Dropped back in on the summit and found another Democratic nonwhite guy. Rep. Xavier Becerra squabbled a bit with Paul Ryan, and makes the point that if you throw out CBO numbers, we can’t discuss this.
(CBO tells us the Dems health care reform bills reduce the deficit by 100 billion in the first ten years. Ryan may disagree with those numbers, but they’re the best we have, and the best we’re going to have.)
Boehner is up:
Thank you for having us. A useful conversation. Don’t disagree with premise of meeting.
Our job is to listen. I’ve heard an awful lot. What I’ve heard more than anything ist hat the American people want us to scrap this bill.
Let’s talk about why
Fiscal condition. We’re going broke. This new entitlement program will bankrupt our country. I think this is a dangerous experiment. We may have problems, but we have the best health care system in the world. A government takeover of health care, and I believe that’s what that is, is risky.
The last thing we need to do is raise taxes. $500 billion in cuts to Medicare. It’s going to drive up unemployment. Employers will dump employees into the exchange. Federal government is going to design every single health care plan in America within five years. For thirty years we've had a federal law that says we’re not going to have federal taxpayer funding for abortions. This bill allows for taxpayer funding for abortions
So let’s scrap the bill. Let’s start with a clean sheet of paper we can agree on.
I’ve been patient, I’ve listened. Why can’t we come to an agreement on selling across state lines, malpractice, etc.
(A thoroughly dishonest and distasteful performance.)
Obama: every so often we go back to the standard talking points. And that doesn’t drive us to agreement. There’s so many things you said, that people here disagree with and based on my analysis, just aren’t true. We were trying to focus on the deficit. The CBO says this will reduce the deficit. Paul may disagree. I’ll get back to you on some of these.
Rep. Jim Cooper. Medical expenses driving us off the cliff. Tough talk is not good enough, we need to take tough votes.
Dick Durbin
Orin Hatch asked CBO about tort reform. It saves $54 billion over ten years.
5.4 billion a year is a lot of money except when compared to the 2 trillion we spend each year on health care.
And if we do have tort reform, more people will die. Thousands more.
There are other ways to reduce medical errors and lawsuits that should not be filed.
The number of paid malpractice claims have been cut in half in the last ten years.
Money paid has been going down, cut in half in last ten years.
This is an important issue but to make it the overriding issue is [wrong]
The best health care system in the world for the wealthy. We should give everyone the same plan congress has. If you think it’s a socialist plot for goodness sake drop out of the federal health benefit plan.
(One of the more powerful, and shortest, speeches today.)
Obama: looking at access now. Republican plan would cover an additional 3 million, Dem plan would cover an additional 30 million.
This may be most contentious part: it does cost money. But let’s not pretend that we’re going to cover another $30 million for free. If we think its important as a society to not leave people out then we’re going to have to figure out a way to pay for it.
John Barrasso
This is about all Americans, not just those who don’t have insurance (???).
He says *everyone* believes that passing the bill will increase costs. Will make care worse. Will hurt seniors.
They all believe that because you keep lying to them.
Gotta take another break.
Thursday, February 25, 2010
sumbloghealthliveit9care
Ok, gotta take a break for awhile. Hopefully will come back late in the day with some kind of summary.
For the record, a nonmale Republican has been sighted.
For the record, a nonmale Republican has been sighted.
livehealtblogcaresummit8
McCain
Wants to talk about process. Taking a pretty critical tone; talking about lack of transparency, “unsavory deal making,” asking rhetorical questions, just being his usual grumpy old man self.
Boy, he’s really making us regret electing Obama.
Obama tries to cut in, McCain steamrolls on, says Americans want us to go back to the beginning. He really reminds me of the debates. I don’t know who this is good for. He’s certainly throwing mud at Obama. Will it stick?
Obama: let’s get back to the issues.
Is Saturday Night Live on this weekend? ‘Cause if it’s a new episode the opening skit should be awesome.
Nancy Sibelius is talking to a roomful of people who probably are counting the minutes to lunch. OK, just an observation. So far this has been going on all morning. Lots of people have been talking. A total of two, I believe, were female. A total of one was not white. The nonmale nonwhite contingent were all Democrats. Just making an observation about how inclusive and diverse our government is these days.
Eric Cantor has a huge stack of paper in front of him, comes about up to his collar. Obama asks about it. I guess Eric wants to be able to look stuff up if he needs to.
“There is a reason why we all voted no.” (Yep, it’s called November).
He says it’s ‘cause the sec. of HHS will define benefits. What these guys are arguing is again, that government can’t work. I guess that’s an argument. Sure isn’t a constructive one, though.
Taking on oversight of insurance premium increases. Government regulation will force premiums to go up, says EC.
Obama ripping apart his talking points. Making the point that regulations are necessary to protect consumers. Explaining the concept of risk pools. Man, it’s sad that we’re at this point.
“We just can’t afford this.” Cantor.
We could afford two wars, massive tax cuts, and the Medicare drug benefit you voted for. Right.
Cantor is dogged, I’ll give him that.
Oh, hey another nonmale. Hello, Rep. Slaughter. Hey, she's pretty good. But she used the phrase "eating my lunch" and I could hear people shifting in their seats.
Wants to talk about process. Taking a pretty critical tone; talking about lack of transparency, “unsavory deal making,” asking rhetorical questions, just being his usual grumpy old man self.
Boy, he’s really making us regret electing Obama.
Obama tries to cut in, McCain steamrolls on, says Americans want us to go back to the beginning. He really reminds me of the debates. I don’t know who this is good for. He’s certainly throwing mud at Obama. Will it stick?
Obama: let’s get back to the issues.
Is Saturday Night Live on this weekend? ‘Cause if it’s a new episode the opening skit should be awesome.
Nancy Sibelius is talking to a roomful of people who probably are counting the minutes to lunch. OK, just an observation. So far this has been going on all morning. Lots of people have been talking. A total of two, I believe, were female. A total of one was not white. The nonmale nonwhite contingent were all Democrats. Just making an observation about how inclusive and diverse our government is these days.
Eric Cantor has a huge stack of paper in front of him, comes about up to his collar. Obama asks about it. I guess Eric wants to be able to look stuff up if he needs to.
“There is a reason why we all voted no.” (Yep, it’s called November).
He says it’s ‘cause the sec. of HHS will define benefits. What these guys are arguing is again, that government can’t work. I guess that’s an argument. Sure isn’t a constructive one, though.
Taking on oversight of insurance premium increases. Government regulation will force premiums to go up, says EC.
Obama ripping apart his talking points. Making the point that regulations are necessary to protect consumers. Explaining the concept of risk pools. Man, it’s sad that we’re at this point.
“We just can’t afford this.” Cantor.
We could afford two wars, massive tax cuts, and the Medicare drug benefit you voted for. Right.
Cantor is dogged, I’ll give him that.
