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Posted at 10:32 AM ET, 02/ 2/2011

The reality of our health-care debate

By Ezra Klein

I don't mind having a conversation about replacing or reforming the Patient Protection and Affordable Care Act. I think we could do better than PPACA. Wyden-Bennett, for instance. Or dusting off Richard Nixon's plan and using that instead. What baffles me is how my conservative friends can delight in the prospect of repealing or voiding PPACA before they have committed to some alternative that could help Hillary St. Pierre:

With a court decision on Monday declaring the health care law unconstitutional and Republicans intent on repealing at least parts of it, thousands of Americans with major illnesses are facing the renewed prospect of losing their health insurance coverage...Hillary St. Pierre, a 28-year-old former registered nurse who has Hodgkin’s lymphoma, had expected to reach her insurance plan’s $2 million limit this year. Under the new law, the cap was eliminated when the policy she gets through her husband’s employer was renewed this year.

Ms. St. Pierre, who has already come close once before to losing her coverage because she had reached the plan’s maximum, says she does not know what she will do if the cap is reinstated. “I will be forced to stop treatment or to alter my treatment,” Ms. St. Pierre, who lives in Charlestown, N.H., with her husband and son, said in an e-mail.

In a world where the two parties' top priority on health care was providing answers for the uninsured and cost control, an argument over the best way to do health-care reform would be a very healthy thing. But that's not what we've got. We've got the Democratic Party, whose top priority is to try and solve our health-care problems and who've shown their commitment to that by moving steadily rightward over the last century in a bid to pick up Republican support for some sort of solution, and the Republican Party, whose top priority is that we shouldn't do whatever the Democrats are proposing and have proven their commitment to that by abandoning previously favored policy proposals as soon as the Democrats demonstrated any interest in adopting them.

And that's the fundamental problem here: It's easy to compromise when both sides are committed to solving a problem, because the appeal of solving the the problem is enough to persuade both sides to make concessions. That's why Democrats gave up on single payer, on an employer mandate, on a public option. But it's impossible to compromise when one side is uninterested in solving the problem, as they lack the incentive to make any concessions. That's where the Republicans are on this, and it's why they've not been interested in joining onto a bill even when Bill Clinton moved to the right and adopted the core of Richard Nixon's plan and Barack Obama moved even further to the right and adopted the core of Mitt Romney and Bob Dole's plan.

By Ezra Klein  | February 2, 2011; 10:32 AM ET
Categories:  Health Reform  
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Comments

--*Hillary St. Pierre, a 28-year-old former registered nurse who has Hodgkin’s lymphoma, had expected to reach her insurance plan’s $2 million limit this year.*--

How much of other people's money are you willing to spend to try to keep St. Pierre alive, Klein?

How much of YOUR money have you spent trying to keep St. Pierre alive, Klein?

Why do you want St. Pierre to die, Klein?

Posted by: msoja | February 2, 2011 10:39 AM | Report abuse

I'm wondering how open Obama is to Wyden and Brown's plan. He could pre-empt any similar move by Romney, and it sounds like good policy, giving the states room to experiment.

Posted by: jduptonma | February 2, 2011 10:46 AM | Report abuse

Interesting that since the President mentioned being in favor of tort reform in the SOTU, Republicans are now back peddling on their most favorite health reform idea. What's left? Moving all insurance companies to S. Dakota?

Posted by: nedinwc | February 2, 2011 10:55 AM | Report abuse

other than propaganda talking points there are other issues at play here that don't tug at the heartstrings so i guess they won't get play here.

1- why couldn't her husband's employer just get an unlimited lifetime cap (assuming its available to them if they're a large enough employer.

2- if her husband's employer changed insurance companies two companies don't compare lifetime caps so it would re-start itself.

Again questions that don't push your argument so they don't get discussed here.


"Like Ms. St. Pierre, Mr. Ell expected to reach the limits of his coverage this year if the law had not passed. In 2010, the bill for the clotting factor medicine he needs was $800,000, and his policy has a $1.5 million cap. “It is a close call,” he said"


Well my first question here is why in God's name does a medicine cost $800k per year. Maybe we should have done something on cost of medicines while PHARMA was flush at 20% profit margins. But i guess since they ponied up $175 million in "pro reform" ads then they were pretty much exempted right? They'll make TRILLIONS off of the horrible negotiation that Obama and PPACA did. In fact in the end it'll make Medicare Part D look fiscally responsible.


Posted by: visionbrkr | February 2, 2011 10:59 AM | Report abuse

Well, I for one have lost all interest in compromise with msoja.

The bummer about trolls is the value of their contributions is in an inverse relationship with their posting volume.

Posted by: BHeffernan1 | February 2, 2011 11:00 AM | Report abuse

This whole debate has become a colossal waste of time. If the Repubs have the juice, they'll freakin' repeal the individual mandate, then scramble to cobble together the cost savings the mandate provides from somewhere else, like cutting Medicaid benefits and trying (again) to gut SCHIP, etc, etc. The problem really is the Republicans don't know what they want.

Posted by: nickthap | February 2, 2011 11:05 AM | Report abuse

They just "know" they don't want a law passed by Democrats. That's about the size of it. That's why this debate is a waste of time.

Posted by: nickthap | February 2, 2011 11:07 AM | Report abuse

Is there a way to block seeing comments from msoja and visionbrkr so I don't have to read their morally bankrupt musings? It makes me wonder if people like that pretend to adhere to any major religion, because obviously they don't follow the tenets of any of them.

Posted by: AuthorEditor | February 2, 2011 11:07 AM | Report abuse

visionbrkr - These aren't "propaganda" talking points - they are realities that Republicans refuse to address because they know they have no ready answers for them, and it demonstrates the genuine consequences of their position. Your proposed solutions also indicate you aren't serious. Getting the employer to change insurance companies is wholly impractical. Firstly, to change insurance companies is a massive, lengthy, expensive undertaking which angers nearly everyone involved, and which they'd never do for one person. Secondly, in a year, Ms. St. Pierre would be right back at square one - having met her lifetime cap. It doesn't qualify as a solution. I question if anyone who argues that our health care system is the best in the world has ever actually used it, or watched someone who has. I can't imagine so.

The real question is if Republicans were always faking in their desire to improve health care? Would this have happened if Clinton embraced the Republican plan in '93? Would they have backpedaled from their own ideas? Is it always a carrot with them?

At this point, Obama could embrace TORT reform (as he has), high risk pools (as he has), and selling across state lines, and Republicans would denounce all of these solutions just as they denounced their last.

They aren't interested in improving the health care delivery system in this country, and never have been. Once people realize the Republicans have no real interest in the uninsured, the argument will start to shift back to Democrats.

Posted by: workmonkey | February 2, 2011 11:15 AM | Report abuse

Ezra

Republicans dont care about normal people. When will you figure that out?

The only time they do care about a person is when they think they can capitalize on it politically or when there is some larger issue at stake that involves corporate profits.

And they have no desire to fix health care or health costs.

Posted by: lauren2010 | February 2, 2011 11:18 AM | Report abuse

"before they have committed to some alternative that could help Hillary St. Pierre:"

Eliminate monopoly profits provided via patents.

http://mises.org/daily/1763

I can't get to the linked article, but if her illness has generated $2 million in costs, surely a good chunk of that is monopoly profits going towards pharmaceutical companies.

