make them more responsive to market forces first. Otherwise, we're just going to inflate the problem with funds, doing nothing to address rationing and quality of care.
But one thing I'd love to see them do is make it illegal to charge any patient for a non-emergency procedure without first getting the patient's consent for their entire out of pocket expense. No more of this "provider will duke it out with the insurer and let you know what you're stuck with sometime long after you've incurred the cost" nonsense.
DBQ - 40 years of government meddling - all by design.
Part of the Obamacare pain was DC math. Obama asked "How much would an insurance policy cost that satisfies every one of our left wing interest groups?" The answer was $X. "How much if we make everybody buy it?" It would be $X - $2500. Therefore, by DC math, Obama could say his bill would save families $2500.
More pain came from the "the Secretary shall..." language dodge. That way they could provide a path for all the special interest group padding that even the Democrats could not have passed straight up. Of course they had drunk the "there'll never be a another Republican president" Kool-Aid so it never occurred to them there would be a Republican secretary. Once he starts dismantling the Secretary discretion special interest system even they might be ready to end it. I was hoping for Rick Santorum but this is a good choice too.
I note that the NYT fails to call him Dr. Price, opting for "Mr." instead. Would they do that to a lefty physician? Not likely.
The pejorative nickname for Beechcraft V-tailed Bonanzas was Forked Tailed Dr. Killers...
Pre-paid medical care for all is not "insurance."
The British government established the NHS in 1948. 68 years later it still takes up about 20% of the time at "Prime Minister's Questions" and is the most hotly debated, but it is kind of a religious question and the government - Conservative or Labour - just cannot get rid of that tarbaby.
Tom Price is from Michigan and he is a University of Michigan/Ann Arbor graduate that went to a top Medical School in Atlanta and then set up his Orthopedics Practice in Roswell, which is on the wealthy north side of town that seems to attract the northern immigrants like Tom.
So back to the slanderama drawing board. This guy is not a racist southern hick. But they have Militias in Michigan...so maybe he can be destroyed by that association. And he went to Med School the same place Gingrich went to History School.
until they figure out how to bring costs down or at least make them more responsive to market forces first.
Until they get rid of insurance for everything, the costs will not come down.
Our family doctor, who we have known for over 30 years, has said that his biggest operating cost is the amount of time and extra personnel that he has to hire to process insurance paperwork and the extra personnel required to comply with Obamacare rules. Instead of the 3 people who used to do clerical work in the office, they had to hire 4 more clerks. Then they need to deal with the hundreds and thousands of new codes for payment from the insurance companies, from medicare, from medicaid. The paperwork is endless.
He has to pay someone to follow him around with a computer to input the information about each patient. Or he writes it down and that person does the input later. He doesn't have time to be a data entry clerk AND a doctor.
Because of the extra work required by Obamacare and to satisfy the insurance companies he also has to hire additional medical assistants, nurse and other medical persons to do the pre visit work. Things like take your BP, temp, weight, ask the questions about whether you still take the same meds, etc and enter it into the computer...as required by law. Electronic records ya know.
All of this adds to the cost of running a practice and because the reimbursement rates are low, the volume of patients seen must be cranked up. More patients, less doctor time with the patient, more personnel to support and personnel costs. Bankruptcy is looming.
Our doctor is about to retire because he just can't take it anymore.
Government medical care. Inefficient, costly, dangerous to the patients.
Jesus - what we (meaning most of us) had (meaning employer-provided plans) wasn't perfect but it was good enough. My employer provided plan has gone up since Obamacare, but not that much,- I will admit that I am almost more nervous about another change to the health insurance system than I am about the eventual collapse of Obamacare.
NB I am philosophically opposed to Obamacare, especially the Individual Mandate, and I think John Roberts (and the 4 Democrat justices) ought to be tried for treason.
"Medicare isn't free. They take money out of my Social Security check to pay for my Medicare."
Who said it is? It's paid for out of our taxes, as would a single payer system. Heck, our tax dollars are given freely to build expensive armaments and to kill people in other countries, why shouldn't they go to treating the ailments and saving the lives of those paying the taxes?
"Mr Cook, may I ask how old you are?"
To quote Jack Benny, I am, uh, "39".
That should give you a suggestion of how old I am.
