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Dec. 10 2009 - 10:47 am | 440 views | 4 recommendations | 64 comments

Health Care For Almost One-Third of Everyone (Who is Left-Handed and Over 50)!

The short answer — subject to Senate revisions — is that those without employer-provided insurance would have more options for buying coverage, but if they are younger than 55, their money would go to a private insurer, no matter what. Rates would be more competitive than what they are offered now, but possibly less so than under a “public option.” And if they are between 55 and 64, they might be able to buy into Medicare early, though at what prices remains to be seen.

via What the Senate health-care deal would mean for consumers – washingtonpost.com.

The race to revamp the American health care system and turn it into an even bigger and more incomprehensible mess than it is today continues. Watching the congressional back-and-forth on this is a fascinating comic exercise, sort of like putting a chess board between a pair of beached Beluga whales and waiting for a game to break out.

If you start with the basic premise that by far the biggest problem with the American health care system is the bureaucracy and the paperwork — I talked to one set of hospital officials in New Jersey who said that half of their administrative personnel were devoted exclusively to chasing claims from all the various insurance companies — then this galactic battle going on right now is already hilarious. Congress is basically arguing over what the best kind of system to install is without addressing the paperwork/bureaucracy problem. To use a very hokey medical metaphor, this is sort of like a bunch of doctors arguing over how to cure the hangnail on the left hand of a patient dying from a gunshot wound to the face.

Okay, fine, so single-payer is off the table, no use continuing to whine about that, even though it’s the obvious solution to all of  the biggest problems and congressional aides in private admit this. So your next-biggest problem is cost, and you can try to address that with some kind of public option, which would force private companies to take a bite out of their own profits or their own inefficiency to drive down rates in order to compete with the naturally cheaper public plans.

But we can’t have that either, of course, because the name of this game is passing something the Obama administration can call health care while preserving massive subsidies to the insurance and pharmaceutical industries. In that regard, the government under the new plan will continue to be barred from negotiating bulk rates for pharma purchases for Medicare, while insurance companies won’t have to trim profits or paperwork to compete with a real public option. The Obama administration also recently reversed itself on yet another campaign promise and decided to come out against plans to allow pharma purchases from Canada, further protecting the pharma industry.

So the old system of inefficient bureaucracies and artificially high prices has basically been completely protected. What we’re left figuring out is exactly how to pay for a hugely expensive new program without taking significant money out of the pockets of these industries. The other challenge for the Obama administration is how to unite Congress enough to pass this gigantic new venture that really doesn’t achieve much, and the strategy there is turning out to be just what you’d expect: rather than pushing a single cohesive plan that makes sense in the long term, party leaders are putting forward a confused mish-mash of non-plans and trying to buy off the various segments of the Congress with pork and other forms of bribery as a means of solving the extremely short-term problem of how to pass this bill in time for the 2010 elections.

This latest plan to reduce the Medicare age is a great example. Rather than put forward a real public option that actually lowers costs and gives people everywhere the ability to buy into a plan, the Democrats are now pushing a plan to offer Medicare to people age 55 and over.  The idea here is to include something that sounds enough like a “public option” that the liberals will be placated and ultimately vote for the bill. It shouldn’t escape anyone’s notice that under this arrangement, all the younger, healthier people who are just starting their careers and most need cheap insurance will be forced to buy private plans while older citizens will be offered the public teat just as they start to become very expensive to their insurers.

I get that some people think this is a good idea, and it’s hard to argue that any kind of expansion of Medicare is a bad thing, given that the program has been popular and successful throughout its history. But this move just smacks of the bass-ackwards Solomonesque bargaining that has marked this whole health care effort from the start. If expanding Medicare is good for people aged 55 and up, why isn’t it good for everybody? Why isn’t it a good idea to provide cheaper insurance for people in their preventive care years, so that they cost Medicare less as they do get older?

Answer: because it’s a political non-starter, because hopsitals and doctors won’t tolerate having to take Medicare rates from everyone, nor will the pharma companies or the insurance companies tolerate having to compete with Medicare for their most profitable customers.

So what they’ll do instead is expand Medicare for people aged 55 and up in exchange for the preservation of subsidies everywhere else in the system, as well as an individual mandate that increases the revenue flow for private insurers by forcing millions of new (and relatively young and healthy) customers their way. This isn’t a health care strategy, it’s a big baby that’s been hacked up into parts and fed in descending size order to the administration’s weightiest political lobbies. I almost can’t wait to see what the next “compromise” is.


