Palin Speaks

[PassedOut]

Disagree entirely. My experience (and I do have a fair amount of it) is that those government bureaucrats, even those in publice service departments, are every bit as bottom-line conscious as anyone in the private sector. For the most part, they don't have the option of creatively raising revenue, so they watch what gets spent. They'll spend everything you give 'em (You don't get rewarded for coming in under budget; if you didn't spend it, you must not have needed it, so next year's budget will probably be smaller), but if they go too far over, it's reduced services for others, cost-cutting layoffs, etc. There's always a department head who most assuredly DOES have a financial interest, and whose incentive it to not lose his job because he came in way over budget, and he's surrounded by policy wonks who are all on the same page.

What you say here is true, but making sure that one comes in exactly on budget is different from making that sure one maximizes profits and bonuses by denying care to as many sick people as possible.

 

Reforming health care won't make all the tough decisions easier, but they will move them away from people with a strong profit incentive to deny care.

 

I'm happy to see that the proposed plan pays doctors to give, when asked, some counseling regarding end-of-life decisions. Much of the money wasted on health care today occurs during the last two months of a person's life - much of it unwanted and unnecessary.

 

Folks do need to know how to stop those indignities legally. For me, it's comforting to know that Constance and I have the necessary documents ready in our safe deposit box.

[mike777]

Been reading media reports of European countries where the per patient cost is roughly around 3500$ compared to around 7500$ in the USA. The outcomes and quality of care seems to be just as good though I suppose there is room for discussion on that point.

 

What I have not seen is a breakdown of why the USA seems to cost so much more. For instance do we basically pay double the price for everything when it comes to medical care? Do we have twice the quantity medical care as everyone else? Examples would be twice the hospital stays, twice the medicine, twice the tests, etc?

 

Side note I do condemn the behavior inside some of these townhalls, lets try and act more civil inside the halls and leave the signs, yelling, and antics for outside.

[mike777]

"Folks do need to know how to stop those indignities legally. For me, it's comforting to know that Constance and I have the necessary documents ready in our safe deposit box."

 

 

Sidenote, in my discussions with doctors I am told these documents carry very little weight in these end of life talks. In many cases these were drawn up ten or twenty or more years ago. The family's wishes carry alot more weight in practice.

[awm]

My impression is that the biggest factors in the higher cost of US health care are:

 

(1) Generally poor health. In particular, a much higher percentage of Americans are overweight than Europeans. This causes a number of expensive (but usually treatable) health issues.

 

(2) Higher prices for prescription drugs. This is caused by a combination of very long-term patent laws (allowing the company that develops a new drug to have a virtual monopoly in the US for a long time), very strict FDA standards (making it hard for new, cheaper drugs to be approved quickly), and the lack of a single large organization which can negotiate bulk discounts on drugs (the US government has basically caved to the drug lobby and promised not to do this).

 

(3) Profit margins and high administrative costs for private insurance companies.

 

(4) Extremely high cost of malpractice insurance due to frequent lawsuits against doctors and hospitals.

 

(5) Inefficiency of hospitals offering emergency room treatment at their own expense to seriously ill uninsured individuals. If these folks were insured (even at public expense), then they could be treated much more cheaply most of the time (for example at local clinics).

 

Determining exactly how much each of these costs can be difficult; I have seen a number of different figures but they are usually "spun" by one side or another. Republicans seem to like to blame litigation (item 4) and illegal immigrants (part of 5) for most of the problems whereas Democrats usually like to blame the lack of a single payer (3 and part of 2).

[helene_t]

Adam's account sounds plausible. Maybe another two (possible minor) issues can be added:

 

- US patients are more likely to go doctor-shopping and ask for 2nd opinion. In most European countries, patients have a decade-long relation to their doctors so they don't have to tell the same story twice, or have the same test made twice.

- US doctors earn more than their European colleagues (OK, part of this is because of the costs of lawsuit insurances which they have to pay themselves afaihu)

[se12sam]

Did you folks watch The Daily Show segment of August 10th, featuring Samantha Bee, John Oliver and Aasif Mandvi?