"Take a look at the health care systems current ran by the US government and get back to me when you find one that is effective, efficient, and provides top quality services. VA? Bureau of Indian Affairs? US Military? Anyone? Bueller?"
Well, obviously we must use better models of how to create an implement such a system.
DBQ: depressing. I think the electronic health records (EHR) law was the poisoned chalice. Healthcare providers were given "free" money to rush out and buy unproven systems to move en masse from paper to digital nirvana. Which has not worked so perfectly and as you say the recordkeeping burden has grown exponentially. Bad enough when the downside was a denied claim for reimbursement; but I believe the penalties for imperfect compliance with EHR are savage.
"As for his opinions on whether it is OK for nine people in black robes to redefine marriage for everyone, so what?"
How did they "redefine" marriage? They simply expanded it to include people previously excluded. It's still just the joining together of two people in a legally recognized pair-bond.
"He's been offering detailed alternative bills going back to 2009, when Democrats got to work on Obamacare."
I've heard (endlessly) that the Republicans wanted to throw out Obama Care but offered no alternative. Now to say there were alternatives.... and DETAILED ones.
Oh mercy me.
It is almost like Democrats and the press have been lying to us.
You don't suppose they have been fibbing about OTHER things TOO, do you? I fear I must lay down for a moment while I take this all in....
"He's been offering detailed alternative bills going back to 2009, when Democrats got to work on Obamacare."
With respect Althouse, you must be in error. We've been told, time and time again, that the Republicans offered no plans. None other than the President himself has said this. Multiple times. And surely President Obama wouldn't lie to us. Especially on something as important as our relationship to our doctors.
"He's been offering detailed alternative bills going back to 2009, when Democrats got to work on Obamacare."
-- That's un-possible. I've been told for years the Republicans had no plans except to let people die on the streets.
Wait a minute. I was assured by Chuck and Unknown and Inga and Sunsong and Garage and Cook that "Republicans haven't offered any alternative to Obamacare" many many times. In many forums. I've even heard prominent Democrats and the President himself say so. Now we learn this guy (a doctor in Congress) has offered detailed bills since 2009.
Gee what else have the Factcheckers missed all this time?
"Healthcare providers were given "free" money to rush out and buy unproven systems to move en masse from paper to digital nirvana."
I was involved in managing one of these systems. I just rolled my eyes when Obama told us that going all-in would save money.
I think what Ann is worried about with the homosexual bit is that, in fact, homosexual activity is a very high health risk. Studies have shown that being an active male homosexual is approximately as healthy as being a crack cocaine addict, and the life expectancy of male homosexuals is, on average, about the age of 40 or so. And that doesn't include AIDS.
It's all entirely self-inflicted, too. There's a really strong case to be made, I think, to having special astronomically high health care charges for male homosexuals; because just like lung cancer from smoking it's all entirely preventable.
The screams of outrage if gays were billed the actual cost to treat the results of their sexual activity, though, would probably echo off of Venus. And any medical personnel should be opposed to homosexual behavior on pure medical grounds--nothing to do with religion.
--Vance
"why shouldn't they go to treating the ailments and saving the lives of those paying the taxes?"
But it is advertised as going to those not paying the taxes.
@DBQ.
See? Obama did create jobs!
Sometimes the "type first read later" system results in duplicate-ish statements. Great minds run in the same gutter or something like that.
"I'd like to hope that his opinion — about the meaning of marriage and the importance of judicial restraint — has nothing to do with anything health-related."
And yet you keep up the meet to these pathetic commenters. Ad revenue doesn't explain it so spare us your "hope".
Free health care for the dirt poor. The rest of America makes competition drive cost down the old fashioned way. Subsidized and tax deductable insurance only makes cost go up.
For those who want to argue: Free means free with no tax dollars to providers. Dirt poor means gross income + net worth < 100k. Net worth includes all assets, including retirement savings with no debts subtracted.
"Who said it is? It's paid for out of our taxes, as would a single payer system. Heck, our tax dollars are given freely to build expensive armaments and to kill people in other countries, why shouldn't they go to treating the ailments and saving the lives of those paying the taxes?"
I really wish you had taken this more reasonable, cerebral tact in 2010 rather than calling everyone that disagreed with Obamacare a racist (it might have worked!!). You live, you learn I guess.
"Great minds run in the same gutter or something like that."
Especially minds named Mike.
