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    10/23/2009
    A public option WON’T increase costs? That’s delusional!

    Senator Roland Burris (D-IL) answered caller questions on C-Span Wednesday morning. He lambasted insurers and said he would prefer a single payer system, but “the next best choice would be the public option that will rein in our insurance providers.”

    Burris tried to explain (about 11:30) why a national program would work when several states programs (Tennessee, Maine, Vermont, New Hampshire, Massachusetts) haven’t or aren’t. Essentially he tried to say that a national program will work because it will have a bigger pool. Let’s just say his answers weren’t too clear. I was interested in the words bolded below (my bolding).
    … rest assured, we’re talking about a national strong policy, a national program that would be operated by the Department of Health and Human Services … that would be competitive.and you have enough participants, insureds in the program in order to make it large enough to compete. And there would be a one time infusion of capital in this program, but then it would be on its own. And the person would then have to pay his or her premiums based on their ability to pay, but it would be a major nationwide program that would be able to compete.
    This business of acknowledging a one-time cash infusion must be a recent Dem talking point. On Fox at almost the same time Wednesday morning, Sen. Mary Landrieu (D-LA) also defended (starting about 0:55) what apparently will be a huge upfront cost for a public option.
    Well, first of all the important thing to understand is that there is going to be some cost initially up front to make these changes. Democrats are committed to cover all of that cost but over time the entire health care system will work in a much better, more efficient way for everyone to reduce cost to business, to reduce cost to the government.

    It’s like retrofitting your home to be more energy efficient. You may have to come out of pocket, $5,000 or $10,000 initially, but your electricity bill goes down by 30% for the rest of the 20 or 30 years you live in the home. That’s the concept, so it really is disingenuous of Republicans to say, or anyone to say that you know, the bill costs [sic]. Yes, there are going to be some upfront costs. Democrats and the President have committed to cover those costs and that’s where the struggle is now.
    Like retrofitting your home?

    And then that big up front cost is supposed to bring costs down by 30% I couldn’t believe what I was hearing. Unbelievable. Does America really believe this stuff.

    Shoebox does a great job detailing the true 10-year cost of the Baucus bill. Be assured, costs don’t go down.
    Philip Klein at the American Spectator took a look at the Baucus costs and found something interesting; the 10 years of costs really only included 4 years of the Baucus program being full implemented. In the words of Desi Arnaz, “Oh Lucy, you forgot something!”
    It’s an excellent graph and a great and helpful read. Costs more in the range of $1.3 trillion instead of “only” $829B promised by the CBO. Senator Hatch (R-UT) says the Dems are playing games – and his number is $1.8T over “a real 10 years.”

    Sen. Landrieu’s had a few too many bowls of gumbo.

    Jo Egelhoff, FoxPolitics.net.




    COMMENTS

    Jo, Our "system" is a rickety pasted together hodgepodge of expensive and many times non-functional parts. Our costs are higher than every other country because of : Fee for Service, Administrative Costs, Lack or consistent primary care, disparity in costs and pricing, and consumption.

    The evidence is overwhelming that Medicare and VA, both of which are large US government run single payer programs are cost effective and deliver a high satisfaction to the patients.

    The evidence is overwhelming that all other westernized single payer systems deliver health care more effectively dollar for dollar than our "system". Unless a single payer system (like Medicare and VA) is implemented across state lines none of the cost drivers mentioned above will be affected. One state or co-ops aren't enough to force real buying power and force change downstream.

    Please, show me your evidence where single payer systems have failed dollar for dollar. I suspect the reason why opponents object to single payer systems has more to to with philosophy than a study of the economics.

    I expect there will be other posters here telling me that they "have a friend" in England or Canada etc. who had "to wait in a line". Totally meaningless. The statistics show that dollar for dollar they all perform better than we do. The statistics show that none of those countries would consider going to a system like ours and that their population is more satisfied than we are. Imagine what would happen to those apocryphal lines in Canada if they doubled their health care expenditure so it matched ours?

