The Obama Presidency - 2008 & 2012

[JPhillips]

Originally Posted by Mac Howard

I think Jon had his tongue firmly in his cheek there, guys.

It is disturbing though when I see some of the distortions (for want of a better word) by the opposition to a universal system, usually aimed at the Canadian system (which I know nothing of). But is is worth repeating: We love our health care system. Particularly because of the peace of mind it brings that we need never avoid seeking medical help whenever we need it. That is priceless!

So don't let anyone ever tell you that people in these countries with nationwide systems would rather have a private only system.

Knowing that if I lose my job and my child gets sick that I would lose my home and face bankruptcy is just motivation for me to work harder. Enjoy your third-world healthcare you Aussie bitches.

[Flasch186]

/sarcasm, I hope

[molson]

Originally Posted by JPhillips

Knowing that if I lose my job and my child gets sick that I would lose my home and face bankruptcy is just motivation for me to work harder. Enjoy your third-world healthcare you Aussie bitches.

Would losing your job immediately put you into the "poor" category where you you can get the government option for free under Obama's original plan? (Not sure where we are at this point with the news of the last few days). I think you'd still be shelling out for insurance out-of-pocket if you lost your job (and possibly before, if your job dropped healthcare as a benefit. Obama recently admitted that when he said, "if you like your current plan you can keep it", isn't literal, as in, the government won't make you switch, but he can't do anything to keep private companies from dropping insurance and making people pay for the "public option", which remember, is promised to be self sufficient, funded by premiums from the middle class that will pay for it.)

There's no "free health care for everyone" on the table. Even our administration apparently realizes that's not possible yet. The comparisons with Austrialia/U.K. aren't relevant because of that difference, but especially when we even now spend 2.5 times more on health care per capita than those countries do. No one's sure what that disparity would be if we just went to their identical system, but I think it's safe to say it would be many, many, many times more. Would Australia/UK still love their health care if they had to pay triple their taxes for the same or less quality of care?

Things are more expensive in America, for the federal government, than other countries. I'm not sure exactly why, but it definitely goes beyond health care.

There's a decent chance the "public option" would have been somewhat cheaper, and it might help to bring the cost of private insurance down (that 1-2 combo is probably the most beneficial part of the plan), Democrats are being just as dishonest as Republicans if they push this as some kind of Europe-like universal plan, because it's not.

[Mac Howard]

Originally Posted by JPhillips

Knowing that if I lose my job and my child gets sick that I would lose my home and face bankruptcy is just motivation for me to work harder. Enjoy your third-world healthcare you Aussie bitches.

And I used to believe that Americans had the irony bone removed at birth (possibly too expensive? )

[Mizzou B-ball fan]

I think I finally got my answer as to why the Democrats just don't go ahead and pass this bill through if they believe it to be best for the country. It appears at this point that even the Democrats can't decide on what they want at this point. They are their own worst enemy right now.

White House's Mixed Messages On "Public Option"

Howard Dean On Public Option: "You Can't Really Do Health Reform Without It"

[Flasch186]

Originally Posted by molson

Would losing your job immediately put you into the "poor" category where you you can get the government option for free under Obama's original plan? (Not sure where we are at this point with the news of the last few days). I think you'd still be shelling out for insurance out-of-pocket if you lost your job (and possibly before, if your job dropped healthcare as a benefit. Obama recently admitted that when he said, "if you like your current plan you can keep it", isn't literal, as in, the government won't make you switch, but he can't do anything to keep private companies from dropping insurance and making people pay for the "public option", which remember, is promised to be self sufficient, funded by premiums from the middle class that will pay for it.)

There's no "free health care for everyone" on the table. Even our administration apparently realizes that's not possible yet. The comparisons with Austrialia/U.K. aren't relevant because of that difference, but especially when we even now spend 2.5 times more on health care per capita than those countries do. No one's sure what that disparity would be if we just went to their identical system, but I think it's safe to say it would be many, many, many times more. Would Australia/UK still love their health care if they had to pay triple their taxes for the same or less quality of care?

Things are more expensive in America, for the federal government, than other countries. I'm not sure exactly why, but it definitely goes beyond health care.

There's a decent chance the "public option" would have been somewhat cheaper, and it might help to bring the cost of private insurance down (that 1-2 combo is probably the most beneficial part of the plan), Democrats are being just as dishonest as Republicans if they push this as some kind of Europe-like universal plan, because it's not.

I'd hope that through compromise there would certainly be some facet of AFFORDABLE health care coverage for those who lose their employer subsidized insurance. I'd point back to my "millions of people' post as a burden we should not have to carry on our shoulders from birth to grave.

[molson]

Originally Posted by Mizzou B-ball fan

I think I finally got my answer as to why the Democrats just don't go ahead and pass this bill through if they believe it to be best for the country. It appears at this point that even the Democrats can't decide on what they want at this point. They are their own worst enemy right now.