Oh, hey another nonmale. Hello, Rep. Slaughter. Hey, she's pretty good. But she used the phrase "eating my lunch" and I could hear people shifting in their seats.
Livehealthcaresummitblog7
Best new catchphrase (and movie pitch) from summit:
Undercover Patient.
Schumer notes that we can’t health care costs without cutting waste in Medicare, hits R’s for saying you can’t cut Medicare.
Sen John Kyl
We do not agree with the question on who should be in charge.
Do you trust your doc or do you trust Washington.
Oh, he’s going back to the premiums. Quotes a letter from CBO; premiums will go up because it’s a richer benefit, because the government would mandate it. Getting into acturarial tables. Govt will mandate that insurance will cover more things, so premiums will go up. Taxes.
Kyl has a big pile of papers in front of him, and danged if I don’t take him more seriously. Best use of props.
Taxes, fees, will increase the cost to the consumer. That’s why R’s would rather start by not having to raise a lot of money to pay for bill, instead take it piece by piece.
(my question: how many years til we get reform that addresses the real problems that way? 5? 10? 25?)
Obama responds:
Premium argument. If I’m self-employed, can’t get coverage. High deductible plan: it’s not health insurance, it’s house insurance. (good phrase) What CBO is saying: if I have an opportunity to buy good insurance, costs more but is real insurance. So yes I’m paying more because instead of buying an apple I’m getting an orange.
The federal benefit has a minimum benefit that all in congress enjoy. We’re saying we’re going to do the same thing for others that we do for ourselves. Saying there’s a baseline of coverage is not some radical idea. A lot of states do it.
I just want to point out the issue of gvot regulation is very different than the way this has been framed. This is not a government takeover of insurance. (He’s hammering home that point, I guess it needs to be said)
James Clyborn is talking up community health centers as a way to address cost and access issues. No matter what we do, there should be sig. expansion of those centers.
Undercover Patient.
Schumer notes that we can’t health care costs without cutting waste in Medicare, hits R’s for saying you can’t cut Medicare.
Sen John Kyl
We do not agree with the question on who should be in charge.
Do you trust your doc or do you trust Washington.
Oh, he’s going back to the premiums. Quotes a letter from CBO; premiums will go up because it’s a richer benefit, because the government would mandate it. Getting into acturarial tables. Govt will mandate that insurance will cover more things, so premiums will go up. Taxes.
Kyl has a big pile of papers in front of him, and danged if I don’t take him more seriously. Best use of props.
Taxes, fees, will increase the cost to the consumer. That’s why R’s would rather start by not having to raise a lot of money to pay for bill, instead take it piece by piece.
(my question: how many years til we get reform that addresses the real problems that way? 5? 10? 25?)
Obama responds:
Premium argument. If I’m self-employed, can’t get coverage. High deductible plan: it’s not health insurance, it’s house insurance. (good phrase) What CBO is saying: if I have an opportunity to buy good insurance, costs more but is real insurance. So yes I’m paying more because instead of buying an apple I’m getting an orange.
The federal benefit has a minimum benefit that all in congress enjoy. We’re saying we’re going to do the same thing for others that we do for ourselves. Saying there’s a baseline of coverage is not some radical idea. A lot of states do it.
I just want to point out the issue of gvot regulation is very different than the way this has been framed. This is not a government takeover of insurance. (He’s hammering home that point, I guess it needs to be said)
James Clyborn is talking up community health centers as a way to address cost and access issues. No matter what we do, there should be sig. expansion of those centers.
HCSummitLiveBlog6
Coburn called for undercover patients. I love that song.
“Undercover patient, midnight fantasy…”
After Coburn, Obama points out again, that many of the cost containment ideas and prevention ideas are already in the bill. This is going to be common theme of today: you guys say you want xyz reforms, hey, they’re already in the bill.
Here’s Steny Hoyer, telling Coburn the bill does exactly what he suggests in working on Fraud in Medicare & Medicaid (hereafter known as M&M)
Steny seems more focused and articulate than Reid/Pelosi. Not necessarily more exciting, but I don’t find myself saying, wait, what? …as much.
Obama: what are your objections to health insurance exchanges? I know some of you have agreed to this concept in the past. (ooo, nice passive aggressive move.)
JOHN KLINE, from MINNESOTA!!
Kline: we’re looking at thousands of pages of legisatlion, better to go step by step. We have proposed that small biz be able to band together.
I love that tie. I mean it, it’s outstanding.
Let small biz band together to get the same advantages that bigger co’s have. Obama, nodding. Kline: we think that’s a better idea than exchanges.
Obama asked Max Baucaus to respond.
Baucus: this is what strikes me. We all know what the problems are. We are actually quite close. The gaps are not that great.
Going back to Lamar. We’ve got most of what R’s want. Across state lines. Tort reform (HHS working on) . Baucus seems nervous and a little tongue tied.
HSAs work pretty well for middle and high income people.
Small business: we’re not that far apart. Association health plans (Kline’s thing) That’s fine, what we provide is the SHIP Act. Bipartisan, allows small business participation in exchanges. Major provisions on fraud and waste in the bill. We basically agree. Looks like he's ready to start hugging people.
(I sense a real advantage here for the Dems. They keep hammering home that they have made reasonable attempts to address the R concerns. They show how the bill incorporates R ideas. They get a chance to explain how the bill works and what it does. The R’s can’t come back with the outright falsehoods, because Obama has made it clear he won’t let them pull that stuff. Obviously, I’m pro-reform so my take on this may reflect that. But this seems effective to me.)
McConnell yields to Boehner, Boehner yields to … who is that? Camp? Rep. Dave Camp. He says if you care about costs, why are you spending a trillion dollars? (because it reduces the deficit?) He says someone (medicare?) says the plan does not bend the cost curve the right way. He wants malpractice reform. Quotes CBO that says med malpractice reform would reduce deficit.
Remember he quotes CBO.
Lots of details with this guy, he’s definitely a policy guy, seems more prepared than some of these guys. Talks about an unelected board to make Medicare cuts (death panels!)
Obama cuts him off: doesn’t want to get off on tangents, then lets him finish.
Obama and Camp getting into premium increases. When all this is structured around a government centered exchange: that kind of approach raises cost. Mandates.
Rob somebody. Robert Andrews.
He says difference between association and exchanges is semantic mostly, one substantive difference. Different consumer protections in diff. states. Shouldn’t be 51 different sets of rules, one reasonable federal standard.
Republican guy just said he doesn’t hear people complaining about their health insurance companies. “We do” says Andrews.
“We don’t agree with the idea that the insurance company gets to make (medical decisions.)
McConnell has been keeping a stopwatch. Sheesh.
Paul Ryan from Wisconsin. Washington shouldn’t mandate things. Let the industries set up their associations for their members. We want to decentralize the system, give more power to small businesses.
Andrews: asks Ryan about setting consumer protections.
