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Health Care Reform by Medicare Expansion

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Posted on Jun 20, 2009
AP photo / Esteban Felix

By Eric W. Fonkalsrud, M.D., and Michael D. Intriligator, Ph.D.

(Page 3)

With an expanded Medicare system, all Americans would be covered regardless of pre-existing conditions, and they would have complete portability of care and medical records throughout the nation. Those people who prefer more extensive coverage for desirable but not essential procedures such as cosmetic surgery, and many other conditions for which very expensive care provides questionable benefit, or self-inflicted disorders, would be placed lower on the list of covered disorders, similar to what Oregon has provided for more than a decade. All citizens would have the option of purchasing supplemental private insurance for these conditions, as now exists in the Medicare program.

Further expansion of the national quality and assessment programs together with outcomes research studies would play an important role in eliminating unnecessary and ineffective services and treatments and standardizing health care delivery throughout the nation. The very erratic and incomplete employer-provided health coverage would be gradually phased out to reduce costs and to make businesses more competitive with those in other nations. Retiree health benefits were first offered in World War II during a period of wage and price controls when many companies had a young work force with few retirees. Today, however, it’s the reverse, particularly in old-line industries. For example, Detroit’s Big Three automakers currently have more than four times as many retirees as active hourly workers.

The Medicare Expansion program has some similarities with the Canadian health care system, although it differs in some major aspects. There would be no governmental limitation of total physicians produced or of entry into specialty training programs. The individual provinces administer the Canadian single-payer system, and it is a more efficient system than the U.S. Medicaid program. It entails minimal paperwork and middle management, while providing rapid and predictable reimbursement. Prompt care is provided for disorders requiring urgent treatment; some delays may occur for patients seeking elective procedures. Physicians are generally busier with direct patient care than their counterparts in the U.S., while their incomes in many specialties are currently very similar. Canadian physicians and patients have repeatedly voted to continue their current health care system.

In designing a package of basic health care benefits, the Obama administration must not only strike a balance between high-powered competing interest groups but also guard against offering too much or too little, and must seek to reduce fraud and abuse. Too extensive a package of benefits could bankrupt a system that is already heavily committed. Conversely, a package without adequate coverage of medical disorders may lead to people delaying in seeking care until illnesses require much more extensive and expensive therapy.

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Considerable attention needs to be directed to what physicians and the government consider to be “basic care,” with reduction of excessive expensive testing and services, based on professional rather than primarily economic or legal considerations, the latter including defensive medicine5. Self-inflicted medical disorders such as obesity could be discouraged somewhat by a low tax on known harmful foods, such as the recently recommended tax for sugar-sweetened soft drinks6, and possibly levies on ammunition for firearms.

The current complex patchwork multiple-payer health insurance programs are much more expensive, regardless of how administered, and do not eliminate the majority of problems. By contrast, Medicare Expansion builds around an efficient and well-established single-payer system, and the incentive-driven but controlled fee-for-service mechanism supplemented by a private partnership for nonbasic and more extensive desired care. Medicare Expansion would thus establish a system of national health care in the United States that would both control costs and provide quality basic health care to all Americans.

This report was written by Eric W. Fonkalsrud, M.D., emeritus professor of surgery and chief of pediatric surgery at UCLA, and Michael D. Intriligator, Ph.D., professor of economics, political science and public policy, UCLA.

References

1. Iglehart, J., “The struggle for reform – challenges and hopes for comprehensive healthcare legislation.” N Engl J Med 2009; 360:1693-95.

2. Oberlander, J., “The US healthcare system: on a road to nowhere?” J Can Med Assoc, July 23, 2002.

3. Intriligator, M.D., and Fonkalsrud, E.W., “Healthcare reform by Medicare expansion” (blog), 2009-04-21.

4. Ashish, K.J., DesRoches, C.M., and Campbell, E.G., et al, “Use of electronic health records in US hospitals.” N Engl J Med 2009; 360:1628-38.

5. Medicare payment policy. Report to the Congress. Washington, D.C.: Medicare Payment Advisory Commission, March 2009.

6. Brownell, K.D., and Frieden, T.R., “Ounces of prevention – the public policy case for taxes on sugared beverages.” N Engl J Med 2009;360:1805-08.


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By ardee, January 11, 2012 at 4:17 am Link to this comment

By JosephBrown, January 10 at 11:33 pm

Responding to an advertisement for insurance may seem a waste of time. But the egregious nonsense contained in your post makes it almost mandatory.

We pay more for health care than any other nation on earth and by a wide margin. We get little for that huge expense as well. Peddle your cheap insurance somewhere else.

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By Sandra Daniels, August 4, 2011 at 1:45 am Link to this comment

The health reform will not occur when insurance companies and business have the finally say, even to congress! The sad fact is that a national health system will not be implemented whilst money is the motivator. The success of many health systems is the underpin, that every person is entitled to a good level of medical care within a framework of affordability.

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By ardee, May 19, 2011 at 5:03 am Link to this comment

The return of Mandinka

In typical fashion this one spouts again:

But as usual the Moron in the WH blames doctors salaries and Ins Co for the problem

1. Obama may be a lot of things, but moron isnt one of them. But I wonder how one (you) fails to recognize another?

2.Doctors salaries (how many outside of HMO’s are actually salaried) Private corporations , most of them

3. Oh certainly, who could blame the Insurance Industry for this mess of a health care industry? Just about everyone with an actual brain I believe….

Folks, for all unfamiliar with this poster, well, you aint seen nothing yet!

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By Dermot Stafford, September 24, 2010 at 3:06 am Link to this comment

Many of the expenses which seem to be ballooning in the medicare system could be addressed by opening up the system of Americans of all ages. By making certain checkups and behavioral health advisories universal the overall well being of people (including those over 65) will begin to improve immediately. By restricting government medical care to only the last three or four decades of a patients life is akin to only performing maintenance on your car after you’ve already owned it for six years and then complaining about the outrageous expenses accrued from never having changed the oil.

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MarthaA's avatar

By MarthaA, February 13, 2010 at 3:01 pm Link to this comment

These interviews with Professor Jeff Cohen are pertinent to this thread:

Progressives and the Democratic Party - Part 1:
http://therealnews.com/t2/index.php?option=com_content&task=view&id=31&Itemid=74&jumival=4775

Progressives and the Democratic Party - Part 2:
http://therealnews.com/t2/index.php?option=com_content&task=view&id=31&Itemid=74&jumival=4783

Progressives and the Democratic Party - Part 3:
http://therealnews.com/t2/index.php?option=com_content&task=view&id=31&Itemid=74&jumival=4786

Progressives and the Democratic Party - Part 4:
http://therealnews.com/t2/index.php?option=com_content&task=view&id=31&Itemid=74&jumival=4787

Free Trade being a soft cover for fascism that must be overturned by the populace through the Democratic Party, as the Republican Party is representative of the Elite Right-Wing EXTREME, and the Democratic Party once was to represent the populace.

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By Tall Paul, February 7, 2010 at 3:55 pm Link to this comment
(Unregistered commenter)

I remain routinely confused by a business community that accepts health care
costs higher than those seen in the rest of the western world.  These added
costs place a heavy financial drag on their struggle to compete in a world that
is increasingly shrinking in its flatness. 

The answer can only lie in the “American Identity” and its ideological belief in
business models and the capital markets.  Perhaps government run single
payor is simply too big a jump for a culture rooted in “Give Me Liberty or Give
Me Death!”

I appreciate the general cynicism leveled at government run enterprises, but as
a health care provider crossing private and public sectors, I find the
bureaucratic barriers actually more onerous on the private side of the line.  I
am also more appreciative of the transparency and responsiveness to
consumers using public sector services.  It isn’t perfect, but it honestly works
better than the messy mixture of private sector insurers. 

Should we go with single payer in an Expanded Medicare model?  It would
certainly allow for continued consumer choice and professional freedom.  It
would, of course, be vulnerable to the erratic vagaries of public sentiment and
the whims of the US political system.  Still, as a fundamentally rational system
that would provide quality care with some measure of communal cost
containment, it seems to offer our best hope.

We may not be ready for it, but Vive the Public Option!

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By mandinka, June 25, 2009 at 5:37 pm Link to this comment

Great article we have 1 MR and a moron PHD. Harvard Medical dept has looked at this issue extensively and their latest report lays the blame where it belongs. TRIAL Lawyers and our Tort system.
Due to frivolous lawsuits doctors are no longer practising quality medicine but defensive medicine. 25% of ALL medical tests and 15% of all hospital admissions are unnecessary but done to prevent malpractice lawsuits.
But as usual the Moron in the WH blames doctors salaries and Ins Co for the problem

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By G.Anderson, June 24, 2009 at 1:54 pm Link to this comment

No, don’t screw them, make them do the worst thing possible for the corporate crooks and their corporate crooks friends in medical care, actually do something about medical care, get people well.

Provide some competition, with single payer, health care.

Get rid, of the corporate revolving door, for the agri business, medical corporations, pharmaceutical companies at FDA, USDA, etc..For former regulatory empoyee’s getting jobs there. 

Then there’s always real reform, at medical schools, stop burdening medical students with decades of student loans, and increase the number of doctors. Stop making it a fortune to be a doctor,as other’s pointed out, in other countries it doesn’t take several decades. 

The current medical system, is not about medicine, it’s about making money for medical corporations, and unless, something is done about the causes, those causes will continue to increase.

