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I've been following the Krugman - Obama dust up with some interest and alarm.

Alarm, because in my opinion, it takes the spotlight off the real healthcare horrors.

I have one request of our candidates.

More than anything, I'd like Senators Obama, Clinton and Edwards to tell me how my day-to-day dealings with the Murder By Spreadsheet insurance industry will improve, when their healthcare reform plan becomes law?  Walk me through this, dear candidates.

Give me a day in the life of an American citizen, the day after your healthcare reform legislation become law. And I'd like to know where we'll stand if flawed legislation becomes the law of the land?

We're desperate.  We need to know that very ill people across the United States will no longer have to fight these merciless insurance industry predators, who take our money then refuse to pay for urgent lifesaving care.

I'd like our candidates to convince me that healthcare reform will mean that the best people in our nation will select medicine as a career.

If so, you'll need to convince the next generation of doctors that they won't face the abuses our current beleaguered health heroes endure.

Will healthcare reform mean that doctors won't continue to spend half their lives battling the for-profit insurance industry to get treatments authorized for critically ill Americans, and then the other half, battling to get paid 20 cents on the dollar for the life-saving work they do?

What a waste of such highly-trained talent. Doctors should be saving lives, not struggling with insurers who seek only to maximize their profits.

And how will healthcare reform deal with criminals health insurance executives like William McGuire, the former CEO of UnitedHealth, who has finally been forced to forfeit at least $418 million to settle claims related to back-dated stock options? You owe it to yourself to read the article in the New York Times. You think you're angry? Talk to me again after you've read the piece.

There's no escaping the fact that the cost issue in heathcare reform is huge. And Obama's recognition that if insurance is affordable, people will be eager to be insured makes sense.

But, as far as I know, Obama has yet  to explain his definition of "affordable".   Nor, I believe, have Edwards or Clinton. The devil is in the details.  

Under Obama's plan will I be paying the same subsidized rate as my Congressperson? Under Clinton, Edwards?

Senator Obama, I am currently paying  $7557.96 a year for barely decent coverage. Under your plan, will I pay the same $188.42 a month that my Congressperson pays for his taxpayer-subsidized coverage?

Senator Obama, next year, assuming another 8-10% increase, my premium will go to approximately $8312.00.  Is this affordable?  If you consider this affordable, then we're circling very different planets. Same question for you, Senators Clinton and Edwards.

Ezra Klein is correct, going on a tear against Paul Krugman, does nothing to solve the crisis, and  isn't helping me or anyone else access affordable healthcare.  It's also frankly rather tone deaf. Paul Krugman is one of our greatest. And I really hope the army of Obama supporters at Daily Kos will recognize I say this as a very concerned citizen, not as a partisan.

Despite the fact that I pay huge premiums, my insurer does not treat me, or my claims, with even a modicum of courtesy, or a smidgen of professionalism. And by the way, trying to reach a human being on the phone at a health insurance company, is an exercise in futility. But it's also deliberate.  They want us to give up in frustration. Always remember, the business model is designed to make you give up.

One small suggestion. I hope healthcare reform will require as a matter of law that all health insurance providers have people promptly answering the phones 24/7. Now of course, this function will be outsourced to a Third World call center, but at least, we'll be speaking to a human being.

Returning for a moment to our present bleak reality. They take our money, then deny all responsibility.  Again, this is the business model in the United States.  They hope we will back off and go away. And many of us do.

Here's the email I just sent to the insurer about a bill they refuse to acknowledge. I've taken out the identifying details because I don't want any additional problems with these scum-suckers.

Reference #:  
This claim MUST be applied against my 2007 deductible. This was a XXXXX PRE-CERTIFIED MRI. The XXXXX pre-certification # is:XXXXXXXXXXXXX This is the fee to the radiologist for reading the damn MRI. As usual, you are trying to weasel out of your responsibilities. Do I need to contact the NYS Attorney General? I pay close to $700 a month for this junk insurance, you take my money then play games with me and everyone else. Kindly apply this against my 2007 deductible and do it immediately. I expect a response from you with 72 hours. Eve XXXXXX

I may have mentioned that I had an MRI a month or two ago.

The MRI facility I went to at the suggestion of my doctor is within the confines of a major New York teaching hospital.

The MRI facility would not allow me to make the appointment until I provided them with a pre-authorization number from my insurance company.

The MRI facility is an approved provider.  Apparently the radiologist who reads the MRI is not an approved provider, so I'll have to pay this doctor the retail price. But his fee of close to $500 should be applied against my 2007 deductible.

Instead, the scum insurer is simply denying the claim outright. They already sent me an EOB (explanation of benefits) which stated the service is NOT PRECERTIFIED - NO PAYMENT.

I'll survive, I've got a loud mouth. But this is right from the insurance industry Murder By Spreadsheet playbook. This is the routine treatment inflicted on people dying of terminal diseases.

So again, my questions to the candidates are simple.

  1. How is your health plan going to make my life better?
  1. Will I still be engaged in endless conflict with an insurance industry which has only one mandate, to increase profits, not provide care?
  1. Will I pay the same premiums as my Congressperson for the same level as coverage?
  1. Will the sort of scenerio I've just described be outlawed? And will your healthcare reform plan include draconian penalties against Murder By Spreadsheet insurers cited for wrongdoing?

Originally posted to nyceve on Sun Dec 09, 2007 at 06:48 AM PST.

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Comment Preferences

  •  The American people want some (236+ / 0-)
    Recommended by:
    pontificator, clio, mickey, MoDem, vicki, tmo, Inky, eugene, vivacia, SarahLee, roonie, Hell Upside Down, Iddybud, ghost2, cosbo, TrueBlueMajority, ljm, RunawayRose, rincewind, Psyche, AAbshier, OLinda, GayHillbilly, Sandy on Signal, devtob, HarveyMilk, RFK Lives, Norwegian Chef, givmeliberty, Heart of the Rockies, pitbullEmily, RubDMC, rasbobbo, cinnamon68, opinionated, joyous, bronte17, megs, Alden, Welshman, srkp23, Kevvboy, KibbutzAmiad, CoolOnion, otto, javelina, oceanspray, Ronit, ClickerMel, Jesterfox, rioduran, andreww, splashy, kredwyn, dejavu, campskunk, Miss Jones, Chicago Lulu, Chamonix, MTgirl, grannyhelen, roseeriter, TiaRachel, votermom, susie dow, churchylafemme, johnnygunn, betson08, hazzcon, tabbycat in tenn, AbsurdEyes, a gordon, lcrp, alizard, barbwires, bwintx, zett, zerelda, ybruti, Kitsap River, DemDog, SanDiegoDem, kd texan, eve, Sassy, macmcd, vivens fons, TexH, rapala, madaprn, angrybird, mrmango, Bluesee, eastsidedemocrat, ichibon, el dorado gal, franziskaner, docangel, Heiuan, Chinton, irate, andgarden, nytcek, MT Spaces, kaye, Brooke In Seattle, Turkana, Bouwerie Boy, eru, howardfromUSA, Chaoslillith, majcmb1, Pam from Calif, Sharon in MD, snootless, EvilPaula, lotlizard, blue jersey mom, Ozzie, The Raven, wiscmass, FindingMyVoice, playtonjr, JanL, empathy, sgary, Asinus Asinum Fricat, noweasels, xaxnar, Jim R, debedb, AceDeuceLady, Topaz7, Major Danby, New Deal democrat, MuffledDrum, RogueStage, Themistoclea, redcardphreek, cookseytalbott, deha, dewey of the desert, Partially Impartial, prodigal, tecampbell, StrayCat, gravitylove, CTLiberal, steep rain, gabriella, Potus2020, ER Doc, doinaheckuvanutjob, BlueMississippi, JugOPunch, midwesterner, Persiflage, Stripe, means are the ends, Dreaming of Better Days, airmarc, creeper, pseudopod, Nulwee, AmericanRiverCanyon, bigchin, One Pissed Off Liberal, J Royce, phonegery, pfiore8, Fredly, blue armadillo, possum, moodyinsavannah, godislove, lordcopper, leftyguitarist, yoduuuh do or do not, LillithMc, CTDemoFarmer, Blue Waters Run Deep, kath25, flumptytail, Jimdotz, Calvin Jones and the 13th Apostle, deepeco, DWG, Unbozo, NoMoJoe, chicago jeff, Demi Moaned, Newzie, MaskedKat, Brahman Colorado, keikekaze, jaosnhouse, willb48, Terra Mystica, TomP, bluesweatergirl, LAMaestra, crystaljim, JDWolverton, GANJA, fayeforcure, sima, davidseth, Spoonfulofsugar, flowerfarmer, dragoneyes, brklyngrl, steveng82, Mr Stagger Lee, skohayes, loree920, minerva1157, Happy Days, dewley notid, Wek, smartdemmg, Runs With Scissors, mofembot, kyril, bakenjuddy, ShainZona, little liberal, MariaIvette, Quilldriver, bring democracy to america, domma, satanicpanic, Chad Michaels, J Ash Bowie, El Yoss, kbal11, fearisthemindkiller

    practical answers, which frankly I haven't heard.

    Maybe at one or another debate, a citizen will ask such a question and receive an honest response instead of a bunch of platitudes.

        •  How will your plan improve cut unnecessary costs? (20+ / 0-)

          We have much more expensive health care than any where else in the world, yet our health care delivery is on par with Cuba's.

          Insurance companies are the obvious cause of the enormous wastefulness of our system.

          "It's the planet, stupid."

          by FishOutofWater on Sun Dec 09, 2007 at 07:07:42 AM PST

          [ Parent ]

          •  You're right: No private insurance company (46+ / 0-)

            can ever cut unnecessary costs. Ever. They exist to make a profit, which is an unnecessary cost to the customer. Their only option for cost-cutting, outside of paying their employees abysmal wages and overworking them, is to cut payouts. This puts them automatically in the position of making health care decisions. There is no other way for them to cut costs.

            A government program that's not obligated to make a profit instantly has more money available to pay out. It also has the option of thinking long-term, running a deficit one year and a surplus the next, generally cushioning the blow to the people it serves.

            During times of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

            by kyril on Sun Dec 09, 2007 at 07:15:44 AM PST

            [ Parent ]

            •  Insurance companies pay people to deny (41+ / 0-)

              care and payments. Medicare costs about 3% to administer compared to about 30% for private health insurance. One quarter of our insureds health care dollars are going into insurance company overhead.

              "It's the planet, stupid."

              by FishOutofWater on Sun Dec 09, 2007 at 07:21:54 AM PST

              [ Parent ]

              •  And right now the insurance companies (21+ / 0-)

                are working on new "products" that will increase their bottom line, i.e., that will pay out less than 70 cents of every insurance dollar for care. they are looking a more junk insurance products that would be marketed to young, healthy people. As long as the insurance companies can cheery pick, it's all about their profits.

                •  The sickest end up on Medicaid (28+ / 0-)

                  after they lose their job and house the government ends up paying at a minimum rate that many doctors won't accept. Medicaid pays for subpar care.

                  We have a cruel, broken system that rations care but costs a fortune.

                  "It's the planet, stupid."

                  by FishOutofWater on Sun Dec 09, 2007 at 07:37:09 AM PST

                  [ Parent ]

                  •  Yes, this is the insurance "death spiral." (23+ / 0-)

                    You lose your job, and you lose your medical insurance. You get sick, and you can't afford proper care. As a result of the illnesses, you are much less likely to ever work again. If you are poor enough, you end up on medicaid.

                  •  Unfair: Not all Medicaid care is subpar (4+ / 0-)
                    Recommended by:
                    Alice in Florida, nyceve, sima, kyril

                    I am a nurse midwife, now an educator.  I practiced for about 10 years with a majority Medicaid population.  I achieved a 9.5% C/Section rate, and low rates of other complications.  The rate of preterm births among my low-income, African-American teens was about half the national rate. My numbers are typical of most CNMs across the United States, who achieve these kind of outcomes while serving the most at-risk women.  

                    Nurse practitioners are doing the same thing:  achieving good outcomes among low income adult and Peds patients on Medicaid.

                    We could do even more if the barriers to our practices were dismantled.

                    Please be careful about painting with too broad of a brush.

                    •  Nurse Practitioners (2+ / 0-)
                      Recommended by:
                      nyceve, kyril

                      must be a key part of any plan to make healthcare more affordable while raising (rather than lowering) quality of care. Unfortunately too many people don't understand the level of training and the capabilities a good nurse practitioner has, and think they are not getting the best care because they're not seeing a "real doctor." I frankly would prefer to see a nurse practitioner, they tend to have more time to listen than "real doctors."

                      "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

                      by Alice in Florida on Sun Dec 09, 2007 at 04:46:12 PM PST

                      [ Parent ]

                  •  Maybe Medicare pays for subpar medical care (1+ / 0-)
                    Recommended by:
                    JG in MD

                    but I don't think so.  I feel off a ladder Oct. 3.  I am 66 and have only Medicare.  I broke both bones in my left arm two inches above the wrist.  I was carried to the emergency room by my brother and I expected a hassle.  I went in and sat down and began to try to find my Medicare card.  The woman looked at me and said the nurse would be there immediately for me.  Not to try to find anything, just try to hold on for a minute.  The nurse came and took me to a room and said that a doctor had come by and told her to give me something for the pain immediately and not to try to ask me anything until I got something for the pain.  She then brought me warm blankets and the pain IV began to stop my shaking.  I don't know when they got my Medicare information but I do know that I was in surgery within two hours.  I spent the night in hospital and have been x-rayed every two weeks ever since.  I now see a chiropractor twice a week and physical therapy three times a week.  I am really lucky.  at 66, I have the bones of a 30-year-old and the bones have completely healed.  So far, I have not been questioned or charged for anything but $8.00 per visit at the chiropractor.  I only wish that all Americans could get the kind of treatment that I have gotten the last two months.  The pain has been horrendous but I am very quickly regaining full movement of my hand and arm.  

                    My interest is for all people to have the kind of health care that can prevent illness and then treat and hopefully cure whatever they get and, finally, to give palliative care when it is needed.  

                    I hope my hospital and doctors are getting paid fairly and I especially hope that I do not get some kind of medical bill as a surprise that makes me suicidal.

                    The soul is not the ego in drag. Ken Wilber

                    by macmcd on Sun Dec 09, 2007 at 07:33:05 PM PST

                    [ Parent ]

                •  Obama vs Clinton vs Edwards on this - (17+ / 0-)

                  I believe the distinctions in a campaign on such a policy issue are cosmetic and not fully indicative of what the policy wonks will propose when things start fresh with a Democrat (we hope) in January, 2009.

                  The candidates who are Democrats - every one of them - care about the cost crisis of health care and insurance for average Americans. The Republicans don't.

                  It will be a new slate in January 2009, we're hopeing. To me, nothing else matters.

                  I don't need to pin these candidates down. I need one of them to win.

                  •  excellent point, joan . . . (22+ / 0-)

                    but then we're kind of voting for a blank slate and promises.

                    I'd at minimum like them to give me the definition of "affordable".

                    Can I expect at bare minimum that I won't pay more than my Congressperson for the same coverage?

                    •  Even if we're voting for a blank slate (3+ / 0-)
                      Recommended by:
                      lrhoke, nyceve, CParis

                      we have no alternative. None of the top candidates is willing to approach single-payer yet. The Republicans don't even want to discuss it. We really have to go fro the blank slate now, and work on whoever it is along with the new Congress.

                      -5.12, -5.23

                      We are men of action; lies do not become us.

                      by ER Doc on Sun Dec 09, 2007 at 10:21:50 AM PST

                      [ Parent ]

                  •  Joan, you are exactly right. (7+ / 0-)

                    To get in a tangle over the details of Dem candidates' plans now is a pointless exercise.

                    No matter which one is elected, the real healthcare program will be crafted after they're in office.  No one is going to be able to walk in and simply put in place the plan they developed as a candidate.

                    All our candidates can succeed at getting some reform through once they're elected.

                    All of them will want to reduce Eve's (and our) monthly payments to something affordable.

                    The question, really, is who will be most able to gain broad public support for the most comprehensive plan?

                    Kucinich may have the best plan, but couldn't get it through any more than he can get congressional support to impeach Cheney (sadly.)

                    In my opinion, and good people may disagree, Barack Obama has the greatest skills to get America onboard with a progressive plan.  He knows how to appeal to people's better instincts, how to counteract fear... his initiative will not be "Harry and Louised" to death.

                    "When tempted to fight fire with fire, remember the professionals use water."

                    by Happy Days on Sun Dec 09, 2007 at 08:08:12 AM PST

                    [ Parent ]

                    •  I want a healthcare plan, not an insurance plan. (27+ / 0-)

                      The American people need healthcare, not more junk insurance. Paying insurance companies is more taxpayer money down the corporate-donor rathole.

                      Any politician who can't see and clearly express their awareness of that corporate scam, will not be capable of getting us to a decent plan, IMHO.

                      Healthcare, not Junk Insurance. For all Americans.

                    •  Then why is he bashing Krugman? (9+ / 0-)

                      There's nothing about appealing to peoples' better instincts in the attacks on Obama's site.  His site, in fact, attacks Krugman the person more than it attacks Krugman's ideas.

                      Krugman raised some legitimate questions about mandates, and Obama's campaign declined to address those questions on the merits.  Instead, they accuse Krugman of inconsistencies.  Given Krugman's track record and his commitment to this issue, I'm not impressed by these attacks.

                      Some men see things as they are and ask why. I see things that never were and ask why not?

                      by RFK Lives on Sun Dec 09, 2007 at 10:52:38 AM PST

                      [ Parent ]

                    •  We don't know that yet (1+ / 0-)
                      Recommended by:
                      nyceve

                      He certainly appears to great abilities as a mediator, but we don't really know what his abilities as a national leader are until they are tested.

                      My problem with his health plan is that he asserts that he can make health insurance available to all at an affordable rate without everyone participating. His plan, as he promotes it, is designed to let people who are happy with their insurance (the basis of his plan is that many if not most people don't want single-payer because they are happy with what they've got) keep what they have, and offer an affordable alternative for those who want insurance. The whole kerfuffle with Krugman is over whether it is really possible to make insurance more affordable for those who want it if only those with the greater medical needs buy it, and thus usage per premium dollar goes up compared to a "mandate" system. Obama's plan appeals to the young and the anti-collectivists out there.

                      Ultimately, all these plans will fail to solve the problem....but that doesn't mean they are wrong. I believe the point of these plans is to demonstrate to the American people why we need single-payer, and to provide a stepping stone to the realization that you can't have universal healthcare through market mechanisms.

                      "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

                      by Alice in Florida on Sun Dec 09, 2007 at 04:56:02 PM PST

                      [ Parent ]

                      •  It appeals to me (0+ / 0-)

                        not as much as single-payer, but infinitely more than Sen. Clinton's "We'll mandate that you pay up front, then give you money back at the end of the year" system. And I may be young, but I'm broke, and ill, and need health care, and would love to have insurance, and I'm about as collectivist as it gets. But I would rather continue to be sick than be hungry or homeless.

                        The day that everybody in this country has adequate food, shelter, and heat, and is not living in fear of losing one of those three things, then we can talk about individually-mandated payments for health insurance from an argument of collectivism. It'll still be wrong though, and by the time we get to that point, maybe we'll be ready to talk about a progressive income tax increase instead.

                        How many people need to go hungry or live on the streets so that the middle-class can have cheaper health care? What would be an acceptable number?

                        During times of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

                        by kyril on Mon Dec 10, 2007 at 04:51:02 AM PST

                        [ Parent ]

                  •  Good point...but..... (4+ / 0-)
                    Recommended by:
                    joan reports, alizard, kyril, skjold

                    Ultimately you are correct, we need a democrat...period.

                    But I am concerned about Hillary's talk of mandates and "forseeing a day when one is denied a job if they aren't paying for private health insurance".

                    I am not really clear where Edwards is on mandates.
                    But right now I have to question any candidate who proposed mandates because I feel they must not have a grasp on what the middle class is dealing with right now.  Many do not have ANY ROOM in their budget for any more mandatory expenses.  

                    Wages are stagnant and food and energy costs are SKYROCKETING.

                    I am fortunate in that our family has insurance through my husband's employer.  But were the employer to drop that coverage, and did not offer SIGNIFICANT compensation for that lack of coverage, there is NO WAY we could afford to pay for health insurance.  If we were to have to pay for the bluecross ppo that we now have, it would cost over $1000 a month....and we couldn't afford it if in only cost $100 a month.  We live paycheck to paycheck and it is all we can do to pay for auto and homeowner's insurance.

                    So now is the time to try and ferret out differences.  But I hope everyone understands that we ultimately need to support the dem nominee, whoever he or she is.

                  •  Well there are differences...... (5+ / 0-)

                    Edwards wants a universal healthcare plan up and running in 6 months or folks in congress will lose their own universal healthcare coverage.

                    Obama, says that by the end of his first term, he wants to have a inversal healthcare plan in place.

                    Hillary says that by the end of her second term she wants a universal healthcare plan in place.

                    As one of the 48 million uninsured, I need it NOW!!

                    Coming from an American cultural background = having an attention span about that of the average hyperactive two-year old. http://www.21stcenturydems.org/

                    by fayeforcure on Sun Dec 09, 2007 at 01:18:23 PM PST

                    [ Parent ]

                  •  while the distinctions are cosmetic (4+ / 0-)
                    Recommended by:
                    chuckvw, zett, phonegery, kyril

                    The candidates who are Democrats - every one of them - care about the cost crisis of health care and insurance for average Americans.,

                    I believe you're suffering from an acute case of wishful thinking.

                    Any plan that uses private insurance as a delivery mechanism (that's ALL of them) indicates that the candidate proposing it is about guaranteed profits for private insurance companies via mandatory enrollment enforced at gunpoint by Federal Agencies.

                    I believe that our candidates are all so insulated by the Beltway Bubble that they believe the lack of health insurance is due to individual responsibility, and this and a care for private insurance company profits are what is driving candidate agendas.

                    So we get ExtortionCare instead of national health care.

                    Looking for intelligent energy policy alternatives? Try here.

                    by alizard on Sun Dec 09, 2007 at 02:20:42 PM PST

                    [ Parent ]

              •  Medicare is almost broke (1+ / 0-)
                Recommended by:
                kkjohnson

                It creates an opportunity for billions of dollars of fraud and inaccurate billing to pass unchallenged which is breaking the programs in half. They have a very limited lifespan unless taxes are raised or the programs are redone from the ground up.

                There is no such thing as 3% administrative overhead in anything that writes check to people without massive fraud. It just isn't workable. You have to attack the cost centers first. If you don't you break medicare as it is. There is absolutely no possibility- zero- that Medicare could be extended to rest of the population at 3% overhead.

                The best you could get  is you pay the same for insurance and your claims get paid.

                No one is going to see $88 full coverage insurance again unless they work for the govt. As the Govt's ability to borrow falls and health care costs contuinue to rise, the taxpayer will no longer subsidize Govt workers health insurance any more than the Govt will subsidize 300 million people's health care.

                Ignoring the cost drivers in health care and focusing on insurance is a ridiculous oversimplification of the problem. The govt will subsidize health insurance for 300 Million people?

                How? Show me the numbers. I dare anyone to do it. 3% overhead- even if fraud could be eliminated gets you a 17% one time discount on Insurance If the Govt takes it over which they can't becuase they can't afford it, it will go broke in a year if Cost drivers aren't addressed.

                Draconian regulation on Private health Insurance without addressing cost will have two reactions, Insurance companies will exit the business and/ or raise prices where $8300 a year will seem cheap with a $5,000 deductible. It took us years to get here. The Govt is going to help? The Govt is broke. 55 trillion in unfunded commitments to Social security and most prominently to Medicare. 55 Trillion for a small percentage of society.

                We take in 2.4 Trillion  a year and spend 2.9 as it is and are 9 trillion in debt soon to hit 10.

                It will take us years and probably a crisis inflection point before we start to roll it back.

                These diaries do no good  as  there is a complete absence of relevant facts at the worst and cherry picked facts about Medicare at the best. All they do is show a complete absence of knowledge of what the govt is fiscally capable of and why insurance costs are so high and why insurance companies who once were allergic to Health Insurance now are eager to get in it.

                Support Col Hackworth's watchdog group for the troops with money or a sign

                by Dburn on Sun Dec 09, 2007 at 07:54:37 AM PST

                [ Parent ]

                •  Dburn, sorry you feel this way . . . (19+ / 0-)

                  Two suggestions.

                  1. no one is forcing you to read them or comment.
                  1. Could we at least agree that the American people should not pay any more than Congresspeople pay for the same level of coverage?  The facts of what they pay are public record.

                  These diaries do no good  as  there is a complete absence of relevant facts at the worst and cherry picked facts about Medicare at the best.

                  •  Eve See this- we agree (2+ / 0-)
                    Recommended by:
                    nyceve, kyril

                    the taxpayer will no longer subsidize Govt workers health insurance any more than the Govt will subsidize 300 million people's health care.

                    I am one of those with Junk Insurance. I see a Donut hole opening for the population at around age 56 to 65 when no one , except the very wealthy, will be able to afford health insurance.

                    I thing that's when the first inflection point will be reached. Employers start firing people over health insurance or discontinuing completely just to stay in business.

                    So we don't disagree at all on the simple premise of govt subsidized Helath insurance not only for Congress, but for all Govt employees. Not only that , most of them keep it when they retire after 20-30 years. Imagine retiring at 48 at 75% pay and having those benefits. In many parts of the country thats a living wage for Govt workers. Imagine two married Govt workers retiring at 75% pay with those benefits at 48. We pay for all of that.

                    It will get to the point where a litmus test will be whether a congressperson will accept govt paid health insurance. That's when we will have hit an inflection point- see below.

                    A presidents position on it has little or nothing to do with it. In order for sweeping legislation to pass to make insurance affordable and pay claims we have to have a willing congress. No President can take away their benefits. The only ones who can are voters who don't send people there every two years who will accept them. The revolution has to start with the House with a pliant President otherwise we go nowhere.

                    Example: Looking over HR 676, I was absolutely stunned that anyone would write such a garbage piece of legislation on such a sensitive issue. The way it dealt with Providers guarantees failure. Read it and put the clause up here that with a corrupt congress, will guarantee failure. I can help, but since you are the Goddess of Health care here, I would prefer for you to start looking further than Health Insurance at the entire picture.

                    Your diaries get attention and if you educate yourself on all of this  you will be able to help the community devise a solution and become a force to be reckoned with within a few years.

                    The piece of crap (Hr-676) was put up to buy votes. It will never reach the floor for a vote. The Co-sponsers signed on simply for evidence that they were for National Health Care or Single payer. However you want to define it.

                    I've written reams of facts on these issues that are completely ignored becuase this crap like HR 676 give people false hope while Presidential Candidates who who don't address the stumbling blocks from the stump are equally as guilty as the authors of 676.

                    I'm equally surprised at Krugman who is supposed to be a sophisticated economist jumping on one of the candidates who was justifiably vague becuase frankly nothing is going to be done until we attack the problem at the congressional level.

                    Just for your own edification: Breakdown the costs of health care and look for a weak point where policy could effectively drop costs 40-50% of that component within one fell swoop. I already put it up here.

                    Then look for Provider dishonesty which adds billions to the costs and what simple procedure could cuts those costs ( at the Hospital level by 50%). Overall savings could easily reach 50%.

                    Finally, I would look into a Fannie Mae type re-insurance program along with re-regulation of health Insurance company. Go back to the 80s and look at why it was so affordable and so few companies were capable of providing it.

                    Here's the point:In a capitalistic system, no business could expect to survive when 40% of their customers hate the company and it's products. But in consumer reviews this was one of the highest scoring health Insurance companies. In capitalistic system you should be able to find a few top performers that have customer dissatisfaction as a low single digit number. Health Insurance companies prosper when 40-65% of their customers HATE them,  Why? They shouldn't survive? It would be an opening for any company to come in and do the right by it's customers and make a fortune, but there isn't any.

                    That should be a huge "tell" right there that the insurance companies are a small part of the over-all problem. It's so huge, there is so many moving parts that one can't address it in a few pages like HR 676.

                    Please, do some research so you won't make statements like Doctors get 20% of what they should make. If your diaries make it beyond these walls and I expect they do, then it's embarrassing and it doesn't advance your pet cause and mine. I know I will get cancer. It runs in my family like the plague. So at age 51,  it's matter of time before I will be in a life and death confrontation with this system. I don't make that much. Nor do I think I should burden my family with these costs.

                    The one thing I was able to do was to insure no copays after I reach my deductible. I would tell everyone to redo their insurance and get a product that after a deductible it pays for 100%.

                    One story you should know and identify with. My 47 year old neighbor is disable and draws social security and Medicare. She lives a very frugal life. She also has a myriad of chronic illnesses. She was forced to file bankruptcy becuase she couldn't afford the copays while on Medicare. What does that tell you?

                    Support Col Hackworth's watchdog group for the troops with money or a sign

                    by Dburn on Sun Dec 09, 2007 at 10:26:24 AM PST

                    [ Parent ]

                    •  Dburn, I believe 100% that your heart . . . (4+ / 0-)
                      Recommended by:
                      splashy, ichibon, Persiflage, kyril

                      and intellect are in the right place.  

                      I'm still not quite able to pinpint your precise peeve with my ongoing writings about the healthcare catastrophe.

                      I think everything I say is based entirely on fact--entirely.  I'm not a policy wonk and I don't pretend to be.

                      I try to lay out the problem on a human, yet totally factual level.

                      Please clarify this statement, it is entirely accurate for doctors who accept insurance. Yes, you're correct, I could be even more accurate and say "doctors who receive between 20- 40 cents on the dollar."  And I probably should do this.  

                      Please, do some research so you won't make statements like Doctors get 20% of what they should make.

                      But doctors battling to be paid and battling for treatment approvals is reality in this country.

                      •  That's true (3+ / 0-)
                        Recommended by:
                        nyceve, Sigmarlin, kyril

                        But, again, look at what some of them charge for procedures. I saw Sicko and I really like the interview with the Specialist who made 200K or so working for the Govt. I like the drug store where all the prescriptions were $6.00.