"How did they "redefine" marriage? They simply expanded it to include people previously excluded. It's still just the joining together of two people in a legally recognized pair-bond."
I notice you throw the as-arbitrary-as-gender-of-participants number of participants in there - "two". If it's unconstitutional to restrict marriage to two genders, is it unconstitutional to restrict it to two participants? What is the logical underpinning for one and not the other?
Dust Bunny Queen said...
He has to pay someone to follow him around with a computer to input the information about each patient. Or he writes it down and that person does the input later. He doesn't have time to be a data entry clerk AND a doctor.
Because of the extra work required by Obamacare and to satisfy the insurance companies he also has to hire additional medical assistants, nurse and other medical persons to do the pre visit work. Things like take your BP, temp, weight, ask the questions about whether you still take the same meds, etc and enter it into the computer...as required by law. Electronic records ya know.
Medicine is only partly a science. Much of medical practice simply follows convention. Often those conventions are less than optimal. Epidemiology is one of the few ways available to figure out what does and does not work. To be effective epidemiology requires accurate data on symptoms and treatments for large populations of patients. Someone complaining about electronic medical record keeping is equivalent to a mechanic complaining that the engine designer wants to know how hot the engine actually runs and what its actual fuel consumption per hour might be. Self-evidently it is essential to understand what does and doesn't work in the clinic and what are the most cost effective forms of treatment.
AReasonableMan said...
rhhardin said...
Doctors have the highest accident rate in general aviation.
Surgeons with money to burn buying planes and flying into mountains.
Why you sound envious. Perhaps you might want to consider surgery in Cuba.
looks like a good pick.
somebody who knows how hospitals work, insurance works, and how sausage is made in Congress
Rhhardin is right about insurance. We were better off with 'fee for service'. Perhaps we need some kind of catastrophic event coverage but, without insurers, most events wouldn't be so catastrophic.
Another bete noir of mine: Nonprofit hospitals' CEOs pulling in millions per year in salary and compensation. I remember when hospitals only had administrators. We have allowed medicine to become an industry which puts the providers and the patients last.
"A member of the Tea Party Caucus," but "no bomb thrower" and "works within the system"? Oh brother.
In my experience, the Tea Party, the people it has helped elect and their caucus have worked entirely within the system and the only "bombs" thrown have been primary challenges to entrenched incumbents.
I'm happy enough with this appointment I guess. It's estimated that within 10 years we'll need one out every three federal budget dollars just for Medicare, Medicaid, CHIP and Obamacare subsidies (or whatever subsidy program takes its place). HHS already has a budget that exceeds a trillion dollars annually. I hope the Trump administration has plans to face this squarely. Unfortunately, candidate Trump did not seem to think that any of our entitlement programs is in need of reform.
We want the best and the brightest to go into medicine, run up considerable debt for their education, and then provide the worlds's finest healthcare on a non-profit basis. How about we nationalize legal care and allow doctors to set the rates for lawyers
Robert Cook: "Obviously we must use better models..."
Notice that Robert Cook has absolutely no idea what those models can be. He just wishes that the old style communism will work, if only the right people are in place to manage it.
Robert Cook cannot forget anything. Robert Cook has never learned anything.
"To be effective epidemiology requires accurate data on symptoms and treatments for large populations of patients. Someone complaining about electronic medical record keeping is equivalent to a mechanic complaining that the engine designer wants to know how hot the engine actually runs and what its actual fuel consumption per hour might be. Self-evidently it is essential to understand what does and doesn't work in the clinic and what are the most cost effective forms of treatment."
As usual, government mandate takes something that people were already doing (in this case electronic medical records) and blows it up into a monstrosity.
I think what Ann is worried about with the homosexual bit is that, in fact, homosexual activity is a very high health risk. Studies have shown that being an active male homosexual is approximately as healthy as being a crack cocaine addict...
My obvious question is why not have male homosexuals pay for their health care? The thing is, that they tend to outearn almost any other demographic, and don't tend to have dependents who need braces, then to go to college. If we look at ability to pay, it would probably make more sense to give smokers a break, instead of gay guys, since smokers tend to earn less than non-smokers.
This is, of course, one of the problems with Cook's socialized medicine - that coverage and cost issues are often based on politics, and not economics. Gays are an officially aggrieved minority, are a key voting block in the Dem party, and, thus, must be coddled. Smokers, on the other hand, are not nearly as stylish, so must pay for their sins.
