The First Dose

Considering the fact the administration is not using the term healthcare reform but affordability and; considering the fact the Baucus committee and chairman are the same people who have been blocking reform and; considering the fact Baucus apparently has stated *we are not Europe or Canada* and *we need a uniquely American solution* and; considering the fact neither Baucus or Grassley have ever authored a lasting land mark bill that passed and; considering the round table of the Baucus committee excluded all except opponents of reform and would not allow proponents a place at the table a tweaking of the status quo is the most likely result. This will delay meaningful help for millions of people. One can only hope any effort like this even fails to pass so that the American public can finally become so incensed radical action ensues. Even to the point of civil disobedience. I can certainly sympathize with those who disrupted the Baucus round table and I never thought I would ever condone such a thing. We don't need healthcare insurance we need healthcare. The practice of medicine should not be left to the vagaries of *the market*. People cannot decide to shop around when sick or forego care if it is too costly. These entrenched politicians are mis reading the American public.

The Daily Dose is a good idea. I am a former Canadian provincial health minister. In Canada, provinces operate their health-care system under the guidelines (oversight)of a federal act. No doubt about it, our system needs tweaking, but at least we have a system to tweak. Your first task must be to understand the national economic cost of not having a comprehensive plan. Talk to Michigan about this. More cars are manufactured in Ontario, than in Michigan. Idealogy, though intriguing, is expensive. Bruce Strachan

PBS television in 2008 had a documentary on the health care national systems in Japan, Taiwan, Great Britain, Germany and Switzerland. The program discovered the good and bad parts of all these systems. Why can't Senator Baucus and other members of his committee be required to view this program. If the Congress develops the Healthcare it will be written by lobbyists who make the largest contributions to the Senator's future re-election campaigns. It will be the biggest debacle ever. Have the President appoint a committee of six outstanding Americans to draft a healthcare plan to present to Congress in January 2010. This committee should review the PBS documentary and visit the countries mentioned in the film plus France and Canada before they develop the plan to present to Congress. I am tired of viewing these committees holding hearings from people who all are protecting the interest of their constituents.

Any healthcare reform must address the deficit impact of Medicare. While the cost reductions promised by the industry are hopeful, why not use the "public option" to add to this? A major problem of Medicare is its asset-liability imbalance-not enough premium income for its over-65 user base. Why not use Medicare as the the "public" option by allowing individuals to purchase a policy, with a premium that would generate a minimum profit on such policies. If this is too politically radical, an alternative would be to mandate that the public plan remit a minimum annual percentage of its premium income to the Medicare/Medicaid fund. This would offset some of the deficit that these programs generate and would address some of the concern that the private helathcare industry has that a public plan would be too cost competitive.

We pay premiums to insurance companies to pool our risks. the agreement is they pay it (our money) back to us when we have health related expenses. So where do they get the money to lobby, advertise, bribe and threaten media against the the best interests of policiy holders? Oh yeah, by finding ways not to do what we pay them to do. http://www.pnhp.org/

It was FDR that gave us Social Security that brought on Medicare, and it was JFK that gave us the President's Council on Fitness. Let BHO be the one that started a realistically affordable health care package by letting the US Public buy into Federal MediCare or State Medicaid. This makes much more sense that starting up a whole new department somwhere in the dizzying basements of Washingtonian America. A simple application based on finacial qualifications with certain levels of insurance would be easy to put into place. How about it America? Vote for America, Into the Future and Back to the Age of the Pioneers. Regards dePaul Consiglio

There are a lot of good ideas here, and I urge anyone interested to check out www.pnhp.org, the site recommended by rooster54, who makes a good point about the enormous profit that insurance companies are draining from our health care spending, which should be used for the most effective and inexpensive treatments, not the costliest regardless of efficiency. depaulconsiglio, I love the "into the future/back to the pioneers" slogan and your idea makes sense. There has also been a suggestion to have Medicare coverage for the 50- to 64-year-old generation on a temporary basis; why not start the public coverage there—on a permanent, rather than a temporary basis—while we work on the rest?