White House's Mixed Messages On "Public Option"

Howard Dean On Public Option: "You Can't Really Do Health Reform Without It"

Good for Dean. I guess it's easy to talk when you're on the outside, but I have the sense that he's a little more genuine than Obama when it comes to the Democratic ideals. He wasn't as smooth on the mic though, so he didn't work out.

[JPhillips]

Originally Posted by Mizzou B-ball fan

I think I finally got my answer as to why the Democrats just don't go ahead and pass this bill through if they believe it to be best for the country. It appears at this point that even the Democrats can't decide on what they want at this point. They are their own worst enemy right now.

White House's Mixed Messages On "Public Option"

Howard Dean On Public Option: "You Can't Really Do Health Reform Without It"

It's taken you this long to realize that Democrats don't all have the same set of priorities?

[Flasch186]

Dean also put forth what is my biggest fear reinforced by Dick Armey's line today in regards to the possibility that GOP doesn't want compromise, period. That sucks for America.

[molson]

Originally Posted by Mizzou B-ball fan

I think I finally got my answer as to why the Democrats just don't go ahead and pass this bill through if they believe it to be best for the country. It appears at this point that even the Democrats can't decide on what they want at this point. They are their own worst enemy right now.

White House's Mixed Messages On "Public Option"

Howard Dean On Public Option: "You Can't Really Do Health Reform Without It"

The Dems being obsessed with having a unified front is exactly what this country doesn't need. I love that there's more than 2 strict ideas floating around now (or really, 1 strict idea and one party just attacking it).

[Flasch186]

I think there are multiple bills being talked about {shrug}

[JPhillips]

Originally Posted by Flasch186

Dean also put forth what is my biggest fear reinforced by Dick Armey's line today in regards to the possibility that GOP doesn't want compromise, period. That sucks for America.

Is today Obvious Day or something? Of course the bulk of GOP elected officials don't want a compromise. In a two party system the opposition benefits most greatly when the majority is ineffective. Sometimes that's overcome by a strong desire for reform(see NCLB), but as long as the media doesn't start blaming the minority for inaction there's very little reason for them to sacrifice such an obvious political win.

edit: That came out bitchier than I intended, but it's frustrating that there's even discussion as to whether the GOP is negotiating in good faith. Grassley has stated repeatedly that he doesn't want anything to pass.

[Flasch186]

except for the welfare of the country and constituents which in most cases comes from compromise from all involved.

[JonInMiddleGA]

Originally Posted by Flasch186

except for the welfare of the country and constituents which in most cases comes from compromise from all involved.

In this instance, this isn't one of those cases so we're probably good to go
(I'm actually not kidding but the smiley should clarify that this particular comment is just a throwaway line for a possible giggle, not some jumping off point for debate)

In a related aside, it's actually kind of comforting to know that I don't have to worry much about my Rep. (Broun) getting into compromise mode. Saves me some worry as well as saves me from feeling compelled to spend much time reminding him that's not what he was elected to do.

[Flasch186]

LOL

[flere-imsaho]

Originally Posted by Arles

In an attempt to get the discussion somewhat back on track - let me ask a question:

What exact problem(s) will a national health care plan resolve and how will it go about doing that? I still am fuzzy on what the actual goal of this plan is.

To be honest, I'm not sure anymore. It seems to morph day by day.

I've always been a proponent of the single-payer plan, because I've lived several years in a country that had one and I just think it's overwhelmingly the better way to provide health care to a nation. Better and, generally, more cost-effective.

I think the key, root problem in the U.S. system is the risk to ordinary people of extraordinary consequences. Pre-existing conditions meaning you can't get insured for something and you go bankrupt. Coverage loopholes meaning the insurance company ends up not paying for something and you go bankrupt. Very high deductibles for certain "unlikely" things that then show up and you go bankrupt. Whole groups of people who don't qualify for Medicaid but can't afford good insurance and run a daily risk of incurring a bill that causes them to go bankrupt. Etc....

I'm not really sure health insurance should be private, honestly. Unlike, say, auto or home insurance, where we pay against the potentially-zero possibility of an expensive event, I think what most people think they want out of health insurance is a vehicle that both spreads your outlay of money out to a predictable level (i.e. you pay a couple hundred a month so that, among other things, you don't have a bill for $20,000 when your baby is born) and also acts as a buffer against catastrophic events.

Originally Posted by Arles

1. Extend unemployment insurance from 2-3 months to 6-8 months (item 2).
2. Work with private carriers to provide a government sponsored "safety net" plan for people making less than a certain amount. There are plans like this in many states, but just setup a federal tax subsidy to cover the premiums for those who qualify (puts a dent in many of the other items).
3. Provide tax credits for small business owners to purchase into a private plan.

