The Other Klein Says True Things

How can you sustain freedom when one party has been overrun by socialists?

And that comment says it all about why the GOP refuses to be a part of any and all reform efforts. It still amazes me that no Republican senators have stepped up with a workable compromise plan, even though I should be jaded enough to understand that the only concern is political power and not the creation of good policy.

etdean1,

they have a plan but no voice for it. their plan is tort reform with market based plans that allow for insurance companies, not the government to sell across state lines and to allow for co-ops on a state, regional or national basis.

They just want them to play by everyone's rules as opposed to the FORCED rule of a government run option that sets prices below sustainability.

They have it, just that no one's listening. Kind of like the democrats who said NO to the Iraq war. Democrats are having their time now but its coming to an end starting in 2009 with the end of Corzine in NJ and starting with McConnell in VA.

There is a legitimate, if wildly improbable, fear that Obama's plan will start a process that will end with a health-care system entirely controlled by the government.

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and Ezra what exactly do you not get about "employee dumping" that's already being talked about by business owners in the Northeast as a way to cut costs. What about prices set below what markets can charge don't you understand? If someone can get a $1000 family rate for a public option what are insurers to do? I'm guessing if that ever happened you'd finally have insurers stand up to hospitals and their cost increases and say no. Then we'd have hospitals closing because there's nowhere else to cost shift.

See below for proof:

http://www.mondaq.com/article.asp?articleid=58696

but hey some hospital's are doing a-ok. I've mentioned on here several times the story about Bayonne Medical center. known in Northern NJ as an average hospital at best but with excellent hospitals around it like Hackensack Univ Medical center and NY hospitals it fell into bankruptcy several years back. Here's what they're up to lately.

http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Lawsuit-brews-between-Horizon-hospital/ArticleStandard/Article/detail/617173

Yes their hospital was charging $29,000 a DAY this year as opposed to $19,000 a day last year.

oops my bad. Bayonne Medical Center went from $13,000 a day to $29,000 a day. And we wonder why our premiums are higher???

It is rare that you have someone commenting on this topic as such a visible and public shill for the insurance industry, but visionbrkr has been making a pretty good go of it... almost transparently in a post that hardly requires such shilling.

John McCain had a perfectly reasonable plan. Tax credits combined with deregulation allowing insurance purchases across state lines. Reform doesn't have to mean more government. Taxpayers already finance more than 50% of expenditures. We have a government failure not a market failure.

Glad to see that the insurance company lobbyists like Kingstu01 and visionbrkr are tasked with monitoring Ezra's blog. It's very flattering, sort of like consumer product companies paying people to post positive product reviewsc on Amazon and E-pinion. And it's so cheap - you can have the young Republicans do it right out of college do it on contract, and *you don't have to pay their health care*!...

It's a great country!

I don't remember any demogogic scare campaigns over Social Security in 2005. I mainly remember (a) Josh Marshall trying to get Republican lawmakers to answer the question yes/no, do they or don't they support privatization/private accounts, which was inordinately difficult to do, and (b) Nancy Pelosi refusing to play the proposal-trading game that op-ed page editors like so much. Joe Klein's wrong about that part, anyway.

constans and dollared,

i'm sorry is there a requirement that i be a member of ACORN to post on here? I thought this was still America that we allow differing viewpoints, no?

Most reasonable people like myself (I won't speak for anyone else) want true reform that reforms the system that studies show 80+% of people like. Is that so wrong? Oh wait, I'm the devil so i guess it is.

"And the problems we face won't wait until we figure it out." Someone should tell Baucus. Oh, that's right, he's part of the Senate problem.

Ok, Visionbrkr, I'll bite. Here are some reasonable questions to your reasonable proposals:

* Tort reforms - it's been pretty thoroughly refuted that tort reform won't lead to a material reduction in healthcare costs. For an objective, non-Acorn influenced study along these lines, check out the 2004 CBO study - Google 2004 Tort Reform CBO for an AMA summary of the study.

* Insurance companies selling across state lines - how does this solve access problems? Opening up competition is going to cause companies to compete for unprofitable customers?

* Co-ops - what does that mean? How does a co-op on a national scale differ from a public plan which isn't subsidized? I know, I know, you don't trust Obambi or whatever it is you guys are calling him these days, but humor me and assume he means what he says and there will be no subsidies. What's the difference between a co-op and non-subsidized plan.

