Time for Some Hard Choices on Health Reform

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the defence bugget = the heathbuget

Augustus caesar 7:57AM October 10, 2009

Now that its clear that a majority of Americans want a public option for healthcare reform, so US News has to nitpick some other talking points from his Big Pharma advertisers.
Give it up already, you got nothing.

Hank of TN 7:13PM October 01, 2009

I would have to agree with John R of MI, unless we want to bankrupt the nation, rationing is the only way. For 19 years I worked as a career Firefighter, most of our emergency calls were medical calls. Many of the ambulance transports were REPEAT calls to the same addresses (either the elderly or the poor). One of, if not the most important points that needs to be conveyed to the American people is that EVERYONE of us is going to DIE!
I know what I'm about to say will have many people waving the torches and pitchforks, but it has got to be said. IMHO way to much money is spent (wasted) on the elderly. Settle down, I'm talking about that time when the end is inevitable, and all measures are taken to keep the patient legally alive. I often wondered to myself, how the dollars being spent here could have been used elsewhere in a more meaningful way. How many of these same patients would want this care if their estate had to pay a large percentage of the cost. I'd also like to say that there are many elderly patients who decline these (life?) sustaining measures because they have accepted the inevitable. As someone in the mid fifties I know that I am close to being a victim of my own proposal (rationing) but have no problem with that.
The poor that I encountered while working the ambulance never, I repeat never showed any concern for the cost of the services they received. They just knew how to work the system and that they were legally entitled. Many times, and I'm not kidding an ambulance would be called when all they needed was a ride to the clinic. They knew we were legally obligated to transport them by saying they were in pain. $700.00 for a ride to the clinic, it goes on everyday in every city across the country.
What we need is a National Health Plan that covers basic levels of care, a non-partisan panel should be created to set that level of care, (you feel sick you see the doctor, your break a bone it gets set) there should be a lifetime cap to be decided by the panel
and adjusted for inflation. This should be paid for with a National Sales Tax so that everyone is contributing to the cost. If the people want a plan better that initially conceived by the panel a national referendum to increase benefits along with the sales tax to pay for it could be held. Individuals could also purchase supplemental insurance from private insurers.
For those who are already whining about the rich being able to afford better care I offer the following.
An analogy: My economic circumstance has never allowed me to purchase a Cadillac, so I have always gotten around town in a Chevy or Dodge, what I could afford. To be more precise, I could have driven that Cadillac but put the extra money into savings. I might decide to use that savings to purchase the supplemental insurance. However I doubt it. I'd rather spend it doing something fun with the Grand kids, or maybe buy that Cadillac while I still have the skills to drive.

Dale L of WI 3:13PM September 22, 2009

Will you please wake up, before you are awakened and you do not like what you are awakened to! Here is my plea, let’s end the Healthcare Reform cold war before it escalates because We the People want to make our own choices about our own Country let alone our healthcare coverage!! If our elected officials truly want us to have healthcare and that is truly their impetus for all of this travail, then they will not even think twice, but to allow us this personal freedom. The People are capable of writing a healthcare policy at the grassroots level where it should be written. We the People are intelligent, caring, loving, empathetic, and sympathetic and do have the heart of our Country as the good seed needed for a healthy Reform. Good seed planted in good American soil will yield only a healthy crop which truly is the best crop, but plant bad seed in barren, heartless soil, I dare say what kind of crop one might anticipate reaping. One sows what one reaps.
The only way to disarm what appears to be a cold war effort is to have a citizen based, green grassroots cooperative that only has the best interest and the true heart of We the People of the United States in mind and find what they truly want and put it to a vote for the People and by the People. Truly, it’s just that simple! Because what Universal Healthcare coverage sounds to the People is a GIGANTIC stepping stone or a portal to either socialization and or globalization. Truly, the People believe Universal healthcare is a euphemism for globalization. Stop! We the People of the United States do not want anything socialized or globalized! The People are not stepping stones to socialization which can quickly turn into the hedge for Communism. We are a Democracy and we will always be a Democracy and all that it stands for which is freedom of choice!
Socialization and globalization are the daydreams of those hungering and thirsting for wealth and power! Will you ask yourself, why does it take a lengthy document to explain healthcare? Sounds like a complicated war plan to keep the proxy, The People, in a state of confusion! It sounds like the perfect vehicle for a covert sabotage. Just think about it, how easy it is to place some simple lines of deceit in very complicated language that requires interpretation for the interpretation. The real impact of sign here, right now doesn’t appear in a few days, weeks, or months as the dust is settling, but one day it occurs and it isn’t as it was explained, but now it is too late. Then you will stop and think, and sadly realize, this is happening to me, this is happening to us.
Ask yourself this question: “What will the cause and effect be inasmuch as we witness daily so much of our citizenry fighting about everything and the growing tension within our borders is building and building yet this type of building is dismantling this country at its very foundation: the Constitution.” There are so many amendments and bills and so many ways for interpretation that the interpretation needs to be clearly interpreted. All that this beautiful country has built and created and stood for since its foundation seems to be falling apart or weakening and we ask why! Because we all want what we want in our own way no matter what the cost might be and we want it right here, and right now! Do we ever think what the cost might be down the road? Think what we will pay in interest and think about that in exponential terms, throw in the fine print of a contract and growth and decay of what you are buying and what do you end up with in the end? Stand up before it’s too late as we are talking about the health of our country!