I remember when Oxcontin was approved, there we’re concerns that this was just another drug, for addicts to abuse. But that was discounted. Then when Oxy, became known as Hillby Heroin, the CEO admitted his company lied to the FDA. Did it get banned, hell no..Now it’s being smoked along with Crack.

Oxy along with other prescription meds account for more ER admissions than street drugs. Still no action by the FDA.

When, Avantia, and Celebrex, and Viox, killed hundreds of thousands of people, what happened? 

How can our government seriously consider giving insurance companies which are owned by doctors, a big pay day?

A public option is the only way to help people get well. Its the only thing that will actually improve health, the others had their chance and blue it.

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By KDelphi, June 24, 2009 at 1:53 pm Link to this comment

RAE—Exactly!! ; )!

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By RAE, June 24, 2009 at 1:49 pm Link to this comment

Good question, KDelphi: “How is Canada homogeneous?”

It isn’t… and that’s one of the major differences between Canada and the USA. Canada considers its society as a MOSAIC… not a MELTING POT as the States likes to bill itself.

I submit the US is more a mosaic than a melting pot as well, especially in the first few generations after emigration. Just consider the number and variety of hyphenated Americans - Afro - Greek - Italian - Canadian (oops)...

The only argument that can exist in a society that wants to consider itself civilized is HOW to go about ensuring that ALL citizens have adequate health care regardless of the circumstances. Those who are still arguing WHETHER or WHY or WHO aren’t ready to take up the responsibilities of living in civilization. Back to the jungle - survival of the fittest.

Swing me from a vine.

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By KDelphi, June 24, 2009 at 12:43 pm Link to this comment

Smoove—This “the US is too homogeneous” is an old argument of neo-cons—“we need a uniquely ‘Merkin solution” which has now been adopted by Dems who take huge sums of money from lobbyists.

It is really simple. YOu think that people are entirely masters of their own fate. Anyone who has spent alot of time working within social groups knows that that is not true.

Until “all men are created equal” and we are “on a level playing field”, it is inhuman to let people die from a lack of what the civilized world considrers a human right.

You disagree with the entire truly free world.

How is Canada homogeneous? Have you checked out the diverse populations of Denmark or the UK lately?

The only argument is , truly, whether it is a human right—let me ask you—do you think that it is. If you dont, ok. I disagree.

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By Phasor, June 24, 2009 at 11:46 am Link to this comment
(Unregistered commenter)

to Smoove, June 24 at 2:04 pm

What gibberish!

This notion of freedom you have is warped. All people live in a society (other than the extremely rare hermit, although I’ll bet you couldn’t find one). All societies are collectivists by definition! Freedom doesn’t mean you live outside a society!

Government incompetence or, at best, inefficiency is another warped idea. To some, government can only be relied to do only one thing well. The government core competence is making war!

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By Smoove, June 24, 2009 at 11:04 am Link to this comment
(Unregistered commenter)

RAE,

I would contend that if a society is truly free, then the individual has full domain over his/her life and his/her labor. As long as they do not infringe upon others rights, then they may live,  dream, work, and play however they see fit.

In a collectivist society, part of your life/labor belongs to the state/society. In other words, you’re not truly free. You necessarily have to take away individual freedoms to achieve the “common good”. In this case, health care for all.  Admittedly this doesn’t sound half bad and in fact it is very likely that early human tribes behaved in this manner with little internal turmoil. But here’s the rub: Our modern society bares little resemblance to the small homogeneous tribes where collectivism works. As I have stated before, Federal redistribution programs have no mechanism for determining who is down or their luck or who is just lazy. This creates a sense of injustice which begets anger. It can breed an environment that allows crafty politicians to prey on human emotions to further their personal (sometimes insidious) agendas. Collectivism is a slippery slope I’m telling you.

I want people to have health care too, but the law of unintended consequences tells me that when govt enters the marketplace, the cost to society can be far more then just higher taxes, it can be perpetual human misery. Yuck!

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By ardee, June 24, 2009 at 10:20 am Link to this comment

G.Anderson, June 24 at 10:32 am #


Opening up medicare to everyone, means opening up medicare to everyones liabilities.

So, who survives and who doesnt is a matter for the bottom line and not the compassion of our nation for its fellow citizens?

It’ means increasing the liabilities of medicare to provide care for everyone. But providing care isn’t the same thing as making people well.

Especially, those that suffer from chronic disease, who will always suffer from chronic disease, and who will never be cured no matter home much so called medical care they receive. Since, 70% of all disease in America, is chronic degenerative disease, that’s a lot of cost.

So, according to you, screw ‘em?

We can’t really even care for the people we’ve got now, with the infrastructure we have now, with chronic shortages of providers in every field.

It’s just like putting a Heroin addict on Methadone maintenance, they don’t get better, yes sometimes they can function ok, but many still use Heroin on the side, and just use the Methadone to keep costs down.

That’s what medicine does now, it strings people along with drugs, and interventions that treat symptoms but not causes, and as long as the causes keep increasing, so will the cost. That’s one of the reasons why costs keep going up, because causes keep going up.

All the problems you speak to exist now, and our medical costs are at least double that of any other nation. Yet you speak as if these problems are new to a single payer of govt run health care system. What one might expect is not a lessening of the problems of health care but the lessening of the cost of the procedures and associated medications as well as access to all instead of allowing people to die in order to protect the bottom line.

So ask yourself, how many liver transplants are you the tax payer willing to pay for, for an alcholic that’s still drinking? Two, three, four….I’ve seen three…

So ask yourself what transplant board has ever or will ever provide livers, or lungs, or hearts, or any organ to an alcoholic or drug addict? This inclusion by you speaks, not to the truth, but to the difficulty you have in making your case.

And how many Octomoms should the government create?

Dude, you descend into unbelievability….no actually you began there!

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By BruSays, June 24, 2009 at 10:07 am Link to this comment

Could all the skeptics on Single Payer or Universal Health Care who question the cost, quality and results of the above please tell us this: What have the vast majority of industrialized countries who’ve ALREADY gone that route and who’ve ALREADY bettered our results been doing wrong?

So stop with all the banter on costs, or who’s covered, or quality or all the other BS the pharmaceuticals and insurance companies are pushing. Single Payer/Universal Coverage WORKS.

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RAE's avatar

By RAE, June 24, 2009 at 8:55 am Link to this comment

G. Anderson asked: “So ask yourself, how many liver transplants are you the tax payer willing to pay for, for an alcholic that’s still drinking? Two, three, four….I’ve seen three…”

Here’s what I ask myself. I wonder, out of nearly 300,000,000 people, how many are chronic alcoholics requiring liver transplants for the first time? Second? Third?

I’m not in a position to research the question to find the correct number but my guess is NOT MANY.

So my second question is: in a Nation that tosses TRILLIONS OF DOLLARS around as if it were chump change, how much strain on the national budget will a few liver transplants cause? Or a thousand?

My guess again is SO LITTLE THAT IT WON’T EVEN BE NOTICED.

The vast majority of those 300,000,000 people are RESPONSIBLE CITIZENS who realize that in return for a richness in services and supplies the likes of which this world has never seen, they have RESPONSIBILITIES to take care of the privilege. Then there are the few who see only the “bad” in others and suspect that every single person (except themselves, of course) will RIP OFF THE SYSTEM IF GIVEN THE CHANCE.

Maybe it’s because they themselves, if given the chance, would rip off the system, so they assume that if they would do it, everyone would.

I can’t believe how SMALL MINDED some people can be when it isn’t their own ox that’s being gored.

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By Himself, June 24, 2009 at 8:50 am Link to this comment
(Unregistered commenter)

Expanding Medicare to all would achieve universal coverage and reduce per capita costs. So, the paper’s basic idea is sound. The manner proosed to get there - proceeding by one segment of the population at a time, selecting the neediest of the group - is not sound because it INCREASES costs. The non-benefit cost of non-means-tested Medicare is between 3% and 4%; for means-tested Medicaid and SCHIP the non-benefit costs run higher - roughly 7%. That tells you that selecting the covered based on means-testing is very costly. Further, every time one adds a segment of the population, Medicare rules governing them must be changed - while those left out remain subject to all the costly variations of our current hidge-podge non-system. That means that the wastedul non-benefit expendityures on them continue unabated and you will have added the cost of differentiating which members of the new segment are sufficiently needy - adding costs.
Doing the job all at once - with interim rules - such as everyone is eligible for the whole poackage without further testing - gets you to the goal not only miore quickly, but more inexpensively.

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G.Anderson's avatar

By G.Anderson, June 24, 2009 at 7:32 am Link to this comment

Opening up medicare to everyone, means opening up medicare to everyones liabilities.

It’ means increasing the liabilities of medicare to provide care for everyone. But providing care isn’t the same thing as making people well.

Especially, those that suffer from chronic disease, who will always suffer from chronic disease, and who will never be cured no matter home much so called medical care they receive. Since, 70% of all disease in America, is chronic degenerative disease, that’s a lot of cost.

We can’t really even care for the people we’ve got now, with the infrastructure we have now, with chronic shortages of providers in every field.

It’s just like putting a Heroin addict on Methadone maintenance, they don’t get better, yes sometimes they can function ok, but many still use Heroin on the side, and just use the Methadone to keep costs down.

That’s what medicine does now, it strings people along with drugs, and interventions that treat symptoms but not causes, and as long as the causes keep increasing, so will the cost. That’s one of the reasons why costs keep going up, because causes keep going up.

