Health Care Reform: What Are We Fixing?

First off, health care reform is needed to bring costs down. We are talking about a vital services that millions do not have any access to and millions more are bankrupted by. Premiums have risen nearly 8 times faster than wages. The current system is not sustainable as employers cut back on benefits and jobs.

I've heard many stories, and have come to the conclusion that people who gripe about insurance companies and Medicare would rather complain than look for solutions.

(Got my info from AARP's magazine concerning the costs I mentioned.)

Thanks EM. How exactly does covering everyone when the supply doesn't change bring down costs?

We don't have to be the most expensive system in the world that provides the least. There's a lot of efficiency that needs to happen, that isn't now. The private model turned into a very very inefficient one.

I agree. Horribly inefficient and wasteful. Will the government run system be better?

We need more competition and "supply" to drive down costs.

By supply, do you mean doctors and medical facilities?

Reform aimed at cutting wasteful practices and spending will help bring down costs. Making health care more efficient and focusing on preventive care and quality care will bring down costs.

If everyone is covered, costs will go down because the hospitals won't need to pad bills and pass the costs of the uninsured on to the insured.

If I can see a doctor before a condition is a crisis, that brings down the cost of treatment. For example, if hypertension is treated early on, the risk of a stroke or heart attack is diminished. If I can get dental care for a cavity before the tooth becomes infected and the infection invades my bloodstream, the savings are huge in costs and health.

If I can afford and have access to basic care, then you don't see a rise in your health insurance premiums because you're not being billed for someone who can't pay.

(Info available at Reality Check.)

A government run system won't be a for profit system. Now, a huge chunk of health care goes to the insurance industry and their profits.

We need to take the profit and "industry" out of health care.

We don't know that a government run system will be hugely better, but we need to try. Private insurance companies have failed many of us by underinsuring, denying insurance, denying care, and racking up big profits on the suffering of millions.

It is not (in the case of the plans being proposed in Congress) private or public insurance, but a choice between the two. Theoretically (if you believe in capitalist theory), the competition will bring about better products coming to the market in terms of benefits and costs.

Thank you Libra: How exactly does a private company compete with the federal government when the federal government can simply add more regulation to the private company? We are not talking business to business competition here. We are talking about one "company" having unlimited resources and the force of law on its side.

When more and more people go to the public option, private premiums will have to rise and more and more people will opt for the public option, but the public option "premium" will have to rise as well to keep up with the demand.

Aren't we right back to square one at that point?

That is not what the Obama administration is talking about at all. They want real competition, a marketplace of options. The "public" plan is not your scary "single-payer government run health maintanence by fiat" system as some seem to think. It is basically an extension of the federal civil service plan, which the congressional reps who use it seem to think is first rate. People pay in and get health insurance, just like the private plans. Everyone gets the same rules as far as governmental regulation of health insurance is concerned, basically to insure that the customer gets what he/she wants to be paying for. If private insurers can't give the customers what we want, they ought to be in another business anyway.

I hear you. But doesn't the civil service plan work so well because there are relatively few people (compared to population) in that system? What happens when you add more people? Premiums (taxes) must go up to pay for the increased demand and quality will suffer. There is no way around that in my mind.

Hopefully there will be more optimistic minds in charge. I believe in the abilities and creativity of the American people in the long run. Even in this plan I believe there are programs to greatly improve communications, record keeping, best care information, medical personnel training and other ways of making healthcare a better overall product.

American families with insurance pay a hidden tax of roughly $1000 for the cost of caring for people without insurance. As more Americans become insured, that hidden tax will begin to disappear. In addition, covering everyone will put downward pressure on costs. Bringing younger, healthier people into the system will spread the risk. As more Americans become covered, insurance companies will compete for their business. That will begin to lower costs. And health insurance reform will create stability and security for everyone. If you lose or change jobs you will have the peace of mind of knowing that you will always be able to find an affordable health insurance option for your family.

(Copied directly from Reality Check, because I am a bit lazy at the moment.)

Good data EMJAY

Much of the discussion, here and elsewhere, is based upon what is being told us about the government "solution". We do in fact need health care finance reform. But before you start discussing what's good about the government proposal, read HR 3200. We need health care finance reform. We do not need HR 3200.

The proposal doesn't add new doctors or hospitals or equipment, it just adds more people demanding more care from the same supply. How does this keeps costs down? Does it make any difference if someone can't afford the premium or can't afford to pay the taxes for the "free" care?

We'll just have to build the hospitals, manufacture the equipment, train the doctors -- you know, have a healthy society.

Training doctors and building hospitals so the "supply" of health care is increasing is the only way to fix this as far as I can see. I would support spending public money to train more doctors because I see that eventually the system would fix itself and be better for everyone.

More educational grants will be available for students seeking medical training. I don't have a link, but I heard Sen. Sherrod Brown assure us of that last Wednesday. He was speaking at OSU Medical Center, which already gets a boat load of money for development and training.

That's why it has to be comprehensive reform. That's why the people complaining about the present bills being too long or too complex are not thinking about the myriad things that will all have to work. You're right, there will have to be more doctors, more nurses, more of an emphasis on preventive medicine.

However, I think you underestimate the will of the insurance companies to stay in business. They've got over 1 TRILLION dollars in reserve by law: most of them are making money. They can still provide a valuable service in the marketplace if the marketplace is opened up, which, I believe, is another aspect of the plan that hasn't been emphasized. They'll want to stay in business, so they'll need to improve their administrative costs to stay in business. They'll also have to keep their executive pay in line with real world costs. No more CEOs who are paid $100K per hour.



The plans I've seen proposed have never been "free for everyone". They've been "affordable for everyone".

Good point Ali.

Do you worry that "affordable" will be what you want when you are sick?

I've got insurance now, but when I didn't, and had to take my daughter to the hospital when she fell down the stairs, it cost $3000 for 8 stitches in her chin.

I'm sure affordable will be cheaper than that.

Thanks Ali, but that's not what I mean. I'm asking if you the quality of "affordable" will be sufficient? Would you want your daughter chin stitched up by an affordable doctor or by the best possible doctor?

Agrred, Ali Hussein Lopez.

That's never the issue, RL. I know that I'm not going to be able to fly her to the Mayo Clinic to get the work done.

Near and affordable will do.