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  1. collapse expand

    But if you think the problem is about not having enough leverage over providers, then this doesn’t work,” he said.

    This is exactly the problem — even our illustrious president has said that the cost of insurance has, and will continue to rise to a point where not only will it be a drain on families but on the economy as a whole (even more than it is right now). While I like the idea that Obama is willing to compromise to bring about some kind of consensus on the health care front he has compromised it right out of existence.
    My husband was in the military so we both have health care, but this last week-end I got to see exactly where the rubber meets the road with his VA health care. He fell and broke his hip; I called the local rescue squad and asked them to transport him to the VA hospital; they said that since they are a county-run entity and the VA is a gov’t-run entity they don’t have reciprocity. We had him transported to a hospital that cooperates with the VA and then I had to call the VA and ask them to come get my husband. If he had had a heart attack, or needed immediate surgery (like say for a gunshot wound) he would either have died before the VA came to get him, or I would be facing enormous hospital bills because we didn’t have any ‘real’ health insurance policy. As it stands it all worked out, but only because I was a mouthy (read: bitchy) advocate for my husband.

    Incidently, the title of your article: I am 56 AND left-handed; I’m really looking forward to what this new health care bill will do for ME!

    • collapse expand

      I don’t want to seem like a jerk but shouldn’t you have known beforehand what to do in a medical emergency? And if your husband did indeed have had a heart attack why couldn’t you have called a private ambulance and then face an expensive ambulance bill rather than a hospital bill hundreds of times more expensive? Just asking. Hope your husband feels better.

      In response to another comment. See in context »
  2. collapse expand

    This is essentially why im never paying my taxes again (I’m a 1099 so i have the choice). On a grand scale, going to prison is everything I could ever need, government subsidized housing, free exercise equipment, free meals, government run health care, free hair cuts, free toothpaste, free dentist…

    Yea yea, anybody who has seen OZ knows the downside of being in jail, but the drugs are good, so if you do enough of them you wont feel the occasional ass rape…and if I could underscore ‘occassional’ I would, because its obviously every politicians job (both sides of the isle) to figure out how to ass-rape the american public daily.

    whats even worse we have a president that loves to jump right in on all the fun…

    im picking up a new language and moving from this god forsaken country

  3. collapse expand

    It’s called the divide and conquer method of psychological political warfare:now we have three groups, under 55, 55-64, and 64 +

    Pretty shrewd move by the land fraud artist reid….

    Reid has also said 6% of american will not be covered….who are this 6%? and why can’t they be covered?

  4. collapse expand

    Very well put. But I have to disagree that “it’s hard to argue that any kind of expansion of Medicare is a bad thing, given that the program has been popular and successful throughout its history.”

    Medicare, while being successful at providing relatively comprehensive coverage to the elderly, has been wholly unsuccessful in it’s ability to control costs. It is a loss-leader and a main contributor to health care’s contribution to our GDP. Additionally, Medicare reimbursement levels to providers are significantly lower than that from private insurance companies – so if the Obama administration were to extend Medicare benefits to all Americans, we would see an extension of the current problem we have now, that doctors don’t want to see Medicare/Medicaid patients, because they don’t make as much money on them. We need a public option to, as you say, “which would force private companies to take a bite out of their own profits or their own inefficiency to drive down rates in order to compete with the naturally cheaper public plans.”

    And that is the bottom line.

    • collapse expand

      “. It is a loss-leader and a main contributor to health care’s contribution to our GDP. ”

      Well it’s not a loss-leader, loss-leader’s a marketing term for something you put on sale and lose money on to bring in customers who hopefully buy other shit. But I get what you’re saying: it costs a lot of money.

      Any sensible person’s reply should be: yes, yes it does. It’s a social benefit. That’s how social benefits work. The applied conservative ideology of governance wherein everything except defense and prisons and intelligence and security and law enforcement and industry subsidy has to somehow be deficit neutral is absurd and shouldn’t be taken seriously. If you think healthcare is important to our society then you accept that it costs a lot of money and you figure out how to fund it, just like we do with the defense department and anything else. I’m always mystified when pundits sit around arguing about whether Medicare is “losing” oodles money. It’s such a stupid argument that it boggles the mind that adults can have it. Yes, when the government spends money on social welfare costs and defense costs we don’t get the money back directly – we “lose” it. Thank you for playing!