So ask yourself, how many liver transplants are you the tax payer willing to pay for, for an alcholic that’s still drinking? Two, three, four….I’ve seen three…

And how many Octomoms should the government create?

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By Purple Girl, June 24, 2009 at 5:47 am Link to this comment

Reason Medicare is having problems is because it only insures those who have the greatest potential for using it. By opening up the program to all under 65 the system would no longer be ‘cherry picking’ just the group most likely to require it’s services.
A Win/win for all

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RAE's avatar

By RAE, June 24, 2009 at 4:46 am Link to this comment

Smoove…

“If I understand your position correctly…”

You’re teasing me, right?

One more try:

EVERYONE has the right to access HEALTH CARE which, in turn, is fully funded by EVERYONE through General Revenue taxation and/or some affordable, limited, patient co-pay scheme. You do it to build and maintain roads, sewers, electricity grid, water supply… things that EVERYONE needs… why not HEALTH CARE?

Sure some will give more to the collective fund than others but that applies to almost everything in a free society. Some people volunteer, others don’t. Some people follow ALL the laws, most follow most of them, and a few follow none of them. So what? Are you going to scrap the whole system because a tiny percentage might abuse it?

It’s the Law of Averages that works to provide EVERYONE with a BASIC level of HEALTH CARE.

Why is it that Americans (mostly) are SO FEARFUL that a few might “get away with something?” You folks remind me of my hyper-cat. She’s just a year old and would rather TOTAL THE HOUSE chasing after it than let the mouse get away. So WHAT if a few abuse a system? THE MAJORITY get the services they need. What more could you want or expect?

One further thing… “Health Care for All” probably smacks of socialism or worse, Communism! Horrors! McCarthy reincarnated! I wonder how long it will take for it to sink in that the AMERICAN WAY is NOT always best for all situations? Why not apply the best solution to resolve the problem instead of sticking like Velcro to solutions that DON’T WORK?

Perhaps too many generations of you folks have watched too many old Westerns - tough, rugged, individualist, do-it-yourself, silent, sullen, rigid, shoot first, string ‘em up, and God help anyone who “comes on my land” etc., etc. You do know that MOST OF THAT is a HOLLYWOOD MYTH and NEVER HAPPENED, don’t you?

Try, for once, not to build imaginary castles in the sky… and then MOVE IN.

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By Smoove, June 23, 2009 at 8:35 pm Link to this comment
(Unregistered commenter)

RAE,

Free markets necessarily guarantee that everyone will have the right to ACCESS goods/services. If I understand you position correctly,  you want to take it a step further and guarantee that not only will everyone have the right to access health care, but also the right to the MEANS to purchase health care.

Remember though, “there is no such thing as a free lunch.” The right to the means to purchase health care necessarily means the right to other peoples means, i.e. the gov’t has to rob Peter to give to Paul. In other words, you will have to violate rights to uphold your right which begs the question, is that even morally right?

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By BruSays, June 23, 2009 at 5:46 pm Link to this comment

Amazing that so much time is spent arguing back and forth on how Single Payer or Universal health care would work, how it would impact on our budget, how the quality would hold up…AS IF IT’S NEVER BEEN DONE BEFORE?

Again, here’s a list of countries currently operating with Single Payer/Universal health care. Surely, couldn’t we do the same? Or are the lies and disinformation put out there by the pharmaceutical companies and health insurance companies (and the politicians who depend on their huge campaign contributions) that persuasive?

Argentina
Austria
Belgium
Bosnia and Herzegovina
Brazil
Brunei
Bulgaria
Canada
Chile
China
Costa Rica
Croatia
Czech Republic
Cuba
Denmark
Estonia
Finland
France
Georgia
Germany
Greece
Hong Kong
Hungary
Iceland
India,
Ireland
Israel
Italy
Japan
Kuwait
Latvia
Liechtenstein
Lithuania
Luxembourg
Malta
Mexico
Netherlands
Norway
Pakistan
Panama
Poland
Portugal
Romania
Russia
Saudi Arabia
Serbia
Seychelles
Singapore
Slovakia
Slovenia
South Korea
Spain
Sri Lanka
Sweden
Switzerland
Taiwan
Thailand
U.K.
Ukraine
Uruguay
Venezuela

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By KDelphi, June 23, 2009 at 4:58 pm Link to this comment

Only Kucinich and Sanders addressed the real issue today—health care is a human right.

Here is what “competition” does

http://www.guardian.co.uk/world/2009/jun/19/funds-investigation-aids-tb-malaria

This was linked from truthdig

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By Outraged, June 23, 2009 at 3:14 pm Link to this comment

“Obama disagreed, sharply.

“The public plan, I think, is an important tool to discipline insurance companies,” he said. “Too often, insurance companies have been spending more time thinking about how to take premiums and then avoid providing people coverage than they have been thinking about ‘How can we make sure that insurance is there, health care is there, when families need it?’”

A public plan would not be unfairly subsidized, Obama said. It would have to collect premiums and provide good service like any viable operation. Public and private providers alike would have to stop the practice of refusing to insure people with pre-existing medical problems, he said.

With those caveats, he said, private insurers “should be able to compete.” If the government-run program “is able to reduce administrative costs significantly, then you know what, I’d like the insurance companies to take note and say, ‘Hey, if the public plan can do that, why can’t we?’”

He practically taunted those who denigrate government bureaucrats and exalt the free market.

“Why would it drive private insurance out of business?” he said of the proposed public option. If private insurers “tell us that they’re offering a good deal, then why is it that the government, which they say can’t run anything, suddenly is going to drive them out of business? That’s not logical…..

.......”“Right now,” Obama said at the news conference, “I will say that our position is that a public plan makes sense.”
http://www.google.com/hostednews/ap/article/ALeqM5j44UJgFSGMRubEpajVBFO0qEYolgD990K59O0

Obama is right, the claims these groups are making is hogwash, complete fiction.  See, I told ya they were pathetic. (but you knew that already, I know)

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By Outraged, June 23, 2009 at 2:54 pm Link to this comment

An interesting take on the new polls out regarding Obama and the GOP, Froomkin @ Wapo:

“The coverage of the latest wave of public-opinion polls has focused mostly on President Obama’s ostensible political weaknesses. But the more important story may be the increased marginalization of his Republican opposition.

Three major polls out in the past week tell the same story: Of a Republican party that is widely disliked and mistrusted—and that is becoming essentially irrelevant. Notably, on the single most polarizing aspect (the “public option”) of the biggest political issue of the moment (Obama’s proposed health-care overhaul), the public overwhelmingly supports Obama’s position.

Republicans have essentially no power in the House. And even in the Senate, their ability to effectively block Obama is minimal without the cooperation of a handful of unreliable center-right Democrats.

In fact, the only real power Republicans have left is granted to them by a media culture that consistently clamors for bipartisan solutions, even as one of the parties increasingly represents a shrunken minority of hardened extremists.”
http://voices.washingtonpost.com/white-house-watch/obama-slayer-of-the-gop.html

That they are…., they seriously are extremists, I agree. See…. all we needed to do was allow them enough rope to hang themselves, and the idiots fell all over themselves wanting to be the first to get his length of rope! (sometimes greed makes people do really stupid things…).

It was only a matter of time, the funny thing is they’re so GOOD AT IT…...lol.  I swear….. it would be impossible to do to them what they do to themselves.  They are so transparent it’s pathetic, while sometimes entertaining…. more often simply pathetic.

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By KDelphi, June 23, 2009 at 10:40 am Link to this comment

Smoove-No, what YOU say makes no sense. Everyone who doesnt die at home, without a dr, will have a catastrpophic expense. If you wish to do that, feel free.

Arguments for “free mkt” will be ignored now. They do not work.
If a society does not provide for its people when they are most vulnerable (and it doesnt have to be cancer) it will not long remain a society. (if we are one now, which I am not convinced that we are)

I dont put down any substantuive arguements because I’ve been doing it for decades and I know that some people, despite all evidence to the contrary, will continue to insist on the so-called “free mkt” for life and death matters. It is a moral argument, not a factual one.

If I put a bunch of links and statistics here , would you consider them? If you would, let me know. I also have many personal experiences, working within the system and being treated in many foreign countries. I have links to professional orgs, that I work with, etc.—let me know.

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By wildflower, June 23, 2009 at 10:14 am Link to this comment

RE SMOOVE’S COMMENT: “gov’t is obligated to protect the life of its citizens against force. However, the maintenance of ones “health” is at the sole discretion of the individual. . .  I maintain health care is a personal choice and not a right.”

And our children? How does a child maintain his/her healthcare if the parents cannot afford to pay the inflated costs of healthcare and medical insurance in the U.S.?  Surely, you don’t consider this a “personal choice” of the child and the parents?  And what about individuals who are being denied insurance and accessibility to healthcare services because of “pre existing” health conditions?  Is this in your opinion a matter of personal choice? 

No, effective governments are concerned about the welfare of its citizenry and our founders obviously recognized this.  If “we the people” aren’t concerned about the lives of “we the people,” why bother creating a government in the first place?  In the case of healthcare for the U.S. citizenry, “we the people” have every right to address and resolve the problem.  The welfare of insurance corporations should be the least of our concerns.  Afterall, they exist solely to promote their own general welfare not the welfare of the U.S. citizenry.

