Does anyone who responds to this blog actually work in health care? There are so many facets to why health care is so expensive. I've seen patients who don't take their meds because they choose to smoke. I've seen patients who don't take care of their diabetes because they say they can't afford fresh vegetables. Obesity is rampant. One of the reasons is because corn and wheat are so cheap because the government subsidizes those crops. In fact, it has lead many Mexican farmers to come north because they can't afford to farm in Mexico because it's cheaper to import corn and wheat from the United States. This is may be true in many parts of the world. Could be a contribution to poverty around the world. Maybe it would be better to subsidize fresh vegetables so people can be healthier. It's hard to say what to do when people chose to live unhealthy lifestyles.

I have great compassion for people who are facing a crisis that is not of their own making but people need to take responsibility for those things they can control. Looking to the government to solve these problems is just going to contribute to further corruption. Medicare and Medicaid have not worked well. In fact, it is my belief that the whole purpose of a public option is to save Medicare and Medicaid. The problem is that once people think something is "free", they will start using it. I am employed by a hospital that gave every employee free health care, including their families. They are self insured. It was just like a public option. This past January, a deductible was started and our copays went from $10 to $15 for primary docs and $25 to $30 for specialists. This January we will be paying a premium for our families. We are locked into using our hospital. It has costed me thousands of dollars to go out of network for resolution to some crippling health issues. Pretty amazing for free health care. Think long and hard about what you are supporting. I had better health care when I was paying for it myself.

I would truly like to know who any of the people who are in favor of a public option thinks is going to pay for it. Have you ever explored what is going on in other countries that have universal health care. Their birth rates are significantly lower than ours and will in very short amount of time have no one to support the elderly. Why do they not have children? The few people with whom I have talked state they can not afford them. Have you considered that China who is a looming superpower offers very little to it's people? This is who we are competing against, also India. France is having riots which the mass media doesn't cover over treatment of immigrants. It's health system has been running a deficit since 1989 and can't get any movement from it's labor unions to better control cost. Interestingly, people don't live that much longer in France than the United States. What brings down our statistic is that Black Men only live to an average age of 69 but that demographic is the one that has improved the most of the last 20 years. Just to let you know, my family my soon be one of the uninsurable but I still don't want any part of government sponsored health care. There are things to be done to improve health care but the government is never the answer.

As far as my comment on education, my school taxes are now 10% of my pretax income. Once again, people will not adapt to the need for change. They just keep thinking the government needs to give the school district more money. My question always is where does the government get their money? Every special interest group is out their saying don't cut our budget. Pennsylvania has not had a budget since June 30th. Instead of cutting the budget, the governor wants to raise taxes. Where does it stop?

As far as you being Mennonite, the Mennonites I live around still drive horse and buggies and ride bikes. I do wonder if they don't have a better handle on life than I do. It is simple and they appear to accept the will of God.

I wish you the best. May you find comfort in knowing that with or without health care, there is security in the Resurrection!

When my government makes a mistake, they make that mistake in my name.
I demand my government fix those mistakes.
I write letters to my representatives, the President, the Supreme Court
whoever is responsible.
I call their offices on the phone, I send faxes.
My public servants don't have the freedom to make mistakes and go on
like nothing happened, no sir.
If it's a big mistake I get out in the street with my friends.
I lost my tenure at a major University by demonstrating against the
Vietnam War.
I was in the streets over Bush's stolen election and his invasion of
Iraq.
I never let those responsible forget they made a mistake in my name.
I don't just say "We are the government".
I believe it and I stand by this belief.

Don't you ever do anything when your government makes a mistake in your
name?

I agree with you that working to fix the government when it screws up or reining it in when it oversteps its Constitutional bounds is "we the people's" responsibility. It is not good enough to sit back and complain.

However, simply repeating that "we are the government" doesn't make it so.

My problem with the "we are the government" stuff is that it gives complete freedom to Congress and the Executive Branch to do whatever they want (assuming they can justify it as Constitutional, which isn't hard these days when the Constitution is interpreted as broadly as it is) if they say "this is what the people want us to do. After all, we are the people and people are us." There's no question of whether or not it's an appropriate thing for the federal government to be doing. "If the people want it we must provide it" or "if it's a problem that affects the American people than we must solve it, because we are the people" becomes the reigning philosophy. This kind of mentality leads to all sort of unintended, negative consequences, and leads to the federal government gaining too much control over our lives. But, of course, if you believe that "we are the government" than there's no problem with too much government control because it's actually us who's in control, not some outside entity with very strong powers of coercion.