                        The one statement that stuck me was the young UK doctor who said they were perfectly content with their salary and benefits. Plus there are incentives for bonuses for practicing preventative medicine. But in a cauteous slam against his American Colleagues he did mention, we are happy with 200K a year, many of your Doctors want much more ( paraphrased), they need multiple houses multiple cars etc et al.

                        If we went to a UK or Canadian system, all of those Doctors pay would be reduced substantially. So despite them getting beat on some bills they still manage to make a hell of a lot of money. How many of them have been caught doing unnecessary procedures to wrack up the billing. It's pretty simple really, if X insurance company only pays x for this procedure, I'll drop out of network for an insurance company that pays a multiple of x.

                        If the Govt doesn't handle the whole deal, then it should facilitate competition between specialists to drive prices down.That may include extending citizenship offers to many of the students who are trained in our schools who go home as long as they stay for x years. The Govt can give an interest free loan for them to set up practices and then they have to adhere to a certain fee structure. Insurance companies would flock to them but they would only enter the network if they were electronically reimbursed on submission of the bill.

                        Cost? A quadruple By-Pass is 100K here. In China or India or Thailand where many of these doctors go, it's a 10th of that. People are starting to fly over to those countries becuase not only is the price better but so is the care. If you have a 20% copay on a quadruple bypass, you owe 20G. So once competition is introduced into the system that drives prices down and reimbursement times to zero.

                        I produce research posters for Doctors who are in training. I would say on any group form Harvard, Yale, John Hopkins to UC-Davis 60% of the students have Chinese or Indian names. Not a solid study, but that gives you an idea.

                        Support Col Hackworth's watchdog group for the troops with money or a sign

                        by Dburn on Sun Dec 09, 2007 at 12:22:58 PM PST

                        [ Parent ]

                •  So what do you suggest? (17+ / 0-)

                  How do you propose to make health care affordable like it is in Canada, France, UK, Spain, Netherlands, Sweden, Norway right on down the line of the G7, the top 30 WHO countries, etc?  Somehow they do it but we can't.  

                  I find that unacceptable.  This is the United States of America. The Land of the Free.  This is the country that fought both fronts in WWII. We built an atomic bomb, went to the moon and won the cold war.  Are you telling me that health care is too hard for us?  Sure, France can do it but not us?

                  Why do we have an economy? Why do we have a government? What good is it to be "the richest country on earth" if our citizens are literally dieing in the streets from lack of basic health care?

                  I reject your comparison for Medicare.  We have the worst all possible worlds today. We have the majority of citizens paying for private health care (which is shooting up at a rate 3 or 4x inflation while wages are not even keeping up with inflation).  Then there are the ones who the private insurance can't afford to cover.  Those people MAY be able to get Medicare.  So you take the worst case scenario and make the government pay while cherry-picking the best and healthiest to cover with private insurance.  You're dividing up the risk pool and making the government pay the ones who are too expensive to insure privately.  

                  Then you come along and point at the government funded system and say it's broken. No kidding.  It's broken because the healthy people aren't paying into that system. They're paying into a private system.  Those trillions of dollars for health care are going to the insurance companies while the sickest and poorest go to the government for help.  It's an idiotic system that give us the worst of both worlds.  

                  "Strength and wisdom are not opposing values" - Bill Clinton.

                  by RAST on Sun Dec 09, 2007 at 09:06:00 AM PST

                  [ Parent ]

                  •  Yes, we don't have to reinvent the wheel (13+ / 0-)

                    Other countries have already successfully implemented single payer health care. We can learn from the experiences of other countries.

                    America must get out of the "not invented here syndrome".

                    Take the blinders off and look at what the rest of the world is doing. Take the best features of other countries plans. Implement them in a way that meets American needs and sensibilities.

                    "It's the planet, stupid."

                    by FishOutofWater on Sun Dec 09, 2007 at 09:14:41 AM PST

                    [ Parent ]

                  •  Here's a few- even though I've detailed this in (2+ / 0-)
                    Recommended by:
                    SingleVoter, kyril

                    other lengthy posts

                    I'll regurgitate a few here:

                    Drugs: Drugs are becoming and increasingly larger and larger percentage of over-all health care expenditures. Yet the ones really help us are usually invented by the NIH and Publicly funded Universities. So why should a drug company get to patent it and make billions when we paid to invent it? Not only patent it, but abuse the patent system by buying off generic makers and getting new patents for the tiniest changes in formulations, scoring and packaging.

                    Patents:  Fix the patent system. No more patents for Govt funded  research and inventions. Not only that, for life or death drugs that contain disease, the FDA should be beefed up to pass through or do the testing and train 6 manufacturers how to make it.

                    Distribution: The distribution system needs to be fixed. Most people with health Insurance have a drug prescription card. This is what gave rise to these massively profitable chain corner drug stores who will mark up a generic 2500% from  Costco because they know people only look at Co-pays.

                    Delivery: The whole system of delivery needs to be changed. If Costco can survive on 12-14%, then it's possible to make the necessary changes to insure that insurance companies don't get hit with outrageous mark-ups which in turn cause them to raise prices.


                    Cure vs Containment:
                    Drug companies don't want to cure you because there is no repeat business on 100K a year Chemo drugs. The NIH and University research should be funded to look for cures including stem cell research after 2009

                    Hospital Overcharges: When audited , 80% of all Hospital bills contain overcharges. Yet it take a sophisticated expert to go through an itemized bill ( which they usually only govt on demand) and decipher the codes the point to the over charges.
                    It's cheaper for a health insurance company to hire claim deniers than audit specialists. That needs to change.

                    A weak point that can be attacked is most hospitals have to give out 3-5% of their annual revenue to charity cases meaning they can't charge in order to qualify for property tax abatement's. That is massive savings for some of these monstrosities. Yet, they will include parking fees as part of their charitable giveaways. There is a problem that can be levered by policy for hospitals to stop coding their bills and force them to itemize all of them so anyone can understand them.

                    Body Part Kickbacks. Manufacturers of hip replacement , joints screw etc pay surgeons huge amounts of money to use their products which is why they are so expensive. That should be against the law.

                    Us: We need to start looking hard at preventative medicine. Health Insurance companies would by law be forced to pay for basic screening tests and two Doctor visits a year. If a customer didn't go, they should be dropped. Diet, exercise, smoking, eating all should be incentives given out by insurance companies to provide lower cost insurance. Take care of yourself and we'll take care of you. The free Doctor visits will be the verification for the insurance companies.

                    Reinsurance A small Reinsurance fund as Kerry mentioned in his 2004 campaign. Where the govt buys policies that have either a sick patient attached or one that has preexisting conditions. Look at the percentage of patients that cost the system the most and you'll see that this is not a insignificant plan. That also allows the govt to re-regulate health insurance providers.

                    Just those  elements alone would drop rates up to 50-65% or more. That's the starting point. Once the whole system starts to undergo repair other things can happen. Then you can regulate health insurance companies without driving them out of the business or forcing them to raise prices to the point where no one could afford it.

                    Should the govt ever find it's fiscal feet again, this preparation also would serve to  bring us close to where the Govt could afford a Canadian, UK like solution. But not before. You slowly have to squeeze fraud and profits by policy so that the whole system is affordable. But we have to be back to a surplus and have reduced govt debt by 50-70% minimum in order for this to happen otherwise any tax increases will just go to earmarks and programs we really can live without or worse deficit reduction.

                    Which also suggests: that Govt itself needs to reduce it's cost footprint and that's a whole new discussion and debate.

                    Support Col Hackworth's watchdog group for the troops with money or a sign

                    by Dburn on Sun Dec 09, 2007 at 11:08:24 AM PST

                    [ Parent ]

                    •  At what point.. (3+ / 0-)
                      Recommended by:
                      splashy, cnmbfa, kyril

                      At what point do we trash this whole crazy system we have now?  I realize the issue is huge and your approach is very pragmatic.  But my fear is that even if we do every single thing you want we're still a mile away from what we need.  

                      There is enough money in the system today to cover everyone without raising premiums a single cent.  If we strip out the profit and overhead of the private insurance companies and replace it with a semi-private nonprofit system (analogous to the USPS) we could cover everyone for what we are covering 80% today.

                      There is no need to raise taxes a single penny.  "All" we need to do (and all is in quotes because I realize it's a huge, huge thing) is shut down the current system and replace it.  This is exactly what they do in every other developed country in some form or another. And they do it for pennies on the dollar for what we spend. Literally 30 - 40 cents on the dollar.  

                      By having all 300 Million of us pay into a single system we would spread the risk pool and have huge leverage (like the VA does already).  And we could do it without raising a single premium for anyone because we are already spending the money.

                      Then with the leverage of 300 million we can go after every single thing on your list and drive costs down to what other countries pay.  Imagine if we only paid 40 - 60% of what we currently pay in health care cots.  We could even pay down the national debt!

                      Sigh. I'm a dreamer, I know...

                      "Strength and wisdom are not opposing values" - Bill Clinton.

                      by RAST on Sun Dec 09, 2007 at 12:54:22 PM PST

                      [ Parent ]

                      •  Rast:At the same time we trash Washington (1+ / 0-)
                        Recommended by:
                        kyril

                        by introducing legislative competition - see below.

                        Until then we have have no choice but to work within the set-up.

                        Assume a corruption problem ( Paid lobbyists are just  symptoms of a disease)

                        Assume a system unused to competition even inside a capitalistic state.

                        Assume bottom line profits are top priority concerns

                        Then use those three to force prices down. Elimating patents brings real competition into the drug market which is a good 40-50% of over-all cost of health care now.

                        Eliminating Drug cards- forcing people to purchase with cash over the net via places like Costco. That puts huge competitive pressures on the corner drugstore. The gola being to get prescriptions into the $10 range we see in the UK.

                        Introduce competition for specialist Doctors by

                        Eliminating funding for Medical schools who don't increase enrollment by 50- 100% maintain standards the whole time.

                        Offering Citizenship to foreign born doctors who enter into important and expensive specialities, offer free fianncing for school and to set up practices who adhere to a reasonable schedule of fees.

                        Those two create a  mountain of competition for specialist and also increases access.

                        Health Delivery

                        Make it illegal to issue non itemized bills for all treatment centers and all bills must be in English that and high school graduate can understand.

                        Make Electronic Medical Record Keeping Mandatory where each patient has and keep all medical records and issues them via secure transmission to health providers. All work done automatically goes into those records the same as we keep a federal court system and lawyers and judges are forced to file all information electronically about a individuals case. Which is accessible by individuals ( Pacer system)

                        This reduces overhead for Doctors and Insurance companies.

                        All pre-approved procedures must be paid by insurance companies electronically upon presentation electronically of the bill which is also place in the medical records of the patient. This also makes it easier for a patient to change providers for any reason whatsoever.  

                        Keep in mind even Krugman is realistic about how much the Govt can fund. He essentially calls for the same amount of money paid to health insurance companies to be paid to the govt for national health care. That means Eve's $8,000 and my $5,000 still has to be paid via a tax increase. However lowering costs as mentioned above will force competition among insurers. The Govt is free to compete too. If we tackle the cost of care than regardless of who handles insurance, it is infinitively more affordable.

                        Once you introduce competition - which many hospital do compete for patients with top tier insurance-but stressing competency (gimme a break) into all levels of the system and eliminate govt corporate welfare with the exception of using it to break almost monopolistic holds that somehow the providers have managed to maintain which allows them to raise prices with near impunity.

                        What all of this does is wedges these players against each other which is exactly what you want to do. If you say National Health Care or Single payer you have created an opposition that is monolithic consisting of idealists on the right and corporate interests above banding together to protect their monopolies.

                        This all of course is contingent on a activist population agitating for change. Once you eliminate costs and introduce competition you gain and important monied ally in this fight;  Business.

                        They will compete with health care lobbyists and pay more for policy so the correct amount of congress people can be purchased to get the appropriate legislation through.

                        If you introduce competition into the system with govt help by policy and a little money that is renewable once it's paid back. You get a substantial reduction in health insurance- costs and increased competition which allows the govt to introduce policy to  eliminate pre-existing conditions and claim denial by private insurance through regulation.

                        Market forces will increase access and increase patient leverage. Ultimately we are the customer and by making our records electronic and portable all Doctors, Hospitals and providers can lose patients in a heart beat.

                        When you eliminate drug cards, you introduce competition into the distribution system. Once people are forced to pay cash for prescriptions then corner drugstores won't mark up generics 2500% becuase they have focused their market plan on those with insurance cards.

                        They have to compete with Costco who marks up 12-14%. Prescription drugs then become as cheap as over the counter drugs. No more 100 thousand dollar a year drugs for cancer victims.

                        A patient is free to purchase his Chemo any place he desires and have it delivered to any treatment center s/he desires.

                        Those who advocate forcing the closure by govt of for profit business lose an important ally. You need monied interests to compete at the legislative level. Sick yes. But we now live in a third world country so lets start acting like it until we get a new generation in that is tired of it.

                        We cannot get to Canada and the UK system from here. Their respective govts. are in much better shape financially and the population has forced increased legislative competition by more parties and parliamentary systems. This forces govt to be more responsive to it's people.

                        Until we are able to launch viable political parties, the incumbents feel little threats from our demands. That's why they have to be paid off. That's why they are completely and totally unresponsive to us now. We can't pay them off.

                        Finally this; there are plenty of professionals in the US who have to work their tail ends off to get to be in their professions that don't make huge salaries.

                        Doctors who enter the profession to become rich won't like the idea of all the hard work and then having to compete in a market with high quality organized competitors. Especially specialists. Hopefully then you get a better quality health care provider who is interested in helping patients first and doesn't consider getting rich based on credential a right.

                        Some here have a higher opinion of Doctors. I think they are human. Some are good and some are bad. The bad ones will be forced out of the system simply becuase they make their employer uncompetitive.

                        That also forces some of these people to treat patients with chronic diseases more humanely. I've seen too many doctors who don't think bedside manners and patient respect are anything they need to deal with.

                        That needs to end.

                        Support Col Hackworth's watchdog group for the troops with money or a sign

                        by Dburn on Sun Dec 09, 2007 at 08:20:57 PM PST

                        [ Parent ]

                    •  Conservative Nanny State (2+ / 0-)
                      Recommended by:
                      Dburn, ichibon

                      by Dean Baker.  Read it?  Because these sound like the exact same thing he argues about the supposed "free market".

                      Its funny because the first thing Conservatives say when talk of gov't supported social programs are proposed is shouts of Socialism! and gov't handouts!  But that is exactly what the free market mess is.  There is no competition at the top like they pretend.  The AMA likes that the numbers of Foreign born capable doctors are kept out of the US so their salaries stay high.  Same for the handouts of patents and copyright protection.  Monsanto funds a Public University Lab and then gets to keep the patent and profits on research revolutions that arise from the public?! WTF?

                      I don't see it changing however since the benefactors of the free market have Congress' ear.  Hell, Thomas Friedman has never had to compete with an Indian journalist who speaks great English and writes better columns--why does he get to write 'analysis' and praise for the Global Economy?

                      More about the marvellous Economist Dean Baker at his site:
                      www.CEPR.net

                      •  Sigmarlin- Totally agree (1+ / 0-)
                        Recommended by:
                        kyril

                        I also don't like the idea of working for govt 4-5 months out of the year who in turn make selected private industries/companies/individuals rich with my money. Example: If we find that we need the National Institute of Health in order to come up with the drugs that help us, I don't like the idea of private companies getting them free complete with patents to protect their profits.

                        If the taxpayers decide to fund research and we get breakthroughs it should be determined if it should be sold or if it's in the taxpayers interest for the govt to set up companies to manufacture it once it's gone through trials. The Govt should also bid out the trials process to make it competitive which also doesn't guarantee the winners of those bids any exclusivity on the drugs.

                        This all is in line with so -called free markets, but should it happen, cover your ears from the screaming from the drug companies.

                        Support Col Hackworth's watchdog group for the troops with money or a sign

                        by Dburn on Sun Dec 09, 2007 at 08:46:25 PM PST

                        [ Parent ]

                      •  National Institute of health (1+ / 0-)
                        Recommended by:
                        kyril

                        Our Taxdollars at work making drug companies rich keeping quality health care out of reach for too many Americans.

                        Support Col Hackworth's watchdog group for the troops with money or a sign

                        by Dburn on Sun Dec 09, 2007 at 08:50:29 PM PST

                        [ Parent ]

                •  You say there's so much fraud (6+ / 0-)

                  prove it.

                  And if we cut defense spending down to 25% instead of 50%, we could do wonders for this country.

                  Finally, who's paying your insurance?

                  Contact Pelosi about impeachment: AmericanVoices@mail.house.gov

                  by Pescadero Bill on Sun Dec 09, 2007 at 09:07:24 AM PST

                  [ Parent ]

                  •  There is plenty of fraud (4+ / 0-)
                    Recommended by:
                    catfish, splashy, alizard, kyril

                    For example, some sleazy bunch of crooks pretending to be a medical lab got my family's medical info somehow and has been billing our insurance company for services not rendered.  The insurance company flags the charges, sends them to us, we tell them it's phony, but the same lab comes back again and does it again, and our insurance company forgets what we told them the last month and makes us help the fix their paperwork again and again.

                    However, if anything, these kinds of games are easier to play in a country with dozens of private insurers.  If there were only Medicare, once Medicare flags them as crooks they just get cut off.

                  •  I pay for my own (1+ / 0-)
                    Recommended by:
                    kyril

                    It's a junk policy with a $5000 deductible that costs me $5000 a year that will go up 10-20% every year until I can no longer afford it.

                    I use to buy health Insurance for my employees in the 80s and it was $2600 a month for 50 Employees and their families with a $250.00 deductible. They were hard to find becuase health Insurance companies were regulated.

                    Usually it could be done becuase it represented a  portion of revenues for most insurance companies. These days most Health insurance companies only do Health Insurance. Quite frankly with customer dissatisfaction rates starting at 40% it's no wonder why other companies strayed. Kind of hard to sell profitable term insurance when people hate your guts.  

                    Any questions?

                    Support Col Hackworth's watchdog group for the troops with money or a sign

                    by Dburn on Sun Dec 09, 2007 at 11:14:06 AM PST

                    [ Parent ]

                  •  Prove it? (0+ / 0-)

                    Why? Do you know how to Google? Come back and prove me wrong. For every case you find, keep in mind there are 100s and thousands of cases that aren't found. Medicare fraud is huge. But why beleive me? Google it.

                    Support Col Hackworth's watchdog group for the troops with money or a sign

                    by Dburn on Sun Dec 09, 2007 at 11:17:08 AM PST

                    [ Parent ]

                    •  You're the one that came out with the (3+ / 0-)
                      Recommended by:
                      splashy, Unbozo, sima

                      blanket statement.

                      Why Google when I can read nyceve's diaries and avoid the planted insurance company google bombs?

                      In general I don't get where you're coming from.

                      A Government health care program is bad?

                      There's more fraud in Medicare then for-profit insurance?

                      The country's going broke so we can't afford a government health care program?

                      You want to keep the for-profit insurance companies in charge of regulating who/why/when people get treated, but clean up the system as is?

                      Contact Pelosi about impeachment: AmericanVoices@mail.house.gov

                      by Pescadero Bill on Sun Dec 09, 2007 at 11:55:41 AM PST

                      [ Parent ]

                      •  He comes from trollville (1+ / 1-)
                        Recommended by:
                        NoMoJoe
                        Hidden by:
                        Dburn

                        Response to:

                        In general I don't get where you're coming from.

                      •  Bill here- this is as neutral as it gets (0+ / 0-)

                        http://www.gao.gov/...

                        You obviously don't believe what I'm saying. I don't want to ruin your fantasy trip. Read it, educate yourself.

                        Long term projections of entitlements.

                        Note in the projections that Medicaid and Medicare in Pink. By 2040 it exceeds 1 trillion a year in todays dollars.

                        Entitlements total comes to 4 trillion  with receipts about half that.

                        As your reading this Note this:

                        According to the 2004 "Green Book" of the House Ways and Means Committee, Medicare expenditures from the American government were $256.8 billion in fiscal year 2002. Beneficiary premiums are highly subsidized, and net outlays for the program, accounting for the premiums paid by subscribers, were $230.9 billion.

                        Now Medicare fraud:

                        It's important to note that there was only 8 employees tasked to monitor Medicaid fraud from 2000 onwards. No one is sure, but the fact that even the GAO says 1000s of providers are cheating it doesn't take a nut to figure with 300+ billion in the two programs going out per year now and 1.1 trillion by 2040 that the accumulated fraud is in the billions. Now extrapolate that for the 200 Million people an expanded program would cover. Also note how subsidized it is.  Employees pay 1.45% of their check and employers match it. The government subsidizes the rest.

                        As you review the reports on the state of our finances and what people here are saying about a medicare program with 3% overhead for the rest of us, I ask a simple question, were is the money coming from? Since we currently subsidize the program heavily via taxes and borrowings and health care goes up each year the opportunity for fraud expands exponentially as the likelihood of the program even surviving in it's current form contracts dramatically.

                        Ask anyone who listened to Bush's Social  Security Disaster tour in 2005 and ask them how medicare/medicaid is doing. This is not like Social security where theoritcally it's self funded provided we have enough workers and I think we do as Boomers had kids and eventually we should get back to a decent ratio.

                        For Medicare/Medicaid We pay only a tiny portion of the actual expense. The rest is subsidized.

                        finally look at this outlook

                        Support Col Hackworth's watchdog group for the troops with money or a sign

                        by Dburn on Sun Dec 09, 2007 at 01:47:51 PM PST

                        [ Parent ]

                        •  The government (0+ / 0-)

                          could auction off payout lists by area [Miami, Brooklyn $$$] and let insurance companies and their clerks audit them.

                          Any fraudulent provider would have to repay the government and pay a multiple to the health insurance company as a finder's fee. A multiple of two if paid within 30 days, a multiple of four if paid after 30 days, and a multiple of eight if paid after a judge hears any part of the case, reducible to six at his discretion.

                          In New York, shoplifters could face the option of paying five times the cost of the merchandise to the store or face the justice system.

                      •  Bill- Medicare fraud (0+ / 0-)

                        Through a variety of billing schemes, phony medical supply companies and payoffs to unscrupulous doctors and patients, these thieves now steal an estimated $60 billion a year in taxpayer money that is supposed to finance health care for 43 million American seniors and the disabled.

                        Consider this a sign becuase thats 22% of their payouts this year. Imagine if they were covering all 2.2 trillion in health care expenditures.

                        Here's the link

                        This is one of the causal effects of the much vaunted 3% administrative overhead. If you add back in the fraud it brings it right into the 25% range. The govt subsidizes much of the program. Employer receipts covers around 30 Billion or so. The Govt can't subsidize anything really.

                        The directed taxes that Krugman advocates would have to cover all of the expenditures. The system of trust that was established with Medicare which is one of the reasons fraud is so high is becuase of minimized paperwork won't work with this much money. These same people will now see a 2.5 trillion dollar pie.

                        That's some big time bucks. One would have to be blind to see that Medicare is going to have to put more into administrative overhead to cut down on the fraud.

                        There's just no free lunch. There's your proof. I think I've covered everything. This is also why none of the candidates are committed to much. A single payer plan that was truly a plan would be far more involved even in summary form than a one page statement or a few pages like  HR 676.

                        Support Col Hackworth's watchdog group for the troops with money or a sign

                        by Dburn on Tue Dec 11, 2007 at 06:34:14 PM PST

                        [ Parent ]

                  •  Defense spending (0+ / 0-)

                    as an overall percentage of govt spending is in the neighborhood of 16% not counting wars. Ok we cut that down to 8%. The interest on our debt now is greater than defense spending.

                    Looking over the GAO projections who use only existing legislation, past growth patterns etc, entitlement spending grew to 53% of Govt by 2006. The Head of the GAO who is non-partisan says that if we stay on the current path, within 10-20 years taxes will have to go up 60% and govt - all govt will have to be cut 50%. Interest payments alone will be 33% of the annual budget.

                    He has mentioned we cannot grow our way out of this plan. Growth in the 90s when 22 Million jobs were created was 2.9% GDP annualized and adjusted for inflation. Even if somehow we could get to double digit growth inflation would be relentless. So we can't grow our way out.

                    These forecast don't assume anything but conservative growth and the obligations we have now based on current tax rates and with the tax cuts expiring in 2010. They factor in the explosion of payments that start next year as the first of the boomers retire. By 2011 when Health Insurance has gone up another 50%- and it will.

                    Boomers who didn't die will be rushing to get signed up for Medicare at which point we will witness and explosion. As many friend who are on Medicare said to me when they turned 65. "I can now afford to get sick".

                    So we are borrowing 500 Billion a year and we are paying 220 Billion a year in interest now. Lets cut defense in half to 230 billion. That halves the deficit but the debt increases each year. As the dollar continues to weaken the Fed eventually will have to raise rates if the Govt cannot produce a surplus. That means interest costs go up. How high can they go? Don't know. We sustained 22% rates in 1980 to get rid of inflation, but Govt debt was 1 trillion at the time or 2.5 trillion adjusted for inflation.

                    Deficits became in vogue in the Reagan years. It also became a vogue to use trust fund surpluses to cover deficit problems. That's why you have to listen to Bonddad when he tells you what we actually borrowed each year vs what the stated deficit is. Assuming a 50% cut in defense and no wars we could probably get the real deficit down to 100-200 Billion until the Boomers start retiring. Then we have to somehow come up with the money we have taken from those trust funds.

                    Interest costs could easily replace all of defense spending if it were cut to zero. No one is going to take on the MIC. They'll have some cuts, but I suspect it will be more like 100 Billion once these BS wars are over which of course all the candidates wish to carry on until 2013 and greater ( The Front runners)

                    So, even if you want defense spending to be cut, it won't, becuase Congressman like Murtha and Lewis will see that their favorite source of earmarks stays healthy. They are number 1 and 2 respectively in defense earmarks. As far as the Presidential Candidates. I have no idea WTF their problem is and who is advising them. I have to assume it's oil.

                    Maybe 10 years from now if we are lucky. Not anytime soon.

                    www.gao.gov.  Spend some time there. Get educated. It will help you change the way you look at things and promises that are made as the GE  approaches. It's reality. That's what we want right?

                    Support Col Hackworth's watchdog group for the troops with money or a sign

                    by Dburn on Sun Dec 09, 2007 at 12:52:52 PM PST

                    [ Parent ]

                    •  "Not counting wars"? (2+ / 0-)
                      Recommended by:
                      chuckvw, kyril

                      That's a heck of a thing not to count...but that's Bush accounting.

                      Regarding Medicare, does the "Medicare for All" bill assume that Medicare would be funded the same way it is now? Because I thought the idea was to capture some of the premiums currently paid by employers--which I'm sure is a hell of a lot. Health Insurace can cost upwards of $1,000 and more for a family...are you saying that if that family was paying in, say, $300 to Medicare the system would still be broke?

                      "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

                      by Alice in Florida on Sun Dec 09, 2007 at 05:19:08 PM PST

                      [ Parent ]

                      •  Wow.-War costs and the real cost (0+ / 0-)

                        are projected at over 2.2 trillion. So yes it's a huge factor.  

                        Here's what I found just poking at the GAO and the CBO. Medicare and Medicaid expenses were around 500 Billion last fiscal year. Total Health care spending is around 2.2 trillion dollars. Total Receipts for 2007 for the Govt was 2.56 Trillion. The deficit was around 170 Billion plus social security for a total of about 450 billion.

                        Medicare/Medicaid covers 43 Million people. In order to cover 230 Million more we could probably be safe and put a 2.5 trillion dollar price tag on a Govt insurance program. We'd also have limited borrowing power so this is just a shot. We would need to collect 2.0 trillion in additional revenues just to maintain our current financial status quo.

                        The question is where does the 2 trillion come from? The total collected from individual taxes was a little over a trillion. So no way that people will pay double or triple taxes for national health care so massive cuts would have to be made. Just cutting the war expense and defense gets us to a 1.5 trillion.

                        It would be a progressive tax where people under certain income levels would pay nothing or a tiny amount, shit, I could give the number but it's useless because no one could pay it.

                        Remember we are covering everyone now. That means if we are spending 500 Billion for 43 million in Medicare/Medicaid it would be safe to add another 300 Billion for the 47 million uninsured. So that means 2.2 trillion in total expenses. Around 1.7 trillion in increased collections. I don't think so. Even cutting it in half or 2/3 thirds is a stretch if we cut delivery and cut govt outlays to the bone. That would still require a 30-60% tax increase at the individual level or a 20-40% tax and doubling corporate taxes.  

                        Ain't gonna happen cause of the deficit. Figure on the 1.7 trillion number and 60-90% tax increase at the individual level and 40-80% at the corporate level. Also remember the number goes up 6%-7% a year, so unless wages increased proportionally, there would have to be annual tax increases.

                        No wonder I couldn't find the details on this. No one would ever put this to paper and survive politically. lol

                         

                        Support Col Hackworth's watchdog group for the troops with money or a sign

                        by Dburn on Mon Dec 10, 2007 at 01:31:37 AM PST

                        [ Parent ]

                        •  Too many assumptions (0+ / 0-)

                          Of course this is a complex matter, but your assumption  of what single-payer healthcare would cost seems to rest on the assumption that there are no savings to be realized in healthcare spending. You also seem to think that extending Medicare to people currently not covered would cost around the same per capita as those currently under Medicare--ignoring the fact that Medicare covers those populations with the highest need for healthcare services (the elderly and disabled). Extending Medicare to young and healthy populations would certainly reduce the per-capita cost, since it would be bringing in people whose utilization rate would be drastically lower than those already in the system. As for increasing people's pay...actually the majority of people who have health insurance through their jobs actually get paid a lot more than they think...they don't see what their employer puts into their health insurance premiums. Maybe if everyone saw on their pay stubs how much their current insurance costs them, they would be willing to entertain a tax to support national healthcare which would a lot of money but still much less than what they're paying now (without knowing it). I found a figure on the National Coalition on Healthcare that says the average premium for health plan covering a family of 4 is $11,500 (2005). That is way more than the average family of four pays in income taxes, and that's just premiums.  

