So does anyone infant mortality rates, life expectancy, etc. for Arkansas?

You shall not crucify mankind upon a cross of Blue.

Brilliant!

In NC Ed Cone wants to know who Kate Hagan works for, (slightly off topic)

are insurance company profits actually driven by the kind of competition that results in better products for less cost — or is the competition to most effectively deny care and select for healthy customers?

a public plan could be used as a dumping ground for the sick, allowing the private insurance companies to limit costs (ie paying the healthcare bills of their customers) and make more money.

careful, effective regulation might be able to avoid the worst effects of adverse selection. but i’m looking at our current record of regulation — of the rating agencies, mortgage fraud, commodities speculation, etc, etc — and i’m not willing to count on effective and appropriate regulation.

It is rather for us to be here dedicated to the great task remaining before us — that from these honored dead we take increased devotion to that cause for which they gave the last full measure of devotion — that we here highly resolve that these dead shall not have died in vain — that this nation, under God, shall have a new birth of freedom — and that government of the people, by the people, for the people, shall not perish from the earth.

Guess Lincoln is rolling over in his grave.

Good morning, pups. It’s [sigh] Douthat and Krugman today, both on health care. Oh, crap. Now we have to start the week with little Ross… He’s given us a thing called “The Hard Part” in which he says just as Bush-era conservatives couldn’t make tax cuts pay for themselves, Obama-era Democrats won’t finance universal health care without middle-class tax increases or spending cuts. Ross, maybe, just maybe, if we hadn’t been pouring our money down the Iraq rathole for 7 years we could… Asshat. Mr. Krugman also addresses the “Health Care Showdown.” Guess who makes more sense? Prof. Krugman says American voters are ready to change the ailing health care system, and “centrist” Democrats who oppose the public option run the risk of undermining effective reform.

Here they are.

The coffee and tea are ready, and the biscuits are out of the oven. The pitchers of cold drinks are ready in the fridge, and we’re looking at a “break” in the weather — temps are supposed to be “only” 95 or so today. Have a great day.

He’s been spinning like a lathe ever since the Republicans started calling themselves “the party of Lincoln.”

I’m in such a funk over this. I truly believe this is the needed first step to get this nation back on it’s feet. To allow small businesses to survive, to allow people to work for themselves, to lift this burden from our school systems and state/county governments, to allow people to retire. It’s more than just insuring the uninsured. We’re all drowning because of the greed of ins. companies. And I’m sitting here feeling very helpless as the team we worked so hard to put in place turns their back on us.

This tax issue is pissing me off. How much is it going to cost working Americans who pay for part of their insurance and also pay School Tax, County Tax, Town/Village tax? How much is it costing us when the cost of health ins. raises the price of goods?
My 57yr old co-worker is retiring this year. Her health ins premium (after retirement) will hover around $10,000/yr. Is the tax increase going to be more than that??? I think not.

Who will be the brave soul that introduces a bill to remove free, and comprehensive, health care for Congress critters until a “public option” is enacted?

And I’m sitting here feeling very helpless as the team we worked so hard to put in place turns their back on us.

I must say that BO was not my first, or second, choice because he was all bullshit and no specifics during the election so I am not all surprised by his tepid support of a “public option”. He is way too deep into the pockets of the Insurance and Pharma industries to even attempt to take them on so, as my wonderful spouse says, forget loooking for a decent health care plan for at least another 8 to 10 years….if then.

My 57yr old co-worker is retiring this year. Her health ins premium (after retirement) will hover around $10,000/yr. Is the tax increase going to be more than that???

My health insurance is about 24% of my SS cheque.

I can’t say enough bad about Blue Cross Blue Shield.

When my mother-in-law was approaching death and confined to a nursing home, BB/BS denied some $15,000 worth of “skilled care” for her as not being “skilled care.” She was resceiving exactly what she received previously and we were reimbursed for. The provider was at a loss as to how to explain BC/BS’ action. Our attorney looked into it and was equally baffled. We complained to the insurance commissioner of IN and joined a class action suit, settled in court for a huge loss. BC/BS simply decided to make more money by denying around fifty thousand claims from old ladies in homes.