The direct cost of cancer in terms of medical care is $93.2 billion. Given ~1.3 million new diagnoses per year, that's $71,700 per person per year in treatment costs.

http://www.cancer.org/cancer/cancerbasics/economic-impact-of-cancer

That St. Pierre's treatment seems to cost an order of magnitude more than that suggests an extremely expensive name brand drug is a big part of the problem.

Posted by: justin84 | February 2, 2011 11:31 AM | Report abuse

Amen, Ezra. And it seems to me Obama has fed into this problem by constantly pursuing "bi-partisanship" long, long after it was plainly patent that the Republicans weren't operating in good faith. I could have wretched when he apologized to them for not "reaching out" enough.

The GOP has no incentive to compromise since they don't want to solve problems, just defeat Obama. Even though they are public officials who are paid (good money) to solve problems. And they pay no price for this malfeasance, since Obama won't call them out on it.

Posted by: jtmiller42 | February 2, 2011 11:37 AM | Report abuse

workmonkey,

personally I think there shouldn't be lifetime caps so I agree with that part of the law (and actually with most of it) but my problem is with how the argument is structured. Some caps are good and warranted (ie caps on physical therapy etc) that gets at abuse of the system. Ms. St Pierre's case is not one of them obviously.

As far as her specific case I don't believe they state in the article that her claims were $2 million per year. They don't say either way. But again I'll point to cost to say that these costs would be less of an issue if there were actually some cost containment in the systems like for example what's being done now in MA.

http://www.boston.com/lifestyle/health/articles/2011/01/21/blue_cross_blue_shield_of_massachusetts_says_new_pay_plan_working/


As far as employer's changing insurance, it happens all the time but I also agree that it won't be done just for a single employee and shouldn't be done for a single employer (in a large employer). The needs of the few or in this case I guess the one can't outweigh the needs of all, no?

Its also difficult to take someone seriously that only brings up the negative parts of our healthcare system without bringing up the positive ones.

Posted by: visionbrkr | February 2, 2011 11:41 AM | Report abuse

That St. Pierre's treatment seems to cost an order of magnitude more than that suggests an extremely expensive name brand drug is a big part of the problem.

Posted by: justin84 | February 2, 2011 11:31 AM | Report abuse

and remember justin84 it was the Dems that made sure that PHARMA's profits were as well off as they are. Remember the Eshoo amendment? Dems always say that Obama is a "bad negotiator" with Republicans but this is some horrible negotiating they did with PHARMA.

http://www.essentialaction.org/access/index.php?/archives/223-Consumer-groups-battle-Eshoos-health-care-amendment.html


Maybe if Ms. Eshoo's amendment didn't pass and instead we got a 5 or even 7 year window for generics then a future Ms. St Pierre could afford their prescriptions and the cost of their healthplan. But hey we'll never know.

Posted by: visionbrkr | February 2, 2011 11:47 AM | Report abuse

"personally I think there shouldn't be lifetime caps so I agree with that part of the law"

Visionbrkr,

It is interesting that a product known as insurance can kick in after incurring costs as low as a few hundred dollars - and for some services kick in on the first dollar of spending - but at the same time no longer pays claims after those costs become catastrophic.

Posted by: justin84 | February 2, 2011 11:49 AM | Report abuse

lauren2010:
"Republicans dont care about normal people."

I've invited you and others before to do just a tiny bit of research, yet you refuse and continue to cling to your tired talking points. Conservative-leaning people outgive liberals in both time and money, across the board. Support for federal bureaucracy does not equal 'compassion', progressive talking points to the contrary. Feel free to be compassionate with YOUR money, and not just with other peoples money....

By the way, lauren2010 is the same person who posted yesterday that the judge in Florida who ruled the ACA unconstitutional is worse that terrorists who blow up Americans. So obviously this person's credibility is rightfully questioned...

Posted by: dbw1 | February 2, 2011 11:50 AM | Report abuse

Uhhh, not to state the obvious but

"Republican Party, whose top priority is that we shouldn't do whatever the Democrats are proposing and have proven their commitment to that by abandoning previously favored policy proposals as soon as the Democrats demonstrated any interest in adopting them."

This has been the defining hallmark of the Republican party in almost every issue since 2008. Well, other than throwing even larger and larger gobs of cash at the top 1%.

Posted by: kindness1 | February 2, 2011 12:00 PM | Report abuse

How about this radical idea, bleeding-heart tightwad liberals: the people in Ms. St. Pierre's town/county can band together and take care of her. Meanwhile, I'll help take care of the people in my town, Ezra can help take care of the people in his town, and you help take care of the people in your town! See, if we all help take care of the needs of those in our immediate vicinity, there's no need for the FEDERAL government to get involved and impose one-size-fits-all 'reforms' on an endless variety of different situations.

Unless, of course, "health care reform" is merely the Trojan horse of progressive-statism that Reagan said it is:

"One of the traditional methods of imposing statism or socialism on a people has been by way of medicine. It’s very easy to disguise a medical program as a humanitarian project, as most people are a little reluctant to oppose anything that suggests medical care for people who possibly can’t afford it." - Ronald Reagan

Posted by: dbw1 | February 2, 2011 12:04 PM | Report abuse

why is it given that she is entitled to more than 2M in coverage?

Posted by: stantheman21 | February 2, 2011 12:11 PM | Report abuse

I don't want to wade into the guts of this discussion, so I'll just pop in to say that while I disagree with visionbrkr on most topics, he's not even close to the same league as msoja, whose rare substantive comments are vastly outweighed by the flood of dreck that spews forth daily on these comment threads.

Posted by: MosBen | February 2, 2011 12:15 PM | Report abuse

Visionbrkr,

It is interesting that a product known as insurance can kick in after incurring costs as low as a few hundred dollars - and for some services kick in on the first dollar of spending - but at the same time no longer pays claims after those costs become catastrophic.

Posted by: justin84 | February 2, 2011 11:49 AM | Report abuse

I, myself agree that first dollar coverage should be in place for things like preventative care and you should also be allowed as an employer or insurer to "pay" people to keep their costs low like Safeway does to keep theirs low. I also agree that lifetime caps should go away so situations like this don't happen. But that doesn't stop the fact that we need to address the costs of these medicines and the overall cost of care.

Like I said MA is addressing that now and its working and it'd be nice if Ezra bothered to do a post on it, talk to any party involved in it etc. but I guess that won't get any play here.

Posted by: visionbrkr | February 2, 2011 12:18 PM | Report abuse

dbw1 -Nice use of a quote Reagan had to stir up opposition to the Medicare Bill in 1961. I believe he called it Socialism. So, i'm assuming your position is that Medicare is socialism, and we should repeal is immediately? In addition to Social Security?

I also like your idea of the people of Mr. St. Pierre's town coming up with the million dollar charges she accumulates every few years. Perhaps, in addition, we should disband fire departments, and let the good people of each and every town take care of fires themselves. Also, we should let the good people of the Gulf-region states deal with affects of the BP spill and Hurricane Katrina - after all, its very easy to disguise socialism as a humanitarian project.

Posted by: workmonkey | February 2, 2011 12:22 PM | Report abuse

mosben,


thanks. I think :-)

Posted by: visionbrkr | February 2, 2011 12:22 PM | Report abuse

"Feel free to be compassionate with YOUR money, and not just with other peoples money."