Should people in Washington decide for everyone?
Obama says its an important point.
Obama: Focus in on this philosophical debate. Legitimate points. When I was young I had to buy auto insurance. It was a joke. Health insurance is different. We should set up minimum standards in the exchange. It is true you can always get cheaper insurance if it has high deductibles or doesn’t cover things. The principle of pooling is at the center of the bills. A lot of talk about government takeover. That’s not the issue. The issue is how much should govt set a baseline?
When we start talking about how much government involvement – it’s not that it’s a takeover, it is that govt is setting up regulation, baseline requirements.
“Undercover patient, midnight fantasy…”
After Coburn, Obama points out again, that many of the cost containment ideas and prevention ideas are already in the bill. This is going to be common theme of today: you guys say you want xyz reforms, hey, they’re already in the bill.
Here’s Steny Hoyer, telling Coburn the bill does exactly what he suggests in working on Fraud in Medicare & Medicaid (hereafter known as M&M)
Steny seems more focused and articulate than Reid/Pelosi. Not necessarily more exciting, but I don’t find myself saying, wait, what? …as much.
Obama: what are your objections to health insurance exchanges? I know some of you have agreed to this concept in the past. (ooo, nice passive aggressive move.)
JOHN KLINE, from MINNESOTA!!
Kline: we’re looking at thousands of pages of legisatlion, better to go step by step. We have proposed that small biz be able to band together.
I love that tie. I mean it, it’s outstanding.
Let small biz band together to get the same advantages that bigger co’s have. Obama, nodding. Kline: we think that’s a better idea than exchanges.
Obama asked Max Baucaus to respond.
Baucus: this is what strikes me. We all know what the problems are. We are actually quite close. The gaps are not that great.
Going back to Lamar. We’ve got most of what R’s want. Across state lines. Tort reform (HHS working on) . Baucus seems nervous and a little tongue tied.
HSAs work pretty well for middle and high income people.
Small business: we’re not that far apart. Association health plans (Kline’s thing) That’s fine, what we provide is the SHIP Act. Bipartisan, allows small business participation in exchanges. Major provisions on fraud and waste in the bill. We basically agree. Looks like he's ready to start hugging people.
(I sense a real advantage here for the Dems. They keep hammering home that they have made reasonable attempts to address the R concerns. They show how the bill incorporates R ideas. They get a chance to explain how the bill works and what it does. The R’s can’t come back with the outright falsehoods, because Obama has made it clear he won’t let them pull that stuff. Obviously, I’m pro-reform so my take on this may reflect that. But this seems effective to me.)
McConnell yields to Boehner, Boehner yields to … who is that? Camp? Rep. Dave Camp. He says if you care about costs, why are you spending a trillion dollars? (because it reduces the deficit?) He says someone (medicare?) says the plan does not bend the cost curve the right way. He wants malpractice reform. Quotes CBO that says med malpractice reform would reduce deficit.
Remember he quotes CBO.
Lots of details with this guy, he’s definitely a policy guy, seems more prepared than some of these guys. Talks about an unelected board to make Medicare cuts (death panels!)
Obama cuts him off: doesn’t want to get off on tangents, then lets him finish.
Obama and Camp getting into premium increases. When all this is structured around a government centered exchange: that kind of approach raises cost. Mandates.
Rob somebody. Robert Andrews.
He says difference between association and exchanges is semantic mostly, one substantive difference. Different consumer protections in diff. states. Shouldn’t be 51 different sets of rules, one reasonable federal standard.
Republican guy just said he doesn’t hear people complaining about their health insurance companies. “We do” says Andrews.
“We don’t agree with the idea that the insurance company gets to make (medical decisions.)
McConnell has been keeping a stopwatch. Sheesh.
Paul Ryan from Wisconsin. Washington shouldn’t mandate things. Let the industries set up their associations for their members. We want to decentralize the system, give more power to small businesses.
Andrews: asks Ryan about setting consumer protections.
Should people in Washington decide for everyone?
Obama says its an important point.
Obama: Focus in on this philosophical debate. Legitimate points. When I was young I had to buy auto insurance. It was a joke. Health insurance is different. We should set up minimum standards in the exchange. It is true you can always get cheaper insurance if it has high deductibles or doesn’t cover things. The principle of pooling is at the center of the bills. A lot of talk about government takeover. That’s not the issue. The issue is how much should govt set a baseline?
When we start talking about how much government involvement – it’s not that it’s a takeover, it is that govt is setting up regulation, baseline requirements.
MST3K5
Obama doesn’t respond much to R criticism, but notes that some areas of agreement,
Says let’s not dwell on process and stick to substance
Everyboy agrees on cost
Talking about costs, costs to businesses,
Talks about exchanges –not a Democratic idea but a Republican one! (dig it!)
CBO cost estimates: plan would lower costs for individual markets, calling Lamar out on this, Lamar cuts in--CBO says premiums will rise Obama-no no no
We have to get our facts straight, what you said, Lamar, was not factually accurate
Costs for families would go down 14 to 20 percent
Because they now have a better deal, they may chose to buy better coverage, which might be more expenseive
(So we have our first tussle. Decision, Obama.)
Obama still going over cost containment in the proposals.
Additional ideas that R’s have suggested, that we have included
Buying across state lines: that’s in the proposal
What we’ve tried to do is take every single cost containment idea and put it in bill
What ideas you have that you don’t think are in the bill to contain costs?
10:00
Not letting LA cut back in.
We’ve adopted a lot of your ideas
LA: I punt on this other stuff.
I think your wrong on increasing premiums, I’ll put my facts down and send them to you.
Obama: I’d like to get this issue on premiums increases settled before the day’s out.
(Yes!)
McConnell: Can I get a Pepsi?
(he did not say that)
McConnell: The American people hate this bill. Hate reconciliation.
Calling Dr. Tom Coburn. Stat!
Coburn (whoa, lookat that hair!)
We’re performing bad medicine.
Govt health care doesn’t work
Cost is the problem.
We could solve this problem if we just address costs! There are lots of ways to fix this!
Tort reform! Change the school lunch program!
(I smell a Nobel prize)
Says let’s not dwell on process and stick to substance
Everyboy agrees on cost
Talking about costs, costs to businesses,
Talks about exchanges –not a Democratic idea but a Republican one! (dig it!)
CBO cost estimates: plan would lower costs for individual markets, calling Lamar out on this, Lamar cuts in--CBO says premiums will rise Obama-no no no
We have to get our facts straight, what you said, Lamar, was not factually accurate
Costs for families would go down 14 to 20 percent
Because they now have a better deal, they may chose to buy better coverage, which might be more expenseive
(So we have our first tussle. Decision, Obama.)
Obama still going over cost containment in the proposals.
Additional ideas that R’s have suggested, that we have included
Buying across state lines: that’s in the proposal
What we’ve tried to do is take every single cost containment idea and put it in bill
What ideas you have that you don’t think are in the bill to contain costs?