An employee of mine came down with a horrible illness while traveling by car from DC to Upstate PA. She incurred bills every so many miles up to her mom’s house and back down to DC as the illness had very strange twists and turns. BC/BS refused to deal with her claims as they decided they were bogus. She had bill collectors calling, letters threatening law suites, and absolutely impossible documentation requests from BC/BS, all while she continued to fight the illness, which dragged on and on. People working on her case quit BC/BS in disgust over how she was treated. I met with several adminstrators and got no where, and I never accept “NO!” I finally convinced my boss, a genuine “Mr. BIG!” of the day, to go see the BC/BS CEO and beat him up for a few rounds. That’s what that one took.

What’s good for BC/BS is NOT good for America. These people are thieves!

Insurance is the ultimate moral hazard business. The profit incentive is to collect your premiums then to deny your claims. In medical insurance, it means you die.

So Rs and DLC say: Who needs regulation. Let profits soar and people die. It’s the U.S. way.

My niece injured her knee during a high school basketball game. Rushed her to the emergency room which refused her because she didn’t have a referral. This was resolved but it’s constant bullshit with these companies, which is why that ‘who needs govt. making med decisions’ isn’t working with anyone who’s had to deal w/ ins. companies.

here’s the point democrats have to make;

for generations republicans have said, let the market decide”

and “private industry is more efficient then government programs”

and “there is too much waste in government programs, don’t forget about that 500 doLlar hammer”

the democrats need to hammer that home with “let the market decide, whichever is the better option will win the most business”

we can EASILY throw their own garbage back in their face

Who will be the brave soul that introduces a bill to remove free, and comprehensive, health care for Congress critters until a “public option” is enacted?

I miss John Edwards’ voice on this. Damn him.

yup, a corporate model is to deny as many claims as possible, they get no return when an individual is returned to productivity

the government model is to help as many people as possible, the government gets a positive return when it returns someone back into productivity

you’ve demonstrated the exact problem with private health care, the fact that their in the business of denying claims

Pardon two posts here, but BC/BS gets me on a roll.

We should not be demanding a “public option;” we should be demanding that insurance companies get out of health care. If all Americans are covered by a plan that pays for all medical expenses, there is no need for insurance…there is NOTHING to insure. The costs will be the costs; that’s an unavoidable outcome.

And, the costs will be MUCH less if there is no insurance industry nit picking of bills submitted, interest lost on delayed claims, and insurance industry overhead and profit to cover within that total cost of all medical expenses.

We should be asking that the BC/BSs be scrapped and the private sector absorb their resources into more productive ventures.

solai, that wouldn’t work for long, the health care industry will simply contribute enough money that it will make up the comenserate differance and then they will be able to say, “see?…we walk the walk”

it’s a nice idea that if they are smart will backfire

Good news, bad news.
Good News: Network news websites are saying the dems are enboldened by the poll results and are going to support a public option.
Bad News: (OT) No mention, anywhere, about Goldman Sachs’ bonuses.

When I was on Wall St. and would point out to clients that medical insurance profited if their customers died, I got the look. Never once did I get an intelligent counterarguement. Don’t think there is one, but will change my mind if someone can convince me.

Attaturk, gone are the days when doctors would make a house-call with the sole purpose of trying to save someone’s life. Not now! Doctors are part of the wealthy class. Personally, I don’t think it should be that way.

(Just so you all know…I had a great Father’s Day! Yep, I did. I made a lemon meringue pie for my father for his Big Day, and he got me a ton of tools to fix my house up with………all from yard sales! LOL)

This health care debate is really pissing me off. I was initially supportive of the public options, because I hoped it would eventually lead to complete single-payer. But if we have to fight this much to get a baby step, we might as well be fighting for the whole enchilada. Maybe we should pull the rug out from under THEM for a change and completely change our focus to full single-payer.

Oh, wrt Obama’s alleged intelligence, he does not seem to know about the moral hazard of insurance. Neither does Greenspan. In the case of the former, campaign contributions are more important than knowledge. In the case of the latter, it’s simple stupidity.

interview in the boston globe today: Single-minded on healthcare

The debate in Washington about how to overhaul the nation’s healthcare system has included little from advocates for a single-payer plan. Dr. Steffie Woolhandler, a Cambridge Health Alliance internist and Harvard Medical School professor who cofounded Physicians for a National Health Care Program, has been raising her voice for a national plan for more than two decades, contending that the current system based on private insurance – including the Massachusetts model mandating near-universal coverage – does not serve people well, whether they are rich or poor, insured or uninsured. Here is an edited version of an interview last week.

