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Tilting at Windmills

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January 3, 2006
By: Kevin Drum

STUPID OR VENAL?....Over at the Prospect, Bob Kuttner asks the eternal question: stupid or venal? The motivation for the question this time around is the Medicare prescription drug benefit, and given George Bush's well-known disdain for actual policy analysis I suppose you could make a reasonable case for stupid as the guiding principle behind this mess although it would be a very specific and willfull brand of stupid. But in the end, it just doesn't stick. Even aggressive ignorance couldn't have produced this particular sausage.

So venal it is. In fact, the Medicare prescription bill is such an astonishingly bad piece of legislation that it's hard not to believe that it was deliberately designed to prove that the federal government can't be trusted to do a good job of administering healthcare as of course it can't be as long as people dedicated to proving this very point are in charge of the federal government. This leads Kuttner to propose that Democrats should campaign this year on the promise that they're the only ones who can fix this abomination, and he may be right. After all, 2006 is the year that an awful lot of people are going to find out firsthand just exactly what the Republican Party's idea of good legislation really is.

Kevin Drum 3:17 PM Permalink | Trackbacks | Comments (124)

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Kevin Drum: the Medicare prescription bill is such an astonishingly bad piece of legislation that it's hard not to believe that it was deliberately designed to prove that the federal government can't be trusted to do a good job of administering healthcare

Simpler, and hence more likely, explanation: payola to drug companies.

Democrats: get blowjobs while in office.

Republicans: give blowjobs while in office.

Posted by: alex on January 3, 2006 at 3:30 PM | PERMALINK

You mean they can't get nothing right?

Posted by: scott on January 3, 2006 at 3:33 PM | PERMALINK

Add to your "malice" argument--

There's a poison pill in the Medicare drug bill. Once Medicare pays more than 45% of its costs out of general revenues (and not payroll taxes) for 2 years, the program is declared to be "in crisis." Congress is limited to only 2 options to resolve this "crisis"--to cut benefits or increase payroll taxes.

Since the new drug benefit will be paid entirely out of general revenues, it's quite obviously going to bring this "crisis" to bear more quickly. In fact, the bigger the giveaway to pharma interests, the more quickly this "crisis" comes.

It's definitely an attempt to kill Medicare, and to give away money to special interests as they do it. This is their idea of "responsible legislating."

http://www.brook.edu/views/articles/aaron/20040115.htm

Posted by: theorajones on January 3, 2006 at 3:35 PM | PERMALINK

bub...bub...but the Democrats don't have any ideas!

Posted by: grytpype on January 3, 2006 at 3:36 PM | PERMALINK

Venal is clearly the best answer.

While the article puts forth several arguments the aspect of the program that most glaringly reveals the purpose is to line the wallets of supporters is found in the portion completely dissallowing government bargaining thereby literally tying both hands behind the back of anyone trying to negotiate a good deal for tax payers.

Look at the two of the most influential people who developed this bill who both got lucrative jobs for employers who benefited greatly from the bill:

Congressman Billy Tauzin (R-LA) became President and CEO of the Pharmaceutical Research and Manufacturers of America (PhRMA), following his retirement from the House of Representatives in January. Congressman Tauzin served 24 years in Congress and is the former Chairman of the House Energy and Commerce Committee. Tauzin is credited as one of the "architects" of Medicare Modernization Act of 2003 (MMA) which created a prescription drug benefit for Medicare recipients.


Medicare chief Thomas Scully, was negotiating with Congress on the shape of the bill at the same time as he was in discussions with his prospective employers, who stand to profit from the legislation. While browbeating lower-level HHS employees into suppressing the cost estimates for the bill, Scully had HHS give him a waiver of the federal law that bars presidential appointees from discussing employment with companies conducting business with their own department or agency.

Posted by: Catch 22 on January 3, 2006 at 3:38 PM | PERMALINK

Actually, the Democrats here in uber-blue California do have an idea -- the wrong one. Diane Feinstein, our 2006 nominee for U.S. Senate, voted for the prescription drugs bill.