      In response to another comment. See in context »
  5. collapse expand

    If you agree that single-payer is the better way to go for American health-care, it doesn’t make a lot of sense to be against dropping Medicare to 55. You’re right when you say why not make it available to everyone? We should- but we aren’t going to yet. But wouldn’t you say that by lowering the age even this much puts us on the road to the better answer?
    The original Social Security plan covered only 1/2 of the people who would eventually be covered.

    With respect to hospitals and doctors not tolerating Medicare to all people, that really isn’t quite true. While Medicare pays 20% less, the overhead savings to physicians vis a vis private health care is about 15%. Thus, a five percent gap – a gap that is addressed in the House bill. You might be very surprised to discover just how many doctors support Medicare for all. They are not the reason that we aren’t yet considering making this available to everyone – the reason is purely political.

    The reality is that the Senate has accidentally tripped upon the best thing they could do – begin the process of making Medicare available to everyone. Private health insurance will not survive in the long term. Their profit margins tend to run between 3% and 5%. They are only the 85th most profitable industry in the country and they only manage to maintain that lowly position by volume and by treating their customers abysmally. While the legislation may drive more patients into their arms, the restrictions being placed on what they have to do will further tighten the profit noose- making them far less attractive to Wall Street. As their goal is precisely the opposite – what’s the point if they can’t stay attractive to Wall Street?- they will begin to alter their policies to require more out of pocket payments. As they do this, it will become harder and harder for even the middle class to afford their product. When that happens, the government will be forced to step in. This will happen. So, why not begin the process of expanding Medicare now so when the government has to do it for everyone (and that day is coming) there will be even less people to work into the system.

    What is happening now is just the end of the beginning of health care reform – not the end.

    • collapse expand

      Rick,

      Has anyone analyzed how many new jobs would be created by putting more people on health care rolls?

      In response to another comment. See in context »
    • collapse expand

      “Private health insurance will not survive in the long term. Their profit margins tend to run between 3% and 5%. They are only the 85th most profitable industry in the country and they only manage to maintain that lowly position by volume and by treating their customers abysmally.”

      This is murkier than it sounds. Many of the companies offering plans also own networks of hospitals and clinics and pharmacy chains that they shovel their people into wherein they make up their losses. From a 30,000 foot view the insurance company is just part of a large network of held companies that, together, generate profits for the holding corporation which in some cases owns everything from the policy writing company to the primary care clinic to the hospital to the pharmacy (and probably the funeral home soon, if not already). Then you add in that some are owned by Private Equity/LBO outfits and you can see how convoluted the concept of profitability becomes for any one element of the chain – it may not even be relevant depending on who owns what. There’s definitely a bunch of money being moved around, but to what benefit and by whom is hard to say because they make it hard to tell.

      In response to another comment. See in context »
    • collapse expand

      My health care premium is about one half of the $7600/individual $15,000/couple projected cost of Medicare. I’m never denied any treatment either,ever.
      http://www.nytimes.com/2009/12/11/health/policy/11insure.html?_r=2&partner=rss&emc=rss

      In response to another comment. See in context »
    • collapse expand

      “If you agree that single-payer is the better way to go for American health-care, it doesn’t make a lot of sense to be against dropping Medicare to 55.”

      Here’s the problem — if it’s not mandatory, what that means is that sicker Americans will gravitate to the program (they’re already older) and make it much more expensive. Many of the people inside the beltway negotiating around this are counting on the fact that maybe we can expand it in the future. It’s a risky bet, and it’s pretty sad that our Congress can’t seem to be doing any better than that, given that the population has wanted something like Medicare available to everyone for years and years.

      In response to another comment. See in context »
    • collapse expand

      Exactly! Even crazy people scream, “keep your dirty guvmint hands off my Medicare!” we’ll just keep expanding it til everyone who needs it gets it.

      Btw, how much of the 3-5% profit goes for lobbying? Most of it, I bet, unless that’s included in the ridiculously high overhead costs the
      industry bears.

      In response to another comment. See in context »
  6. collapse expand

    Clearly logic has no part in this debate, if you can call it that. Amazing how quickly “change” in DC became “business as usual”. I wish I could be as charitable as some who defend Obama’s administration with oblique references to inherited messes. But c’mon: he knew what he was signing up for.

    With apologies to The Who, meet the new boss; same as the old boss.

  7. collapse expand

    I think you’re putting too much of the blame on Obama. Not that I’m happy with everything Obama’s done regarding health care or I think he isn’t influenced too much certain industry interests, but he can’t force senators to vote for a bill. The particulars of whatever shit sandwich we end up with – and whether it is or isn’t a shit sandwich – are dictated by our ridiculous legislative system, not what any particular president happens to want.

