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Barack Obama was in Montana today for a town hall on health care. I've pasted his remarks below the fold. They're most interesting for what's not in them. The word "cost" never appears. Nor does "curve." The word "insurance" appears 36 times, as in "insurance companies will no longer be able to cancel your coverage because you get sick." Moreover, the president isn't selling "health-care reform." He's selling "health-insurance reform."

The cost argument wasn't working to marshal public support. But that wasn't its real failing. its real failing was that it didn't work to marshal Washington support. That, after all, was the audience. "Bend the curve" was a strategy with particular potency in the Beltway. People care about the deficit here, or at least pretend to. And the plan was to keep this in Washington: Pass the House and Senate bills by August, use the recess to reconcile the two pieces of legislation, and take a vote in September. That required a Washington-centric argument. It failed.

Now the argument moves to the country, and it's going to sound a lot different. The opposition hasn't found purchase making arguments about cost. They've found resonance with government control and rationing and death. You don't win appealing to the wallet, you win by grabbing the gut. And the White House is following suit.

Think about this. You do the responsible thing. You pay your premiums each month so that you are covered in case of a crisis. And then that crisis comes. You have a heart attack. Or your husband finds out he has cancer. Or your son or daughter is rushed to the hospital. And at your most vulnerable – at your most frightened – you get a phone call from your insurance company. Your coverage is revoked. It turns out, once you got sick, they scoured your records looking for a reason to cancel your policy, and they found a minor mistake on an insurance form you submitted years ago.

Obama's full remarks follow.

Remarks of President Barack Obama—As Prepared For Delivery

Health Care Town Hall

Belgrade, Montana

August 14, 2009

Hello, Montana! It’s great to be here again. It’s always nice to take a break from the back and forth in Washington. And I’m thrilled to have the chance to spend some time with the folks in this beautiful state. After all, here in Montana, you’ve got bears and moose and elk. Back in Washington, we mostly see a lot of bull. So this is a nice change of pace.

I especially want to thank Katie for her introduction. I appreciate your willingness to talk about such a painful experience, because it’s important that we understand what’s at stake in this health care debate. These are the kinds of stories I’ve read in letters and heard in town halls all across America. The stories of hardworking people who are doing the right thing and acting responsibly, only to find out that they’re penalized because others aren’t doing the right thing – others aren’t acting responsibly.

On Tuesday, I was in New Hampshire talking about the people denied insurance coverage because of preexisting conditions. Today, we’re talking about folks like Katie who’ve had their insurance policies suddenly revoked, even though they were paying premiums, because of a medical condition. And tomorrow, in Colorado, we’ll be talking about the people who have insurance but are still stuck with huge bills because they’ve hit a cap on their benefits or they’re charged exorbitant out-of-pocket fees.

And when you hear about these experiences, when you think of the millions of people denied coverage because of preexisting conditions, when you think about the thousands who have their policies cancelled each year, like Katie, I want you to remember one thing: there but for the grace of God go I. These are ordinary Americans, no different than anyone else, held hostage by health insurance companies that deny them coverage, or drop their coverage, or charge fees that they can't afford for care that they desperately need.

It’s wrong. It’s bankrupting families and businesses. And we’re going to fix it when we pass health insurance reform this year. And I want to thank Senator Max Baucus for his hard work on a bill as chair of the Finance Committee – and for his commitment to getting this done.

Now, this is obviously a tough time for families in Montana and across America. Just six months ago, we were in the middle of the worst recession of our lifetimes. We were losing about 700,000 jobs each month. Economists of all stripes feared a second coming of the Great Depression. That's why we acted as fast as we could to pass a recovery plan to stop the freefall.

The recovery plan was divided into three parts. One third of the money in the Recovery Act went to tax cuts that have already started showing up in the paychecks of about 400,000 working families in Montana. We also cut taxes for small businesses on the investments that they make, and more than 200 Montana small businesses have qualified for new loans backed by the Recovery Act, including ten businesses in the Bozeman area alone.