Tax money received by the government is as much mine as it yours, and everyone else posting here. Every single taxpayer in the US has a say. How do you get to decide what is a valuable use of that money and I don't? That's what elections are for, and guess what? Elections put enough democrats in congress to pass health care reform. It's perfectly legitimate. Stop whining. Or rather, post what you think are universally accepted expenses for tax moneys collected by the US government.

Posted by: workmonkey | February 2, 2011 12:28 PM | Report abuse

dbw

I said, correctly, if Vinson causes ACA to halt implementation permanently, he would cause more American deaths than all terrorists combined. I stand by that.

And BTW, that includes all deaths in Iraq, Afghanistan and 911 combined.

One study shows every year over 45000 Americans die due to lack of quality health care.

http://www.reuters.com/article/2009/09/17/us-usa-healthcare-deaths-idUSTRE58G6W520090917

I suspect that number is too large, but it is certainly in the 10000s.

And your factoid about charitable giving may be right or wrong, but either way it is irrelevant.

Charitable giving is just one variable. Others include how many deaths are caused by lack of access to quality health care, how many people are killed in unjust wars that conservatives and organized religion made possible, and so on.

Also, before we can even begin to think about banning abortion, we have to have universal health care because otherwise millions of families each year would go bankrupt trying to care for severely disformed babies.

Posted by: lauren2010 | February 2, 2011 12:30 PM | Report abuse

visionbrkr - I think most supporters of this bill are partly supporters because of the cost containment policies that are part of it. Obviously, no matter what reforms pass, costs are the number one problem with health care, and I agree the fact that treatment for some conditions surpasses $1 million a year is repugnant. Some caps are necessary. Massachusetts has done a solid job of at least attempting to bring these costs under control, but, because of the sheer scope of the entities involved, it has to be more of a national effort.

Posted by: workmonkey | February 2, 2011 12:33 PM | Report abuse

The President, or Daley who is smart enough to do it, needs to have an intense meeting with Reid and Pelosi and a very few top people (not Gibbs or Axelrod LOL).

They need to realize that if the SCOTUS eventually rules against the legislation before November 2012, it means handing the Senate and the Presidency to the GOP as well.

If the likelihood is a loss, then everybody needs to back a quick total repeal now. You can't dicker over small changes, because the GOP will have you over a barrel and try to run out the clock.

There is still time to frame the debate, if things move quickly, before 2012. Make a small bill with all the popular pieces from the last and consider that the best that can be done for now.

I used the Henry IV "Paris is well worth a Mass" analogy yesterday. (which nobody found interesting btw ) for a reason.

In changing sides, Henry not only secured the throne to his descendants for 200 years, but ALSO was able to then issue the Edict of Nantes and diminish the opression of the Protestants he left behind too.

If Obama sticks to an ultimately unsuccesful piece of legislation, he not only loses office, but the Democrats lose control of the ability to fix health care in the future too.

Posted by: johnmarshall5446 | February 2, 2011 12:35 PM | Report abuse

Do you know how many children could be given a college education for $2 million? At what point is a human being just not worth saving anymore? A billion dollars? Ezra, let's get a number. Because if you don't give one, then the death panels will have to come up with one.

This person is the poster child for why PPACA is going to be a huge fiscal black hole, nothwithstanding the CBO's pronouncements to date.

Posted by: ElGipper | February 2, 2011 12:37 PM | Report abuse

I don't think it is fair to criticize Republicans for not just going along with what Democrats say, even if they are saying something that Republicans said in the past.

The question you never hear is, if these are such good ideas, the ideas that Democrats are proposing and that came from Republican sources, why didn't the Democrats agree to them in the first place?

Essentially you are saying that because Republicans don't want to cooperate, they are just rejecting things hypocritically. That very well may be true. But because Democrats also didn't want to cooperate and compromise at the time of action, they are also being hypocritical by wondering why, oh why, are these Republicans acting so mean?

The fact is it was political calculus on the part of the Democrats, more than a willingness to solve the problem, just as much as it is political calculus on the part of Republicans. If Democrats cared above all else about solving the problem, which is ridiculous, they would have compromised years ago, and NOT after the fact - while it was actually possible.

Posted by: puzzlemuse | February 2, 2011 12:43 PM | Report abuse

"Conservative-leaning people outgive liberals in both time and money, across the board. Support for federal bureaucracy does not equal 'compassion', progressive talking points to the contrary. Feel free to be compassionate with YOUR money, and not just with other peoples money...."

Hmmm well I would have to look at specifically what numbers you're talking about. But "conservative leaning people" tend to have more money to give, first of all. We have hedge fund managers making hundreds of millions of dollars and some Billions of dollars IN A YEAR, most of which is taxed at 15%. I'm not sure of their political stripes but conservatives tend to be wealthier than liberals, I presume, hence they have more money to give, especially since those monies are tax deductible and conservatives are already against paying taxes, so that makes sense. Secondly, in regards to time, if a couple has a spouse making millions and millions of dollars, then the other spouse doesn't have to work, hence freeing up time to do volunteer work. I'm sure there are many many liberals, myself included, who would love to be able to give more time and money to charities, and various organizations that work toward creating a better world. But most people have to work long hours to barely scrape by. So I think saying that conservatives "outgive" liberals doesn't provide enough context to make that argument mean anything. Do they "outgive" as a percentage of their income? Do they "outgive" as a percentage of their free time? That would be a more accurate number, though still wouldn't tell the whole story.

But what is clear is that Republicans don't seem to want to solve the problem of 30 to 40 Million uninsured Americans. They don't want to solve the problem. It's clear. They had 6 years of total control and did nothing except for the prescription drug benefit that they didn't pay for. Democrats got something done that, albeit imperfect and probably not strong enough, strives to create a solution for the problems and, at the same time, lowers the deficit! The health care problem can't be solved by charities I don't think. If someone needs charitable help then that's a failure of our health care system to provide meaningful health care for most Americans. Republicans have no solutions to these problems that we KNOW the private sector can't solve. Government has to be involved. Health care is a right, not a commodity.

Posted by: kmgunder | February 2, 2011 12:47 PM | Report abuse

workmonkey,

thanks. that's my main point. Costs are and should be the #1 concern. They're why costs are going up so high people are having to drop coverage. They're why premiums escalate at such a rapid rate. They're why people who leave a job can't afford COBRA and they're why the uninsured have been growing at an alarming pace.

if we actually attacked the costs like MA is finally doing now then we'd be much further along the way towards access and I wouldn't have to have my religion questioned by the likes of AuthorEditor. I don't know anyone that wants individuals like Ms. St Pierre to suffer or to not be treated (I sure don't want her to suffer) but at some point we need to address costs before those decisions get made for us.

What happens when/if cancer drugs costs $1 million per year or more? Just like we had to address the access issue with PPACA because costs were skyrocketing we'll be forced to address the costs issue becuase subsidies will be skyrocketing along with costs and it will eventually crowd out other spending in the federal budget.

Posted by: visionbrkr | February 2, 2011 1:09 PM | Report abuse

"Is there a way to block seeing comments from msoja and visionbrkr so I don't have to read their morally bankrupt musings?"

Care to elaborate on your charge of moral bankruptcy, AuthorEditor?