Posted by: Alan in SF on January 3, 2006 at 3:39 PM | PERMALINK

Over at the Prospect, Bob Kuttner asks the eternal question: stupid or venal? The motivation for the question this time around is the Medicare prescription drug benefit

The motivation for the law was to help the elderly get the cheapest drug bill possible given the current system. Unfortunately the current system is a big government liberal system where the government is controlling the price of drug benefits and spending massive amounts of money on what is basically a welfare check for drugs. This causes huge problems because this prevents the free market from working on the system where competitors would sell drugs and the competition would cause low prices. If liberals really want to help the elderly they should support eliminating any government regulations and support for drugs. Then the free market would take over and drug prices would be much more cheaper and affordable.

Posted by: Al on January 3, 2006 at 3:41 PM | PERMALINK

Venal it is.

Don't forget the logic of making the program so complicated to enlist in that it discourages participation, hence avoiding the universal constituency that's made Social Security so hard for the GOP to kill.

Posted by: brooksfoe on January 3, 2006 at 3:43 PM | PERMALINK

Then the free market would take over and drug prices would be much more cheaper and affordable.

Al, drink your tea and get ready for bed. That's a good boy.

Posted by: brooksfoe on January 3, 2006 at 3:46 PM | PERMALINK

If liberals really want to help the elderly they should support eliminating any government regulations and support for drugs.

What a good idea. Let the buyer beware. Thalidomide for all pregnant women.

If we have learned one thing, we have learned that drugs kill people. The standard moron liberatarian like Al the Bozo suggests that the public be used as the test bed for new drugs.

You're an idiot, Al.

Posted by: POed Liberal on January 3, 2006 at 3:47 PM | PERMALINK

What the dems need to do is the following

1) The Repukes don't care about the elderly.

2) They do want to kill Social Security.

3) If re-elected, they will try to kill SS again.

4) Or, even more likely, it will be made as confusing and as unfair as the Medicare prescription program.

Posted by: POed Liberal on January 3, 2006 at 3:48 PM | PERMALINK

POed Liberal has it. Nice work.

I think we can also slip in something about balanced budgets there, too. Like, Clinton balanced the budget and Bush blew it up. Democrats are more responsible.

Posted by: theorajones on January 3, 2006 at 3:51 PM | PERMALINK

I'd throw in Lazy.

Good governance is hard work. Developing effective social policies in immensely complicated areas like health care, or pensions takes a lot of hard studying and analysis. You have to weigh dozens of complex trade-offs and examine multiple possible un-intended consequences.

And it doesn't appear that the modern GOP cares about that. Just do it. (Based on whatever we happen to believe at the moment.)

I see few, if any stories, anywhere about top leaders of the administration working hard to really figure out issues and develop effective policies. You see tons of stories of swaggering around and blustering. But few about actual nuts and bolts hard work.

So that's my suggestion: they just don't like to work hard. They're lazy and that's a big common feature in the deficit, Iraq, Medicare, etc.

No-one wanted to put in the hard work required. And thus, it wasn't done right.

Posted by: Samuel Knight on January 3, 2006 at 3:56 PM | PERMALINK

Just another big government failure.

Posted by: Matt on January 3, 2006 at 4:02 PM | PERMALINK

I wonder what the price markup on a drug from the manufacturer to the drug store is?

Posted by: WhoSays on January 3, 2006 at 4:06 PM | PERMALINK

all that mattered when this legislation passed was giving bush something to hold up to seniors in the 2004 campaign and say "i've done something for you." didn't matter if it worked or not, since he would not feel the rath of voters if it didn't. all he wanted was to neutralize somewhat the democrat's advantage among elderly voters. cynical politics at its worst.

oh, and al does not exist.

Posted by: mudwall jackson on January 3, 2006 at 4:12 PM | PERMALINK

Actually, on this time, troll Al is exactly right. Although he has no f'n idea what he's talking about. The free market is actually the solution for the pharmasutical problem. Too bad the Bush solution is to eliminate the free market.

Allow the government to negoiate as a mass buyer, and as well vastly shorten the patent length for pharmasuticals...and if it uses research paid for by public funds, play hardball with it.

A kind of fruit of the poison tree type thing.

Posted by: Karmakin on January 3, 2006 at 4:13 PM | PERMALINK

Matt wrote: "Just another big government failure."

