[y66]

A horse walks into a bar. Bartender asks "Why the long face? Did you vote for Joe Lieberman?" "No man, I voted for Obama".

The bill that's taking shape is disappointing but not as bad as OP's analogy suggests IMO.

Should Congress pass it? Yes. Will they pass it? Yes.

I don't get the animosity directed toward Republicans and Lieberman. This is politics as usual and these guys are known quantities who still, sadly, have little or nothing to say or offer beyond stunts and slogans. The only thing sadder is that Obama and the democratic leadership, who once seemed poised to run circles around these guys, are stumbling so badly.

[jonottawa]

Trinidad, on Dec 17 2009, 01:40 PM, said:

I don't know what the current sentiments in the USA are, but my idea was never that the doctors or the patients were the main problem.

My view is that the problem lies with the insurance system.

Rik

I've always hated insurance. Betting on myself dying or my house catching on fire or my car crashing always seemed stupid. I've always considered it a shady enterprise. But that applies to all insurance, there's nothing particularly weaselly about the folks who sell health insurance.

Here are my health insurance thoughts:

First, this pre-existing condition nonsense. You can't buy fire insurance if your house is burning. You can't buy collision insurance if the police are at the scene. Your heirs can't top up your life insurance when you're lying in the casket. Why on Jon's green earth would you (or should you) be able to buy health insurance that covers a pre-existing condition? Anyone who believes you should is too dumb to understand the concept of insurance.

Second, this 'discriminating against women' nonsense. Women get pregnant. Pre-natal care and delivery costs are very expensive. Women visit the doctor more. Women incur more healthcare costs. Women should be charged accordingly.

Third. Denying claims. Since doctors have no motivation not to overmedicate/overtreat and since patients have no motivation to insist that their doctors not overmedicate/overtreat them, it's up to someone to contain costs. That someone is the health insurance adjuster. I'm glad that SOMEONE in the system is trying to contain costs.

Dropping coverage/portability. Okay, here's where the critics finally have a valid point. If you pay your insurance premiums every month, they shouldn't ever be able to drop you. And you should be able to keep your insurance if you lose/change jobs.

The only other criticism with any validity against the health insurance industry is that their target profit margin is too high given the minimal risks they incur.

Bottom line, health care insurers, like casino owners and morticians, are weasels, but they've got to earn a buck too and they've been given way too much of the blame in this debate.

http://www.dailykos.com/story/2009/12/16/8...-Save-You-Fools

[luke warm]

jonottawa, on Dec 17 2009, 11:44 AM, said:

Since doctors have no motivation not to overmedicate/overtreat and since patients have no motivation to insist that their doctors not overmedicate/overtreat them, it's up to someone to contain costs.

i pretty much agree, except for this part... the motivation for the doctors is provided by the drug companies (free samples, kickbacks, etc)... have you ever asked why we see so many drug commercials on tv? nowadays there are patients telling doctors what drug to prescribe, based on what they've seen on tv... ban these commercials if you want to save costs, after all the docs know (or should) how to diagnose and prescribe treatment(s)

[jdonn]

jonottawa, on Dec 17 2009, 11:44 AM, said:

I've always hated insurance.  Betting on myself dying or my house catching on fire or my car crashing always seemed stupid.  I've always considered it a shady enterprise.  But that applies to all insurance, there's nothing particularly weaselly about the folks who sell health insurance.

Could you elaborate. Why is it stupid?

jonottawa, on Dec 17 2009, 11:44 AM, said:

First, this pre-existing condition nonsense.  You can't buy fire insurance if your house is burning.  You can't buy collision insurance if the police are at the scene.  Your heirs can't top up your life insurance when you're lying in the casket.  Why on Jon's green earth would you (or should you) be able to buy health insurance that covers a pre-existing condition?  Anyone who believes you should is too dumb to understand the concept of insurance.

You can get a new house, or live without one. You can get a new car, or live without one. You can get a cheaper funeral for your loved one, or live without one. You can neither get a new brain, nor live without one. But then again maybe I don't need mine, since I'm apparently so dumb that I don't think everything in the world should be treated the same as everything else.

I agree with your second, third, and fourth points. Your last point about who is a weasel is true, but left out... well, everyone trying to make money doing anything.

[kenrexford]

The "pre-existing condition" discussion is, IMO, one of the most difficult of the issues.