                          Anyone who says we can switch to single-payer healthcare tomorrow is full of it...but those who say we can't afford national health are also full of it. Cutting the private insurance bureaucracy, the amounts wasted on paperwork and skilled workers to handle it (people who could be doing something productive) would yeild huge savings.

                          "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

                          by Alice in Florida on Tue Dec 11, 2007 at 07:53:03 PM PST

                          [ Parent ]

                          •  Cut 700 Billion off (0+ / 0-)

                            Does that care of the assumption. That's a big enough  mistake area to drive a truck through.  Then Add I trillion to Corporate and Indivdual taxes.

                            So we then get into a means test for income . That pushes the 1 trillion to a smaller portion of the population say all those earning 60K and above. Anyone making 200K or more would probably be against it. That leaves support in the 60K to 199K income groups. Cut that in half for ideology, party, selfishness and you have a minority who would want to swallow that.

                            The road to national health care is via policy attacking the profit of the providers.
                            That means drugs . It means 400-500K specialist earnings who have to be cut in half just to lower procedure costs. For profit hospitals would get regulated.

                            Now if the govt did this and was successful against the push. I think it would work. Because it drives the stock prices of the for profit delivery companies into the ground where the Govt could afford to buy them and have willing Sellers. Then you have a true national health care plan.  

                            Private Health Insurance is a problem that is really a reflection of the much larger problem. We have the highest costs in the world for health care delivery. Ignoring that and attacking just the insurance side  is a road to failure.

                            Medicare fraud is running 60 Billion a year now or 18% of the pay-out. Medicare covers 43 Million people  out of 300. We add to that 257 million people and that's 6 times the fraud potential

                            That's almost as big as the annual deficits ( the real one) the govt runs now. Forget the insurance and look to make the health care business unattractive to investors and then the Govt could provide a Canadian like experience.  More-over, the Congressional Turds would have monied interests bigger than the Health industry to help them with policy: The Big business and small business lobbyists .The Non-profit lobbiests that have big money. Look at Harvard's endowment just as an example. That's some serious money there.  

                            You have to drive a wedge between the money people before policy can be turned into law. If it's not done, you face a monolithic giant that will roll over national health care /insurance like a steam roller.

                            Support Col Hackworth's watchdog group for the troops with money or a sign

                            by Dburn on Fri Dec 14, 2007 at 11:56:39 AM PST

                            [ Parent ]

                •  Our whole health care system is going broke (11+ / 0-)

                  at the health delivery level. ERs are turning into disaster areas. Nyceve's diaries attempt to address the problem by raising awareness.

                  You make many claims but don't provide much supporting evidence for those claims.

                  Insurance companies take their own cut and shift costs. That's why countries that have single payer can afford more health care for less. The sickest patients get shifted onto the taxpayers' tab by insurance companies. Single payer is the most effective way to begin cutting unnecessary costs.

                  As for fraud, enforcement can be stepped up. Insurance companies are defrauded by unscrupulous hospitals and providers, just as Medicare is.

                  Making for profit hospitals illegal is one way to cut incentives for fraudulent billing. For profit hospitals have a strong incentive to pad their bills.

                  "It's the planet, stupid."

                  by FishOutofWater on Sun Dec 09, 2007 at 09:08:52 AM PST

                  [ Parent ]

                •  These diaries do a great deal of "good" (6+ / 0-)

                  I see you have bought into the government can't afford to cover everyone concept, but did you know the our government already pays 50% of the health care for everyone?
                  We have multiple government plans:
                  Medicare
                  Medicaid
                  Worker's Compensation
                  Tricare
                  Champva (and several related programs for veterans)
                  FECA (Black Lung)
                  Federal Employee insurance plans (there are about 1,000 different policies...or so it seems)
                  State government employees (another 1,000 or so policies)
                  Local government employees

                  The only people not covered by government insurance are the people paying to supplement these plans.

                  As to Medicare going broke. That goes to: "If you repeat a lie long enough and loud enough, people will come to see it as truth." The surplus funds collected for Social Security and Medicare have gone into the US general fund for years. These programs are still collecting a surplus of funds, but the surplus hasn't been invested into anything like T-Bills. It's been spent on whatever. The surpluses are to end starting anywhere between 2010-2050 depending on the source du jour.

                  We can pay for healthcare for all. (I would select Tricare over Medicare as the best governmental plan, but the people here like the Medicare name.)
                  Here's a couple sites for you:
                  PNHP
                  PNHP's support for HR 676
                  John Conyer's explanation of HR 676

                  You are correct in noting that reigning in healthcare costs will need to address how physicians and hospitals determine what care to give. Right now we have a system that rations care based upon income or the patient's ability to pay for the care they receive. A more rational system would ration based upon patient outcome - giving prevention and education a priority. A single payer system would need to address over utilization, fraud and abuse, which both Medicare and Medicaid do a decent job in detecting and prosecuting. It will also partially negate malpractice issues as since all care would be rendered under a "single-payer"; the care for medical error would be bourne under the system.

                  Going single-payer would be in name only. Currently, both Medicare and Medicaid operate under fiscal intermediaries, about 50 each. (Worker's Compensation might even make sense after being tucked into a more rational based system.) These privately held companies (fiscal intermediaries) administer the Federal Health plans at a cost plus basis. To cover everyone, we would expand the fiscal intermediaries to about 250-350 (segmented by population, area or claim type). All would have to follow the same rules. Condensing the payers from the current thousands with differing, arcane reimbursement rules to a single play book would be a vast improvement.

                  If a nation expects to be ignorant and free, in a state of civilization, it expects what never has and never will be. Thomas Jefferson

                  by JDWolverton on Sun Dec 09, 2007 at 10:46:55 AM PST

                  [ Parent ]

                •  Excuse me. . . (7+ / 0-)

                  Insurance companies will exit the business and/ or raise prices where $8300 a year will seem cheap with a $5,000 deductible.

                  $8,300 a year with a $5,000 deductible is more of a norm than it is unusual.  Where have you been?

                  "Our lives begin to end the day we become silent about things that matter." ~ Martin Luther King, Jr.

                  by givmeliberty on Sun Dec 09, 2007 at 12:45:49 PM PST

                  [ Parent ]

              •  Overhead (2+ / 0-)
                Recommended by:
                ichibon, kyril

                One quarter of our insureds health care dollars are going into insurance company overhead.

                Well, of course!  Someone's got to pay for those spiffy buildings and travel to "conferences" at Hilton Head.

                Right the Wrongs...Gore in 08!

                by creeper on Sun Dec 09, 2007 at 02:12:43 PM PST

                [ Parent ]

              •  the problem is that "overhead" (3+ / 0-)
                Recommended by:
                nyceve, chuckvw, kyril

                is actually what makes health insurance the big money.  I fear we'll have to pry health care away from insurers using a very big and nasty stick.  None of the top 3 candidates is really up to that job - though Edwards is closest.

            •  I agree (13+ / 0-)

              My health insurance costs for my husband & myself are $13k annually...luckily my employer pays $8k of that. I still have to fork over $5K a year in deductibles, and co-pays for visits, meds, procedures..and I'm one of the lucky ones!
              We must eliminate the health care for profit...it is inherently a flawed system with a built in conflict of interest.

            •  I Just Spent Ten Days (5+ / 0-)
              Recommended by:
              chuckvw, zett, ichibon, gkn, kyril

              battling my prescription drug plan to get them to cover Prevacid for a bleeding esophagus.

              The experience was a nightmare.  They knew better than the doctor I've been going to for twenty years.  "Try Prilosec," they said.  Did that.  Bleeding returned.  "Well, maybe you could consider Nexium...no, wait--that's not covered either.  You'll need to have your doctor file an appeal."

              I didn't do that.  I started asking for supervisors.  By the time I got to the fifth level of the bureaucracy I finally reached someone who had the authority to say "Yes."

              The worst part of this experience is that I am otherwise healthy as a horse.  I can't imagine what people with serious medical problems experience at the hands of insurance companies.

              Right the Wrongs...Gore in 08!

              by creeper on Sun Dec 09, 2007 at 02:10:52 PM PST

              [ Parent ]

          •  Only a single payer (9+ / 0-)

            would have the incentive to provide care that is concerned with promoting health and reducing overall cost to the system.

            That single payer must have extensive citizen oversight- to the point of transparency.

            Congress shall make no law... abridging the freedom of speech, or of the press.

            by gravitylove on Sun Dec 09, 2007 at 08:07:48 AM PST

            [ Parent ]

          •  So true, Fish (2+ / 0-)
            Recommended by:
            ER Doc, FishOutofWater

            The "Well, duh!" factor is high with this one. It may be the single most important question in the discussion.

            I am not hopeful. The forces of Capitalism Run Amok will prevail on this one, I fear.

            What if the hokey-pokey really IS what it's all about? -Anon.

            by deha on Sun Dec 09, 2007 at 09:05:41 AM PST

            [ Parent ]

          •  I saw that the various US governments, (0+ / 0-)

            Feds, States, Cities, Counties (in New York, for one)pay 48% of all medical bills anyway!

            Can't link, any help?

            Do you have a child? Will you send her to the war?... anon

            by andreww on Sun Dec 09, 2007 at 09:26:00 AM PST

            [ Parent ]

          •  None of the candidates plans address (0+ / 0-)

            that issue. We have the most expensive health care which by world standards is at the bottom in term of quality. If our Health Care system had to compete with someone else's like a company it would be driven out of business in a heartbeat.

            GP Doctors seem in favor of a single payer plan, but then again they make less than most congreeman. The ones that are the block inthe road are the specialists who charge outrageous rates to insurance companies becuase they expect to make large amounts of money.

            It made me sick to read a new revelation ( for me) that body part replacement companies (Joints , screws, stents etc) pay surgeons up to 2-3 million a year -individually if they use their product. Well someone pays for that.

            That is another special interest group among many that have the money to buy congress off and continue to raise rates becuase they bill insurance companies.

            Like I have mentioned, there will be an inflection point. When the entire economy dies becuase of health care costs- banks go under- companies shutter then all of a sudden no one can pay for insurance. At that point a lot of death would occur- more than now until providers started to get realistic with rates.

            I don't expect Govt to be of assistance until the day it's fiscally sound - which may be never and free of cash and carry policy. When Edwards mentions that Lobbyists stopped one of his plans, that's just a little disingenuous. Lobbyists only talk to congress people and they choose whether or not to accept the bribes and gifts and ultimately how they vote.

            Until Congress is clean, even policy changes that could decrease costs are going to go nowhere.

            I read his plan and it doesn't even mention the cost of healthcare.

            Support Col Hackworth's watchdog group for the troops with money or a sign

            by Dburn on Sun Dec 09, 2007 at 11:59:36 AM PST

            [ Parent ]

            •  I'm sure (0+ / 0-)

              there are some (very few) surgeons paid like that to use given artificial joints, etc.

              However, I know a hell of a lot of surgeons, and not one of them is paid by their suppliers - at least, not beyond the occasional meal or travel costs to learn a given procedure.

              I don't think pharma/biotech/etc. should be allowed to do any of those things, either.  But it is very, very far from the norm for surgeons to be "bought" as you claim.

              Politics is like driving. To go backward, put it in R. To go forward, put it in D.

              by gkn on Sun Dec 09, 2007 at 04:19:37 PM PST

              [ Parent ]

    •  The only honesty I've heard... (16+ / 0-)

      is from Dennis Kucinich.

      "The truth shall set you free - but first it'll piss you off." Gloria Steinem

      Iraq Moratorium

      by One Pissed Off Liberal on Sun Dec 09, 2007 at 07:45:25 AM PST

      [ Parent ]

      •  Yup. I wonder why even talk about (4+ / 0-)

        "when President ClintonEdwardsObama is inaugurated?" since we still seem to have the option of not-for-profit-single-payer-healthcare already on the table by a Democrat-who-is-running-for-President... Why keep ignoring him? What is up with this?

      •  If that was HR676? (1+ / 0-)
        Recommended by:
        SingleVoter

        It has zero chance of passing. It won't even reach the floor. If Kucinich authored that , there was no honesty in there unless he is deaf dumb and blind to how his colleagues do business.

        What it did do was give people false hope and a place where congresscritters could hang their hats on the health care debate. One look at the plan though and anyone wise to ways of congress can see it would never get to any presidents desk. 80 Co-sponsors does not make a bill into law.

        Whoever wrote it who spent more than two years in congress and has an IQ above 80 knew it had no chance. IMO it was cynical piece of crap designed for fellow congress people to say "I coposnsered HR 676 knowing fully well most people won't read it and if they did, not see the weak points that would make it impossible to pass.

        But some people would beleive if we only had more democrats then it would become reality. It has no chance. None. It's maddening to me becuase it gives people false hope.  

        Support Col Hackworth's watchdog group for the troops with money or a sign

        by Dburn on Sun Dec 09, 2007 at 11:32:50 AM PST

        [ Parent ]

        •  Dburn, I fear some of what you say (1+ / 0-)
          Recommended by:
          SingleVoter

          may be accurate, particulalrly this.

          designed for fellow congress people to say "I coposnsered HR 676 knowing fully well most people won't read it and if they did, not see the weak points that would make it impossible to pass.

          I certainly wouldn't call it a piece of crap.  Whether anyone ever thought there was a snowball's chance in hell for passage, you could be correct.

          I will say, I have been told, and I believe it 100%, for John Conyers, if he could only pass one bill, it would be HR 676.

      •  But OPOL, Kucinich is going to be . . . (0+ / 0-)

        the nominee, so we all have to choose from among those we think is best, can get elected, and once elected deliver some profound change.

    •  Eve, please check out this. (27+ / 0-)

      Edwards Evening News Roundup: Taking on Health Insurance Co!

      And this:

      As part of "Building a Better America" week, Edwards calls for stronger insurance laws to prevent abuse and ensure American families can get the care they need

      Manchester, NH – As part of "Building a Better America Week," John Edwards announced today a bold policy to improve the quality of health care in America by taking on health insurance companies and preventing the abuses and gaps in health coverage that put millions of Americans at risk.

      "My proposal for universal health care will cover every man, woman and child in America – but that's not enough," said Edwards. "Right now, even families that have health insurance are often unprotected from catastrophic events, as insurers reject legitimate claims, impose coverage caps, and look for technicalities to cancel policies.

      snip

      Insurance Industry Abuses: The current health care system is broken, often letting down even families with insurance. The abusive behavior of insurance companies includes:

      Designing confusing forms and procedures that make it very difficult for patients to claim the benefits they deserve and forcing patients to hire paperwork consultants. [Pryor et. al, 2007; NY Times, 10/13/2005]

      Using complex and unfair rules to cancel insurance policies after people get sick, despite accepting past payments. California regulators fined one insurer, Blue Cross of California, $1 million for violating state rules and abusively canceling insurance policies from 2004 to 2006. Another insurer, Health Net, paid bonuses based upon the number of patients whose policies were canceled for technicalities. [Pryor et. al, 2007; Sacramento Bee, 8/29/2007; LA Times, 3/28/3006 and 11/9/2007]
      Wrongly denying medical treatment needed to live and covered by insurance. [Wall St. Journal, 11/16/2007]

      Charging patients more for "out-of-network" doctors at "in-network" hospitals, leading patients to unwittingly incur thousands of dollars in bills despite trying to follow the rules.
      Creating procedural barriers and paperwork that keep doctors from providing needed care.

      John Edwards Announces Bold Policy To Prevent Health Insurance Company Abuses And Protect American Families

      "The truth is the system in Washington is corrupt." John Edwards

      by TomP on Sun Dec 09, 2007 at 07:49:19 AM PST

      [ Parent ]

      •  Thanks so much Tom . . . (19+ / 0-)

        excellent and fact filled comment.

        Under Edwards, would I pay the same amount as my Congressperson for the same level of coverage?

        This is a very important question for me and others, I'm sure.

        Tom, I cannot continue to pay these outrageous premiums, then have to go to battle for every claim.

        •  I don't know the specific answer, but (7+ / 0-)

          costs are subsidized up to 100,000 of income.

          I am pretty sure yuur premiums will go down.  Competition from the single payer portion would seem to ensure that.

          "The truth is the system in Washington is corrupt." John Edwards

          by TomP on Sun Dec 09, 2007 at 07:59:18 AM PST

          [ Parent ]

          •  well tom, frankly this isn't great news . . . (13+ / 0-)

            Why are we heavily subsidizing Congressional healthcare?

            I believe they make $163,000, shouldn't the American people receive exactly what Congress rewards itself?

            •  "We" are heavily subsidizing Congressional (10+ / 0-)

              healthcare so that Congress people don't have to feel the pain that the rest of Americans do. Because if they did feel our pain, they might actually try to do something to fix the system.

              I figured that surely you would understand that.

            •  So, would you be OK if (1+ / 0-)
              Recommended by:
              SingleVoter

              congresspeople made $155,000 and paid for their own health care like you with the other $8,000?

              I realize I am one of the more obtuse posters here, but I just cannot understand your obsession with getting the same health care package as the members of congress - sure, one issue is whether they are over- or under-paid.  It seems like a completely separate issue is health care for the rest of us.

              •  Sounds like you've never been on COBRA, and (10+ / 0-)

                been denied further coverage.

                I cannot express the relief and help that having the same coverage for the same price as Congress would give to millions of Americans

                Instead of paying $1,200 a month for coverage which then runs out and then  being uninsurable for almost any money (for the prior condition of psoriasis, I kid you not!), a family like mine would be insured for a couple hundred bucks.
                --And be insured.
                --And not lose all savings to the insurance corporations.
                --And not go bankrupt!
                --And not become eaten up with worry.
                --And not be haunted by the fear of being fired yet again.
                --And not be virtual slaves to companies which provide benefits.
                --And etc.

                •  Sure, I understand that (0+ / 0-)

                  but I am sure that it would be a huge relief for everyone to be give the same salary ($163,000/year) as congress.

                  I'm not saying that people shouldn't have health care, I'm just wondering why EVERYONE should be expected to receive the same financial compensation as Congress. Personally - and this is hypothetical - these people have a tough job and they SHOULD get way more pay than the average person.  which, once again is a completely separate issue than whether EVERYONE should be provided with adequate health care.

                  I'd say it three more times, but doubt if that'd be all that helpful . . .

                  •  WRONG. (9+ / 0-)

                    Congress should have the SAME healthcare as every other American citizen. They can be compensated other ways for their tough job, which they're hardly doing anyway. Note the ignoring of the electorate and the continuation of this stupid war.

                    Edwards: Giving us hope, giving greedy corrupt bastards hell

                    by cosbo on Sun Dec 09, 2007 at 10:06:31 AM PST

                    [ Parent ]

                    •  Why do you say "WRONG" ? (0+ / 0-)

                      when you said essentially the same thing that I did (Congress should have the SAME healthcare as every other American).

                      I agree with that.

                      What I'm wondering about is the obsession over how much financial compensation Congresspeople receive for their doing jobs.  

                      •  Wrong because if Americans had (2+ / 0-)
                        Recommended by:
                        chuckvw, splashy

                        the same health plan as Congress, we'd be better off.
                        If Congress had the same health plan as Americans, they'd be as fucked as we are.
                        The right or wrong of it depends on whether you're talking in the now, or in the what if.

                        Virginia Wilderness Bill passes House! Thanks for the help, kossacks!

                        by emmasnacker on Sun Dec 09, 2007 at 01:50:29 PM PST

                        [ Parent ]

                        •  I think that's exactly what scares a lot of (0+ / 0-)

                          people - i.e., you dictating exactly what their health care plan should be.

                          Right now, I have 7 choices for health care, ranging from me paying out $70 a month to over $5000 a month.  Let's say I could afford the $5000 a month option (I can't, since I don't even make that much money, but that's not really the issue here - there are some who can) - don't you think that the people who opt for this level of coverage would object to their decision to spend their money on it (as, let's say, a new SUV every second year).

                          So you say, let's just give everyone the $60,000 a year health care (which is presumably what Congress is receiving).  

                          Do the math, the country can't afford it.

                          Which is not to say that the country can't afford a basic level of health care for everyone on par with Canada, the UK, Germany, etc.

                          How is that so difficult to understand?  

                        •  Another thing (0+ / 0-)

                          you say you want Congress to be a fucked as we are.

                          Yeah, that's feel good rhetoric, but really, don't we want top notch, qualified people to serve?  Under your scenario, I bet the quality of congresscritter would decline even further (even though that might not seem possible)

                          •  Huh? (0+ / 0-)

                            I want Congress to be as fucked as we are?
                            What scenario? Mine? Where?
                            Where did I dictate exactly what their health care plan should be?
                            Are these replies to my post?

                            Virginia Wilderness Bill passes House! Thanks for the help, kossacks!

                            by emmasnacker on Sun Dec 09, 2007 at 03:27:04 PM PST

                            [ Parent ]

                          •  You said (0+ / 0-)

                            If Congress had the same health plan as Americans, they'd be as fucked as we are.

                            and in the same post insinuated that Congress and Americans should have the same health plan.

                            Which means one of two things:

                            1. Americans would rise to the level of Congress
                            1. Congress would sink to the level of Americans

                            Since there is absolutely no way in hell every American could be provided with the health care package of someone making $163,000/year - only the second option has anything approaching practicality.

                            Hence, you were suggesting that - for all intents and purposes - Congress should be put in the same boat as all of us.

                            While it's always popular to dump on Congress, my point is merely that I do not begrudge those idiots their financial compensation (or at least their 'official' financial compensation - what they rake in from lobbyists is entirely a different matter - and I don't think taking away their cushy health plan would make them any less likely to eschew that gravy train .  .  .)

                          •  insinuated? (1+ / 0-)
                            Recommended by:
                            chuckvw

                            you were suggesting that

                            Please don't make up things and claim that I said them.
                            Please don't make assumptions about what I think.

                            I suggested only that IF they had what we had, IF we had what they had, that segment of the population would either be fucked, or better off.

                            I understand your point about it being financially impossible for all citizens to have what the congress persons have for health insurance. You don't need to make shit up to make your point.

                            Virginia Wilderness Bill passes House! Thanks for the help, kossacks!

                            by emmasnacker on Sun Dec 09, 2007 at 04:43:34 PM PST

                            [ Parent ]

                          •  Sure, but if you say something (0+ / 0-)

                            you can't really then immediately turn around and deny the logical consequences of your statement.

                            For example, if all Americans had the level of health care the Congress has, you postulate that everybody would be better off.

                            I sincerely doubt that would be the case - from the sounds of it, Congress has very inefficent health care - and if it were replicated across society, health care costs would go from 16% (if that's what they are now) to maybe 40% of this country's economic output.  Something else would suffer a corresponding decrease in funding (if it were the military, great, somehow I doubt that it would be however).  At the end of the day, it'd be a tossup if everyone would be better off - they might be better off healthwise but if the highways were in shambles, the court system even more dysfunctional, etc - people might look back on today as the 'good ole days'.

                            OTOH, if EVERYBODY had basic care at the level of Canada or the UK (at 10% or less of the GDP), then I think it'd be a lot more likely that everybody would indeed be better off.  I think the key is not to increase spending levels obscenely, just keep the current levels and distribute the funds more equitably (making provisions, of course, for those who wish to spend their own money on a much higher level of "care").    

                        •  No, they'd probably find a way (0+ / 0-)

                          for someone to make sure their costs were covered - the AMA, big Pharma, insurance companies...

            •  What? I do not understand (1+ / 0-)
              Recommended by:
              mdgarcia

              your point.

              People who will pay for insurance, not congressional subsidies.

              "The truth is the system in Washington is corrupt." John Edwards

              by TomP on Sun Dec 09, 2007 at 09:00:35 AM PST

              [ Parent ]

        •  Some sort of answer. (3+ / 0-)
          Recommended by:
          cosbo, barbwires, mdgarcia

          Nyceve, I have not heard Edwards compare what you would pay to what Congress pays, and I don't know what they pay. I have heard him or Elizabeth say that between subsidies and cost savings in his plan, people would pay no more than 5% to 7% of their income for health coverage, which is much less than many are paying now. And I'm sorry, I don't have a link to this. I heard it from one of them at an Edwards event.

          I guess this isn't quite the answer to your question, but it's something along those lines.

    •  Practical Answers (2+ / 0-)
      Recommended by:
      vivacia, kyril

      The American people want some practical answers, which frankly I haven't heard.

      You're right. Clinton's, Edwards' and Obama's plans all are incredibly thin on practical details. At seven pages, Edwards' core plan is the thinnest. Bulk-wise, Clinton's and Obama's plans are about the same at about eleven pages each not counting pictures (4pages Clinton), citations (3pages Obama).

      I think this partly is in the nature of the legislative beast, and practical politics. These things have to be negotiated, and any detailed approach is vulnerable to high caliber sniping.

      That said, Krugman has lost a good measure of credibility on this issue with me because I read the plans myself to consider Krugman's comments on the merits.

      Mandates have problems with enforcement, non-compliance, exemptions, and coverage affordability in the case of low-income workers. These issues are not resolved in Clinton's plan. The "free rider" issue raised by Krugman is misleading to the extent that he implies it is resolved by Clinton's mandate.

      Compared to Obama's plan, Clinton's plan favors industry. Obama's plan is more progressive. Even the mandate is a boon to industry to the extent they get their way on setting prices. All Clinton says about that is that she wants affordable prices, which Obama says as well, but Obama doesn't mandate in the case industry interprets "affordability" differently than low-income workers.

      Examples of ways in which Obama's plan is more progressive:

      1. public-plan-portability (Obama);
      1. sliding scale subsidies (Obama) vs. income-percentage-based refundable tax credits (Clinton)[Read the plans on this one. Health08.org conflates the terminology.];
      1. requiring industry transparency (Obama);
      1. monopoly power restrictions regarding price increases (Obama);
      1. minimum standards for state plans (Obama);
      1. IT investment of $10 billion/yr (Obama) vs. $3 billion/yr (Clinton);
      1. allow drug re-importation (Obama); and
      1. strengthening anti-trust laws (Obama).
      •  Akonitum, the problem is . . . (15+ / 0-)

        without mandates or whatever you want to call it, we have a huge problem known as adverse selection.

        The bigger the pool, the lower the costs.

        If guaranteed and affordable healthcare does not become a part of citizenship, then healthy people will opt out until they get sick, causing costs to be unaffordable for the rest of us.

        This is why we need a system which will include every single American.

        It's that old me/I or us issue that Michael Moore addresed in SiCKO.

        •  But can you imagine... (15+ / 0-)

          Let me use myself as an example. I am, right now, a student. I have no income besides my GI bill, which pays about $9900/academic year. I am an adult with no children and not disabled by Social Security standards. Imagine what would happen to me if I were suddenly mandated to pay even half what you're paying. I couldn't do it. And no refundable tax credit would make it possible.

          To many Americans who are currently uninsured, no premium could ever be affordable. It's just not possible for me or millions of others to cough up even an extra $200/month. Even if we were promised a tax credit at the end of the year, that sort of bill would put us in a poverty death spiral - lose our car because we can't pay for it, lose our job (or school) because we can't get there, lose our home because we have no income. That tax credit would do absolutely nothing to prevent us from ending up homeless on the streets.

          Decent, honest, progressively tax-funded single-payer wouldn't have this problem. Insurance-based systems requiring monthly payments cannot avoid it. If you must have an insurance-based system, at least leave the damn mandates out of it, unless you're trying to kill more people than you save.

          During times of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

          by kyril on Sun Dec 09, 2007 at 08:52:33 AM PST

          [ Parent ]

          •  YES!! (11+ / 0-)

            I'd copy/paste your entire comment, there's nothing I care to leave out.  

            For millions of Americans, this is THE point.  There is no way on God's green earth that I can add another payment into my monthly budget right now.  

            End-of-the-year tax credits mean NOTHING because I can't put off buying groceries or paying for housing until after I file my taxes.  Those are expenditures that simply will not wait.  I do without insurance because I like to eat and have a place to live.

            The apocalypse will require substantial revision of all zoning ordinances. - Zashvill -6.25 -5.69

            by Heiuan on Sun Dec 09, 2007 at 09:21:00 AM PST

            [ Parent ]

          •  Since I am not an American (1+ / 0-)
            Recommended by:
            splashy

            I admit I have trouble understanding your system. :)

            But just to mention it, in Germany students pay only a reduced health insurance fee. Around Euro 50 a month.
            That is, if you aren´t insured already through your parents. If your parents get health insurance by a public health insurance fund, any kids under the age of 25 are automatically insured too.

            And if you´re certain to get a tax credit for next year´s tax declaration, in Germany you can call your tax office. So it´ll get subtracted from your monthly taxes immediately. Can´t you do that in the US too?

            •  Subtraction from taxes (5+ / 0-)
              Recommended by:
              Detlef, alizard, zett, Brooke In Seattle, gkn

              can work if you pay taxes - we can claim what we call exemptions, which lower our monthly tax liability.

              But Sen. Clinton's proposal would be a refundable tax credit, which means that you can get money back at the end of the year even if you don't pay that much in taxes, which is a good thing - but the people who will be hit hardest are those of us with the very lowest incomes like me, and here very-low-income people pay very little or no tax.

              Students here can be covered under their parents' insurance up to age 23. Some college and university health centers offer reduced-price insurance, but many do not (including mine), and I don't expect to see a student discount on the public plans. Besides, that still wouldn't solve the problem for the millions of people who have an equal or lower lower income and are not students; there are many people living in abject poverty in this country.

              Just as a point of comparison for living costs, I'll use the U.S. military's calculations of average rents in various areas (these are average rents for what's considered "adequate housing" for a single soldier at the very lowest ranks, so a 1-bedroom apartment in a moderate-to-low-income neighbourhood)

              Washington, DC metro area: $1234/month
              San Diego metro area: $1209/month
              Portland metro area: $783/month
              Pensacola metro area: $769/month
              Denver, CO metro area: $761/month
              link to BAH calculator

              Heating and electricity bills generally run about $80-150/month most places. An absolutely minimal food budget for survival, as calculated by the food stamp benefits agencies, averages about $21/week, or $90/month. So, assuming someone splits a 1-bedroom apartment, we're looking at an absolute minimum spending of $521-757/month for nothing but shelter, food and heat. If they can't find a roommate we're looking at $951-1424/month.