    • collapse expand

      The whole damn admin is being run and ruined by Geithner and Rahm. Obama will go down as a bait and switch President. I’m hoping he proves me wrong, but this is exactly the reason we wanted Dennis Kucinich in office, to FDR the shit out of the entire town.

      In response to another comment. See in context »
    • collapse expand

      I wish to god you were right that Obama was just an innocent progressive whose legislative efforts were being thwarted by a corrupt congress, but as I type this sentence he is working desperately to crush an amendment being pushed by Byron Dorgan to allow for the re-importation of pharmaceutical drugs from Canada. Obama’s using the power of the White House in an all out effort to kill this universally popular progressive legislation that Democrats have championed for years, that the President promised to support, and that the Senate has the votes to pass. His motive? A backroom deal between the administration and Pharma to continue the double-standard of only allowing manufacturers to import and export drugs, but not consumers or wholesalers. All so that the pharmaceutical industry can control drug prices from the competitive pressures of free trade. This is just one example from a single legislative effort. Depressingly, if I had to write down every single sellout like this one it might take me a month to complete. Maybe part of Pharma deal was for Obama to increase the sales of heartburn and anti-depressant medication among his constituents. Sigh.

      In response to another comment. See in context »
  8. collapse expand

    reason # 5783450998 to hate baby boomers

    maybe in 15 or so years, after my student loan is paid off, i can get my own health insurance. then i can finally start saving up to buy a house.

    • collapse expand

      I hate to say it, but amen to that. I was buying yogurt at the grocery store the other day, and marveling at the new currency of marketing. Buying yogurt used to be about the flavor, the quality, a nice snack, maybe low fat. Now it’s all geared toward attracting boomers with constipation problems. Every other commercial on TV has some work-hot boomer with his dignified, gray-haired ex-model wife, bounding around like gazelles after taking a crap/fortifying their bones/dosing their overactive bladder syndrome. I always knew growing up that my parents’ generation would leave us with a huge mess, I just didn’t know it would start so soon.

      In response to another comment. See in context »
  9. collapse expand

    True desperation is when an atheist invokes god’s mercy. God fucking help us.

  10. collapse expand

    Matt, just realized that I was duped again by a clever campaign on promises of change/hope. I know your readers probably think it’s pretty naive and funny but I just realized this president and his congress is no different from the previous one except he’s better at reading from a teleprompter.Joke’s on me for being stupid i guess. Keep up the good work.
    m

  11. collapse expand

    Money = Politics

    Separate the money from the politics and allow a multi-party system. Until then, every issue will continue to be addressed with half-measures and platitudes that resolve nothing because there’s more incentive to do nothing, or worse yet, do more harm.

  12. collapse expand

    I guess my favorite part of the plan is forcing so many new customers to purchase a flawed product that they otherwise would take a pass on. While the Congress is at it, they might as well legislate that we all buy American-made cars and sub-prime mortgages.

  13. collapse expand

    It is beginning to look like Obama actually wants to be a one-term President…this supposed health care “reform” is such a blatant give-away to the industry that it isn’t fooling anyone.
    I particularly object to public monies being given to the “for profit” robbers, along with potential jail sentences for anyone who doesn’t buy from these crooks!!
    Prison Industries had their lobbyists working hard on the bill apparently. Jeeezus.
    Tax payer funds should ONLY be allowed to pay for non-profit public option available to ALLLLLL!!
    To anyone that has been rooked, to anyone that hates their Ins Co, to anyone uninsured and to all that are required to buy Ins, especially employers, this public option must be available.
    And to the “forms factories” that Insurers use to waste Dr’s time, they need a universal form that fits all insurance.
    I am so sick of this dirty joke called “reform”. It’s about as true as Tiger Woods’ fidelity.

  14. collapse expand

    Man, I used to think you were cool, but, you know what, Fuck you you fucking handist bastard! I’ll have you know that left handed people, who you deride so easily, actually make up 23% of the population, making us the largest unrecognized majority in the country! (eat that latinos!) Your fucking bigot ass was probably to stupid to realize that because left handed people tend to be smarter than you dumb ass righties, you prick! Oh, you think a “hangnail on the left hand” is so unimportant! Oh, “we’re LEFT figuring out is exactly how to pay for a hugely expensive new program.” You know what you’d be RIGHT to do? Give me a left handed handjob on my massive cock, cause lefties have bigger dicks too, you shit stained, right handed, cunt faced baboon! So take your sanctimonious derision of left handed people and shove it directly up your fat, greasy, handist ass! (please use your right hand for this! also, disregard if you happen to be left handed!)