 

I have to admit I thought it was a scathing criticism of the US Insurance Sector. And it was hillarious --- as always with these segments, these other presenters completely overshadow Jon Stewart.

[ArtK78]

“Nobody ever went broke underestimating the taste of the American public.”

Henry Louis Mencken.

 

I read this thread with some intererst. Most of the time the only exposure that I have to Fox News and the various commentators on the Fox News Network are the brief snippets I see on The Daily Show. However, the health care debate and the disgusting orchestrated behavior of the protestors at the town hall hearings prompted me to view some of the ongoing "discussion" of the issues on Fox News.

 

I could only watch about 10 minutes at a time before I became violently ill.

 

Sarah Palin and her admirerers appear to be playing to the absolute dark side of the American public, with a good deal of success. While I certainly hope for a rational and enlightened discussion of the issues will result in the creation of a national health care system which will be the envy of the rest of the world, I have been disappointed many times before.

 

I am old enough to remember 1968, when the Republicans nominated Richard Nixon for President. I thought it was a sick joke at the time, but it turned out that the joke was on all of us.

 

We survived Nixon (barely), Reagan and Bush Sr, and Bush/Cheney/Rove (barely). We finally have a President and an administration which is marked by intelligence and rationality. Hopefully they will be able to get past the politics of fear and hate and accomplish something desireable.

[Al_U_Card]

The economy (and individual rights and welfare) do better under Dems because they are reining in the rapacious, conservative and moneyed elements of society. The Republicans let loose the hounds of war and their profiteers giving them carte blanche to pillage the public coffers with the expected results. (Trickle down illusions and gush-up prosperity).

 

Obama is so far on the side of the bankers and financial community that I pause at endorsing his actions whole-heartedly. Goldman-Sachs etc. were too big to fail? They were not too big to run it up before the fall. Had the government decided another route to take, then maybe chaos would have ensued.....3rd term for W under the Patriot Act.

[vuroth]

56,899,510 Americans voted to put this lady one heartbeat away from the presidency.

How many voted to put someone with less executive experience than her into an actual position of power?

 

You guys seriously need more choices.

[kenberg]

ArtK, I am getting ill over the way this debate is going and I haven't even tried watching Fox News. As I get it, there are now two competing views (if "views" is a word that can be used here.

View 1. Obama plans to kill your grandmother.

View 2. All concern of any sort over Obama's plan are caused by Sarah Palin being so evil.

 

I most heartily recommend that Sarah Palin be given the obscurity she deserves. It is not possible to keep some people from listening to her but if it wasn't her it wouold be someone else.

[Winstonm]

the disgusting orchestrated behavior of the protestors at the town hall hearings prompted me to view some of the ongoing "discussion" of the issues on Fox News.

 

I could only watch about 10 minutes at a time before I became violently ill.

 

You have hit on one of the best solutions to lower health care costs in the U.S. - banning Fox News would go a long way toward restoring sanity. Of course, this would never happen as the loss in revenue to the pharmaceutical companies that make drugs to treat mental illnesses would prompt a rapid response by "Americans for the Right to Stay Crazy" a right-wing think tank sponsored as is just so happens by Rupert Murdoch.

[Lobowolf]

the disgusting orchestrated behavior of the protestors at the town hall hearings prompted me to view some of the ongoing "discussion" of the issues on Fox News.

 

I could only watch about 10 minutes at a time before I became violently ill.

 

You have hit on one of the best solutions to lower health care costs in the U.S. - banning Fox News would go a long way toward restoring sanity. Of course, this would never happen as the loss in revenue to the pharmaceutical companies that make drugs to treat mental illnesses would prompt a rapid response by "Americans for the Right to Stay Crazy" a right-wing think tank sponsored as is just so happens by Rupert Murdoch.

This has been a Public Service Announcement from the Concerned Citizens for Freedom.

 

Shame about the big-pharma conglomerates. Oh, and that pesky First Amendment.