Obviously, it seems bad for someone with a "pre-existing condition" to have no options for treating that condition. However, if anyone can get "insurance" to cover the costs of treating a pre-existing condition, then this creates an incentives problem. Don't get insurance until a condition exists. That way, "insurance" is no longer "insurance." Rather, it is just a payment plan at a controlled cost. Insurance no longer exists, except for suckers.

So, to combat that problem, you have to force people to get insurance, restoring "insurance" to what it was supposed to be, actually insuring against lost by spreading costs.

But, if you force people to get insurance, this allows insurance companies a free check as to the price, because you don't have any option. You must get it. Sure, competition might help, but only so much. Plus, it simply offends people to be forced to do anything. But, let's forget the affront for a moment. You still have the potential of higher fees when the product is not optional.

So, we combat that with price controls. But, the price controls drive people out of the industry, because it is too complicated to control prices of everything. If insurance has price controls, you then have to cap medical fees, hospital bed space charges, nurses' salaries, doctor's salaries, medical school tuitions, salaries for professors, drug costs, medical equipment costs, and so on.

Because you cannot do this, you end up needing to create a completely government-run system, because that makes it somehow easier to control costs all the way along the food chain. But, the government never does anything itself. Even war now is outsourced. So, someone ends up getting $450 for a toilet seat, now in a hospital instead of in the military.

And so on, and so on, and so on.

This, of course, explains why 2500 pages is probably not close to enough pages for a bill like this. It wouldn't be anyway -- still have the administrative code to fill in the blanks.

[jdonn]

Ken you just used a very logical chain of reasoning to end at a single payer system, then had nothing to go against it except a cliche and a fictional anecdote. Interesting...

[kenrexford]

jdonn, on Dec 17 2009, 03:59 PM, said:

Ken you just used a very logical chain of reasoning to end at a single payer system, then had nothing to go against it except a cliche and a fictional anecdote. Interesting...

Actually, what I just did was precisely what you said. I agree that I gave a very compelling reason for a single-payer system. I also with a cliche noted that our government sucks at doing sensible things right. I think that's the main point many have been raising.

Lots of good ideas fail because they look good on paper but fail in the execution because people are political, corrupt, and idiots.

On a different note, I think I could solve the entire problem very easily. We came up with gambling to help schools. What about legalizing drugs to pay for health care? These seem obviously related. The drug trade is worth billions, we'd save on housing the drug criminals, and we could use fewer police officers, prosecutors, judges, and criminal defense attorneys then. I bet it would just about pay for whatever health care system you would ideally want.

[jdonn]

I doubt it would raise what is needed, but I'm all for it!

[hrothgar]

jdonn, on Dec 18 2009, 12:07 AM, said:

I doubt it would raise what is needed, but I'm all for it!

Works for me as well

(FWIW, my drug use is limited to booze and caffeine)

[kenrexford]

Wow. Massive agreement on the horizon??? LOL

Actually, I'm also a caffeine and nicotine man, but these industries are already paying down medical costs a lot.

[Winstonm]

I'm all for a single payer as long as it is: YOU.

[kenrexford]

Winstonm, on Dec 17 2009, 08:07 PM, said:

I'm all for a single payer as long as it is: YOU.

So few words, so much said.

[luke warm]

dems to use obscure ping pong strategy to get fast(er) passage

Quote

As one might expect, Republicans in Congress are aghast over the move. Michael Steel, a spokesman for House Minority leader John Boehner, told Yahoo! News that such a tactic would break President Obama's campaign promise of health care debate transparency. He labeled the strategy a "disgrace":

[kenberg]

Is there really a Michael Steel acting as a spokesman for Boehner? This will be confusing, since Michael Steele is the RNC chairman. I'm not trying to be picky, I am wondering if there is both Steel and Steele? And maybe Steal?

As to the issue, very few things in life are as clear as the fact that no Republican in either chamber will be voting for this bill. Why should Dems go through the pretense of soliciting their opinion or Reps go through the pretense of suggesting ideas? If the Dems hold their coalition together there will be a bill, otherwise there will not be a bill. It is fair and natural to judge the Dems on the content of the bill, since it is totally their bill. But as to tactics, the Reps have made it clear that they will defeat it by any means possible and it hardly makes sense to criticize Dems for trying to prevent this from happening.