I hear what you're saying Ali, but when thinking about my own daughter's severe chin laceration, I expected and asked for the best. I think you would too.

My fear is that our choices will be severely limited and that the new system will create an even bigger divide between those of who can't afford the best and those who can. It won't fix anything.

RL;

Perhaps you can afford to be a dreamer: I have to be a pragmatist.

I'm not talking about going to a butcher or a veterinarian, or even a nurse-practioner (although I wouldn't mind it in less severe cases). I'm talking about a real Medical Doctor.

There will always be a gulf between the very best care and regular care. For 90% of Americans, regular care will probably be sufficient. The top 10% won't be using those doctors anyway, they never have.

Again, I'm talking about comprehensive reform. That by necessity will demand the admission of more students into medical and nursing schools, limited tort reform, and other solutions that have barely been determined at this time.

As a health professional, I have to take issue with the "real doctor" vs other medical professionals. Nurse Practioners and Physician Assistants are very highly trained professionals, and many are far superior to some of the MD's and DO's in practice today. Many schools have increased enrollments by decreasing the amount of time and education involved in training. Experience is still the best teacher, and those graduating from some of today's programs still need a lot more education and exposure to the real world of medicine.

The AMA was known for regulating admissions 50 years ago so as to ensure an excellent salary for all. Thankfully, this has changed. But they are still over-charging in many areas. They were totally against having "para-professionals", such as physician assistants until they realized how much more lucrative their own practices could be when they could hire these people to do a lot of their work and still bring in the big bucks.

Yes, there needs to be comprehensive reform, but be careful and do the research before making comments about "regular" vs "superior" care. In teaching hospitals, interns and residents do most of the care under the supervision of doctors.

I don't think that man can fix it at all. We need God in our lives and his healing touch and love and his government before we finally get it right.

So we don't need any worldly doctors ??? Just some laying on of hands ????

Oh Lord, Kum-by-yah.

God is notorious for not getting things done. "His" people spend too much time arguing over interpretations of an outdated life manual to ever get anything positive done on a grand scale. In a nutshell, Jesus's people don't really play well together and don't really give a damn about the rest of us.

EM Jay: I think that's a little harsh.

Jen: I do believe in God and his ability to heal, but we certainly need worldly doctors in our lives to be agents of that healing- if you will.

- that wasn't harsh for EM Jay ... and the way "christians" have been so selfish, mean, and cold hearted in the immigration and health care debates, I agree with her.

EmJay and Peter - I am one of "Jesus's people" or a Christian (whichever you prefer to label me as), and I care. Not all christians run on the conservative belief system. Please dont bunch us all into one group. I am all for healthcare reform. We need it.

If by placing "christians" in quotes, you mean the self-righteous, know nothings who follow their particular brand of Christianity in opposition to biblical principles, then I agree with you.

If you mean to lump all Christians into the same category, then I have to heartily disagree.

And, EM's comment is a little harsh in that she uses a broad brush to paint an entire group of people the same color. There is no less bigotry in that than there is in claiming any racial group is responsible for any of the ills we face today.

Ooops.

Sorry - I got lazy. I used to always say "right wing christians" to make the difference. I was hoping that putting it in quotes and making a small c would make that clear enough.

I grew up with right wing "christians" and have a chip on my shoulder about them.

I have many liberal Christian friends (who actually include the Sermon on the Mount in the religion) - and I certainly don't include them when I rant like this.

I am hearing some valid and thoughtful points so far.

Does everyone believe the system will work the way it's intended to work? And, again as part of my original question, where do we turn when the system started by this bill grows into as uncaring and as mismanaged a debacle as are the insurance companies today?

Russ, try talking to doctors and nurses about the demoralizing effect of not being able to do their job because of beign told what they can or cannot do by the insurance companies. Ask them how many of them fake insurance reports to cast something that is not covered into something that is.

How much they like having to manage all that paperwork and effort, and cost of hiring paper-pushers to handle the nightmare billing?

Physician used to be one the most satisfying careers anyone could have, now we actually have doctors quitting practice over what health care has become.

Common sense would tell us that this would be good for morale. Most people become doctors to do good, if the insurance companied would get out of their way things would probably be much better for everyone.

I totally agree with you. I am very worried about the increased financial burdens health care will be applied towards the middle class and the poor. In any case, is this something we should trust to the government to run efficiently? I am very skeptical, but hope for the best.

Beth ... the financial burden you pay already in health insurance, assuming you have it, is a political tax instituted to go to the private health insurance companies that are totally incompetent by the numbers which compare America's health care record and any other Western country's health care metrics.

Why do you ignore that?

The money you work for or your husband or wife or dog, whatever works for is removed from your check so a company can pay for their health care plan - so it is much the same as a tax, in fact companies only do it because they get taxed less to provide you with X dollars or health care than they do pay you X dollars in your paycheck ... check it out.

If you take the money that people and companies pay in health care, and compared that to a Single Payer system the savings would be enormous, enough to cover all those who are without care now, with money left over. It would also boost productivity less sick days. more healthy people, and increase the tax base from those people working who would be bankrupt, destitute or homeless.

The only negative would be for those in the insurance industry who are used to making millions of dollars doing nothing ... they might have to actually get a real job and work for regular wages ... ugh, no wonder they want to keep their vaunted position high above you and me and suck out money out of our wallets and lie to us.

Russell, my thoughts are in my numerous articles, to which I have noticed your conspicous absense ... don't worry, it's OK.

But you don't seem to get it at least from my reading of one of your first sentences:

> I hear countless tales of insurance company greed and corruption
> followed by the same number of stories about government
> mismanagement and corruption.

Since I don't really know or track what you hear or read, I have to make a guess that you are hearing real stories about greed, corruption, and let's not forget media manipulation and lies ... contraposed against lies and made up stories about the government. Since there is not a government health care plan how can there be the SAME NUMBER OF STORIES as you claim?

No, maybe that is what you are hearing, but comparing BS with BS and throwing the whole subject away in favor of how easy it is to beat up a straw man. I think I understand at least somewhat what your values are, or what you proclaim your values to be, but over and over, I keep seeing this with the right, Republicans, or the New Republicans, those who say they are Conservative or Libertarian ... that is a honest since tone followed by stories and facts that make no sense but that tow the party line.