[PassedOut]

banning Fox News would go a long way toward restoring sanity

Now, now, Winston! Surely Fox News and any other news has the right to try to persuade folks.

 

The right way to counter them is to have a good position on the issue and to sell it better than their side does.

[Winstonm]

Shame about the big-pharma conglomerates. Oh, and that pesky First Amendment.

 

Couldn't agree more. Kill the First Amendment. I for one am thankful Bush and Cheney saw fit to rid of us of that awful Bill of Rights thingy and Obama has been wise enough not to overturn those great statesmen.

 

I say if you are a Patriot you should Act like one and sacrifice your rights for the good of profits.

[Winstonm]

banning Fox News would go a long way toward restoring sanity

Now, now, Winston! Surely Fox News and any other news has the right to try to persuade folks.

 

The right way to counter them is to have a good position on the issue and to sell it better than their side does.

Interesting take on the role of the news - an organization utilized to sell an argument.

 

Whatever happened to reporting news?

[PassedOut]

Interesting take on the role of the news - an organization utilized to sell an argument.

 

Whatever happened to reporting news?

Fox News: Okay, I see your point. Maybe they could be charged with the offense of false labeling...

[kenberg]

Short story followed by a quiz:

 

Story:

 

I have a rash, I saw the doctor, he sent me to a dermatologist. ("We have specialists who could examine that. We call them dermatologists"). The derm looked at it for 30 seconds or so, asked if I had prescription drug insurance and when I said yes he wrote a prescription for a tube of lotion and gave me a coupon that gives me $40 off the price. I got the stuff. It turns out that w/o the coupon and the insurance, the price of one tube of lotion is $250. A cynic might note the clever pricing strategy. If they sold it for $210 but no coupon I would need a copay on the lotion and I might object. But at $250 the insurance pays $210 (or more ) and the coupon covers the rest. So the total price to me for the doctor, the specialist that they call a dermatologist, and the tube of stuff was $0. I am happy, at least if it works.

 

The quiz: Never mind what you think should happen. I ask, under your understanding of Obabma's plan:

 

1. Can every guy in the US, if he gets a rash, see two doctors and get a $250 tube of lotion for free? If yes, please comment on how the cost of medical care, including the cost to the government, will be reduced.

 

2. Or will, instead, it be decided that at $250 a tube we can all live with our rash or at least make do with cheaper ointment? If so, how will this improve health care?

 

 

3. Or will I still be able to get my freebies because I am a really nice guy but others can buzz off?

 

 

4. Or will the government decide that $20 is plenty for lotion and tell the drug companies to buzz off?

 

5. Or what?

 

Remember, the question is not what you believe should happen, the question is what you believe is intended under the Obama Healthcare Plan. No joke, I am not sure of the answers here (except I imagine that the answer to 3 is no).

[Al_U_Card]

Faux News specializes in editorializing and presenting a viewpoint concerning current events.

 

Reporting of the facts? PBS comes close with a leftward liberal lean to it. Papers, radio etc. since the time of Hearst and before, the advertisers call the shots and they are invariably the corporatocracy.

 

With CGI seeing is no longer believing.

 

You have to be smart and work hard to get a clear view of the situation. No one is going to make it easy for you but they will certainly bias and obfuscate according to their whim and requirement.

 

Faux gave new meaning, during the Bush-Cheney era, to the term "Rove-ing" reporters. :)

[awm]

To answer Kenberg's questions:

 

1. No. There are different levels of health care plans. Presumably you have a very good plan. Someone with a very minimal health care plan would have had some co-payment at some stage in this process. Obama wants to make sure everyone has a health care plan, but he isn't providing everyone with this level of coverage.

 

2. Decisions are not being made "for everyone." There will continue to be many different health care plans. The reforms are based on making these plans more transparent (so everyone has a choice and knows what they are getting), mandating some minimal level of coverage (probably would not cover free $250 rash ointment), and creating a fairly minimum "public option" plan to keep the insurance companies honest. It will remain the case that people with good insurance plans (paid for by themselves or their employers) will get this sort of thing covered whereas people with lower-end insurance will have to pay some money (but not the full costs).