Posted by: justin84 | February 2, 2011 1:22 PM | Report abuse

Guys, don't feed the trolls. Any time there is an online discussion of an issue that might end up costing someone (or something, i.e. a corporation) money they gather like flies. And there is a reason for this:

http://www.guardian.co.uk/commentisfree/libertycentral/2010/dec/13/astroturf-libertarians-internet-democracy?commentpage=2#start-of-comments

Posted by: ExperimentalTheologian | February 2, 2011 1:31 PM | Report abuse

Who kids themselves into thinking that the government will spend however many millions it takes to keep Ms. St. Pierre alive?

If you can use different realities to compare one alternative to the other, you might as well be setting the criteria for CBO scoring of the bill. Oh, wait...

Posted by: whoisjohngaltcom | February 2, 2011 1:38 PM | Report abuse

The Democrat Party's top priority was not to solve the country's health care problems. Their top priority was to destroy the current system and install a federal bureaucracy to find solutions to our health care problems. Their priority is about control and ideology. They trust in the state and hope to empower it at the expense of all others. People such as Mrs. St. Pierre is likely to be hurt by the decisions of the federal bureaucracy eventually.

The destruction of maximums and constituency handouts (Part D rebates, child coverage, small business credits) are temporary and/or ploys to earn favor. The state eventually has to wield a stick. It always does. Even in liberal welfare states like France.

Posted by: cprferry | February 2, 2011 2:13 PM | Report abuse

*****How about this radical idea, bleeding-heart tightwad liberals: the people in Ms. St. Pierre's town/county can band together and take care of her. Meanwhile, I'll help take care of the people in my town...*****

Well, that's not so much a radical idea as a stupid one. It makes far more sense to spread those costs over AS LARGE A POOL OF PEOPLE AS POSSIBLE.

In other words, instead of small population/economic units "banding together" it makes FAR more financial sense for as large a population/economic unit as possible -- the entire country -- to "band together" to take care of people like the woman in question.

Posted by: Jasper999 | February 2, 2011 2:15 PM | Report abuse

*****They need to realize that if the SCOTUS eventually rules against the legislation before November 2012, it means handing the Senate and the Presidency to the GOP as well*****

Why? I don't follow this logic at all. Polling reveals a clear majority of Americans either want the law kept in place or prefer something stronger (meaning they're most likely lefties like me). A judicial repeal by SCOTUS therefore would almost certainly HELP Democrats, by galvanizing opponents of repeal, and generating a powerful backlash among progressives and moderates.

Posted by: Jasper999 | February 2, 2011 2:19 PM | Report abuse

Jasper999:
"Well, that's not so much a radical idea as a stupid one. It makes far more sense to spread those costs over AS LARGE A POOL OF PEOPLE AS POSSIBLE."

Then perhaps we should have a global health care system? Dang it....I shouldn't have planted that idea in the feeble mind of a progressive.

Which costs more....
A) 1,000 people chipping in to cover a $100,000 medical bill for one person, or
B) 2,000 people chipping in to cover the $100,000/each medical bill for two people.

Please show your math.

When you realize the fallacy of your point, you will discover that the progressive march toward federal-governement control of health care is about power and control, and has nothing to do with actually providing better health care or lowering costs.

Posted by: dbw1 | February 2, 2011 2:30 PM | Report abuse

workmonkey:
"Nice use of a quote Reagan had to stir up opposition to the Medicare Bill in 1961. I believe he called it Socialism. So, i'm assuming your position is that Medicare is socialism, and we should repeal is immediately? In addition to Social Security?"

Uh, yes, not necessarily, and yes.

I mean, you guys are the party of 'choice', right? So why not give people the choice to opt out of contributing to Medicare/SS in return for not being eligible for it's benefits when they would otherwise qualify?

Let's try that....keep Medicare, but start giving people the choice to opt in, or out. Then, let's see how long it takes Medicare to go belly up.

Why? Because it's not a 'savings' program...it's a Ponzi scheme. So yes, I would gladly opt out of it if I had the choice, and take responsiblity for buying my own long-term insurance to cover me when I'm retired.

Thanks for asking :o).

Posted by: dbw1 | February 2, 2011 2:36 PM | Report abuse

workmonkey:
" Perhaps, in addition, we should disband fire departments, and let the good people of each and every town take care of fires themselves."

I can't find the FEDERAL bureaucracy that pays for the fire department down the street from my house. Could you please point me to it?

Or, like most liberals, are you unable to discern between a country and a state?

Posted by: dbw1 | February 2, 2011 2:42 PM | Report abuse

*****When you realize the fallacy of your point, you will discover that the progressive march toward federal-governement control of health care is about power and control****

My point is not fallacious. The smaller the risk pool, the greater the volatility and unpredictability of costs, and the greater is the chance that said costs will be unaffordable. A single family with a genetic disease could bankrupt a small town attempting to cover its own residents. That's pretty unlikely to happen to the US as a whole, given its $15 trillion economy and its ability to print money.

You, sir, are and idiot.

Posted by: Jasper999 | February 2, 2011 2:54 PM | Report abuse

dbw1 - The BP Oil Spill and Hurricane Katrina, as two examples, demanded a federal response. Why were states not able to handle those catastrophes on their own? And, FYI, the Stimulus included funds to help state and local governments shore up their finances and not lay off police officers and firefighters (in addition to federally funded anti-terrorism training, etc), so your claim that federal funds don't pay for that fire department down the street aren't entirely correct.

Posted by: workmonkey | February 2, 2011 2:55 PM | Report abuse

Do those of you arguing against the government being involved in health care really trust for-profit insurance executives to make the best choices to provide the most Americans with affordable health care? How's that been working out? This is the problem: When a human right becomes a commodity upon which millions can be made, abuses and out-of-control costs will ensue. Healthy people drop out, and the costs sky rocket so that fewer and fewer can pay and the vicious cycle continues. Profits take precedence over care.What we have now DOES NOT WORK and will work less and less if we continue in that direction. The ACA's not perfect but it's a start. Why people trust insurance sales people and executives more than the government is beyond me. I'm not saying government is perfect, it's not. But some involvement of government is necessary so as to balance the power of the insurance industry. A balance between the private and public sector is what seems to work best. Government is not all bad all the time. Nor is it the answer to every problem. Such fixed, cemented thinking, ideological thinking is what gets us into trouble. We need to find a balance and have an open mind. I think the Democrats have given up much to find a workable solution that Republicans could work with. But today's Republicans don't care about solving problems. They care about winning elections.


Posted by: kmgunder | February 2, 2011 2:56 PM | Report abuse

visionbrkr - it's a bit simplistic to say that all we need to do is attack costs. I think anyone and everyone would agree with that. The core of the debate is HOW you attack costs. The PPCA was an attempt - albeit imperfect - attempt to attack costs. It was modeled after the Massachusetts reforms that you are referencing, and includes many of the same attempts to curb costs. The core of the debate in Washington is who has the better ideas to curb costs, not whether or not that should the overall goal (in addition to universal coverage, which Republicans actually do not want. in fact, i would argue Republicans don't want to lower costs, either, as they still have not submitted any viable ideas on that front other than tort reform and opening up cross-state exchanges, which the CBO has scored tepidly).

Posted by: workmonkey | February 2, 2011 3:01 PM | Report abuse

workmonkey,

I'm sorry but IMO MA didnt' attack costs in the origination of Romneycare. they attacked (successfully) access. Attacking of costs will mean one of two things.

1-Capitation as is being done now (in the past year) in MA with success albeit at an early stage.

2-rationing of some form. Rationing could include rationing of providers, of services or of payment.