              Now, the federal poverty threshold for the 48 contiguous states is $10,210 for a single person. In 2006, 12.3% of Americans, or 36.5 million, lived in poverty, meaning they earned this much or less (the larger the family, the less income per person - for a family of two, the guideline is $13,690).

              Therefore, an individual living in poverty who shares a barely-adequate one-bedroom apartment with another individual (not of the same household) can survive most places with enough left over for sanitation, transportation and a slightly more nutritious diet. However, $100-200, the lowest ballpark estimates for the likely up-front monthly costs, is a lot of money for us. Those not sharing housing, or living in two-person or larger households, are far worse off, living on the very edge of what they can afford already - and this extends far past the official poverty line in areas with high costs of living, all the way up to people making $17,000/year or more in the Washington, DC area. And people in this income bracket pay little or nothing in taxes already.

              It's no exaggeration to say that mandated insurance premiums, required to be paid up-front and reimbursed at the end of the year, will absolutely lead to many people being forced to choose between losing their housing and breaking the law.

              During times of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

              by kyril on Sun Dec 09, 2007 at 12:05:34 PM PST

              [ Parent ]

              •  Kyril, thanks for the explanation. (2+ / 0-)
                Recommended by:
                denise b, kyril

                Subtraction from taxes can work if you pay taxes - we can claim what we call exemptions, which lower our monthly tax liability.

                I wasn´t sure about that. Nice to know it´s the same.

                But Sen. Clinton's proposal would be a refundable tax credit, which means that you can get money back at the end of the year even if you don't pay that much in taxes, which is a good thing - but the people who will be hit hardest are those of us with the very lowest incomes like me, and here very-low-income people pay very little or no tax.

                Well, in that case. If the federal government would be ready to pay you back at the end of the year, why not make it a monthly pay-back? It would be just common sense, wouldn´t it?
                (In Germany, the publicly owned health insurance funds have to insure anyone. Regardless of their current income. Their fee a percentage of your current income. Low income, low fee.)

                Students here can be covered under their parents' insurance up to age 23. Some college and university health centers offer reduced-price insurance, but many do not (including mine), and I don't expect to see a student discount on the public plans.

                That seems to be a problem of regulation. Students are usually young and healthy. Low risk, so insurance companies should be eager to insure them on lower rates since later on, they (and their future families) would pay more to stay insured. Especially since students tend to become higher income employees. If that formula doesn´t work in the USA, your system does seem to be screwed. :)

                Besides, that still wouldn't solve the problem for the millions of people who have an equal or lower lower income and are not students; there are many people living in abject poverty in this country.

                See above.
                If you´re unemployed or on social benefits, you´re insured through them. Much cheaper than pay for any emergency rooms visits later on.

                <snip>

                Now, the federal poverty threshold for the 48 contiguous states is $10,210 for a single person. In 2006, 12.3% of Americans, or 36.5 million, lived in poverty, meaning they earned this much or less (the larger the family, the less income per person - for a family of two, the guideline is $13,690).

                Believe me, I know that.
                I was an orphan when I went to university. No family available for help, no assets (poor family) and only the German "Bafoeg" (money subsidy for lower income students) available. Around Deutschmarks 700 per month back then. Including help for rent. Although I should mention that back then health insurance was only around DM 50, if I remember correctly. Long time ago. :)

                Anyway, let´s not get distracted from the main point.
                The main point is, mathematically speaking, you want to insure as many people as you can. To spread the risk. Unless of course - as in the US - you can "weed" out sick people. Which is not possible in Germany.

                That means that:
                a) you´ve got an interest to insure students at low rates. (Good risk, potential higher paying customers later on)
                b) if every insurance company has to pay for preventive care (and people can change insurance companies), it´s in the interest of every company to pay for preventive care.
                c) you have to really regulate the whole market. Make sure that every company offers at least the minimum required by the federal regulation office. (Which helps doctors and hospitals too. Knowing that they get paid for all "normal" procedures.)
                Let them compete only on the extras they offer.
                d) which of course means that health care insurance should be independent of a job. Coupled with the fact that you shouldn´t loose health insurance once you´ve got sick.
                e) all of that will only work if practically everybody is insured (large risk pool).

                In Germany, everyone with an income below around Euro 46000 is required to be a member of a public health care insurance fund (fee a fixed percentage of income). With public assistance for low income employees. Anybody above that and self employed people can choose between the public insurance funds or a private health insurance company.
                Germany isn´t richer than the US but we don´t have 16% uninsured.

        •  Adverse Selection, Cream Skimming, Free Riders (4+ / 0-)
          Recommended by:
          nyceve, Dburn, alizard, kyril

          "Adverse Selection" happens when people who sign up for an insurance plan have costs that are greater than the expected costs that the insurance plan used to calculate the premium.

          "Cream skimming" occurs when an insurer knows more about consumers' expected costs than the consumers themselves and uses marketing or plan design to enroll a healthier-than-usual population.

          The "free rider" problem occurs when recipients don't pay for their care, forcing the rest of us end up footing the bill one way or another.

          "Economy of scale" addresses the observation that bigger pools often can lower costs.

          With regard to comparing Clinton's, Edwards' and Obama's plans, all of these problems remain unresolved.

          Clinton and Edwards' mandates simply do not solve these problems (addressing non-compliance, exemptions, actual costs, enforcement) at the level of detail they have chosen. Regarding these problems, Clinton's plan is weakest (Edwards has begun to address enforcement).

          Without those details, Clinton's and Edwards' mandates equally could be a recipe for a more regressive health care system, i.e, industry exploitation on the backs of workers. Meanwhile, we know with Obama's approach, they have to get it right or the reform will fail by non-participation.

          So that takes us back to your initial observation about unknown practical details.  Moore advocates a single payer plan that begins, step 2, by abolishing all health care insurance companies.

          The obvious problem for Edwards and Obama is that aiming to get to a single payer system in one step would be political suicide. People still are too confused. Popular political will does not yet exist to counter industry's exploitation machine.

          •  "Free riders" (5+ / 0-)

            Isn't that the exact right wing point republicans used to enact welfare reform?  Remember the "cadillac welfare queens"?

            I for one do not want mandates if they are going to be a bonanza to the insurance industry.  

            •  then the only other choice ... (5+ / 0-)
              Recommended by:
              chuckvw, splashy, alizard, Akonitum, kyril

              ... is to eliminate the private insurance companies.  Otherwise the "death spiral" will persist.

              The "death spiral" is that fact that insurance is expensive, so people who are barely making it and are healthy will skip it, while people who are barely making it and are sick will do what it takes to sign up.  This means that everyone in the plan is sick, so costs have to be raised and companies will do whatever it takes to screen out the sickest.

              But if everyone is covered under one plan, there's no incentive to deny care to the sickest.  In fact, the incentives are reversed!  Now the bean counters are going to want to get the sickest people diagnosed and treated early, because that's a lot cheaper than heroic measures in the ICU after they've gone years with no treatment.

              That's why people in countries with single-payer health care live longer.

    •  Excellent questions (3+ / 0-)
      Recommended by:
      nyceve, denise b, cnmbfa

      That is precisely what voters really want to know -- how will your health care plan get me the care I need when I need it and in a way I can afford?

      A really big problem, however, is that Murder by Spreadsheet is not just a problem in the ridiculously expensive and inequitable American health care system.  It is also a large problem in all of the universal health care plans available in industrialized countries -- including single payer. MRI's, to use your example, are simply not prescribed by doctors as often in most other industrialized countries. There are three possible reasons for this: 1) There are not as many MRI facilities available, and/or 2) Doctors have less financial incentive in prescribing MRI's in other countries; and/or 3)Many MRI procedures are not medically necessary, so their prescription is more constrained by the health care systems in the countries with universal health care systems. The same finding of different rates of MRI prescriptions with no effect on health care outcomes can even be found in different states within the United States.

      All of the universal health care systems yet proposed, including single payer plans such as the one proposed by Physicians for a National Health Program, target reducing expensive and often unnecessary procedures such as MRI's as the primary way of reducing the cost of health care.  It's still going to be murder by spreadsheet, regardless of the plan, so I think we need to focus rather a more equitable distribution of health care, rather than the current system of the wealthy getting all the MRI's they need while the rest of us have to scramble and wonder whether it is  our health care provider or our insurance that is screwing us.

      •  An MRI machine (0+ / 0-)

        is simply a machine.

        It can be made in China cheap.

        The average person in their 40s should be getting about two MRI scans a year to search for cancer. In their 50s, about four MRI scans a year.

        A government health care technology manager should be able to summon patent holders and doctors to a conference.

        If the doctor's needs aren't met at congressionally set federal budgeting levels, the patents should be trashed as not meeting the 35 USC 101 usefulness requirement.  

        •  An MRI machine is not exactly cheap, (0+ / 0-)

          MRI machines cost several million dollars and cost more per exam to perform than CT scans -- typically about $1000 although this can vary widely.  Furthermore, the equipment is just a fraction of the total cost of performing an exam in the United States, which also include personnel, liability insurance, administration and facility expenses, etc.

          Although your prescription for frequent MRI's might indeed be a guarantee of finding cancer early, that does not mean such a presciption is good medicine. That's why all institutional health care systems -- from Canadian single payer to American private insurance -- try to employ "evidenced based medicine" practices.  It has not been shown that frequent use of MRI's actually improves health care outcomes, so your prescription for twice yearly exams would never be accepted under any plan -- private or single payer.

    •  My Practical Solution (7+ / 0-)

      Expand Medicare to people 60 and above and those kids seven and under.

      Phase in over five years.

      Expand ages up and down a year at a time.

      After 10 years we're at 55 and 12.

      Those in their 30's and 40's see how well the program works and demand to get in.

      In 8 years nyceve's premiums "jump" from 1.35% of her income to 3%. For nyceve's premiums to equal $8,500 she will then be making $283,333 per year.

      The insurance companies?

      Where in Capitalism does it say that certain companies have a "right" to exist?

      Buggy-whip time.

      Do you have a child? Will you send her to the war?... anon

      by andreww on Sun Dec 09, 2007 at 09:23:11 AM PST

      [ Parent ]

      •  that's what a compromise should look like (2+ / 0-)
        Recommended by:
        andreww, sima

        If we have to compromise with the insurance companies it should be over the duration of their total phase-out in favor of Medicare for all. I would go for a more aggressive phase-in of Medicare for all, like explicitly say we are going to do it for everyone and start with everyone not in the 15-55 age range covered, then shrink the uncovered group a set number of years per year until everyone is covered. That lets the companies plan their exit from this business.

        There are also certainly going to be "controversial" medical expense that won't be covered in any initial proposal that the insurance companies can offer optional insurance on--you can guess what those are based on our Puritanical attitudes toward anything related to sex. In fact, they can offer optional insurance on anything they want, as long as all the basics are covered by Medicare and Medicaid.

        •  We're on the same page. Anybody else? (0+ / 0-)

          Do you know of any "player" who sees the logic of this phasing?

          As to "controversial" procedures and expenses, I'd sure as hell rather complain for coverage to my Congressional Rep (Carolyn Maloney in my case) than to the friendly folks at the insurance company.

          And it's not just sexual stuff. nyceve's MRI ridiculousness will be history (maybe).

          Do you have a child? Will you send her to the war?... anon

          by andreww on Sun Dec 09, 2007 at 01:05:43 PM PST

          [ Parent ]

      •  Also (0+ / 0-)

        put some controls on the insurance companies in the mean time. No turning people down, individuals and small groups put into large pools to get better rates, no penalties for pre-existing conditions, fines for unreasonably jerking people around. Is there any good reason why we can't do this right away?

    •  I just had to go to the ER (0+ / 0-)

      I rolled my foot walking across campus and sprained it.  I was worried on Saturday morning that something was broken in there, so I called my doctor's after-hours nurse and they sent me to the ER for an x-ray, because none of the hospital system's urgent care sites have an x-ray machine.  Fortunately, nothing's broken.  This is going to cost me $200 copay plus 20% of whatever else they charge.  I should have just toughed it out.  Maybe I can learn to perform field surgery on myself like the Javier Bardem character in No Country for Old Men.

      •  Yes, you could have saved quite a bit (0+ / 0-)

        by elevating and icing first. If something is broken, no amount of ice will stop the swelling, and the ER is always there if it won't go down, or in the case of a green break, the pain continues.
        With things as they are, a lot of folks could save themselves a lot of money and trouble if they learned something about how the human body works, and how to treat minor injuries.

        Sorry about yours.

        Virginia Wilderness Bill passes House! Thanks for the help, kossacks!

        by emmasnacker on Sun Dec 09, 2007 at 05:06:54 PM PST

        [ Parent ]

      •  It might be $1000 or more (0+ / 0-)

        if you had no insurance.

  •  RIGHT ON. (23+ / 0-)

    This is exactly what I'd love to hear too.

    Vague reassurances aren't really cutting it any more.

    I don't go to the doctor because I can't swing the co-pays or the annual deductibles.  I skip medication because I can't swing the co-pays.

    "Just for the record: you were right, I'm an idiot, and God bless you." -- Xander, BTVS

    by prodigal on Sun Dec 09, 2007 at 06:56:54 AM PST

  •  Insurance for appearances only (49+ / 0-)

    Look, I have car insurance, but only because it's the law.
    If I have an accident, I don't expect the insurance company to actually help me. Probably raise my rate, or drop me altogether.
    If I get sick, I don't have any real belief that I will be cared for by Blue Cross.
    Insurance is OK for objects, but people are too precious to leave to any insurance policy.
    Universal Health Care, paid for by the tax payers seems to be the only humane way to go.
    Thanks nyceve, fighting the good fight.

  •  What the insurance industry is unethical at least (19+ / 0-)

    and murder at worst.  Pets in this country get better medical care than humans these days......

    It's so frustrating to hear how everyday Americans do their best to jump through all the hoops to get their procedure covered only to find that the anesthesiologist or the guy reading the test results is not covered by the insurance -- after the fact.  It's beyond absurd.

  •  Access. (29+ / 0-)

    There are problems with all of these healthcare plans, but one major one is access. Will each plan require doctors to accept it? What if there is no doctor who accepts the plan within 100 miles? 300 miles? For many Americans living in remote areas (or states with high malpractice insurance) that would become a huge problem real fast.

    It's not just providing affordable care, it's providing accessible care.

  •  Thanks, nyceve (13+ / 0-)

    We need real answers. How are we expected to support any plan with a mandate when we don't know what the cost will be or how the premiums and benefits will be regulated? "Trust me" doesn't cut it anymore.

    During times of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

    by kyril on Sun Dec 09, 2007 at 07:00:53 AM PST

  •  Well we have to do SOMETHING (12+ / 0-)

    Sometimes, when you're trying to empty a container of something into something else, you have to whack it a few times, just to get something moving.

    Maybe we are in a situation like that. The health care industry right now is wired in a certain way to maximize profits and curtail losses, so as to function like any other kind of business. Like making cars, or lawn ornaments.

    But health care isn't a commodity - it's a way that we value ourselves as a people. I'll support anybody who indicates that they will make some changes. I don't need a perfect plan to start with. I'll support anyone who at least indicates that they're gonna whack the container a bit and get things moving.

    Once we're actively changing the system, we can keep tuning it. But right now, there is no change in the cards.

    Every day's another chance to stick it to The Man. - dls.

    by The Raven on Sun Dec 09, 2007 at 07:01:29 AM PST

    •  This is true Raven . . . (20+ / 0-)

      But speaking personally, will I be expected to pay $10,000 a year and still fight with the insurer when President ClintonEdwardsObama sign healthcare reform into law?

      If this is what they have in mind, count me out.

      •  I've been giving this a lot of thought (3+ / 0-)
        Recommended by:
        drewfromct, snootless, gkn

        The health care industry employs so many people, at so many levels, it's impossible to count them all. My own salary is derived from medical publishing, the millions of dollars that flow through the journals, the advertising, the honoraria, it's so much. And as we correct the system and get toward universal provided coverage, seeing it as infrastructure and not widgets for sale, a lot of jobs are going to die.

        The drug reps, many clerical staff, the graphic designers, the advertising people, and the gazillions employed by the insurers. The stock being held by millions of people who own a part of the insurers will need to be made worthless. The armies of people who shill for medical equipment manufacturers will hit the chopping block.

        It won't be pretty.

        I can't see all this happening at the stroke of a pen. The bloodletting will be appalling. Personally, I'm betting that we'll see a mandate for insurance. Everyone will have to be covered - one way or another - so as to get all the healthy people who don't have insurance paying into it and driving down the cost. Next, those premiums will become tax deductions. Once government has absorbed the cost that way, we can start talking about how it can absorb the cost in other ways because we will then know that the cost is containable.

        Perfect? No. But that's how I think it's gonna go.

        Every day's another chance to stick it to The Man. - dls.

        by The Raven on Sun Dec 09, 2007 at 07:19:12 AM PST

        [ Parent ]

        •  How do you compel those alleged (5+ / 0-)
          Recommended by:
          eugene, vivacia, askyron, snout, kyril

          non-paying healthy people into the system?

          I have tried to collect child support from dead beat dads. Not very often but I have.

          It is not a financially winning proposition.

          HRC is among the top 5 people I'd prefer as POTUS come Jan09. How can that possibly be seen as hateful?

          by Bill White on Sun Dec 09, 2007 at 07:36:52 AM PST

          [ Parent ]

          •  Straight outta the paycheck (1+ / 0-)
            Recommended by:
            denise b

            just like S.S. and income taxes.

            Al Qeada is a faith-based initiative.

            by drewfromct on Sun Dec 09, 2007 at 07:38:19 AM PST

            [ Parent ]

            •  If it is to be a payroll tax (15+ / 0-)

              why not exclude the private insurers and go straight to single-payer? I am okay with using tax revenue to fund a single payer system that covers everyone.

              I am not okay with laws that compel people to buy private insurance under penalty of federal sanction.

              Offer an affordable Medicare buy in that circumvents the private insurance industry is my current favored place to start.

              = = =

              But in any event, Hillary, Obama and Edwards, need to pull together and commit that no matter who wins they agree they can and will work together to gte the job done.

              Simultaneous mutual ceasefire on "who has the better plan"

              HRC is among the top 5 people I'd prefer as POTUS come Jan09. How can that possibly be seen as hateful?

              by Bill White on Sun Dec 09, 2007 at 07:42:45 AM PST

              [ Parent ]

              •  Additionally, when you have a gov't requirement (7+ / 0-)

                the insurance companies respond with a cheap "fake" policy that covers almost nothing, at low prices for those healthy, so to maximize their "healthy" coverage at minimal cost. this does little to drive down the prices for those who require coverage.

                The National Guard: They're in firefights over there, so they can't fight fires over here

                by askyron on Sun Dec 09, 2007 at 07:50:45 AM PST

                [ Parent ]

              •  I thought (8+ / 0-)

                If it is to be a payroll tax
                why not exclude the private insurers and go straight to single-payer?

                that's what we were talking about. It's certainly what I meant, anyway.

                I am not okay with laws that compel people to buy private insurance under penalty of federal sanction

                .

                Totally agree. Or, at the very least, any law compelling citizens to purchase insurance must contain strict regulations that guarantee coverage and payment of claims while capping overhead such as profits, advertising, and executive salaries.

                Offer an affordable Medicare buy in that circumvents the private insurance industry is my current favored place to start.

                Perhaps we should consider using education as a model. Every taxpayer supports the system, but those who are rich enough can still go to private providers if they wish to, so long as they pay their own way.

                Al Qeada is a faith-based initiative.

                by drewfromct on Sun Dec 09, 2007 at 08:12:56 AM PST

                [ Parent ]

                •  I'm totally down with that (7+ / 0-)

                  In fact, that must be a cornerstone of anything we wind up with: if you want it, private care must be available. I'm not making it up, either. When I lived in Japan, I participated in kukumin kenko hoken, the national health insurance policy. That worked by charging me a 5 percent income tax, paid just like you pay your IRS tax.

                  But if you wanted, you could always see a for-profit doctor. That works.

                  Every day's another chance to stick it to The Man. - dls.

                  by The Raven on Sun Dec 09, 2007 at 08:45:17 AM PST

                  [ Parent ]

                  •  Kokumin Kenko Hoken (4+ / 0-)

                    I participated in the Japanese national health care plan for most of my adult life.  I never met a doctor who did not accept my insurance "card".  Whether public or private, all medical care cost a fraction of what it costs here while the premiums were very fair.  

                    I realize that my information is dated but twenty years ago while my mother was visiting, she had to have emergency surgery.  She had to pay full price because as a tourist she did not qualify for kokumin kenko hoken.  The total charge (all doctors visits, surgery, hospital recovery, test, anesthesia, ALL of it) came to a grand total of $3000.  If that had been my surgery I would have paid about $900, in addition to the approximately $100 per month premium for my family of four.

                    We had to borrow money to pay the full cost of childbirth in advance, but the prefectural government paid us back the entire amount and then some a couple weeks after the birth of the child.

              •  Congress is going to write the plan anyway (0+ / 0-)

                and it probably won't resemble any of theirs. I just afraid we're going to end up with Medicare Part D redux.

        •  We can do it (7+ / 0-)

          Many of those who are currently employed in for-profit healthcare will still be needed. Even a non profit system will still need trained and experienced administrators who can examine claims to protect against fraud, and even in a universal system, there will still be such a thing as triage, and there will still be difficult and heart-rending decisions to be made about allocation of care. Advertisers and sales reps will suffer some at first, but the money freed up by taking profits and advertising out of medicine will soon migrate to other industries. The middlemen will simply have to adapt to a new marketplace. As for shareholders...if the City of New London can use eminent domain to take family homes so that Pfizer can expand, then it seems to me that the Federal gov't. can certainly compensate stockholders with gov't bonds in exchange for their shares, or pass a law capping profits in the healthcare industry at a modest but very reasonable 3-5%, just as we used to do, and should again, with essential utilities such as water and power. As for the CEO, they've been way overpaid for quite a while now, so they should have enough saved up for a very comfortable retirement.

          Al Qeada is a faith-based initiative.

          by drewfromct on Sun Dec 09, 2007 at 07:37:28 AM PST

          [ Parent ]

          •  Right (2+ / 0-)
            Recommended by:
            vivacia, drewfromct

            Exactly. You're seeing the same landscape I am. Once you start picturing how much has to change, you realize the gargantuan size of the task. When you're trying to chop down a tree with an axe, you don't ponder how many swings it's gonna take. You take the first swing and work from there.

            Every day's another chance to stick it to The Man. - dls.

            by The Raven on Sun Dec 09, 2007 at 07:49:47 AM PST

            [ Parent ]

      •  Call it Romneycare (7+ / 0-)

        Under the Mittster, Massachusetts passed legislation requiring everyone to buy junk insurance, or face tax penalties. I admit to being unfamiliar with the details, so I don't know if it requires the private, for-profit companies it benefits to accept clients with pre-existing conditions, or if it has any caps on multi-million dollar CEO pay. But why would I not be a bit surprised if I were to learn that it requires people to pay the insurance companies while not requiring these companies to deliver any sevices?

        Al Qeada is a faith-based initiative.

        by drewfromct on Sun Dec 09, 2007 at 07:24:41 AM PST

        [ Parent ]

        •  I'd rather call it ExtortionCare (0+ / 0-)

          That renders academic the arguments about whose candidate came up with the idea first (personally, I find a candidate supporter arguing in favor of his candidate originating an ExtortionCare program rather like his arguing that he was one of the 9/11 conspirators - even if true, why tell us if you're trying to sell us on him?) and accurately describes the nature of a "mandatory" profit boost for health insurance company plan.

          Looking for intelligent energy policy alternatives? Try here.

          by alizard on Sun Dec 09, 2007 at 05:53:52 PM PST

          [ Parent ]

    •  We can't afford to gamble on this (16+ / 0-)

      How many people, faced with a mandate to pay premiums the size of nyceve's, would have to choose between starving, losing their homes or breaking the law?

      This is too important to simply accept promises of "regulation" and "affordability." If they fail on either count, people are going to end up worse off and the program will fail due to lack of popular support.

      I agree with you:

      But health care isn't a commodity - it's a way that we value ourselves as a people.

      Which is why I will not support just anyone who wants to make changes.

      During times of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

      by kyril on Sun Dec 09, 2007 at 07:09:16 AM PST

      [ Parent ]

    •  Please see my post downstream (1+ / 0-)
      Recommended by:
      The Raven

      http://www.dailykos.com/...

      Lots that citizens can be (and are) doing.

  •  Incremental change won't work. Single Payer (21+ / 0-)

    is the only solution that can be applied equitably and is the only solution that could immediately generate the revenue to cover the uninsured - by eliminating costly insurance company overhead.

    The devil is always in the details of these plans. And insurance company lawyers and bean counters are masters at manipulating the details. If insurance companies are not removed from of control of the system, they will manipulate the plans to their benefit.

    "It's the planet, stupid."

    by FishOutofWater on Sun Dec 09, 2007 at 07:03:35 AM PST

    •  Agreed (5+ / 0-)

      I had a long discussion this week with someone over the significance and relevance of the newly released unemployment figure. The value of employment as a measure of the health of the economy and an individual or family is decreased since wages are down, inflation is up, and since employees are contributing so much more for employer-based health care (or else gambling on their lucky stars without it).

      Sometimes I wish my antecedents never left Europe.

      "And tell me how does god choose whose prayers does he refuse?" Tom Waits

      by madaprn on Sun Dec 09, 2007 at 07:47:03 AM PST

      [ Parent ]

    •  asdf (4+ / 0-)

      If insurance companies are not removed from of control of the system

      Absolutely key. Until this is done we are just playing around the edges of the issue.

      The end game is the presidency not the nomination

      by stevej on Sun Dec 09, 2007 at 07:48:10 AM PST

      [ Parent ]

    •  There is no other way but incremental (2+ / 0-)
      Recommended by:
      vivacia, Justanothernyer

      The consttution was written to force incremental change.

      I want single payer as much as anybody, but unless we have wide and unqualified consensus, it simply won't happen.

      The same systemic failsafes that kept the GOP from privatizing social security and foisting school vouchers on the nation are the ones that also force us to change heathcare incrementally.

      When I look at Barack Obama, I think about John F. Kennedy, who leaped over Hubert Humphrey's generation to bring in fresh voices and fresh ideas.-Bill Moyers

      by snout on Sun Dec 09, 2007 at 08:11:04 AM PST

      [ Parent ]

      •  "incremental" that involves existing (0+ / 0-)

        health insurance policies is like being "incrementally" pregnant.

        AFAIK, the Founding Fathers did not have protecting the profits of health insurance companies when writing the Constitution.

        Looking for intelligent energy policy alternatives? Try here.

        by alizard on Sun Dec 09, 2007 at 05:55:17 PM PST

        [ Parent ]

  •  i don't have any faith on a system... (13+ / 0-)

    ...that doesn't give the public access to a non-profit, medicaid-type alternative to the for-profits. without this competition for business, they'll never change.

    Hillary 2008 - Flying Monkey Squadron 283

    by campskunk on Sun Dec 09, 2007 at 07:04:30 AM PST

  •  Sadly, I do not much hope for reform (11+ / 0-)

    as long as the Murder by Spreadsheet purveyors of junk insurance are allowed to remain a major part of the system.  The only immediate effect might be something along the lines that Edwards has proposed which would make expanding Medicare to everyone who lacks insurance or does not want to buy the junk insurance.  Unfortunately, to make that option viable, he will need to fight against the AHIP lobbyists and the spineless in Congress.  

    For those of us covered under an employer supported plan, it will be a long time, if ever, before we see change.  The only consolation is getting coverage to those without insurance that is the focus of the Democratic candidates policy portfolios.  If the republicans remain in control of the Executive Branch, the Murder by Spreadsheet racket will steal us blind.

    I believe in an America where the separation of church and state is absolute. - John F. Kennedy

    by DWG on Sun Dec 09, 2007 at 07:08:10 AM PST

    •  Well if you're correct, DWG . . . (17+ / 0-)

      very fundamentally, we're looking at some very bleak endgame for this nation.

      Healthcare costs are projected to consume around 20% of GDP within the next ten years or so.

      This is unsustainable.  Now if you and I know this, you can be sure so do the criminals at AHIP, the candidates of both parties, etc.

      If significant reform is not in the cards, then i don't see how this nation which has relied on a strong middle class, don't know exactly what word to use here, survives.

      •  If we cannot get HR 676 passed (10+ / 0-)

        then the Edwards plan is the best on the table.  He would not mandate insurance until he has set up a viable Medicare-like option and then competitition would force the junk insurance to improve their product.  He would also cap their overhead at 15%.  Obama and Clinton have weaker reform proposals.  

        I guess it is just really difficult for me to be hopeful about reform given the amount of money AHIP is throwing around, the relatively small incremental steps toward reform offered by the Democratic candidates for president, and the track record of the current Congress is pushing back against an entrenched industry, be it the energy companies, the defense contractors, or the AHIP dirtbags.

        I believe in an America where the separation of church and state is absolute. - John F. Kennedy

        by DWG on Sun Dec 09, 2007 at 07:23:27 AM PST

        [ Parent ]

      •  20% is indeed unsustainable (0+ / 0-)

        Once Iraq is shut down, the military will have to be rebuilt.

        We also have to start the most expensive program America will ever participate in, fixing our part of the global warming problem. If this winds up costing less than $100T, I'll be happily surprised.

        We can't afford to piss away money on stupid anymore.

        And subsidizing the class of parasites we call the national health insurance industry is stupid by definition.

        I won't support any plan that depends on the national health insurance industry for service delivery.

        Looking for intelligent energy policy alternatives? Try here.

        by alizard on Sun Dec 09, 2007 at 05:59:11 PM PST

        [ Parent ]

    •  Think of all the money we would have (0+ / 0-)

      if it weren't for Iraq.

  •  Dear Eve: (11+ / 0-)

     The mere purchase of an MRI at your expense indicates that we would be likely to get large bills in the future which our contract would require us to pay.