 

3. You still get your freebies. Other people don't. Of course, in the long term the structure of insurance coverage may change due to increased competition.

 

4. The government will not make these decisions in most cases. The government decides the minimum level of coverage allowed under law (probably does not totally cover $250 rash cream) and also the level of coverage in the public option (again, it's supposed to be pretty minimal, so probably will not cover the full costs here). Private insurance plans will remain, and can charge more in exchange for more thorough coverage. Medicare coverage presumably will not change much either.

 

The idea is that in the current system, health insurance companies often have effectively local monopolies. It is hard for an individual to tell what the options are (in many cases there are not a lot of options). They are not really competing with each other on the open market. Further, large groups of people (such as a big employer) can negotiate good deals whereas individuals or small businesses trying to buy in get screwed. The plan is to create a government-sponsored forum where health insurance companies could be compared effectively and where people and small businesses could form groups to get better deals, and also to provide a government-run plan to help break up monopolies and drive the private companies to lower administrative costs. Note that the plan doesn't really make health care "better" for people who already have insurance -- the goal is that quality of care for people with insurance stays the same, but that cost of insurance is driven down (for everyone, but especially for people buying insurance on their own) and that certain unfair and/or deceptive practices in the insurance industry are curbed.

[kenberg]

Adam,

 

I think Mr. Obama should put you on the payroll and in charge of clear explanations. I often understand things through taking some specific real life experiences and asking how/if this would change under proposed reforms. Of course lotion for a rash is not very dramatic but I have had good health so it's the best example I can supply from my direct experience. A far more dramatic example kept me from most of the nationals, but it was someone else's heart not mine that was involved. The care was very good and very successful, and I would not want to see anything changed in the way it was handled.

 

 

Mr. Obama of course assures us that all will be well. Skeptics know that "the large print giveth, and the small print taketh away". If Mr. Obama's team can get away from reacting to claims that they will be shooting grandmothers and get on to calm explanations of actual issues then they may well be able to pull this off. Cost issues very definitely need to be addressed openly. I understand that the CBO analyzed an early draft and announced that the costs would not be quite as contained as advertised. I think some serious people are addressing this and we need to hear how it is going.

 

 

Ken

[PassedOut]

Adam,

 

I think Mr. Obama should put you on the payroll and in charge of clear explanations.

The healthcare reform is of great interest to me, so I've been paying attention. From where I sit, Obama has been very clear about what he wants congress to do.

 

To get the concise form, I listen to Obama's easy-to-find weekly addresses: The White House. To get more details, I read transcripts of his town meetings: Obama’s Health Care Town Hall in Portsmouth.

 

Whether congress will pass the legislation Obama wants remains to be seen. But congress will have let the US down big time if they fail to get it done.

 

I also note that Stephen Hawking was in DC yesteday: Stephen Hawking Defends Health Care in Britain.

 

Mr. Hawking — who received the Presidential Medal of Freedom at the White House on Wednesday — responded to the editorial this week, telling The Guardian newspaper, “I wouldn’t be here today if it were not for the N.H.S. I have received a large amount of high-quality treatment without which I would not have survived.”

Fortunately he lived in the UK, where he got the treatment he needed. Had he been born in the US, the world might have lost this brilliant man long ago.

[kenberg]

I went through the Portsmouth reference, most of it anyway, and it left me uneasy. I had trouble putting my finger on exactly why, but a Post article

http://www.washingtonpost.com/wp-dyn/conte...ST2009081301797

that helps me get it straight.

 

In the Portsmouth article the president goes on about Medicare. His initial comments don't seem to amount to much but on page 7 we find:

 

 

THE PRESIDENT: Well, first of all, another myth that we've been hearing about is this notion that somehow we're going to be cutting your Medicare benefits. We are not. AARP would not be endorsing a bill if it was undermining Medicare, okay? So I just want seniors to be clear about this, because if you look at the polling, it turns out seniors are the ones who are most worried about health care reform. And that's understandable, because they use a lot of care, they've got Medicare, and it's already hard for a lot of people even on Medicare because of the supplements and all the other costs out of pocket that they're still paying.