Q. What do you think of current efforts in Washington to improve healthcare?

A. What’s currently on the table, what [President] Obama and [Senator Edward M.] Kennedy are talking about, will not fix healthcare. They don’t have any way to pay for it. We can’t just keep pumping money into the system. We actually have to fix the system.

Q. Why aren’t single-payer advocates at the table?

A. I think that was due to the tremendous influence of the private health insurance industry. We’ve pushed some and the process has moved some. At first Senator [Max] Baucus had 13 people, mostly doctors and nurses, arrested outside the hearing he was leading. We did get a hearing on single payer for the first time in history in the House Education and Labor Committee.

Q. How would a single-payer system pay for itself?

A. A single-payer system contains its own funding. It would fix the system by dramatically reducing administrative costs. Just the complexity of having competing insurance firms and the system overhead make costs go way up. In the United States, administration costs us 31 cents of every healthcare dollar. In Canada, it’s about 16.5 cents for every healthcare dollar. If we could have the administrative efficiency they have in Canada, we could move $400 billion in annual costs.

Bad News: (OT) No mention, anywhere, about Goldman Sachs’ bonuses.

Does that somehow tie in with the projected 10% unemployment rate?

Doctors in France and Italy routinely make house calls.

Reducing administrative costs is a tiny part of the savings. The real way that govt paid medical care reduces costs is by price controls. That’s why no supplier in the current U.S. system wants it.

precisely so

Reducing administrative costs is a tiny part of the savings

you have a link for that?

because everything i’ve read from people who’ve been studying the issue says it’s somewhere between $350 – $400 billion dollars a year. even people who aren’t single payer advocates. in fact, you are the very first person i’ve seen say that’s not so.

… point out to clients that medical insurance profited if their customers died, I got the look.

That really says it all. It’s in the interest of the insurers to provide a minimum of care, the hasten the demise of their policy holders.

there are factors that aren’t even considered;

the government gets positive revenue from productivity, adding to federal, local revenue through taxes, that pretty much pays quite a bit into health care right there

then there is the peripheral income when a family member suffers socially and economically because their relative is ill or has died…their productive efficiency is greatly reduced as well

I am willing to bet, if we consider the revenue lost, business not invested, bankruptcy through health issues, that public health care might even cost less then no health care at all

I wonder if there’s a way to conduct a study on just how much the government would save and continue making with health care vs the amount they spend on it

No link. Just first principles. U.S. system costs 1-1/2 times per capita than the next most expensive country, Canada. (That’s 1998 data. May be different now.) Administrative costs can’t possibly account for that big a difference. Also, in Sicko, there’s a lot of talk about docs incomes in U.K. They’re handsome, but not nearly as much as in the U.S.

We keep talking about the “health care” crisis. It’s actually a “sick care” crisis. If more attention were directed to preventive medicine and education (and getting stores with fresh fruits and vegetables into poorer neighborhoods, but that’s another whole issue) fewer people would need the “sick care” that costs so much.

In poor neighborhoods in NYC there are more fast food restaurants than purveyors of fresh vegies. The farmers’ markets in the city are all in higher income neighborhoods. NYC just started a program to get carts with fresh produce in poor neighborhoods.

no one claims it’s the whole cost difference between canada and the usa. that’s just a strawman. the issue is the difference in administrative costs only. canada is used as an illustrative example (as is medicare) for adminstrative costs (uk is not because the system is too different).

this is a really important point — that the cost of keeping private insurance companies in business could be used to provide health care to the millions who don’t it today.

I am willing to bet, if we consider the revenue lost, business not invested, bankruptcy through health issues, that public health care might even cost less then no health care at all.

You’re stating the obvious there.

Americans don’t need Health INSURANCE.

They need Health CARE.

Paying $400 per month to Blue Cross does nothing to deliver health or care, particularly if you never use it.