These are fine but I'm sure most small business owners would prefer an option where they don't have to pay for health care at all. Imagine all the good workers small businesses lose out on because they can't provide good health care now?

Originally Posted by molson

I always thought there should be a "medical bankruptcy". It seems silly to lump in people who bought houses and cars they can't afford with people who got sick. Maybe have some kind of government guarantee to pay the bills if a person goes through the medical bankruptcy process.

I like this too. But if you're going to start off in this direction, why not go single-payer, as that's essentially what you're describing?

Originally Posted by molson

I actually think that's a good long term goal. For some reason the single-payer system scares me less than a complicated attempt to attempt to co-exist with the private sector.

Oh heck yes. Agreed 100%.

The only problem of course, is that a single-payer system would mark the end of medical and technological developments in this country. As long as you have a richer, capitalist company and their corporations to leach off of (like everyone else in the world has with the U.S.), it's a great system. But who can we leech off of?

As I've stated before, this simply isn't true.

Originally Posted by molson

Not disagreeing but asking - why aren't there cutting edge medical technologies and drugs coming from European states (or are they)? Why is it all American companies?

I can best speak for the pharma industry, where I have some experience. A lot of the more cutting-edge drugs (i.e. new approaches to medical problems, not incremental improvements of current treatments) are primarily produced in Europe because of the superior support EU member states provide for various types of R&D plus, critically, extensive clinical trials. For instance, much of the H1N1 vaccine development is being conducted in Europe at the moment for these very reasons.

Also note that the big pharma companies you know (Pfizer, GSK, Bayer, etc...) typically don't develop a lot of "breakthrough" drugs these days, in-house. They'll do increments of their blockbusters, but rely on acquisitions of small startups who happen upon pot-of-gold breakthrough drugs. This process operates a lot like the dot-coms did. Some guys will spend their own money (or some grant money as well) to try and find a cure for, say, the common cold. Now 90% of the time they're going to fail, but a group that comes up with a good treatment will then get bought by a big pharma after a bidding war and they'll all be able to retire.

From what I've seen, these small startups crop up all over the place, primarily in North American and Europe, but also in Aus/NZ, India, Japan, and some in South America. And of course they're bought by big pharmas who exist anywhere (but typically in the U.S. and Europe).

If Big Pharma, for whatever reason, suddenly has less money for Acquisitions (a budget expenditure typically far more reliably affected by profit margins than general R&D) then the result is likely to be that the purchase price in these bidding wars will be lower. But I very much doubt it will be low enough to keep these small startups from still trying to strike it rich, especially when in many cases part of their research will still be funded by government grants (moreso in Europe).

Originally Posted by Arles

Now, some may say that's a bad thing (and many have). But, there's no way to avoid the fact that US price controls/rationing would throw a serious monkey wrench into R&D money for pharm companies (US and abroad).

You seem to be painting a picture that suddenly all the world's major paying markets for drugs will start buying drugs for cost only. That doesn't happen now, and it seems unlikely, to be honest.

Originally Posted by Arles

However, if the same UK/Europe/Canada system is setup in the States, the profit margins will go down for a lot of these pharm companies. Past activity shows when this occurs than money spent in R&D will decrease to keep the profit margin/share price higher. Now, maybe the US should stop being the financier of drug companies. But the reality is that once that happens, a lot of dollars currently going into R&D for new drugs will dry up.

That's not my experience, to be honest. Acquisition dollars go down before R&D ones do, but both after the organization finds savings elsewhere (administration, marketing, IT, salaries, etc...).

Originally Posted by Arles

For those wondering about the British NHS, here's an article on the major issues it faces moving forward:

The NHS is a terrible example, to be honest. The Thatcher/Major governments spent almost 20 years finding ways to subtly dismantle the NHS and the ensuring Labour government never took the time to do a root-and-branch reform of the system to recover from that, so it's limped on in a sort of half-assed nature since then.

Having said that, the quality of care I received from the NHS when I lived there in the mid/late-90s was just as good as the very good PPO plan I have in the U.S. now, which about a billion times less paperwork.

Originally Posted by JPhillips

The Dems are married to seniority. The Rrpublicans would have ditched him or at least set up a killer primary opponent, but the Dems aren't going to do that. The Dems can't do much of anything but write sternly worded letters.

The Congressional Dems are the U.N. of American politics.

[Mizzou B-ball fan]

Interesting comment in this article. James Carville actually suggested that the Dems let the Republicans kill health care to save face and perhaps gain a minor political advantage since it doesn't appear that the Democrats will be able to construct a bill that they all agree on.

Health concession fuels blowback - Mike Allen - POLITICO.com

[CamEdwards]

I'd pay good money to see Cynthia McKinney and Tom DeLay dancing together.

Okay, maybe I wouldn't pay... but I'd probably watch it on YouTube.