Sorry if I seem a bit strident here, but my wife is on my policy, but she has a pre-existing condition that probably won't bankrupt us, but could. My mom can't get insurance at all, and it will be 5 years before she is eligible for Medicare. It's not a question of ability to pay premiums, it's that no insurance is available. So when folks come up with half-cooked solutions, or wrap themselves in the flag and bray about how we've got the best healthcare system in the world, I do my best to hold my temper and politely explain my objections.

You think this is what's happening? I think Max Baucus is bought and paid for and is selling us out to the insurance, hospital and pharma industries with Rahm Emmanuel's help and Obama's blessing.

visionbrkr - If we allow private health insurance across state lines will they all wind up in DE & SD like the credit card companies and offer poicies with a $50,000 lifetime limit on hospital care?

Here are the facts on "trot reform" which I have posted 473,921 times:

1. The total of all malpractice insurance premiums amounts to 0.56% of health care costs.
2. The CBO has examined the idea of defensive medicine. They found no difference in practice between states with limits on tort settlements and those with no limits.
3. There is no correlation between the price of malpractice premiums and the amount given out in malpractice settlements.
4. The price of premiums does (anti) correlate with interests rates.
5. If you take all the money given out in malpractice settlements over $250,000 in NJ ( a state without caps) in a year and give it to physicians, each doctor would get $15.

These come from the book The Malpractice Myth by Peter Baker (U of Chicago Press)

Thus the doctors are wrong on almost every count. Malpractice premiums are not a significant factor in health costs. Physicians order unnecessary tests and treatments even when there are draconian limits on lawsuits as in Texas. Caps would save us nothing. The price they pay for insurance has nothing to do with the large settlements given out, and the total amount of money involved in these settlements is trivial. What they believe is a fantasy.

So many myths--so little time. Here is the beginning of an article of thr mythy of "cost shifting":

"A recent Milliman, Inc. analysis on behalf of America’s Health Insurance Plans (AHIP) argues that Medicare doesn’t pay hospitals enough, causing private payers to pay well above costs to keep hospitals solvent. This is referred to as ‘cost-shifting.’ (1) The non-partisan Medicare Payment Advisory Commission (MedPAC) refutes this argument and finds that a hospital’s relative market strength – and not Medicare-related cost-shifting – determines what a hospital is paid by private payers. This issue is central to the current debate on establishing a new public health insurance plan option and the authority of the new plan to establish reasonable provider rates."

lensch,

don't be silly. The laws in many states require no caps on maximum costs including OUR OWN of NJ. I'd expect you would have known that but who knows. Also the President is proposing no plan can have a cap anywhere nationwide which I agree with.

I've seen your stats on tort reform and I don't buy them. I believe that anytime you awards that are drastically more than any one family could ever spend caring for an affected individual it needs to be reviewed. When someone is seriously hurt they need to be justly compensated but it also shouldn't pay for lawyers to make millions and then some for their 33% cut. They need to cap what lawyers can make off the sick and injured. What they should do is set up panels that determine judgements who actually know what they're doing as opposed to juries who can easily be swayed by a sympathetic victim.

Also we need to look at medical malpractice insurance because many doctors end up paying still hundreds of thousands of dollars in malpractice insurance. Heck, loss ratios for everyone. if its good for medical insurance its good for medmal.

and so if you buy your $15 argument you should also believe its not bad for health insurers to profit, right? If we gave back every cent of profit last year it would amount to a penny for every healthcare dollar. What would that save???

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as far as the cost shifting arguemnt I'm also not buying it. I've spoken to several hospital administrators at town hall meetings this summer who have admitted to me they couldn't survive on the razor thin margins that Medicare and even less that Charity care paid. They have to ask insurers of private insurers for more to survive. Its not every hospital which is why not every hospital asks for a raise in their rates but many do.

See below for my proof.

http://content.healthaffairs.org/cgi/content/full/hlthaff.w3.480v1/DC1

Also taken directly from this article is the following proof that they not only cost shift with Medicaid but that its done ON PURPOSE:

"Stuart Altman, who chaired the Prospective Payment Assessment Commission (ProPAC, now subsumed into the Medicare Payment Advisory Commission, or MedPAC) for twelve years, maintained that state policymakers knowingly account for cost shifting when setting Medicaid rates."

msporter1,

let me start off by saying I hope Republicans straighten up (i hope) and liberal democrats don't forsake all reform for what they want as ideal (public option)on the first shot and you get what you and your family needs, ie an end to pre-ex and more reasonable rates for all.