Corrupt and unethical medical insurers may not qualify as foreign invaders in your eyes, but most of us have recognized that foreign invaders are not the only enemies that “we the people” face. The World Health Organization, for example, estimates that 3 million people die each year as a result of exposure to air pollution.  And if everyone shared your way of thinking, we wouldn’t be taking the steps necessary to protect our citizenry against deadly air pollution.

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By bcc, June 23, 2009 at 9:41 am Link to this comment
(Unregistered commenter)

Hello Smoove,
“In a free market and in a free society, one has the right to sell…labor through a voluntary transaction.  But if that service becomes a right then don’t you…force one party into servitude?

I was a libertarian at one time, but I really think it is unnatural, and have moved on. Humans are biologically imprinted to be social creatures. Lock humans up alone and they get strange fast. So you are a product of society and have benefited from this incredible social structure. Government is naturally involved in something so basic. I do agree though that their needs to be a proper balance between individual rights and laws that are intended to benefit society as a whole.

The problem is we have shifted too far into unencumbered capitalism. It is not necessary to have business men able to make $100,000,000 per year to be motivated. When you refer to doctors who might be regulated to incomes that still qualify them as upper class citizens that is hardly an oppressive “servitude”. I recall in college how virtually everyone interested in science was a “pre-med” major but most were filtered out by the lack of medical schools to train them (thank you AMA) so there are other reasons behind the doctor shortage and their high salaries.

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By G.Anderson, June 23, 2009 at 7:02 am Link to this comment

Health care for a few, means health care for none. Because a large population of sick people means that even if you have good health or decent care at the top there is no way to prevent the illness of everyone else from spreading upward, as it does now.

Just for the record egalitarian societes, could never be described as social darwinism in action, it’s almost an oxymoron. There’s a vast difference between production for exchange, and production for consumption.

Out health system does not work, Medicare does not work, our insurance system does not work. We have severe shortages of medical providers, in fact our entire system is riddled with incompetency, greed, corruption, and is dominated by the medical-insurance-pharmecutical-food corporate agribusiness Giants, who have spent decades poisoning, and addicting everyone in this country. They are why we cannot have a health system like the French. These interests will fight to the death -theirs and everyone else’s - to protect the money they make, burning you cutting you and poisoning you. 

But they cannot heal you. Our health system is collapsing, as are the corporations that keep us ill, give us cancer and the degenerative disease we suffer from. Health care reform is their last chance, if there isn’t reform, then they will go under just like GM.  Leave them alone, and they will die, on their own.

What will replace them, look around it’s already here.

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By RAE, June 23, 2009 at 6:48 am Link to this comment

Well, Smoove, it seems we’ve plunged into a discussion of “how” before we’ve settled such nettlesome details as “who” and “why.”

It is my conflicted and convoluted view that ALL HUMAN BEINGS have a basic RIGHT to whatever services are required to promptly relieve, and hopefully repair, their mental and physical suffering, disease and dysfunction. (By “all human beings” I mean just that - everyone in every circumstance.) To be sure, I’m averse to providing expensive services to those whose need for medical services is entirely their own fault. But my aversion to just letting them suffer and perhaps die is greater.

So we have a competition of “rights.” I guess I maintain that we all have a right not to be used and abused while simultaneously holding the right to use and abuse.

In my view, this “right” is absolute - as with pregnancy, either you have it or you don’t. Once you start piling on limitations and regulations you’ve hit the slippery slope from which there’s no recovery. Experience has shown that the absurdities and inequities pile up during any attempt to manage this endless struggle faster than you can apply a bandaid.

So my “who” is EVERYONE. My “why” perhaps is not entirely altruistic. As I progress through my senior years I find great personal comfort in KNOWING that no matter what happens or why, I have a RIGHT to competent basic care and repair. (Actually, where I live in Canada, only my mental and physical medical needs are looked after. Prescriptions are capped at $15 each to a maximum of $500 per year. However, if I want to SEE anything, or CHEW anything, I must either purchase rather expensive “insurance” to cover eye exams and glasses and dental services, or pay cash out of pocket. Because I’m fortunately healthy and because I look after myself, it’s cheaper for me to just pay rather than purchase insurance. I may get a surprise when someday my dentist informs me that I need $10,000 worth of dental work or have them all yanked. Then, I’m screwed. It will be milkshakes for the rest of my days. You win some and lose some.

To wrap up the “why” - most people can live with slightly blurry vision and a few teeth missing so these services are “optional” and at our own expense. But when people need cuts sewn up, bones set, hearts transplanted and everything else inbetween, there is no Plan B but to suffer and/or die. Therefore there is no acceptable Plan B, in my view. Plan A covers EVERYONE for EVERY REASON.

Life doesn’t come with guarantees. It’s a crap shoot from the beginning. But there are lots of things we can do to relieve the “life is brutal and short” kind of indifferent environment. I maintain we CAN and SHOULD load the dice in favor of universal basic PUBLIC health care paid for from PUBLIC coffers. Why? Because we’re human.

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By Smoove, June 22, 2009 at 5:48 pm Link to this comment
(Unregistered commenter)

“He has probably never been hit by a drunk driver or had a family member denied cancer care, either.”

KDelphi, You have to be able to recognize the difference between normal/routine health care and emergency/catastrophic health care. You’re advocating a total health care system but your scenarios only involve catastrophic cases/events.

You don’t present any real argument as much as you create a false premise in an attempt to demonize any position that doesn’t agree with yours.

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By Smoove, June 22, 2009 at 5:28 pm Link to this comment
(Unregistered commenter)

RAE,

Thanks. I’m enjoying the exchange.
Why cannot “health care” be both? But I think our interpretations of “health care” are passing in the night. When I use “health care” I mean the SERVICES AVAILABLE…”

Can they be both? If health care is a service, then that means someone has to provide the labor, correct? In a free market and in a free society, one has the right to sell (or not sell) their labor through a voluntary transaction.  But if that service becomes a right then don’t you necessarily force one party into servitude? If the service is a right, then one side of the transaction is compulsory even if the gov’t compensates me for it (and how would compensation be set, btw?). As I see it, this would necessarily mean infringing on individual rights. As I have stated before, I believe the proper role of government is to protect individual rights not infringe upon them.

Gotta go…I should really register.

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By KDelphi, June 22, 2009 at 3:32 pm Link to this comment

RAE—As I said, Smoove doesnt think it is a human right.

He has probably nver been hit by a drunk driver or had a family member denied cancer care, either.

I have to pay for a military that I dont approve of. The Constitution either oprovides for a “well-regulated militia” (which most people think means INSTEAD OF a military—thats what you base gun-ownership right on, no?), but not a standing military. Yet I have to pay for it. I didnt ask for this empire, and I paid into a pension I will not never get. Hell, I didnt even ask to be born here , nor born at all.

These are human rights. Every civiliized country in the world think so. The uS is obviously not among them.

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By ThomasG, June 22, 2009 at 3:00 pm Link to this comment

All insurance is a legislatively institutionalized Ponzi Scheme; a Ponzi Scheme because the requirement to have insurance is legislated but legislation does not guarantee the consolidation of the risk pool, so that all of the people in the United States are a part of the risk pool and everyone that buys insurance shares risk with the entire 300 Million people that are the population of the United States.  As it is the risk pool has been fractionalized into smaller and smaller sub groups for the purpose of separating high risk population from low risk population, so that high risk pays a higher premium and low risk pays a lower premium.  The purpose of having a risk pool that is the entire 300 Million people that are the population of the United States is to allow those who have small risk because they have small resources to pay insurance rates for the risk of what they own and spread that risk out over the entire 300,000,000 people that are population of the United States.  What has happened in the United States is that special interests have divided up the risk pool and forced legislation requiring insurance so that those with the least subsidize the risk of those who have the most.  This situation must be brought to an end, so that those who have greater assets and therefore greater risk pay their own costs for that risk, rather than forcing those with the least to subsidize the risk of their greater possessions.

Insurance is required by law and therefore the risk pool should be regulated by law to include all of the people of the United States, so that all of the people can share in the benefit of a broad base that guarantees low rates for everyone that is inclusive of the entire 300 Million people of the United States, rather than being exclusive for those who have greater advantage and resources.

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By RAE, June 22, 2009 at 2:00 pm Link to this comment

First, thanks Smooze for your cogent & civilized explanation and amplification.

Let’s take it one at a time:

“The gov’t is obligated to protect the life of its citizens against force.”

  Except “forces” of nature, I guess. Or except force of it’s own making. Or except the forces that exist (thrive) in the financial world where life savings are confiscated and/or swindled from citizens BY THE MILLIONS with no effective government “protection” that I can see. I guess maybe the government is not living up to its obligations?

“However, the maintenance of ones “health” is at the sole discretion of the individual. Thus, I maintain health care is a personal choice and not a right.”

    Why cannot “health care” be both? But I think our interpretations of “health care” are passing in the night. When I use “health care” I mean the SERVICES AVAILABLE - what one either does him/herself or asks others to do regarding his/her health (taking an aspirin, going to a doctor or hospital or dentist). It seems to me when you use “health care” you mean CARE OF ONE’S HEALTH - regardless of what services are available, it’s the individual’s choice whether or not to use them.

    As I said in an earlier piece, I too believe that whether or not you choose to look after yourself is a RIGHT and YOUR PERSONAL CHOICE. However, if you choose NOT to care for your own health and become ill or injured through deliberate neglect, I still maintain a HUMAN BEING HAS THE RIGHT TO BASIC TREATMENT (CARE FOR HEALTH). I mean, what’s the alternative? Just let him/her SUFFER or DIE?