Sorry; I get a little ornery, sometimes. i care too much about justice, and
that…

<3 TV2

Yes, WE are the government, right or wrong.
Our government makes mistakes all the time, just like we make mistakes
as individuals.
Since we ARE the government, it's our duty as citizens to work on
correcting those mistakes.

When nutjobs notice a mistake made by the government, they hold the
mistake up as evidence that the government is the enemy of the people.
In doing so, nutjobs abandon their responsibility as citizens to correct
those mistakes.
Whining about the mistakes of your government is not citizenship.
When you see mistakes, your duty as an American citizen is to DO
something about it.

YES YOU ARE WRONG
FIRST MEDICAID DOES NOT PAY FOR ALL NEEDED CARE A VERY BASIC PROGRAM , THAT NEEDS TO CHANGED
SECOND WHAT DOES A MOTHER OF TWO CHILDERN DO WHO WORKS AND MY JOB DOESN'T OFFER HEALTH INSURANCE
MY DAUGHTER NEEDS TO SEE A SPECIALIST FOR . WELL I WONT GO INTO THAT
THE FIRST VIST ITS 400 , WHERE DO YOU SUGGEST I GET THAT MONEY
SERIOUSLY , I BEEN CALLING ALL DAY TO FIND A DOCTOR WE COULD AFFORD
YOU SO CALLED BORN AGAIN CHRISTIANS ARE THE WORST PEOPLE ON THE PLANET, NO COMPASSION NO UNDERSTANDING OF WHAT OTHER PEOPLE ARE GOING THROUGHT
CAN YOU EXPLAIN WHY THE GAY RIGHTS PEOPLE GET IT AND YOU CHRISTIANS DONT, YOUR SUPPOSE TO BE CHRIST LIKE RIGHT?
SOME OF THE MOST HEARTLESS
WELL ANY WAY
TO A WOMAN WHO IS PREG, AND THINKING ABOUT HAVING AN ABORTION BECAUSE SHE CAN NOT AFFORD A CHILD YOU SAY????
TO WORKING PARENTS LIKE ME WHO WENT TO SCHOOL , GOT A JOB HELPING PEOPLE, BUT DOESN'T PAY WELL YOU SAY?
TO MIDDLE CLASSB WORKERS CAUGHT IN THE MIDDLE NOT POOR ENOUGH AND NOR RICH ENOUGH
WHAT DO YOU SUGGEST?
TRY HARDER?
SUFFER AND DIE?
RIGHT TO LIFE
SURE

Neeraj, VA hospitals treat veterans who, in addition to the usual illnesses which afflict the rest of us, very often have injuries from battle. If memory serves me correctly, it would be quite a feat for an insurance company to accurately price coverage for those who have been wounded in battle. Since their service was for the country, it really does make perfect sense to see them through the care they need. VA medicine is a poor simile in this debate for the reason just stated, and certainly is not a model for running any kind of system.

As for Medicare and Medicaid, you have these programs in place to supplement a private system so stressed by lawsuits, compartmentalized state plans, and 20 million ‘hard core’ uninsured, to borrow your phrase, that it makes it all the more expensive to serve Medicare and Medicaid patients.

The democrat initiatives do not hit at some of the biggest cost drivers such as tort reform, carrying coverage across state lines, and folks going to the ER for cold and flu checkups. All of these drive up the costs for hospitals, often reflected in your bill for two $3 Advil tablets (here I am simply illustrating). Those bills, paid by your insurance company, are reflected in your premiums.

Should all insurance be non-profit, or cooperatives set up by groups of individuals? Perhaps that could help. However, unless at the very least the three cost drivers I have mentioned are addressed successfully, even getting rid of ‘greedy’ companies will not help. Putting a government-run mandate in their place will also be of no benefit without real reform.

It does not matter if the number of uninsured, whether it includes 'under-insured' or not, is 20 million, 40 million, or even 60 million. If you improve the system, those numbers are irrelevant. If we were debating the need for reform, then perhaps those numbers would provide context and justification. We are not, as I have yet to see dissent on the need.

The democrat initiatives do not hit at some of the biggest cost drivers such as tort reform, carrying coverage across state lines, and folks going to the ER for cold and flu checkups. All of these drive up the costs for hospitals, often reflected in your bill for two $3 Advil tablets (here I am simply illustrating). Those bills, paid by your insurance company, are reflected in your premiums.