Below are answers to your questions:

tort reform I answered above in relation to lensch's post.

* Insurance companies selling across state lines - how does this solve access problems? Opening up competition is going to cause companies to compete for unprofitable customers?

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this cannot be quantified easily nor underestimated. I'll use my state of NJ as an example. For the individual market we basically have one or two carriers that handle it all. For small companies (2-50) we have basically 5 major players and that's it. What we theoretically would do is open up to hundreds if not thousands of insurers. More competition, lower rates is the idea. For example a couple years ago the BCBS association allowed two new carriers to "sell across state lines" in new corporate entities. They are Amerihealth (a subsidiary to Independence BCBS from PA) now selling in NJ and WellChoice (a subsidiary of Empire BCBS) selling in NJ. This added two new carriers to the market which desperately needed them and helped keep rates down as they were one other option for individuals and small employers to choose from.

Also if reform also includes an end to pre-ex every carrier will have to work within the same structure but the expected cost from covering pre-ex will be offset by the additional funds by the individual mandate. that is why the insurance industry is for an end to pre-ex as long as it comes with a mandate that everyone be covered.
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* Co-ops - what does that mean? How does a co-op on a national scale differ from a public plan which isn't subsidized? I know, I know, you don't trust Obambi or whatever it is you guys are calling him these days, but humor me and assume he means what he says and there will be no subsidies. What's the difference between a co-op and non-subsidized plan.

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I'm not Anti Obama like some are. In fact I give him credit for stabilizing the economy from disaster that it was about to go into although i'm not thrilled now with what he's doing in some areas and expect as many do a long, slow painful recovery where jobs will continue to be scarce. As far as co-ops go to me they're the same as a non-subsidized public option. The devil is in the details but I do think they or the public option should get some start up money but neither should have the full backing of the Treasury as that will only lead to over-spending like we have in medicare. I also think they should both have to adhere to the same laws and rules that insurers have to, ie paying premium taxes, keeping monies in reserve etc.

Right! So we have exactly the right president for these times, no? Imagine how much worse it would be with a polarizing figure in the White House. Nothing else would be moving but we would much further away from resolving the situation.

visionbrkr - I am afraid I cannot reply because you do not read what I wrote and then you never over any real evidence to argue against my points. All I can do is repeat.

Try again. I even point out that NJ has no caps. The CBO argument depends on the fact that some states have caps and some do not.

What do you expect hospital administrators to say, "Oh my gosh, private insurance pays too much. Give me Medicare rates." People who charge $35 for a Tylenol don't have a lot of credence in my book. The data is there (MedPac). Let me explain the proof again.

The claim is that Medicare and Medicaid pay hospitals less than it costs them for treatments so in order to make this up, they shift the cost by charging private insurers more. Thus it makes Medicare appear cheaper and private insurers more expensive. Now it is true that different hospitals get different payments from private insurers for the same treatment, but the payments do not correlate with the percentage of Medicare and Medicaid patients they treat. Some hospitals with a lot of public patients get paid less than some with very few. (MedPac).

Get it?

Joe Klein said a mouthful and no doubt some of it is a bit more right than wrong. But the following claim is way off base, and it is sloppy of Ezra to let it skate through with the rest of Klein's self-serving fatuities:

"This year, the liberal insistence on a marginally relevant public option has been a tactical mistake that has enabled the right's 'government takeover' disinformation jihad."

Who exactly died and put Joe Klein in charge of determining, from the standpoint of healthcare economics, that the public option is "marginally relevant"?

Sure, an eviscerated public option would be marginally relevant. But not a robust one.

I assume Ezra knows this. Though he would probably retreat behind the nostrum of what is "politically possible."

But that is nonsense too.

Imagine if, instead of quaffing his own post-partisan Kool-Aid in such Brobdingnagian quantities, Obama had ignored Max Baucus and the Senate Finance Committee and instead praised the work of the House committees and Senator Kennedy's HELP Committee in the Senate? You know, "Let's win one for Teddy!"