    I cannot think of a single fractured, cost laden, over priced industry like the health care industry. The people who lambaste "government inefficiency" would have a field day if every road had different widths, speed limits and government toll booths staffed with overpaid toll takers at every mile and where the tolls went up 10% per year and where road bidding was limited to not more than 10 miles per contractor. But that is what our private "efficient" health care system is.

    I remember when the US auto industry produced shabby inefficient over priced products. Then along came the Japanese and we had real competition. Unfortunately, it isn't easy to have foreign competition in health care unless you engage in medical tourism, which thousands of American do every month.

    fox cities news, appleton, wi
    dave allen (Fri Oct 23 07:25:07 2009)

    Well I'm back again with my "same old solution" to the health care issue - and I'm going to keep pounding on it because I KNOW it's the BEST solution. Read on, there's a new twist at the end.

    Take the 3rd Party Payer out of the loop.

    If the patient pays the 'clinic' or 'doc' a monthly retainer - the health care provider will have the financial base to sustain themselves, and the patient has the best possible bang for their buck. Nobody in the middle to argue with over denials or rate reductions - whether we're talking about an "insurer" or the government.

    And I come this time with ammunition! I just learned yesterday that there is a doctor in New York who is doing exactly this ... $79 / patient / month ... and it's working out GREAT for both sides.

    To fix this problem we have to do something that's going to make a lot of people unhappy. Specifically all the people who want to get their fingers in to the Health Care Finances pie, but don't even belong in the kitchen.

    fox cities news, appleton, wi
    Jeff Riedl (Fri Oct 23 08:42:31 2009)

    Jeff - I caught the same segment of Hannity's show last night, and I thought at the time that contracting for medical services with a doctor or clinic was a solution I too would much prefer over what we have now. We may have a hodge-podge of insurance funded services now, but if you consider the "health care experiment" in Maine, to jump into the same system nationwide would be going from the frying pan into the fire.

    Besides, I will fight to the very end to prevent the government from getting their meat hooks into one-fifth of our country's economy. They've bankrupted Social Security, taken over parts of our lives that are none of their business, and now are working on bankrupting our nation for generations yet to come. These medical and insurance choices need to be in the hands of people, not governments.

    fox cities news, appleton, wi
    Duke (Fri Oct 23 09:38:20 2009)

    Postscript - only because I'm getting old and forgetful: Sheboygan County has gone into the contracting business for medical services for our county employees. We've saved a TON of money.

    Jo, perhaps you could contact Adam Payne, the County Administrator to get the specifics on how the program got started and how well it's working. It might be a great subject for a future article on FoxPolitics.

    fox cities news, appleton, wi
    Duke (Fri Oct 23 09:42:30 2009)

    You are right, Jo, costs for ObamaCare are going to go up. That’s because the biggest waste, the 31% frittered away on our insurance bureaucracy, is left in the system. That industry paid $46 million in campaign contributions to make that happen.

    Dave Allen is right to support single-payer. For the same amount of dollars we are spending today (16.5% of GDP) we could provide first-class Cheney-care to 100% of our population. Including those in BadgerCare and Medicaid, and those who are uninsured and under-insured.
    .
    It’d be a Medicare-for-all system that would eliminate the insurance bureaucracy waste and we’d spend those dollars on patient care instead. We’d pay for the system through our national infrastructure (taxes) and eliminate this cost for businesses. They could spend their savings on keeping jobs in the US instead of outsourcing to countries already with universal healthcare. A bailout for 100% of our businesses, not just the banks and car manufacturers.
    .
    Get that? NO cost increase to the public! Just the elimination of a middleman that isn’t adding one iota to the care of patients. But THAT is why a single payer could not get by the politicians. They enjoyed the $46 million already but they are looking forward to the hundreds of millions more if they can keep the industry (and high costs) in the system.

    fox cities news, appleton, wi
    Jack Lohman (Fri Oct 23 10:30:48 2009)

    Jeff is absolutely right--TAKE THE THIRD PARTY OUT of the equation. Whether that third party is govt or insurance companies, makes no difference.