Another third of the money in the Recovery Act is for emergency relief for folks who've borne the brunt of this recession. We've extended unemployment benefits for 40,000 Montana residents. We've made health insurance 65 percent cheaper for families who rely on COBRA while they're looking for work. And for states facing historic budget shortfalls, we provided assistance that has saved the jobs of tens of thousands of workers who provide essential services, like teachers and police officers. We’ve prevented painful jobs cuts – and a lot of painful state and local tax increases.

The last third of the Recovery Act is for investments that are already putting people back to work. These are jobs rebuilding infrastructure; there are nearly seventy transportation projects already approved here in Montana. These are jobs fixing up the roads that run through national forests. These are good jobs doing the work America needs done. And most of the work is being done by local businesses, because that's how we're going to grow this economy again.

So there is no doubt that the recovery plan is doing what we said it would: putting us on the road to recovery. We saw last Friday the jobs picture is beginning to turn. We're starting to see signs that business investment is coming back. But that doesn't mean we're out of the woods. You know that. In Bozeman, for example, the local job center recently reported seeing more than 8,000 job seekers for just 160 jobs. We cannot sit back and do nothing while families are still struggling.

Even before this recession we had an economy that was working pretty well for the wealthiest Americans – working pretty well for Wall Street bankers and big corporations – but it wasn't working so well for everybody else. It was an economy of bubbles and busts. It was an economy in which recklessness, and not responsibility, was rewarded. We cannot go back to that kind of economy.

If we want this country to succeed in the 21st century then we have to lay a new foundation for lasting prosperity. And health insurance reform is one of the key pillars of this new foundation. Because this economy won’t work for everyone until folks like Katie and her husband can start that small business without fear of losing their health coverage; until companies aren’t slashing payroll and losing profits to pay for health insurance; until every single American has the security – the peace of mind – of knowing that they’ve got quality, affordable health care.

The fact is, health care touches all of our lives in a profound way. So it is only natural that this debate is an emotional one. And I know there’s been a lot of attention paid to some of the town hall meetings that are going on around the country – especially those where tempers have flared. You know how TV loves a ruckus.

But what you haven’t seen – and what makes me proud – are the many constructive meetings going on all over the country. Earlier this week, I held a town hall in New Hampshire. A few thousand people showed up. Some were big supporters of health insurance reform. Some had concerns and questions. And some were downright skeptical. But I was glad to see that people weren’t there to shout. They were there to listen. And I think that reflects the American people far more than what we’ve seen covered on television these past few days. And I thank you for coming here today in that spirit. But before I take your questions, I want to talk about what health insurance reform will mean for you.

First, health insurance reform will mean a set of common-sense consumer protections for folks with health insurance.

Insurance companies will no longer be able to cancel your coverage because you get sick. This is what happened to Katie. Think about this. You do the responsible thing. You pay your premiums each month so that you are covered in case of a crisis. And then that crisis comes. You have a heart attack. Or your husband finds out he has cancer. Or your son or daughter is rushed to the hospital. And at your most vulnerable – at your most frightened – you get a phone call from your insurance company. Your coverage is revoked. It turns out, once you got sick, they scoured your records looking for a reason to cancel your policy, and they found a minor mistake on an insurance form you submitted years ago.

One report found that three insurance companies alone had cancelled 20,000 policies in this way over the past few years. One man from Illinois lost his coverage in the middle of chemotherapy because his insurer discovered he hadn’t reported gall stones he didn’t know about. Because his treatment was delayed, he died. A woman from Texas was diagnosed with an aggressive form of breast cancer and was scheduled for a double mastectomy. Three days before the surgery, the insurer canceled the policy. Why? In part because she forgot to declare a case of acne. By the time she had her insurance reinstated, the cancer had more than doubled in size.

This is personal for me. I will never forget my own mother, as she fought cancer in her final months, having to worry about whether her insurance company would refuse to pay for her treatment. The insurance company was arguing that she should have known that she had cancer when she took a new job – even though it hadn't been diagnosed yet. If it could happen to her, it could happen to any one of us. It’s wrong. And when we pass health insurance reform, we’re going to put a stop to it once and for all.