Co-pays can be a positive deterrent for those who seem to make doctor visits recreational, but I suspect those people amount to a small percentage of patients. I definitely am not going to lay down $30 if I am just feeling under the weather, and I am absolutely not going to run up a $300 ER co-pay unless surgery is required.
We already have universal care. Hospitals have to treat everyone who comes in their doors. Just like fire companies have to run every call, even if it turns out you just burned toast.

Insurance is simply a risk management tool offered to people with a lower threshold for risk. Thos 20-odd million who choose not to get coverage in spite of ability to pay have a much higher appetite for risk than I do; I do not like the specter of a $10,000 bill. Look at the other insurance around: car insurance is required to pay for the OTHER person, but not required to insure your car or your own bills. Fire/home insurance is required so long as you have a mortgage, but not if you own free and clear. Life insurance can be a good idea depending on your circumstances, but not required by law.

Instead of simply placing a very large, unaffordable band-aid on the problem you should be pushing for real solutions.

Right, that's from the Constitution, which sets up the ground rules under which the government is to operate. We the people have set those up. But what about when the government violates those ground rules? Is it still us?

An Insurance Executive Blows the Whistle


By NICHOLAS D. KRISTOF
Published: August 26, 2009

Opponents suggest that a “government takeover” of health care will be a milestone on the road to “socialized medicine,” and when he hears those terms, Wendell Potter cringes. He’s embarrassed that opponents are using a playbook that he helped devise.
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Fred R. Conrad/The New York Times

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“Over the years I helped craft this messaging and deliver it,” he noted.

Mr. Potter was an executive in the health insurance industry for nearly 20 years before his conscience got the better of him. He served as head of corporate communications for Humana and then for Cigna.

He flew in corporate jets to industry meetings to plan how to block health reform, he says. He rode in limousines to confabs to concoct messaging to scare the public about reform. But in his heart, he began to have doubts as the business model for insurance evolved in recent years from spreading risk to dumping the risky.

Then in 2007 Mr. Potter attended a premiere of “Sicko,” Michael Moore’s excoriating film about the American health care system. Mr. Potter was taking notes so that he could prepare a propaganda counterblast — but he found himself agreeing with a great deal of the film.

A month later, Mr. Potter was back home in Tennessee, visiting his parents, and dropped in on a three-day charity program at a county fairgrounds to provide medical care for patients who could not afford doctors. Long lines of people were waiting in the rain, and patients were being examined and treated in public in stalls intended for livestock.

“It was a life-changing event to witness that,” he remembered. Increasingly, he found himself despising himself for helping block health reforms. “It sounds hokey, but I would look in the mirror and think, how did I get into this?”

Mr. Potter loved his office, his executive salary, his bonus, his stock options. “How can I walk away from a job that pays me so well?” he wondered. But at the age of 56, he announced his retirement and left Cigna last year.

This year, he went public with his concerns, testifying before a Senate committee investigating the insurance industry.

“I knew that once I did that my life would be different,” he said. “I wouldn’t be getting any more calls from recruiters for the health industry. It was the scariest thing I have done in my life. But it was the right thing to do.”

Mr. Potter says he liked his colleagues and bosses in the insurance industry, and respected them. They are not evil. But he adds that they are removed from the consequences of their decisions, as he was, and are obsessed with sustaining the company’s stock price — which means paying fewer medical bills.

One way to do that is to deny requests for expensive procedures. A second is “rescission” — seizing upon a technicality to cancel the policy of someone who has been paying premiums and finally gets cancer or some other expensive disease. A Congressional investigation into rescission found that three insurers, including Blue Cross of California, used this technique to cancel more than 20,000 policies over five years, saving the companies $300 million in claims.

As The Los Angeles Times has reported, insurers encourage this approach through performance evaluations. One Blue Cross employee earned a perfect evaluation score after dropping thousands of policyholders who faced nearly $10 million in medical expenses.

Mr. Potter notes that a third tactic is for insurers to raise premiums for a small business astronomically after an employee is found to have an illness that will be very expensive to treat. That forces the business to drop coverage for all its employees or go elsewhere.

All this is monstrous, and it negates the entire point of insurance, which is to spread risk.

The insurers are open to one kind of reform — universal coverage through mandates and subsidies, so as to give them more customers and more profits. But they don’t want the reforms that will most help patients, such as a public insurance option, enforced competition and tighter regulation.