There might be 1% or 2% of ALL THE PEOPLE who are stupid enough and selfish enough to deliberately do themselves harm and demand from any health care system an inordinate amount of resources. So because this might occur you’re willing to deny the other 98% the comfort of knowing there’s help out there no matter the condition of their wallet?

But that is the American way, isn’t it. Because there MIGHT be a terrorist or two out there that MIGHT do some harm in the USA, it’s quite OK to CONFISCATE THE FREEDOM OF EVERYONE ELSE IN THE COUNTRY.

I simply don’t agree. Gotta go.

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By Smoove, June 22, 2009 at 1:25 pm Link to this comment
(Unregistered commenter)

kdelphi,
I’m happy to report the “Social Darwinism” you speak of already took place. It took place in our Paleolithic past where we evolved as egalitarian hunter-gathers. The problem lies in the fact that the environment where the bulk of human behavior evolved bares little resemblance to today’s modern world. As such, humans tend to be xenophobic, have a natural tendency to resent wealthy people, distrust free markets, and misunderstand the bottom-up process of modern economies and try to control them from the top down, usually with disastrous consequences (e.g., bubble creation and consequent bursting through the Fed’s constant manipulation of interest rates).

I understand how supporting these programs might satisfy your moral intuitions, but the reality is that these programs routinely fail and/or never come close to meeting expectations. Moreover their failure can create far worse costs on society.

I believe liberty provides the best solution to most social problems. I think we just need to learn how to appreciate it is all.

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By Smoove, June 22, 2009 at 12:30 pm Link to this comment
(Unregistered commenter)

RAE,
“If you don’t think that’s what governments are for, explain what they are supposed to do.”

Fair enough. I would contend that the (proper) role of government is to protect individual rights, i.e to defend its citizens against force and fraud. The constitution guarantees US Citizens equal rights, but not equal outcomes. The gov’t is obligated to protect the life of its citizens against force. However, the maintenance of ones “health” is at the sole discretion of the individual. Thus, I maintain health care is a personal choice and not a right. 


“That makes it a defacto “insurance scheme” - if you need it, it’s there. If you don’t need it, it’s there for someone who does.’

I get it. I really do. Heck, I like the idea of pooling risk too. However, one of the serious flaws about gov’t run health care is that it pools risk without making an important distinction: Those who suffer because of bad luck versus those who suffer because of laziness or lack of ambition. Therein lies my biggest beef with gov’t sponsored (wealth) redistribution programs. When the gov’t confiscates wealth and gives it to others we don’t know, humans tend to get resentful. I understand you want to create a better society, but without making that distinction I feel we are doomed to create more class warfare, not less. I live close to the US-Mexico border and I see that when you don’t make that distinction and people think others are “gaming the system”, the resentment and hate that it breeds is truly sickening.

Health care needs massive reform. I just have serious reservations that handing the reigns over to the feds is going to make things better.

http://headlines.ocregister.com/articles/care-21940-health-veterans.html

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By KDelphi, June 22, 2009 at 11:19 am Link to this comment

RAE—the problem that people like Smooze have is that they dont believe that anything is a human right. You are just born into the world and, whatever happens to you is your own merit/fault.

Anyone who paid attention in Sociology 101 knows that that is simple horse crap, but, that dosent stop them from screaming about the “costs to them” of others’ survival.

Social Darwinism.

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By RAE, June 22, 2009 at 11:08 am Link to this comment

“Again, as a society I feel that we would be much better served if we would work towards affordable health care not affordable health insurance (more affordable health care = more people will have access to health care). Insurance should be used as protection from catastrophic events not to subsidize normal/routine health care.”

Good going, Smoove - you may have read my posting but you managed to miss the entire point:

The point is NOT that “MORE people will have access to health care” but that ALL PEOPLE ARE ENTITLED TO BASIC HEALTH CARE regardless of race, religion, age, financial situation, employment or any other status. And ALL PEOPLE should contribute equitably to the fund through their taxes. That makes it a defacto “insurance scheme” - if you need it, it’s there. If you don’t need it, it’s there for someone who does. There’s no need of a separate insurance scheme except for those who want coverage for cosmetic, elective or luxury procedures/accommodation.

And you didn’t answer my question: “That’s what governments are for… to look after UNIVERSAL needs, infrastructure, services. If you don’t think that’s what governments are for, explain what they are supposed to do.”


I guess you have trouble understanding that there are some things you can’t tack a price tag on and charge for. Perhaps that’s an UN-American concept? Maybe you believe that if you don’t have to hand over cash for it, it isn’t worth anything?

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By KDelphi, June 22, 2009 at 10:47 am Link to this comment

The reason Medicare costs have gone up so much is the privitization of it, by Medicare “Advantage” and “Part D”. Even Medicaid is “managed” by private HMOs now, that build luxury suites down town and collect 6 digit salaries.

Since Medicaid switched to “HMOs” the cost have gone up almost 41%—50% of cost is profit.

http://www.pnhp.org/search.php?cx=015249405663905105964:ebn8t4lcngk&cof=FORID:11&ie=UTF-8&q=Medicaid+HMOs&sa=Search#958

http://www.ihatoday.org/issues/payment/medicaid/chictrib6-9.pdf

http://www.aliciapatterson.org/APF1804/Schulte/Schulte.html

The “level of care” is abominable.

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By Smoove, June 22, 2009 at 10:34 am Link to this comment
(Unregistered commenter)

No doubt our health care system needs reform, but let’s be careful what we wish for.

“U.S.-run health care? Ask a veteran”

http://headlines.ocregister.com/articles/care-21940-health-veterans.html

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By Smoove, June 22, 2009 at 10:13 am Link to this comment
(Unregistered commenter)

RAE,
After reading your reply, I think I can safely assume you don’t spend much on health care. Because anyone who can jump to so many conclusions without tiring must be in peak physical form. Impressive, good sir!

Again, as a society I feel that we would be much better served if we would work towards affordable health care not affordable health insurance (more affordable health care = more people will have access to health care). Insurance should be used as protection from catastrophic events not to subsidize normal/routine health care.

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By tommy, June 22, 2009 at 9:11 am Link to this comment
(Unregistered commenter)

“effective”? The only things medicare has been effective at are 1. violating the constitution, 2. buying votes, and 3. killing an economy….

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By wildflower, June 22, 2009 at 8:46 am Link to this comment

Guess Fonkalsrud and Intrilligator haven’t figured out that many of our so called “leaders” in Washington aren’t interested in actually assuring American citizens have access to affordable health care services.  The fact that a large segment of the American public is suffering is irrelevant from their perspective.

The grotesque reality about these “leaders” is that they simply lack human values, especially when it comes to the American public. As long as the medical insurance industry is reaping big profits and is happy with limited accessibility, exploding costs, and uneven quality, they’re happy. What more is there to say?

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By AWM, June 22, 2009 at 7:44 am Link to this comment

One benefit of non profit health care is that in order to control costs Administrators have realized that preventative medicine is in fact cost effective and have started to make investments in preventing disease

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By MarthaA, June 22, 2009 at 7:28 am Link to this comment

RAE,

I agree.  There’s a place for insurance, insurance can carry sports players, and optional cosmetic and elective surgeries, but for the average citizen of the United States, which is the 70% MAJORITY Common Population, 210 Million people, medical and dental should be FREE, like France, England, Canada, Cuba and 58 other countries, and medical should be free for the other 90 Million, as well. Medical and dental for all should be able to be FREE for ALL by just cutting out the parasitic insurance companies that have been making 428% profit for nothing:  http://www.dailykos.com/storyonly/2009/6/21/745219/-Why-no-public-O-P-T-I-O-N-428-profit-increase

Where there is a will, there is a way.  There are just as many ways that can be found to do something beneficial for the country as there are defeatist ways not to, it is time the nation starts choosing what is of benefit to the country as a whole, instead of only for a few people who aren’t really even loyal to the nation or the flag, but would just as soon take their money and live in China, like Rupert Murdoch, the right-wing media mogul.

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By RAE, June 22, 2009 at 5:29 am Link to this comment

“Consumers need to start paying full cost for normal/routine health care.”

Dear Smoove:

#1: I am NOT A CONSUMER. I am a CITIZEN.

#2: The last I checked approximately 10% of the employable are UNEMPLOYED. That means NO MONEY. I suppose you would just deny anyone health care who hasn’t the price of admission - just let ‘em die!

#3: In a country with the resources (real or imagined) that exist in the USA, YOU DON’T NEED ANY INSURANCE COMPANIES to cover BASIC services. BASIC HEALTH CARE COSTS, INCLUDING DENTAL and EYE CARE, SHOULD BE FREE (or at least capped at a nominal amount affordable even by pensioners & welfare recipients) AND PAID FOR BY PUBLIC MONEY - TAXES. Isn’t that what taxes are for? Or do you think the priority should be for all your tax money be blown on making war or bailing out billionaires rather than ensuring that your CITIZENS are as healthy as possible?

I fully agree that the individual should be on the hook for OPTIONAL or ELECTIVE services. You want bigger breasts or penis? Go for it… you pay every penny. Want your tatoo removed - you pay. Nose job? Face lift? Hair implants? Designer eyeware? Same. Etc.