10:00
Not letting LA cut back in.
We’ve adopted a lot of your ideas
LA: I punt on this other stuff.
I think your wrong on increasing premiums, I’ll put my facts down and send them to you.
Obama: I’d like to get this issue on premiums increases settled before the day’s out.
(Yes!)
McConnell: Can I get a Pepsi?
(he did not say that)
McConnell: The American people hate this bill. Hate reconciliation.
Calling Dr. Tom Coburn. Stat!
Coburn (whoa, lookat that hair!)
We’re performing bad medicine.
Govt health care doesn’t work
Cost is the problem.
We could solve this problem if we just address costs! There are lots of ways to fix this!
Tort reform! Change the school lunch program!
(I smell a Nobel prize)
LVHCS4
9:35
Alexander:
this has to be bipartisan. (I think this is a good argument, if we have a bipartisan, goodwill effort on both sides. We clearly don't. But let's see where this argument goes and how Obama's team responds)
Re-earn the trust of the American people.
Obama:
kicking it to Nancy and Harry. I loved that movie.
Nancy opens with some lovely hand gestures. Bipartisan passage of House bill to lift anti trust exemption for health insurance cos.
Talking about Sen. Kennedy. (Now you are just bumming me out.)
Character of country, kitchen table,
People don't have time for us to start over
I've seen grown men cry
(I bet she has! I bet she has! Know wot I mean?)
(very sorry)
What it means for economy. People locked to jobs.
some discussion of early legislation health technology, children's insurance
innovation, prevention, wellness
Most people haven't heard about that
they don't want to hear about process they want to hear about results
lower cost, accessibility,
NP kind of rambles at times. Teleprompters aren't always bad, you know.
But making OK points.
Here comes the REIDINATOR!
Babies with prexisting conditions,
Lamar A is entitled to opinions but not facts (that is getting so old)
Make sure we talk about facts
Kaiser Foundation poll found poeple would be angry if we did not do hcr this year
(we are going to hear a lot of dueling polls today)
What is Reid's point on opinion and facts?
No one has talked about reconciliation (what?)
Now he's talking about how Reconciliation has been used for major things, often by R's. Finally a good point but not delivered well.
Bill reported out of committe has more than 150 Repub. amendments
Ok, taking abreak...
Alexander:
this has to be bipartisan. (I think this is a good argument, if we have a bipartisan, goodwill effort on both sides. We clearly don't. But let's see where this argument goes and how Obama's team responds)
Re-earn the trust of the American people.
Obama:
kicking it to Nancy and Harry. I loved that movie.
Nancy opens with some lovely hand gestures. Bipartisan passage of House bill to lift anti trust exemption for health insurance cos.
Talking about Sen. Kennedy. (Now you are just bumming me out.)
Character of country, kitchen table,
People don't have time for us to start over
I've seen grown men cry
(I bet she has! I bet she has! Know wot I mean?)
(very sorry)
What it means for economy. People locked to jobs.
some discussion of early legislation health technology, children's insurance
innovation, prevention, wellness
Most people haven't heard about that
they don't want to hear about process they want to hear about results
lower cost, accessibility,
NP kind of rambles at times. Teleprompters aren't always bad, you know.
But making OK points.
Here comes the REIDINATOR!
Babies with prexisting conditions,
Lamar A is entitled to opinions but not facts (that is getting so old)
Make sure we talk about facts
Kaiser Foundation poll found poeple would be angry if we did not do hcr this year
(we are going to hear a lot of dueling polls today)
What is Reid's point on opinion and facts?
No one has talked about reconciliation (what?)
Now he's talking about how Reconciliation has been used for major things, often by R's. Finally a good point but not delivered well.
Bill reported out of committe has more than 150 Repub. amendments
Ok, taking abreak...
LBHCS3
McConnell kicks it to Alexandar! Alexander has the ball and is pulling the Governor end run. OH, the tea party gambit! Not even three sentences into it! Town Halls proved we should start over!
Good they're not going to talking points.
We want you to succeed, but would like you to change direction.
Detroit auto show (what the-- trying to tie this to the unpopular auto bailout??? Yeah, they've done that before)
Should start with a clean sheet of paper. ( --I am very interested in hearing Obama's response to this talking point--)
New taxes, premiums will go up, unfunded mandates, just maybe a few scare tactics here, dumps millions of americans into a Medicaid program (yeah, they're going to HATE having health insurance--ok, legit concerns about reimbursments but come on)
This is car that can't be recalled and fixed
Is he going to throw in a Toyota reference? Come on Lamarr, go for it!
We don't do comprehensive well. Our country is too big and complicated (to govern, I guess)(why are these guys senators. I mean, really why are you in government if you think it's a waste of time?)
going over points of R plan. Cost control, selling across state lines, medical malpractice, Health savings accounts, Hey, we have SIX ideas! Oh, and maybe we need to rein in insurance companies. But maybe not.
Renounce your plan! Give up on reconciliation! Surrender Dorothy!!!
All yr bases R Mine!
Good they're not going to talking points.
We want you to succeed, but would like you to change direction.
Detroit auto show (what the-- trying to tie this to the unpopular auto bailout??? Yeah, they've done that before)
Should start with a clean sheet of paper. ( --I am very interested in hearing Obama's response to this talking point--)
New taxes, premiums will go up, unfunded mandates, just maybe a few scare tactics here, dumps millions of americans into a Medicaid program (yeah, they're going to HATE having health insurance--ok, legit concerns about reimbursments but come on)
This is car that can't be recalled and fixed
Is he going to throw in a Toyota reference? Come on Lamarr, go for it!
We don't do comprehensive well. Our country is too big and complicated (to govern, I guess)(why are these guys senators. I mean, really why are you in government if you think it's a waste of time?)
going over points of R plan. Cost control, selling across state lines, medical malpractice, Health savings accounts, Hey, we have SIX ideas! Oh, and maybe we need to rein in insurance companies. But maybe not.
Renounce your plan! Give up on reconciliation! Surrender Dorothy!!!
All yr bases R Mine!
LIve Blogging the Health Care Summit 2
Outlining the problem: families suffering, drain on economy, things are getting worse, hurting businesses, effect on the federal budget (bad), exploding cost of medicare and medicaid...
Personal stories--his kids going to the hospital when they were young, what would've happened if he didn't have reliable health care, his mom's cancer. I think this personal, low key approach is good for setting the tone as not intimidating or confrontational. I guess since his real audience is the country it also is a way to connect with normal folks.
"This became a very partisan battle" um hmmm.
That plant by his head is distracting
Overlap of ideas, areas of agreement
9:20
Hope as we discuss each section today, hope to bridge some gaps, don't know if we *can* bridge gaps, but I'd like to make sure this discussion is actually a discussion and not just us trading talking points.