No. This one was deliberately set up to be a "failure," at least so far as its stated goals. It was and is, however, completely successful with respect to its real intentions. And the whole point of Kevin's post is that this is anything but an ordinary failure. The law of unintended consequences does not apply when so many of the consequences quite clearly were intended.

Posted by: PaulB on January 3, 2006 at 4:13 PM | PERMALINK

Holy sweet Jesus Kevin... Abramhoff has pleaded guilty and is expected to implicate members of Congress. Time to shift gears.

Posted by: tripoley on January 3, 2006 at 4:16 PM | PERMALINK

The answer clearly is venal, as in "who can I reward today so that they will continue to support me".

Posted by: JB (not John Bolton) on January 3, 2006 at 4:17 PM | PERMALINK

Medicare Part D is a badly flawed benefit, but it is a real benefit, enabling people to get equivalent or better drug coverage at a lower price than they would be charged on a Medigap policy, for example. Also, since large insurance companies are providing the programs, it is not true to assert that they have no bargaining power with the drug companies.

But probably it could be carried out at lower cost to the government by Medicare itself, and someday this will happen as the insurance companies lose their benefactor Bush.

Posted by: bob h on January 3, 2006 at 4:19 PM | PERMALINK

My father is one of the those Republicans who doesn't care about anything else as long as they cut his taxes kind of guy. He's 69 and is trying to figure out the Medicare prescription plan mess for himself and his 93 year old mother-in-law. This Christmas, for the FIRST TIME EVER I heard him criticizing (vehemently) the Administration and Republicans in general about how they've screwed up Medicare and made it impossible for everyday folks to plan or figure out.
So maybe there's hope in this issue after all

Posted by: Andy on January 3, 2006 at 4:19 PM | PERMALINK

Holy.

It makes some of my most devoted servants (Drug Company CEO's) very rich, at everyone else's expense, so hell yes, Holy. Not stupid. Not venal.

Such legislation shall be enshrined in the holy scriptures of my religion.

Bow before the almighty dollar you cockroaches.

Posted by: Mammon on January 3, 2006 at 4:22 PM | PERMALINK
Medicare Part D is a badly flawed benefit, but it is a real benefit, enabling people to get equivalent or better drug coverage at a lower price than they would be charged on a Medigap policy, for example. Also, since large insurance companies are providing the programs, it is not true to assert that they have no bargaining power with the drug companies.

But probably it could be carried out at lower cost to the government by Medicare itself, and someday this will happen as the insurance companies lose their benefactor Bush.

That's a boy, Dr. Pangloss... I mean Dr. Hall. One ought to apply a little creative destruction and revoke your degree.

Posted by: SavageView on January 3, 2006 at 4:28 PM | PERMALINK

Don't get your hopes up.

One more red alert and one more speech about we are fighting them over there so we don't have to fight them over here will silence the sissy seniors and everybody else. Sad but true.

Posted by: lib on January 3, 2006 at 4:29 PM | PERMALINK

"Unfortunately the current system is a big government liberal system where the government is controlling the price of drug benefits and spending massive amounts of money on what is basically a welfare check for drugs. This causes huge problems because this prevents the free market from working on the system where competitors would sell drugs and the competition would cause low prices. If liberals really want to help the elderly they should support eliminating any government regulations and support for drugs. Then the free market would take over and drug prices would be much more cheaper and affordable."
--Al

Al,

You just couldn't be more wrong, if you tried. I'm not sure what 'current system' you are referring to, but if you mean Medicare Part D, it was in fact, engineered by Republicans. It is also the antithesis of free market economics. In fact, the Republicans prohibited the government from using the leverage of their size and the economies of scale and scope they command in negotiating with the big pharmaceutical companies. As a result, everyone will pay higher drug prices.

Don't kid yourself. The Bushies don't want so-called free markets - they want rigged markets. That is a distinguishing hallmark of fascist regimes like this one. If markets were truly "free", behemoths like ExxonMobil and Alcoa would have ceased to be years ago. They continue to function and dominate in certain markets due to anti-capitalistic protections they are provided by the GOP criminals in Congress.

So, next time, before you so publicly display your ignorance, could you please bother to read a little about a topic before you make such a damn fool of yourself? Thank you.