As liberals are good at pointing out currently (pre-PPACA) we rationed on ability to purchase insurance (depending on the state and the level of pre-ex in those states) and cost. If we found a way to lower cost (without compromising the number of doctors we had or heaven forbid increase it) then that would be a coup.

Personally I don't think either side reallly wants to attack costs (although maybe dems do a little more than Republicans). If either side did they'd find a permanent fix to the Doc Fix they both keep blaming the other on.

Posted by: visionbrkr | February 2, 2011 3:13 PM | Report abuse

That's why Democrats gave up on single payer, on an employer mandate, on a public option


oh and Ezra, there's an employer mandate in PPACA. It may be horribly weak ($2000 per year per full time worker) but its in there.

Posted by: visionbrkr | February 2, 2011 3:31 PM | Report abuse

"Do those of you arguing against the government being involved in health care really trust for-profit insurance executives to make the best choices to provide the most Americans with affordable health care?"

Remember the government is the entity that guaranteed the success of the for-profit comprehensive insurance model to begin with.

Universal comprehensive insurance might not be the best way to go. Maybe a system of nonprofit hospitals funded primarily by charity and income-based fees would work better, but there's no way for such a system to evolve under the status quo.

"When a human right becomes a commodity upon which millions can be made, abuses and out-of-control costs will ensue."

Health care is not a human right.

"Healthy people drop out, and the costs sky rocket so that fewer and fewer can pay and the vicious cycle continues."

This is true with community rating, but not true if insurance companies can charge more based on anticipated health care costs. ACA goes with community rating, hence the mandate.

"Such fixed, cemented thinking, ideological thinking is what gets us into trouble."

It helps keep one's thinking coherent.

Trying to invent a human right which negates the very real rights to liberty and property is just one example of intellectual muddle that results from the lack of an ideological framework.

Posted by: justin84 | February 2, 2011 3:47 PM | Report abuse

"My point is not fallacious. The smaller the risk pool, the greater the volatility and unpredictability of costs, and the greater is the chance that said costs will be unaffordable. A single family with a genetic disease could bankrupt a small town attempting to cover its own residents. That's pretty unlikely to happen to the US as a whole, given its $15 trillion economy and its ability to print money."

Medicare alone threatens to bankrupt the country as it is.

Posted by: justin84 | February 2, 2011 3:50 PM | Report abuse

****Medicare alone threatens to bankrupt the country as it is.*****

So let's find ways to curb medical inflation. But the fact that a particular federal program is costly hardly obviates the reality that spreading risks over as large a pool as possible is superior from the perspective of predictability and non-volatility, which is all I'm saying.

Medicare's costs are indeed rising. As is the national cost of healthcare in general. But a small pool's costs could increase by 40% or 50% or even 70% in a SINGLE YEAR, which is why the commenter's idea about each town "insuring its own" is idiotic.

Posted by: Jasper999 | February 2, 2011 4:00 PM | Report abuse

Medicare alone threatens to bankrupt the country as it is.

Posted by: justin84 | February 2, 2011 3:50 PM | Report abuse

while that's correct its partly due to the fact that medicare only takes in the sick and aged so that works to its detriment and also the fact that about $100 billion is taken from the system fraudulently on an annual basis shows that it can't be trusted in government's hands. A private run, heavily regulated system that tells providers either 1- what they'll be paid on a patient basis with incentives or 2-what they'll be paid per service will work best. that being said there are serious access issues that will come to that with limiting provider payments to what we all can afford and that needs to be address PRIOR to making provider payment reforms.

Posted by: visionbrkr | February 2, 2011 4:16 PM | Report abuse

Jasper999:
"As is the national cost of healthcare in general. But a small pool's costs could increase by 40% or 50% or even 70% in a SINGLE YEAR, which is why the commenter's idea about each town "insuring its own" is idiotic."

The point you keep missing is that to a liberal only a FEDERAL solution is ever an acceptable solution.

Since you obviously haven't read enough of my posts to know the point I was making was not literal, but simply emphasizing local solutions vs national, I'm more than willing to meet you halfway....how about we leave health care up to each state manage on it's own?

That way, if people in New Hampshire really want to live free or die, they can do so and they won't have to worry about being on the hook to pay for the surgery of someone in California. Conversely, if a state like New York wants to have a universal state-run health system with 100% coverage, and assess 40% sales tax rates to do so, then more power to them.

Hmmmmm....this idea sounds vaguely familiar....I think I read something about that in the Constitution somewhere (like maybe the 10th Amendment?)

Posted by: dbw1 | February 2, 2011 4:39 PM | Report abuse

Medicare is imperfect and costly, but I would sign up for it any day over an unregulated private insurance company. Furthermore, privatizing Medicare would cost more, not less, and be less efficient, not more - Medicare Advantage is a blatant example of this experience. On average those private plans cost 15% more for no additional coverage. Some of this was pandering to the insurance lobby by Republicans, but it still is an ominous warning about privatizing the whole system.

Medicare is loved by conservatives and liberals alike. Even the tea partiers were carrying around signs saying "take your government hands off my Medicare" - they're stupid, but still like the program.

All of us hate going to the DMV and maybe the post office, and yeah dealing with a Medicare service rep over the phone probably isn't the greatest experience in the world. But imagine talking to a private company that profits from not paying for your health care - maybe even gives the person on the phone a bonus for denying your claim. These kind of practices are happening all the time.

People who advocate for private insurance need to accept that it will cost more and likely cover less - for example, including the public option in the ACA would have saved $110 billion over 10 years. That savings comes from economies of scale and from eliminating the small percentage normally taken as profit (I believe this is 3-5% for major insurance companies). More importantly however, it would have put downward pressure on other insurance plans to compete effectively (duly noted by the CBO).

I honestly don't mind private insurance companies if they are regulated strictly, down to what they reimburse and to whom (for example - different rates for teaching hospitals, community hospitals, etc). This really makes them more like utilities. And honestly - they could even be profitable - but make them incentivized to do the right thing. Give them breaks if they add less overhead to the system, or put pressure on providers to provide care with proven positive outcomes (just some ideas).

Oddly enough, the fact they have to take everyone now (the glorious individual mandate) may provide them this incentive - a healthy customer is a more profitable one. But too often the profit incentive drives them to demand cheap care versus quality care even if it is expensive, and I don't know if they will be sufficiently pressured to do the latter.

Posted by: kmani1 | February 2, 2011 4:50 PM | Report abuse

"Maybe a system of nonprofit hospitals funded primarily by charity and income-based fees would work better"

Maybe you could come up with an example of that model working somewhere outside the US? Otherwise, you're just pulling stuff from where the proctologist looks.

"Health care is not a human right."

Seven little words that allow me to ignore your voluminous prose-generating.

Posted by: pseudonymousinnc | February 2, 2011 4:57 PM | Report abuse

kmani,

Did you really say "I honestly don't mind private insurance companies" in the same post that you claimed they "give customer service reps a bonus for denying your claim".

You do realize 99% of reps that you speak to on the phone at an insurance company (or Medicare for that matter) have no physical ability to pay a claim don't you? I guess not.

Just becuase you think (or were told by liberals) that Medicare advantage is a "giveaway" to private insurers doesn't necessarily make it so. Please tell me your understanding of how its a "giveaway".