Then a robust public option would have been an "of course" rather than a media gang-banged "marginally relevant tactical mistake." Of course Rush, Glenn, Sean, and the Republican cynicians would be braying their inanities as usual, but they would be getting nowhere near the traction they have acquired, even with professional "I'm my own man" self-strokers like Joe Klein, if Obama had made consistently liberal/progressive choices, rather than the narcissistically mangled ones he has made.

And make no mistake about it, while their is over determination in all things involving human behavior, and especially human political behavior, the poor choices Obama has personally made have, by far, been the primary determinants of the health care "reform" farce we now have on our hands -- Joe Klein's economically cretin "marginally relevant" musings to the contrary notwithstanding.

lensch,

its amazing to me that you state I don't read your evidence when you choose not to read mine when it comes to medicare and medicaid cost shifting. Did you bother to read my article i posted? Did you see the disparity in the rates? do you not know that medicare and in turn medicaid SETS rates?

Let's go back to basics to try to help you understand. If a hospital needs $1 to sustain itself and receives 80 cents from Medicare and Medicaid they are going to need some factor over $1 from private insurance to maintain solvency. How much over $1 they need is determined by the number of private payers vs medicare and medicaid payers. So when medicaid enrollment jumps (as under the guidelines the president sets forth) insurers will need to pay more for hospitals to stay solvent.

GET IT??

visionbrkr - Yes I understand you argument about what MAY happen, but you do not understand mine, that it does NOT happen. If what you said really did happen, then those hospitals with a high percentage of Medicare and Medicaid patients would have to charge higher rates to the private insurance than those hospitals which have a lower percantage. Right?

BUT THEY DO NOT!

my question is this: what does it matter if people have insurance? Why is our govt so intent on giving people insurance?
Shouldn't they be talking about access to care?
Isn't that what's important?
And then if they cared about our health CARE, they'd just be opening up clinics to see how it goes.
right?

And the other thing - why would be want to do something on such a ridiculously large scale? Why not put in pilot programs in a few states? And see which ones work better?

""And then if they cared about our health CARE, they'd just be opening up clinics to see how it goes.""

No, because the government does not really have an interest in hiring a bunch of doctors, nurses, and administrators as federal employees. That's the model the NHS has, and we feel that simply making sure that everyone has coverage is a better way of going about it, in part because we already have caregivers all over the US, where the uninsured already are. Coverage just ensures that caregivers get paid rather than denying care or driving into bankruptcy those who need care.

And why is it whenever you scratch a right-winger, he starts frothing about ACORN?

haha. what MAY happen. 40 years of factual data isn't enough for you??? Guess not when you're trying to argue against it and trying to argue that Medicare for all would be a God-send. Would you agree that the world is round?? The sky is blue?? Grass is green???

And while tort reform may or may not help end defensive medicine you cannot argue that it does not happen. That people in this country don't get tested until the cows come home and all those tests are one of the main reasons that costs are skyrocketing?

Again when we get to national 85% medical loss ratios and costs still go up what is your excuse then???

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And why is it whenever you scratch a right-winger, he starts frothing about ACORN?

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I'm guessing the same thing that whenever a right winger brings up the ever growing defecits that a left winger froths about Bush and the Iraq War. Just depends on your perspective.

well, you guys sure know how to crowd out a discussion.

Don't you know that people gave up on this thread, and went back to a more fruitful source, namely Ezra's other posts?

I stopped when I read this:
"I've seen your stats on tort reform and I don't buy them. I believe that..."

Which translates as, "I've seen your facts and prefer this version of reality, with no facts supplied to get in its way."

Visionbrkr,

Thanks for the response. I agree with you that I hope Democrats can get the public option, but if for whatever reason the public option just doesn't have the votes, they do push through guaranteed coverage and no pre-existing. I know individual mandate without a public option to keep the insurers honest is very controversial, but it could work if regulation was tight (a big IF I know if the "all regulation is wrong" crowd takes over again.)