As to the moral case against socialized medicine - why should it be a right? Why should those who sit around on their butts all day at home, stoned or drunk, get the same level of medical care that those who work 40, 50, 60 hours a week get?
Which is why I like the idea of a safety net such as Medicaid for basic medical care for those who can't afford anything better, and private insurance for most everyone else (and, yes, Medicare, for those of us who contributed to it for 40 years).
@CJ: NB I am philosophically opposed to Obamacare, especially the Individual Mandate, and I think John Roberts (and the 4 Democrat justices) ought to be tried for treason.
Don't lay this on the liberal justices. The cheese stands alone on this one. While I didn't agree with the basis for the liberals' opinion, they at least had an arguable position. Roberts just made shit up as he went along. He was the only one of the nine who held that the mandate was a tax which was the basis for his upholding the law.
I figured electing Trump would mean the end of Affordable Care Act, but don't remember medicare being a campaign issue. A lot to take on at once.
The problem with epidemiology is that it doesn't get into the costs. And, the costs are often not nearly as straight forward as you might think. Sometimes, the most cost effective solution is a more expensive one, and sometimes, it is a cheaper one. And, yes, it is also very hard to identify the most efficient, and the least efficient, practitioners, since most often you are comparing apples to oranges, due to different practice mixes. Very hard to normalize.
No expert here, but worked with experts doing patent work in this area. Far more complex than most realize (which is why much of the technology to do this well is patented, and, yes, in litigation). And, HHS, under Obama, seems completely oblivious to this.
"I really wish you had taken this more reasonable, cerebral tact in 2010 rather than calling everyone that disagreed with Obamacare a racist (it might have worked!!). You live, you learn I guess."
You are seriously confused. I have never called anyone who disagreed with Obamacare a racist. (In fact, I tend to avoid calling people racists unless they have overtly demonstrated it, and then it is usually unnecessary to point it out.)
I never was in favor of Obamacare, because it forced people by law to buy expensive services offered by private businesses. It provides a captive audience to the private health insurers. It is a poor substitute for what it really needed: universal health care, paid for by taxes and available to all, as are the services of other public works: police departments, fire departments, public schools, bridges, highways, etc.
One of the big lies in the selling of ObamaCare is that the medical profession is not working to determine "what works and what doesn't". What do these people think happens in medical schools?
As usual, government mandate takes something that people were already doing (in this case electronic medical records) and blows it up into a monstrosity.
Well said, O-Mike. This is one of those things we only got to see after the bill was "passed" as Nancy said would happen. It is pernicious. I have great employer-sponsored health care insurance, and a world-class provider in Loma Linda. Best doctors on the planet for some things. But my PCP spends almost all his time entering stuff on his laptop instead of interacting with me. Same for specialists. Same for the nurses who have to "confirm" so much info repetitively now that they do nothing but data entry, the thermometer and cuffing the arm.
This will be hard to undo.
"If it's unconstitutional to restrict marriage to two genders, is it unconstitutional to restrict it to two participants? What is the logical underpinning for one and not the other?"
As long as all involved are consenting adults, I can't think of a constitutional reason why it should be limited to two. If others can present rationally compelling arguments against polyamory as a legal institution, I am open to considering the arguments against. (No one has ever provided a rationally compelling argument why marriage between two persons of the same gender should be prohibited.)
"As to the moral case against socialized medicine - why should it be a right? Why should those who sit around on their butts all day at home, stoned or drunk, get the same level of medical care that those who work 40, 50, 60 hours a week get?"
Well, because it's the moral thing to do.
Also, financial, legal, or other reasons that impede or prevent stoned, drunken layabouts from obtaining healthcare tend to impede or prevent many other people from obtaining healthcare who are not stoned, drunken layabouts. How many of those sitting around on their butts all day do so because they cannot work, or cannot find work? Also, a healthier society is less expensive and less dangerous than a society with many of its citizens living with chronic (or mortal) physical, mental and/or emotional ailments.
"You are seriously confused. I have never called anyone who disagreed with Obamacare a racist. (In fact, I tend to avoid calling people racists unless they have overtly demonstrated it, and then it is usually unnecessary to point it out.)"