Medicare Advantage basically takes your medicare premiums and has the private insurer of choice manage them. If they can negotiate a better deal with the doctors in their entire book then they (the insurer) keeps the savings. I guess that can be looked at as a giveaway but its as if you are given the task at your job to find savings in a certain segment of your business and are told that if you save that money you can keep a portion of it. Once you find the savings and its huge, your employer says, oh no that's a giveaway and takes it back from you. Is that fair? The idea of it is to find a way to build a better mousetrap and allow those that find the way to do that to keep the savings. But if it works better for you to think Republicans and the insurance lobby conspired to get you then so be it.

And I keep going back to the fact that insurers profits are always less than Medicare's waste fraud and abuse but if you'd rather I have no problem with requiring all insurers to be non-profits.

Posted by: visionbrkr | February 2, 2011 5:03 PM | Report abuse

"Maybe you could come up with an example of that model working somewhere outside the US? Otherwise, you're just pulling stuff from where the proctologist looks."

Unfortunately, every major country in the world has fallen for your socialist claptrap.

The notion that without government involvement people wouldn't be able to provide health care services is absurd.

"Seven little words that allow me to ignore your voluminous prose-generating."

You can ignore all you want, but it will only contribute to your ignorance. Health care is not a human right no matter how much you hope it would be - reality is what it is.

Posted by: justin84 | February 2, 2011 5:43 PM | Report abuse

Here's the problem with people banding together and taking care of so-and-so:

10,000 people had hard luck stories. Their neighbors find out about 100 of them -- maybe the local TV channels feature them -- and rally round and help them. What happens to the other 9,900? Ezra finds out about Ms. St. Pierre: suppose he simply rallies a bunch of people to help her: at best that takes care of just Ms. St. Pierre -- because he happened to hear of her. msoja and dbw1 are giving a 19th century idea. It doesn't do the job. Pretty much all the developed countries on the planet -- except us -- have universal coverage; one way or another, it relies on some kind of governmental mechanism to be sure pretty much everybody gets covered. Governmental actions are imperfect; but alternatives which abstain from any governmental action can be counted on to work worse.

Posted by: Virgil_E_Vickers | February 2, 2011 6:01 PM | Report abuse

"But it's impossible to compromise when one side is uninterested in solving the problem, as they lack the incentive to make any concessions"

you are absolutely right.
selfish people. who wish to take care of themselves, and dont care about what happens to others.
nothing good can come from that.

Posted by: jkaren | February 2, 2011 6:07 PM | Report abuse

"Medicare's costs are indeed rising. As is the national cost of healthcare in general. But a small pool's costs could increase by 40% or 50% or even 70% in a SINGLE YEAR, which is why the commenter's idea about each town "insuring its own" is idiotic."

A national bankruptcy is far worse than any set of individuals going bankrupt. It brings ruin to literally everyone. As much as people like to say that the U.S. government can print money and will never go bankrupt, understand that hyperinflation is just as disastrous.

Furthermore, funneling dollars through government naturally pushes costs higher and higher. You can push back against this to some degree, but the U.S. traditionally hasn't had much success. European countries do a better job in this regard, but they are able to keep provider incomes at levels which would be considered unacceptable in the United States, and they are able to restrict access to services in a way that is also unacceptable here.

Furthermore, you have people paying into the system disproportionally to their values. Each person is an end in themselves, and I find it troubling to ask them to support something they claim not to want. I wouldn't find much to object to in a mostly universal system which allowed individuals to opt out of both the financing and benefit portions, but the inability to opt out of the various government insurance programs is troubling to me.

Posted by: justin84 | February 2, 2011 6:07 PM | Report abuse

Virgil E Vickers,

It's sad that you think TV is the only way to know your neighbors. It's quite telling why you trust in the anonymous, emotionless state institution to fulfill human needs.

The best service provider is always the one closest to the person in need. Not because others don't have to take responsibility. But because they can serve their needs fully and treat them with dignity.

Posted by: cprferry | February 2, 2011 6:23 PM | Report abuse

"Their neighbors find out about 100 of them -- maybe the local TV channels feature them -- and rally round and help them. What happens to the other 9,900?"

Suppose you lived in a world with a very limited government that was never going to help.

Do you really think that people acting on their own free will wouldn't be able to create some sort of safety net to address this?

Would you just give up, shrug, and say "well, so much for those 9,900 - there's nothing we can do"?

Remember, the people would have $6.5 trillion in resources the government currently controls at their disposal. A lot of that is waste (e.g. maintaining an empire).

It's hard to imagine that there wouldn't be a decent amount of funding going to help those down on their luck, probably $1 trillion+ (charitable giving is already $300 billion). If 50 million Americans would require charitable aid in any given year, $1 trillion provides $20,000 per person in terms of resources - more than U.S. per capita income two generations ago, and three times the per capita income of present day China, adjusted for price differences.

Maybe I have too much faith in my fellow citizen, but I'd be very surprised to see a country that tends to support helping the poor via government programs turn their back on the poor if those programs suddenly disappeared.

In any case, people have a right to decide how their property is disposed of, and if they decided not to be charitable then that's that. I doubt it would come to that.

Posted by: justin84 | February 2, 2011 6:33 PM | Report abuse

justin84,

Isn't it just easier to pay it to the government? Do you really want thousands of panhandlers lining the streets and offramps? Gangs of needy folk going door to door looking for scraps? Do you really want to handle the disenfranchised one by one as you meet them? The government is what is keeping them from grabbing pitchforks. Pay your historically low taxes, and praise the benefits of common funding for common cause.

Posted by: Amminadab | February 2, 2011 7:45 PM | Report abuse

The problem with considering it not "fair to criticize Republicans for not just going along with what Democrats say, even if they are saying something that Republicans said in the past" and asking , "Why didn't the Democrats agree to them in the first place?" [12:43 PM]:

WHAT first place? If Democrats propose what Republicans proposed in the past, expecting that way the Republicans will support it, and again the latter come up with something else -- how on earth can you strike a deal with somebody who keeps doing that?

Posted by: Virgil_E_Vickers | February 2, 2011 8:13 PM | Report abuse

"Unfortunately, every major country in the world has fallen for your socialist claptrap."

A simple "no" would have sufficed, justin-eighty-bore.

Posted by: pseudonymousinnc | February 2, 2011 8:22 PM | Report abuse

"Health care is not a human right no matter how much you hope it would be"

You're on the wrong side of history, no matter how much you how much your airy effusions pretend otherwise.

Posted by: pseudonymousinnc | February 2, 2011 8:25 PM | Report abuse

@visionbrkr

C'mon man - read the whole comment - "I honestly don't mind private insurance companies if they are regulated strictly, down to what they reimburse and to whom (for example - different rates for teaching hospitals, community hospitals, etc)." That second part you eliminated makes it consistent with the rest of my statement.

You should definitely read the testimony by Wendell Potter if you're not convinced about devious tactics by insurance companies. It was pretty eye-opening.

Also here's some background on Medicare Advantage from Wikipedia - the extra cost comes from subsidies included in the legislation, not "building a better mousetrap" by insurers.

"Although the Patient Protection and Affordable Care Act of 2010 does not eliminate Medicare Advantage, it does do away with the subsidies which the federal government first used to establish the Medicare Advantage program and which many Medicare Advantage health insurance plans use to offer supplemental benefits. These subsidies (which added an additional $14 billion to the Medicare program last year alone) will gradually be reduced until they are eliminated altogether. In 2011, these Medicare Advantage subsidy payments will be frozen at 2010 levels. After that, Medicare Advantage subsidy payments will be reduced an average of 12% per year until they are brought in line with traditional Medicare payments"

Glad to hear we're in agreement on the non-profit insurance though!