Well, good luck with that
...(it could happen)...
Personal stories--his kids going to the hospital when they were young, what would've happened if he didn't have reliable health care, his mom's cancer. I think this personal, low key approach is good for setting the tone as not intimidating or confrontational. I guess since his real audience is the country it also is a way to connect with normal folks.
"This became a very partisan battle" um hmmm.
That plant by his head is distracting
Overlap of ideas, areas of agreement
9:20
Hope as we discuss each section today, hope to bridge some gaps, don't know if we *can* bridge gaps, but I'd like to make sure this discussion is actually a discussion and not just us trading talking points.
Well, good luck with that
...(it could happen)...
Live blog the health care summit? Sure, why not?
I'm keeping one eye on the health care summit in washington today. So I figure it might be fun to drop a few comments here. Or not. We'll see how it turns out.
9:05, POTUS in the HOUSE!
Sorry, just trying to spice it up. Mostly the diff. lawmakers were sitting around looking nervous,now Obama is making the rounds shaking hands. Some of these guys are introducing themselves to the Prez,so I'm guessing they're aides or -- wait, Paul Ryan just introduced himself. What? Those two have never met?
Obama has a nice tie... oh, had to wait a sec for Biden to sit down. Get it together, Joe!!
9:05, POTUS in the HOUSE!
Sorry, just trying to spice it up. Mostly the diff. lawmakers were sitting around looking nervous,now Obama is making the rounds shaking hands. Some of these guys are introducing themselves to the Prez,so I'm guessing they're aides or -- wait, Paul Ryan just introduced himself. What? Those two have never met?
Obama has a nice tie... oh, had to wait a sec for Biden to sit down. Get it together, Joe!!
Wednesday, January 27, 2010
Post-State of the Union Preview!
Republicans: He sux!
Dems: Home Run!
Everyone else: I want an iPad!!!
Ok, seriously, if you are one of the literally ones of Mod Lang readers, I'd like to hear your two cents on the State of the Union.
Dems: Home Run!
Everyone else: I want an iPad!!!
Ok, seriously, if you are one of the literally ones of Mod Lang readers, I'd like to hear your two cents on the State of the Union.
"Throwing Molasses in the Road"
TPM's on a roll today, as their new article on filibusters really shows how obstructionism has become the GOP's most defining feature.
This fits the narrative that we've been hearing from the left, namely that our system is too dysfunctional to allow for effective governance. Now, some might say that's just making excuses. But there's no doubt that we're not getting much accomplished on the most pressing issues of the day. And from my point of view, we didn't get much accomplished when the Rs were in charge, either. I mean, besides wars. Surely we can be good at more than one thing?
The point is, and I hear this from all sides, is that our system does not work well. Is the answer as simple as getting rid of the filibuster?
(Hint: I don't know.)
This fits the narrative that we've been hearing from the left, namely that our system is too dysfunctional to allow for effective governance. Now, some might say that's just making excuses. But there's no doubt that we're not getting much accomplished on the most pressing issues of the day. And from my point of view, we didn't get much accomplished when the Rs were in charge, either. I mean, besides wars. Surely we can be good at more than one thing?
The point is, and I hear this from all sides, is that our system does not work well. Is the answer as simple as getting rid of the filibuster?
(Hint: I don't know.)
"Either we fix this problem going forward, or the game really is over."
An interview on the economy that is funny and sobering at the same time.
| The Daily Show With Jon Stewart | Mon - Thurs 11p / 10c | |||
| Elizabeth Warren | ||||
| ||||
Thursday, January 21, 2010
You Win Some, You Lose Some
OK, I’ve had about enough with the hyperventilating and weeping and wailing from the left the last couple of days.
They lost an election. It happens. The Democrats still have strong majorities in both houses. They can still get things done, although the filibuster is going to make it very tough to pass meaningful health care reform. But tough is not the same as impossible, no matter what the blogs tell you.
It’s clear that Democrats have a reason to be worried. But enough with the finger-pointing. Simply saying that Dems have to be more ideologically pure, as tempting as that is, is not going to cut it. We can wish that Obama would’ve been more partisan and made this a big fight about good (Democrats) versus evil (Republicans). But he’s never been that kind of guy. The left-leaning blogs see life that way. He doesn’t.
And really, that may be a good thing. After all, isn’t he supposed to be President of the entire country, both D and R? Didn’t we hate George W. Bush because he never listened to the other side? Should we be more like him?
I know it’s not “fair” that Obama got stuck with cleaning up the mess, and the people who made the mess are now saying it’s his fault. But it is reality. It’s his job, and his supporters’ job, to find a way to communicate a better vision. Yes, it’s not “fair” that professional assholes and liars like Hannity/Beck/Limbaugh push and poison the political debate as much as they do. But that’s reality. Obama, and the rest of us, need to find a way to overcome that. And we won’t get there by screaming louder.
So what do the American people want? If we go by the Massachusetts election, we can conclude a few things:
1. “No more back room deals, we want transparency in government.”
2. “We demand deficit reduction.”
3. “Work to help Main Street, not Wall Street.”
4. “Health care reform has to be something that we can understand.”
I think that’s a list that all my Republican friends could agree on. Of course, when Bush was in office, they all said:
1. “We don’t care about that.”
2. “We don’t care about that.”
3. “We don’t care about that.”
4. “We don’t care about that.”
But hey, bygones. The mood of the country has changed, and if voters have unreasonable double-standards, well, welcome to democracy.
The point is, Obama and the Dems need to respond to the mood of the country. They don’t need to become Republicans to do it. After all, transparency, anti-big banks, deficit reduction—those are all things Dems can support, right? Take the message, reframe the debate, move forward and prove your side has the better ideas.
It’s time to get back to work.
They lost an election. It happens. The Democrats still have strong majorities in both houses. They can still get things done, although the filibuster is going to make it very tough to pass meaningful health care reform. But tough is not the same as impossible, no matter what the blogs tell you.
It’s clear that Democrats have a reason to be worried. But enough with the finger-pointing. Simply saying that Dems have to be more ideologically pure, as tempting as that is, is not going to cut it. We can wish that Obama would’ve been more partisan and made this a big fight about good (Democrats) versus evil (Republicans). But he’s never been that kind of guy. The left-leaning blogs see life that way. He doesn’t.
And really, that may be a good thing. After all, isn’t he supposed to be President of the entire country, both D and R? Didn’t we hate George W. Bush because he never listened to the other side? Should we be more like him?
I know it’s not “fair” that Obama got stuck with cleaning up the mess, and the people who made the mess are now saying it’s his fault. But it is reality. It’s his job, and his supporters’ job, to find a way to communicate a better vision. Yes, it’s not “fair” that professional assholes and liars like Hannity/Beck/Limbaugh push and poison the political debate as much as they do. But that’s reality. Obama, and the rest of us, need to find a way to overcome that. And we won’t get there by screaming louder.