    All middlemen EVER do is drive up costs of whatever the commodity is. All anyone ever really needs is NOT "health" insurance, but MAJOR MEDICAL, to cover any catastophic event. If the govt really had guts, they'd admit this.

    fox cities news, appleton, wi
    emily matthews (Fri Oct 23 11:16:57 2009)

    P.S. Jack, what makes you think govt is not a middleman? How could they NOT be? Do you think they'd ever just say, "Go pay your doctor directly, as you would pay any other tradesman?"

    Or would they insert themselves into the MIDDLE--as in Medicare and Medicaid--and keep forcing all the dr's paper-pushers to have to send their bills in, for their own gov't-paid paper-pushers to process? And then force the dr. to wait to get paid whenever Big Bro felt like paying them? How is that NOT being a middleman!?!

    What about the people refused certain medical treatments because Medicare won't pay for them? (YES, it's true!!) How is that not being a middleman?

    However bad the private middlemen (insurance co's) are, the govt is way more inefficient! All you have to do is look at all the budget deficits for proof. Or look around and see all the make-work road construction, for another example of gov't waste. I take it you never read "Not Yours to Give" by Crockett yet...

    fox cities news, appleton, wi
    emily matthews (Fri Oct 23 11:29:20 2009)

    Emily said:
    "Or look around and see all the make-work road construction, for another example of gov't waste."


    You wouldn't be so bold as to speak ill of those 152 roundabouts we're building while the transportation fund is running in the red, would you?!

    fox cities news, appleton, wi
    Duke (Fri Oct 23 11:40:15 2009)

      "However bad the private middlemen (insurance co's) are, the govt is way more inefficient!"

    Wow. Is this why privatized Medicare Advantage plans are costing taxpayers 17% more than that bad-old government-run Medicare plan? I never would have thunk it.

    fox cities news, appleton, wi
    Jack Lohman (Fri Oct 23 12:24:49 2009)

    Dave, I don't understand your love affair with single payer. You are a free market kind of guy. Compassionate yes, but let the markets work. I think you come from a point of view that includes the importance of individual responsibility. Yes, the system needs overhaul. Increase transparency, increase opportunity for delivery, costing and payment innovation? Why go to the government? I just don't understand that from you. But that aside, I don't buy your continued argument that Medicare is cost-effective. Certainly not Medicaid. And customer satisfaction is high for Medicare? Well of course. Wouldn't it be high anytime almost anything and everything is paid for and the system hardly ever says no?

    Yes Duke, know of Adam Payne's system; I think he modeled it after the success (or was at least motivated by the success) Bob Ziegelbauer found in Manitowoc Co. Good idea to talk with those guys again. It's not the full answer, but they're trying, within the constraints of the current system.

    Emily - the government as the penultimate middle man. Yes. Penultimately (is that a word?) the most inefficient as well? No research no evidence, don't know that! Just trying to stir things up a bit... - with no extra time to find the research...

    fox cities news, appleton, wi
    Jo (Fri Oct 23 12:25:25 2009)

    Jack, I think the differential these days is something more like 11%. I think the differential was to motivate private insurers to pick up on the program. I'm not so sure that differential is needed anymore, but the seniors with the hefty program don't like to hear that said. I don't know enough about the numbers of the program, but would like to see private insurers tackle Medicare programs for the same reimbursement levels. They've crafted some wonderful programs - some that actually involve personal choice and personal responsibility. Cut the subsidy, fund the programs at the same cost per insured (regionally, I suppose it would have to be)as Medicare and let the market have at it. Does that require 5013 pages or whatever the 5 bills these days total?
    fox cities news, appleton, wi
    Jo (Fri Oct 23 12:31:25 2009)

    Jo, I would absolutely support a system that allowed private (non-profit) insurers to compete with Medicare, providing they had to abide by the same cost and rules of coverage (ie, no rescissions, no cherry-picking, no cancellations, etc.) The best way to do that is through healthcare providers such as ThedaCare, DeanCare, etc.

    But they must be non-profit because profits to shareholders come at the expense of lower care to the patient.