OK, I went back through old posts (as many as I could find in 10 minutes) and I'll give you credit I didn't find any "racist" accusations or any support for Obamacare in your comments on the Althouse blog.
I was wrong to have accused you of that directly and you are right that you haven't.
Let me rephrase - I wish the Democrats had made the cerebral argument rather than calling opponents racist, which they did, incessantly, and got a Republican Senator in Massachusetts (and sowed the seeds for Trump in 2016) for their troubles.
@MayBee: But we won't hear that. We'll hear the other sad stories and be asked to have a heart.
I remember in the early aughts when the Democrats wanted to expand the SCHIP program to include children from middle class families (and their parents because, you know, it makes no sense to have children insured if their parents aren't). They trotted out some little bald kid who wouldn't have been able to have his brain surgery without SCHIP because his family couldn't afford insurance. Later we found out that dad was self-employed and while the family chose to do extensive remodeling on their home, they chose not to buy health insurance. And that mom had voluntarily given up a job that provided benefits for one that didn't. And the kid had been injured in an auto accident that was their fault and their auto policy didn't include medical payments coverage. In other words, the parents made one bad decision after another, but we were expected to take pity on the child and assume the parents' responsibilities.
Well, because it's the moral thing to do.
Why is it moral to enable people to sit around on their butts all day at home, stoned or drunk?
@rhhardin: In the 50s doctors tailored their bill to the patient and it worked okay.
I worked in the medical field in the 70's and it was still working "okay" then. Healthcare was still affordable and most patients did not have insurance that covered routine care.
Third party payments do drive up costs and the third party that drives up costs faster and higher than any other is government.
How radical! Actually having a doctor involved!
I remember during our first co-president Hillary's secret meetings to create HillaryCare, doctors weren't invited. Experts and lawyers were.
Well, because it's the moral thing to do.
Why is it moral to enable people to sit around on their butts all day at home, stoned or drunk?
I love how Cook tries to end the argument by imposing his morality on everyone else. But, that means that is is in favor of forcing the rest of us to financially support his own, personal, morality.
Of course, one problem with conservatives is that the left uses our money to buy votes by providing free stuff (including health care) to low income voters (most of whom are, hopefully, citizens, entitled to vote). That way they can skim off their share of the trillions squandered by our country every year in this way, giving free stuff in trade for votes. Which is, maybe, part of what I find immoral about Cook's position here. It would be fine if he were to spend his own money giving the needy free health care, but he, inevitably, is in favor of using our money too, and extracting it by gunpoint. He, at least, isn't getting rich doing it, as Crooked Hillary, Dingy Harry, etc. have managed to do so.
"'Well, because it's the moral thing to do.'
"Why is it moral to enable people to sit around on their butts all day at home, stoned or drunk?"
I never said it was. Either you have very poor reading comprehension or you are purposely misrepresenting my comment.
It is the moral thing to provide medical care to people who need it.
Readering said:
I figured electing Trump would mean the end of Affordable Care Act, but don't remember medicare being a campaign issue.
Not so much a campaign issue, but Medicare reform was rolled into the general healthcare reform- both in the Affordable Care Act and under the High Tech Act which did a lot of harm to the practice of medicine in electronic record mandates. So reforming the Affordable Care Act can also encompass reforming the harm done to Medicare. You wouldn't believe the complicated payment and documentation schemes the current administration has cooked up. They are predicting that it will destroy small practices. This was the intent, though, to favor corporate medicine over private medicine. A few large groups are easier to control than many small entities.
"Which is, maybe, part of what I find immoral about Cook's position here. It would be fine if he were to spend his own money giving the needy free health care, but he, inevitably, is in favor of using our money too (sic)...."
I'm in favor of medical care being made available to all, paid for by all of us, for all of us, just as we all pay for police and fire services for all of us, and for public schools for all of us, and for bridges and roads for all of us.
"I'm in favor of medical care being made available to all, paid for by all of us, for all of us, just as we all pay for police and fire services for all of us, and for public schools for all of us, and for bridges and roads for all of us."
I might be with you if government were remotely capable of providing it fairly and economically. They demonstrably aren't.
I'm in favor of medical care being made available to all, paid for by all of us, for all of us, just as we all pay for police and fire services for all of us, and for public schools for all of us, and for bridges and roads for all of us.
The main problem with this being: We all end up with VA-quality healthcare, and many of us die while waiting in line.