 

Now to the Post article, discussing some work on a possible bill:

 

 

In the Senate, where the Finance Committee is painstakingly crafting the only bill that has a chance to win support from both parties, Chairman Max Baucus (D-Mont.) announced that his bipartisan working group had come up with a plan that would save the government money by 2019. With Congress in recess, the "Gang of Six" finance negotiators will probably continue to meet next week via teleconference, a Finance Committee aide said.

 

Baucus has declined to release details. But people involved in the talks said the plan would make more than $500 billion worth of changes to Medicare over the next decade, charging wealthy seniors more for prescription drug coverage, cutting $120 billion in payments to private insurance companies that serve some seniors and trimming projected payments to hospitals by $155 billion in an effort to spur efficiencies.

 

 

This is merely a sample. I could give similar examples with, say, cost and scope. What I get out of this is that no one, not you, not me, not Mr. Obama, knows what will be in the bill that reaches his desk. This is not a settles issue. Mr. Obama's explanation of "The Plan" is more a recital of a wish list. It is not possible to say what the bill will or will not do or will or will not cost because it is still in the ether. That's OK, but it's not OK to call concerns about the effect on Medicare a "myth". I realize the Baucus approach may not be the one favored by Obama, but as the CBO report of a while back makes clear, Obama may not be able to reconcile everything in his wish list while staying within budge constraints.

 

I am going to go out on a limb here and predict that there will be a bill and that Mr. Obama will sign it. The ex-governor of Alaska might wish to have the tribute "effectively killed health care reform for the foreseeable future" as something that she can put above the fireplace next to the moose heads, but others would want no part of such an honor. Better to have "worked across party lines to get a bipartisan bill through the House and Senate and then signed by the President". This is a tribute that first and foremost a guy can tell his grandchildren about, but it can also be the basis for a very strong political career.

 

So I will place my bet: We will have a bill. Even more, I suspect I will like it (but not love it) when I see it. But I do not think any of us have seen it yet.

[cherdanno]

Its hard to tell what is happening to health care in the finance committee. From what I can tell Baucus is desperately trying to find get a bipartisan consensus, but while at least some of the Republicans he is negotiating with (Grassley) have interest in negotiating, but really no interest at all in advancing a bill and eventually voting for it.

[PassedOut]

Baucus has declined to release details. But people involved in the talks said the plan would make more than $500 billion worth of changes to Medicare over the next decade, charging wealthy seniors more for prescription drug coverage, cutting $120 billion in payments to private insurance companies that serve some seniors and trimming projected payments to hospitals by $155 billion in an effort to spur efficiencies.

 

 

This is merely a sample. I could give similar examples with, say, cost and scope. What I get out of this is that no one, not you, not me, not Mr. Obama, knows what will be in the bill that reaches his desk.

All true. I'm going to end up paying more in taxes and (probably) in copays than I do now. And, as I've said before, I certainly disagree with Obama's "tax cuts for the middle class" instead of asking for sacrifices from everyone.

 

But this has to get done, and I subscribe to Obama's insistence on not making the perfect the enemy of the good. No way would this congress simply pass a bill written by the white house at Obama's direction.

 

So we certainly need to keep the focus on what congress does with healthcare reform to keep them honest (so far as is possible).

[PassedOut]

Obama's Death Panel Claims First Victim

 

In a shocking foretaste of what we can expect from socialised healthcare, evil Kenyan-born "president" Barack Obama today publicly strangled a distinguished disabled physicist. "Professor Hawking's quality of life did not meet the assessment criteria laid down in subsection 6 paragraph 3b of the Life (prolongation of) regulations", a White House spokesman explained. "As a British citizen, he had in fact been looking forward to this for many years."

 

"This is not the America I gave up governing Alaska for. Hell no!" said Sarah Palin, giving her reaction on Facebook this evening.

[With photo of the killing] :)