The ONLY solution to the health CARE crisis is to remove the most expensive layer in the business model. Insurance does nothing to deliver care. If politicians represented US instead of the INSURANCE LOBBY, they might actually open their minds to delivering the only answer that makes any sense. If you’re going to even discuss providing Health CARE for every American, then you need to at least discuss terminating Health INSURANCE in that mix. There’s no need for insurance if health care is guaranteed.

Health Insurance ONLY adds Cost and delivers NO care.

But now you know why Warren Buffett wanted to stay close to Obama.

I don’t understand your point.

My point is that, regardless of the single payer system you point to, the way they all hold down costs is by price controls. The payer (govt) decides what the supplier gets paid. That’s the 800 pound gorilla in the room that unites all the medical suppliers in the U.S. against a govt paid system, regardless of how it’s organized.

It’s not just NYC. Anywhere I’ve ever lived the poorer neighborhoods were inundated with fast food and “quickie marts” selling crap, and it took an extended trek to get to a place where good, wholesome food was available. It’s a national disgrace.

i agree.

Do they charge an exorbitantly high price for doing so? Doubt it. If profit was taken out of the mix, our healthcare system would be so much better.

OT

democracynow reports that European telecoms (Siemans singled out) are helping Iranian govt censor internet & put out disinformation.

the point is that unnecessary administrative costs — costs that could be avoided with single payer — account for something like $400 billion dollars a year. and that is NOT a “tiny part of the savings”

as an aside, last poll i saw showed a majority of physicians support national health insurance. it’s the private insurance companies that are fighting that — because they would no longer have a business in insuring medically necessary healthcare.

My late uncle worked at Raytheon (with Paula Poundstone’s father, who my uncle said was a real card) and he used to get those calls from the Pentagon towards the end of the fiscal year. The caller would be asking him to re-price various items that Raytheon had sold to one of the military services earlier in the fiscal year. The whole point of the exercise was to take what would have been a budget surplus and make it disappear into thin air, and companies like Raytheon would take the P.R. hit if and when the shit hit the fan. You can’t ask for more money in the following year’s budget if you haven’t spent all of this year’s budget. That’s all that that was ever about.

Single payer universal health care is inevitable because it is the only way that the health care system will survive. It may not happen this year, it may not happen even five or ten years from now, but it will happen because the affordability crisis will only deepen as the years pass. The system is broken. It is filled with perverse incentives, which include those that are peculiar to all insurance models, but which extend to the manner in which doctors and hospitals are reimbursed, and that reimbursement model is divorced from
any relation to the patient’s ultimate health outcome.

I occasionally work with some cheap bastards from New Hampshire. Guys who live in New Hampshire and work in Massachusetts (where the jobs are) as independent contractors and pay no income taxes on their earned income to either New Hampshire and Massachusetts. These guys are hard core Republicans who would have voted for Bush a third time, and even these guys are now in favor of a public health insurance option or a universal single payer system because their wives, who work part or full-time and receive the family health care benefits, are now seeing those benefits reduced. These guys realize that it’s only a matter of time before those benefits are eliminated and they don’t want to be in the position of subsidizing the private health care insurers with their hard earned dollars.

By the way, Kay Hagan needs to be recalled if she runs to the right on this and other critically important issues. By all means let’s get a real Republican in there if she is going to be a DINO. Let’s make sure that if she fucks over her constituents and all other Americans that she gets fucked over in return.

I know the right wingers are inspiring fear with of “rationing,” which they say would be inevitable with any government option or single payer system. Of course there is rationing now, based on wealth, but it does seem that some sort of guidelines will ultimately have be used to achieve cost reduction.

Regardless of preventive health measures, we are all ultimately going to die, and may or may not be able to pass from healthy to dead without a long series of complications. At some point, the only resolution would have to involve some sort of, to put it crassly, cost-benift analysis. Otherwise, I don’t know the answer to hip replacements for 85 year-olds with otherwise terminal illnesses. Rightly or wrongly, the government option gives some appearance of allowing those who can afford it to make those choices, rather than “beaurocrats” deciding. Perhaps it allows greater liklihood of public acceptance than what the right can portray as a stark transition to decision by some sort of committee reminiscent of the housing commissariat in Dr. Zhivago.