Posted by: kmani1 | February 2, 2011 9:15 PM | Report abuse

So, I'm still wondering: How much of Klein's own money has Klein donated to St. Pierre?

I wouldn't *dream* of posting anything like Klein has above if I hadn't first donated a sizable amount to the cause as an example of my good faith.

Lacking such example, Klein is just a two bit propagandist, playing on his readers emotions.

And none of the whining lefties here have answered: How much of other people's money are they willing to spend to keep St. Pierre alive? How much?

Posted by: msoja | February 2, 2011 9:57 PM | Report abuse

--*I don't want to wade into the guts of this discussion, so I'll just pop in to say that while I disagree with visionbrkr on most topics, he's not even close to the same league as msoja, whose rare substantive comments are vastly outweighed by the flood of dreck that spews forth daily on these comment threads.*--

Did Mosben fail to catch the parallels between my "Why does Klein want St. Pierre to die" and Klein's "Why does Joe Lieberman want to kill all those people"? Tch. Tch.

If Klein isn't willing to donate his own money to keep St. Pierre alive, where does he get off suggesting that other people should be *forced* to do so?

And, remember, it was Klein who said it would be much better use of his own money to hire people to fix broken windows in *abandoned buildings* than to put it in his own savings account. Apparently, giving work to glaziers is higher on Klein's list of priorities than saving people like St. Pierre from Death.

Posted by: msoja | February 2, 2011 10:12 PM | Report abuse

@kmani1,

I did read your whole post which is why I thought it was odd you put that blurb in there about representatives at insurance companies getting paid bonuses to deny coverage or claims which is totally false btw.

I don't know who Galen Institute is but it gives a detailed description of the Medicare Advantage "overpayment". Some call it a subsidy but I'd say its more of a mechanism to make sure these plans got out to rural areas where it was needed. Kind of like if we wanted to make sure broadband was in rural areas we'd have to subsidize it to be there. Same goes for "green energy" that I heard former Governor Rendell of PA argue for tonight on Cynk Ulrick's show on MSNBC. If they're starting out in that market then they need to have help getting a foothold there. Similar to what I'd expect they'd do for the non-profit ops in PPACA. Similar to what they would have done for the public option (although that'd be allowing them to piggyback Medicare's network). I'm guessing the link below is a right wing group so I guess we should take it with a grain of salt but I'm sure we could find likewise on CMS if its available.

http://www.galen.org/component,8/action,show_content/id,13/blog_id,51/category_id,6/type,33/


CMS argues that other comparisons of MA payments and costs under traditional Medicare are flawed.29 Using data for 2007, CMS estimates that if one is only measuring the equivalent cost of delivering Part A and B services alone, MA plans are paid 2.8 percent more than the cost of traditional Medicare. CMS points out that part of that extra payment is the result of implementing risk-adjusted payments to the plans on a "budget neutral" basis. By 2011, risk adjustment will no longer be budget neutral, which will mean lower payments on average to the plans. However, CMS also indicates that nearly 93 percent of enrollees are in MA plans that are paid above the cost of traditional Medicare in 2007.30

Describing these benefits as "excessive payments to plans" fails to account for the fact that both taxpayers and beneficiaries gain when MA plans bid below the benchmark. In those cases, 25 percent of the Medicare payments which are above the plan bids for the cost of delivering Part A and B services go back to the Treasury and the remainder is returned to beneficiaries in the form of these extra benefits. Thus the higher benchmark payments have provided a mechanism to convey extra benefits to enrollees.

---------------------------------


And if we're going to require insurers to be non-profits shouldn't we also require hospitals, labs, x-rays, pharma and doctors to be non-profits too? That'd only be fair, no?

Posted by: visionbrkr | February 2, 2011 11:24 PM | Report abuse

****The point you keep missing is that to a liberal only a FEDERAL solution is ever an acceptable solution.******

Don't be absurd. I think there's indeed an overwhelmingly compelling case for a federal solution in healthcare access and insurance coverage -- yes, that's true. But there are plenty of areas of national life where that's not the case.

Posted by: Jasper999 | February 2, 2011 11:28 PM | Report abuse

*****A national bankruptcy is far worse than any set of individuals going bankrupt. It brings ruin to literally everyone*****

Sure it is. But what does this have to do with healthcare?

You do realize that the pre-ObamaCare, non-national, non-universal status quo system in the US is VASTLY MORE EXPENSIVE than competing rich world universal social insurance systems, don't you?

If "bankruptcy" is your concern, you should be loudly agitating for ANYTHING but America's absurdly costly profit-driven model.

Posted by: Jasper999 | February 2, 2011 11:36 PM | Report abuse

*****If Klein isn't willing to donate his own money to keep St. Pierre alive, where does he get off suggesting that other people should be *forced* to do so?*****

msoja: He "gets off" suggesting this because, like most Americans, he supports the idea of a social contract involving taxpayer-financed social insurance. Taxpayer-financed items are by definition "forced" because if you don't pay your taxes you'll quite rightly be thrown in prison. I suppose you think taxes should be voluntarily, is that right? Or perhaps we should fund government operations by telethon?

Posted by: Jasper999 | February 3, 2011 12:18 AM | Report abuse

--*Or perhaps we should fund government operations by telethon?*--

I would like that much better, yes.

Posted by: msoja | February 3, 2011 12:21 AM | Report abuse

--*I think there's indeed an overwhelmingly compelling case for a federal solution in healthcare access and insurance coverage*--

How do you reconcile that with the idea of a country "conceived in liberty" within a framework of a vastly constrained government (the idea was radical, even in its day)?

Elsewise, if you don't give a fig for freedom or personal responsibility, or if you don't trust in the benevolence of your fellow man, how do you counter the overriding evidence that socialism *depends* on the very free markets that it usurps, and that it then slowly strangles those markets (witness health insurance), in the process strangling innovation, efficiency, and endeavor, and that the end result inevitably looks like the old Soviet Union, or Cuba, or North Korea? How "compelling" *is* your "case" then?

Posted by: msoja | February 3, 2011 12:45 AM | Report abuse

"You're on the wrong side of history, no matter how much you how much your airy effusions pretend otherwise."

That has no bearing whatsoever on whether or not health care is a right. It ain't.

Apparently tens of millions of people in Nazi Germany, China and the Soviet Union were on the "wrong side of history" in the 20th century, but the trampling of their human rights was and remains disgusting - at least to me. Maybe to you there is no moral distinction - just bad luck, wrong side of history and all.

I'm not going to throw up my hands and give in to evil because hordes of morons are convinced that individual rights are irrelevant and can be safely dispensed with.

And what is it with collectivists always thinking history is on their side?

Posted by: justin84 | February 3, 2011 1:22 AM | Report abuse

We commentators are arguing over whether we have an obligation to pay for St. Pierre, and others like her. Some claim to cover $2,000,000+ worth of health care is ludicrous and a galling request.

I happen to agree, but not because I disagree with ACA. I disagree with the nature of pharmaceuticals, insurance providers, and the like.

The health care system is where it is today because of its cutthroat for-profit nature. Not to trivialize people like St. Pierre, but their treatment plans are like buying hot dogs at Yankee Stadium- only game in town, so if you're on the supply side, why not profiteer? And that's what's wrong.