     We will give you a first class runaround in the strong hope that you will take your premiums and your likely large future cost to one of our competitors.

        Get Lost,

                 Cindy Claimshandler              

     

  •  What I don't understand is why we insist on (24+ / 0-)

    insurance to take care of our health care.

    Insurance is the completely wrong model for how to finance health care.  Look at every other instance where you have insurance: car, life, homeowners, renters, liability, etc.  In all of these cases, the purpose of insurance is to aggregate the risk of a catastrophe across many people, all of whom are unlikely to experience the catastrophe.

    Contrast this with health care, where we consume health services on a regular and continual basis.  Do we really think that an insurance company is the right type of organization to handle this?

    There is an inherent conflict of interest between the insurance company and the insured.  The insured wants to get paid for their claims, and the insurance company makes more money when they do not pay out claims.  This conflict of interest makes for an amazingly bad fit when it comes to something we consume on a regular rather than catastrophic basis.  I am astounded that we are still thinking that somehow insurance companies can be part of the answer here.

  •  Well, I'm no left wing firebrand (15+ / 0-)

    But I've become convinced that well-funded Medicare for everyone is the only solution. There are doctors in my family who would be upset by such a shift. So be it.

  •  We have to start somewhere (4+ / 0-)
    Recommended by:
    vivacia, nyceve, Noodles, alizard

    and all of our candidates are promoting what they believe is the start.  We have to work toward single-payer, end of story.  The insurance companies are not going to go down without a huge fight and folks, neither are most Republicans.  The real issue is who is the candidate most likely to be able to get their plan approved in Congress.  It is really silly to argue about whose plan is best, because what they are saying now is certainly not going to just sail thru Congress in its current form.

    •  I expect (0+ / 0-)

      "national health care" to be passed in the first 60 days of a Democratic Administration.

      I expect the 60 days to be spent removing all the safeguards for patients and the US Treasury that might have originally been in the legislation.

      I expect it to pass with near unanimity due to a insurance industry propaganda and lobbying campaign, and threats to the political career of anyone who dares oppose it.

      I expect a White House lawn signing ceremony with lots of politicians from both parties around taking credit for the "solution to ensuring massive health industry profits extracted from Americans at gunpoint the American health care problem".

      I expect all hell to break loose when tens of millions of Americans find out the hard way that "mandatory" means choosing between complying with Federal law and paying for rent / food / utilities. . . and that complying means buying junk insurance.

      I am hoping for massive blowback against incumbents in both parties.

      Looking for intelligent energy policy alternatives? Try here.

      by alizard on Sun Dec 09, 2007 at 06:05:45 PM PST

      [ Parent ]

  •  Well My DVD If Sicko Arrived Yesterday (15+ / 0-)

    and it went right into the player. I had read a ton about it. Seen many clips. But my gosh I was still blown away.

    The last ten minutes, when the 9/11 workers got free health care in Cuba, was about the most powerful and sad thing I've seen in a long long time.

    I am also sorry you are going through this. I mentioned in one of your post awhile back I went through a similar thing. I fought and fought them, but in the end they just broke my will to fight and I ended up playing the $50,000 in bills myself.

    I was lucky I was able to afford to pay the bills off over a period of time. It hurt. But I am sure most people wouldn't have access to some of the resources (insert money and a lawyer) that I did.

    It is a sad thing on many, many different levels.

    Let us not forget New Orleans. Visit Project Katrina.

    by webranding on Sun Dec 09, 2007 at 07:16:54 AM PST

  •  How about a televised healthcare debate? n/t (2+ / 0-)
    Recommended by:
    opinionated, nyceve
  •  awesome news and thankyou, nyceve (16+ / 0-)

    thanks for this.  Yesterday, I read Krugman's piece and was alarmed about Obama's plan.

    Both my husband and son are classified as uninsurable.  My husband has to work (he was retired) just for family health care.  My husband has Diabetes Type 1 and our son has arnold-chiari malformation, syringomyelia and autism.

    At some point in everyone's life, they will need health care.  It is not fair for insurance to even be allowed to have a say in who or what they will do.  As far as I am concerned, we would be better off without the insurance business in the way of health care.  

    Here is our mri ordeal, I will share with you:  

    Six years ago, our son was having many health problems (he was 4), a neuro psychology professor told our pediatrician we needed an mri and to see a neurologist.  The appointment for the neurologist took 5 months.  When we went to him he told us he would not order an mri even though Vanderbilt University, our pediatrician and a local psychologist all thought we needed one.  We went back to Vanderbilt and more tests.  Finally, one year later after exhausting all tests, an mri was performed.  His cerebellum had herniated and was obstructing CSF flow into the brain.  The CSF blockage formed a cyst in his spinal cord from the top of his spinal cord c2 to middle of his back (t8).  

    He had a craniectomy and decompression surgery the next week and this slowly caused the cyst to shrink.  It is now just in the top of his spinal cord.  The first mri cost $9600 and radiology read was $1800 .  He has mri's each year now because things are better for him.  I worry one day, insurance will say sorry you are tapped out and not cover the mri's.  Facing another surgery would be a nightmare too.  The worst part is our son needs help and monitoring, why is insurance a part of the picture?  They really are an obstacle to getting help.  If we had an mri right away, his cyst would not have grown so large.  A cyst in the spinal cord causes incredible pain and paralysis.  

    •  I worry about caps (0+ / 0-)

      I worry quite a lot about insurance industry "lifetime maximum" caps for things like transplants. I need a kidney transplant. My husband's employer's group insurance has a cap of $500,000. That will get me one, I hope, and everything associated with it, but it probably won't get me more. Many people on the dialysis boards have gone through three or four in their lifetimes so far. There is no cure for kidney disease; transplantation is a treatment, not a cure.

      Medicare will cover 80% of the cost of the transplant once I'm eligible for that, but only after I've been on it for 30 months already. I had better hope to stay on dialysis for at least three years so that I don't use up my lifetime maximum transplant cap the first time. Of course, staying on dialysis longer has other negative health consequences, but the insurance companies don't care. Nor does the government.

      "George Bush remains about as popular as a germ at a medical conference." - The Economist, June 23, 2005

      by Kitsap River on Sun Dec 09, 2007 at 10:17:40 PM PST

      [ Parent ]

  •  Reading all the available plans on the net, (10+ / 0-)

    I see tremendous support for the single payer option (which is the one we have in most of Europe, and Canada, and it does make the most sense, ok, it's the obvious one) but there is also enormous opposition to reform the existing system wholesale. A lot of constituents (and doctors) will not budge and I see a huge battle ahead. I hope your next President sees fit to address this most important issue. The right way.

    The Democratic Congress is now divided into three parts: igneous, metamorphic and sedimentary.

    by Asinus Asinum Fricat on Sun Dec 09, 2007 at 07:24:35 AM PST

  •  Thanks, eve. (11+ / 0-)

    I'm a professor, and every year my premiums go up and benefits go down, and even though my job "comes with benefits," I still have to pay $91 a month for this insurance--ya' know the "free" insurance I'm getting through my employer that Shrub wanted to consider to be taxable income?

    And I was recently denied a CT scan. Too tired to fight I just didn't get it, and am just glad that the pain I've been having seems to have dissipated.

    Seul l'incrédule a droit au miracle. - Elias Canetti Road2DC

    by srkp23 on Sun Dec 09, 2007 at 07:27:51 AM PST

  •  THANK YOU!!! (4+ / 0-)
    Recommended by:
    vivacia, MsSpentyouth, loree920, kyril

    My biggest problem with the Obama plan is that it, like the plans of other major candidates, still involves huge amounts of $$ flowing into the pockets of the insurance companies.  This is not universal healthcare, with or without a mandate.

    One quibble: I still fail to see how making a list of past and present statements by Krugman (with links to provide more context), WITHOUT commentary, constitutes going on a tear, or personally attacking somebody.  Obama's supporters here?  Sure.  The Obama campaign?  I haven't seen it (although I'd be happy to check out a link if one exists.)

    Thanks for another insightful diary, Eve!

  •  The current state of health insurance (11+ / 0-)

    in America amounts to regular people making huge monthly donations to rich weasels and getting nothing in return.

    If Jesus saves well, He'd better save Himself from the gory glory seekers who use His name in death

    by minerva1157 on Sun Dec 09, 2007 at 07:29:24 AM PST

  •  my plan (8+ / 0-)

    my wife and I pay $400 a month for a plan that has a $3000 deductible.   We are relatively young and healthy and thut is made more sense than paying the much higher rates for real health insurance.  

    Just checked the paperwork last week.  Our deductible has been moved up to $5,500 a year.  If I didn't read the fine print we would never have known.  

    A friend of mine recently visited from London.  He moved there about 8 years ago.  He was saying how great the health care plan they had was.  

    Here's my prediction.  Nothing changes.

  •  I believe that it will be impossible to have (11+ / 0-)

    the discussion we need (and I agree with nyceve that we need it desperately) until after the election. I also believe that for the three candidates to fight each other, now, over health care is counter productive.

    IT DOES NOT MATTER, if candidate A is better than B or C at this moment.

    The reforms we need cannot be issued from the White House via mandate. The reforms we need will require a consensus amongst the House, Senate, POTUS and the American people.

    Arguing about whether Krugman and/or Obama started it is a waste of time. Everyone needs to stop attacking each other over health care because we will all need each other come January 2009.

    POTUS Obama will need Hillary and POTUS Hillary will need Obama and POTUS Edwards will need Obama and Hillary. And so on. To do what nyceve asks, we all need each other.

    No one's "plan" will survive until the general election let along first contact with the legislative process. Therefore I propose that everyone who wishes to argue that their candidate has the better plan simply STFU.

    HRC is among the top 5 people I'd prefer as POTUS come Jan09. How can that possibly be seen as hateful?

    by Bill White on Sun Dec 09, 2007 at 07:31:31 AM PST

  •  None of the Democrats health care plans works (10+ / 0-)

    which is why Krugman parsing the failed plans for minute differences is a bit pointless.

    Single payer, universal health care (HR 676), Medicare for All, would work giving the US a health care system similar to those of Europe, Japan etc. A system that would cost 40% less, cover 30% more and have better health care outcomes (more babies surviving, people living longer).

    Because none of the Democratic candidates had the courage to advocate Medicare for All, there will be no meaningful health care reform during their presidency. The didn't run on reforming health care so they will have no political base to reform health care once in office.

    That is what Krugman should be hammering on.

    •  I'm not sure we can cut 40% of costs (3+ / 0-)
      Recommended by:
      vivacia, SarahLee, Sandy on Signal

      but I agree with the rest of your comment. There is no doubt we can do more for less if we eliminate the insurance company morass.

      "It's the planet, stupid."

      by FishOutofWater on Sun Dec 09, 2007 at 07:39:38 AM PST

      [ Parent ]

      •  Europe/Japan costs are 50% that of US (5+ / 0-)
        Recommended by:
        vivacia, SarahLee, splashy, drewfromct, kyril

        US cost is 16% of GDP.
        Europe/Japan avg. cost is 8% of GDP.

        Everyone has health care access, more of their babies survive, they live longer.

        The facts are overwhelming.

      •  Why not? (4+ / 0-)
        Recommended by:
        tmo, vivacia, splashy, kyril

        I'm no economist, but I'd bet that if we stopped spending our aspirin money on things like advertising, salesmens' commissions, CEOverpay, and return to shareholders, we could save as much as 40% if not more.

        Al Qeada is a faith-based initiative.

        by drewfromct on Sun Dec 09, 2007 at 07:58:51 AM PST

        [ Parent ]

        •  Serious shit would go down (1+ / 0-)
          Recommended by:
          tmo

          as raven says above

          The drug reps, many clerical staff, the graphic designers, the advertising people, and the gazillions employed by the insurers. The stock being held by millions of people who own a part of the insurers will need to be made worthless. The armies of people who shill for medical equipment manufacturers will hit the chopping block.

          It won't be pretty.

          With single-payer, and the eliminations you speak of, we certainly would spend less.  But that additional 8% of GDP needs to come from somewhere.  Radical change could spin the country into depression.  

          There is no easy fix here, as we all know.  And medicare for all is great idea, but part of that legislation will have to be a plan to reincorporate many of the jobs in the current healthcare industry into the federal government.  This will make half the country (the far better armed half, I should add) really upset.

          This isn't directed at your comment persay - it just seems appropriate at this point in the thread.

          "You never change things by fighting the existing reality. To change something, build a new model which makes the existing model obsolete."-Buckminster Fuller

          by georg on Sun Dec 09, 2007 at 08:06:27 AM PST

          [ Parent ]

    •  There's no doubt single payer is optimal, (2+ / 0-)
      Recommended by:
      vivacia, denise b

      but that doesn't mean that "[n]one of the Democrats health care plans work."  It just means that they don't work as well as they could, but each, even Obama's, is a distinct improvement on the status quo.  Measure of how well a plan works lies on a continuum, not in a binary space in which plans either work perfectly or fail utterly.

      "In my line of work you got to keep repeating things over and over and over again for the truth to sink in, to kind of catapult the propaganda."--George W. Bush

      by cjmarshall on Sun Dec 09, 2007 at 07:54:04 AM PST

      [ Parent ]

      •  Democrats plans don't fix the problem (3+ / 0-)
        Recommended by:
        SarahLee, drewfromct, kyril

        which is the private insurance industry control of US health care access.

        Tweaking a failed system such as the US system cannot work.

        For a good explanation of why.

        Physicians for a National Health Program.

      •  Actually, it's not (10+ / 0-)

        Individual mandates are a huge step backward: they force people to buy insurance they may not be able to afford (already those in MA who make more than the subsidy limit feel a need to choose between their mortgage and their mandate), and they turn uninsured Americans from a problem we all need to care about into a criminal class of people we need to penalize.

        Mandates aren't a step forward, they're worse than the status quo.

        I'm not part of a redneck agenda - Green Day

        by eugene on Sun Dec 09, 2007 at 08:34:34 AM PST

        [ Parent ]

        •  ^^ what he said (10+ / 0-)

          How many people here have an extra $200-500/month just laying around not being spent, after all your bills are paid, food's on the table and everybody's clothed, washed and provided with the necessities of life? Is it more than 10%? Because I guarantee you, the uninsured don't have any more wiggle room in the budget than you do, and probably less - we tend to be younger and poorer. Our money's all spoken for. Mandatory insurance means forcing people to choose between insurance and basic needs. Break the law or starve or lose your home.

          During times of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

          by kyril on Sun Dec 09, 2007 at 09:04:45 AM PST

          [ Parent ]

        •  Hadn't thought of it that way (4+ / 0-)

          they turn uninsured Americans from a problem we all need to care about into a criminal class of people we need to penalize.

          Hadn't thought of it that way but you're right. I'd love to see a longer diary on this.  My aversion to the individual mandate stems from two things: my belief that the only real way to cover everyone is to give it away, and that a mandate is unenforceable (Enforcement mechanisms proposed so far are unlikely to pass Congress, as well.) Well, now, there's a third thing.

          I did get around to reading your diary on one of Krugman's columns re: mandates, and you're right about the lefty critique of mandates and how Krugman doesn't allow for that.

          As a practical matter, I don't like where the healthcare coverage debate is going... it's getting too focused on mandates and moving away from which package is best, whether the overall package moves us forward or backward, etc. I just don't like how universal coverage is now hinged on mandates, when there's an abundance of evidence that mandate or no mandate, none of the plans will actually cover anyone. I wish everyone would stop the parsing of the plans (or if they're going to do that, look at the entire plan), and rally around the only thing that is truly universal healthcare: single payer.

      •  distinct improvement? (0+ / 0-)

        only if you own lots of health insurance industry stock.

        Looking for intelligent energy policy alternatives? Try here.

        by alizard on Sun Dec 09, 2007 at 06:10:58 PM PST

        [ Parent ]

  •  IMHO It Doesn't Matter Who Is Elected (5+ / 0-)

    nothing is going to change. Nothing. As soon as the drug and insurance companies level their lobbyist on Capital Hill the will to do anything for the "people" will end.

    I mean Congress can't even get our troops out of Iraq.  I don't think many meaningful health care reform has any chance.

    I hate to be so negative, I didn't use to be this way. But there is no chance.  

    Let us not forget New Orleans. Visit Project Katrina.

    by webranding on Sun Dec 09, 2007 at 07:37:48 AM PST

    •  Obama has the track record on healthcare reform (3+ / 0-)
      Recommended by:
      vivacia, play jurist, Stroszek

      Obama's strengths on health are two fold.

      1. He is the only candidate with experience in crafting universal health care legislation. He actually proposed universal health care in Illinois.
      1. He is the only candidate who has demonstrated ability to get universal health care legislation enacted. He managed to build a coalition of Democrats and Republicans to get it passed.

      Clinton gets points for building a health care package but it also demonstrated why she would likely not get health care reform passed. Her plan was too complex. She did not consult with health care reformers in Congress. She could not build a political coalition to pass the legislation. We could hope she learned from her failure but why not go with Obama who knows how to be successful?

      Edwards has no record on health care reform. His lack of experience in crafting or passing health care reform would likely doom his efforts.  That he is new to the issue, having never involved himself in it while in office, would bring up questions about how committed he is to real health care reform.

    •  Whoops...meant to say it matters a LOT. (0+ / 0-)
    •  Some things should simply be socialized. (10+ / 0-)

      It's a human rights issue. Food, shelter, and medical care are no-brainers; they should not be subject to free market pressures.

      I don't care if you're a socialist or not, if you don't think that everyone should work together to ensure that everyone has food, shelter, and medical care, you're not much of a person.

      We need a national health system. Not just single-payer, but unprivatize the entire system. Doctors, hospitals, emergency personnel, etc., top to bottom.

      -9.63, 0.00
      I'm not a bleeding heart liberal—I'm an extremely angry leftist.

      by nobody at all on Sun Dec 09, 2007 at 07:53:34 AM PST

      [ Parent ]

  •  They threw Clark and the Wilsons under the bus (5+ / 0-)

    Why not Krugman?  
    I can remember a time not too long ago when Krugman was rather favorably disposed towards Obama.  Now, Krugman is persona non grata to the Obama folks?  It reminds me of when Wes and the Wilsons defended that toothless resolution of Lieberman-Kyl because it makes not a whit of difference to Cheney anyway .  That stoopid resolution was designed as a trap for Democratic candidates and Obama punted.  He frickin' didn't even vote.  For all I know, Holy Joe and Obama worked it out in advance.  
    But, whatever, we had to diss Wes because he stuck up for Hillary.  
    Wes Clark, who worked his skinny ass off for us last year - HE is suddenly the enemy.  
    I swear to Goddess, Kossacks, if there was ever a time when I wanted to dope slap a great number of you, it was then.  That was one of the most egregious betrayals of our friends that I have ever witnessed.  It was shameful.  
    And now Krugman.  Just because he criticizes one of your favorites.  Like you're going to take your dishes and go home if he doesn't take it back.  
    Poor fragile little Obama folks, throwing a hissy fit after all of the times they joined in with the Edwards crew who methodically destroyed Clinton's reputation.  
    And which candidate has stood by our friends steadfastly? Who didn't slap MoveOn and then cowardly backtrack on it?  Who has been there for the difficult votes and risked everything?  
    Who?!
    Well, it damn sure wasn't Obama or Edwards.  

    -3.63, -4.46 "Choose something like a star to stay your mind on- and be staid"

    by goldberry on Sun Dec 09, 2007 at 07:38:09 AM PST

    •  It does not matter who POTUS is (10+ / 0-)

      with respect to the issues nyceve raises. POTUS cannot fix this alone.

      STOP using trivial differences over health care as a wedge to divide Democrats.

      POTUS Hillary will NEED the support of Senator Obama to pass any comprehensive reform. And vice versa.

      Senate majority leader Clinton would be very well positioned to accomplish the reforms nyceve describes.

      This issue is bigger than Obama versus Hillary versus Edwards. We all need to STOP using this issue as fuel for a primary food fight.

      And that includes Hillary's supporters, Taylor Marsh and yes, Paul Krugman.

      HRC is among the top 5 people I'd prefer as POTUS come Jan09. How can that possibly be seen as hateful?

      by Bill White on Sun Dec 09, 2007 at 07:53:42 AM PST

      [ Parent ]

      •  Mostly I agree with you (0+ / 0-)

        But Krugman reaches a lot of people, and as an economist his views on what's financially feasible and what isn't should be heard. Since he favors single payer, I want him to stay on the topic as much as possible.

    •  It is telling that you type "they" (3+ / 0-)
      Recommended by:
      vivacia, play jurist, CooperCraigM

      I support Obama but I still consider Hillary supporters as part of "we"

      Very telling, your choice of words.

      HRC is among the top 5 people I'd prefer as POTUS come Jan09. How can that possibly be seen as hateful?

      by Bill White on Sun Dec 09, 2007 at 07:55:20 AM PST

      [ Parent ]

      •  OooOOOooo! Now we are WE (1+ / 0-)
        Recommended by:
        YellowDogBlue

        Where were WE a couple of months ago?  Now all of a sudden when Obama is leading (ever so slightly) you need us to unite with you in solidarity against the Republicans.  But just a couple of months ago, WE wanted anyone but Clinton and Kossacks were swearing left and right that they would NEVER, EVER in a MILLION YEARS vote for that lying corporatist money grubber.  Remember?  We Clintonistas have the TRs to prove it.  We practically got thrown out of our own club.  Heck, I had snippy little Kossacks sneer at me at the breakfast table at YK07 because I have a 'corporate' job.  "We don't approve of your kind".  Yes, they actually had the nerve to say that to me over their honeydew and bagels.  
        But now that the shoe is on the other foot, we're supposed to forget all of that and teach the world to sing in perfect harmony.  
        You Edwards and Obama people have a lot of atoning to do.  You didn't like the inevitability meme so now you've got your fucking horserace.  You've trashed her character to high heaven and the Republicans are going to glom onto everything negative you've ever written about her.  But now you want to make nice in case your Messiah of Change! ends up on top.  
        Ok, fine, you say you're sorry that you trashed her and that you didn't mean any of it and it was just the silly primary season and she's not really a lying corporatist money grubber and I'll let bygones be bygones.  
        Can't do it, can ya?  
        Well, then, we'll just have to meet on the other side of the primaries won't we?  And if it turns out that Obama is a mystery candidate with mystery backers talking trash about social security, healthcare and missing important votes because he's afraid to tick off his money, then I hope you won't mind if I stick with an excellent candidate with intelligence and courage who is connected to an administration with a proven record of good government.  
        Then, when the last delegate is counted, we can be WE again.  Until then, I'm afraid there is no WE.  That was YOUR choice, not mine.

        -3.63, -4.46 "Choose something like a star to stay your mind on- and be staid"

        by goldberry on Sun Dec 09, 2007 at 08:36:46 AM PST

        [ Parent ]

        •  Wow! The bitterness is breathtaking . . . (5+ / 0-)

          Back in the day, anyone whom dared disagree with Hillary was said to be filled with hatred, which was bullshit then and bullshit now.

          And in the beginning, Obama offered his hand to Hillary and she slapped it away. How dare he presume to challenge her coronation.

          Simply put, I reject your comments and say they are factually false and reflect mostly your own bitterness.

          HRC is among the top 5 people I'd prefer as POTUS come Jan09. How can that possibly be seen as hateful?

          by Bill White on Sun Dec 09, 2007 at 08:42:44 AM PST

          [ Parent ]

          •  I'm not bitter. I want a retraction. (1+ / 0-)
            Recommended by:
            YellowDogBlue

            Give me a retraction and I'll make nice.  
            As for people being Hillary Haters, the voluminous body of written evidence speaks for itself.  Do you REALLY want me to go back and dig up the most hyperbolic of the diaries written about her by the oh so helpful Edwards gang?  
            Ya know, I've heard that little scenario of the hand slapping related before.  IIRC, it was Obama that spread that tale of chilly reception.  It's almost like from the very beginning he wanted to create an atmosphere of tension.  Oh, I'm not saying it didn't happen but we've never heard her side of the story, have we?  
            I'd call that classy on her part.  Maybe it was just a bad first impression or maybe she really does hate his guts.  Well, thanks to MoDo, we have it from HIM that she was a total bitch.  
            Hmmmm, MoDo seems to favor him... and she's the queen bee of the popular crowd in the Village....
            So, what does that mean?  That the Village crowd can't take the Bushies anymore so they're looking for the more malleable of the Democratic candidates?  Sounds about right.  It could explain all of those missed votes.  There's nothing the Villagers loathe so much as the MoveOn crew.  And they sure as hell wouldn't want their guy to put his career on the line for a stupid Iran war resolution that has no meaning or teeth.  
            Yeah, it's all starting to make sense now.  A vote for Obama is a vote for the Villagers.  
            Sorry, I'll pass.  
            But you can still offer that retraction.  I'm sure there is more than one Clintonista who would accept it.  
            Go ahead, I'll wait.

            -3.63, -4.46 "Choose something like a star to stay your mind on- and be staid"

            by goldberry on Sun Dec 09, 2007 at 08:53:27 AM PST

            [ Parent ]

            •  Retract what? (2+ / 0-)
              Recommended by:
              alizard, kyril

              That Hillary is the DLC poster child?

              That the Iraqi AUMF vote was the wrong vote?

              That Kyl-Lieberman was the wrong vote?

              That federal mandates to buy private insurance has real potential to become a financial feast for insurance companies and a wet dream for K Street?

              That someone can be one of the top 5 or 10 progressive leaders in America but still not our best choice for POTUS?

              HRC is among the top 5 people I'd prefer as POTUS come Jan09. How can that possibly be seen as hateful?

              by Bill White on Sun Dec 09, 2007 at 08:59:24 AM PST

              [ Parent ]

              •  Yes, I want a retraction or STFU (1+ / 0-)
                Recommended by:
                SaneSoutherner

                She didn't go to the DLC meeting, she came to YearlyKos.  

                The IWR was a mistake but one that the vast majority of candidates voted for and Obama talks a good game but he never had to vote on it, did he?  And we've seen how he handles tricky votes - he doesn't.

                The Lieberman-Kyl resolution has been hyped waaaay beyond its actual significance.  She voted for a toothless, sense of the senate "opinion" that Cheney would disregard if it failed anyway.  It calls for no action.  
                BUT the difference between my candidate and yours is that Hillary spoke on the senate floor against the Bushies taking us into war with Iran without congrssional approval back in February and she was the sole co-sponsor of Webb's amendment.  If Obama was soooo opposed, he had an opportunity to vote against Kyl-Lieberman.  He gets no brownie points for ducking.  

                And if you think it's so bad to have universal insurance, maybe you should ask someone in Germany if they would trade what they have, which is universal health insurance through private companies, with what  we have now or a voluntary plan like Obama's.  I'm guessing that the health insurance industry is going to HATE Clinton's plan because covering everyone means covering sick people.  Whereas they are going to LOVE Obama whose plan doesn't require the potentially sick to carry their weight until they need services.  That would seem to fly in the face of the common good insurance part of it.  Oh, and thanks Obama for putting my social security in danger unnecessarily.  And I really look forward to being rich in a couple years in this extremely high cost state.  

                No, I used to think Edwards was the one.  Then he showed himself to be a one-trick pony who slacked the last four years.  Then I thought Obama was fresh and new until I started to hear very nasty Republican policy memes coming out of his mouth.  Clinton has been consistent, intelligent and hardworking.  I trust her.  

                And I'm not changing my mind and giving Obama a break just because he's feeling a little heat.  If he'd actually made some of those votes he skipped, he'd be used to the heat by now.  He either has to committ to making hard choices or stop whining.  

                GOD, there's nothing I hate more in a candidate than a fucking whiner.

                -3.63, -4.46 "Choose something like a star to stay your mind on- and be staid"

                by goldberry on Sun Dec 09, 2007 at 01:44:10 PM PST

                [ Parent ]

        •  This may be emotionally satisfying for you (0+ / 0-)

          but it really isn't helpful.

          •  Awwww.... (0+ / 0-)

            I suppose being helpful would entail make up sex with the Obama crowd.  
            Sorry.  He needs to think about why he's pissing me off  and get his act together on SS and healthcare first.  
            Oh, and dump his skanky friends.

            -3.63, -4.46 "Choose something like a star to stay your mind on- and be staid"

            by goldberry on Sun Dec 09, 2007 at 08:26:08 PM PST

            [ Parent ]

    •  goldberry, (1+ / 0-)
      Recommended by:
      play jurist

      This just won't do.  I am still a Krugman fan, I just think his ideolgical approach on this issue is NOT helpful.

      I say we stick to the topic and not allow nyceve's diary to divolve into yet another disgusting partisan slugfest.

      P.S. BTW, you're an awesome diarist.

      •  I'd like to oblige (1+ / 0-)
        Recommended by:
        SaneSoutherner

        But I'm afraid the genie is out of the bottle on this one.  Krugman is onto something here.  Maybe he doesn't quite have a handle on it yet but I don't like the vibes I'm picking up from the Obama camp.  
        As for partisan slugfests, I have never read a bigger instance of historic revisionsism that in the last couple of days where we have been asked to pretend like the last couple months of relentless Hillary bashing never happened.  It's beyond absurd and if they aren't going to issue a retraction then we let them slip in their slurs without consequence or penalty.  
        It's very clever to ask for leniency now. We're all beat up and sick of the sniping.  So, now we'll all just go along to get along and Barack benefits while Hillary's character has been shredded.  This is the way bullies operate.  It's the way the GOP has operated for the past eight years, always accusing us of being shrill just when we start feeling our cheerios.  It is designed to take the wind out of us.  
        This is politics in it's meanest state and if we let them roll over us, they win and we lose.  It's ugly and it feels unpleasant- at first.  You quickly get over it.  
        They're whining now.  That means we're landing some blows.  
        good.  