Transgenderism, polygamy, bachelorhood, etc. and other dysfunctional and trans-social orientations.
Why is it moral to enable people to sit around on their butts all day at home, stoned or drunk?
It's not. However, tolerating dysfunction is a lesser evil than normalizing abortion. So, we conflate circumstances of chance and choice and treat them as equivalent. It's a viable policy until it serves to obfuscate a progressive condition (e.g. cancerous and especially malignant).
Mike says: Best doctors on the planet for some things. But my PCP spends almost all his time entering stuff on his laptop instead of interacting with me.
And doctors really, really hate this. It's one of several reasons more are leaving the profession early.
I'm in favor of medical care being made available to all, paid for by all of us, for all of us, just as we all pay for police and fire services for all of us, and for public schools for all of us, and for bridges and roads for all of us.
Who is this ALL that you speak of. Illegal aliens? Welfare recipients? Non property owners?
There are millions of free riders out there who don't pay jack squat but get the benefits of the taxes that the rest of us pay.
There is no ALL. The burden of paying for those things falls disproportionately. You are delusional.
Sorry, Robert, but if people who sit around all day at home drunk or stoned know you will provide the things they need, then you are enabling them and abetting their lifestyle. That's not moral. I may be unwilling to withhold necessary medical care, but it's not because I believe it's the moral thing to do.
I'm in favor of medical care being made available to all, paid for by all of us, for all of us, just as we all pay for police and fire services for all of us, and for public schools for all of us, and for bridges and roads for all of us.
Cookie, like most Socialists, does not recognize the difference between objects, like highways and bridges, and people, like doctors and nurses.
It's not "Medical Care" Cookie. It's work by people
The guy Trump nominated sounds OK to me and has certainly been working on this for years. I'm suspicious of the AMA but he sounds pretty good.
Personally, I prefer the French system which has the highest satisfaction rates in Europe. The British middle class is flocking to France and signing up for the French Securities Sociale. The problem is that they have not paid into it and they are flooding the welfare arm on the program.
They refuse to go back to Britain, which is 2 hours away, and be subject to the abuse that is the NHS.
I wrote a series of blog posts on the French system a few years ago beginning here.
It is probably out of date but give the idea of how it could be done. I wrote those before Obamacare.
Now, I think the best way to do it is to go to HSAs and a cash market, which doctors are already moving into to flee Obamacare.
Genuine insurance could deal with real emergencies and a fund for the uninsurable would be cheaper than blowing up the health insurance of 90% of the population. McCain actually had a pretty good plan in 2008 but, of course, he could not explain it.
Ah, the joys of free-market medical care!
To offer my own counter experiences to this account--simply to be fair and balanced--I have been hospitalized several times, once for pneumonia, (the more recent hospitalization, about six years ago), and previously for leukemia and associated pneumonia, nearly 19 years ago. (In that instance, I was in and out of the hospital three times in two months, after which I was able to return to work.)
In my experience, the nurses and doctors were all considerate and concerned, (or they faked it well). I did not go through any of the travails described in the linked article. I don't know, however, whether this was a difference in our providers, in our insurance, or in the way things once were. Perhaps my experience would mirror the account linked to if I were to be hospitalized again, or perhaps I would enjoy once again good care by conscientious professionals. However, people who extoll the virtues of for-profit healthcare ignore the many other horror stories that are easily found.
"Cookie, like most Socialists, does not recognize the difference between objects, like highways and bridges, and people, like doctors and nurses.
"It's not 'Medical Care' Cookie. It's work by people."
And...?
"And...?"<
And, by saying it's your right, you are laying claim to the work and assets of the people you insist treat you, at the rate you specify. Sounds totalitarian to me.
Why? They would still be paid. Why wouldn't they?
Michael K: I've been reading your posts on french medicine with interest. Thanks for link. However, please revise this sentence:
"Low population growth, after the catastrophic loses of men in World War I, was blamed for defeat even though the French Army was larger than the German in 1940 and had better equipment."
This is wrong. The German Army had 200 Divisions (140 used in the attack on France) vs. the French 100 Divisions and pretty much everything in the German Air force and German Army "equipment-wise" was equal or superior to the French equivalent. The Germans had 12 million men of military age vs. France's 6 million. Hence, the concern over the low birthrate.