  15. collapse expand

    Typical. Forcing the taxpayers to buy a crappy product by these life sucking leeches. This is a huge give away to the same corporations who deny care and who are responsible for the deaths of thousands. Now we will be forced to hand them more money for Walmart quality health insurance.

    It made me sick to my stomach to listen to the radio today and hear all of these “liberals” talk about what great news this is. More sloppy blow jobs for Obama.

    The people need immediate Recall power for all elected “representatives”. Drag these robberbarons out of office by their toe nails, make them stand on a crate, and throw rotten vegetables at them.

  16. collapse expand

    I don’t think Lieberman will vote for anything. His game and maybe Nelsons is to just block anything and everything that is attempted.

  17. collapse expand

    This is completely pointless – everybody has their own plan, why add mine in – but I like the symmetry of it so much I have to vent it somewhere besides friends over dinner tables:

    Next year, Medicare covers 64-year-olds and 18-year-olds.

    2011, it also covers 63 and 19; then 62 and 20. A little math will tell you that everybody is covered in about 24 years.

    Older people now have to wait only half as long to get to their medicare age. Nobody not yet an adult will ever lack for health care.

    And the older and younger additions to the Medicare population balance out the risk.

    The 24 years is bad (very much so if you turn 19 on Dec 31) but the plus is that the industry gets 24 years to wind down, minimizing shocks to their stockholders, whose stock values will decline gradually instead of suddenly. It just becomes a sunset industry like tobacco.

    If this were wishful thinking, I wouldn’t bother. (Wishful thinking for this Canadian, would be “Xerox our health care system and pass it as a bill, for the love of mercy!”) But the “closing vise” idea strikes me as politically saleable as well.

    A variant, by the way, concerns what to do with the under-18’s. Adding them in to Medicare at the start would be quite a boost for Medicare revenues, but I don’t think it would hit the insurance companies too bad. They don’t charge that much for kids now; mostly, your kids are covered under your plan at work, if you have one, whether you have zero, 1, 2 or six kids, for instance.

  18. collapse expand

    By lowering the bar on Medicare age, hopefully they create room for negotiation in the legislation.
    i.e. –
    Change “age 55 and older” into “age zero and older”, then require all members of congress to buy into it and make it an optional buy-in for everyone else under 55. The insurance companies will have to compete with Medicare. Then untie the negotiating hands of Medicare with drug companies so we can get competitive prescription prices.

    Oh… I’m sorry. I think I’m making too much sense for Congress. Perhaps we need to throw in a “free ice cream on Fridays” amendment.

  19. collapse expand

    A lot of Obama supporters seem to be willing to give him a pass on almost anything, based on the idea that he’s pursuing some comprehensive plan to chip away at the old and usher in the new. While that point could be made about this new expansion of Medicare, there is no explaining away the counterpoint on protecting big pharma. It is absolutely unconscionable, and the disappointments are less shocking every day. However, the great cultural benefit to this presidency is that it acts as an equalizer. We voted for him based on aesthetics (let’s not fool ourselves), and that’s just what we’ll get.

  20. collapse expand

    Purely academic question here: could Matt, Rick, or one of the informed commenters here, please make an educated estimate of how big a percentage of the Gross National Product could have been freed up by replacing private for-profit health insurance with a single-payer system?

  21. collapse expand

    What I find rather baffling is that it seems no one took the time to actually research how other countries that have very successful health systems are running it and how we can adapt it to the needs of the US. There are multiple kinds to choose from in nations that are ranked high in health than the US. This myopia is endemic in our political system where we can’t even mention another country without touching off some nationalist jingoistic BS. It does not help that the most of those in Congress have entrenched interests in helping the pharm and health industries maintain the status quo so they can keep pulling in their donations. I’ve said it before and I’ll say it again: campaign finance reform is the only way we can take a step forward and making sure that the bureaucrats we hire as a people actually stand for the best interests of the people.

    I’ve strayed a bit but I think there are some basic institutional problems within the political system that must be addressed before we could see any real progress on anything (taxes, health care, education, or defense expenditures).

    • collapse expand

      If anyone in this public debate of any consequence actually seriously took into account the evidence about what health care is like in France, they’d never again be able to discuss ours without just breaking out laughing.

      It’s a universal, single-payer, government-run insurance system in which private doctors take insurance from that as well as any other insurer, because private insurance for extra coverage is still available and widely used. However everyone who’s a citizen has coverage, no matter what.