        -3.63, -4.46 "Choose something like a star to stay your mind on- and be staid"

        by goldberry on Sun Dec 09, 2007 at 02:01:38 PM PST

        [ Parent ]

  •  PS Anyone have a link to Obama's OpEd on Krugman? (0+ / 0-)
  •  Some important questions for all presidential (11+ / 0-)

    candidates are:

    1. What will it take, if anything, for you to sign HR 676 into law?
    1. What will it take, if anything, for you to sign HR 1200, the American Health Security Act, into law?
    1. Will you sign into law patient advocate powers like those found in California's SB840?
    1. Will you insist on mandatory assignment so patients receiving covered care only have to pay amounts defined by law?
    1. What is the value to American society of basic private health insurance under your plan?
    1. Do you think a private health insurance company will have to be taken over by a government because it will not be able to pay claims because it had to compete with the Federal government?
    1. Will you insist on the right to the award of attorney fees at a statutory rate because a claim wasn't paid by a health insurer when the insurer has had all the information a reasonable person would need to know that the claim is proper for at least 30 days?
    1. Will you sign into law the legal authority to pay all health claims by experienced Federal government Medicare contractors even if the funds come from private health insurance company accounts?  
    1. Will you sign into law the compulsory licensing of medical technology?
    1. Where will payment for mandatory health insurance for union families come from when the union member is on strike?
    1. Will the union be able to pay for actual care at government plan rates and let the insurance drop?
    1. Will guest workers be able to get coverage right away?
    1. Do you support the Federal licensing of medical personnel as an alternate choice to be made available to top-quality medical practitioners?  
    1. If a majority of the 300 million Americans get a health care insurance subsidy under your plan, what would be the average per person amount of this subsidy?
  •  Presidential candidates (8+ / 0-)

    should say they look forward to signing a bill on Inauguration Day on the Capitol steps that will:

    1. open Medicare to all Americans
    1. have age-based premiums for adults under 65
    1. be free with no co-pay or deductible for children under 18 or students under 23 in college

    Premium reductions will be provided to ensure that  all adults will retain at least a decent level of spendable income after:

    1. all governmental and debt/housing/support contractual obligations
    1. all home and car insurance
    1. home heating oil/gas & electric service allowance
    1. reasonable car cost allowance
    1. basic telephone service
    1. all educational expenses
    1. 401-K matching
    1. all uncovered medical expenses

    Financing sources could include:

    1. employer payroll taxes [with full credit for medical payouts made for the lowest paid 90% of company workers]
    1. a national sales tax on non-essentials
    1. an excessive [compared to Western Europe] domestic drug/medical technology sales revenue clawback
    1. 10% state funding of provider services in lieu of Medicaid burdens
    1. tobacco tax and settlement payouts
    1. taxing capital gains from stock options, real estate [with personal residence exclusions], REITs, and medical earnings portion of stocks as ordinary income [to be taxed by law ASAP, but collected after 2009]
    1. a fifty cents per gallon gasoline tax increase
    1. state-level wealth taxes on each resident's wealth above $2 million
    1. a temporary [time-progressive] income-tax surcharge on state residents until the state version of the wealth tax kicks in
    1. a 10% surcharge levied on states for inpatient stays of more than 7 days in a year so states prevent improper hospital confinement and fraud
    •  Add to funding (2+ / 0-)
      Recommended by:
      barbwires, sima

      a tax on junk food -- sure, I might have to shell out a little more when I have a Big Mac or Ho-Ho jones, but if it means I and millions of other Americans get health insurance I'm all for it.

      You're only as popular as the last diary/comment you posted. -- Zachpunk

      by Cali Scribe on Sun Dec 09, 2007 at 08:46:32 AM PST

      [ Parent ]

    •  Why students under 23? (4+ / 0-)
      Recommended by:
      SarahLee, alizard, Brooke In Seattle, sima

      Why discriminate against people who worked or join the military to pay for our school? All full-time students are equally broke, no matter what our age. And the under-23s can still be covered by their parents' policies, which tend to be employer-funded, better and cheaper; the rest of us can't.

      Also, re; your "decent level of spendable income," many people don't have that now, even before health insurance premiums. We need comprehensive economic reform including a massive minimum wage hike - that alone will place more of the burden for funding people's basic needs onto the shoulders of employers rather than taxpayers.

      Otherwise, good list!

      During times of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

      by kyril on Sun Dec 09, 2007 at 09:14:50 AM PST

      [ Parent ]

  •  FUCK Insurance. Coverage or NO VOTE for u. (6+ / 0-)

    I'm 47 and sick of listening to the fucking excuses from the chickenshit sell outs on my side --

    I've been hearing about justifications for enriching boeing, ge, ..., AND their fat ass managements AND rich people

    since I was in college in 1982-4 and I had financial aid cut to feed rich corporate pigs and rich pigs.

    rmm

    Yond Cassius has a lean and hungry look; He thinks too much: such men are dangerous

    by seabos84 on Sun Dec 09, 2007 at 07:44:55 AM PST

  •  HR 1200, the American Health Security Act (7+ / 0-)

    SEC. 201. COMPREHENSIVE BENEFITS
    (a) if medically necessary or appropriate for the maintenance of health or for the diagnosis, treatment, or rehabilitation of a health condition:

    (1) HOSPITAL SERVICES- Inpatient and outpatient hospital care, including 24-hour-a-day emergency services.

    (2) PROFESSIONAL SERVICES- Professional services of health care practitioners authorized to provide health care services under State law, including patient education and training in self-management techniques.

    (3) COMMUNITY-BASED PRIMARY HEALTH SERVICES- Community-based primary health services (as defined in section 202(a)).

    (4) PREVENTIVE SERVICES- Preventive services (as defined in section 202(b)).

    (5) LONG-TERM, ACUTE, AND CHRONIC CARE SERVICES-

    (A) Nursing facility services.

    (B) Home health services.

    (C) Home and community-based long-term care services (as defined in section 202(c)) for individuals described in section 203(a).

    (D) Hospice care.

    (E) Services in intermediate care facilities for individuals with mental retardation.

    (6) PRESCRIPTION DRUGS, BIOLOGICALS, INSULIN, MEDICAL FOODS-

    (A) Outpatient prescription drugs and biologics, as specified by the Board consistent with section 615.

    (B) Insulin.

    (C) Medical foods (as defined in section 202(e)).

    (7) DENTAL SERVICES- Dental services (as defined in section 202(h)).

    (8) MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT SERVICES- Mental health and substance abuse treatment services (as defined in section 202(f)).

    (9) DIAGNOSTIC TESTS- Diagnostic tests.

    (10) OTHER ITEMS AND SERVICES-

    (A) OUTPATIENT THERAPY- Outpatient physical therapy services, outpatient speech pathology services, and outpatient occupational therapy services in all settings.

    (B) DURABLE MEDICAL EQUIPMENT- Durable medical equipment.

    (C) HOME DIALYSIS- Home dialysis supplies and equipment.

    (D) AMBULANCE- Emergency ambulance service.

    (E) PROSTHETIC DEVICES- Prosthetic devices, including replacements of such devices.

    (F) ADDITIONAL ITEMS AND SERVICES- Such other medical or health care items or services as the Board may specify.

    (b) Cost-Sharing-

    (1) IN GENERAL- Except as provided in this subsection, there are no deductibles, coinsurance, or copayments applicable to acute care and preventive benefits provided under this title.

    (2) COST-SHARING FOR LONG-TERM CARE SERVICES-
    ...

    (i) payments for home and community-based long-term care services are subject to coinsurance of 20 percent; and

    (ii) payments for nursing facility services are subject to coinsurance of 35 percent.

    ...
    (i) such coinsurance shall not apply to an individual with income (as defined by the Secretary) of not more than 100 percent of the income official poverty line applicable to a family of the size involved; and

    (ii) in the case of an individual with such income that exceeds 100 percent, but is less than 200 percent, of such applicable poverty line, the coinsurance shall be reduced in the same proportion as the proportion of such income is less than 200 percent of such applicable poverty line.
    ....
    (e) State Program May Provide Additional Benefits...at the expense of the State.

    (f) Employers May Provide Additional Benefits...to employees or their dependents, or to former employees or their dependents.

    SPECIFIED PREVENTIVE SERVICES
    (A) Basic immunizations.

    (B) Prenatal and well-baby care (for infants under 1 year of age).

    (C) Well-child care (including periodic physical examinations, hearing and vision screening, and developmental screening and examinations) for individuals under 18 years of age.

    (D) Periodic screening mammography, Pap smears, and colorectal examinations and examinations for prostate cancer.

    (E) Physical examinations.

    (F) Family planning services.

    (G) Routine eye examinations, eyeglasses, and contact lenses.

    (H) Hearing aids ...[ by prescription]

    Dental Services
    (1) IN GENERAL- In this title, subject to subsection (b), the term `dental services' means the following:

    (A) Emergency dental treatment, including extractions, for bleeding, pain, acute infections, and injuries to the maxillofacial region.

    (B) Prevention and diagnosis of dental disease, including examinations of the hard and soft tissues of the oral cavity and related structures, radiographs, dental sealants, fluorides, and dental prophylaxis.

    (C) Treatment of dental disease, including non-cast fillings, periodontal maintenance services, and endodontic services.

    (D) Space maintenance procedures to prevent orthodontic complications.

    (E) Orthodontic treatment to prevent severe malocclusions.

    (F) Full dentures.

    (G) Medically necessary oral health care.
    ....

    Mental Health
    and Substance Abuse Treatment Services-
    ...
    (A) INPATIENT HOSPITAL SERVICES
    (B) INTENSIVE RESIDENTIAL SERVICES- ... up to 120 days during any calendar year...
    (C) OUTPATIENT SERVICES- Outpatient treatment services of mental illness or substance abuse
    ....

    SEC. 631. MANDATORY ASSIGNMENT
    (a) No Balance Billing- Payments for benefits under this Act shall constitute payment in full for such benefits and the entity furnishing an item or service for which payment is made under this Act shall accept such payment as payment in full for the item or service and may not accept any payment or impose any charge for any such item or service other than accepting payment from the State health security program in accordance with this Act.

    (b) Enforcement- If an entity knowingly and willfully bills for an item or service or accepts payment in violation of subsection (a), the Board may apply sanctions against the entity in the same manner as sanctions could have been imposed under section 1842(j)(2) of the Social Security Act for a violation of section 1842(j)(1) of such Act. Such sanctions are in addition to any sanctions that a State may impose under its State health security program.

    SEC. 811. PAYROLL TAX ON EMPLOYERS.

    [8.7 percent]

    SEC. 59B. HEALTH CARE INCOME TAX.

    [2.2 percent of the taxable income of the taxpayer for the taxable year]

    SEC. 821. INCREASE IN EXCISE TAXES ON TOBACCO PRODUCTS.

    Every Federal candidate should support HR 1200, the American Health Security Act. HR 1200 with an Oregon style efficacy rating system added is the most likely long-term future health system in my opinion.

    A transition to HR 1200 relying on Medicare will probably be needed. People could pay for a three month period of coverage by sending in an age-based premium like they do with estimated taxes, but about a month in advance so they can get a three-month Medicare card in time. People needing subsidies could just go to a welfare office or health department and pay whatever their share is with a check, cash, or a postal money order, the agency would make up the difference in a check to the IRS.

    I think transitional funding sources could include

    1. taxing capital gains from stock options, real estate [with personal residence exclusions], REITs, and medical earnings portion of stocks as ordinary income [to be taxed by law ASAP, but collected after 2009]
    1. a fifty cents per gallon gasoline tax increase
  •  writing people off is what (2+ / 0-)
    Recommended by:
    Sandy on Signal, nobody at all

    legislators do and some of them relish doing it - GOP! others are just doing their j-o-b which is not solving problems just maintaining the status quo;  once in awhile giving themselves a face lift to look 'new and improved';

    Competition is useful up to a point and no further but cooperation the thing we must strive for begins where competition leaves off. Franklin D. Roosevelt

    by pollwatch on Sun Dec 09, 2007 at 07:50:05 AM PST

  •  How politicians think matters, (2+ / 0-)
    Recommended by:
    SarahLee, sima

    not just the substance of their stated policies.  If you want to know what policies a man might propose in the future, his thought processes are at least as important a predictive tool as his already stated policies.  

    Obama's health insurance mandate thinking is a real and very serious problem.  His thinking, or at least his self-professed thinking, is extremely muddled and confused at best.  He doesn't appear to have any understanding of what he's talking about.  His view of the world is simply not reality based, and Democrats need to be called on that as much as anyone else.

    The fact that Obama is so careless and reality challenged in how he derives and talks about health care policy says a lot more about the risks of how he'll generally govern than the substantive content of his other positions.  He can't be trusted to come to good policy decisions in the future because his thought processes simply aren't adapted for coming up with and understanding sound argument.  His previously stated good policies are, for all intents and purposes, accidents, because there isn't any sort of coherent world view from which he's derived them.

    If there's one lesson to be drawn from modern American government it's that soundness of judgment is a more important indicator of how a politician will govern than are stated positions and campaign promises.  Generally sound judgment might sometimes get things wrong, but getting things wrong on ocassion isn't so bad; being vulnerable to influence by sophistry, however, is a disaster waiting to happen.

    "In my line of work you got to keep repeating things over and over and over again for the truth to sink in, to kind of catapult the propaganda."--George W. Bush

    by cjmarshall on Sun Dec 09, 2007 at 07:50:12 AM PST

    •  Unfortunately, we'll never know their thoughts (0+ / 0-)

      All we know about our candidates is what they put out there for us to know.  Even their "personal memoirs" are carefully crafted, ghostwritten, vetted, and edited.  We'll never know their true ideological opinions and perspectives and personal debates with their consciences, because they're politicians who want to win the chance to lead the United States.

      And there's nothing wrong with that!  Community members all have different roles to play, and we need that in order to work together productively.  We didn't win civil rights in this nation by all taking the same tack.  It took a great diversity of strategies, personalities, perspectives, and willingness to take risks in order to change the balance of power.

      We can do that in this coming election, too.  But we'll never know in real time what our candidates think.

  •  nyceve, Krugman's columns are being used (7+ / 0-)

    by Hillary's supporters to go on a tear against Obama.

    We can argue "who started it" but it would be better if we all agreed to a simultaneous multilateral ceasefire on squabbles over which candidate has the "better" plan.

    Fixing our FUBAR system will not occur because of a mandate issued by the White House. Executive Order cannot touch "Murder by Spreadsheet"

    POTUS Hillary will NEED Obama's support to pass genuine reform. POTUS Obama will NEED HRC's support, possibly as Senate majority leader. POTUS Edwards will need both HRC and Obama.

    Right now what all progressives need to do is agree that we can disagree about the details, as of today.

    Reasonable progressives can disagree about mandates, for example, and remain progressive and should not be attacked. Did Krugman "start it" or did Obama "start it" -- I dunno, nor care.

    Everyone needs to stop.

    Multilateral simultaneous ceasefire. No more "Obama is not serious about heath cate diaries" as one part of that, or the nonsense Taylor Marsh is writing.

    Come January 2009 we will all need each other AND no plan presented today will survive intact therefore who has the "better" plan today is not really relevant.

    HRC is among the top 5 people I'd prefer as POTUS come Jan09. How can that possibly be seen as hateful?

    by Bill White on Sun Dec 09, 2007 at 07:50:33 AM PST

  •  Fee, payments and denials (3+ / 0-)
    Recommended by:
    nyceve, SingleVoter, kyril

    Eve wrote:

    This is the fee to the radiologist for reading the damn MRI. As usual, you are trying to weasel out of your responsibilities.

    Eve, I have Tricare insurance which is similar to Medicare but for certain Uniform service personnel. When I get an EOB (Explanation of benefits), such denied charges, as your rediologist charge above, are not just denied from the insurance company's perspective, but are denied to the provider if they want to take any such Medicare patients.  Ultimately my EOB will show what Tricare pays to the provider, what my co-pay is, and how much is written off the provider's fee schedule, period. The usual amount written off is 50-60%, and the providers seem to accept this!

    What am I saying here? Either your insurance company has no clout to negotiate a good fee schedule or you have picked a poor company period.  I often think the biggest benefit I get from my insurance company (Tricare) is their ability to name a fee schedule (and get it accepted) that looks reasonable to me because on my own, I sure couldn't tell what was reasonable.  Now many of my provider friends tell me that Medicare-Tricare fees are too low and are being subsidized by other patients and by provider incomes being too low.  That is another subject that I think has to enter into any reform equation. However, with a national fee schedule for all, whether single payer of private insurance administered, all the fee schedule actions and negotiations will be out in the open treating all equally and hopefully fairly!  It is these unknowns today that are unfair to many.  Jeez, if the uninsured could just be given the Medicare price for everything, they would save 50-60 % right there period.    What the heck happened, and how did we ever get so screwed up in such and important social area??!

    •  truthbetold, I am not a member of Congress . . . (3+ / 0-)
      Recommended by:
      tmo, drewfromct, kyril

      my insurance choices are extremely limited, even in a relatively merciful state like NY.

      In California, for example, i would be uninsurable.

      Other companies are far more expensive than mine.

      You take what you can get.

      If we were Congresspeople, we would have a banquet of taxpayer-sudsized choices.

    •  In the late 1970s (0+ / 0-)

      the State of Maryland published fee and hospital cost surveys.

      The hospital costs are online in Excel format.

      The Wisconsin price point system
      for hospital prices:

      http://www.wipricepoint.org/

      It's slow.

      The system gives results in four categories:
      Hospital
      All Hospitals in
      this County
      All Hospitals with Similar Patient Volume
      All WI Hospitals

      Vaginal Delivery at one Milwaukee hospital
      January 2006 - December 2006  
           
      Number of Discharges 933 12,284 26,691 50,270
      Average Length of Stay 2.2 Day(s) 2.3 Day(s) 2.3 Day(s) 2.2 Day(s)
      Average Charge $7,560 $7,754 $6,545 $5,753
      Average Charge Per Day $3,407 $3,317 $2,857 $2,612
      Median Charge $6,750 $6,725 $5,805 $5,202
      Median Age 24 26 27 27

      Appendectomy at another Milwaukee hospital
      January 2006 - December 2006  
           
      Number of Discharges 171 953 2,388 5,471
      Average Length of Stay 2 Day(s) 2.7 Day(s) 2.5 Day(s) 2.4 Day(s)
      Average Charge $22,808 $22,384 $17,759 $16,535
      Average Charge Per Day $11,272 $8,356 $7,203 $6,765
      Median Charge $21,240 $19,722 $14,891 $14,308
      Median Age 32 27 29 30
      Percentage Male 57.9% 56.3% 55.9% 55.5%
      Percentage Female 42.1% 43.7% 44.1% 44.5%

      The format doesn't transfer well.

      These are the hospital charges alone. The doctors charge for their services separately.

      •  But it does not matter what they charge, (2+ / 0-)
        Recommended by:
        SingleVoter, kyril

        what matters is what will they accept as payment in full. The Medicare-Tricare programs have providers accepting 50-60% less than their published fee schedules.  There is no way a person on their own (say in a Consumer directed healthcare atmosphere) would know these real accepted limits by providers.  Without a socially-grouped aspect to this negotiation, we are all little davids against goliaths who have the power and knowledge, but the outcome will not be the biblical one!!

    •  Limiting charges (5+ / 0-)
      Recommended by:
      SarahLee, truthbetold, chuckvw, alizard, kyril

      to uninsured people to Medicare amounts doesn't cost any government a damn thing.

      Failure to do so simply tells me you the vote-seking politician won't lift a finger to help sick people.

  •  say it loud, but say it slowly - every word (8+ / 0-)

    is important - "not for profit, health care for all."

    Anyone who advocates, supports, defends, rationalizes, or excuses torture has pus for brains and a case of scurvy for a conscience. - James Wolcott

    by rasbobbo on Sun Dec 09, 2007 at 07:52:20 AM PST

  •  Just to echo the comments of many before me. You (8+ / 0-)

    can't provide proper Health Care where Profit and Loss is part of the equation.

    Simple logic will prove this with a thought experiment as Bonddad once did on this Blog.

    And 59 years of running the actual experiment on real live human beings has confirmed the point many times over.

    The mere fact than none of the Democrats will come out openly for some form of Socialized Medicine should make it very clear to everyone just who is running this country -- regardless of which party is in power.

    It is K Street ( AKA The military / Industrial Complex ) and untill we take them out of the equation with a Constitutional Amendment we will not have decent Health Care, or decent Schools, or Decent Jobs or Decent Protected Pensions etc etc )

    By now you should all know what is coming next.

    Go here to learn how to begin the process of taking your government back from the Special Interests which now control it.

    http://www.foavc.org/

  •  I pay $200 a month (8+ / 0-)

    My employer pays the balance. I use to pay less but then I got paid less. I also paid $450 a month for a single person back in 2002 before I went back to work because I needed health insurance. Now, I would hate to know the premium. Scary. So to me, the $200 per month is a fair price for me to pay. My insurance company did not require a pre-cert on my PPO plan for my MRI. I have Bells Palsy right now since July 4th. My face should be cleared up soon and has improved greatly. There were no questions asked from my insurer and I am grateful for that. It was just treated.

    So my fair amount for what I make is $200 per month. But I am a single person. What about the families who have to pay a whopping large sum just for being a family. Yep, I agree with you. We need some more specifics vs vague. The candidates need to be less vague. About everything. I mean, we believed the 'we will end the occupation in Iraq' scenario. They just did not tell us in what year.  

    "No, we're not questioning the Generals. Mr. President, we are questioning you."

    by BarnBabe on Sun Dec 09, 2007 at 07:53:59 AM PST

    •  this is the problems with mandates (12+ / 0-)

      my circle of friends - all freelance artists - would literally not be able to eat if it were mandated that we spend $200 a month on healthcare.  it's totally impossible for many many people.

      i'm glad your condition is improving, and that you didn't have any trouble from your insurers.

      cheers,

      "You never change things by fighting the existing reality. To change something, build a new model which makes the existing model obsolete."-Buckminster Fuller

      by georg on Sun Dec 09, 2007 at 08:12:11 AM PST

      [ Parent ]

      •  Same here (6+ / 0-)

        And there are many like us. No mandate can fix the fundamental microeconomic problems we face. Many of us go without insurance because we like to eat.

        During times of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

        by kyril on Sun Dec 09, 2007 at 09:22:43 AM PST

        [ Parent ]

        •  OK, I said for ME, I can handle that. (0+ / 0-)

          That is the most I could and would be able to handle. But because I can handle this and so many people can not, I want to hear figures in the proposal. What is ok for me is not ok for others. But if the proposal is that $200 max or a prorate for income, that is more specific. Maybe for the candidates, $1k a month is ok for them because, 1) we pay for their insurance, 2) they have more money or they can get a deal. Period.

          So what is affordable to one is not affordable to another and that is why I want to hear what 'they' consider affordable. If one says $200 a month or even $400 a month, it might seem affordable to them, but what to the people who choose to eat over health insurance. And in some cases, people choose to have that health insurance.

          Also remember, at 20, I was very healthy and health insurance was the last thing I worried about. After 40 things start to break down a bit. Then the choice might be going to the doctors or eating. But by then many of us were working where there was health insurance available because health insurance was now important. And then it was needed more as we aged.

          So, if there is a plan, give me figures so I can figure out what is important to my needs.  

          "No, we're not questioning the Generals. Mr. President, we are questioning you."

          by BarnBabe on Sun Dec 09, 2007 at 09:38:37 AM PST

          [ Parent ]

          •  For me specifically, zero (2+ / 0-)
            Recommended by:
            tmo, sima

            or maybe $5-10. No more. Even that is 2-3 days' food, but I might be able to stretch it by eating more ramen.

            Of course, I'd likely qualify for 100% subsidy with most candidates' plans because I'm below the poverty line, but Clinton's wouldn't work because she wants to use tax credits instead of subsidies.

            For my dad, who's a GS-14, I know he pays about $500/month for a government plan for him, his wife and her two boys, and considers that pretty reasonable for a plan with low deductions and decent service. So that might be a decent upper boundary for the $80-100k bracket.

            During times of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

            by kyril on Sun Dec 09, 2007 at 09:48:08 AM PST

            [ Parent ]

            •  Universitities face this same issue (3+ / 0-)
              Recommended by:
              tmo, alizard, kyril

              every time they want to raise tuition.  There are any number of responsible frugal students barely living within their means for whom the tuition increase is truly bad news.  But when the university suveys its students, conducts public forums, and synthesize all the data including financial aid data, what they find out is that for most of the students, what they are really complaining about is that the rate increase means less beer and pizza money.  

              So no matter how much some of us complain and document the hardship the rate increase will have on us personally, majority rules, the university increases the tuition and six months later there is new landscaping around the dorms.  (This is a true story).

  •  Major, major spine surgery (6+ / 0-)

    some years ago.  My insurance would pay for the neurosurgeons and everything else related to the surgery but not the irradiated bone that was grafted into my spine!  After many letters claiming they were irrational, I believe they paid for the bone, but I cannot recall.  I was very ill for some time so memory isn't the best.  

    Today those letters would likely go unanswered.

  •  I expect an every child S-CHIP bill (3+ / 0-)
    Recommended by:
    Sandy on Signal, nyceve, kyril

    out of the current Congress.

    If they can't even take care of the children, I think we are wasting keystrokes.

  •  When are we going to have an honest debate... (3+ / 0-)
    Recommended by:
    eugene, vivacia, bthespoon

    ...on healthcare?

    We treat these candidate plans as if whomever we vote for will bless us with whatever plan they dream up.  If this were true, why wouldn't all of the frontrunners promise us single payer and wrap up the nomination already?

    Nope - what is happenng here is that all of the candidates are describing the outer limits of what they think they can get accomplished.  The likely scenario is that none of these plans will look anything like they do now after congress gets to them.  Once that process is finished, passing anything will be extremely hard.

    We allwant single payer.  We all want a more moral health system.  The reality is we won't get where we want to get in one giant step.  We'll make a series of smaller steps.

    I share your admiration of Paul Krugman.  But his contributions to this debate have contributed to the silly atmosphere of cognative dissonance in which we all pretend that splitting hairs on an issue such as mandates is really all that meaningful.  Having driven without car insurance in a mandated state I can't get all that worked up about them.

    When I look at Barack Obama, I think about John F. Kennedy, who leaped over Hubert Humphrey's generation to bring in fresh voices and fresh ideas.-Bill Moyers

    by snout on Sun Dec 09, 2007 at 08:03:29 AM PST

  •  Higher premiums and less coverage... (1+ / 0-)
    Recommended by:
    kyril

    what is the breaking point? And how soon?

    Congress shall make no law... abridging the freedom of speech, or of the press.

    by gravitylove on Sun Dec 09, 2007 at 08:04:36 AM PST

  •  Yup. We should keep focused on the core of this (2+ / 0-)
    Recommended by:
    vivacia, little liberal

    issue and not get distracted by pointless petty battles.  While I disagree that the Obama camp went "on a tear against Krugman," I did read what they posted on their site and I think it misses the point, which you have so eloquently articulated here.  The point is not whether Paul Krugman has or has not been consistent in his criticisms of Obama's plan.  That is a pointless distraction.  The point is whether the criticisms have merit and, ultimately, the point is:  how well will any of these plans work?  I would like to hear more substantive discussion from all the candidates.  I would like debate moderators to stop fomenting bickering and then cutting off the topic before anything of substantive importance can be reached.

  •  The grasroots single-payer movement (12+ / 0-)

    breathes and lives and grows--no matter the stupid, out-of-touch media and the stupid out-of-touch politcians with their heads up their asses and their hands in the tills of the health insurance lobby.

    Just a few weeks ago, the Sacramento Bee ran an alarmist story about "the window for health insurance reform in California closing," because of the failure of the governor and the legislature to compromise on some phony "healthcare reform" bill.

    Uh, to quote Monte Python, "we're not dead yet."  

    I've got news for you in the media establishment and the political establishment: you can run, but you can't hide, because we are fucking everywhere. We are a pesky presence passing at farmer's markets and other public venues. We are energetically making the phone calls and writing the letters and donating and turning up at the capital in numbers, and speaking out, and, as you get more greedy and arrogant and feel more entitled, damn, it's only gonna get worse. Our fliers are only reaching more and more ordinary people. There's been a perceptible surge in the participation in the lobby for SB 840 (a single-payer healthcare bill in California) since Michael Moore's SiCKO hit this summer, and it's continuing to snowball.

    Bringing down for-profit insurance is not a question of if, at this point. It's a matter of when.

    •  Agree. That's why The Serious People (2+ / 0-)
      Recommended by:
      karmsy, kyril

      continue to marginalize Kucinich. It is also why his support is growing. We're past the point where people will accept bullshit answers and blind trust. Only the media and the politicians don't get it. The more vague and manipulative the politicians are, the more it pisses the rest of us off.

      I agree - fairly soon, the pie-in-the-face moment will come.

      "Using church pews as precincts, Rove turned religion into a weapon of political combat" --- Bill Moyers

      by Spoonfulofsugar on Sun Dec 09, 2007 at 09:25:38 AM PST

      [ Parent ]

    •  karmsy, I like your style. (1+ / 0-)
      Recommended by:
      karmsy

      I've got news for you in the media establishment and the political establishment: you can run, but you can't hide, because we are fucking everywhere. We are a pesky presence passing at farmer's markets and other public venues

      Fuckin' yeah.

  •  Somebody's old post (12+ / 0-)

    My brother, ______, died suddenly on the night of Aug. 13.

    In May of this year, he was a patient in the hospital and at that time was treated by a local urologist who accepted his TennCare insurance. However, after it was deemed necessary to transfer him to the nursing home, the doctor refused to care for him any longer, as he said he did not accept my brother's TennCare in his office setting.

    snip

    My brother passed away because of "sudden cardiac arrest due to overwhelming sepsis." Serene Manor tried valiantly to locate a urologist who would accept his insurance and finally did. However, he could not be seen until Aug. 15 - two days too late for him, sadly. The good news is that my brother was ready to meet his Lord and Savior.

    TennCare is the Tennessee public plan.

    Every doctor needs to accept the public plan as a condition of licensure.

    •  Agreed (1+ / 0-)
      Recommended by:
      opinionated

      This is why our system is the worst of both worlds.  We have private insurance for most and public for those who can not afford anything.  So we are paying twice and getting half.  

      "Strength and wisdom are not opposing values" - Bill Clinton.

      by RAST on Sun Dec 09, 2007 at 10:36:20 AM PST

      [ Parent ]

  •  This mandate vs. no-mandate garbage... (9+ / 0-)

    is getting ridiculous and NYCeve is absolutely right, the top three have a lot of questions to answer.