Insurance companies will also be prohibited from denying coverage because of your medical history. A recent report found that in the past three years, more than 12 million Americans were discriminated against by insurance companies because of a preexisting condition. No one holds these companies accountable for these practices. But we will.

And insurance companies will no longer be able to place an arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. That will help 3,700 households in Montana. We will place a limit on how much you can be charged for out-of-pocket expenses, too, because no one in America should go broke because they get sick. And finally we will require insurance companies to cover routine checkups and preventive care, like mammograms and colonoscopies. That saves money and that saves lives.

This is what health insurance reform is all about. Right now we have a health care system that too often works better for the insurance industry than it does for the American people. And we’re going to change that.

Now, if you’re one of the nearly 46 million people who don't have health insurance, you will finally have quality, affordable options. If you do have health insurance, we will help make that insurance more affordable and more secure. If you like your health care plan, you can keep your health plan. If you like your doctor, you can keep seeing your doctor. This is important: I don't want government bureaucrats meddling in your health care – but I also don't want insurance company bureaucrats meddling in your health care either.

Under reform, more than 100,000 middle-class Montanans will get a health care tax credit. More than 200,000 Montanans will have access to a new marketplace where you can easily compare health insurance options. And nearly 30,000 small businesses in Montana will be helped by new tax benefits as well. And we do all of this without adding to our deficit over the next decade, largely but cutting waste and ending sweetheart deals for insurance companies that don’t make anybody any healthier.

The fact is, we are closer to achieving health insurance reform than we have ever been in history. We have the American Nurses Association and the American Medical Association on board – because America's doctors and nurses know how badly we need reform. We have broad agreement in Congress on about 80 percent of what we're trying to achieve. And we have an agreement from the drug companies to make prescription drugs more affordable for seniors. The AARP supports this policy, and agrees with us that reform must happen this year.

Because we are getting close, the fight is getting fierce. The history is clear: every time we are in sight of health insurance reform, the special interests fight back with everything they've got. They use their influence. They run their ads. They use their political allies to scare the American people.

Well, we cannot let them do it again. Not this time. Because for all the scare tactics out there, what is truly scary – what is truly risky – is if we do nothing. If we keep the system the way it is right now. We will continue to see 14,000 Americans lose their health insurance every day. Premiums will continue to skyrocket, rising three times faster than wages. The deficit will continue to grow. Medicare will go into the red in less than a decade. And insurance companies will continue to profit by discriminating against people simply for being sick.

So if you want a different future – a brighter future – I need your help. Change is never easy – and it never starts in Washington. It starts with you. I need you to knock on doors, talk to your neighbors, and spread the facts. The cynics will continue to exploit fear for political gain. But we know that this isn’t about politics. This is about families and businesses. And at this moment – at this time defined by so many challenges – this about whether we will look back years from now and say we did what was right. We did what was hard. We did what was necessary to leave for our children a country stronger than the one we found.

Thank you. And now, I’d be happy to take your questions.

By Ezra Klein  |  August 14, 2009; 5:46 PM ET
 
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Comments

Too little, too late, I fear. Kent Conrad has just announced he'll vote against a bill that contains a public option, giving cover now to Landrieu, Nelson, the Wal-Mart Twins, Snowe, Collins, possibly Lieberman. You'll recall, of course, your appearance on PBS a couple of weeks ago, when you debated that right-wing orthodox dude. He confidently claimed there would be no public option in the final bill. You plaintively said, yes, there would be. So were you wrong?

The GOP has united behind "The Black Man Must Fail" strategy. Because I'm 44, and have seen this tragedy played out time and again, I sense that ANY reform is in grave peril. Any thoughts?

Posted by: scarlota | August 14, 2009 5:02 PM | Report abuse

I fear scarlota is closer and closer to having the right take on things -- events are breaking that way. I thought the President did a great job in Montana today. I wish I thought it was enough.

Posted by: bdballard | August 14, 2009 5:16 PM | Report abuse

LOL. You can't convince people their health care is no good, so tell them their insurance company is evil. When all else fails, blame it on big business.

Meanwhile, insurance companies approve "unnecessary" procedures everyday, and your guy would rather we just "take a pill."