I absolutely would have preferred cooperative efforts of Dems and Reps on this. It would have been better for the country, and I think it could have been a better bill. It is now completely impossible that this will happen, so the reality has to be dealt with.

[Winstonm]

The healthcare debate is like a box of chocolates - if it isn't squishy in the center it must be a nut.

[jdonn]

kenberg, on Jan 5 2010, 07:38 PM, said:

As to the issue, very few things in life are as clear as the fact that no Republican in either chamber will be voting for this bill. Why should Dems go through the pretense of soliciting their opinion or Reps go through the pretense of suggesting ideas? If the Dems hold their coalition together there will be a bill, otherwise there will not be a bill. It is fair and natural to judge the Dems on the content of the bill, since it is totally their bill. But as to tactics, the Reps have made it clear that they will defeat it by any means possible and it hardly makes sense to criticize Dems for trying to prevent this from happening.

Exactly. But since when did Republicans ever need a reason that makes sense in order to criticize someone?

[Winstonm]

Quote

It is fair and natural to judge the Dems on the content of the bill, since it is totally their bill.

I believe it to be the bill White House wanted from inception of the idea - public option and medicare buy-ins were red herrings to make it appear that progressive concerns were being addressed.

[blackshoe]

jdonn, on Jan 5 2010, 08:27 PM, said:

Exactly. But since when did Republicans politicians ever need a reason that makes sense in order to criticize someone?

Fixed.

[jdonn]

blackshoe, on Jan 5 2010, 10:19 PM, said:

jdonn, on Jan 5 2010, 08:27 PM, said:

Exactly. But since when did Republicans politicians ever need a reason that makes sense in order to criticize someone?

Fixed.

Lol what's funny is I had "Republicans and Democrats" typed out, stared for like 30 seconds, then settled on what I put. The Republicans have just raised the bar in this area over the course of recent years. But you are right that I was referring to politicians.

[mikeh]

Quote

First, this pre-existing condition nonsense.  You can't buy fire insurance if your house is burning.  You can't buy collision insurance if the police are at the scene.  Your heirs can't top up your life insurance when you're lying in the casket.  Why on Jon's green earth would you (or should you) be able to buy health insurance that covers a pre-existing condition?  Anyone who believes you should is too dumb to understand the concept of insurance.

I think that this passage, and the mindset behind it, is revealing.

To many citizens in other western democracies, health care...and the right to affordable treatment for ALL health issues...is a basic human right...it is something that we, collectively, owe to all members of society.

In the US, the basic approach is that individuals are responsible for their own survival...that society owes them nothing at all (altho Medicare is an exception to that....and it is ironic that many of the beneficiaries of medicare are outspoken opponents of 'socialized medicine').

So, in the US, health insurance is akin to any other kind of insurance....it is up to an individual to obtain it, and if they can't afford it....well...they and their ancestors must be failures in life...they don't deserve health care....unlike the hundreds of thousands (if not millions) who inherited enough money that they need never worry about such mundane matters.

Leaving aside this major issue, the US individual responsibility approach is manifestly an economic disaster.

The US ranks appallingly low in any survey of health care in terms of the quality of service afforded the population as a whole. It ranks at the top for the wealthy, but near the bottom, of western democracies or nations such as Japan, for the population as a whole. This is reflected in mortality rates as well as other metrics.

And it accomplishes this dubious distinction despite having a huge number of doctors per unit of population, and despite having the world's most aggressive retail pharmaceutical industry and the world's highest health care costs.

In addition, the cost to society of having so many millions of people deprived of regular health care advice is correspondingly large. When people are forced to seek care only when seriously ill, and cannot get access to preventative care, their illnesses last longer, are more disabling, and more expensive to treat, while keeping those affected, and sometimes their family members, out of the productive work force. Even tho most of these people work in low-paying jobs, or don't work at all, the loss to the economy of their labour, and the increased costs of dealing with them only late in their disease process makes this approach irrational.

Moreover, a health care system designed to improve the health of the population, rather than to generate profit, would focus more on maintenance and prevention, including education of the young so as to avoid or reduce the incredible growth rate in diseases that stem from obesity and lack of exercise.

At least, based on what reading I have done, the foregoing appears to be accurate.

I now await the knee-jerk response of the conservatives