Self-inflicted injuries are in the same category. JOCKS pay their own freight. Those who CHOOSE to engage in a sporting or exercise activity that’s LIKELY to cause themselves or others injury pay their own medical bills that relate to those injuries.

Those amongst the unlucky who are injured or fall ill through circumstances NOT UNDER THEIR OWN CONTROL shouldn’t be further penalized/injured by being forced into bankruptcy and poverty. 

I’m talking BASIC services - the minimum necessary to gain or maintain physical or mental health. It should be a fundamental ENTITLEMENT of all citizens. EVERYONE requires health care just like everyone needs clean air and water. That’s what governments are for… to look after UNIVERSAL needs, infrastructure, services. If you don’t think that’s what governments are for, explain what they are supposed to do.

And… YOU be the one on the ambulance crew or in hospital emergency to ask for the CREDIT CARD before attending to their ailment. YOU tell them - sorry, no money, no service. Die you sucker.

If that’s the kind of society - the “American Way” - you want to live in, you can have it - you deserve it. I don’t want to know you.

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By Smoove, June 21, 2009 at 10:55 pm Link to this comment
(Unregistered commenter)

America needs affordable health care, not affordable health insurance.

Insurance should be used as protection from outlier events. Consumers need to start paying full cost for normal/routine health care. What congress should do is end the tax exemptions for premiums paid to health insurance companies effectively decoupling health insurance from employment. This would create price competition between health care providers as consumers would be much more inclined to price shop.

End all the corporate welfare to drug companies too.

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By bcc, June 21, 2009 at 8:47 pm Link to this comment
(Unregistered commenter)

My kudos to the authors of this article. I wish you could replace that sh*thead Baucus and our gutless president. It is a wonderful dream but this proposal is too brillant and too reasonable and too centered on solving the health care crisis for our “representative” government to pass. Since our politicians represent smart lobbyists and the easily manipulated public, solving the health care problem is not the goal. I would feel great about paying taxes if serious solutions and intelligent policies such as these were the norm. Instead one is just left sickened by the reality that your money just pours into completely corrupt wars, bailouts, and profiteering. 

Democrats are the new Republicans. Need to find a new party for the next round!

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By Ed Harges, June 21, 2009 at 6:07 pm Link to this comment

This looks like a very smart idea. It’s the only way to avoid the structural headaches of the other options.

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By Outraged, June 21, 2009 at 5:41 pm Link to this comment

RE: RAE

Your comment: “So what do we do with those who DELIBERATELY ignore this responsibility in some way? Same as we do with those who ignore the law. First offence, a warning. Second offence, you get the bill. Third offence and you’re “made an offer you cannot refuse” - I’ll leave it up to your imagination what this might be.”

This is NOT why costs are so high.  This mentality only qualifies the nanny-state mentality of abusers.  They love mantra like this, then they simply INVENT reasons that illness is the victims fault, in much the same way that the current Republicans (who protect business interests) claim that poverty is the fault of the impoverished.  It isn’t.

Re: G.Anderson

Something I came across that exposes your HMO theory of supposed cost savings in HMOs.

From Daily Kos:
The insurance companies have produced a 428% profit margin off the backs of American tax payers and people who have managed health care.

NMDan’s diary :: ::
So if your a company selling healthcare, you can produce a 428% increase in profits, you dam sure don’t want a cheaper government OPTION (not mandate) ruining your scheme.  It is no different than Bernie Madoff’s scheme to screw people out of money while they screw people out of health care and constantly raise the cost of people’s insurance.

If I were to use the whole right wing logic in regards to their views on abortion than one could conclude that Health Insurance companies are proponents of letting innocent people die everyday by denying them access to affordable healthcare!!!

They are no different than a serial killer who’s twisted and derranged view of the world ruthlessly kills innocent people.

The Republican’s will cry “higher taxes” but isn’t the exact same when insurance companies selectively game the system and tax your paycheck at a much higher rate than inflation?  Isn’t it a back door tax?

I can attest as a neuromotor-therapist working in an outpatient clinic, insurance companies are continuing to cut back therapies, length of stays in rehabilitation, the reimbursment rates, durable medical equipment (they want you to buy toilet seats at Walmart), etc.  While they continue to make more and more profit.”
http://www.dailykos.com/storyonly/2009/6/21/745219/-Why-no-public-O-P-T-I-O-N-428-profit-increase

The link to the information regarding the 428% profit increases is here, or click on the hypertext “428% profit margin”.

http://blog.aflcio.org/2009/05/27/health-insurance-profits-soar-as-industry-mergers-create-near-monopoly/

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By MarthaA, June 21, 2009 at 4:30 pm Link to this comment

RAE,

The 1% that play the system do not get off with 1% of the money corporate welfare plays the system to get.  We need to quit looking with a microscope at what some of the people are getting and start looking with a microscope at all the money corporations are getting, because since corporations have made themselves people, they should get no more than the people.

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By RAE, June 21, 2009 at 4:05 pm Link to this comment

You’d think the USA, with the reputation of “shoot first, ask questions afterward” could extend this philosophy a tiny bit to “treat first, settle the bill later.”

There are RIGHTS and with them come RESPONSIBILITIES. I believe prompt and adequate health care is a universal RIGHT. It is unthinkable in a civilized nation that anyone ill or damaged be denied treatment by a hospital or clinic at any time for any reason.

That said, every citizen must accept the RESPONSIBILITY to conduct himself or herself in such a manner as to MINIMIZE the risk to their health and well being at all times.

So what do we do with those who DELIBERATELY ignore this responsibility in some way? Same as we do with those who ignore the law. First offence, a warning. Second offence, you get the bill. Third offence and you’re “made an offer you cannot refuse” - I’ll leave it up to your imagination what this might be.

And let’s face it… 99% will do their best to live up to their responsibilities. And that 99% will just have to live with the fact that 1% are incorrigible freeloaders. If the government can find TRILLIONS to put bandaids on greedy corporations, they can find the few bucks to look after the basic health needs of that 1%.

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By ardee, June 21, 2009 at 3:29 pm Link to this comment

felicity

From one oldie to another:

http://www.cbo.gov/doc.cfm?index=4794&type=0

Medicare has been “going broke for over a decade, yet it is still only a scant 3-4% of GDP.

http://www.watsonwyatt.com/us/pubs/insider/showarticle.asp?ArticleID=19169

Certainly ,funding is an issue, if only in part becuase of the resistance to making it viable because of pressure from the insurance industry and the for profit health care folks.

Expanding Medicare to include everyone increases revenues collected, corresponding cuts to the waste of money found in private for profit facilties saves money…...Streamlining and slashing the numerous restrictions on Medicare ( I.E. competitive bidding on prescriptions) will help as well.

Doom and gloom need not apply.

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By MarthaA, June 21, 2009 at 2:43 pm Link to this comment

It appears more and more the United States is engaging in class warfare and becoming an “us” and “them” society; there was NO bickering at all about how to FUND the TWO TRILLION DOLLARS of taxpayer money doled out to capitalize the capitalists, the “us” of the nation; but it’s a whole different situation for “them”, the 70% MAJORITY COMMON POPULATION, having public health care for “them” has to be considered carefully as to how it can be FUNDED with as little money as possible.  As a nation the “us” of the United States, can hardly see a way to afford public single payer health care for “them”, as the amount of money it will take to FUND public health care is just too exorbitant, but TWO TRILLION DOLLARS to recapitalize greedy corrupt “us” capitalist bankers, NO PROBLEM with how to FUND that—after all that’s “us”, let’s get on with the FUNDING of the greedy bankers ASAP, but for “them”, it’s wasting money, it just can’t be figured out; there’s something wrong with this picture, wouldn’t you say?  It is “them”, the MAJORITY Common Population, that will foot the bill for the greedy, corrupt, corporate, bankers, not the “us” capitalists; so since the MAJORITY COMMON POPULATION have footed the bill for the greedy, corrupt, corporate, bankers to save their capital; public health care for all of “them” can be done the exact same way, that way at least the “them” people will have health care for all to show for why they can no longer afford anything for “them”, instead of nothing, if single payer health care for all isn’t legislated.

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By bcc, June 21, 2009 at 12:50 pm Link to this comment
(Unregistered commenter)

“This supposed reform will be ... manna from heaven to those now sitting around the health care reform tables” -Virgina

Agreed, I have got to believe that the insurance lobbyists have their eye on using the forced coverage mandate to tap into a lucrative market of uninsured healthy young people. If they can manipulate the public option into a dumping ground for sick people and rig it so they get the cream of the uninsured crop they will score big time.

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By felicity, June 21, 2009 at 12:30 pm Link to this comment

Very interesting.  Expand a program, Medicare, that’s going broke as I write.  What a marvelous idea.

I have Medicare (because I’m old) and I have to have a supplemental plan, why, I have no idea and Medicare money is deducted monthly from my SS check, and I have to have supplemental insurance to cover meds under Medicare Part D.

We’re talking $400/month. I’d be more than willing to pay out that four-hundred if everyone of us had access to health-care.  As it is, it only covers me.

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By KDelphi, June 21, 2009 at 9:03 am Link to this comment

Big B is right.

As long as life or death is a commodity, the USAns will die younger and live less well.

There is no sense of community or concern, as evidenced by the fact that the biggest question is usually, “what will it do for the middle class”.

Its as though “lower classes” simply do not exist im the mainstream eye.