Oh, and don't forget that Ted Kennedy will never have to take the pill, either. Nice.

Posted by: whoisjohngaltcom | August 14, 2009 5:38 PM | Report abuse

Your answer in the C-SPAN piece about why the insurance cos are being demonized was dead on. They clearly need a bill if they are going to have universal coverage, which is their alternative model. So in that sense they need Obama. They can go on as they are, but they are just begging for more regulation, and employer coverage will shrink because costs will rise. It is kind of a game of chicken. The insurers may get no bill, but will then be left with an unsustainable business model. And no hope, really, of seeing a GOP takeover of Congress in the near future, even assuming the ideological GOPers would give them the universal coverage they need.

The other point is the cost issue. That came out in the interview as well. Often cutting costs means denying certain kinds of care. One hopes that it is the ineffective or not-cost-effective kind of care that is being denied, but of course the patient may well not see it this way.

For both Perotistas and Blue Dogs "the deficit" and "costs" are battle cries, but neither group wants to do anything to keep costs down except limit coverage by denying it to "those people." Blue Dogs in particular fight hardest to keep Medicare reimbursement high and fighting health effectiveness reviews while screaming about costs. Kind of the CA problem applied to health care.

I think Obama is doing the right thing but it may be too late. He is going to have to go just with Dems and even there the public option may not survive. Is universal coverage and the insurance reforms enough?

Posted by: Mimikatz | August 14, 2009 5:41 PM | Report abuse

Clearly Obama's anticipating a final bill that contains nothing but the insurance-company reforms. He's going to get that passed and declare victory. That's the smartest strategy at this point.

Posted by: tomtildrum | August 14, 2009 5:49 PM | Report abuse

50 votes, people. That's what it takes under reconciliation. And the Dems will have them. They remember what happened in '94 after they failed. Not gonna happen again.

As for insurance companies. They are indefensible,corrupt, entities who will screw you at the most vulnerable moment in your life. Ask my sister-in-law who was told she had coverage for chemo, and now they are finding a reason not to cover.

Posted by: cmpnwtr | August 14, 2009 6:34 PM | Report abuse

"As for insurance companies. They are indefensible,corrupt, entities who will screw you at the most vulnerable moment in your life. Ask my sister-in-law who was told she had coverage for chemo, and now they are finding a reason not to cover."

Oh, and yet we are supposed to believe that the magic cure for healthcare is to eliminate all this "unnecessary" care those same insurance companies are providing?

I hope your sister enjoys her pill.

Posted by: whoisjohngaltcom | August 14, 2009 6:37 PM | Report abuse

I'm wondering if any of the protesters and contrarians are gonna give up on the Republican party when they realize that they've been doing nothing but dancing for the organ grinder. I hope so, but pride is a weird thing.

Posted by: Firebert | August 14, 2009 7:35 PM | Report abuse

So now Murtha has said publicly that a healthcare bill may be delayed until January, or even past then. What do we know about Murtha? He's a conservative Dem. He's close to Pelosi. Um, Ezra?

Posted by: scarlota | August 14, 2009 8:26 PM | Report abuse

they had better not delay. we need reform more than ever. if we delay past January it doesn't get done and the unsustainable system goes further astray.

Do the 80% we agree on now and then try more later. As mentioned many times around here incremental reform is better than NO reform.

Posted by: visionbrkr | August 14, 2009 8:40 PM | Report abuse

I cannot believe Murtha would be the one chosen to deliver a message of delay like that. He's talking out of his you know what. This is going to move very quickly in the Fall. The leadership know it has to. Read Ezra's prior blogs on 51 SEnators voting for the reform bill, then agreeing not to filibuster. Not sure we'll need reconciliation.

Posted by: LindaB1 | August 14, 2009 10:12 PM | Report abuse

"if we delay past January it doesn't get done and the unsustainable system goes further astray."

Utter nonsense. If what we have is "unsustainable," then time is on your side.

If, on the other hand, what you want is a mistake, then you will only get the country to embrace it in a moment of weakness.

Why the rush?