Mr. Potter argues that much tougher regulation is essential. He also believes that a robust public option is an essential part of any health reform, to compete with for-profit insurers and keep them honest.

As a nation, we’re at a turning point. Universal health coverage has been proposed for nearly a century in the United States. It was in an early draft of Social Security.

Yet each time, it has been defeated in part by fear-mongering industry lobbyists. That may happen this time as well — unless the Obama administration and Congress defeat these manipulative special interests. What’s un-American isn’t a greater government role in health care but an existing system in which Americans without insurance get health care, if at all, in livestock pens.

Thanks. I wasn't sure your tone, earlier.

If you are over 45 years old or have kids under 14 years old, please learn about the perspectives of Dr. Ezekiel Emanuel, Obama's health care advisor. Betsy McCaughey has an article on this in today's (8/27/09) Wall Street Journal opinion page.

Here are a few quotes from Betsy's article:

"In numerous writings, Dr. Emanuel chastises physicians for thinking only about their own patient's needs. He describes it as an intractable problem: "Patients were to receive whatever services they needed, regardless of its cost. Reasoning based on cost has been strenuously resisted; it violated the Hippocratic Oath, was associated with rationing, and derided as putting a price on life. . . . Indeed, many physicians were willing to lie to get patients what they needed from insurance companies that were trying to hold down costs." (JAMA, May 16, 2007).

Of course, patients hope their doctors will have that single-minded devotion. But Dr. Emanuel believes doctors should serve two masters, the patient and society, and that medical students should be trained "to provide socially sustainable, cost-effective care."'

---

"In the Lancet, Jan. 31, 2009, Dr. Emanuel and co-authors presented a "complete lives system" for the allocation of very scarce resources, such as kidneys, vaccines, dialysis machines, intensive care beds, and others. "One maximizing strategy involves saving the most individual lives, and it has motivated policies on allocation of influenza vaccines and responses to bioterrorism. . . . Other things being equal, we should always save five lives rather than one.

"However, other things are rarely equal—whether to save one 20-year-old, who might live another 60 years, if saved, or three 70-year-olds, who could only live for another 10 years each—is unclear." In fact, Dr. Emanuel makes a clear choice: "When implemented, the complete lives system produces a priority curve on which individuals aged roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get changes that are attenuated (see Dr. Emanuel's chart)."

---

"Dr. Emanuel has fought for a government takeover of health care for over a decade. In 1993, he urged that President Bill Clinton impose a wage and price freeze on health care to force parties to the table. "The desire to be rid of the freeze will do much to concentrate the mind," he wrote with another author in a Feb. 8, 1993, Washington Post op-ed. Now he recommends arm-twisting Chicago style. "Every favor to a constituency should be linked to support for the health-care reform agenda," he wrote last Nov. 16 in the Health Care Watch Blog. "If the automakers want a bailout, then they and their suppliers have to agree to support and lobby for the administration's health-reform effort.""

No, I am not a nutjob, thank you very much. And God bless you too.

For one thing, the current proposal is for government to help pay for health care, not "run" it.

For another, the government currently "runs" the military. Really runs it, not just pays for it. Are you OK with that? If so, why--aren't bombs more dangerous than medicine? If not, then are you an anarchist?

For a third thing, if this is really a democracy, then government isn't "them," it is, in a real sense, "us," or at least our elected representatives. I don't get to elect the head of Oxford or Kaiser Permanente or Pfizer or Merck. I am a lot more worried about the folks who currently make health care decisions (i.e., my HMO) than about what my elected representatives would do if they had more influence.

It is a totally cool monicker, from your skis, and all.

I was playing on'ex-free,' like 'ex-wife' or 'ex-president.'

'Formerly free,' 'free no longer…'

I was trying to say that we the people of the US have pretty well abdicated
our sovereignty and that it's gone so far that desperate measures,
Jefferson's 'blood of patriots and tyrants,' would be necessary should we
choose to take it back.

Which doesn't look too likely.

Too bad; it was a pretty good republic in many ways from time to time.

As a Christian I think the Lord expected us Christian citizens and other
citizens to do better by it.

<3 TV2

Our system of government is essentially a balancing act between a capitalistic economy on the one hand and a deomcratic republic consisting of laws that are designed by the people and for the people on the other.