I’m not advocating. I’m just saying that I can understand the rationale for approach by a government option, rather than single payer system, at this point. To paraphrase Franklin, “It’s a government health program, if you can keep and expand it.”

The “big bad scary government-run healthcare” PR offensive is on in full effect. See this on the Yahoo frontpage this morn:

http://news.yahoo.com/s/ap/200…..ital_error

Is “botched” a medical or journalistic. Watch for this one or others like it all over BigMedia in the next few weeks.

Of course, we’ll see no reports about the huge amounts of medical mistakes in the privately-run systems.

So if the U.S. came down to a per capita cost of the next most expensive country, it would save well over a trillion/year, making your figure on administrative costs less than 40%. Granted that’s not a tiny part, but neither is it the critical mass. And I dispute any estimate on parts of the system because the whole thing is so f’d up that working on a piece is worthless.

Docs, or that % of docs (some # less than 100) who support govt paid sys do so because private insurance sys is making it difficult for them to get paid.

When you have an industry that had market power, like the medical industry, the particular participants within that industry fight for the goodies. In the old days, the docs, courtesy of their specialized knowledge, were able to get the lion’s share. But over time the “insurance” companies (i.e. prepaid medical care) got market power & started lording it over docs. So now that docs are getting gored, they’re running to the govt.

from an interview with Uwe Reinhardt:

Edie Magnus: We were in a hospital that was affiliated with McGill University, and it was a regional system that had six hospitals that were affiliated with one another, and they annually have some 39,000 inpatients, and they do about 34,000 surgeries and they deliver about 3,000 babies. And managing all of this is a staff of 12 people doing the billing, the administration. What would an equivalent hospital in the U.S. take to run administratively?

Uwe Reinhardt: You’d be talking 800, 900 people, just for the billing, with that many hospitals and being an academic health center. We were recently at a conference at Duke University and the president of Duke University, Bill Brody, said they are dealing with 700 distinct managed care contracts. Now think about this. When you deal with that many insurers you have to negotiate rates with each of them. In Baltimore, they are lucky. They have rate regulations, so they don’t have to do it. But take Duke University, for example, has more than 500,000 and I believe it’s 900 billing clerks for their system.

Edie Magnus: What are 800, 900 people doing?

Uwe Reinhardt: Well first of all there’s a contract. With each different managed care contract you have different rates. You have different things that need pre-authorization, not depending on the contract. You haggle over every bill. You submit the bill, the insurer rejects it, you haggle, and it may take 90 days to settle one bill. They don’t have that in Canada. You see, we spend in this country an enormous amount of money just administering claims. It’s a huge wrestling match over the payment.

Edie Magnus: When we pay a medical bill, how much of that bill goes to these kinds of administrative costs?

Uwe Reinhardt: Well, in general what you’ll find in our official statistics, we’re spending 7 percent on administration, but that only accounts for the insurers’ administrative costs and that includes Medicaid, which burns only two percent of its money throughput on administration. On the other hand, Medicare and Medicaid both cost the hospitals administrative costs that are booked as medical care, but it’s really administrative costs.

Steffie Woolhandler and David Himmelstein of Harvard did a study comparing Canada and the U.S. looking at what it costs employers, providers, doctors and hospitals and the insurance mechanism and compared Canada and the US, and they found that we in 1999, spent $300 billion on administration for all these three functions, and that was about 24 percent of national health spending there, but they say it was actually 31 percent because of the fraction of spending that they could actually identify and link to administrative costs. So they came to 31. So it’s somewhere between 25 and 30 percent that goes for administration and it doesn’t even include the patients’ time of billing. Anyone who has had anyone really sick in their family knows how much time you spend haggling over the bills and they have none of that in these systems.

Edie Magnus: I know that there’s some dispute about all those numbers, about what percentage of our spending the administrative costs represent, but you have said that with what America could be saving in administrative costs, that it could completely fund universal health care for all Americans.

Uwe Reinhardt: Oh yes, I’m totally convinced of that.

swim is up…

You mean you liked the mandate for all Americans to join the privately run system, with no public option, which forces everyone to partake in the flawed system with the promise of “lowering costs?” This is a boon for insurance companies. That’s what Edwards and Clinton were proposing.