I am really sorry to see you engaging in this.

Again:

> For every horror story about the current system, there seems
> to be a horror story about the proposed system.

A made up horror story to scare people. Can you honestly compare
a woman who has cancer and died trying to fight for treatment against
a giant corporation to the BS story of how Obama wants to kill your
Grandmother?

Come on ... turn that light bulb on, quit trying to pass off lies to your countrymen and women.

These are all great comments everyone. We all obviously do not all agree, but its clear there are some thoughtful opinions being expressed.

I'm not so sure government controlled health care is the way to go. On the other hand we shouldn't let insurance companies control our health care either

OK, that might be a valid concern Roger if there were not 12 or more Western country with superor health care systems to our that all spend less per-capita and have better outcomes with no bankruptcies ... not really that hard to figure out ... so what's not to be sure about?

Bruce, as you are want to do on occasion, you are not clearly representing what I said and superimposing your own opinion of what I said onto what I said.

I think I made myself perfectly clear when talking about hearing horror stories from both sides and not repeating the horror stories from both sides.

Bruce, I am surprised that, in order to call me a liar, you are falsely comparing apples to oranges and engaging in the very straw man behavior of which you accuse me.

I made a simple statement of personal fact..I hear and have read horror stories on both sides of the argument. Are some of the stories overblown to scare people? Of course. Are some of the glowing accounts of how wonderful both systems are or will be overblown? Of course.

Don't make me out to be a liar when I've spread no lie Bruce.

It is a lie to say there are stories about the proposed system ... those are projections - many of them based on lies - so what should on think when you utilize them to balance the data on both sides?

In order NOT to misinterpret you I used direct quotes and I think they were in context ... so maybe you could explain to me what I distorted that you said Russell?

Bruce: Are people telling stories on both sides of the issue? Yes.

Can anyone of us produce a story of the good quality of care from Kaiser to offset a story about the horrific quality of care from Kaiser? Yes.

Can anyone of use produce a glowing account of the wonderful things that will happen under the proposed system or a scary story about what will happen if we don't change course?

All I have been saying is that there ARE stories - both good and bad - on both sides of this issues. Your complaint falsely alleges that I am assigning a particular value to either side. I am doing no such thing - except to say that because of all I keep hearing, I am left wondering what we are fixing and asking for YOUR opinion.

Again you are misquoting your own self, that is not what you said:
> I hear countless tales of insurance company greed and
> corruption, followed by the same number of stories about
> government mismanagement and corruption.

When I catch you in a mistatement, and you rephrase into another
misstatement it almost seems like bad faith in what is supposedly
being cast as a good natured "town hall meeting" on the Internet
here.

The reason we have such a push for UNIVERSAL health care is
because there is something wrong. Many more Americans than
is acceptable are being shut out of the health care system, thus
providing the motivation to fix it.

You seem to act as if this came out of nowhere, a commie plot
to have the incompetent government take over the health
care system for the fun of it?

As with the financial system the government, we the people,
would not have to step in and fix it if it was not broke ....
so much for the superiority and efficiency of the private
sector.

Bruce: You bring up a good and oft-repeated point about "superior" health care in other countries. Define "superior"? Do any one of have anything but anecdotal evidence of the superiority of health care in other countries?

I will leave it to you to find the metrics on health care.
You can get some good ones in the movie SickO, but I am sure
if I quoted that you would point to more obfuscation from the
right.

So, you might want to look at life expectancy, or infant mortality,
those are two easy ones.

Alternatively some countries are not starting to define what they are calling a happiness index, which I think is problematic but the best way to go. All the things that need to be available for a human being to be free, and able to pursue happiness. It is so off to me that we who have the pursuit of happiness in our Constitution seem to believe it is just a phrase to give lip service to.

Bankruptcies is a very easy number to compare. Other western countries have -0- ZERO bankruptcies dues to illness and health care ... 40% or more or our banruptcies in the US are due to catastrophic costs of health care. That not only affects the person who is sick, but their family as well.

I know from your articles you are a concerned and engaged father ... what you do you think life would be life if you had cancer and lost your job and had to file for bankruptcy ... would your family ever recover ... in generations?

There is a Frontline documentary called "Sick Around The World" that is on the web and free to watch that talks about these numbers and how various systems work as well.

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

Also the term superior is a misnomer, the very rich will always have superior access to health care, so I see that as another attempt at obfuscation Russell. You define superior for me. One metric would be how many people have access to whatever is the norm or health care in their home regions. Another area the US fails miserably at.

I try not to get TOO much of my data from conservative sources and would suggest that Michael Moore may not be a highly credible source for you to rely on either.

I can't address your entire comment here, but I will ask..When thinking about bankruptcies in other countries...WHY is that so? Is it because health care is provided free of charge to those suffering a life-threatening illness or because they can't get health care from any other source but the government and so die with money in bank?

I am asking, not telling.

You crack me up man. YOU used the word "superior" and now accuse me of obfuscation when called on to define what you mean?

Glad you can take having your logic shredded with a smile! ;-)

It is a simple tactic, throw out a value judgement term and then argue over what that term means ... Bill Clinton would be proud of you Russ.

I gave you some metrics and examples of what I mean by superior, but it seems you have nothing so you have to latch onto attacking me when I ask you what you think of as superior.

Did you read my posts ... bankruptcies, coverage, infant mortality, life expectancy. Did you take a look at the Frontline documentary?

??

Oh, and ad hominen against Michael Moore ... hurray for critical thinking? Did you see the movie? Did you hear any debates about it. Are you aware that ad hominems are right out of the insurance industry's playbook in terms of discreditiing Michael Moore. The facts in that movie were checked and triple-checked before it came out ... and the facts are not in question, so they have to make fun of Mikey .... why not just call him a fat slob?

Reagan's closest advisor Lyn Nofziger was a fat slob too, but he was a conservative fat slob. How about that Rush Limbaugh? How about answering some of my questions and comments ... I know I do type pretty fast ... you should hear me talk.

Go check out some of the latest Bill Moyer's Journals where he has a former health care excutive who talks plainly and clearly about all of this and says he was there when they wrote the playbook of how to defeat Health Care reform so they can protect their profits.

Does Mikey Moore Have His SickO Facts Straight?

I love you man! You are IMPOSSIBLE to argue with. ;)

I'm glad I was able to enlighten you my friend.