If the republicans succeed in whatever it is they are doing, all that will happen is a reversion to status quo- rich can afford the exorbitant prices, middle class and poor cannot. But in consolation, oh yes, we will save a whole lot of money in taxes.

Posted by: sanonymous | February 3, 2011 7:36 AM | Report abuse

So the end result of "a federal solution in healthcare access and insurance coverage" is that Britain, Canada, Australia, New Zealand, France, Germany, the Netherlands, Sweden, Norway, Denmark, Finland, Switzerland, Japan, South Korea, Singapore, etc. etc. etc. inevitably end up looking like "the old Soviet Union, or Cuba, or North Korea" [see 12:45 and 1:22 AM above]? Wow.

No point in arguing with hardline neolibertarians. Back in the real world, every developed nation on the planet has a mixed economy of one kind or another; but these people want to go back to nineteenth century social arrangements. Amazing.

Posted by: Virgil_E_Vickers | February 3, 2011 7:40 PM | Report abuse

My dad told me about "Wise Health Insurance" or something which helped him to find a lower priced health insurance (with ALMOST similar benefits) he is recommending this to me. Any suggestion? What do you think of them?

Posted by: dichack | February 4, 2011 5:16 AM | Report abuse


When getting health insurance I usually go through wise health insurance website. The reason for this approach is because I get more personalized service and assistance. Once I went though ehealthinsurance and it offered no customer support.

Posted by: dichack | February 4, 2011 5:18 AM | Report abuse

--*The health care system is where it is today because of its cutthroat for-profit nature. Not to trivialize people like St. Pierre, but their treatment plans are like buying hot dogs at Yankee Stadium- only game in town, so if you're on the supply side, why not profiteer?*--

Your "cutthroat" is debatable, but businesses aren't businesses very long if they don't succeed in terms of "for-profit", so it's hardly meaningful to single out health care related entities for that assessment. As to your Yankee Stadium analogy, ask yourself who has built the health care stadium over the sixty or seventy years, beginning with the law granting tax write offs for employees getting insurance through their places of employment, moving through the establishment of Medicare and Medicaid, through the HMO permutations, etc., etc. Health insurance companies are some of the most heavily regulated entities around. Nothing they do isn't scrutinized or constrained by existing law or regulations. Same with hospitals and doctors.

The problem the country is *actually* experiencing is that the free market in health care is not *allowed* to work as it ought, owing to all the laws and regulations preventing choice and freedom within the system. Certainly, many of the current laws and regulations have been imposed with the blessings, or even at the request, of various health care providers, but those entities could never have brought the field to the current state without the complicity (aka corruption) of politicians and regulators.

And now you and others are asking for exactly more of that which people have spent the last fifty years trying to get, but somehow now you expect that the very process that has failed you over the last half century, and indeed, has been the very cause of the problem staring everyone in the face, is somehow going to find the winning miracle solution. It ain't going to happen, but it is government interference in the health care market that is causing the problems, and more government interference is only going to exacerbate the existing problems while creating new sets of unintended consequences that will contribute to the atmosphere of crisis.

Posted by: msoja | February 4, 2011 10:39 AM | Report abuse

So the problem is that healthcare is not a free market? How exactly does that explain why pharmaceutical companies can charge such high prices for drugs that they happily and profitably sell in other countries for a fraction of what they cost here, due to those governments refusing to pay more? How does that explain why an MRI here costs ten times what it does in Japan, because the Japanese government buys MRI machines for half of what the identical machine brings in America? Whatever arguments you want to make in favor of a free market for healthcare, you sure can't work cost cutting into it.

Posted by: gzuckier | February 5, 2011 4:44 PM | Report abuse

--*How exactly does that explain why pharmaceutical companies can charge such high prices for drugs that they happily and profitably sell in other countries for a fraction of what they cost here, due to those governments refusing to pay more?*--

Well, it seem absolutely perverse, doesn't it, until one contemplates other market entities, even ones as simple as the ol' Big Mac.

Big Mac Index here:

http://www.oanda.com/currency/big-mac-index

Wikipedia Big_Mac_Index:

"The burger methodology has limitations in its estimates of the PPP. In many countries, eating at international fast-food chain restaurants such as McDonald's is relatively expensive in comparison to eating at a local restaurant, and the demand for Big Macs is not as large in countries like India as in the United States. Social status of eating at fast food restaurants like McDonald's in a local market, what proportion of sales might be to expatriates, local taxes, levels of competition, and import duties on selected items may not be representative of the country's economy as a whole.

"In addition, there is no theoretical reason why non-tradable goods and services such as property costs should be equal in different countries: this is the theoretical reason for PPPs being different from market exchange rates over time. The relative cost of high-margin products, such as essential pharmaceutical products, or cellular telephony might compare local capacity and willingness to pay, as much as relative currency values."

In other words, there are all sorts of variables to take into consideration just to explain a free market scenario, and THEN there are a host more parameters to take into account of a *political* nature. Businesses *will* enter into agreements that seem not to make business sense to outsiders for sake of market share and the like. That's *their* business, and NOT yours.

Posted by: msoja | February 5, 2011 10:38 PM | Report abuse

Personally, I believe caps on life-time payments should be illegle. But considering Insurance Companies are private businesses, it would seem they can offer any product at any cost they want.

This is why for the 30+ years I have been in Health Care Management I have promoted "
Health Insurance Regulation". Regulation alone could have accomplished what we most needed; control of annual premium increases allowed, no life-time caps, ability to continue current group coverage if layed off or changing jobs by personal paying 100% of the current premium, allowing children to remain on parents policy while they are attending college and graduate school,(I don't believe age should be the consideration but rather they are still a "dependant" and are attending school),
as far as pre-existing conditions, most group coverage doesn't include such as clause anyway. As far as pre-existing conditions on Indivdual/Family policies thats difficult and is the real reason the "indivdual mandate" is the corner stone to mandating insurance companies have no pre-existing clause on these policies. The increased number of policies they would write due to the individual mandate is meant to offset the substaintial losses they will incur by insuring those with costly health problems. Allowing employees to keep their current group coverage by paying the premium themselves(probably with a miminal additional administrative cost) if they are layed-off or change jobs or become to ill to work; would solve the problem of the majority who lose their insurance and due to pre-existing can't find new coverage.
For those that have no group coverage to keep and due to a pre-existing cannot find coverage; they should be offered health insurance through a "high risk plan" that pools all of the individuals and families in this situation. Much, as the Government took over the Flood Insurance market, their is no reason the can't do the same here. They could accept bids from various Insurers to write this "group policy" thereby, being able to provide the coverage at a lower cost.

Those who support the individual mandate don't understand how the IRS is going to determine your ability to pay premiums. Unless you have an extremely low income or at the poverty level, you won't qualify for "premium assistance", and you have to purchase insurance through the exchange(which none of us knows what the cost will be). The formula for determing your "modified adjusted gross income" will not take into account you electic, gas, water, food, tutition, loan, credit card payments. So if after paying those expenses you don't have enough left over to pay the premium they say you can afford; guess you will have to charge your premiums or take out a loan. And, the IRS, can take you penalty you are accessed for not obtaining insurance out of any refund you are due.

The mandate may look reasonable on the surface but once you "dig in" you will see the huge problems that exist.

Posted by: fedupwithgovernment | February 6, 2011 5:14 PM | Report abuse

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