So what do the American people want? If we go by the Massachusetts election, we can conclude a few things:
1. “No more back room deals, we want transparency in government.”
2. “We demand deficit reduction.”
3. “Work to help Main Street, not Wall Street.”
4. “Health care reform has to be something that we can understand.”
I think that’s a list that all my Republican friends could agree on. Of course, when Bush was in office, they all said:
1. “We don’t care about that.”
2. “We don’t care about that.”
3. “We don’t care about that.”
4. “We don’t care about that.”
But hey, bygones. The mood of the country has changed, and if voters have unreasonable double-standards, well, welcome to democracy.
The point is, Obama and the Dems need to respond to the mood of the country. They don’t need to become Republicans to do it. After all, transparency, anti-big banks, deficit reduction—those are all things Dems can support, right? Take the message, reframe the debate, move forward and prove your side has the better ideas.
It’s time to get back to work.
The Republican Plan for Health Care Reform Is to Not Pass Health Care Reform
Minnesota Public Radio gives us a timely reminder that no matter what they say, the Republican strategy since Obama’s election has always been to stop health care reform efforts.
In this story, former Republican Senator Dave Durenberger, who’s no longer in office so he doesn’t have to toe the party line, spells it out.
“Durenberger contends most Republicans never intended to commit to changing health care policy, even with ideas brought forward by other Republican senators -- for example, tax changes that John McCain recommended or Medicare changes that Olympia Snow recommended.
“‘There were plenty of good Republicans in the past that have worked together with Democrats -- [Charles] Grassley, Orrin Hatch and others,’ said Durenberger. ‘Those people made a choice, along with the Republican leadership, to be negative this time, not to play ball. And of course that was a factor that perhaps should've been anticipated by the Democrats, but clearly wasn't.’”
It didn’t matter how much the Dems tried to work with the R’s, it didn’t matter how many Republican ideas were incorporated into reform legislation, the Republicans were not going to support it. And they still won’t.
Somehow, that message has to be part of this story: that one party wants to address a critical problem, and the other would rather see Americans go bankrupt, get sick, and die because they’re playing politics.
I have no problem with Republicans who have different ideas of what we should do. I have a problem with them refusing to do anything, and refusing to allow the process to go forward because they don’t get exactly what they want. And that’s where we have been for some time.
In the meantime, health care providers here in Minnesota can take comfort in the fact that because of the Brown victory in Massachusetts, well, we’re screwed.
In this story, former Republican Senator Dave Durenberger, who’s no longer in office so he doesn’t have to toe the party line, spells it out.
“Durenberger contends most Republicans never intended to commit to changing health care policy, even with ideas brought forward by other Republican senators -- for example, tax changes that John McCain recommended or Medicare changes that Olympia Snow recommended.
“‘There were plenty of good Republicans in the past that have worked together with Democrats -- [Charles] Grassley, Orrin Hatch and others,’ said Durenberger. ‘Those people made a choice, along with the Republican leadership, to be negative this time, not to play ball. And of course that was a factor that perhaps should've been anticipated by the Democrats, but clearly wasn't.’”
It didn’t matter how much the Dems tried to work with the R’s, it didn’t matter how many Republican ideas were incorporated into reform legislation, the Republicans were not going to support it. And they still won’t.
Somehow, that message has to be part of this story: that one party wants to address a critical problem, and the other would rather see Americans go bankrupt, get sick, and die because they’re playing politics.
I have no problem with Republicans who have different ideas of what we should do. I have a problem with them refusing to do anything, and refusing to allow the process to go forward because they don’t get exactly what they want. And that’s where we have been for some time.
In the meantime, health care providers here in Minnesota can take comfort in the fact that because of the Brown victory in Massachusetts, well, we’re screwed.
Monday, January 18, 2010
MLK Day
On this Martin Luther King Day, I am thinking about Massachusetts, and the election there. It appears that many voters in Mass. are thinking that we can solve today's problems by going back to the failed policies of yesterday.
I've had too many arguments lately with people who simply don't make sense to me. And I'm hearing too much hate and anger. So this quote seems fitting today:
“Like an unchecked cancer, hate corrodes the personality and eats away its vital unity. Hate destroys a man's sense of values and his objectivity. It causes him to describe the beautiful as ugly and the ugly as beautiful, and to confuse the true with the false and the false with the true.”
Martin Luther King Jr.
I've had too many arguments lately with people who simply don't make sense to me. And I'm hearing too much hate and anger. So this quote seems fitting today:
“Like an unchecked cancer, hate corrodes the personality and eats away its vital unity. Hate destroys a man's sense of values and his objectivity. It causes him to describe the beautiful as ugly and the ugly as beautiful, and to confuse the true with the false and the false with the true.”
Martin Luther King Jr.
Saturday, December 19, 2009
The Conservative Vision of Health Care Reform Wins the Day
It is a measure of the political environment of the United States that a proposition as basic as trying to improve health care coverage for the millions of uninsured has unleashed a firestorm of controversy, with unusually strong opposition from people who stand to directly benefit from the reform. In this county, some on the Christian Right are praying that their fellow Americans be denied an opportunity to have better health care.
It is a testimony to the toxic power of media ideologues like Rush Limbaugh and Glenn Beck that they can so poison the atmosphere of political dialogue that people have spent months arguing over myths and distortions, with very little understanding of what the reform bills actually are trying to do and what the consequences of action—or inaction—will be.
What strikes me, as we see the Senate bill do exactly what many political insiders long predicted it would do—lose the public option—is how conservative health care reform is turning out to be. If the Senate bill passes and the final legislation mirrors its current proposals—which is not certain, but still likely—we will have what should be a conservative’s dream health care reform law.
It is still a private system. It has no large government plan. It reduces the deficit. It provides subsidies to health insurance plans to cover the uninsured (which is the only realistic way to solve this problem, if you refuse to consider a government option). It gives the drug manufacturers what they want. It doesn’t force physicians to deal with a new government bureaucracy.
Certainly it doesn’t please everyone. All those groups and many more have found reasons to criticize the bill. But it would be wrong to be willfully blind to how much this reform tries to meet all the various stakeholders half way.
In today’s political realities, of course, that’s not good enough. Willful blindness is all the rage. The bill is too conservative for Howard Dean, so he wants to tear it up and start over. It’s too restrictive for the health plans, so they oppose it. And of course, if it comes from the Democrats and Obama, the Fox News world must reflexively hate it.
What the Fox News world doesn’t realize is, they’ve won. If they really believe what they say: that they in fact DO want to reform health care, but they want to do it without the government taking over the health care system, then they have won.
But what they say and what they really want are obviously two different things. Their real opposition is to letting the Democrats get credit for fixing the county’s most pressing domestic problem. It is, to use a cliché, politics as usual.