[Flasch186]

Originally Posted by Mizzou B-ball fan

Interesting comment in this article. James Carville actually suggested that the Dems let the Republicans kill health care to save face and perhaps gain a minor political advantage since it doesn't appear that the Democrats will be able to construct a bill that they all agree on.

Health concession fuels blowback - Mike Allen - POLITICO.com

'since it doesnt appear that both sides will be able to construct a bill together that will help achieve the reform a vast majority of Americans want'

[RainMaker]

Originally Posted by Mizzou B-ball fan

Interesting comment in this article. James Carville actually suggested that the Dems let the Republicans kill health care to save face and perhaps gain a minor political advantage since it doesn't appear that the Democrats will be able to construct a bill that they all agree on.

Health concession fuels blowback - Mike Allen - POLITICO.com

Not going to work this time. The Dems could say it before when Bush was in office and/or they didn't have power. Kind of tough to say the Republicans stopped your plan when you have massive majorities in both the Senate and House, along with a Democratic President. They can't keep blaming Republicans forever.

[RainMaker]

Originally Posted by Arles

I feel the government can help be a safety net in certain instances. When it comes to paying for unemployment coverage (ie, a few months after you lose your job), paying for coverage for people in poverty or kids under the age of 18 and helping seniors who are no longer employed afford coverage.

I don't see how being in favor of government subsidies/intervention in the above safety net situations means I have to then support the government providing coverage for people who currently have good coverage options. And, again, my preference is for the government to help pay the premiums and broker private options for the above cases, not go into the business of health care (but that ship has sailed with medicare).

It seems this viewpoint would be akin to saying that welfare should be given out to everyone regardless of employment/earnings. So, Bill Gates and an unemployed person in poverty should both get a welfare check for the same amount. It doesn't make sense here, yet people feel it should be the case for health insurance premiums.

It's just that you've railed against public options. You've stated how horrible other countries have it. The wait times, the costs, etc. Then you say you want 50% of our country to be under it. If the private way is so much better, shouldn't we want everyone to enjoy the vast benefits you have touted?

[Mizzou B-ball fan]

Originally Posted by RainMaker

Not going to work this time. The Dems could say it before when Bush was in office and/or they didn't have power. Kind of tough to say the Republicans stopped your plan when you have massive majorities in both the Senate and House, along with a Democratic President. They can't keep blaming Republicans forever.

I'd agree. They've gone too far down this path to back down now and blame the Republicans. The Democrats have to continue to fight this out within their own ranks to make it work.

[Flasch186]

right the GOP have had nothing to do with where we are today.

[molson]

Originally Posted by Flasch186

right the GOP have had nothing to do with where we are today.

Still waving the party flag? They failed you.

[RainMaker]

The major difference between the parties is the Republicans fall in line much easier. Bush wanted something and it got done. Didn't matter if it was a moderate or conservative Republican. They cut deals, made concessions with one another, but ultimately got shit done.

They also weren't so fucking disorganized. I can't remember them ever putting out a bill that hadn't been vetted by members of Congress beforehand and they knew what the reaction would be from their own party. Seems amateurish to put out a bill and then have your own party shit all over it. Why wasn't a lot of this stuff discussed in private beforehand? Reminds me of the first TARP that got rejected in the House. Can't fathom that happening under a Republican controlled House.

Sadly, the Democrats need someone with more power at the top of the Senate and House. A guy like Tom Delay who would just get shit through one way or another. Not sure who in the party has that kind of weight though. A Jim Webb would be good at it for the Senate while someone like Dave Obey would be a great leader in the House.

[RainMaker]

Originally Posted by SteveBollea

To quote Will Rogers, "I'm not a member of an organized political party. I'm a Democrat."

But, the problem is deeper than that. The Republicans are a _party_, the Democrats are a _coalition._ In no other nation in the world would Ben Nelson and Ted Kennedy be in the same party.

The same can be said about Sam Brownback and Olympia Snowe. Our two party system is just fucked up and unfortunately we have no way out of it. With that said, if you want to get shit done, you have to play within those rules and the Democrats can't seem to figure it out.

[Flasch186]

Originally Posted by molson

Still waving the party flag? They failed you.

The Democratic party havnt failed me or you, NOTHING has been put to a vote yet! Jesus, this isnt about winning and losing.

[ISiddiqui]

Originally Posted by JPhillips

Obama certainly did need the centrists to pass the stimulus. Remember that Franken hadn't been seated and the new rule in the Senate is that everything takes sixty votes to pass.

WTF?! There was little to no attempts to filibuster the stimulus bill. McConnell spoke aloud about it, but there was no way in Hell he was going to get 41 votes to stall the bill.

[flere-imsaho]

Originally Posted by RainMaker

Sadly, the Democrats need someone with more power at the top of the Senate and House. A guy like Tom Delay who would just get shit through one way or another. Not sure who in the party has that kind of weight though. A Jim Webb would be good at it for the Senate while someone like Dave Obey would be a great leader in the House.