I mentioned all the ag subsidy, etc, urban planiing, etc that need to be done. But, that doestn take away from the fact that USAns PAY the most and GET the least. It is a direct result of all the money in politics. Survey after survey shows what most peopel want—they just do ot have the power. Which is money.

Addressing social concerns matters little to a woman who is afraid to take her sick child to the dr for antibiotics because of the cost or the elderly who just decide to lay down and die rather than get dialysis. The fact that many of these people end up in the ER is presented to the media, like everything else in US society, in terms of its effect on the middle classes and up, not in terms of WHY they end up there in the first place.

Let us FIRST get these people covered—ALL of them

I wonder if Obama has considered the fall-out there will be if he passes a bi-partisan lame plan. Hey, what happened to “everyone have the same plan as Congress”?? I KNEW that that was crap…

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By Virginia from Virginia, June 21, 2009 at 8:49 am Link to this comment

Several issues:    Explain how forcing American business to continue to pay for the health care of its workers will then make American products more competitive internationally.  Forcing all us Americans to join a health care plan, makes it likely that future costs under such mandates will likely cost more than they do now.  (I’m assuming future hoped-for cost savings such as electronic health records will be the same – no matter what system will be put into place.)

Employers should NOT be involved in selecting or running health care for their workers.  It’s a CRAZY system we have.  Employers prefer to select inexpensive plans (and why wouldn’t they?) and employees want the very best health plan – likely to be expensive.  Get American business OUT of the health care system.

The cost effective health plan is a SINGLE-PAYER NON-PROFIT system.  Taking profit out of keeping us healthy is a self-evident advantage.  It’s a self-evident MORAL advantage, too.  And having health care workers handle all that paperwork from the myriad health care plans is a waste of precious talent and time.  Wasting talent and time is a cost.

It seems to me that keeping the SINGLE-PAYER NON-PROFIT health plan off the table will be NO REFORM at all.  What it will produce is more money (from businesses, the insured, and our taxes) to Big Health.  This supposed reform will be a cash cow, golden goose, manna from heaven to those now sitting around the health care reform tables and a disaster economically for our country.  It will be WORSE than what we have now!

These health care “planners” say they can’t put SINGLE-PAYER NON-PROFIT health plans into effect right now as it is too different from our current system.  (Recall please, that our current system is broken and needs fixing and needs top be different.)  Explain how putting all these money grabbing health schemes into effect will make it easier in the future to change into the plan that most Americans strongly prefer: a SINGLE-PAYER NON-PROFIT health plan.

.

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By Big B, June 21, 2009 at 7:52 am Link to this comment

I have said it before, and it becomes all too true as time rolls along, Americans do not share the same sense of community and collective national responsibility as do the Europeans, canadians, and japanese. As long as we allow health care to be a commodity instead of an essential part of the public good, we will continue to be the weak link in the world community.

Of all the problems facing america right now, the health care crisis will drag us down faster than any other. And we are, in the typical American fashion, unable to change (maybe somebody ought to fly a 747 into the AIG building, do you suppose americans would change then? it seems to be the only thing we are capable of comprehending)

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By hark, June 21, 2009 at 7:36 am Link to this comment
(Unregistered commenter)

This is all fine, but it’s pie in the sky, not going to happen, no way, not ever, in this country.

Our representative government does not serve the people.  It serves the special, moneyed interests.  We haven’t, as a nation, absorbed that truth.  Until we do, real problems like health care, unending wars, energy and climate change, runaway military spending and imperialism, will never be solved because it doesn’t serve the top 1% to solve them.  They either don’t care about us peons or they make too much money off us to change.

More people protested against the situation in Iran over the last week than dysfunctional health care in the USA, which is destroying the middle class.  The American people are clueless.

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By G.Anderson, June 21, 2009 at 7:19 am Link to this comment

No not true, without a public option health care won’t work, because the HMO’s are greedy and heartless, and because the practise of medicine in the USA no longer exists. I just don’t want that public option to be like medicare, because yes, it’s become another way to feed the greedy corporations.

70% of all disease in this country is, degenerative disease, allopathic medicine has little to offer in this regard. To continue the current system of medicare, and it’s devotion to allopathic medicine, would not be productive.

Were talking about doing something about the health of people in this country, but instead we’re too focused on arguing about systems, not how we’re going to improve the health of people.

There should also be some concerns about the failure of our health care providers to improve the health of people.

We spend so much money, so why don’t people get well?

For example, weight loss surgery, some people need it, and it’s highly profitable, $40,000 in profit for each one. Hospitals love it, cause it makes them lots of money. In fact some have added wings onto their facilities, so they can do more.

Is this medicine? What about, high fructose corn syrup, and Bisphenol induced hormonal changes that keep people from losing weight, and stores full of sugar, carbohydrate saturated food, and sweet soft drinks?

70% of all disease in this country is caused by degenerative disease, there’s lots of money to be made in sick people, but not much money getting them well.

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By Lester Shepherd, June 21, 2009 at 7:06 am Link to this comment
(Unregistered commenter)

G Anderson:  You are the problem in our society.  You believe what you are told.

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By ardee, June 21, 2009 at 6:46 am Link to this comment

G.Anderson, June 21 at 12:48 am #

That’s why HMO’s were created ardee, the bill payer had to manage care because the provider has no vested interest to do it, the more they bill the more they make. You made my point for me.
.......................................
HMO’s were created because enormous profits could be realized. They make those profits by denial of admission to high risk people and by denial of service to their own patients. You fail to discuss real issues, Mr. Anderson , and I cannot help but wonder why?
........................................

Yes medicare has a three percent overhead, however they don’t have to make a profit, because their subsidized the tax payer, if this weren’t a problem then why, so much talk of limiting Medicare payments, including the big news of cutting prescription costs….It’s because it’s costing the tax payer a fortune.
........................................

The talk of limiting Medicare comes from those politicians subsidized by your health care industry, that’s why. Prescription costs are easily brought down through the medium of competitive bidding, a process denied to Medicare by your , oh so honest, health care industry through its control of our Legislators.

You seemingly care so much for the tax payer yet you support a system that is robbing them and killing them, why is this? Sixty percent of all bankruptcies are health care related and none of that is blamed upon Medicare.

Foreclosures, death and great hardships are the legacy of our current system and all the myths you care to display about the way out of this morass, all the right wing lies about Medicare as well do not mask this problem. I think you a Reagan disciple, one who has swallowed the pill of any govt intervention being a bad thing. It is a matter of saving our govt fromt hose who now run it , the ones who have propagandized you so well.

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By Purple Girl, June 21, 2009 at 3:21 am Link to this comment

Accessing BOTH sides of the Free Market Table IS our Constitutional Right!
Limiting the American people to mere labor and consumer is NOT adhering to the American Way.
Our Constitution, which designates our Gov’t as ‘We the People’s Proxy/representative has every right to act as an agent for US in the market places as Providers/producers/suppliers/sellers.
A Public Option, where WE the People are the investors is our Right. To limit US to only one side (or as merely supportive elements)of the market Table is Innately UnAmerican.
Beyond that we are also granted the Inalienable Right to “Life, Liberty and the Pursuit of Happiness” - and without your health, you haveno ability to pursue or exercise these Birthright, Your civil Rights have been negated if not outright Usurped.
These Corps and their Pocket Politicians have been committing violating our Constitutional and civil rights for decades.A Free market was envisioned and decreed specifically to allow ‘We the People’ To be Merchants, not just customers (or their labor), and we were guaranteed the basic human rights to fullfil our potentials- and health is Number one.

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By Outraged, June 21, 2009 at 12:25 am Link to this comment

Article: “The Medicare program has established an effective track record during the past 43 years, covering almost 20 percent of the population, primarily the elderly and the disabled, who use medical resources much more than any other age group.”

If we deduct this 20 percent from one hundred percent covered, then deduct the percent who receive healthcare in the form of veterans benefits, then deduct the percent now covered through medicaid (which is at least somewhat subsidized by federal dollars, right…?) So… what percent is there left to cover…?

Additionally, are the dollar SAVINGS from the abolishment of these programs entered into the overall cost figures?  These dollars (should be mandated) to automatically be tranferred into the single-payer plan so that they aren’t “confiscated” by other interests.

The plan should include dental. We’re the richest country in the world for god’s sake, let’s not be front tooth toothless or have some patch-up job on America’s smile.

Americans overwhelmingly support single-payer.

NYT: “The national telephone survey, which was conducted from June 12 to 16, found that 72 percent of those questioned supported a government-administered insurance plan — something like Medicare for those under 65 — that would compete for customers with private insurers. Twenty percent said they were opposed.”
http://www.nytimes.com/2009/06/21/health/policy/21poll.html?bl&ex=1245729600&en=d44716a77315c19c&ei=5087

Think about it, even if you like your plan, you could have all basic healthcare at a cost savings you, if you want something in particular you’d pay for that portion only.  And you would NEVER be denied healthcare for pre-existing or semi-acute conditions.

CBS: “Americans generally see government involvement in health care in a positive light, and most support it. Fifty percent think the government would be better than insurance companies at providing medical coverage (up from 30 percent in 2007), and 59 percent think the government would be at better holding down costs (up from 47 percent in 2007).

More generally, 64 percent of Americans say the government should guarantee health insurance for all Americans. Just 30 percent think this is not its responsibility. Those percentages have been stable for many years.