Cookie, I am curious about something. Have you ever worked in the private sector?
More wonders of the free market!
"Why? They would still be paid. Why wouldn't they?"
I assume you never ran any sort of small (or large, of course) business. You pay rent and employees and other expenses, like malpractice insurance for doctors and nurses.
Then you send bills to people. Insurance companies vary in what they choose to pay. Almost all now require you to sign a contract to be paid at all. When I retired, before Obamacare came along, I had 276 contracts with various entities. Some were HMOs and some were insurance companies and various things that were sort of intermediate. I was once fined $500 for sending a patient to the "wrong" lab for a $16 culture of a wound infection. I paid it but stopped seeing those patients in that office.
My information, which is now second hand, is that Medicare pays about 20% of billed charges and those charges must be according to the Medicare fee schedule. The AMA and the Harvard School of Public Health wrote that fee schedule, which is why I am suspicious of the AMA, which is a rent seeking organization.
Obamacare pays worse that Medicaid which pays about 10% of billed charges and it takes two years to get paid by California.
I knew GPs who took out second mortgages on their homes to keep their office going. When I was still in practice, more than half of the medical groups in California were insolvent.
What has happened is that hospitals have been buying up medical groups and medical practices. The hospital administrators loved Obamacare because it gave them to opportunity to assert full control over doctors who most administrators hate.
The doctors have given up, either selling out to the new vertically integrated corporations or dropping all insurance, including Medicare, and going for a cash practice. The best specialists are doing that and more and more older docs are doing the same.
The reason for going all cash is that the office staff , and overhead, drops about 75%. When I was practicing in a group in the 80s, we had 14 employees, 12 of whom were occupied with collecting bills from insurance. That was for 5 doctors, all surgeons who typically ran a low percentage of overhead, GPs I knew had over head of about 80%.
Maybe you should know a bit more about how medicine works before opining. Doctors now are working for salary paid by a large corporation. I;m sure you prefer that to the small business model that existed for 100 years. I don;t and feel so sorry for the medical students that I finally quit teaching,. They are running up $250,000 loan balances or more and expect they will make enough to pay back the loans and live a middle class life.
They won't.
The failure of Obamacare, which will get much worse very fast if not radically changed, is that those vertically integrated corporations that now pay doctors are losing money. THey make up the loss in the way that many large corporations of dubious ethics do. They cheat.
A friend of mine is a gastroenterologist who has had his own office with avery nice endoscopy suite that me built 30 years ago.
Recently the hospital, where he practices and where I used to practice, contacted him and suggested he should more outpatient endoscopy in their suite instead of the one he has had for 30 years. He already does the endoscopy of inpatients there but why would he want to inconvenience himself and his patients (like my wife a month ago) by going to the hospital to do outpatient procedures?
It's called "Nice practice you have there. It would be a shame if something happened to it."
So he agreed to go over and look at some charts of patients being scoped there to see what the diagnoses were, He rad the charts and said ll the patients had maximum lab work ordered, whether necessary or not. That is fraud.
He is hoping they stop asking him.
There is much more but I doubt you care.
In the event a bill seeking to establish single payer healthcare were to be written, there's no reason to assume it would simply expand the current Medicare system, with its faults; it could create a new system that addressed the needs of both patients and providers. It all depends on the will of the people. You certainly can't think our present system is a model to be admired.
You speak of the ruinous effects of the corporatization of medical care, and it is this corporatization that is at fault for our present ruinous system. Why do you assume I prefer this model to the small business model? I'm sure the small business model would result in lower costs for medical care. However, is there much chance the trend will be reversed and the giant corporations will divest themselves of their holding in medical practices, hospitals, pharmaceuticals, etc.? I guess not, and therefore, the trend will continue worse, not just for patients but for providers.
So, it seems to me that providers would wish for a reinvention of the system as much as do the patients.
Of course, this is all just theoretical; none of this will happen. The corporatization of medical care is just an affect of the corporatization of our nation, and of the world. We do not live in a democratic republic, the voters have little or no affect on the doings of government, whose real constituents are the financial elites, and there is little public outrage at the outrages of government against us: universal and unceasing spying on us, militarized police treating protesters like enemy in wartime to be physically tortured, etc.
All is doom and gloom. We're living through the end of the world as we have known it, and a worse world is being born.
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