Posted by: whoisjohngaltcom | August 15, 2009 12:43 AM | Report abuse

visionbrkr, as someone in the industry, you should know that it is not run on profits. I am sure you know this but here is a primer.

The goal of a well run corporation is to make money for shareholders. In the case of health insurance companies this is in conflict with providing good efficient health care to the country.

The for profit insurers have learned that the way to get a high stock price is to have a low Medical Loss Ratio which is the percentage of inflow (premiums) paid out in medical benefit to patients. Notice that they consider medical benefits as "losses."

They do this in two ways. They make the numerator smaller by making it difficult for doctors and patients to collect, by cherry picking, and by recession. They make the denominator larger by obscene executive compensation, high profits, billions spent processing complicated forms they require of physicians and patients, and still more billions spent on fighting with doctors and patients over coverage and payments. This money lowers profit, but because it is money spent on things other than medical benefits, it lowers the MLR.

We waste about $200 Billion each year because the major companies have managed to get their MLR down to 70% - 80% and another $200 Billion each year because of compliance costs for physicians and patients filling out forms and fighting to get paid. But all this goes to lower the MLR.

Posted by: lensch | August 15, 2009 8:00 AM | Report abuse

lensch:
"Notice that they consider medical benefits as "losses.""

LOL. That's because they're insurance companies. Insurance companies insure against "loss."

Why do you ridicule insurance companies for treating claims as losses without questioning the insanity of filing insurance claims for routine care?

Apparently, you're only half as smart as you need to be, lensch.

Posted by: whoisjohngaltcom | August 15, 2009 11:07 AM | Report abuse

Ezra, the Republican message boils down to, "Let us charge you 20% more for rationing and denial of coverage!"

Similarly the Democrats should combine the cost curve and the denial of coverage. Just link these facts: that the insurance companies ADD NO VALUE, while skimming a huge chunk of money off the top.

And they are a monopoly (or an "oligopoly.") And they appear to have some Senators on the take, and defending them.

What do the health insurance companies do with the money? They invest in financial assets.

So let's add this: We just bailed out all of these so-called capitalists on Wall Street, where the insurance companies were in mortgage derivatives, up to their fat butts. Therefore, add part of that financial bail-out to the cost of healthcare under our brilliant system.

Now, with their "Nazi death panel" public-relations campaign, they are using some of our money to prevent a better society.

Not to mention they hope to prevent a more democratic society. People should have the right to choose a universal public option for basic coverage. People have a right to a system where costs aren't ginned-up by useless health insurance companies.

Imagine Social Security managed by private insurance! It would cost 20% more, and they'd be telling you not to get old in the wrong way!

In your recent interview with him, Sen. Lindsey Graham is wrong about one thing. Private health insurance won't be run out of business. They will find a proper niche covering new and advanced procedures, and helping to smooth out those difficulties.

We need a no-insurance-company public option! People should not back away from this!

Posted by: Lee_A_Arnold | August 15, 2009 3:01 PM | Report abuse

Lee_A_Arnold,

you mean the social security that's going bankrupt??? 401k's while down are still doing MUCH BETTER than Social Security. Trust me by the time I'm 65+ (I'm 38 now) Social Security will be LONG GONE. I'm just glad i'm paying into it all these years and wasting my money all this time. Soon if YOUR public option gets its way then I'll similarly have to put money away to take care of my healthcare needs once MEDICARE IS BANKRUPT which isn't far behind. When will you people realize that social entitlement programs only breeds laziness, contempt for productivity and nothing of real value. The only social entitlement programs that work are Fire dept's, police departments, military and roads.

public schools are a mess. Over my lifetime I'll pay about $500,000 in property taxes where i live if i can afford to remain here and do i get that much out in value, NO. But hey I only WORK for it, why shouldn't those that aren't working benefit from it.

Posted by: visionbrkr | August 15, 2009 4:49 PM | Report abuse

Visionbrkr, you don't seem to know that you are already paying for other people's care, though in a highly inefficient and costly way, and that you are paying an unnecessary 20% for your own care.

Social Security is not going bankrupt, it may need a little fix in 20 or 30 years. Google "Social Security in Ecolanguage" and watch it.