As to tort reform, there are undoubtedly abuses, but my personal philosophy is such that I would err on the side of the individual's ability to sue, and not protecting the institution - but I recognize that's just an opinion. The CBO study was pretty persuasive that in the grand scheme of things, tort reform wouldn't make a material dent in costs. At some point, I think, although not in this particular attempt at reform, we're going to have to address the fact that we spend to much on care, even without insurers in the equation. But starting with ensurers is the easiest battle to fight initially (though clearly, it's not an easy battle!)

wapomadness,

i'm sorry its been insinuated that i can't post or shouldn't post because my views are different than others (ie not liberal or progressive but more conservative, not crazy conservative just conservative). I would hope that Ezra wouldn't just want shills that agree with his viewpoints to stroke his ego but I won't speak for him. As far as CBO they're not always correct. Wasn't their predacessor the group that stated that Medicare would cost $9 Billion in 1991 at its start date and then ended up actually costing $60+ Billion. That's the reason they only forecast out only 10 years now because longer than that in many instances is too difficult to predict one way or another as entitlements fly off the track. The only thing I'll say is more entitlements = skyrocketing costs. Sometimes those entitlements are justified to me and sometimes they're not.

No one has said you shouldn't post. I *have* said that you are a hilarious, dishonest shill for the insurance industry whose views aren't worth anything because they only serve your very provincial business interests, rather than any concerns that would help people's actual access to health care.

Your statements on tort reform, are, of course, astoundingly ignorant because you're obviously unaware of states that do have tort reform and don't see an improvement while actively denying and reveling in your ignorance when someone points out to you that the costs of medical malpractice aren't as high as you claim you are.

You shouldn't really whine and play the victim. People are free to have views that are as stupid as yours. But when someone comes in here dishonestly acting like an "honest broker" when he's just a shill for the insurance industry -- an industry that plays no role in actually providing health care -- that's a reason to hold such a joke of a person up for ridicule and mockery.

constans,

maybe you should look up what insinuate means.

I'd love an explanation by you about tort reform and how it relates to defensive medicine. If tort reforms have no benefit then why do doctors still practice defensive medicine? They may not actually be sued but its the fear of such lawsuit that drives many of them and these are doctors that say this, not shills like me as I'm referred to.

Its funny you don't know me personally at all but yet you call me dishonest. How exactly can you do that? Just from posting on a website? Maybe I should just change my screename on here, adjust my views slightly in my posts and then maybe you're take will change. At very least it will show how shallow you are in your charachterizations of me.

I swore I wouldn't do this, but..

"If tort reforms have no benefit then why do doctors still practice defensive medicine?"

The correct question is

"If tort reforms have benefit, why do doctors still practice defensive medicine after they have been enacted?"

lensch,

thank you. You've proven that I typed it wrong because some of you have infuriated me so with your hatred of what i do. That I spend my days helping my clients through the current system and yet you or some like you blame me for the entirety of the ills of the insurance industry. Who else is to blame? The 60 year old woman working as a claims processer making $10 an hour barely squeaking by? The 25 year old secretary that answers the main phone lines at an insurer and transfers people?

You do realize we all don't live in mansions with CEO salaries don't you?? I have clients that I've recommended and they've gone to plans where I don't get paid a dime and yet still help them understand their Medicare plans and advise them on what plans to go to. I don't expect or want sympathy I just want the hatred to stop. Hopefully when pre-ex is a thing of the past the healing can start but I doubt it with some of the venom I see on here. I understand it because many have been denied what they believe is a right but I would contend that its misdirected at many.

To give an analagous example I guess that your small town community banker is to blame for the economic meltdown even if they had nothing to do with it just because they're a "banker". Nice generalizations.

First off, I don't like the insurance plans currently on offer and I don't care if they all die. That doesn't mean that a public plan that commits the same errors is actually going to do anything to address the real costs of health care. What bugs me is that the insurance exchange is going to continue to drive people to buy care they don't want- prepaid care, not real insurance.

Direct payments drive down provider cost. By insulating consumers from the cost of the product, we create an environment where everyone is pursuing the most expensive care that they can get others to pay for. I want the government to give people health stamps.

The shrill nature of this debate is preventing the good ideas from making it forward and leaving us with an incredibly stupid Democratic plan and a bunch of Republican idiots lying about it.

If these weak people we elected can't even revisit the Medicare part D, slimeball Billy Tauzin (so slimy he was a Democrat and a Republican) perpetuated retail price drugs scam, how can we think they are being serious about health care.

For me, health care reform starts with "we can't afford Medicare", not insurance.

staticvars,

I agree. We need complete transparency in costs from insurers to doctors to hospitals to pharma.

Also HSA's which i have one and i love it need to be continued and they're in danger with some provisions in this bill relating to mandated levels of benefits. I understand the need to ensure people can afford their deductibles that apply to an HSA but if they can't afford the acutal coverage without an HSA how is that an answer?