Posted by: Stephen Kriz on January 3, 2006 at 4:31 PM | PERMALINK

Holy sweet Jesus Kevin... Abramhoff has pleaded guilty and is expected to implicate members of Congress. Time to shift gears.
Posted by: tripoley on January 3, 2006 at 4:16 PM | PERMALINK

You honestly expect Kevin Drum to devote yet another post to "the criminalization of politics"? (for which Abramoff is, and will remain for the rest of his days (may they all be behind bars) deeply sorry).

Posted by: Osama_Been_Forgotten on January 3, 2006 at 4:31 PM | PERMALINK

I agree with Kuttner that V.A.-style bulk buying should be implemented. I also think it would be simpler and cheaper NOT to farm out the program to private insurers. But this bitching and moaning about the "doughnut hole" has got to stop. Heaven forbid that government require beneficiaries to share some of the costs of the program along with taxpayers. I notice he's all for raising taxes, too, but is strangely silent on the concept of charging rich old people more for plan participation than poor ones. Funny, that.

Posted by: Fangorn on January 3, 2006 at 4:31 PM | PERMALINK


A slogan for Democrats that shows up only a handful of times in a Google search:

If you care about Medicare . . .

Posted by: Ross Best on January 3, 2006 at 4:39 PM | PERMALINK

Unless you have elderly relatives you have no idea just how craptacular this program is. I spent two full days with my mother-in-law going over her options. There were 44 different private plans with a multitude of options. Some cover 50% of costs for monthly premium of x dollars and 70% of costs for a monthly premium of y dollars. You have to check each plan to see which drugs are covered and which are not -- they all have different coverage. You have to figure out if it is better to get the plan that covers your three cheap drugs or the other plan that covers your one expensive drug. The matrix of combinations is enormous. The only practical way to research the plans and figure out which drugs are covered is via the internet. Good luck if your mother doesn't have a computer. And as soon as you sign up with one insurer, they can completely change their rates and coverage with 30 days notice. You are only allowed to change plans once a year so are stuck. And for every month that you delay signing up to start paying premiums after May 2006 your rates go up by 1% per month -- for the rest of your life. My mother-in-law was furious at the coersion and implied threat. We finally decided to sign up for the very cheapest plan -- only $10 a month with minimal coverage -- just so she could avoid the future penalties. We assume this is all going to blow up and completely changed in the next six months.

Posted by: BillB on January 3, 2006 at 4:39 PM | PERMALINK

AL is almost right,It is a big wefare check,But to big Phamra.Good eye AL.

Posted by: scott on January 3, 2006 at 4:44 PM | PERMALINK

I keep reading these stories, but my experience is different than what they would lead you to expect. I have enrolled my mother, my aunt, and a friend of my mother's in two different programs. They all willsave money over what they have been paying for prescriptions assuming nothing changes, and there is some coverage for anything new that might come up. At least one company, Humana, does offer coverage for the doughnut hole, if you want to pay more for it. And, the government may not be able to negotiate discounts with the drug companies, but the insurance companies sure as hell have, and the plan my mother signed up for will allow her to get the negotiated discount price on prescriptions that aren't covered-- for exzmple,the amount required to meet the deductible. The first prescription I picked up for her, Humal;og (a form of insulin) today was about a third less thnn she had payed a month ago because she now gets the discounted price.

If you assist any elderly folks with their medical and financial decisions, don't tke these polemical articles as necessrily applying to their situation. Go to www.medicare.gov, and you will find tools you can use to get the EXACT costs for the precise prescriptions they take.

Also, at our church, the folks that have been helping our elderly members say that at least a fourth of the people they have helped qualify for premium assistance, which means, in essence, they pay nothing for coverage, and only 5% of out of pocket costs, without the doughnut.

Your mileage may vary, but don't assume these negative remarks will aspply to everyone. For my aunt, this was a Godsend, since her assisted living facility went up at the first of the year; the medicare drug progam cost savings will cover about ahlf of tht for her.

Posted by: Dan on January 3, 2006 at 4:48 PM | PERMALINK

What about seniors without smart children? Or seniors who are not smart?

I wonder if anyone will track the fatalities that will result from this latest example of Bush's once vaulted CEO management style.