      I’ve lived here for years and it’s insanely better care than what I find in the US. I don’t mean just cheaper and more humane, which it clearly is, but I mean better, also.

      So, of course no one can actually look in any clear-eyed way at this, they have to resort to juvenile Republican scare-mongering talking points instead. It’s the law, I think.

      In response to another comment. See in context »
  22. collapse expand

    still support Obama now, you robots? “change” hahahahaha.

    i am so sick of the elderly ripping me the fuck off.

  23. collapse expand

    Taibbi makes so much sense that it’s depressing. What a bunch of clowns we have running this country. This whole system is whacked. But, Matt, I need some reassurance. Are we still better off than Russia?

  24. collapse expand

    I’m 49 and have been paying in to this f’d up system in spades since I was 23. I haven’t yet had and probability is I won’t have even a single year where my actual paid out claims get to even half what my employer sends to my and my wifes healthplans (and deducts from our wage package) until I’m late 50’s. It looks like I’m on track to have spent about more than half a million in actual dollars in health insurance premiums, deductibles, copays and medicare taxes by then.

    Suck it up young people, at least once the few of you who actually have insurance get done helping us mid-lifers pay for the current crop of geezers to get the most costly end of life care in history, (orders of magnitude more than what they paid in for it) you won’t have to do the same for us when we’re 65. You simply won’t have enough money. The costs will be so high and the number of working people will have so demographically shrunk and fallen so far behind in wages at the current rates of decline that there will be no way to perpetuate this big rigged casino of age, wealth, skill and electoral demography.

    We’ll all get our change then, and we’ll be the old sick helpless ones, your backs and brains will still have a ways to go. For now just be glad for a small change in the right direction and buy some fricking health insurance already if you’re not willing to hold out for a job that buys it for you. For every young person who settles for a job with no insurance and skips buying their own, a middle age person (whose much more likely to have insurance) has to pay in for you (we don’t make that many claims either), and there’s still dick for money left after the really old farts reef through it all.

  25. collapse expand

    The health care system will kill Obama chances of re-election if it fails, my twitter profile has a word on this? under the user writtenviews.

    most of us await his failure, but let us hope that it benefits Americans, for your health care system is bad.

    • collapse expand

      None of the benefits even start until 2013, though how that works out changes day by day. All that’s going to matter for Obama come 2012 is jobs, jobs, jobs. If people are working they’ll commonly view their healthcare situation as “better” and he’ll get the credit. If they’re not working they’ll commonly view their situation as bad, unchanged or worse, but the few early benefits of this legislation (i.e. ending recision) are purely corrective in nature and while I’m sure they’ll be popular they’ll also be perverted quickly by the insurance companies no doubt. The benefits themselves are watered down so as to be unrecognizable and don’t kick in for the most part until after the election, so while I imagine that he’ll take a lot of heat for such a stupid piece of legislation, I also know that at the end of the day when people are more employed and making more money and have more benefits then they think the President is doing a good job and when they’re not employed and making less money and have fewer benefits they think the President sucks. Obama came in with the bar on the floor, so assuming there’s not another bubble it’s going to be pretty easy to show improvement by 2011/2012 and he’ll probably get the credit for it.

      In response to another comment. See in context »
  26. collapse expand

    Any of the Congressional brain trusters think about the 14th Amendment?
    Section 1. All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.

  27. collapse expand

    hey matt,
    do you think there will be some sort of 11th hour intervention by obama that might be beneficial or positive? bush was able to do similar things in the final stages of lawmaking, right? after all, the public option has been killed and resurrected a couple of times now.
    maybe i’m just deluded from the powerfully charismatic qualities of which he once again just exhibited in his nobel prize speech, but you see this man speak at rallies and in interviews about policy and it almost makes you want to forget the fact that he’s filled his administration full of goldman sachs alumni…

  28. collapse expand

    All through my 20’s, 30’s, and 40’s, I paid into employer-provided Cadillac health care plans. Young and healthy, I seldom visited a doctor; I subsidized my older coworkers. For my 50th birthday, I got laid off and lost my health insurance.

    When I first heard of the possibility of Medicare at age 55, I thought — from a self-interested perspective — it was a fantastic idea. As I read more, though, I understand that only those who are turned down by insurance providers can apply. In other words, Medicare will take on the burden of the people with expensive medical needs on whom insurers could not make a profit. Additionally, all citizens will now be forced to buy Cadillac plans: high-deductible plans will not be an option. Like the young people, I will be forced to send excess money to the insurers for coverage that does not fit my life situation.