Medicare WILL be bankrupt, if we don't bring down health costs. If the medical system is not drastically altered, the long-term cost curve suggests that everybody is going to go bankrupt.

The health costs we can bring down are mostly transaction-costs of dealing with the system, such as: the time and energy costs of finding and understanding medical insurance ... the costs of keeping up with changes and reading the fine print ... the cost of your doctor dealing with the insurance company ... the costs of arguing and worrying when coverage is denied ... the costs of waiting and worrying if you don't have any medical insurance ... the "agency" costs of the private insurance, which after management, payrolls and profit adds 20% or more to the bill ... and even the costs of bailing-out the financial industry, because the insurance industry along with all the other players were up to their butts in mortgage derivatives. These are all current transaction-costs of the system of privately paying for medical insurance.

Republicans want us to waste our time, dealing with this stuff. They want choice-liberty -- not time-liberty, and certainly not freedom from stupidity. Indeed there's much more money in it for them, making you waste your time and energy. There's lots more money in it for the financial industry, skimming off the top of the insurance business.

Sometimes choice-liberty is good, like if you're buying consumer electronics or renting the DVDs. For standard basic universal medical coverage, it's a waste of time and energy and money.

Reducing transaction costs is the function of an institution, and if this isn't being done, that means we need a new one. It may be partly market-based; that is immaterial to the main argument. If parts of it can be re-privatized in the future after incentives have been realigned, so be it. But right now, PEOPLE IF THEY WANT IT SHOULD BE ABLE TO CHOOSE A PUBLIC OPTION OF UNIVERSAL COVERAGE.

Right now, it will increase productivity by saving personal time and energy (and not least among marginal workers.) It will reduce the long-term budget deficit, because part of your old private insurance can be used for the new system, while part of that money can stay in your pocket, and the savings appear to be massive in the long term.

Posted by: Lee_A_Arnold | August 15, 2009 5:23 PM | Report abuse

http://www.washingtonpost.com/wp-dyn/content/article/2007/04/23/AR2007042301963.html

lee_A_Arnold,

the point is these estimates (similar to the climate change ones) are always being revised earlier. Medicare cost shifts to private insurance and they STILL Can't manage themselves well. This argument that lensch puts forth that expense ratios for medicare are 2% are ludicrous. They don't factor in fraud which accounts to $60-$70 BILLION a year by the government's own admission. Charity care is another mess. I hope reforms are put in place to resolve that issue.

my only issue is that I've seen for years (since the mid 90's) insurance rates go up becuase profit somewhat growing which is wrong but you can't tell any industry that they can't make a profit. EVEN HEALTHCARE. And insurers for whatever reason didn't want to be hated anymore so they got away from their cost containment models that worked so well in the 90's and the cost shift from medicare and charity care has gotten worse. Ask any hospital administrator about it. I have.

Posted by: visionbrkr | August 15, 2009 5:44 PM | Report abuse

Visionbrkr,

Are you arguing that it has to be bad, that there is no way to design a responsible institution?

Every downside to U.S. public coverage that you claim here is ALREADY in the private insurance system. Is there any less fraud? It can't be stopped by making sure the system is transparent?

All arguments so far defending the private system, whether based on economic efficiency or liberty arguments, are already compromised: because the system presently is rationing, and because the system presently is denying coverage by faceless corporate bureaucrats using fine print.

I think an industry should be able to make a profit, IF THEY PROVIDE A GOOD OR SERVICE IN RETURN. What value-added is given by the health insurance companies? Worth a 20% surcharge on the bill? That they gamble in financial markets to cover your proctologist? Will somebody please name one thing?

We shouldn't even call it "insurance." You may never make a claim on your fire insurance, but you know you're going to need healthcare.

Posted by: Lee_A_Arnold | August 15, 2009 6:10 PM | Report abuse

Visionbrkr says, "the point is these estimates (similar to the climate change ones) are always being revised earlier" which is totally 100% wrong. This is the first year since at least 1988 that they were not revised later. I've made a graph of the date SSA predicts that the SS Trust Fund will go to zero and it goes straight up during all of the 90's.