Well, imagine if Tip O'Neill was Speaker. He wouldn't stand for this crap.

Actually, imagine if Rahm was Speaker, as was his original ambition. LOL

[RainMaker]

Originally Posted by flere-imsaho

Well, imagine if Tip O'Neill was Speaker. He wouldn't stand for this crap.

Actually, imagine if Rahm was Speaker, as was his original ambition. LOL

Rahm would have been perfect for that role.

[Arles]

Originally Posted by RainMaker

It's just that you've railed against public options. You've stated how horrible other countries have it. The wait times, the costs, etc. Then you say you want 50% of our country to be under it.

What? Seniors and uninsured poverty/kids under the age of 18 are 50% of the population? This must be the dust bowl.

I'm not a fan of medicare, but I think that we should have some option for uninsured kids and seniors. Kids because it's hard for a 5-year old to fill out paperwork for insurance or find a job. Seniors because of the pre-existing conditions that will often disqualify them from current private plans (I would prefer a reform on private plans for seniors to medicare, but as I said above that ship has sailed).

Outside of Medicare (which is its own beast right now), we're talking about maybe 5-10% of the population who fall into uninsured kids or people in poverty without insurance. 80-90+% of kids have insurance from their parents and won't even need to partake in it. Plus, we already have a ton of state systems that help cover uninsured kids right now.

Setting up a federal plan to cover kids who aren't insured (very few), stipends/credits to those who can't afford coverage (poverty, small business owners, don't get it from their employer) and an extension of unemployment coverage for those who lost their jobs will be minimal cost when compared to whatever the bill of the day is in congress. The beauty of this is that only a comparative small number will be taking advantage of this plan as you either need to be an uninsured kid, in poverty, recently laid off or small business owner/hourly worker/other to qualify. Yet, it would put a dent in the number of uninsured people and give us a starting point if increasing coverage is a concern (as has been stated numerous times in this thread). After this effort, the focus can shift to improving the infrastructure and working on cost issues (which there also many simple things that can be done from opening state-to-state competition to dealing with the medical malpractice elephant to other ideas).

This won't involve massive waits or a change to the system as 80+% will still be under their same employer provided plans. It will just give options to many people who don't have any now (and some of whom will still probably not take advantage of for various reasons). There's no real government health care plan (outside of maybe the uninsured kid piece), the majority is tax credits/stipends for people to use to buy their own. The problem we have now is waiting to fix everything with a magic wand instead of taking a more measured approach and dealing with each area as its own bill/problem.

If the private way is so much better, shouldn't we want everyone to enjoy the vast benefits you have touted?

That's exactly what I am saying. Outside of Medicare (which we can't change even if we wanted) and some minor uninsured kids plans (many of which already exist), all I am doing is providing government funds to select people who simply can't afford private premiums. So, I'm basically finding a way to add them to the current private way. Again, it's not optimal, but it's the best alternative if increasing coverage is your goal.

[Arles]

Originally Posted by RainMaker

The major difference between the parties is the Republicans fall in line much easier. Bush wanted something and it got done. Didn't matter if it was a moderate or conservative Republican. They cut deals, made concessions with one another, but ultimately got shit done.

The difference is that the republicans are split on social issues (ie abortion, gay marriage/unions and stem cells). Democrats are split on fiscal/industry issues. If you want a bill on abortion, it will sail right through for democrats. If you want a bill on tax cuts/health care reform, the republicans will be united. However, a bill on abortion would get hosed in the republican machine (depending on the scope) just as a bill on fiscal policy/health care reform will get caught in the gears of the democratic party.

There's also a lot of pressure on the clear majority (esp in a recession). It hosed the republicans in the early 90s and seems to be hammering the democrats now. Just like the republicans in 1991, the democrats can *do* whatever they want - they (esp Obama) are just smart enough to know that things aren't going to change much before the next election cycle and they will need some coverage to keep the majority. Politics isn't (and hasn't been for years) about "doing the right thing", it's about doing something that helps you keep your job.

[RainMaker]

Originally Posted by Arles

The difference is that the republicans are split on social issues (ie abortion, gay marriage/unions and stem cells). Democrats are split on fiscal/industry issues. If you want a bill on abortion, it will sail right through for democrats. If you want a bill on tax cuts/health care reform, the republicans will be united. However, a bill on abortion would get hosed in the republican machine (depending on the scope) just as a bill on fiscal policy/health care reform will get caught in the gears of the democratic party.

There's also a lot of pressure on the clear majority (esp in a recession). It hosed the republicans in the early 90s and seems to be hammering the democrats now. Just like the republicans in 1991, the democrats can *do* whatever they want - they (esp Obama) are just smart enough to know that things aren't going to change much before the next election cycle and they will need some coverage to keep the majority. Politics isn't (and hasn't been for years) about "doing the right thing", it's about doing something that helps you keep your job.