    Matt, you mentioned that no one will address the bureaucratic and paperwork waste. I would be very interested in hearing debate on another topic that is off-limits. Unnecessary prescription medicines. I’m sure there are others, but I am thinking specifically of statins, the cholesterol-lowering drugs. In January, 2008, Business Week published an excellent examination of statins, coming to the conclusion that they are not effective. They have an NNT (number needed to treat in order to help one person) of 100, a 17% rate of adverse side-effects (some quite serious), and do not affect mortality rates. This is objective fact: the manufacturers do not deny or contest this. I really wish you could write a piece on this topic in Rolling Stone, but short of that I’d still love to hear your view regarding statins, and their marketing. Some 30 million Americans take them, some of whom are undoubtedly convinced global warming is a hoax, yet never think to question the efficacy of the pills they gobble every day.

  29. collapse expand

    Let’s face it. Our democracy is gone. Our “government” is unable, if not unwilling, to represent its citizens. On financial reforms and health care, the sleazebags in Congress are emitting thick smokescreens, attempts to make it seem as though they are Making Progress. But they are harlots who do the bidding of their johns in finance and medicine. Our elected reps are further cementing into place widespread fraud and deception. It’s congealing into outright kleptocracy. It’s all intended to protect the profits of banks, insurers and pharma, who have ripped off and are ripping off Americans at an incomprehensible rate. And they get away with it because they fund the campaigns of their little harlots in Congress and the White House. Our money is flowing from the market and from the Treasury itself directly to the business mafia. It’s then laundered to the pols, who are directly participating in this rapacious plunder.

    Since voting doesn’t seem to work, I say it’s time to discuss how the great mass can protect itself, if not retaliate. What are the best grassroots methods of fighting back, denying them the lucre they use to perpetuate their crimes.

  30. collapse expand

    I haven’t reviewed all the comments here (sorry) so someone may have already injected this new article from the New Yorker (12/14 issue) as a point to start a new discussion about the state of the Senate bill and beyond:

    http://www.newyorker.com/reporting/2009/12/14/091214fa_fact_gawande

    It’s a long article but it’s written by someone who actually HAS read the Senate bill and sees what they are trying to do. What is interesting in reading this article is that NO ONE has picked up on this at all. And actually, it’s ingenious.

    As a hint, the author very effectively compares the state of our medical industry in 2009 to the state of our agricultural industry in 1909 (1903, actually). He shows that what the Senate is trying to do thru its provisions and programs is to transform our inefficient, fragmented, over-priced and poorly coordinated medical industry into the overly productive, highly affordable and market satisfying condition of today’s agricultural industry.

    He very pointedly makes clear that the agricultural industry (which was in terrible condition in the early 1900s and was the biggest hinderance to developing a truly productive society) did not become the efficient world leader because of market forces and capitalistic intent; instead, it was the direct result of governmental trial and error, effort & investment.

    I hope you get the chance to review this very important article. You’ll get an entirely different view of the effort that needs to be made.

    • collapse expand

      As a hint, the author very effectively compares the state of our medical industry in 2009 to the state of our agricultural industry in 1909 (1903, actually).

      should we be expecting fewer or more lynching next? Is it a good time to add Mark Twain to my dead pool?

      In response to another comment. See in context »
  31. collapse expand

    Matt: in this post you’ve hit on an idea I have long advocated. It wouldn’t be a FIX for the health-care mess, but it would help. Why not require standardized medical forms? The best would probably be the current Medicare form, but I might be wrong about that. If you ask the paper-pushers in doctors’ offices what makes their job so difficult (besides getting the healthcare giants to actually PAY), I’ll bet they’d say that the plethora of different forms, and mastering them, is a big part of it.
    I’m sure you’d get the “slippery slope” argument in response. Tough shit. It would be a start and something a Senator might even be able to slip in to the current un-bill.

    • collapse expand

      Interesting. For a follow-up, you might try this one as well:

      http://blogs.reuters.com/felix-salmon/2009/12/11/fernholz-vs-taibbi/

      In response to another comment. See in context »
      • collapse expand

        Interesting exchange, I would call it the “detailed critique of Taibbi by someone who doesn’t seem to have really read, or understood, Taibbi’s piece.

        There’s another one where Fernholz “refutes” the idea that Biden and thus his adviser aren’t focused on regulatory issues, which Fernholz claims is a massive error because Biden does in fact deal with jobs and stimulus issues sometimes.