I’ve heard, over and over again, the talking points: conservatives want to reform health care, but it should include tort reform. It should allow health plans to sell insurance over state borders. It shouldn’t explode the deficit. It should empower doctors and patients to make decisions, not the government.
Well, that last one—as nonsensical as it is, since the government was never going to intrude on medical decisions in the way that reform opponents suggested—should be satisfied by the death of the public option. The sell-insurance-over-state-borders idea is part of the Senate bill. The CBO has scored both the Senate and House bill as reducing, not increasing, the deficit. Tort reform is another idea that has merit; however, the state that has done the most in the area of tort reform is Texas: a state with one of the highest rates of uninsurance as well as the most out-of-control health care cost increases. So much for that silver bullet.
The point is, conservative ideas have been co-opted by the reform bills much more than conservatives are willing to admit. The exception is tort reform, and that, by the examples we’ve seen, is not going to make that much of a difference.
But overall, a conservative approach to reforming health care is exactly what we’re looking at. The fact is, conservatives have won this round. And really, if they would realize it and support health care reform, we’d all be better off. But they won’t realize it, and they will keep trying to go down a path that will damage the country and its future, to the bitter end.
Let me be clear in what I’m trying to say. I don’t care if some on the left see this as a sell-out or defeat of some principled ideal (single payer). I support addressing the problems we have with health care delivery in the country. If that means a conservative approach, so be it. It’s a step in the right direction. The Senate bill is very much a step in the right direction. But in its basic approach and philosophical framework, this is not a liberal reform bill.
It is a conservative one.
It is a testimony to the toxic power of media ideologues like Rush Limbaugh and Glenn Beck that they can so poison the atmosphere of political dialogue that people have spent months arguing over myths and distortions, with very little understanding of what the reform bills actually are trying to do and what the consequences of action—or inaction—will be.
What strikes me, as we see the Senate bill do exactly what many political insiders long predicted it would do—lose the public option—is how conservative health care reform is turning out to be. If the Senate bill passes and the final legislation mirrors its current proposals—which is not certain, but still likely—we will have what should be a conservative’s dream health care reform law.
It is still a private system. It has no large government plan. It reduces the deficit. It provides subsidies to health insurance plans to cover the uninsured (which is the only realistic way to solve this problem, if you refuse to consider a government option). It gives the drug manufacturers what they want. It doesn’t force physicians to deal with a new government bureaucracy.
Certainly it doesn’t please everyone. All those groups and many more have found reasons to criticize the bill. But it would be wrong to be willfully blind to how much this reform tries to meet all the various stakeholders half way.
In today’s political realities, of course, that’s not good enough. Willful blindness is all the rage. The bill is too conservative for Howard Dean, so he wants to tear it up and start over. It’s too restrictive for the health plans, so they oppose it. And of course, if it comes from the Democrats and Obama, the Fox News world must reflexively hate it.
What the Fox News world doesn’t realize is, they’ve won. If they really believe what they say: that they in fact DO want to reform health care, but they want to do it without the government taking over the health care system, then they have won.
But what they say and what they really want are obviously two different things. Their real opposition is to letting the Democrats get credit for fixing the county’s most pressing domestic problem. It is, to use a cliché, politics as usual.
I’ve heard, over and over again, the talking points: conservatives want to reform health care, but it should include tort reform. It should allow health plans to sell insurance over state borders. It shouldn’t explode the deficit. It should empower doctors and patients to make decisions, not the government.
Well, that last one—as nonsensical as it is, since the government was never going to intrude on medical decisions in the way that reform opponents suggested—should be satisfied by the death of the public option. The sell-insurance-over-state-borders idea is part of the Senate bill. The CBO has scored both the Senate and House bill as reducing, not increasing, the deficit. Tort reform is another idea that has merit; however, the state that has done the most in the area of tort reform is Texas: a state with one of the highest rates of uninsurance as well as the most out-of-control health care cost increases. So much for that silver bullet.
The point is, conservative ideas have been co-opted by the reform bills much more than conservatives are willing to admit. The exception is tort reform, and that, by the examples we’ve seen, is not going to make that much of a difference.
But overall, a conservative approach to reforming health care is exactly what we’re looking at. The fact is, conservatives have won this round. And really, if they would realize it and support health care reform, we’d all be better off. But they won’t realize it, and they will keep trying to go down a path that will damage the country and its future, to the bitter end.
Let me be clear in what I’m trying to say. I don’t care if some on the left see this as a sell-out or defeat of some principled ideal (single payer). I support addressing the problems we have with health care delivery in the country. If that means a conservative approach, so be it. It’s a step in the right direction. The Senate bill is very much a step in the right direction. But in its basic approach and philosophical framework, this is not a liberal reform bill.
It is a conservative one.
Monday, December 14, 2009
Gold's Fool
News from the health care reform front is pretty grim today, so let's go back a week or so to Jon Stewart taking on Sold Gold Glenn.
Just a money changer in the Temple.
| The Daily Show With Jon Stewart | Mon - Thurs 11p / 10c | |||
| Beck - Not So Mellow Gold | ||||
| ||||
Just a money changer in the Temple.
Saturday, December 12, 2009
More Medicare stuff
Ezra Klein, who else, had some more comments on Medicare that I think are worth noting.
First, in a chat, he relays that according to MedPac--the agency that advises Congress on Medicare-related issues--96.8 percent of physicians say they will take new Medicare patients. So the argument that Medicare's lower reimbursements are driving doctors to stop taking Medicare patients seems, well, questionable.
Second, this very insightful post
argues that it's a mistake to simply paint insurers as the villians and physicians as the victims. Insurers seem like villians because they're doling out health--they're distributing life and death-- on a free-market basis. Of COURSE the people trying to make such a system profitable are going to seem evil. But it's the entire system that needs reform, and that includes providers.
Here's how Klein puts it:
"Most importantly, they [physicians] should be forced to work in a way that doesn't hurt society. That, after all, is the guiding principle behind the insurance reforms: Insurers will have to live with a market that society can live with. Similarly, providers will have to live within a market that society can afford. That will mean a strict budget, at least within the federal programs (and over time, as the private programs become unaffordable, they will probably come on budget as well).
First, in a chat, he relays that according to MedPac--the agency that advises Congress on Medicare-related issues--96.8 percent of physicians say they will take new Medicare patients. So the argument that Medicare's lower reimbursements are driving doctors to stop taking Medicare patients seems, well, questionable.
Second, this very insightful post
argues that it's a mistake to simply paint insurers as the villians and physicians as the victims. Insurers seem like villians because they're doling out health--they're distributing life and death-- on a free-market basis. Of COURSE the people trying to make such a system profitable are going to seem evil. But it's the entire system that needs reform, and that includes providers.
Here's how Klein puts it:
"Most importantly, they [physicians] should be forced to work in a way that doesn't hurt society. That, after all, is the guiding principle behind the insurance reforms: Insurers will have to live with a market that society can live with. Similarly, providers will have to live within a market that society can afford. That will mean a strict budget, at least within the federal programs (and over time, as the private programs become unaffordable, they will probably come on budget as well).