I don't know about that. Republicans spent a shitload of money this decade and expanded socialized medicine more than Obama has. Republicans seem to be united more, but it's dependent on what the President wants. President wanted big spending and they obliged. Democrat gets in power and they're about reform.

[RainMaker]

Originally Posted by Arles

What? Seniors and uninsured poverty/kids under the age of 18 are 50% of the population? This must be the dust bowl.

I'm not a fan of medicare, but I think that we should have some option for uninsured kids and seniors. Kids because it's hard for a 5-year old to fill out paperwork for insurance or find a job. Seniors because of the pre-existing conditions that will often disqualify them from current private plans (I would prefer a reform on private plans for seniors to medicare, but as I said above that ship has sailed).

Outside of Medicare (which is its own beast right now), we're talking about maybe 5-10% of the population who fall into uninsured kids or people in poverty without insurance. 80-90+% of kids have insurance from their parents and won't even need to partake in it. Plus, we already have a ton of state systems that help cover uninsured kids right now.

Setting up a federal plan to cover kids who aren't insured (very few), stipends/credits to those who can't afford coverage (poverty, small business owners, don't get it from their employer) and an extension of unemployment coverage for those who lost their jobs will be minimal cost when compared to whatever the bill of the day is in congress. The beauty of this is that only a comparative small number will be taking advantage of this plan as you either need to be an uninsured kid, in poverty, recently laid off or small business owner/hourly worker/other to qualify. Yet, it would put a dent in the number of uninsured people and give us a starting point if increasing coverage is a concern (as has been stated numerous times in this thread). After this effort, the focus can shift to improving the infrastructure and working on cost issues (which there also many simple things that can be done from opening state-to-state competition to dealing with the medical malpractice elephant to other ideas).

This won't involve massive waits or a change to the system as 80+% will still be under their same employer provided plans. It will just give options to many people who don't have any now (and some of whom will still probably not take advantage of for various reasons). There's no real government health care plan (outside of maybe the uninsured kid piece), the majority is tax credits/stipends for people to use to buy their own. The problem we have now is waiting to fix everything with a magic wand instead of taking a more measured approach and dealing with each area as its own bill/problem.


That's exactly what I am saying. Outside of Medicare (which we can't change even if we wanted) and some minor uninsured kids plans (many of which already exist), all I am doing is providing government funds to select people who simply can't afford private premiums. So, I'm basically finding a way to add them to the current private way. Again, it's not optimal, but it's the best alternative if increasing coverage is your goal.

I'd bet that seniors and kids equate well over half the health care spending in this country.

The rest of your ideas that you presented was pretty close to what Obama presented. Why are you opposed to it again?

[Arles]

Well, the Bush medicare bill was also a "reform", just a poorly constructed one. The problem with health care is that the democrats themselves are split when it comes to a public option. If you can't get a clear purpose on a bill within your own party, it's going to be hard to sell it to the public/other side of congress.

If Obama would have just come out in June and said "We need a bill that includes specific items X, Y and Z (ie, public option)", I think the democrats would have fallen in line. He didn't want to do that, though, because he knew the public wasn't a big fan of the public option and he didn't want to be tied to specific items in the bill (in the event they needed to be cut to land his "victory" on health care). So, while that may have been more politically expedient for Obama long term, it pretty much sunk the health care debate. These poor democratic congressmen were forced to defend every aspect of all 20 bills in congress in these town halls because they didn't know what Obama wanted in the final version (or what would be there).

Bush, for all his warts, was very specific on what he wanted (for better or worse) and that's why it was easier for republicans to fall in line. It's hard to back the president when you don't even know specifically what he wants.

[JPhillips]

Originally Posted by ISiddiqui

WTF?! There was little to no attempts to filibuster the stimulus bill. McConnell spoke aloud about it, but there was no way in Hell he was going to get 41 votes to stall the bill.

The cloture vote was 60-36 with Collins, Snowe and Specter voting for, Franken unseated and a couple non-voters. The only reason McConnell couldn't get 40 votes was because of the compromise bill negotiated by the moderates.

[ISiddiqui]

Collins, Snowe, and Specter would have ALWAYS voted against cloture. Collins and Snowe are not the type to filibuster anything, even if they disagree.

[Arles]

Originally Posted by RainMaker

I'd bet that seniors and kids equate well over half the health care spending in this country.

You're not following. I would prefer a private system for seniors, but we have medicare and it's not going anywhere (I feel like I'm repeating myself a lot here). For kids, I'm in favor of a publicly sponsored option for CURRENTLY UNINSURED KIDS. That number is estimated to be about 8 million nationally. A pretty far cry from half the spending. Plus, we already have the CHIP program and numerous state-run coverage plans for kids. I'm just ensuring there are no cracks for the remaining few kids who currently can't get coverage (which is well under 8 million total).