    The only presidential candidate (or surrogate thereof) who can criticize Obama's health care plan is Dennis Kucinich, because he is the only candidate offering truly universal health care - single payer.

    As an Obama supporter I'm happy to hear the criticism from Kucinich and his supporters because they are 100% right. Clinton and Edwards and their supporters however, need to STFU about these mandates which are the most absurd thing any Democrat has come up with in a while.

  •  I have "good" insurance (16+ / 0-)

    Even so, because I have a chronic leukemia, I count on paying $6,000 to $10,000 every year for out-of-pocket medical expenses -- copays, deductibles, my 20% of cost, etc.  This summer when I had to undergo chemo, I had to pay $2,000 for my June medical expenses, and then the new fiscal year started on July 1, so the financial counter started from zero and I had to pay all over again for the rest of summer's care.  All told, it was $6,000 for June, July, and August alone.

    I'm pretty much indentured to my current jobs (I have two full-time jobs -- one to pay for the medical costs and the other to pay the other bills) because I don't know whether another insurance company would pick me up with this "preexisting condition" issue hanging over my head.

    The crazy health-care costs we're shouldering (total charges were $2,900 for my first week of chemo, which included only one dose plus a test dose) are breaking us individually, as families, and as a nation.  If you don't think your well-being is influenced by my having to work two full-time jobs in order to stay alive, you're not living in the real world.  One day I'm not going to be able to sustain the two-jobs thing, and then who's going to be footing the bill?

    •  $6,000 to $10,000 (4+ / 0-)

      That's insane. The federal poverty line for a single person is about $10,000, so that's enough for one person to live on for a year. I'm under that, and uninsured to boot...if I get sick, I'll have to just go die quietly. How do they justify those costs?

      During times of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

      by kyril on Sun Dec 09, 2007 at 09:27:56 AM PST

      [ Parent ]

      •  I make 24,000 a year right now (9+ / 0-)

        but that has only been for the past 9 months as a steady income - generally I have some decent times like this and then I am making less while looking for the next long term project.  

        I can LIVE on about $500 to 800.00 a month (winter is higher), but the rest of the money goes to pay on credit card debt (mostly medical bills and interest) and existing medical bills and an occasional vehicle repair or household need.

        If I get really sick again, then like you, I will just die.  (I've got a dental problem just now cropping up, that may hurry that along as I sure don't have money for a dentist).  I had a blood test last year that indicated that my cancer might be returning.  Naturally they wanted to do more tests, but since I can't pay for it, I decided it was best not to know. I've got a staff of veterinary drugs to take if the pain gets too bad or I can't care for myself. I wouldn't let my dog suffer so that seems a reasonable thing to do for myself as well.

        Meanwhile, I continue to fight for Universal Health Care and Peace and the environment for the sake of my grandkids and their kids to come.  For all of the next seven generations.

        •  I'm sorry to hear about the blood test results! (2+ / 0-)
          Recommended by:
          opinionated, AmericanRiverCanyon

          I sooooo understand why you haven't gone back for follow-up on the blood test.  I hope your hunch about the indication of the results is wrong.

          If I were to do it over again, I would ask my oncologist to withhold diagnosis and refer me to a university study, because studies keep individual patient records confidential , don't require payment, and don't show up on insurance records.  

          Would you consider doing that, or at least talking with your doctor/a doctor about financial concerns?  

          •  checked into some studies (1+ / 0-)
            Recommended by:
            AmericanRiverCanyon

            but I live in the middle of no-where, so transportation and lodging were problems I couldn't overcome.  Local docs understand the financial problems and help out as they can - but it only goes so far.  I have labs that won't do any work for me anymore because I am so far behind on payments to them.

            I can't afford to not work for as long as I can.  Social Security is dependent on your average income for the last years you work.  I have to keep that in mind.  Individual responsibility and all that, you know.  

            If I think about it too much, I just get depressed and tired.  I've got family not doing too well right now so I'm saving my  depression for worrying about them.    Some days life is simply too hard.  I can't think about it too much while others in the family need me to be strong for them.

  •  The cost of health care will be huge. (9+ / 0-)

    The cost to repair Social Security will be huge. The cost of fixing the infrastructure of our country will be huge.
    So what?
    If we can find billions (trillions) to kill, maim and otherwise destroy other human beings (including some of our own citizens) then we can find the money for what is important.
    Essentially, that is the difference between Liberals and conservatives. Liberals believe in all of us, and conservatives believe only in themselves.
    I'm still thinking John Edwards is the only one who gets this.

    "The truth shall set you free, but first it will piss you off!" - Gloria Steinem

    by MA Liberal on Sun Dec 09, 2007 at 08:26:35 AM PST

  •  My problem. My health Insurance is (16+ / 0-)

    $ 545.00 a month. They make me pay 2 months up front. Pigs. My deductible is $1500 a month. They cover 70% of the bill after I reach my deductible at the "rate" they charge them. So even this year when I have reached my deductible (spinal stenonis + 4 bum disks) So now even reaching my $1500 deduct. I have been having pain in my left upper stomach (right below and under the rib area) I can't afford to get a colonoscopy as I can't afford the 30% of the procedure my insurance doesn't cover and some of it is not even covered under my PPO Blue Cross Bullshit insurance. Mother of DOBSON'S God HELP ME. Besides my new found Back issue I am FUCKING HEALTHY, in my 40's and Don't smoke. WTF is going on in our COUNTRY. Under Clinton I paid $200 a month. 90% covered for Doctor office visits and everything else was covered 100% including Hospitals. Only $500 deductible. I am paying a fortune for Health care and I CAN'T AFFORD TO USE IT.

    "Embarrassing, embarrassing. No Wonder why we're going down the tubes." Larry Craig's arresting officer.

    by Chamonix on Sun Dec 09, 2007 at 08:27:07 AM PST

  •  Universal Health Care is the only answer... (9+ / 0-)

    and once again, Kucinich is right.

  •  thank you, again, nyceve (5+ / 0-)
    Recommended by:
    tmo, nyceve, CoolOnion, alizard, kyril

    for your tireless hammering away on healthcare reform.

    We really need to hold our candidate's feet to a very hot fire of outrage re the current state of health care in America.

    Good luck on recouping your MRI charges (and for whatever reason required the MRI).

    I also just had to have an MRI. My deductible on my BCBS plan of $240/mo is $2500, so I just went ahead this close to the end of the year as a "self pay".

    In my town, the radiologist wanted $2600 for the MRI and would only give 10% off for self-pay.

    I drove two hours to a bigger city and got it for $1,100 (with a 25% off self-pay).

    So folks, check around if you need a pricey procedure. You'd be suprised what you can save (without even flying to a foreign country!).

    •  But what about the folks (5+ / 0-)

      who don't have the time or the energy to shop around? And those who don't live near a bigger city and even if they did they couldn't drive there?

      It's not just about us, it's about millions of Americans.

      You're only as popular as the last diary/comment you posted. -- Zachpunk

      by Cali Scribe on Sun Dec 09, 2007 at 08:50:49 AM PST

      [ Parent ]

      •  I don't disagree with you (1+ / 0-)
        Recommended by:
        gkn

        I'm for universal single payer, BUT, to be honest, after >50 years since Truman proposed this, and the Dems have done NOTHING much at all, I am (cynically) not expecting anything (or very much) to change with ANY of our Dem candidates.

        The Congress is bought off by corporations. When it costs millions of dollars to gain office, we know who controls our elected officials.

        Why would anything change? Please, someone tell me. Every year corporations gain more and more leverage with "our" government.

        So, we must make do the best we can for now -- like shopping for better prices -- with a shitty system.

        Please excuse my cynicism,,, I have been in the health care trenches too long perhaps....

  •  Thanks for another wonderful diary (7+ / 0-)

    I'm with Bill White on this, in that I no longer believe we can have an honest and serious discussion about these issues until after the primaries are over. The various candidate supporters have chucked their reason and common sense to the wind and instead argue for their candidate's plan as if it were perfection, all while trying to silence those who disagree.

    Individual mandates are a terrible solution. My diary on Friday criticizing Krugman was from that basis - I was saddened that he felt the need to defend mandates using flawed assumptions instead of castigating ALL Democratic plans for not being single-payer.

    Insurance is NOT the solution, because as your diaries have so often shown us, insurance is NOT health care.

    I'm not part of a redneck agenda - Green Day

    by eugene on Sun Dec 09, 2007 at 08:40:35 AM PST

  •  Wonderful diary...n/t (3+ / 0-)
    Recommended by:
    nyceve, pamelabrown, kyril
  •  Clinton's Plan Ellliminates Murder By Spreadsheet (0+ / 0-)

    The insurance companies will not be able to deny coverage for individuals or certain procedures, and others will be covered by the government's own single payer plans.

  •  The deception of "in-network" facilities (12+ / 0-)

    Great piece, nyceve.  I wanted to rant about a minor point in your diary:  the concept of "in-network" facilities.  I HATE that you can go to a facility that is supposedly in-network and they utilize contract labor that isn't in-network.  

    I recently had a medical procedure that was 10 grand total and made the naive assumption that if a facility is in-network then all services and staff within that facility are also in-network.  Boy was I shocked to find out that wasn't the case.   The problems were eventually worked out and I paid 20% of all costs, but I was alarmed to find out after the fact that parts of the care I received at an in-network facility were not, in fact, considered, in-network.  If I knew ahead of time, I might have looked for another facility to have the procedure.

    The other problem with the procedure is that no one would tell me a price.  I hate that.  I want to know what kind of financial situation I am walking into so I can plan accordingly.  Heck, just give me an upper limit.  How much am I on the line for if insurance pays absolutely nothing?  I could find no one at the facility or the doctor's office that could even speculate on a total possible cost. I have since found some websites in which people post the billing info for certain procedures, which is useful.

    I think all this talk of mandates is distracting from the real problem with the health care discussion in the United States.  The big companies must be grinning ear to ear because they have successfully altered the debate from universal health CARE to Universal health INSURANCE.  We will just become a country of under-insured.

    Never underestimate the comfort of ignorance.

    by Mote Dai on Sun Dec 09, 2007 at 08:52:01 AM PST

  •  Thank you for (4+ / 0-)
    Recommended by:
    nyceve, Ellicatt, FishOutofWater, kyril

    another excellent diary, eve.

    I sent you an e-mail (something I've only very rarely done).  When you have some free time, please give it a read.

    Again, sincerest thanks.

    "Ancora Imparo." ("I am still learning.") - Michelangelo, Age 87

    by Dreaming of Better Days on Sun Dec 09, 2007 at 08:58:32 AM PST

  •  No candidate (2+ / 0-)
    Recommended by:
    nyceve, Kickemout

    can promise a detailed health care program, at this point.

    How and what and how much will depend on what will they can get passed.

    •  Every Senator is being paid (5+ / 0-)
      Recommended by:
      tmo, nyceve, hoolia, AmericanRiverCanyon, kyril

      about $200,000 a year by taxpayers to work, not to strut about the country in a quest for higher office.

      Every Senator should know where the Senate bill hopper is.

      The text of SB 840, H.R. 676, H.R. 1200, and other bills are online.

      Every Senator's office has word processing equipment with cut-and-paste capability and full-time staffers.

  •  They scammed you (3+ / 0-)
    Recommended by:
    nyceve, alizard, AmericanRiverCanyon

    approved facility, pre-certified, then they use a contractor who can claim not to be approved in order to bill you at full rate instead of preferred rates given the insurer. You should haggle the doc down, since he is running a scam.

  •  Thank you nyceve (2+ / 0-)
    Recommended by:
    nyceve, kyril

    for once again, cutting straight through the BS. Krugman and Obama can fall all over each other fighting about words, but none of this helps the day-to-day American who's struggling to pay the bills.  They're both missing the big picture.

  •  I'm sending a link to this diary to the campaigns (4+ / 0-)
    Recommended by:
    SarahLee, nyceve, kyril, little liberal

    To the "top three," anyway, not to my candidate (Kucinich) who already gets it.

    In TX-32, track the voting record of Pete Sessions at SessionsWatch.

    by CoolOnion on Sun Dec 09, 2007 at 09:10:15 AM PST

  •  forget the Presidential Candidates (10+ / 0-)

    We need to keep our focus on the House and the Senate.

    If we can apply enough pressure to get HR 676 passed in the House and get an equitable Senate bill passed, then I feel pretty sure any Democratic President would sign it.

    Thus our work is to continue to educate our off-line and non-dKos neighbors and doctors.  That means teaming up with others in your area for lobbying actions, letters to the editor, education on blogs attached to local newspapers, creating flyers that we can hand out and leave around town - in magazines in our doctors offices, etc.  

    Join the LETTER WRITING BRIGADE. Write joykal1 [at] aol.com to add your name and receive articles to respond to via email.

    I keep a bag of educational goodies, from CD's I've burned myself, full of info, to flyers, bookmarks, etc. so I can leave a trail of material when I am out running errands, doing laundry at the laundry mat, etc.  Organize some House Parties around viewing Sicko.  

    There are a lot of things an individual or small group can do, like organizing Healthcare-Now Truth Hearings or getting signatures for this petition.  

    Universal Single Payer Healthcare Now!

    Get your city (or organization) to pass a resolution supporting HR 676.

    Check out these 27 Action Ideas.

    We have a lot of material in the files section of the Daily Kos Health Care Google Group.  Material is also available through Healthcare Now or Physicians for a National Health Program (PNHP).  

    The Sicko-CURE Road Show is still on the road - join up if you are around one of these points:

    Dec. 7-8 North Carolina
    Winston-Salem
    Highpoint
    Charlotte
    Mooreville

    Dec. 8-9  North Carolina
    Durham
    Chapel Hill
    Raleigh

    Dec. 9-11  North Carolina
    Rocky Mount
    Wilson

    Dec. 12-13 West Virginia
    Morgantown
    Clarksburg

    Dec. 14
    Pittsburgh
    Celebration

    HealthCare NOW! North Dakota - Website
    Private Health Insurance Must Go Coalition!
    HealthCare NOW! South Dakota - Website
    Michael Moore helps answer "what can I do?
    HealthCare-NOW! Iowa - Website
    Sicko Cure
    HealthCare-NOW! Wisconsin - Website
    California Nurses Association
    HealthCare-NOW! Minnesota - Website

    Sick this yard sign up in your yard:
    HR 676 - Universal Healthcare yard sign

  •  A self-absorbed rant (0+ / 1-)
    Recommended by:
    Hidden by:
    alizard

    without a whit of information or analysis relevant to health care policy.

    No wonder it's top of the rec list.

    If you don't think a mandate for coverage is essential for the viability of an insurance system, for goodness sake argue your case. I don't think you have one.

    And if you're concerned about affordability, take a look at the proposals and compare them with availability of coverage for both poor and middle-class people under Medicaid, Medicare, and SCHIP -- that's where the debate has been and provides a guide for how it will likely continue, i.e., will subsidized coverage apply to families at 200%, 300%, or 400% of poverty level.

    But this -- this is just self-referential complaining. Do some research or come up with some new ideas.

  •  Keeping the doctors on board (5+ / 0-)
    Recommended by:
    nyceve, hoolia, gkn, kyril, Tropical Depression

    I think it's very important for doctors to understand that they can continue to make a good living, in most cases a better living than they do now.  That's why Michael Moore went into such depth (comparatively) with the British NHS doctor.  

    With the exception of some superstars and non-practicing MDs in executive positions, doctor incomes are not the problem with our health care system.  Income for the average doctor could actually go up, and job satisfaction could go WAY up, if they didn't have to put so much effort and personnel into feeding the for-profit insurance monster.  That's currently eating something like 40% of our health care spending.  

    Plus with universal coverage, the malpractice system would shed the burden of having to cover sometimes lifelong health care costs for the results of catastrophic medical mistakes.  That would be a psychological benefit, even if (as some kossack commented the other day) malpractice payouts constitute less than 1% of all health care costs.

    The amazing thing is that with our health insurance industry reviled by everybody, doctors and patients alike,  politicians are still so afraid of the insurance companies.

    From a PR perspective if no other, we should NOT be talking about not-for-profit health care.  (Even people who think it's necessary to eliminate for-profit hospital corporations are self-defeating fools to lead with that frame at this point.)  Talking about not-for-profit alienates the people we need most: the doctors.  It suggests they'll get pinched even more than they already are, and that's just not the truth of rational reform.  And make no mistake, reform can succeed without the support of insurance companies, but it cannot succeed without the support of doctors.

    We should be talking about how well that doctor in 'Sicko' was doing.  We should be talking about getting the insurance companies out of the picture.  They are nearly the most unpopular industry in America.  We should be playing up how they act as drag, indeed as leeches, on the system.  They increase the overall cost while sucking money directly out of doctors' pockets, both through the claims they don't pay and the very high administrative costs that doctors pay to get claims processed.

    Where are the frame doctors when we need them?  To me, the selling of health care reform appears to be the single most incompetently sold idea in the entire 2008 Presidential campaign.

    •  Greed and avarice can take care of themselves (3+ / 0-)
      Recommended by:
      nyceve, kyril, Tropical Depression

      First get something like universal Medicare in place and do it well.  The vast majority of doctors will find they're actually doing better than they were before the shift.  If there are no longer obscene profits available for hospitals (which hospitals? -- not in my city, they aren't), you won't have to legislate away the profit-taking.  It'll just dry up and the forces that are most interested in making obscene profits will find other industries in which to do it.  That will leave the field to people who actually just want to make a good living taking care of patients.

    •  Look to the leeches (2+ / 0-)
      Recommended by:
      alizard, cnmbfa

      Health insurers are unnecessary middlemen keeping us divided, conquered and from utiliing efficiencies of scale.  They suck 31% of our health care dollars away from desperately needed care and care providers.  Of $2.1 trillion spent on health care last year ($7000 per capita), $600 billion ($2000 per capita) went to health insurance profit and overhead.  Half of that would be more than enough to pay for all necessary care for all of our uninsured plus add reliable mental, dental, vision, precription and long-term care for everyone else while maintaining independent providers and expanding choice among same.  The only choice anyone wants or needs for coverage is to be covered if we need it, and I dispute the theory that many people will want medical procedures performed on them that they don't need just for the fun of it.  Besides, that kind of thing should be between a patient and care provider who don't need a profit-taking interloper's interferance.  The other $300 billion saved would need to be used at first to buy out one portion of an insurance and finance industry that will still be just fine (trust me) while everyone else will be a whole lot better off.  With a national median household income at $48,200 and average cost of health insurance alone for a family at $12,100, providers are going to have to start looking at the 31% of our health care pie the leeches (insurers) are leeching because the turnips (people) have been bled.  The best place to find the money we need is to look and take it from where tons of money is being wasted.

    •  Here's a thought- (2+ / 0-)
      Recommended by:
      denise b, gkn

      It’s time to rethink the whole system of HMOs and managed care. This entire unnecessary level of corporatism rakes off profits and worsens the quality of care. But HMOs did not arise in the free market; they are creatures of government interference in health care dating to the 1970s. These non-market institutions have gained control over medical care through collusion between organized medicine, politicians, and drug companies, in an effort to move America toward "free" universal health care.

      One big problem arises from the 1974 ERISA law, which grants tax benefits to employers for providing health care, while not allowing similar incentives for individuals. This results in the illogical coupling between employment and health insurance. As such, government removed the market incentive for health insurance companies to cater to the actual health-care consumer. As a greater amount of government and corporate money has been used to pay medical bills, costs have risen artificially out of the range of most individuals.

      Only true competition assures that the consumer gets the best deal at the best price possible by putting pressure on the providers. Patients are better served by having options and choices, not new federal bureaucracies and limitations on legal remedies. Such choices and options will arrive only when we unravel the HMO web rooted in old laws, and change the tax code to allow individual Americans to fully deduct all healthcare costs from their taxes, as employers can.

      As government bureaucracy continues to give preferences and protections to HMOs and trial lawyers, it will be the patients who lose, despite the glowing rhetoric from the special interests in Washington. Patients will pay ever rising prices and receive declining care while doctors continue to leave the profession in droves.

      •  I agree with you, but (0+ / 0-)

        there are lots of people who get health care paid, at least partially, by their employers, who are very satisfied with what they have. Lots of these people will end up paying more under single payer, and they're going to be a hard sell.

  •  We need a constitutional ammendment (8+ / 0-)

    that makes health care a right and bans for profit health care.

    The whole industry needs to be taken out and shot.

    •  As a Kaiser victim (1+ / 0-)
      Recommended by:
      AmericanRiverCanyon

      I couldn't agree with you more.

      •  isn't Kaiser supposedly non-profit? (0+ / 0-)

        From what I've heard, Kaiser is a good example of why nothing but single payer will work.  I wonder if the candidates are already negotiating with Kaiser to provide the public options in their plans.

        •  I guess you're right (2+ / 0-)

          I only know that when I lived in CA you could not sue an HMO.  For good reason.  They would have been history long ago.

        •  No, Kaiser is not really non profit, they just (1+ / 0-)
          Recommended by:
          nyceve

          ... run an excelllent PR campaign to portray themselves that way.

          Kaiser is a really poor example of how single payer could work because they cherry pick the people they will cover.  They do this by making the actual use of their health plan difficult, by delaying or denying appointments repeatedly, by having extremely long waiting times for tests and proceedures,  by having physicians engaging in the practice of telling the patient on the first visit, no matter what for, that nothing is wrong with them, etc.

          People with other options who can, say To Hell With This, and bug out and take something else. This leaves them with a healthier, younger pool of people who don't have to use their services very often so they are not frustrated and appalled by what passes for "medical care" from Kaiser.

          Once you're stuck with Kaiser as your last option, however, you don't have anywhere else to go for a huge number of state and government employees and retirees.

          If Kaiser had to actually not only cover but provide real treatment for all comers the amount of outrage over the way they treat people with chronic conditions (they excel in "blame the patient")   would quickly cause them to have to jack up their rates.  Or the American public would be found to be further sliding down that slippery slope of "once over 45 you are not worth salvaging from a medical cost/benefits analysis".

          •  I hear such mixed things about Kaiser (0+ / 0-)

            I'm in Northern California and most of the people I worked with chose Kaiser because it was the cheaper alternative. I hear mostly good things from them - and not just from healthy people.

            •  I am also in NorCal and Thank God every day (0+ / 0-)

              that I do not at the present time have to use Kaiser as health "insurance."
              My main fear is that at some point in the future I would be forced back into that system, which could be fatal... but hey, the rest of you would have cheaper premiums if they killed me off quicker!  

              •  Can you say more about it? (0+ / 0-)

                I've always gone for the PPO but I'm considering Kaiser now because of the cost.

                •  Stay with the PPO (0+ / 0-)

                  ... if you can afford it.  
                  Kaiser won't give you appointments when you call them. They say they will wait for a referral from your personal physician. Your personal physician will not get "aroundtuit." You call again. They lose the referral. You call again... each time the cycle starts, it's about six to eight weeks of waiting for the appointment. Finally, they send you a postcard with the appointment.  No phone call, no asking if this time/date works for you... after 4 months, there's your appointment.
                  You go.
                  You wait a long time. (okay, this part isn't a deal breaker, everybody waits everywhere, what's a few more hours)....
                  and the Doctor listens attentively and TOTALLY BLOWS YOU OFF.  Or the Doctor is just downright hostile before trying to blow you off.
                  This does not work well if you have a pre existing chronic condition  .  Or if you have a work schedule.
                  I guess it works out okay for old retired folks who just go in for refills on their cholesterol and hypertensive drugs once every 6 months.

                  I broke my hand six weeks ago and I had this intense feeling of relief that the next morning when it was still looking sorta odd and turning colors, that I could just CALL THE DOCTOR'S office, get some sort of appointment,  and was not going to get BLOWN OFF by the screening nurse, be told to wait for a phone call , go down there, and the doctor was not going to assume I was a head case until the ex rays showed up.  And it's been about 4 years since we had to do Kaiser.  

                  When we quit them after several years of frustration, (and I was having some horrible symptoms) the next doctor finally cultured an ongoing infection I had, gave me better antibiotics, killed the germs, and that started me on getting my body healthier.

                  if you want to do more research,
                  Kaiser had that problem with their kidney transplant program a few years back where they decided to make their own transplant program instead of using another hospital's as they were doing... to save money.... horrific scandal... they just warehoused the people on wait lists and didn't do any transplants... until finally the state of CA stepped in.  There but for grace....

                  I would love to see somehow Kaiser becoming a better system just as any other health care system has parts that can improve.  But first they would have to seriously prune some doctors out of that plan.

    •  Now thar's a good idea...but then (0+ / 0-)

      you'd just be driving up health care costs because that industry is covered.

    •  End discrimination against sick people in America (2+ / 0-)
      Recommended by:
      hoolia, cnmbfa

      We now legislate legal discrimination ("cherry picking" and "lemon dropping") against sick people in America for the sake of profit and greed. Both proposals that Hillary and Obama offer continue legal support of this dispicable and deadly practice with loopholes for profit-driven health insurers to rate up and out any American who becomes ill, therefore dumping all "losers" onto the taxpayer-funded group.  Hillary's calls for not allowing insurers to charge "large" differences based on "modified" community rating; Barak's loophole is more deviously well-hidden, and says we can all have the same plan as federal employees "except for the way (we) are rated".  I call both unsustainable, unaffordable, misleading and immoral. Shame on them.  Of course the critical mass of healthy people is not and will never be unhappy with its coverage because the majority are for the most part healthy so will never seriously test it.  Insurers count on this critical mass to fear change.  Profit-driven health insurers will dramatically lose at the game of providing reliable, affordable, efficient, sustainable and high quality health coverage with freedom of choice among independent providers...if forced to play by the same set of non-discriminatory rules as Medicare.  Inviting them to be part of the "solution" when they are the problem, is like inviting the KKK to help solve racial discrimination or Al Qaeda to help with national security.  Their goals are perverse and directly contradictory to our ability to form a transparent, high quality, affordable and non-discriminatory health care system.

      •  it's the most vile discrimination possible (2+ / 0-)
        Recommended by:
        nyceve, cnmbfa

        socioeconomic status is the deciding factor in who has the right to live and who doesn't.

        If they can't afford to treat everyone, there should be a lottery or something

        •  size of employer matters most (5+ / 0-)
          Recommended by:
          nyceve, alizard, denise b, gkn, cnmbfa

          If you are sick and work for a small group almost no amount of money will save you.  A recent Consumer Reports study concluded the median household income for our uninsured is $59,000 compared to $48,200 nationally.  Superman (Christopher Reeves) was cut off by the insurance company his great grandfather co-founded.  My other friends were rated up to $46,000/year in premiums alone the day after their daughter was diagnosed with leukemia.  We should all be in one large protective pool under one set of fair and consistent rules instead of divided and conquered into multiple smaller and aptly-named "risk groups".  Now nobody knows who is paying how much for what, and we're all paying vastly disparate prices for precisely the same things.

          •  This is why I think (0+ / 0-)

            it's possible to improve the situation even if we don't get what we want right away. Eliminating cherry picking and creating large pools with non-discriminating rating would go a long way.

            •  Agreed, thats why Killary and Barak (0+ / 0-)

              ...will never get my vote.  They both already provide loopholes allowing profit-driven health insurers to continue cherry picking healthy and lemon dropping sick people by singling out and rating up.  I've done my homework on this, and am truly sad to have to report the disappointing results.

        •  Richest nation in world only one that "can't"? (2+ / 0-)
          Recommended by:
          nyceve, cnmbfa

          Does it make any logical sense that the richest nation is the only civilized one on Earth that claims it "can't afford" to protect the  health of its people?  Especially when those people are paying twice as much as any other nation to leave out one in every six Americans (with wait times until "after it's too late" and rationed to zero)??  We're paying through the nose for Cadillacs while our health insurance industry is delivering Yugos (as in "You get sick, YOU GO").  It's the health insurance industry, Stupid!  (not referring to you or anyone specifically)

      •  Don't you know? (0+ / 0-)

        It's your own fault that you're sick.

  •  Take it to the people (7+ / 0-)

    Like the civil rights movement, I believe we have to take universal health care to the streets. We are not going to get healthcare reform by relying on the politicians in D.C. Most of the politicians are to much in debt to the health insurance industries. The health insurance and pharmaceutical industries spend millions in lobbyists to keep their corporate profits up and to maintain murder by spreadsheet. We can not depend on them for reform. We have to take it to the people. This is why I believe Edwards is the best person to pass universal health care. Yes his plan includes health insurance but he supports heavy regulation. Also if enough people choose the Medicare Plus option then our health care in America can lead to single payer. But more importantly his promise to use the bully pulprit to take away Congress, his cabinet, his VP and his own health care is brilliant. I know people have complain about his approach but you have to admit it shows leadership. It would force Congress to finally do something about healthcare. If Congress do not then it shows lack of sympathy for the American people who lack affordable healthcare. The test will come when Congress has to choose between what is best for America or what is best for big corporations. We will know what side they are on.  What concerns me about Obama and Clinton is their approach? Clinton wants to give a seat at the table for health insurance lobbyists and pharmaceutical lobbyists. Why? Does she honestly believe they will be unbias on reform and actually put the needs of Americans first over record setting profits?  Or does she feel she has to give them a seat because they are heavy donors to her campaign? As for Obama, I feel his heart is in the right place but the fact that he wants to compromise with the health insurance industry bothers me. How is he going to compromise? We know the insurance and pharmaceutical will not give up their record profits. So the compromise will be between lower quality or lower quanitity. We might have lower healthcare but it will result in lower quality healthcare. Only Edwards has a good approach to achieving universal healthcare.  He will take it to the American people and he has the only plan that can lead to single payer.

  •  Excellent points...but they must also be asked (0+ / 0-)

    of single payer plans. Even Medicare has exclusions, and you must get pre-certified, etc. So keep up the questions because they're important. But single payer is not a panacea, either.

  •  Mandated private insurance (10+ / 0-)

    ...will not work.  We're already seeing that in Massachusetts.