T. Strom of ID 12:47AM September 22, 2009

First, much depend on forcing the uninsured to pay for alot of it. While this is within the power of the states, but not of the Federal government.
Proposing subsidies up to molre than $88,000 income is ridiculously unafordable.
Some bad ideas.

John D. Froelich of PA 7:48PM September 21, 2009

take the 600 billion obama's going to save in medicare and insure the apx 12million who cant aford it.
Problem solved

djmelfi of WI 6:05PM September 21, 2009

This column is a huge disappointment - it seems to start out accepting the stated goals and policy preferences of the advocates of "reform" as a given, and focuses mainly on finding a way to raise enough taxes to pay for achieving them.
Start with a couple of salient points: the goal is to have everyone in the country covered by "insurance", and the "insurance" will pay most (or potentially nearly all) medical costs for all patients, with no family paying more than $10,000 out of pocket in any year under any circumstances. This approach is the heart of the cost problem: all patients would be separated from the cost-benefit analysis to determine whether a particular test/procedure/treatment/prescription is worth paying for. On the contrary, patients would reasonably conclude that they had already paid for all available treatments through their enormously high premiums, so it would only be right to use any treatment that offered benefits. You briefly touch on this issue under "tackling costs directly", but you don't give it the attention I believe it deserves. Many have pointed out that any system will ration health care in some way: either through price, or through access, or through waiting lines, or through "formularies" that detail what will or won't be paid for. Any system that doesn't include the patient will inevitably leave the patient feeling abused by the system; forcing the decision on the patient will force him to deal with the cost issue. I wouldn't be so foolish as to think that any of us would gladly forego treatment to save money, but we'd at least have a better chance of recognizing that we did the best possible, and we could live with the consequences.
All of this would not necessarily reduce overall health care spending. Some of us might prefer to have an insurance policy that guaranteed all available treatment, and be willing to pay for it. This wouldn't threaten government finances, productivity, or competitiveness: it would simply be a decision on allocation of resources. But there's fundamentally no "right" level of total health care spending, and spending that's constrained by individuals' resources won't endanger anyone's finances. Fostering the expectation that we can have all the best care as a matter of right, while paying no more than 5% of our income (or some other arbitrary limit) is a sure road to dissatisfaction on the part of patients and fiscal ruin for the government.

CTObserver of CT 5:15PM September 21, 2009

It's nice to read someone actually studying this... and has valid examples of how and why what the libs are trying to tell us, are bald faced lies. Their bills will not do what they say they will... which has been proven over and over by the likes of the CBO and others. I would rather no reform, and wait until we get a sensible majority back in office to pass something along the lines of HR3400, than this massacre of our excellent health care system.
Why blow up a system that works for 95% of americans, and at least 85% of those insured, are happy with their care... just to insure the remaining 5%. Costs can be brought under control using some of the ideas in HR3400 (some of which were explained in this article). There is no silver bullet, but putting several of these free market principals can create the silver bullet we are longing for.
Also the libs are making things more complicated by intertwining cost problems with the plight of those without insurance. Lets keep things uncluttered. We have 2 problems: Costs, and the uninsured. Costs can be rectified pretty painlessly (HR3400).
The uninsured problem can be solved/helped by allowing people to buy insurance across state lines, and allowing small businesses and individuals to band together to buy group policies that are cheaper, thus bringing insurance cost down to more affordable points for more people.
Unfortunately, not all people WILL get insurance, or can be insured due to massive risks, or because they are young and don't really need it... however some reforms such as allowing people to keep their insurance when they lose their jobs, will help alleviate that problem, as if you are insured via work, and are conically ill, and lose your job, you can still maintain coverage. Cause once you lose coverage due to unemployment, the chronically ill cannot get more insurance.
TLDNR(too long didn't read version): Keep your filthy hands off my health care!

JC of CA 5:15PM September 21, 2009

I have had three cancer diagnoses/treatments (for breast, melanoma, and colon) since going on Medicare 9 years ago and am very thankful that Medicare plus my retiree's medical insurance have been there for me. However, in my experience I have encountered on three occasions (that I know of!) prescribed procedures that I believed were unnecessary. In each case when I questioned the doctors' recommendation, each responded that the procedure wasn't really necessary, just precautionary and I opted out. I suspecr that there is a lot of this "in the system" and removing such recommendations would significantly reduce Medicare costs without affecting the quality of care or desirable outcomes.

Elizabeth of GA 4:43PM September 21, 2009

If the Dems really wanted to put forth a bill that the Repubs would accept, they should give up on all of this public option stuff and instead implement some reforms that have been tried and do work. Hillarycare offered managed care where healthcare services were capitated. This lowerd costs quite a bit in California when implemented, but it put the cost savings part of the plan on the backs of the service providers. Large HMOs set up regional plans called IPAs which then cut the physician cost component way down. The only thing they never were able to work on prior to the Dems killing the model was the hospital component.
However the reason the capitation model worked was because the major insurers in the state, Blue cross and Blue Shield (different plans in CA) audited the Medicare and Medicaid claims for the government... so Medicare slid right along. There were even new Medicare managed care plans that emerged such as Secure Horizons.
I see this type of system working nationally because it will give the government something that it knows how to do... rate setting. It will also give the Dems their government option.. and 2-3 years down the line monney will actually be saved (it takes 2-3 annual cycles of bidding before the real cutthroat competition comes into play). And the best part is... patients love it because they get all the care THEY want for the same price.
Since Hillary is in a box over at the State Department and will quit in 2010 to run for President against a hapless Obama... better to put her to immediate use.

Spotty's Dad of CA 4:39PM September 21, 2009