    As well, I support an increase in Medicare payments to physicians by, say, 5%, so they are reimbursed more fairly than they currently are.

    fox cities news, appleton, wi
    Jack Lohman (Fri Oct 23 12:54:27 2009)

    Well, I don't have to say I know someone in Canada..
    I lived there for 4 years.
    All these posts are hogwash.
    First, my income tax rate was 50 %
    Thats right folks 50 % ( "They" never tell you that part)
    Should get you some pretty good medical coverage, Right ?
    Wrong.
    Dirty secret,is when the Government takes over Health care, you sudddenly have a doctor shortage.
    SO you are faced with:
    1. either lowering your medical standards and getting doctors from other Countries, or
    2. living with fewer doctors , which means:
    3. Driving long distances to see your doctor who may be in another town.
    It was typical for people in my area to go at least 50 miles just for a Cancer specialist, because the government puts them in one centralized Location

    Think about this, and they did it.
    They took the hospitals in our town and divided them up , so one took all heart patients and another did the births.. Sounds cool right !
    But when they do this, they try to get ALL beds occupied. That means while we "had" three hospitals in town, they shut one down and the other two became "fully loaded"
    Now you tell me what happens?
    Forget voluntary Surgery, it doesn't exist.
    You don't believe me? I can give you the name of a friend who waited over 15 years to have her foot operated on so she didn't have to buy two pairs of shoes in different sizes each time.
    I have other true stories as well

    I listen to these guys who are filled up more than a 40 year old outhouse.
    Whats happening in Massachusetts?
    Are they happy ?
    I think not, as Old Teddy wanted the US Government to bail them out.
    Notice Nancy Pelosi is even saying that the program would need extra funds to start it. Yeah, sure !

    If the program works, why not put it in one State and evaluate it over 5-10 years before turning the Country on its ear?

    The problem with all these people that know so much is they think Americans will all settle for the same car, with the same engine, and the same paint job.

    Doesn't work!
    And if you don't know why, YOU may be the reason for the confusion (on your part of course)

    Open your wallet...Nice and Wide !

    fox cities news, appleton, wi
    Rich Carlstedt (Fri Oct 23 21:16:36 2009)

    Jo,
    Much of the sentiment above talks about taking out the "middleman". In any business we all agree with that. However, you just can't "take out the middleman" in every business. You can only "take out the middleman" when the service the "middleman" provides are either not needed or can be substituted for by the consumer. Farmer co-ops for example become the "middleman" and serve their members in a way that protects the members. But they still store crops and negotiate prices etc. I am a free market guy and my private market experience is why I know a single payer system is the right solution. In economics 101 we all learn that the lowest price is achieved when there is unlimited buyers, unlimited sellers, perfect market knowledge and all the products are the same or there is substitutability in products. Commodities on the wholesale level (other than speculative ones like oil and gold)are a good examples of responsive markets in the classic sense.(don't get me started on market subsidies etc. I'm talking about the exchanges not the production side) Health Care in the US is the exact opposite of a market in the classical supply/demand and price point curves. The need for health care services is relatively stable and predictable and does not respond to price. For example (and please, please don't give me stories about the people showing up at the ER because of the sniffles, we're talking basic economic theory here) , you don't get twice as many flu shots if the price is lower but if the price is lower you do bring in people who can't otherwise afford it. The latent demand for flu shots is fixed and whether the market clears the latent demand or not depends on the limits of the supply system and price but you don't get additional demand by lowering the price further. Secondly, the supply of health care can't react to demand/price since the supply follows the dollars but the demand is latent. For example, did Aurora build a palace hospital in Green Bay to serve the unmet health needs of the people in Green Bay? No. They followed the money and built what they could get money for. They simply drew dollars from the existing facilities since demand is relatively static. So what do the other facilities do? They need to raise prices to cover their overhead. Now, another part of this equation is product standardization and substitutability. As a business person who falls under the small group rules and who has had an HSA I have dealt directly with the layers and layers of bureaucracy that exist in our system. It is impossible for the individual to know healthcare services and make intelligent decisions. So, under the current system I am not in a position to be one of those "unlimited buyers with unlimited knowledge" that classic economics requires. I am picked off as we all are to some degree. Only a single payer system can aggregate enough of us to give the buying side any leverage and knowledge. I have had to investigate any procedure that I or my family needed. It is impossible (really impossible, not a metaphor) to research even the simplest procedure, say an endoscopy to find the lowest price without spending hours and hours on it. This does not meet the market knowledge that classic economics demands. There are many reasons why this happens but it is absolutely true.
    The "middleman" is needed in healthcare just like Wal-Mart is the middleman between the consumer and producer of goods. But the question is what role the middleman plays and for what cost. My opinion is that the healthcare middleman must fix the supply/demand failures of our "system" For the classic market issues it must increase the market knowledge, provide standardization, aggregate demand into the largest buying groups. Only a single payer can do this. Now, this discussion has focused on the economics side. Markets don't give a damn about who is healthy or not. They only care about the highest possible profit within the constraints they must operate. I believe that the values we espouse as a nation require us to have a system that delivers health care as the goal of our system not as a by product of the profit motive of the providers. Only a single payer system , government run, can provide the that philosophical goal. With all due respect again to the people who rightly are concerned about Social security and other government run programs. They constantly fail to look at the facts that these programs provide outstanding service at a very low operating cost. The reason why they are in trouble is because they are under funded. We want the benefit from Social Security but we don't want to pay for it (other than up to the absurdly low payroll cap), plain and simple. We already pay the highest amount per capita, per family and per procedure than all other westernized countries on health care. We have the money. It's the "system" that is the problem. look at the other countries, what do they do right? Steal their good ideas. Have the humility to admit that our "system" evolved as a hodge podge after WW2 to avoid wage/price controls and has nothing to do with the goal of delivering health care at the lowest cost. We are stuck with it like we were stuck with an inefficient highway system before the Interstate Highway System. It is time for fundamental change.