One quick question. Are you ready to let your mother, father or child die because it is cost efficient? I'm not ready for that.

LOL .... yeah, one quick little question. Ask the insurance companies - they give their people bonuses for letting the most people die and saving the most money ... I assume some of them are someone's mothers, fathers or children.

I'd like to ask you a quick question: do you think that a company that can afford to pays its CEO $100000 PER HOUR is doing it be providing health CARE or health DENIAL?

I want to thank everyone for ringing in on the discussion. Lots to chew on.

But, for now, I am heading back into the land of poetry and fiction and lighter nonsense. I am not as young as I used to be I guess.

Where's my sponsor?? TRACY!? TRACY?!? I fell of the wagon maaaan...fell off the wagon...I didn't mean to get into politics, but I am weak maaan...weak!

I'm here, dude. Sorry I was offline most of the day but as soon as I saw the article title I thought OH NO! RUSSELL DIPPED HIS TOE IN THE POLI-WATERS AGAIN! NOOOOOOO!!

But it was too late. Still, you had to know. I don't recommend you try this approach if you're battling alcohol or drugs, but it's probably okay with Gather, and besides, your heart rate has probably settled down by now.

Cold turkeeeeeeey has got meeeeeeeeee

on the run.

Tsk, tsk, you fell off the wagon. You just can't stay away. You're a politicoholic.

Since I'm not in the States any more, it's harder to follow the debate. My only comment: the U.S. is the only industrialized country left in the world without universal health care. It is also the only country that has nearly this much debate and discussion about how bad their system is. Although I know that the Canadian system is not perfect, I do not know of anyone up here who has had to pay anything for a health-related problem, never mind going bankrupt: but in the States I knew/know several who could not pay their medical bills.

It is a lot easier to fight a change to your insurance if (like ours) it has to pass through public debate and parliamental scrutiny and thus people are provided opportunity for comment than if it is simplied levied "from above" as in the case of a private insurance agency.

Ian, I think it would be great if you wrote an article about your personal experience with the Canadian health care system. What we get stuck with here in the States is people on the right screaming about how terrible a national system will be and people on the left screaming about how wonderful its going to be.

Everyone making public noise on the subject has a vested interest in their position dominating the debate. I don't know of any large scale source of input from "disinterested" citizens of countries with a nationalized health care system.

Have you followed what is going on in Britain right now about how a hell of a lot of citizens there are all standing up for their system and putting down the US? I wonder how you can miss most of this stuff if you are interested in facts.

Of course you are going to be confused if all your input comes from the commercial radio or TV. No one can make reasonable decisions as a citizen in the US by using that as their sole information source. I try to point you to some information and you say I'm impossible to argue with ??

Yes, I have seen some stories about the Brits being a little defensive of thier system. I have also read an article in which the director of the Canadian program is talking about how their system is ready to implode because of demand.

http://www.news1130.com/more.jsp?content=20090816_121822_7032

I did write a post about my personal experience with Israel's nationalized health care system, for whatever it may contribute to the discussion here. For 22 years, I could choose my own doctor, see a specialist without a referral and never saw a medical bill of any sort. My experience was that the system worked.

Thanks Maurice. I will read it for sure.

How do you feel the difference in populations will affect the "theoretical" experience in the US?

I cannot be sure of that. I am also not sure if the end result of the bill in formation will be anything remotely like the system that I experienced, so comparisons may not be valid.

I think a more realistic concern than all the socialized medicine talk is that the current bill will be so badly mangled and will only make things worse rather than offer a real solution.

Even if that were the case Russell, at least the data would be out in the open and the concerns could be transmitted to you Senators and Congresspeople.

Have you ever had to contact your Congressperson for anything more than just grumbling ... I have found them to be very helpful and concerned.

If people bitch and moan about getting the system I think we can count on them complaining when they find things about it that might not work, and I think when that is out in the open we will see the concerns and the suggestions to fix them dealt with in a reasonable amount of time.

I think a subtext to the concerns of many is a sort of cross between greed and fear. I think many Americans have been tweaked to be afraid of change and to expect that the unwashed hoards of bums are going to be camped around the hospitals so no one else can get to their doctors.

This has not been the case anywhere else in the world so far and it's not going to happen here. Somehow Americans are conditioned to think they are Middle Class, and have it better than anywhere else in the world and need to hoard and lie and fool other Americans and the rest of the world to maintain our preferred place.

By the way ... did you happen to take a look at the Frontline documentary link I left for you? There is lots of data, specifically the data you said you were so interested in.

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

Hi Bruce: I will certainly read through your suggested research.

I am a retired health administrator. I know the problems of our current systems of health care delivery and have seen many models for national health care proposed over three decades.
It is my opinion that we should not implement a hasty, problematic plan as is the current plan. I think it's only wise to take time to study the best use of resources, while providing care and payment plans and systems for those without insurance.

thanks

I didn't read any of the comments...but would like to say...

I am against the health reform act, but do not agree with the current health care system either...

and I agree with this article!

You voiced exactly what I've been trying to voice!!

You should take a look at Ron Paul's proposals...

He wants to make it so insurance policies can be bought out of the state you live in...
lower the cost of malpractice insurance...

as you probably already know Ronald Raegan gave a speech in 1961 warning about socialized medicine and warning that there's no way we can insure everyone in the US on a state run program. There will inevitably be shortages of vital resources and the government will get to decide who is eligible to receive these resources. He also stated that once government gets their foot in the door with socialized medicine a single payer system will follow.

How would it help to have insurance companies out of the state you live in? They all register with the state insurance commissions, do they not? I have my car, house and life insurance from a state I don't live in. Please explain how this would help.

Thanks Jenysie!

I agree..the current system is too expensive and too exclusionary and I guess all I am REALLY trying to understand here is what this proposal will really do for us. I admit I could be wrong, but at the moment, I think we are trading bad for bad.

You shopped around right? You got the cheapest plane, and the reason you bought out of state because it was cheaper correct?

If the Government would remove regulations on interstate health insurance then you would be able to shop around for the cheapest plan.

Because you can't have interstate health insurance as it is now...

Also if you bought multi-year contracts for your insurance your rate would stay the same for your duration of the contract...