The rest of your ideas that you presented was pretty close to what Obama presented. Why are you opposed to it again?

As long as it doesn't have a public option, I'm not necessarily against it. The co-op idea by the "gang of six" appears (per the CBO) to be much more fiscally responsible and offer help in landing private options. Given the alternatives a month ago, I think it's a step in the right direction.

[RainMaker]

Originally Posted by Arles

Well, the Bush medicare bill was also a "reform", just a poorly constructed one. The problem with health care is that the democrats themselves are split when it comes to a public option. If you can't get a clear purpose on a bill within your own party, it's going to be hard to sell it to the public/other side of congress.

If Obama would have just come out in June and said "We need a bill that includes specific items X, Y and Z (ie, public option)", I think the democrats would have fallen in line. He didn't want to do that, though, because he knew the public wasn't a big fan of the public option and he didn't want to be tied to specific items in the bill (in the event they needed to be cut to land his "victory" on health care). So, while that may have been more politically expedient for Obama long term, it pretty much sunk the health care debate. These poor democratic congressmen were forced to defend every aspect of all 20 bills in congress in these town halls because they didn't know what Obama wanted in the final version (or what would be there).

Bush, for all his warts, was very specific on what he wanted (for better or worse) and that's why it was easier for republicans to fall in line. It's hard to back the president when you don't even know specifically what he wants.

If by reform you mean letting drug companies pick their own price, then yes, it was reform. The Medicare was a bloated pile of shit that did nothing but make a ton of money for big Pharma. It's no secret that many of the Congressmen behind the bill went on to cushy million dollar jobs with those companies.

Obama would have been better off crafting a bill he liked and discussing it in private with the leaders in the Democratic party. Moderates and liberals alike. Get a consensus and a bill that the party would support. Then come out with a united front and 60% of Congress behind it. When you come out and put up a strong offensive, you have a better shot at winning. Bush did that with whatever he wanted passed.

[RainMaker]

Originally Posted by Arles

You're not following. I would prefer a private system for seniors, but we have medicare and it's not going anywhere (I feel like I'm repeating myself a lot here). For kids, I'm in favor of a publicly sponsored option for CURRENTLY UNINSURED KIDS. That number is estimated to be about 8 million nationally. A pretty far cry from half the spending. Plus, we already have the CHIP program and numerous state-run coverage plans for kids. I'm just ensuring there are no cracks for the remaining few kids who currently can't get coverage (which is well under 8 million total).

Do you really think a private system works for seniors? Do you have any idea what the rates would be? You'd be looking at 70 and 80 year olds paying up to $40,000 a year in health insurance. What percent of seniors can swing that? On top of dealing with all the hassles that come with insurance companies. Considering private insurers can drop you at your renewal rate, we'd be seeing a lot of seniors with serious illnesses and no health insurance.

Private option may work for the average 18-60 year old, but over 60 it's just too much trouble. You need the rest of society pitching in to help them out. You can't honestly believe there is a way to create a private system for the elderly.

[RainMaker]

You also have this belief that everyone on insurance is somehow taken care of. Insurance is great if you don't really get sick much, but if you're unhealthy, it's a different ball game. Ask anyone who's had extended hospital stays how hard it was to get their bills paid for. Or those who needed treatments prescribed by doctors that insurance companies just didn't want to pay for. The minute you start costing the insurance company a lot of money, they turn into shitbags that are nearly impossible to work with.

[JPhillips]

Originally Posted by ISiddiqui

Collins, Snowe, and Specter would have ALWAYS voted against cloture. Collins and Snowe are not the type to filibuster anything, even if they disagree.

Maybe so, but the cuts in the final bill were made to appease them so they would vote for cloture. The cuts didn't materialize out of thin air.

[JPhillips]

Originally Posted by RainMaker

If by reform you mean letting drug companies pick their own price, then yes, it was reform. The Medicare was a bloated pile of shit that did nothing but make a ton of money for big Pharma. It's no secret that many of the Congressmen behind the bill went on to cushy million dollar jobs with those companies.

Obama would have been better off crafting a bill he liked and discussing it in private with the leaders in the Democratic party. Moderates and liberals alike. Get a consensus and a bill that the party would support. Then come out with a united front and 60% of Congress behind it. When you come out and put up a strong offensive, you have a better shot at winning. Bush did that with whatever he wanted passed.

That plan didn't work so well when Clinton tried it.

[Arles]

Originally Posted by RainMaker

Do you really think a private system works for seniors? Do you have any idea what the rates would be? You'd be looking at 70 and 80 year olds paying up to $40,000 a year in health insurance. What percent of seniors can swing that? On top of dealing with all the hassles that come with insurance companies. Considering private insurers can drop you at your renewal rate, we'd be seeing a lot of seniors with serious illnesses and no health insurance.