Posted by: Matthew on January 3, 2006 at 4:50 PM | PERMALINK
Your mileage may vary, but don't assume these negative remarks will aspply to everyone. For my aunt, this was a Godsend, since her assisted living facility went up at the first of the year; the medicare drug progam cost savings will cover about ahlf of tht for her.

The program could have been better. It should have been structured as an entitlement, not an insurance program. The transactions costs are vastly higher under the current program.

Posted by: SavageView on January 3, 2006 at 4:56 PM | PERMALINK

"the Medicare prescription drug benefit ... is such an astonishingly bad piece of legislation that it's hard not to believe that it was deliberately designed to prove that the federal government can't be trusted to do a good job of administering healthcare"

But that's just it, it's NOT a "MEDICARE prescription drug benefit". It is a private-sector provided drug benefit. So it's not the federal government that cannot be trusted, but Corporate America.
.

Posted by: VJ on January 3, 2006 at 4:58 PM | PERMALINK

Judging by the initial reception by beneficiaries, Congress and the market alike, the Medicare drug benefit is off to a rocky start. That should come as a surprise to no one for a program that was designed to fail.

For the full story, see:

"Medicare's Prescription for Failure."

Posted by: AvengingAngel on January 3, 2006 at 5:01 PM | PERMALINK

I jsut checked, and according to the Medicare web site, in this area a senior would pay $1401 out of pocket if all he or she took was Zocor and Protonix at the most commonly used dosages. That is a $1000 a year savings over Kuttner's scare examples.

Plus, my doctor says Zocor goes generic this year, so the deal gets even better.

Posted by: Dan on January 3, 2006 at 5:02 PM | PERMALINK

Then the free market would take over and drug prices would be much more cheaper and affordable.

I wonderful piece of trickledown thinking. Not much trickled down to shrub. His daddy calls it voodoo.

Posted by: G on January 3, 2006 at 5:05 PM | PERMALINK

Any time I am asked about the drug plan nonsense, I recommend not having anything to do with it. It will not last more than a few months past this current President. It is, beyond insane levels of defense spending, THE biggest budget buster in the government's budget and it simply cannot be sustained. It HAS to die, there is no option.

Between the idiocy of having a bazillion different plans with a gazillion lines of fine print per plan and the fact that it is unsustainable, PERIOD, budget-wise, there is no point in getting in on the debacle. Just forget about it, wait a few years, and the entire shitpile will disappear and, with any logic or justice, be replaced by a nice, cheaper, superior single-payer medical system that involves EVERYONE. True medical system reform.

The Medicare Drug Plan is a joke and will go down in flames as one of the most irresponsible, idiotic schemes ever devised...and hopefully become a permanent part of GOP history. A way to scare voters forever from ever giving those clowns anything remotely close to the reigns of governance ever again.

The Medicare Drug Plan is a rope that the GOP (and Bush) is using to put a noose around the neck of the lot of them.

Posted by: Praedor Atrebates on January 3, 2006 at 5:07 PM | PERMALINK

"The Medicare Drug Plan is a joke and will go down in flames as one of the most irresponsible, idiotic schemes ever devised"

Well, of course, the libeals can spend twice as much and do it better?

Get real. More Medicare Drug Plans is exactly what we expect when big government liberals are in charge. And no amount of screwing Frenchmen (are there any left?) will change that.

Posted by: Matt on January 3, 2006 at 5:20 PM | PERMALINK

This is a PERFECT EXAMPLE of the recent psychology masterpiece "The Paradox of Choice: Why more is less." If you have 1 choice, you feel constricted. 2, 3, 4 great. When you get to 5 or 6 things start to get confusing.

44 is insane.

When you have many many choices, which differ on many many dimensions, you cannot choose, because it is too difficult to understand the number of dimensions. You can't trade them off.

The main fault here is that the repukes WANTED it to be confusing, and they wanted huge numbers to FAIL to take the program.

Why?

Simple. They get it both ways. They have offered a drug plan. However, they don't have to pay for it, since no one wants it.

We need to start to organize the old, to get them on their feet and screaming at these anti-individual corporate theives in the Repukeliscum party.