So if you were to buy a 20 year contract as opposed to a one year contract your rates would stay the same throughout your contract

"As I thought about it, it came to me that we are only trading one set of terrible controls for another set of equally terrible controls. When the government denies your claim, who do you go to? When the insurance company denies your claim, who do you turn to?"

Most if not all states have a system to deal with insurance claims and fraud. We all have congressmen and women who can be contacted if the appeal system doesn't work. I would imagine this would still be a viable way to get help if it were a "government system". The VA and Medicare are government systems with the same kind of appeals. The difference between the insurance companies and the government are 2 very different situations. Insurance companies are "for profit" organizations and they make money by denying benefits and allowing excesses. The government wants to save tax-payer money, so is more apt to use progressive ideas, such as prevention and cost containment.

"

Thank you Elsie. I appreciate your comments - and definitely worth thinking on.

I have a question though...Do you really believe that government employees (or agencies) are really interested in saving tax payer dollars? What about all the waste and mismanagment that seems to go on in other areas? Don't you think the same thing will happen in a government run medical system?

Do you have any fear that one of the "cost cutting" tools will be the same denial of service we currently experience?

I was wondering almost the exact same question.

Empoyees are employees and employers are employers. I have been gainfully employed for the better of 58 years. I have worked in proprietary hospitals, non-profit hospitals and agencies and have seen both sides of the issue. It doesn't much matter where you work, there are devoted emplyoees everywhere, and there are dead-beats. Same goes with the bosses and supervisors. Where there is accountability and high morale, there is generally high production. And where there is slacking and back-biting and lack of integrity, there is low morale and low production.

For me, I'd rather work in a place where I, and everyone around me, is held accountable, where we all receive equal pay for equal work, and we have pride in a job well done. I would hate to have the responsibility of making decisions that have the potential to harm someone, knowing that if I don't comply, I will be fired while my bosses are raking in millions of dollars as a result of my decisions.

As a much younger and inexperience nurse, I saw Medicare abuse in the 60's when it was first out. I chose not to be a whistle blower because I needed my job. But I sure avoided any instances where I could be implicated. There are a lot of gray areas in most places and people need to be held up to higher standards, proprietary or government. Much of the abuse at that time was part of the rebellion by the doctors and hospital administrations because they didn't want "the government" interfering in health care.

Sound familiar? So here we are 40 years later fighting the same battle. Well Medicare turned out to be not so bad until the insurance companies found a way to rule. Progress has stopped dead in its tracks and thus, we are where we are today, still looking for the solution of finding excellent health care at reasonable prices.

I say, get the insurance companies out of it. We don't need the middleman reaping the benefits and making money off the ills of others. They taught us well that they cannot be trusted with our money or our lives.

Elsie C: Thank you. You make some points here that are well worth considering and studying.

Does anyone know when health insurance was first offered in the US?

Wasn't there a time when health care was simply paid for by individuals only with any insurance or government subsidy?

When exactly did prices begin to spiral out of control?

> get the insurance companies out of it. We don't need the
> middleman reaping the benefits and making money off
> the ills of others.

That is the bottom line here.

No one can explain worth a damn what we pay the insurance companies for, what do they do for all that money.

One could speculate that they hold the health care system in a kind of limbo where they just keep making huge amounts of money.

Why should an operation cost 6 times more on average for a person without insurance? This is the kind of twisted behavior we get. This is fact. They say it is because the uninsured person is not part of a group ... but to the hospital that is asked to do the work, what difference does that make to them?

No, what this does is to extort people to be afraid to death NOT to have insurance, and you know if someone is fearful on that level they are being manipulated and not treated fairly.

What the insurance companies do is to turn health care into a lottery. Instead of spreading the risk, they maximise the amount terrified people will pay to NOT be left out of health care.

This whole article written ostensibly in the tone of questioning and being afraid for one's family is really disingenuous. This is not that hard to figure out.

The potential for abuse will always be with us and every other country not matter what system we have. We can only speculate that we might have less abuse and crime if we have a society that treats people fairly as equals instead of basing life, death, and status on how much status you can buy or steal.

sorry.. that s/b WITHOUT any insurance or government subsidy...

If you had watched the movie SickO instead of poo-pooing it without seeing it, you would recall that the first health insurance scheme was Kaiser.

"This whole article written ostensibly in the tone of questioning and being afraid for one's family is really disingenuous. This is not that hard to figure out."

Do you mean my article?

I'm seeing phrases that indicate you want me to believe that you have an open mind on this, a questioning tone, yet you have been offered by me and others some facts and pointers to information and I see no indication that you have looked at it or acknowledged it.

What I do hear you keep repeating is how you are afraid you might lose the care that you have and you son might not get the best care possible. I feel like you are more concerned with seeming like a nice guy so that you can infecting people with the fear you are expressing in sympathy rather than doing any enlightening on the health care issue.

I don't hear any understanding that the current system may be acceptable to you, but it has locked 30-50 million people out of health care, and is taking the money from many more that when the time comes to serve them or provide care they may not get anything. Maybe a good question to ask is, would it be necessarily true that people with health insurance now will get a lower level of service if everyone is allowed to have health care, and the moral quandry that implies?

Maybe I am amping up the intensity of my comments because none of the questions that I have asked are being answered or acknowledged by you, and none of the pointers I am giving you to answer your questions are being acknowledged or looked at.

Dude! It's hard to be totally open to your comments without first getting past the way in which you sweep in with machetes and bombs. You started off by calling me a liar of sorts and then expect me to openly and happily absorb the data contained within the folds of the insults and assaults on my character.

You know I like you and respect you. I will read your comments again and TRY to get past your attacks and maybe grasp what you are saying.

Maybe you could work on the approach as a way to enhance the effectiveness of your often worthwhile comments?

Here the effing President of the United States at the time, Nixon, conspiring against the American people using Kaiser's plan as a prototype putting profits before people.

You-Tube: Here is another story from the movie SickO of a woman whose daughter died as another result of this insurance mess, that is, in network treatment. Her daughter was sick and needed care, but the hospital they were delivered to was out of the Kaiser network and they forced her to take her daughter to an in-network hospital where she died on arrival.

We need a system that prevents this kind of thing, there is no need for someone to die because they cannot get to the right place or do their paperwork or get permission in time.

Bruce: I just watched the snippet with Nixon.