Private option may work for the average 18-60 year old, but over 60 it's just too much trouble. You need the rest of society pitching in to help them out. You can't honestly believe there is a way to create a private system for the elderly.

I think it would still cost the government a ton, but I think private insurance companies could run health care for seniors. It would just be that a large percentage of the premiums would be paid by the gov't and there would need to be other qualifiers (restrictions on dropping and so forth). I doubt it would cost any more than what we are paying now, but it would be similar. At the end of the day, health care for seniors is always going to be expensive and Medicare isn't going anywhere. So, it's a fairly pointless debate.

[JPhillips]

Originally Posted by Arles

I think it would still cost the government a ton, but I think private insurance companies could run health care for seniors. It would just be that a large percentage of the premiums would be paid by the gov't and there would need to be other qualifiers (restrictions on dropping and so forth). I doubt it would cost any more than what we are paying now, but it would be similar. At the end of the day, health care for seniors is always going to be expensive and Medicare isn't going anywhere. So, it's a fairly pointless debate.

The Medicare Advantage plan does essentially what you are proposing, but costs significantly more per person than Medicare.

[Arles]

Originally Posted by JPhillips

That plan didn't work so well when Clinton tried it.

They didn't have near the margins in the house and senate they have now. Plus, their plan was extremely unpopular. I think if Obama had come out with a specific bill he wanted in the summer, there's a strong chance it would have passed by now.

But, I think that experience Clinton had scared Obama and he was hoping he could just grease a final bill through (just on sheer numbers in congress) without ever having to stick his neck out on certain specifics.

In a broader context, I see this as a problem that will continue to pop up. You can't work multiple sides of an issue and then act surprised when a specific side is chosen for a bill and there's disagreement. Either Obama needs to set a specific agenda for what he wants congress to pass or this will keep happening again and again.

[RainMaker]

Originally Posted by Arles

I think it would still cost the government a ton, but I think private insurance companies could run health care for seniors. It would just be that a large percentage of the premiums would be paid by the gov't and there would need to be other qualifiers (restrictions on dropping and so forth). I doubt it would cost any more than what we are paying now, but it would be similar. At the end of the day, health care for seniors is always going to be expensive and Medicare isn't going anywhere. So, it's a fairly pointless debate.

Well the private insurance industry has helped us have double the health care costs of nearly every major country in the world. Why do you have this idea that private means cheaper in health care? Especially considering these companies are relative monopolies in their regions.

Private only works in true free markets. Health care is not and the insurance companies and pharmaceutical companies like it that way. What you want is a private plan in an industry that is built so these companies can't lose.

[JPhillips]

Originally Posted by Arles

They didn't have near the margins in the house and senate they have now. Plus, their plan was extremely unpopular. I think if Obama had come out with a specific bill he wanted in the summer, there's a strong chance it would have passed by now.

But, I think that experience Clinton had scared Obama and he was hoping he could just grease a final bill through (just on sheer numbers in congress) without ever having to stick his neck out on certain specifics.

In a broader context, I see this as a problem that will continue to pop up. You can't work multiple sides of an issue and then act surprised when a specific side is chosen for a bill and there's disagreement. Either Obama needs to set a specific agenda for what he wants congress to pass or this will keep happening again and again.

I agree that the Clinton experience has played a big part in how this was (mis)handled, but I still think it's important to point out that a public option would likely pass an up or down vote. The problem is Max Baucus and a handful of Senators that apparently won't vote for cloture.

[ISiddiqui]

Originally Posted by JPhillips

Maybe so, but the cuts in the final bill were made to appease them so they would vote for cloture. The cuts didn't materialize out of thin air.

The cuts were to get them to vote for the final bill to call it "bipartisan", NOT to get them to vote for cloture. If the later was what was intended, then I have a far lesser view of the Obama Administration's political acumen than I previous had.

[Arles]

Originally Posted by JPhillips

The Medicare Advantage plan does essentially what you are proposing, but costs significantly more per person than Medicare.

It often costs more because it covers more than medicare (ie, prescription drugs, dental care, vision care and health club membership), plus there's out of network fees like normal plans (so, if your current doctor is out of network, it will cost more). That was needed in order to get people to switch from traditional medicare+medigap plans. Plus, because these plans are with companies for profit, there's more incentive to put cost and quality control measures in place, and more freedom to tie innovative care strategies to payment (ie, certain preventive measures).

For example, the Berensen and Dowd survey found that 99% of private plans used some type of disease management program in 2000, whereas CMS is considering terminating an ongoing disease management demonstration in traditional Medicare because it has been so unsuccessful. So, long term, it could end up costing less and atleast there's a reason for these plans to control cost (ie, they are for profit).