When presented with the option of a government-administered health insurance plan similar to Medicare to compete with private health insurance companies, 72 percent are in favor and just 20 percent oppose. Even 50 percent of Republicans favor that option.”
http://www.cbsnews.com/stories/2009/06/19/opinion/polls/main5098517.shtml

Lots of “regular joe/jane” Republicans ALREADY receive some type of government healthcare and they like it.  Many others will endorse the overall cost savings.  We may disagree on many issues, but they can add and subtract as well as anyone.  I’ve NEVER met a Republican who HAS government sponsored healthcare, who thought it sucked, NEVER!

The only issue I have heard is that veterans many times need to travel quite far to attain their care, due to the lack of veterans clinics or hospitals in their area.  Single payer would UNEQUIVOCALLY end that, they could go anywhere.  This too would be a cost savings, as after a certain distance they are reimbursed for their travel costs.

Think what that alone would mean to a disabled or elderly veteran, even IF they are already covered by a government program.  My brother travels 75 miles one-way, to the veterans hospital for care.

Call and write your reps in congress and The President, be heard.

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By KDelphi, June 21, 2009 at 12:14 am Link to this comment

Can G. please explain to me what is so (un) “special” about the uS, that we cannot do what every civilized country in the world does.

No one ever answers that question, because they know it is just greed and, they havent experienced the consequences of family bankruptcy over an illlnes or catastrophic accident—or several.

There is no answer, except greed. Drs in countries that have single payer do just fine—they may not have yachts and two mansions—but, who wants a dr that went into it just for the money? It was an odd question, I saw on HuffPo—I believe, that, asked, “Would you want a dr who would do your surgery for just $14,000??”” Hell yes!! Then, I would know he was doing it for the right reasons! I had a surgeon who did a surgery for not much more, and, it is a reason I have a left leg. I will be forever grateful. He works at Cleveland Clinic. They work on salary, so money was not a problem. But, he practices the art of medicine—-not for profit.

They recieve salary at Mayo Clinic also, and, there is no reason that the US couldnt go to salary, vs fee for service. They also took Medicaid, before they decided to not allow people to cross state lines with Medicaid…

BTW—Medicare costs so much because it has been privitized, with Medicare Advantage (some advantage—for insurance corps!!) and Part D, which forces taxpeyer to pay more than any other plan or country for Rx drugs.

37% of medical care paid for in this country goes to useless insurance bureaucrats. When people mean more than money in this country, we will go to single payer and not before.

The insurance industry exists for profit only—and everyone knows it and admits it but the US…how stupid.

Save 37% by 2014—enact single payer—or enact a plan that leaves out 30 million and costs $1.5 trillion. Or do nothing and let people die in the streets. 20,000+ every year.

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By G.Anderson, June 20, 2009 at 9:48 pm Link to this comment

That’s why HMO’s were created ardee, the bill payer had to manage care because the provider has no vested interest to do it, the more they bill the more they make. You made my point for me.

Yes medicare has a three percent overhead, however they don’t have to make a profit, because their subsidized the tax payer, if this weren’t a problem then why, so much talk of limiting Medicare payments, including the big news of cutting prescription costs….It’s because it’s costing the tax payer a fortune.

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By tp, June 20, 2009 at 9:21 pm Link to this comment
(Unregistered commenter)

the discussion seems to be closed to me. So, fuck it. I’m way too moderated.
good article. good dream. bad country
tp—over and out

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By ardee, June 20, 2009 at 8:33 pm Link to this comment

G.Anderson, June 20 at 7:27 pm

The difference between Medicare and a private system, is easy to see, Medicare doesn’t do that great a job managing costs, where as private insurance takes cost managment to the extreme.

Medicare operates at a three percent overhead.No other current health care option can manage this feat.

I see too many cases in which people on medicare are kept doped up forever on some sort of pill, and kept in a so called retirement home until they drop dead staring into space to belive it’s the answer.

Ive no doubt that this occurs but it is not the fault of the bill payer but the care provider. Blaming medicare for this is unrealistic.

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By KDelphi, June 20, 2009 at 6:57 pm Link to this comment

Making profits from illness and death is immoral.

Every other country in the civilized world manages to do it, and, I have been treated in 4 of them. It works.

Its about money. And thats it. That is the biggest difference.

But, not to worry, if you like it the way it is. The do-nothing Dems will probably fall on their ass again.

But , if not, we get the “best of both worlds”—the Kennedy/Baucus plan, which will cost over $1 trillion, and, you guys asked for it by not demanding single payer, which could be alot cheaper over time.

Thats the problem with the uS—no one cares until it directly effects them. So we end up with the worst of both worlds—socialism for the rich, “capitalism” for the poor…you can just feel it in other countries…

USAns just do not care about each other, have no sense of community and, the only reason I can think of, is that the country was built on murder…

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By G.Anderson, June 20, 2009 at 4:27 pm Link to this comment

Unfortunately, I would have to disagree with this article. Sadly, there is no panacea for this, just as we badly need a public option to compete with private insurers, we also need a private option to compete with a public one.

For too many, health care providers medicare is either a gravy train, or a system of frustration, in which that can’t get paid.

The difference between Medicare and a private system, is easy to see, Medicare doesn’t do that great a job managing costs, where as private insurance takes cost managment to the extreme.

I see too many cases in which people on medicare are kept doped up forever on some sort of pill, and kept in a so called retirement home until they drop dead staring into space to belive it’s the answer. On the other side of the issue, I’ve also seen too many people damaged by the cattle drive that is managed care.

We need the best of both systems. Otherwise this country will soon go broke.

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By KDelphi, June 20, 2009 at 3:49 pm Link to this comment

MeHere—I would agree , but I have been working on a health care system like the one described (or close to it) for many years. The Kennedy “plan” is monstrous and the Baucus “plan” is worse. I think we’ve had “solutions” on the table for many years.

The real solutions will be ignored as long as profit is the primary motivation.

Just “a health care plan” at all would be a huge improvement—-what we have now is a death for profit “system”. Medicare for All is the only system being proposed (and ignored) that would make any real difference. The time for talk is over—-for 20,000 this year.

But, I think the US would rather focus on “US uniqueness”. That is just plain silly and is a tool for those who wish to keep making money at the peoples’ expense.

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By MeHere, June 20, 2009 at 3:39 pm Link to this comment

The effort and thorough thinking behind this article is very much appreciated. Regardless of which decent health care plan we could have, the fact that there are people working on this issue in order to bring ideas for a compassionate, inclusive system, is very meaningful.  We need as many inspired and inspiring people as we can get.

I agree with KDelphi that, in order to make sensible and workable changes at this point, we need to have more than just a good health care plan in place. However, if more people could get behind one good thing, it would give us a bit of hope…. maybe?

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By Warren Metzler, June 20, 2009 at 2:10 pm Link to this comment
(Unregistered commenter)

The authors are crazy. Medicare is a ridiculous program. Not liked by any doctor who wants to do a thorough job, who doesn’t want to have two full time people to process all his insurance forms, who wants to be reimbursed reasonably for the time it takes to practice effective medicine. Not liked by any patient who wants effective care for her conditions. Only liked by patients who have no need to receive care other than therapies that are totally status quo, and continue to suffer.

My favorite image of medicare is being in medical school, spending an elective in my senior year in England, visiting the office of a typical GP; who sat behind his desk, prescription pad in hand, giving each person about three minutes of expression before he would write a prescription.

There is no socialized government program in the world that offers quality work experiences for its doctors and quality treatment experience for its patients.

The main problem of health care in this country is the use of rarely successful purely mechanical theories to determine what treatments are offered. The problem is not at all a lack of health insurance for people.

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By tp, June 20, 2009 at 1:55 pm Link to this comment
(Unregistered commenter)

It is nice to know that a little thought has been put in on this article. But it’s a dream to think it will make one iota of difference in this greedy country.
Billions are to be made in the medical professions and drug companies from this captivated brain washed population. As Obama’s idol, “Ronald Regan”, once said, “I’d never take away that dream that one dreams of wanting to becoming extremely rich”—even at the expense of dieing and/or afflicted people it seems.

We need health care reform we are getting wealth care reform via the same shysters who deregulated the banksters mafioso. There was no debate on that massive give away??? Why so much debate on health care reform which by the way don’t even mention ideas which are prominent in this article. The AMA and Big Pharmaceutic will win. It’s just understood.

We, the people, do all the work, take all the risk and get none of the rewards—typically, that means we don’t even get medical care.
Shame shame shame.

Are you patriots proud? Is it Bush pride? Obama pride? or just plain stupidity?
tp

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By KDelphi, June 20, 2009 at 1:47 pm Link to this comment

This makes far too much sense to be enacted by the US Govt….

There would have to be standardized definitions, possibly those already used by Medicaid, etc., as to who is “most needy”, which problems are “self-afflicted”, etc. This should also lead to a discussion about govt subsidies for products that serve no useful purpose and threaten life, how neighborhoods, both urban and suburban, are set up (with little or no way to walk or use public transit, how urban neighborhoods are filled with liquor stores and high-priced little groceries without produce, etc).

There is only one reason that this cannot happen—-money.

All that being said, to avoid Third World status, the US must take the profit motive out of life or death issues, whether it is war or heatlh care. Making money from others’ misery is immoral, society-defeating and leads to Capitalist Dictatorship.

Profressionals, like those who wrote this article, can lead the way to a more happy, self-sustaining society, if we will allow it.

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