    fox cities news, appleton, wi
    dave allen (Sat Oct 24 08:28:37 2009)

    Rich said:

    "If the program works, why not put it in one State and evaluate it over 5-10 years before turning the Country on its ear?"


    It's already in two states, Mass. and Maine. The most favorable comment I've seen is 'it's not performing as expected,' and the worst is 'it's a nightmare.'

    Socialized medicine in America isn't about medicine, it's about money. Don't confuse medical care with medical insurance. Since the days of WW2 our federal government has gone off the political "gold standard" of the Constitution and found out that the people of our country will stand still for open and blatant disregard for our founding documents. They've also found that by making up a crisis they are able to funnel $ trillions to their own interests and their own cronies.

    It's not about medical care, folks. That's just the means to an end. It's about medical insurance, aka "Public Option." It's about money - your money.

    fox cities news, appleton, wi
    Duke (Sat Oct 24 08:30:28 2009)

    Yes, it is about money, Duke. Let's get the $46 million of insurance industry campaign contributions out of the political system and then see how our politicians vote. It'll be in the best interest of their constituents.

    And Dave, you should love the results, because single-payer is the only good option. Health care is not "elastic," like other consumer goods, and eliminating the unnecessary shareholder profits and CEO salaries will let doctors concentrate on patient care.

    And Rich, Canada's problem is not systemic, it is underfunded. Thy spend 10% of GDP versus our 16.5%. But their "system" is good, though hampered by the sparseness of their country. Increase their funding to 12% of GDP and you'll see their wait times disappear. OR, take 1 out of every 6 Canadians out of their system, as we do here through uninsurance, and you'll also see their wait times disappear.

    Yea, single-payer will increase personal taxes slightly, especially for the wealthy, but it would be the best corporate bailout ever. For all corporations, not just the bankers.