How does what they said translate to putting profits before people?? How is the government plan - with a focus on PREVENTATIVE care - going to be any different than Kaiser's plan?

Niether one can profit by providing unlimited care of all kinds to all people. Even Obama himself talks frequently of better preventative care Why? As a means to reduce costs!

And, this is a perfect example of why I don't trust Michael Moore. Did you notice the photos edited for effect? Do the tapes include photos of Nixon smiling broadly and saying "I like that" or did Moore strategically place those to paint a picture?

I Kaiser can help you keep from getting sick, they spend less money to cure you when you do. What is so damn evil about that idea??

The proposed plan does the EXACT SAME THING!!

sorry "If"

Isn't that essence of what we're talking about?? Isn't that the gist of the proposed plan? More efficiency? More preventative care to avoid higher expenses later?

I think the point of my article is a valid one: How is the proposed system going to be ANY different than what we already have??

Russell, I think you missed the key part of what Nixon said ... he said, they make more profits by delivering less care.

You asked a few comments back how this whole mess started, and I think it started when the government .... the "corrupt" part of the government ... the part of the government that is driven solely by money and profits ... got so much influence in Washington that it was able to elect who it wanted and push the country to do things like Viet Nam, and this health care system, which is really a sort of monopoly granted to certain private interests with huge influence. The consequences of that is that over time the positive feedback loop has cut everyone else out of being represented by the government, and even served by industry, except the very rich, who every time they can think of another way to rip us off the get the government to pass a law to enable them to do it ... and then they blame the government for being incompetent on top of it.

What a great game, except that sooner or later is leads to moral and economic collapse.

I see a lot to agree with here.

However, I still don't see the difference in the Nixon statement versus one of the key arguments of the Obama plan. Save money by providing less care.

Kaiser is an HMO - a maintenance organization. They focus on preventative care rather than reactive care. Effectively, that's providing "less" care and maintaining profitability and sustainability. Obama's plan is asking for the same thing. Semantics Bruce. Its just a word game.

Do you sincerely believe that Obama doesn't have closed door conversations using language that might be less flowery and altruistic?

Russell asks:
> If Kaiser can help you keep from getting sick, they spend
> less money to cure you when you do. What is so damn
> evil about that idea??

No, Kaiser does not spend less money to cure you, that would
imply that they are bringing efficiencies into the system and
bring down costs ... but that is not what we are seeing and it
is the heart of the whole problem.

Maybe you don't get it, but when you keep going back and
asking the same distorted questions the same way I do start
to question your motives. You are refusing to travel the line
of linear logic, just like the Republican playbook says to do.

Act bewildered and inject some down home family or
American values to take the high road.

The gist of the plan the way I see it is insurance reform.
The subject in the news has gone from universal health
care, which I think should be the goal, to health care reform,
and now to health insurance reform.

The health insurance industry, which you should know before
you even open a discussion on this subject, sucks the most amount
of money from American of any group in the world, and delivers
measurably inferior care to most of them and locks the rest of
them out by charging on average 6 times more for any given
procedure ... to punish people for not being in the system, and
then if you try to get into the system as an individual they
punish you ever more by either rejecting you outright, or
disallowing existing conditions, or making the premiums
so high no one can afford them.

The basic unfairness of this discussion is that you ask a question
and I take the time to answer it at length, and you ignore the
question and ask another question that takes you a line or two.

That is a strategy, it is a Republican strategy, is it in fact
unAmerican in that I get the impression after a while you are
not interested in questions and answers, you are just interested
in wasting my time and seeming like a nice guy while you do it.

> I think the point of my article is a valid one:
> How is the proposed system going to be ANY
> different than what we already have??

So someone tries in good faith to answer that, you do
not bother to read or acknowledge their facts, and you
keep asking broad rather uninformed questions and
saying you are scared and ask another question that
takes a short amount of time.

Another answer, another brush off ... and so on.

If you are truly interested in the facts, look at some of
them, and quit re-asking the same questions over and
over. Failure to engage in the conversation seems to me
to read between the lines, I've got my care and do not
care about anyone else.

if you do, then what is your solution to fix the problem
or do you not think there is a problem?

I have read your responses and I don't follow some of them honestly. I don't know if things are getting lost in the sheer verbosity of it all or if I am just missing something. You keep telling me about how bad the system is now. OK! I get that and I have even AGREED with that. What I don't hear you saying is how government will do better over time.

BUT..I will re-read your comments and see if I can gain a clearer understanding.

My solution? I've said it before. We need more supply to match the demand. We need to spend money to train doctors and build hospitals. We need to create such a supply that prices are naturally driven downward and more and more people can afford to pay for their own care rather than depend on insurance companies or the government. Make BOTH irrelevant.

Will it take investment of tax dollars? Yes. As an evil right wing Republican liar and hate monger, do I support the idea. Yes.

How many medical schools are there in our country? How many new doctors do we (as a society) turn out every year? What about a government academy like West Point that trains and equips doctors and medical personal at government expense in exchange for a certain number of years in service?

Can you imagine if we could shrink the ratio of doctors to patients to dramatically low levels? Everyone could afford to see the doctor when they are all competing for my business.

I want to live in a country where people can afford to see the doctor, stay healthy and get help when they are not. I simply DO NOT see how the government taking over the roll of the insurance company is going to make that a reality.

Bruce: In all your diatribe, you - as you often do - make blustering remarks about my motives, my right wing agenda and my disingenuous statements...what you DIDN'T do was answer my question.

You didn't address the question on preventative care, you didn't address my comment about Moore's strategic use of photographs to accent a point that was never made by the original Nixon statements.

You keep treating me as though I have written a glowing defense of the current system! I have NOT.

Now..instead of ranting about and throwing up red herrings, answer the question:

How is what we're proposing going to be different than what we have?

My (clear and without reservation ) opinion is its not and all you've given me is a one sided diatribe against the current system and called me a liar.

You are not listening to me. You are preaching a sermon and following the liberal play book of talk long and talk loud and villify your opponent but whatever you do DON'T have an honest discussion.

You know, the current health care system is so complex, by design, that it is hard to say exactly how to change it. And those who do get attacked or over-shouted in the media. Not to mention there is no coverage about single-payer system which is what the majority of people want at all.