If you are going to just make things up, we cannot have a discussion.

We were talking about MLR's which have nothing to do with fraud. Try and stay on topic.

You have not addressed my point that for profit insurance companies like to process complicated forms they require of physicians and they like to fight with physicians and patients because spending money on non-medical items LOWERS their MLR. Their business model is all wrong for an item like heath care that you want everyone to have. Think about your fire department.

Posted by: lensch | August 15, 2009 7:51 PM | Report abuse

By law, Medicare must go after fraud and publicize the results. Nobody knows anything about the fraud in private insurance, but here's a story that may amuse you:

When my eldest daughter was 14, she needed a very serious dental operation. When I tried to find out exactly what was covered, my private insurance company, as usual, would tell me nothing, but our rep told me unofficially that they would only pay for laughing gas in any dental procedure. When I told this to the surgeon, he said there was no way he would use anything as unreliable as laughing gas on a 14 year girl for this operation. If I insisted on laughing gas, I would have to find another surgeon. (BTW, I have never had Medicare interfere like this.) So I told him I would pay him and see if I could get the money back from my insurer.

The operation went fine and when I submitted the bill, the insurance company refused to pay for the anesthetic, $800. After a few days trying to get the insurance people to talk about this, I realized they had no authority to do anything. At first they would not put me in touch with anyone with authority, but when I started to yell, they gave me the name and address of someone with authority.

I wrote a letter to her and received no reply, but a week later I got a check for $200. So I sent her a longer letter, and I got the surgeon to write a letter, a copy of which I also sent. Again, no reply, but I got a check for $200. Even though I may be stupid as John Galt says, I began to see a pattern. So I sent her the same letter with another copy of the surgeon's letter. A week later, I got another check for $200.

As a test, the next time I sent the letter that referred to the surgeon's letter, I omitted the surgeon's letter to see if anyone would notice. A week later I got a check for $200. Now I had the entire $800 they owed me, but purely as a matter of scientific curiosity, I sent them the letter again. A week later I got another check for $200.

Now at this point I had vision of augmenting my income by about $5,000 a year, but I decided I had proved my point. We have no figures, but I would bet that sheer incompetence loses more money for the private insurance companies than Medicare loses through fraud.

Posted by: lensch | August 15, 2009 8:29 PM | Report abuse

lensch,

I would also find it hard to believe that you could get them to just give you $200 each time in your example. Every insurer that i work with (your standard BCBS, Aetna, Cigna, United etc) have these claims sorted within their systems by day and their systems shouldn't allow that. That being said anything is possible.


Trust me as the attached from John Stossel of ABC News mentions private insurance has MUCH LESS fraud than does Medicare.

http://blogs.abcnews.com/johnstossel/2009/06/medicares-efficiency-.html

Posted by: visionbrkr | August 16, 2009 11:41 PM | Report abuse

lensch,

oh forgot this good study too. I know you'll likely disagree with many of the points in the study but truly they are valid when looking at comparing the TRUE costs of admin of medicare vs private insurers.

http://www.cahi.org/cahi_contents/resources/pdf/CAHI_Medicare_Admin_Final_Publication.pdf

Posted by: visionbrkr | August 16, 2009 11:58 PM | Report abuse

Seems to me like the real word cloud for Obama is "BUT WE WON'T"

Posted by: thomasn5281 | August 17, 2009 12:30 AM | Report abuse

visionbrk - My example actually happened. I am now engaged in a 10 month fight with Humana trying to get my Part D coverage canceled. I sent them a letter in Nov, 2008, and they told me it was canceled but they never notified Medicare. Now they tell me it is too late.

The study you quote is mathematically a mess. But look, there are at least 23 other countries that get better health care results than we do at half the cost. They all are vastly more efficient than our private insurers. Are you going to write 23 misleading reports to explain them? Friar Occam would say, "Well they all have a government run universal plan. The simplest explanation is that such a plan is more efficient than for profit insurance." And he would be right.