Here we have a President doing townhalls last week and coming out strong for a public option, and his approval ratings go down this last week. The Noize Machine is ramped up and he needs every bit of backing he can get on this issue.

I feel the public option is a subversive way to get us single-payer faster than expected. Was confused by it at first, but now see it’ll use their own “framing” against them, since we know so many people will sign up for the public option, which will diminish the “scary government-run healthcare” talking point, and the noble (in their minds) competition will bring us single-payer or close approximation.

Yet, at this crucial and potentially historic moment in time in America, so many of the single-payer proponents (around here at least) are “pissed” and “depressed” while on the verge of getting it. Dianne Feinstein and the other DLC leftovers are lining up to scuttle it already. The old fissures are becoming clearer once again.

We’re at a “all hands on deck” moment. I hope more people will realize the stakes of where we’re at right now.

i think this is the woolhandler and himmelstein paper reinhardt is referring to.

Costs of health care administration in the United States and Canada
Authors: Steffie Woolhandler, Terry Campbell, David U Himmelstein
The New England journal of medicine. 01/09/200309/2003; 349(8):768-75.

BACKGROUND: A decade ago, the administrative costs of health care in the United States greatly exceeded those in Canada. We investigated whether the ascendancy of computerization, managed care, and the adoption of more businesslike approaches to health care have decreased administrative costs. METHODS: For the United States and Canada, we calculated the administrative costs of health insurers, employers’ health benefit programs, hospitals, practitioners’ offices, nursing homes, and home care agencies in 1999. We analyzed published data, surveys of physicians, employment data, and detailed cost reports filed by hospitals, nursing homes, and home care agencies. In calculating the administrative share of health care spending, we excluded retail pharmacy sales and a few other categories for which data on administrative costs were unavailable. We used census surveys to explore trends over time in administrative employment in health care settings. Costs are reported in U.S. dollars. RESULTS: In 1999, health administration costs totaled at least 294.3 billion dollars in the United States, or 1,059 dollars per capita, as compared with 307 dollars per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada’s national health insurance program had overhead of 1.3 percent; the overhead among Canada’s private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers’ administrative costs were far lower in Canada. Between 1969 and 1999, the share of the U.S. health care labor force accounted for by administrative workers grew from 18.2 percent to 27.3 percent. In Canada, it grew from 16.0 percent in 1971 to 19.1 percent in 1996. (Both nations’ figures exclude insurance-industry personnel.) CONCLUSIONS: The gap between U.S. and Canadian spending on health care administration has grown to 752 dollars per capita. A large sum might be saved in the United States if administrative costs could be trimmed by implementing a Canadian-style health care system.

i haven’t read it (just stuff they’ve written for the lay reader).

btw, woolhandler and himmelstein are coauthors with elizabeth warren on the medical bankruptcy studies, so if you think their work is flawed, i’d really like to know more.

Thanks so much for occasioning this thread, Attaturk, and for reminding us what scums BCBS is.

Blessings to all

In the current private market-based employer-provided health insurance system, the healthcare consumer is NOT one of the participants. In today’s health insurance market, the providers are the private health insurance companies, and the consumers are beancounters in the corporate HR departments.

The average citizen, by the time he gets to choose ANYTHING about his health care is presented with a particular provider chosen by his bosses, and at best can choose either the company’s HMO or PPO plan – both of which come with rising salary deductions, rising copays, rising pharmaceutical copays and drug availability limitations, rising annual deductables and shrinking annual caps on some payouts. In addition, the consumer is forced to select from a limited in-network list of doctors and hospitals or, if your chosen doctor isn’t in the network, pay the bulk of your out-of-network costs.

The private health insurance system is NOT a free market (except between corporate insurance providers and corporate HR departments). The biggest threat to the current system is the public health option – which will allow healthcare consumers themselves to enter the market directly and make their own choices.

The health industry and some of its GOP handmaidens have predicted that up to 119 MILLION Americans will opt for the public health option. That’s an explicit admission that the product they are pushing is not one the consumer would choose in a real free market. And that’s much too much free market for the greedheads running their huge hydra-headed monopoly on health insurance.

It isn’t the threat TO the free market that scares them so much, its the threat OF a free market that forces them to compete directly for consumer business.