There is not perfect new system, there cannot be. The best thing we could do would be to utilize the best of what other countries have ... but that is an option that will be fought against by the insurance industry tooth and nail because they are all - in 12 developed countries of the world - they are all basically government administered.

They are all cheaper, and they all give better results than our system.

So ... if you are going to argue that we have to have a system where you personally have to understand every little aspect of it you are just shilling for the status quo. To shut up the noise we have to regulate or get rid of the insurance companies. Then we can begin to see what works and what does not.

The insurance companies are playing chicken with the US, and you ... have feathers.

"So ... if you are going to argue that we have to have a system where you personally have to understand every little aspect of it you are just shilling for the status quo. To shut up the noise we have to regulate or get rid of the insurance companies. Then we can begin to see what works and what does not."

WHAT? Are you advocating that we change the system before we fully understand how the replacement system works?? And if I DEMAND to know how what you will propose will effect me and the rest of the people in the country I am a shill??

C'mon man. We can do better than that!

Hey, Guys, you're muddying the water here. R.L., I think the key difference in the 2 plans is the word "profit". The government is not out to make a profit. The insurance company is. Prevention is key to lower costs as fewer people will need health care. I understand that at one time in China, people paid the doctor for staying well. When they got sick, they did not pay and he had to treat them back to health.

The reason the insurance companies, hospitals, unscrupulous doctors, pharmaceuticals, etc are against the government plan is because it interferes with their bottom line. They tout the fact that free enterprise saves money, but all it really does is screw the little guy. That's why we now have an economic crisis. We don't need to continue this road. We have come a long way in the past few months making banks, lending institutions, some insurers, auto makers and others accountable for their actions of the past 8 years. Now it's time to do the same for the health care system. We already have the statistics that prove what we have is lousy.

We don't need Michael Moore to prove anything. We don't have to rehash Nixon and Reagan's comments. All we have to do is use a little common sense, become educated by being open-minded, and attempt to understand this craziness. We are being bombarded on both sides with interpretations that, although sounding logical, may not be that correct. Consider the source, educate yourself and come to your own conclusions.

All I have been trying to get to is understanding how replacing the insurance company with the government is going make any difference in the quality of care we all receive or prevent any one of us from being denied treatment or going bankrupt trying to pay for it ourselves.

Both plans must maintain costs at certain levels or they must raise taxes/premiums to maintain service and treatment levels. You simply can't tell me that addressing inefficiencies is going to generate enough money to pay for unlimited treatment of all patients at all times.

SOMETHING will have to give. How is that any different than what we have now?





Bruce rings in with Michael Moore to tell me that the current system is bad and needs reform. Ok. I'll stipulate to that. But nobody has been able to tell me how the government plan will do any better.

Oh, BS Russell, I have you lots more info than Michael Moore, this is why I see you as being a biased unfair right wing shill. Quit picking on Michael Moore and using him as a proxy to undercut a lot of good info that I have put here and pointed you too.

Did you watch the Frontline documentary, did you check in the many interviews Bill Moyers had with insurance company insiders. You are just not trying.

I want the insurance companies out of business or completely changed. I don't know if Obama's plan or the Democrat's plan will do that because there is so much money being spent and influence being brought to bear on the government.

I hope you are happy that about 500 million of your insurance premiums are being used to undercut the democratic process and prevent reform?

We know what it looks like from other countries, but 500 million dollars has a lot of weight. Out country is not going to work until this kind of thing is stopped.

If you stipulate that the system needs reform, then stop talking in favor of it. Put it this way, the health care system is not going to disappear, so those of us who have doctors and insurance are going to be fine while this thing works itself out, be part of the solution, and the main problem is the insurance industry.

Now, is that too much for you to digest at one time and are you going to say I'm confusing you yet again?

"I don't know if Obama's plan or the Democrat's plan will do that because there is so much money being spent and influence being brought to bear on the government."

THANK YOU! FINALLY! You DON"T know how it will be different.

Bruce, you've quoted Moore and referenced and linked to Moore a number of times. Sicko is one of the primary basis of your argument and yet you're upset with me about mentioning it.

You keep saying the same thing..you want the insurance companies out of business. Ok. That doesn't mean people will suddenly have the ability to pay for their own care so now the government takes on the role once filled by the insurance company. Revenues are taxes instead of premiums and cost cutting measures disappear because the evil insurance companies are out of the picture??

Nonsense in my opinion.

> Revenues are taxes instead of premiums and cost cutting
> measures disappear because the evil insurance companies
> are out of the picture?? Nonsense in my opinion.

No nonsense about it, the US spends more than any other
country on health care and the difference between us and
every other developed country is our insurance industry.

Watch the Frontline documentary and see
how this works in other countries around the world. You say
you want information, but you just spew negativism and fear
and claim my information comes from Michael Moore.

I also did not say I do not know how it will be different, because
I do not know what kind of bill is going to get passed.

Russell, if you do not like being called a liar then do not lie about
the information I have given you, which apparently you only
able to badmouth Michael Moore ad hominem and have not
bothered to look up the information.

I mentioned Michael Moore once, when you asked about
evidence, then you attacked him without bothering to check
out the facts when you claimed to not get much of your
information from conservative sources.

If you don't like the word liar is not very bright to twist
something that can be checked on right above in earlier
comments.

Bruce, I love you man, but you are not being entirely honest. You've mentioned Sicko and provided Youtube links to the movie in several comments. (Which I have addressed and you've all but ignored) My "attacks" on Moore have to do with his agenda and film making style, yet you insist that I am attacking him personaly.

From Me: > Revenues are taxes instead of premiums and cost cutting
> measures disappear because the evil insurance companies
> are out of the picture?? Nonsense in my opinion.

From You: "No nonsense about it, the US spends more than any other
country on health care and the difference between us and
every other developed country is our insurance industry"

Once again, you didn't address my point. You simply ignored what I said, effectively called me stupid and gave me a comment that does not address anything I said.

The point is that whether we have a government run system or a private insurance run system, there WILL be "premiums" and there WILL be cost cutting measures that result in denied claims, lack of treatment and/or financial burdens to individuals if they choose to pay out of pocket for things the government refuses to pay for.

Why do you keep ignoring this point?? Is it easier for you to twist my words and call me a liar than it is to admit that we might end up in the same boat we're in??