Capitalism has proven itself historically as a system that generates tremendous wealth. This is all well and good. However, capitalism has its limitiations. Left unchecked, it posits power in the hands of the wealthy, creating a situation where the rich are simply building their riches on the backs of the poor.

Therefore, we are also a rebublc of laws that are meant to protect the interests of the poor and powerless-- those who are not able to effectually protect themselves.

In a rational discussion, I think we would all agree that the government has certain legitimate roles that it can play. It clearly has a mandate to protect us from any outside threat. It also has to protect it's citizens from internal influences--citizens from violence;races from racism; sexes from sexism, lifestyles from bigotry; consumers from the excesses of capitalsim etc.

It can also be argued that our country has thrived not just because we have given capitalism considerable free rein, but because our government has taken up the slack where the free market has had little incentive to invest. The perfect example of this is our massive highway system. While it is certanly true that the government has invested massive amounts of money into this enterprise, the resulting econmic growth has been well worth the investment. We have the very best universities in the world because our government has poured hundreds of billions of dollars into research grants.

I would argue that health care is simply one of those areas where the free market has failed to deliver. And that is not because we do not have quality health care available to us. We actually have some of the best hospitals and clinics in the world. Unfortunately, because cost has gotten so far out of control, access to this kind of care has become increasingly the privilege of the well off and wealthy. Only the callous amongst us is willng to continue along the same path forever.

The reason for this dilemma is clear. With the introduction of the insurance companies, we no longer have a direct provider/client relationship. This means that no one has an incentive to control costs. The consumer is not payng the bulk of the bill, so he has no reason to make careful choices. The medical community has every reason to gouge the insurance companies because, after all, they are not exactly their client. And the insurance companies are going to pass along all of their expenses to the consumer.

The only answer to this mess is an accross-the-board, comprehensive reform. Cost-cutting measures must be mandated within the medcal communty and guidelines set forth for appropriate care. Social engineering techniques must be implemented to educate the consumer to make better choices and live a more healthful life. Finally, as a minimum, public option must be implemented to break the effective monopoly big insurance has established and introduce some healthy competition.

As Obama has outlined, everyone must play a role and no one can be left out.

We the people of the United States, in order to form a more perfect
union, establish justice, insure domestic tranquility, provide for the
common defense, promote the general welfare, and secure the blessings of
liberty to ourselves and our posterity, do ordain and establish this
Constitution for the United States of America.

"The only argument you have offered is that you don't think it makes
sense. Facts need not necessarily make sense to you in order to be
facts."

Well, the FACT is that 46 million people are without health insurance.
Just because this doesn't make sense to you doesn't make it any less a
FACT.

I'm not even sure what your response was trying to say.

My username is based off the model of snow skis I owned in high school and college... I really liked them. It sounded like a cool handle.

Please do not postpone getting checked out. I take it you live in Kansas. Please get on the computer and find out what programs might be available to you. Call the American Cancer Society. Call and keep calling til you get some help.
My nephew, who is a doctor, had a brain tumor first spotted by his dentist. Do not give short shrift to the dental hygenist. Having looked into and around the faces of thousands of people, she has developed an eye for detail. Pay attention to what you are being told. There are programs to help people with cancer. I know. I was diagnosed with a fast growing tumor and needed immediate surgery. I had insufficient insurance for a normal surgical hospital stay. I spent two weeks on the phone, in people's offices, on the internet, etc, trying to find help. Ultimately, my help came from an unexpected source, the scheduling nurse at the hospital. She scheduled me for a Friday afternoon "outpatient" visit which could have been extended to Monday night if necessary. Apparently week-ends don't count when figuring out a 24 hour outpatient procedure.
The moral of the story is to keep on bugging people until you find a way, or until they find a way!
You do not have time to waste.

Then all is lost, isn't it?

It's a matter of us the people getting pissed off enough and staying pissed
off long enough to get out in the streets, and be willing to face down the
riot police and probably the military, and some of us getting ourselves
killed and that sort of thing, to take back our sovereignty.

Democracy doesn't come naturally to us; it's just the last five minutes or
so of our evolutionary history. I have no illusions that 'everybody wants
liberty.'

Or we could drop down on all fours like dogs and become good obedient
subjects, as you might seem to have done. 'Ex-free,' indeed; well-chosen
pseudonym.

TV2

It has seemed to me that it is his primary way of communicating, which is why it is so easy to get past his disguises. It is unfortunate since sometimes he makes very goog points when dealilng with the actual subject matter.