"Providers won't like this, of course. It means adjusting to a lot less revenue than they currently expect to have, and no one quite knows how to do that. People run businesses atop the assumption of growth, not contraction. And the complaints are understandable: They haven't been doing anything wrong, and don't feel like they should be punished.
"But this isn't punishment. This is, well, medicine. It's that or national bankruptcy. And the problem, if left untreated, will only get worse, and the eventual correction, when it comes, will only be more severe. That, however, is exactly what they're asking Snowe, and the rest of Congress, to permit. The fear with Medicare buy-in is that Medicare pays somewhat lower rates than private insurers because it tries to live within a budget, even if it fails. But like it or not, that's the future, or one variant of it. And as most providers know, putting a scary diagnosis off is generally not a good idea"
Wednesday, December 09, 2009
The Public Option is Dead. Long live the Public Option.
Very big developments in the health care reform bill being considered by the Senate. The latest is that a bunch of Senators have negotiated away the Public Option in favor of: expanding the age of Medicare eligiblity down from 65 to 55; doing some regulatory ju-jitsu to allow nonprofit health plans to compete in the insurance exchanges; and requiring health plans to spend 90 percent of every health premium dollar on actual health care.
I think that last one might be the most interesting. By some estimates, plans now use 70 percent of every premium dollar on actual health services. That would be a big change, and in theory could make health care less expensive and more efficient. Health plans in MN are required to be nonprofit and are currently spending 91 percent of ever premium dollar on health services. So it can be done. But it will be a big change for some of these for-profit plans. IF this actually happens, it could be that health plans nationwide are going to rue the day they celebrated the death of the public option.
The change in Medicare is going to be bitterly fought by hospitals and providers, who insist that they can't get by on current Medicare reimbursements. If you expand the number of people using Medicare, then the dollars coming in will be even less.
I understand their concerns, but really, doesn't everybody agree we have to bring health care costs down? So how will we do it without someone taking a hit? If the medical community had united in insisting on stronger reforms for the insurance side (ie public option or something like it) then the dollars would've come from health plan profits. Now... well, they didn't want a big govt plan for everybody, so they won't get one. But they will get a larger chunk of the population on Medicare, and less reimbursement. Tell me, do you think physicians will throw their hands up, say "I quit" and take on a different job, like, say, public school teacher, or sanitation worker?
Sorry to be snarky, but I don't think so either. There is no fixing this system without someone experiencing a little less income. The Medicare change means that someone is probably going to be (some) doctors. I would rather it had been insurance company CEOs. Maybe with the new 90 percent rule, we'll see some changes there too.
The bottom line is; everybody to right of Evan Bayh (not the most liberal of senators by a long shot) was screaming about socialized medicine and the horrors of a public option.
Maybe they should've been careful what they wished for.
I continue to think that the public option, or something like it, will eventually be tried. But what we're looking at with this bill is: regulation of plans to force them to be more inclusive and more efficient, controlling payments to providers, subsidizing citizens to help them afford premiums, and some combination of taxes/subsidies for businesses--depending largely on the size of the business. There's a lot more, obviously. But all of that falls squarely in the "significant reform" camp in my opinion. And it is very much still a private/public mix with the emphasis on private insurance.
Still, a big improvement over the current death spiral; again, in my opinion.
Update: I've been gently reminded by a certain provider that low Medicare reimbursments are a real financial problem for many primary care physicians and hospitals. And there is an actual trend away from primary care as a career because of such financial pressures. As with all of the health care reform debate, it's complicated, and my "doctors won't take up ditch digging" snark was probably an unfair dig in itself. For the record, Medicare reimbursments are an issue that many health care reformers are trying to address, and there are various parts of the current reform bill that take on this issue. I'm not sure yet how those are faring in the latest negotiations, but I'll try to provide an update at some point. In any case, reform is an ongoing process that is going to need a lot of fine-tuning. Medicare certainly is going to have be tweaked as we go down this road. But it will be easier, not harder, to do that if reform passes.
I think that last one might be the most interesting. By some estimates, plans now use 70 percent of every premium dollar on actual health services. That would be a big change, and in theory could make health care less expensive and more efficient. Health plans in MN are required to be nonprofit and are currently spending 91 percent of ever premium dollar on health services. So it can be done. But it will be a big change for some of these for-profit plans. IF this actually happens, it could be that health plans nationwide are going to rue the day they celebrated the death of the public option.
The change in Medicare is going to be bitterly fought by hospitals and providers, who insist that they can't get by on current Medicare reimbursements. If you expand the number of people using Medicare, then the dollars coming in will be even less.
I understand their concerns, but really, doesn't everybody agree we have to bring health care costs down? So how will we do it without someone taking a hit? If the medical community had united in insisting on stronger reforms for the insurance side (ie public option or something like it) then the dollars would've come from health plan profits. Now... well, they didn't want a big govt plan for everybody, so they won't get one. But they will get a larger chunk of the population on Medicare, and less reimbursement. Tell me, do you think physicians will throw their hands up, say "I quit" and take on a different job, like, say, public school teacher, or sanitation worker?
Sorry to be snarky, but I don't think so either. There is no fixing this system without someone experiencing a little less income. The Medicare change means that someone is probably going to be (some) doctors. I would rather it had been insurance company CEOs. Maybe with the new 90 percent rule, we'll see some changes there too.
The bottom line is; everybody to right of Evan Bayh (not the most liberal of senators by a long shot) was screaming about socialized medicine and the horrors of a public option.
Maybe they should've been careful what they wished for.
I continue to think that the public option, or something like it, will eventually be tried. But what we're looking at with this bill is: regulation of plans to force them to be more inclusive and more efficient, controlling payments to providers, subsidizing citizens to help them afford premiums, and some combination of taxes/subsidies for businesses--depending largely on the size of the business. There's a lot more, obviously. But all of that falls squarely in the "significant reform" camp in my opinion. And it is very much still a private/public mix with the emphasis on private insurance.
Still, a big improvement over the current death spiral; again, in my opinion.
Update: I've been gently reminded by a certain provider that low Medicare reimbursments are a real financial problem for many primary care physicians and hospitals. And there is an actual trend away from primary care as a career because of such financial pressures. As with all of the health care reform debate, it's complicated, and my "doctors won't take up ditch digging" snark was probably an unfair dig in itself. For the record, Medicare reimbursments are an issue that many health care reformers are trying to address, and there are various parts of the current reform bill that take on this issue. I'm not sure yet how those are faring in the latest negotiations, but I'll try to provide an update at some point. In any case, reform is an ongoing process that is going to need a lot of fine-tuning. Medicare certainly is going to have be tweaked as we go down this road. But it will be easier, not harder, to do that if reform passes.
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