        One of the many “Hunhn??” moments in reading Fernholz’s piece. He got many more things wrong than Taibbi did as far as I can see, and he was only critiquing one article, which anyone could fact-check him against. It appears that Taibbi used the wrong first name/diminutive for someone, but that’s about it. Hardly a “Oh what a mess” as Fernholz tries to sneer.

        In response to another comment. See in context »
  32. collapse expand

    I think Steny Hoyer nailed it the other day.

    “…the hard choices that are being forced on our country demand engagement from both parties. I’m thinking of challenges like reforming our massive entitlement programs, controlling the growth of health-care spending, and responding to climate change — issues that are fraught with political risk and so easy to demagogue that it is almost impossible for one party to take them on alone. Those challenges are dangerously likely to stay untouched as long as at least one party is willing to be a “Party of No.” “

  33. collapse expand

    I am a supporter of HR 676, a 50 page bill that takes a phased in approach of expanding Medicare to the entire population. And for business reasons here is why:

    Economies of scale matter. A lot. Both from a risk pooling perspective, but also in terms of cost efficiency. See, the larger the entity, the lower the fixed costs relative to variable costs. Why do you think companies try and get big? To have a cost advantage over their competitors.

    If size is a detriment, why does the UK, which has four times the population of the Netherlands, have an even LOWER per person cost? Or Italy? Or Japan?

    But there’s a far bigger issue here, that also should lead the US to have among the LOWEST per capita cost (instead of the world’s highest), it’s called the Aging Index, and it’s the ratio of those over 60 (big consumers of health care) versus those under 16 (light users of health care)

    In the US, there are 84 people over 60 for every 100 people under 16

    In NL, there are 112 people over 60 for every 100 people under 16.

    In Japan, there are over 200 people over 60 for every 100 people under 16.

    America has the BEST demographic profile within the OECD, and yet it has the worst health care expenses.

    Single payer countries still have profitable health insurance companies that offer additional coverage such as private rooms for hospital stays, elective surgeries and abortion if it is not available within the single payer plan. This is an enormous boon for large American muti-national companies operating overseas because their costs per employee are so much lower in terms of offering attractive benefits packages.

  34. collapse expand

    Good article, Matt, except you blew it with this one line, “because hopsitals and doctors won’t tolerate having to take Medicare rates from everyone”.

    Uh, no. Doctors and hospitals not only tolerate taking Medicare rates, they often take in nothing and dispense billions per year in charity care.

    When it comes to reimbursement, Medicare has not kept up with the rise in payments from private insurers, so Medicare patients are not as eagerly sought out.

    I am glad Rick corrected you on this. I got so sick of the doctors are greedy jerks mantra that runs so deep in this country that I quit medicine. Physicians and clinical services (whatever that means) make up 22% of the health care budget. Physician pay is something like 9% of the total budget, but it is like 90% of where the griping from the public is.

    “Half of their administrative personnel were devoted exclusively to chasing claims from all the various insurance companies”

    And this is where you and the others in the media need to focus. For every service provided in the health care industry, you can add between 10 and 20% of administrative cost due to this bureaucratic bs.

    Hospitals and doctors wouldn’t need to see rates raised if this bureaucratic beast could be tamed. You wouldn’t believe how stupid, random, and tiresome the payment process for doctors and hospitals truly is.

  35. collapse expand

    I read both the article in RS and the rebuttal, and was amazed that the only difference was the Rubin information. I have a feeling that the ‘Rebuttal/Fact Check’ was written for people who would NEVER read the original, as the information was basically the same. Their point seemed to be “The President is on Everyones Side”, and while that may be the ‘Hope’, it is definitely not the Practice. I voted for the current president, based on the ‘Hope’ of ending the two wars that are STILL raging, as I have been in war and know the affects, not only to the soldiers but also to the mentality of those running it. There seems to be another war taking place at the same time, but one that is inflicting casualties to the common citizen, through financial means.
    We got here by one of two way: Incompetence, or Prior Planning. I tend to think that nothing that is currently happening was a ‘fluke’. I still go back to the immortal line stated by the acting run of the Administration “Never let a good crisis go to waste”.
    Please keep reporting, please keep researching and digging. Truth is relative, but the facts stand regardless of the slant trying to be applied.
    I applaud your courage and dedication Mr. Taibbi. Please keep up the excellent work.

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    About Me

    I'm a political reporter for Rolling Stone magazine, a sports columnist for Men's Journal, and I also write books for a Random House imprint called Spiegel and Grau.

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