Posted by: lensch | August 17, 2009 8:34 AM | Report abuse

lensch,

ok we agree to disagree. we are not the 23 other countries, we are America and our problems and strengths are uniquely American (taking a cue from Mr President) and we need an American solution. The point is the single payer model you espouse to give to all has proven in the US that it is not working, henced the 34 Trillion unfunded liability.

I don't doubt that it actually happened or that its happening to you. Look no system is perfect. I've been fighting for almost a year now for my father who still works at 70 and his employer is under 20 employees but Medicare doesn't get that they should be primary and his employer should be secondary in terms of coverage.

My suggestion to you in dealing with Humana is the same as I would say if it was with Medicare. If you don't like the answer you get when calling Humana or Medicare, call back, you'll get a different one. Eventually you'll find a person there to help you and in the end you may now realize that my job is a necessary evil. The job of an insurance agent. 4% is a small price to pay to know something's getting fixed and someone's accountable.

Posted by: visionbrkr | August 17, 2009 9:38 AM | Report abuse

"34 Trillion unfunded liability."

Do you have the fainest idea of what that statement means? Over what time period? What are the assumptions on growth? What are the assumptions on funding? The real question is whether we can afford Medicare as it is today. The answer is yes, Uwe Reindardt who holds two chairs at Princeton, has computed that under very conservative assumptions, in 2050 the average person will have 70% more money (in real diollars) after paying for Medicare than he does now after paying for Medicare. The problem is all in the cost of private insurance. I can post his computation if you want.

About my problems with Humana, you are dead wrong. Medicare is on my side. Humana just called me to acknowledge the receipt of an official compliant from Medicare. I first called Medicare 3 days ago. I have been fighting with Humana for 10 months. Noy only is Medicare on my side, they are vastly more efficient.

Your job is a necessary evil because private insurance is an unecessary evil.

Posted by: lensch | August 17, 2009 12:00 PM | Report abuse

How to figure out 2 + 3

Suppose we had the problem of determining 2 + 3. We had been using 23 as the sum which seemed pretty reasonable, but it hadn't been working out so hot. The rest of the world has been using 5, and they've been getting pretty good results. They live longer than we do. Their babies weigh more at birth. And so on. AND they've been saving a bundle.

So we say we're gonna reform our 2 + 3 policy. We gonna consider every and all possibilities and pick out the best. I like 6; it works well for the product. Why not for the sum?

BUT wait a minute. We want a UNIQUELY AMERICAN solution. We will not consider 5. We won't even discuss 5. Our newspapers will delete 5 from their fonts. If you try to talk about 5, YOU WILL BE ARRESTED! We sure don't want to do what them damn ferriners do.

Posted by: lensch | August 17, 2009 12:03 PM | Report abuse

lensch,

your example is one example. Did Humana let you down, yes but they don't let everyone down. Medicare is on your side in this example but how many times do you hear stories like mine that my father's having a problem getting claims paid by medicare and bills from his doctors because they don't understand the concept of whose primary or secondary.

As far as medicare's sustainability goes the problem I have is that no one has seemed to calculate the increasing life expectancy and the fact that it has been growing into calculations. Things like cancer, heart attacks, diabetes that used to kill people years ago in relative short order are now being survived and the costs of survival are great in dollar terms.

the birth weight argument doesn't hold water in my opinion. I'd love to see studies that point out what I believe to be the case. reproductive endocrinology in our society is much more prevalent than others and that leads to low birth weights etc. If we have more incidents we have lower birth weights. simple explanation.

And as for your "5" argument the only way that gets in is through Obama's backdoor.

Posted by: visionbrkr | August 17, 2009 12:32 PM | Report abuse

The demographic factors you cite are easy to take into consideration and are. What's hard are the economic factors like trying to figure out how much a given Medicare tax will take in. They are why I say that the best approach to long term (> 15 min.) economic forecasting involves a shaman, a goat and a sharp knife.

Posted by: lensch | August 17, 2009 1:10 PM | Report abuse

Mickey Kaus takes apart Mr. Klein piece by piece here: http://www.slate.com/blogs/blogs/kausfiles/archive/2009/08/17/this-is-plan-b.aspx

Posted by: Craig_Colgan | August 18, 2009 10:30 AM | Report abuse

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