Russell, you called yourself a liar, I merely said if you don't like the word don't fit the definition.

You did not say I "mentioned" SickO, you said it was my "only" point. That is plain dishonest BS, sorry, there is no other way to phrase it.

I mentioned SickO once, and you keep resurrecting that comment maybe perhaps because you think it helps your case? You asked for metrics about health care and that was one link I provided, now you have to keep jumping up and down about SickO & Michael Moore, like there's something wrong with it.

There is no bad info in SickO, there was a big silence from the right when the movie came out. Now we keep hearing downright lies from the right about death panels and breaking the budget and then trying to equate the two sides because Republicans seem to think everyone lies. Limbaugh, Hannity, O'Reilly, etc are passing on the bad info. Now the opposition is carrying guns to the town hall meetings. If you want to associate with that ilk I'm sorry for you. All because you do not want someone else's little boy to get health care like your son has?

Now, since you do not want to deal with the facts in SickO, can you move on, or at least make all your anti-Michael Moore posts somewhere else so that I don't have to keep trying to get you to look at facts you refuse to look at?

When I mentioned Frontline and Bill Moyers and have asked you about it several times you come back with Michael Moore. You seem obsessed with him. Do me a favor and let your next post address something else, watch the Frontline documentary or listen to the health care experts being interviewed by Bill Moyers, or just say, I want to keep my head in the sand - whatever, but just be honest.

I am not the one with the honesty issues and the comment above demonstrates that as cleary as anything can.

Clear as mud, as most of what you are presenting here.

Quite honestly, this is getting hard to keep up with. I seem to be losing track of the incoming comments because they land at any spot along the line and don't necessarily follow in order!

Yeah, Gather needs to put indexes in their links and when you get an update of a new post it needs to go to that index, not just point to the whole message board page. But then Gather is kind of slow to figure this stuff out.

I think they also need to make their email notifications of comments a little more mobile friendly. I can't always be at my pc and following the link on my phone is often hit and miss.

I will also express - as I have done before - my belief that so many of these conversations would be much more productive in real time. So much additional meaning or clarification can be given face to face than can ever be acheived in a comment string over days with countless distractions between the posts.

Russell, you are taking the lies and distortions "excreted" by the right and presented as fact and just saying everything out there is fact and so confusing and scary.

Just today another story about Republicans lies ...

If you believe all these claims and everything you hear, no wonder you are scared. Buck up man, find out, look for some facts, and stop being so negative.

http://www.cnn.com/2009/POLITICS/08/20/health.care.bad.info/index.html

the story:
WASHINGTON (CNN) -- A woman asked Rep. Allen Boyd at a town hall meeting the other day if health care reform proposals would force people to let the government access their bank accounts.

"That's not true," the Florida Democrat responded. "When someone sends you something on the Internet that sounds crazy, how about just checking it a little bit?"


so ...... how about it, check a little bit

AND ... ask yourself why the TV cameras are there when someone stand up and rips out lies, or carries a gun to a town hall meeting, but they have not covered any of the over 11,000 events that the American people have hosted in favor of health care reform?

The bottom line is that any change will allow you to:
- if you like your doctor you can keep your doctor.
- if you like your health insurance you can keep your health insurance.
- you will not be forced to be in a public option.
- the lies about killing old people and others are just that - lies.
- you will not go bankrupt or lose your insurance if you get sick.
- you will not be dropped or denied care if you have a pre-existing condition.

Thank you. I appreciate the statements without the attacks.

I have copied your comment and added my response/questions.

The bottom line is that any change will allow you to:

- if you like your doctor you can keep your doctor. (perfect)

- if you like your health insurance you can keep your health insurance.
- you will not be forced to be in a public option. - (until such time as your premiums and taxes rise to the point you can no longer afford to stay with private insurance and are then "forced" to take the less expensive option)

- the lies about killing old people and others are just that - lies. (agreed, but there are legitimate concerns about the effect of section 1233)

- you will not go bankrupt or lose your insurance if you get sick. (how do you KNOW this? You don't. You have no more gurantee that the government won't deny treatment claims than you do under the current system and you MAY be required to pay out of pocket if you want to continue treatment.)

- you will not be dropped or denied care if you have a pre-existing condition. (great. how will this affect premiums and will this "force" more people into the public option because they can't afford to stay with their plan?)

I don't care how bad you think the current system is, I want to know exactly how everyone is so sure the new regime will be better? These things sound good on the face, but what will the real effect be?

> - you will not be forced to be in a public option. - (until such
> time as your premiums and taxes rise to the point you can
> no longer afford to stay with private insurance and are then
> "forced" to take the less expensive option)

There you go again with scare tactics, you are assuming that will happen. You are also ignoring how many people are denied health care and insurance now for the same reasons ... again the reason we are here discussing this is because the insurance companies have not solved the problem of offering health care at a price Americans can afford - yet they are increasing their profits. Do you ever address this? I have not seen it.

But how else do you think the private insurance industry is going to be incentivized to stop their abuses and cost overruns ... they have a monopoly?

President Obama has been talking about this on webcast for the last hour ... did you bother to find this out and listen to it? Are you actively trying to be part of the solution or just presenting the irresponsibly outrageous comments from right wing media.

I notice you cannot resist putting in an attack on me saying thanks for stoppiong the attacks. Just because you are nicer in you attacks does not mean you are not attacking, such as this last comment which you could have omitted without the superior attitude.

If you refuse the public option and have no other health care you will be taxed or jailed. It is IN THE BILL. So yes, I WILL be forced into the public option. Either that or go to jail and allow this ridiculous society to raise my child for me.

Don't be silly. You are more concerned over something that has not even been implemented because you fear it will be absurd ... when what is in place now is killing or letting die about 5 times as many people per year as have died in war in Iraq and Afghanistan in 6 years. Try dealing with a fact or two and quit relying on your stuffed animal to tell you what to think.

Russell said:
> I don't care how bad you think the current system is

That does seem to be clear from your statements and tactics. You want the American people to wait until lack of healthcare is your and your family's problem too, and then, believe me you will be wanting the government to move as fast as possible. Isn't that a bit unpatriotic and selfish?

Whatever you say Bruce. Responding to you isn't worth it anymore.

wrong.
It IS my problem and I STILL want the government to keep their grimy hands out of it.