Health care reform starts and ends with making it affordable. Whether healthcare is public or private, it is a marketplace commodity - goods and services that someone pays for. Ask any RN if they are paid for their work and you get the picture. It is not a free service. So the problem is the cost, and the industry pledge to Obama to lower the rate of growth for costs at least recognizes that. But the industry has almost zero credibility. It's a bit like the banking or automotive industries, Americans no longer trust their born-again conversions to gain salvation. In Michigan the average cost of individual health care is about $4,500 per year, with families at $11,700. The rule of thumb is that health care should cost about 7 percent of annual income. Someone working for $12 per hour earns $21,000 after taxes and should be paying about $123 per month for health care. If this person split the cost 50-50 with an employer, the total premium would be about $250 per month. In fact the average individual's cost is $187 when split with an employer. And family coverage costs about $500 per month for employers and employees. So whatever the solution is, the cost have to come down significantly. It's arguable whether or not a government plan can reduce costs without rationing care - and that's the debate. However, if you read the principles set down by Obama, he proposes to change the infrastructure of the health care marketplace to reduce costs, thereby making it affordable for both government entitlement programs and private consumers. Changing the health care infrastructure may just revolve around the idea of breaking up the gridlock that the insurance industry has on health care. The concept of a competitive public plan is not a trojan horse towards a single payer system, as opponents of reform are now charging. It is the concept of competition, which is the nightmare scenario to monopolies, and that's what the health care industry has become. After a decade of consolidation, the insurance industry is a monopoly interest group. Obama has said he is open as to how the design of a public plan may look, as long as the principles of what it would do are retained in any new legislation. The Massachusetts plan is one example. Other states are innovating with other examples. In the end these innovations are all seeking to expand access by making health care affordable - and in Massachusetts, mandated. The handwriting is on the wall for the industry, there will be changes to their marketplace dominance. But providers are also served notice by the Obama Administration. They too must cut costs attributed to needless and inefficient delivery of health care. Finally, the consumer must cut costs as well by changing to healthier life styles. There is no silver bullet in reforming health care and that is what Obama has said all along. Folks need to understand that simplistic solutions are no longer acceptable.

people need to realize that a public plan is not the option. they point to windfall profits that insurers make that aren't true. Insurance company profit margins are 3%. that's not windfall. Insurance companies in many states (including my own, NJ) cap what insurance companies can make already. currently in NJ for every dollar taken in in premium 80 cents have to go out in claims. if the insurance co isn't running its ship well it can't raise rates BY LAW. There have been several instances in the past where insurers have paid back to policyholders. A public plan would destroy the current private industry and put hundreds of thousands out of work in multiple indutries including doctors/hospitals/health insurance brokers. What it would do is put the private companies at a disadvantage. They have advertising costs the public plan would not (When is the last time you saw an advertisement for medicare?) They pay for insurance brokers to advise and help employers and employees navigate the difficult world of insurance. In the public plan you're on your own and good luck with that. Just go ask any senior citizen how easy it is to understand medicare and how it works. They (private insurers)also don't have the ability to tell providers what they will pay. In Northern NJ a hosptial system just after it received a notice several years back that medicare's reimbursements were reducing substantially again with no recourse had to do all they could do to survive (they have 2% profit margins as well) and they went to Blue Cross and told them (even in the middle of a contract) that they needed an immediate 30% increase in their reimbursement to make up for the medicare shortfall. Horizon BCBS said no originally until it feared it would lose policyholders because of losing a major hospital network. Eventually BCBS had to relent to a 25% increase in its reimbursement and in turn had to turn that cost over to policyholders in the form of rate increases. When everyone ends up in about 5 years on a public plan hospitals will have no one to turn to for those increases like they did BCBS and hosptials will go out of business. WHen that happens remember that i warned you of this. Be careful of what you wish for you may get it.

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