    Medicare-for-all has 70% public support (obviously from those not in your tax bracket).

    fox cities news, appleton, wi
    Jack Lohman (Sat Oct 24 10:12:07 2009)

    Duke,
    Notice how I never labeled our current 'system" as socialized support for insurance companies. Unfortunately you use labels because you don't have facts in the argument and resort to labeling. You point to Maine and Massachusetts as failures without defining what failure is. You say that the debate is about money and not medical care. I agree with you in part. However the overwhelming evidence is that Medicare and the VA and similar programs are about health care and the money is a means to an end -as are all rational budget questions. What I submit is that with insurance companies the money is the ends and health care is a means to the money. I fail to see your Constitutional questions as having any relevance to a single payer system. If you believe that our rickety expensive failure of a health system is preferable to having a better system on constitutional grounds then I ask you to explain your position better.

    fox cities news, appleton, wi
    dave allen (Sat Oct 24 14:14:51 2009)

    Paying a doctor $79 per month seems simple enough. One big problem. I go to a hemotologist, a cardiologist, a orthedpedic surgeon, my family doctor, my dermatologist, physical therapy, etc.
    At $79 per crack, that's approaching $500 per month. About the same as one would pay for Medicare and a suppletment. Some I use once a year, every six months or monthly. How would specialists work in that program. pay as you go when needed....several hundred per visit...MRI at $2,000 a crack! The monthly kind would be over $1,000 per month with lab work, etc.
    Sounds lole ot may be better to go with one payment a month to an insurance company and let them cover all details, paper work and payments for everything.
    Sounds like a lot to work out....not as simple as it may sound.

    fox cities news, appleton, wi
    John Hyland (Sun Oct 25 09:04:36 2009)

    John, what Jeff didn't say is that this $79 is for VERY BASIC doctor-office coverage and does NOT cover outside testing (MRIs, etc). Probably a good spot for Newbie doctors to start developing a client base, but let's give it time to see if they can survive. See their site at http://amgmedicalgroup.com

    My concern is that people will go with that, forgo any extensive policy and then get into a high cost need that they have no coverage for. And when they decide they need real coverage they'll be denied because of pre-existing disease. It could backfire big time on the patient.

    fox cities news, appleton, wi
    Jack Lohman (Sun Oct 25 09:31:38 2009)

    I also note that the $79 per month program also accepts insurance. They do not necessarily eliminate the middleman unless all someone needs is the limited services they can get for $70 per month. One of the biggest problems with our "system" that this group may help solve is the lack of regular, accessible and affordable primary care. The overall cost structure will not be affected by groups like this. They're just nibbling around the edges. No fault of their own it's just the way it is at present.
    fox cities news, appleton, wi
    dave allen (Mon Oct 26 07:10:56 2009)

    Well if $79 / month could work for the 'basic' services, why wouldn't $125 / month work for a "basic plus"? That would still be a huge savings for our family ... the 'plus' part would probably only be used very rarely but the money would be squirreling away for months (maybe years) before it gets touched.

    By plus, I'm referring to the specialist services. Whatever the number, the economics are the same. Patient pays doctor for a little more than they are currently using. Doctor saves the overage for that rainy day when the patient needs more care. NONE of the money gets sucked in to the black hole of "corporate profits" none of the money gets sucked in to the black hole of D.C. paper-pushers.

    Sure, some massaging of the numbers would be necessary, but if you're going to fix a severely broken system - you're going to have to do something radical, not just move a box of money from one building in New York to another in D.C.

    fox cities news, appleton, wi
    Jeff (Mon Oct 26 08:57:53 2009)

    Jeff, the concept is there, mainly in eliminating the insurance bureaucracy (profits, salaries, bonuses, commissions, et al). And if the "Plus" category covered *everything else*, including transplants and etc, and there were no denials and other gaming of the patient, it could possibly work. Perhaps with a catastrophic policy to help.

    But the truth is, we could have all of that today with a Medicare-for-all (single-payer) system, were our politicians not so corrupted with campaign cash from the insurance industry.

    fox cities news, appleton, wi
    Jack Lohman (Mon Oct 26 10:42:08 2009)

    One problem I do see is "doctor politics," a fact of life. This doctor may not be friendly with the specialist the patient prefers and thus will not refer the patient accordingly. With the Medicare-for-all system the patient as control.
    fox cities news, appleton, wi
    Jack Lohman (Mon Oct 26 11:14:03 2009)




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