    We know what works.  Medicare works.  The only way to skip payment is not to pay taxes.  You can't make it more mandatory than that.  

    But instead of treating Medicare like Social Security, folding the income into general revenues, we need to give it a separate fund that doesn't get "borrowed against" (aka plundered) for wars in Iraq and such, and which doesn't get tar-brushed with the term "entitlement" as though people were getting something they hadn't been paying for throughout their earlier life.

  •  If you're paying $8000 a year (4+ / 0-)
    Recommended by:
    SarahLee, DelRPCV, nyceve, Akonitum

    is clinton's plan going to save you $6000 a year?  If not, is it reasonable for her to say that you should be mandated to buy healthcare?  Should you be fined if you don't?

  •  Good questions (1+ / 0-)
    Recommended by:
    tmo

    and obvious questions as well. What will it cover and what's it going to cost me? The candidates obfuscate details as much as possible.

    An informative article on state initiatives that I just found is this one from a California progressive group. A key issue I find, with regard to costs at least, is a broad agreement to consider a cap to costs (premiums/deductibles/copays/max contribution) as a percentage of income. These tend to be fairly reasonable (between 5% and 10% it appears, depending ). Exactly what the percentage applies to (e.g. premiums alone or premiums+deductibles, etc) is of course important. If the candidates would just address this issue, that would be helpful. For example, Hillary Clinton's proposal does propose such a cap but it is applicable only to premiums and there is no figure, or even estimate, provided. This is ridiculous for a serious proposal. I didn't see even any specific individual cost control mechanisms from the other candidates, only vague notions of subsidies, tax credits, and so forth. So they have a long way to go to even answer the most basic questions about their proposals.

  •  I agree with all of this diary, with 1 exception (3+ / 0-)
    Recommended by:
    nyceve, gkn, Kickemout

    If so, you'll need to convince the next generation of doctors that they won't spend half their lives battling the for-profit insurance industry to get treatment authorized for critically ill Americans, and then the other half, battling to get paid 20 cents on the dollar for the life-saving work they do?

    I do agree that many many many doctors are having trouble getting fiar(?) payment, BUT consider this:

    At a recent visit, my urologist billed my insurance $100 for a 30 second bladder ultrasound.

    Healthcare providers are jacking up their charges in order to get their original charges pais.

    If a doctor requires $50 for a procedure, knows insurance will pay say $20, they raise the price to $150 in order tyo get their original charges paid.

    Its a catch 22 I guess, both sides responsible for out of control healthcare costs.

    We as 'consumers' are at fault too. Running to the doctor for every hangnail doesnt help

    "Patriotism is the virtue of the vicious" -Oscar Wilde

    by Goodbye Kitty on Sun Dec 09, 2007 at 10:14:05 AM PST

  •  How the Edwards Plan Works (4+ / 0-)
       1.  How is your health plan going to make my life better?
    ----------------------------------------------

    A couple different ways. First of all, you can drop your plan and buy into a new plan, including a public plan. Second, if you keep your current insurer, they will have to abide by new rules: guaranteed issue, community rating, no rescissions, minimum standard of care, 85% of premiums spent on care, and a Patient's Bill of Rights. (Which, by the way, Edwards did push through the Senate when he was a Senator).

    Moreover, the broader health insurance picture will change: with everyone required to be insured, premiums will fall across the board as the "risk" is spread over the maximum population. Moreover, strict new regulation and competition from a robust public system will force companies to compete in very different ways than they have before.

       2. Will I still be engaged in endless conflict with an insurance industry which has only one mandate, to increase profits, not provide care?
    -------------------------------------------------

    Not if you buy into the public plan. Even then, the insurance industry would be newly bound by guaranteed issue, community rating, and so forth.

       3. Will I pay the same premiums as my Congressperson for the same level as coverage?
    -----------------------------------------------

    Probably not, although I'd need to know what your income level is (also, I don't know what premiums your Congressperson pays). Basically, you'd probably see lower premiums than what you're paying now, due to universal inclusion, community rating, and so forth. Then, you would get a subsidy to help you pay for your premiums that depends on your income. On the other hand, you could just go into the public system, where the answer would probably be yes (not entirely sure on that).

       4. Will the sort of scenerio I've just described be outlawed? And will your healthcare reform plan include draconian penalties against Murder By Spreadsheet insurers cited for wrongdoing?
    -------------------------------------------------

    Yes. Minimum standard of care, community rating, and a host of other provisions would prevent this sort of thing. Moreover, Edwards has said that the Justice Department would be put to over-see the health insurance market.

    ---------------------------------------------

    Overall, I would recommend you do this:
    Call the campaigns. Ask to speak with their policy team about health care. Get them to explain their plan to you.

  •  Thank you (1+ / 0-)
    Recommended by:
    nyceve

    I came across this passage in Obama's plan, and I was wondering if it did what you were requesting in regards to junk insurance a while ago.

    (2) NATIONAL HEALTH INSURANCE EXCHANGE. To provide Americans with additional options, the Obama plan will make available a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan.  The Exchange will act as a watchdog and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible.  Through the Exchange, any American will have the opportunity to enroll in the new public plan or purchase an approved private plan, and income-based sliding scale subsidies will be provided for people and families who need it. Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend upon health status.  The Exchange will require that all the plans offered are at least as generous as the new public plan and meet the same standards for quality and efficiency.  Insurers would be required to justify an above-average premium increase to the Exchange.  The Exchange would evaluate plans and make the differences among the plans, including cost of services, transparent.

    What I'm reading here is that the established public plan is a minimum standard, and all private plans must meet or exceed that standard. I just wanted to know your opinion of that, since you are much better prepared about this than the rest of us.

    I want to say something intelligent, but I've lost that capacity.

    by bhagamu on Sun Dec 09, 2007 at 10:26:40 AM PST

    •  Required to JUSTIFY above average increase...? (0+ / 0-)

      Is this not a contradiction to the term "risk sharing" which is what successful health insurance coverage for consumers is based upon?  Isn't charging "above average increases" discrimination against anyone who falls ill?  Are you interpreting this the same way I am reading it?  Is this not just more legalized "cherry picking" and "lemon dropping" by "rating up and out" (assuming there IS ANY "justification" for "above average increases")...at all in the first place?  How about "are not allowed to charge different amounts based on private medical conditions or information found in personal medical records"...period.....?  Otherwise we're condoning separating the sick people among us from the herd when they are most vulnerable (sick)...not very humanitarian or moral in a successful society if you ask me.  We need to shame our leaders into stopping their condoning of this discriminatory practice against the ill in our society.  Lord please help us get rid of the mind set that accepts such action among human beings  as "OK".  

      •  It says (0+ / 0-)

        that the premiums cannot be based on health status, so the rate increases must be across the board.

        •  But, but, but.... (0+ / 0-)

          Insurers would be required to justify an above-average premium increase to the Exchange

           That means above average premiums would be charged....legally.  How do you think health insurers could or would "justify" charging "above average" premium increases (and I think the use and irony of the word in this context is dispicable)... if not for health reasons?  

          •  I don't know (0+ / 0-)

            what it means. But I don't think it's based on health status, since that part is clearly stated.

            •  Poor naive puppy (like me sometimes).... (0+ / 0-)

              Politicians say one thing then do another ALL the time.  The fact that Obama says one thing clearly and then says the opposite slightly more opaquely in the same policy statement should tell you more than you want to believe about what kind of politician he is, as well as expose the sham in his health care plan.  That doesn't make him different, but more of the same.  I was very hopeful about Barak but as I watch what he (and other politicians) DO more than listen to what they SAY (especially when talking out both sides of the same mouth), I have become more and more disappointed in him.   The industry's donations to his campaign understand what he means as well as provide further evidence to my claim.  The fact that his former Democratic buddies are in full control here in Illinois and we still don't have real health care reform proves that too many Democrats have sold "we the people" down the tubes in favor of moneyed interests.  When I saw him hug Evil Jones my heart sank.

  •  This question here is the winner: (4+ / 0-)
    Recommended by:
    Meteor Blades, tmo, nyceve, Noisy Democrat

    Senator Obama, I am currently paying  $7557.96 a year for barely decent coverage. Under your plan, will I pay the same $188.42 a month that my Congressperson pays for his taxpayer-subsidized coverage?

    I had no idea. That is outrageous.

    Excellent diary, as usual.

    Stop quoting the law, we have swords. --Roman General Sulla

    by Residentcynic on Sun Dec 09, 2007 at 10:38:57 AM PST

    •  The Congressman is a worker and (1+ / 0-)
      Recommended by:
      chuckvw

      like many others he gets employer subsidized health insurance.

      If Eve wants lower health insurance costs, Eve will need to move.

      Under each candidate health insurance costs will rise.

      There may be one year when the Bush tax cut money gets added and a slight premium cut with the subsidy results, but charges will continue climbing unless patent, FDA, and scope of practice laws get radically changed.

      Rich medical types simply can't have enough money.

      There is no cure for avarice. Incoming money only softens the hunger momentarily.

      Healthy people will almost certainly need to mandated to pay the escalating premiums.

      Don't upset the apple cart. The medical industry is just years away from all possible cures Mr. Politician. We really need to fleece the sheep.

      A total lowerclasscashtomy cutting along the "affordable" margins is indicated.

      Baaa.

  •  thanks so much nyceve (3+ / 0-)
    Recommended by:
    nyceve, Kitsap River, Residentcynic

    for framing the 2008 election.

    I have no clue who, among Edwards, Obama and Clinton, would do the job that needs to be done on health care.
    if I were sure I'd know who to vote for. (And that goes for every other problem that needs solving)

    I was confident that had Wes Clark run and been elected, he would have solved health care because he said he reached the conclusion that universal single payer health care was only solution because administrative costs of private insurance are 10 times that of medicare and there are over 45 million people uninsured.

    I trusted his judgment, his reliance on logic, his fairness and his courage to do what's right.

    But he's not running and we need to know before we vote who has the judgment character smarts and courage to get the job done.

    It's health care, the environment, jobs, human rights, peace, justice, fiscal responsibility, transparency, internet neutrality and all the other crises we face that require a new direction that doesn't pander to special interests.

    I want proof who can deliver these things before we fall off the cliff that special interests are driving us toward with their short term goals and shortsighted agendas.

  •  And how 'bout HPV vaccine? (1+ / 0-)
    Recommended by:
    nyceve

    Apropos of being under-reimbursed by the for-profit insurance industry, doctors lose money on HPV vaccine, which protects women from cervical cancer, because the vaccine costs more than the insurance cos. pay them in reimbursement.  And that doesn't take into account the space they have to allocate to storing the vaccine, which has to be paid for in rent.  So a life-saving horrible disease-preventing vaccine for young women is considered a money-loser and doctors don't stock it.

    Then see how much the individual has to pay to go out and buy it on one's own: it costs hundreds of dollars!!  

    One more horror of our for-profit health system.

  •  20 cents on the dollar? (0+ / 0-)

    battling to get paid 20 cents on the dollar for the life-saving work they do?

    Twenty cents on what dollar? When did doctors become underpaid?

    Eli Stephens
    Left I on the News

    "Philosophers only interpret the world, the point remains to change it." - Karl Marx

    by elishastephens on Sun Dec 09, 2007 at 11:30:36 AM PST

    •  Yes, 20 cents on the dollar, paid weeks to months (2+ / 0-)
      Recommended by:
      nyceve, gkn

      later after the clinic submits tons of paperwork and pays the salaries of an entire department whose job it is to fight for payment.

      Ask anyone in a medical practice about what they have to do to get paid.  it will amaze you.  I know; I've been there.

      Many family practice docs and pediatricians ($100-$150,000 annual salary)have seen their incomes fall, or fail to keep up with inflation over the past decade. Internists have done slighly better, but all of them are under huge pressure to be more productive and see more patients in less time.  

      They are hugely unhappy.  Most are discouraging their own children from going into medicine. Why come out of medical school with $100-$150K of debt, and face this kind of pressure?  

      •  More like 200-250K debt for most of my friends. (0+ / 0-)

        Studying for boards has become ridiculously cutthroat these days because everyone's terrified that they'll have gone through all of these hellish years of education and get stuck with family practice.  It's just not worth going through the misery of med school/internship/residency if you've got that level of debt and only 100-150K/yr salary to look forward to.

        Politics is like driving. To go backward, put it in R. To go forward, put it in D.

        by gkn on Sun Dec 09, 2007 at 09:21:13 PM PST

        [ Parent ]

  •  Thank you nyceve. I really appreciate your (2+ / 0-)
    Recommended by:
    nyceve, Residentcynic

    tireless work on this. It scares me so much I can barely stand to think about it, which is not helping anyone. You are a brave and wonderful person.

    The sound of several slobbering horses scarfing up sticky rotting persimmons is fairly disgusting! klk

    by flumptytail on Sun Dec 09, 2007 at 11:54:06 AM PST

  •  I want the federal plan (1+ / 0-)
    Recommended by:
    nyceve

    Why can't we all get the federal plan for $188 a month?  That is a huge bargain in comparison to what I currently pay for what I consider to be a sub-standard plan.

    It may take a while to get a single payer system, so in our less than ideal world where is the candidate who will open the federal plan to all comers????

    "Our lives begin to end the day we become silent about things that matter." ~ Martin Luther King, Jr.

    by givmeliberty on Sun Dec 09, 2007 at 12:36:56 PM PST

    •  Certainly Clinton will make it available. . . (0+ / 0-)

      But don't count on getting those gold-plated subsidies Congress gets.

      Wouldn't that be the limit, we'll get the same stuff they have finally, but we'll pay through the nose, for what they receive taxpayer subsidized.

    •  Because it costs the taxpayers money (0+ / 0-)

      We eat the costs for Congress, but we cover everyone then we have to raise taxes a lot. I'm not opposed to that, but it would be nice if we had some estimates of what it's going to cost. Because most of us are going to have to pay for it one way or another, and it's going to be expensive.

  •  It's never gonna happen in the USA. (3+ / 0-)
    Recommended by:
    nyceve, xanthe, pkbarbiedoll

    Universal health care. At least as I've said nyceve, not in my lifetime.

    Blue Cross Blue Shield just sent me a notice that my $306/month total junk insurance is raised to $336/month beginning next month. I don't have a birthday or anything and have not used the insurance since I started buying it, so I don't know why it's going up.

    I want to cancel because I know I'm just throwing that money away and they'll deny any claim that my happen in the future. It's just fear that keeps my paying it, hoping beyond hope that if something really serious happens, they will help. Why do I feel so stupid?

    •  You feel stupid because... (1+ / 0-)
      Recommended by:
      OLinda

      ...you will soon be paying $642/month for coverage that will probably not be there for you if you really need it.  That is stupid, but the only option is going without any feeling (no matter how delusional) of any protection at all.  You and we are trapped in a stupid system, and it feels stupid.

    •  It's always going to go up. (1+ / 0-)
      Recommended by:
      OLinda

      I had mine raised twice in one year once, I forget how much in January and then 15% in July. You can count on it continuing to increase on a regular basis.

  •  It's not just the insurers, nyceve. (6+ / 0-)

    Nearly $500 to read an MRI? Seriously? As a physician I am quite ready to state this is an obscene amount of money to demand for the service of simply reading an MRI. I know my local radiologist quite well. He spends perhaps-being generous-all of five minutes reading the average MRI. Even allowing time for coffee, that suggests that he's billing about $5,000 per hour for his services. With numbers like these, I can certainly understand why the insurance companies are nickel & diming doctors on fees.

    Thing is, as a family doctor, my average office visit runs about $80. This includes quick re-checks on ear infections, but it also includes 45 minute marathons trying to supervise the care of 87 year old chronically ill patients with 23 medications who are hard of hearing and have a worried daughter 600 miles away. I have to see an awful lot of people just to keep the lights on and pay for my malpractice insurance. And when my radiology colleagues charge such obscene fees, the inevitable insurance company claw-backs hurt me a lot more, because I have to submit documentation for 10 or 12 patient encounters while he has to submit for just one for a similar payback.

    I guess that explains why my radiologist owns a private plane, two Audis and two Beemers. Nice work if you can get it. The real tragedy of course is that the grotesque disparity in pay means no medical students are willing to go into primary care anymore. We are desperate for more family docs in my rural area, as three of my partners are retiring soon, but we have had zero success. Medical students I talk to imply they'd have to be stupid to go into primary care. And so the patients suffer. As always.

    •  Not to mention (2+ / 0-)
      Recommended by:
      nyceve, gkn

      that the radiologists have bankers' hours, providing they're in a large group and only have to take call like once every month or so, unless the overnight and weekend readings are outsourced to Australia.  Like you said, "nice work if you can get it."

      And I'm guessing, although I don't know, that the radiologists' med mal insurance is cheaper than a family doctor's.

      Bush gives press conferences before the blogs or TM have time to research past comments & the next time he takes questions, reporters never revisit his lies

      by gooderservice on Sun Dec 09, 2007 at 02:46:18 PM PST

      [ Parent ]

    •  Excellent points (4+ / 0-)
      Recommended by:
      nyceve, chuckvw, gkn, gooderservice

      Medical students I talk to imply they'd have to be stupid to go into primary care

      I know you're already feeling the effects of this in a rural area but in 5-10 years everyone will.

      Not only will there be no family doctors but who will do all of the obligatory referring you guys do so that the radiologist can gas up his private plane, two Audis and Beemers?

      We've got to do something or those poor radiologists will be in trouble. ;-)

      This ain't no party. This ain't no disco. This ain't no foolin' around!

      by Snud on Sun Dec 09, 2007 at 05:35:21 PM PST

      [ Parent ]

    •  Someone told me (0+ / 0-)

      that radiologists are the highest-income physicians. That was pretty surprising. But aren't they starting to outsource this overseas now?

      •  Nah, not radiologists.... (0+ / 0-)

        Plastic surgeons receive the highest income. A lot of their work they do is paid out of pocket by their patients for elective surgery or procedures, not covered by insurance.  

        I always wondered about anesthesiologists, though.  I don't mean to offend any who are Kossacks... but years ago, it was one anesthesiologist assigned to one surgery the entire length of surgery - from induction to coming out  of anesthesia, including postop care.  Then CRNAs came along (Certified Registered Nurse Anesthetists) who were assigned one surgery case each, yet one anesthesiologist supervised a number of cases at the same time, overseeing the CRNAs, yet billed for each case individually... as though they were actually in attendance at each case the entire time.  

        I'm still scratching my head over that change in health care delivery.

        Bush gives press conferences before the blogs or TM have time to research past comments & the next time he takes questions, reporters never revisit his lies

        by gooderservice on Sun Dec 09, 2007 at 09:25:09 PM PST

        [ Parent ]

  •  I Can NOT Recommend This Diary Strongly Enough (2+ / 0-)
    Recommended by:
    nyceve, OpherGopher

    This is brilliant.

    Right the Wrongs...Gore in 08!

    by creeper on Sun Dec 09, 2007 at 02:03:45 PM PST

  •  RAP Clause Reminder (1+ / 0-)
    Recommended by:
    nyceve

    I know I commented about this in one of your previous diaries, but just to remind you:

    The MRI facility is an approved provider.  Apparently the radiologist who reads the MRI is not an approved provider, so I'll have to pay this doctor the retail price.

    If the facility is approved (in network) then it should come under the RAP clause; Radiology, Anesthesiology, and Patholoy clause, where the provider has to accept the insurance company's reimbursement as if they were in network... since they're working in a facility that is in network.

    At least if that's what you're talking about with the radiologist not being an approved provider.

    Bush gives press conferences before the blogs or TM have time to research past comments & the next time he takes questions, reporters never revisit his lies

    by gooderservice on Sun Dec 09, 2007 at 02:42:01 PM PST

    •  Thanks so much goodservice . . . (1+ / 0-)
      Recommended by:
      gooderservice

      could you give me a link of some sort.

      Last time you mentioned this I looked around, but couldn't find anything.

      A link of any sort would be very helpful.

      Thanks.

      •  Sorry, I don't have a particular link... (1+ / 0-)
        Recommended by:
        nyceve

        I just got that information from a very nice lady in billing at an anesthesiologist's office, after I got a really high bill for services recently rendered.  When she looked it over, she immediately told me, "Oh, this is covered by the RAP clause."  I asked her to explain, and her answer was as I previously posted.

        So I called my health care insurance company, and even the person there, upon immediately looking at the bill, realized it was an incorrect reimbursement paid to the anesthesiologist.  I was the one who mentioned the "RAP" clause to her, and she agreed.  So she was going to resubmit the bill to pay the anesthesiologist more money (which subsequently occurred... $320.00 more, to be precise.)

        I suggest you call the radiologist's office and mention the term "RAP clause" or just simply, "Why am I not being billed under RAP."  

        After spending a few minutes on google, keyword searching RAP radiology, anesthesiology, pathology, I came across numerous articles.  At first glance, it seems it started with Medicare.  But in my previous comment to another diary of yours, I had included a random link that referred to a particular health care company and its RAP "clause" or "agreement" or whatever that terminology is.  I'll see if I can find that again.

        Or I suggest you also call your health insurance company about this bill and ask  why the radiologist isn't following the RAP clause... since the facility is in network.

        Bush gives press conferences before the blogs or TM have time to research past comments & the next time he takes questions, reporters never revisit his lies

        by gooderservice on Sun Dec 09, 2007 at 09:39:11 PM PST

        [ Parent ]

      •  Some links from previous diary... (1+ / 0-)
        Recommended by:
        nyceve

        I can't say that your insurance company accepts the RAP theory, but it seems that that's a common practice.

        Here are the links from a previous diary of yours where I wrote when I first learned about it.

        My first comment

        A link I later found about this topic

        Identification of the blockquote I included

        I hope some of this helps you.  Apparently this has been a big secret kept from me (maybe many others) when the insurance company screws up the payment, as it seems they're just following their protocol to screw it up... unless a subscriber catches them at it.

        Bush gives press conferences before the blogs or TM have time to research past comments & the next time he takes questions, reporters never revisit his lies

        by gooderservice on Sun Dec 09, 2007 at 09:47:59 PM PST

        [ Parent ]

  •  Medicare for me (2+ / 0-)
    Recommended by:
    chuckvw, gooderservice

    costs about $90/month taken from my social security check.  I also pay $89/month for Senior Advantage through Kaiser.  This is the same insurance we had before we turned 65 that at one point was close to $700/month for 2 of us and rapidly rising.  I asked for charity from Kaiser and paid $350/mo. at age 64 for myself.  I am required to go to Kaiser hospitals and follow their system.  So far I have not been sick.  My friends have mixed reviews about Kaiser.  I am writing this because not only can Medicare insure the oldest, sickest people on about $90/month, but Kaiser still makes a profit on their $89/month.  The US health care system has a bad odor.

  •  Near as I can tell... (0+ / 0-)

    ...mandates don't guarantee universal coverage.

    http://www.nytimes.com/...

    Yet Krugman seems to believe they do.

    Is that correct?

    •  No Bush Bites. . . (1+ / 0-)
      Recommended by:
      chuckvw

      I don't like to speak for someone like Paul Krugman, i think he would agree that mandates don't guarantee universal care.

      But more important, i think he would also say that universal care means all Americans go in the pool.

      The larger the pool, the lower the costs, the healthy in effect subsidize the less healthy.

  •  I Think Mr. Krugman's Implied Point Is Correct (2+ / 0-)
    Recommended by:
    chuckvw, betson08

    Each of these Democratic prez candidates -- if one of them is elected -- is about to fumble a big opportunity to truly reform the way we pay for health care in this country.  These opportunities don't come along very often, and all of them have already shown they're not up to the task.

  •  single payer or bust (3+ / 0-)
    Recommended by:
    nyceve, betson08, bthespoon

    I find the focus on the various "plans" of the candidates somewhat misplaced. What I want to know is, how hard will each candidate fight the uphill battle for true universal single payer?

    •  there is only 1 candidate who has promised (2+ / 0-)
      Recommended by:
      mightymouse, bthespoon

      a single payer plan. That is Dennis Kuchinch, and he's got it in bill as well. I'm not even decided yet, to tell you the truth, except for having eliminated 1 warmongering candidate, but if you're looking for real health care reform, go ask Dennis what his plan says. He's been very straightforward about it all along.

      (now I'm not intending this to be a string of "but that means you haven't heard what Edwards is saying... or plug in your favorite candidate instead of that name...it's just that to my ears Dennis has the clearest voice so far on this issue - because the real solution will be simple to describe - single payer health coverage).

  •  Reading something like this (2+ / 0-)
    Recommended by:
    nyceve, Tropical Depression

    ..I wish this was published in every newspaper around the country. I wish this was a challenge to ALL presidential candidates and politicians. Your personal example is so spot on as to how these companies screw us.
    I swear that I will never forget receiving a letter from MY insurance company approving my surgery to remove atypical cells from my breast.....3 weeks AFTER the surgery!!!

  •  For people with good incomes (1+ / 0-)
    Recommended by:
    nyceve

    to see premiums go from ~$7,500 to ~$2,000 a person per year means a $5,500/person subsidy.

    Only about $350 per year is going to be available per person on average for subsidization and those with above average incomes will see less than the $350 average subsidy.

  •  All excellent questions nyceve.... (1+ / 0-)
    Recommended by:
    nyceve

    and I for one am anxious to hear the answers from all the candidates.
    And by coincidence, I just had a MRI yesterday.  I am getting worried about the cost for it.  I have junk insurance too, and I have a $2700 deductible so I'm sure I will be paying for the whole MRI out of my own pocket.
    I hope your MRI didn't reveal anything bad Eve.  I'm still waiting for my results (fingers crossed).

    "Imagine all the people, Living life in peace..." -John Lennon

    by angrybird on Sun Dec 09, 2007 at 07:19:58 PM PST

  •  Health care is such an important issue in this (1+ / 0-)
    Recommended by:
    nyceve

    country.  I trust Paul Krugman lots more than I trust Obama.  Krugman has been right on every issue for such a long time.  I wonder why Obama doesn't sit down with him and try to come to an understanding on both health care and on social security.  It seems that Obama has a lot to learn about both problems.

    The soul is not the ego in drag. Ken Wilber

    by macmcd on Sun Dec 09, 2007 at 07:36:35 PM PST

    •  Gore, Oprah, Krugman and a few others (0+ / 0-)

      ...need to get Obama and his wife Michelle together in a room somewhere and lobby HARD for him to do what is right and just on health care.  It would be just the injection his campaign needs.

  •  Health care, employment, and debt (1+ / 0-)
    Recommended by:
    nyceve

    I have a few fun health conditions that keep me out of work, and I've applied for disability and been turned down; I'm reapplying with a lawyer. One of those health conditions is kidney disease, and another is diabetes. In fact, I'm now in end stage renal failure and will be starting dialysis after the first of the year, and I'm hoping for a transplant from a living donor some time in 2008. I get my health insurance through my husband's employer.

    This past summer, my husband started a job with a small firm, under 50 people in size, and was there for all of a month and a half when his job suddenly vanished. My husband had been doing well at work, and was roundly praised for what he was doing, but he was told that his skill set, with which they were familiar when they hired him six weeks earlier, was not what they were looking for. He asked what he needed to learn, and what he could do, and was told that the decision had already been made and that there was nothing he could do. He was let go that day (the first day of the month). Experiences of other friends and family members, including a friend whose late spouse also had diabetes and kidney disease, lead me to believe that the reason he was suddenly let go is that their health insurance carrier told them that they'd raise the company's premiums if they continued to cover me. My friend said that she'd had quite a few jobs vanish that way when it was learned that her husband had kidney failure.

    He is now with a much larger company and I'm still getting my health insurance through him. I think the company is large enough that my health issues will cause few, if any, problems with the insurance carrier. The insurance company even has to cover my transplant under their own rules, without any waiting period, as I had continuous coverage for two years before my husband started with his current employer and became eligible for insurance.

    Ironically enough, now that I am actually starting dialysis, I'm eligible for Medicare, though for the first 30 months, Medicare takes a back seat to employer-provided group health insurance or other coverage.

    But even with insurance, our medical bills - mostly mine - are crippling us financially. We make the maximum contribution to a flexible spending plan that we can by law, $400 a month, but spend well over that on prescription co-pays alone. (On Medicare Part D, I'd reach the $2510 cap before the "donut hole" in January every year.) The insurance has a 20% co-insurance as well, with an individual maximum out-of-pocket of $1500 and a family maximum out-of-pocket of $4500; a family of two, as we are, pays that latter maximum, not $3000.  In a year, I've racked up about $10,000 in medical and dental bills, mostly medical. We were hurt by the fact that I was covered under four separate insurance plans this past year, one right after the other, each with its own new deductible and out-of-pocket maximum to meet, despite the fact that three of the four were with the same insurance company and were virtually identical. That's over $15,000 in medical costs, including the prescription co-pays, most of it mine.

    My husband earns a gross of $57,000 a year. We're drowning.

    "George Bush remains about as popular as a germ at a medical conference." - The Economist, June 23, 2005

    by Kitsap River on Sun Dec 09, 2007 at 08:22:00 PM PST

    •  As an employer I guarantee this is true (0+ / 0-)

      But it techinically is against the law for employers to discriminate against anyone because of their health, so no one must ever know what really happened.  Health insurers do not have to abide by any such anti-discrimination laws. In fact discrimiination against people because of their health by profit-driven health insurers is legal and will continue to be so under both Hillary and Obama's plans.  We call it "cherry picking" and "lemon dropping", and for some reason we seem to think it's immoral for employers to do but OK for insurers.  Please don't ask me to explain why bccause I can't.  Before HIPPA, health insurers regularly provided employers with a list of every medical procedure performed including on which employee.  Afterwards, insurers could only say that "Betty Smith has an unspecified medical condition that will raise your rates", dumping the ability (or inabilty) to pay for Betty's mystery health condition squarely on the shoulders of many employers who simply cannot afford to, or refuse to do so, rather than on the insurance plan for which everyone else (as long as they stay relatively healthy) continues to pay for dearly.  Also check and see if your name is on the MIB ("Medical Information Bureau") list.  If it is you are actuarial toast amd the only insurers who will sell health or life insurance to you (unless you work for the government or a very large account) are snake oil salesmen, and there are lots out there.    

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