Posted by: POed Liberal on January 3, 2006 at 5:37 PM | PERMALINK

Was the electricity deregulation in California stupid or venal?

Bad legislation is not confined to one party or another. Buy a few votes, blow smoke around the issue, stir a crisis, then vote it through in a rush. Stupid and Venal are both best buddies to the corrupt.

Posted by: MobiusKlein on January 3, 2006 at 5:37 PM | PERMALINK

What was needed to make this a useable, sensible program is simple:

1) The government should use its vast clout to negotiate.

2) You get certain amounts of benefits. You can trade them off in 2 or 3 ways, no more

3) Every aspect of the program would be regulated.

This isn't capitalism. It's the Ownership Society, in which you, the consumer, are owned by the corporations.

Posted by: POed Liberal on January 3, 2006 at 5:40 PM | PERMALINK

...Stupid and Venal are both best buddies to the corrupt.
Posted by: MobiusKlein on January 3, 2006 at 5:37 PM | PERMALINK

They're the MO of the Republican Culture of Corruption.

Posted by: Osama_Been_Forgotten on January 3, 2006 at 5:53 PM | PERMALINK

Dear POed Liberal:

I love the phrase "Ownership Society", because then liberals can ask conservatives, 'Since you believe in ownership so strongly, I guess you are also taking ownership for the $5 trillion in debt that the last three Republican presidents have rung up too? After all, ownership means taking responsibility not only for your assets but also your liabilities too.'

It shuts them up real quick.....

Posted by: Stephen Kriz on January 3, 2006 at 5:53 PM | PERMALINK

2006 is the year that an awful lot of people are going to find out firsthand just exactly what the Republican Party's idea of good legislation really is

Very True. Eventually, Bush the Lesser, will have done more to further the liberal cause that either FDR or LBJ:

The cagey incompetence of Karl Rove & the twisted values of the Republican-Corporate party as represented by Bush's attempt to give social security to Wall Street and Medicare to the Pharmaceuticals will linger in the minds of every aging baby boomers for years to come.

Posted by: Matthew on January 3, 2006 at 6:16 PM | PERMALINK

So venal it is.

It's defensive. Bad as it is, it will cost less in tax money than the Democratic alternative. The Democrats want price controls on new medications ("negotiated", not "forced"). With such a price regime, the US pharmaceutical companies would have to reduce their investments in new drugs to the levels of Canada and Brazil (a continuation of the medical economics themes from the other thread.) Liberals want to starve the goose that lays the golden eggs, but the Republican alternative does not do that.

After all, 2006 is the year that an awful lot of people are going to find out firsthand just exactly what the Republican Party's idea of good legislation really is.

With construction booming (see my earliest post), with the energy program getting under way, with the tort and bankruptcy reforms taking effect, and with fuel prices having plummeted about 33% from their highs because of market adjustments, I bet that the voters will on the whole be more satisfied with the Republicans than with the Democrats.

Posted by: contentious on January 3, 2006 at 6:18 PM | PERMALINK

I think liberals are just cheesed off that this program came out with a Republican stamp on it instead of a Democratic one.

1) The government should use its vast clout to negotiate.

The "negotiation" bit is shorthand for Federal price controls at these levels of usage. Who pays the difference, or makes up the costs?

If you're going to be slashing the profits, is the government going to be giving the pharmaceutical companies any breaks on the costs of drug approvals?

Posted by: tbrosz on January 3, 2006 at 6:34 PM | PERMALINK

More than one paid hack on this site.

Posted by: scott on January 3, 2006 at 6:37 PM | PERMALINK

"Have the Democrats Gone Too Far?"

But any fool can see that the handling of this is a ploy by the Democrats to single out and descend on an opponent like sharks.

Skip the drama, let the courts handle this.

Although I could very much see it in Bush's favor to pardon him and get back to business.

Posted by: Lowtax on January 3, 2006 at 6:49 PM | PERMALINK

If you're going to be slashing the profits, is the government going to be giving the pharmaceutical companies any breaks on the costs of drug approvals?

Such a turnip.

They can take it out of the marketing budget. Maybe we can get all those ED ads off TV.

See, that isn't so hard, if you aren't a moron.

Posted by: POed Liberal on January 3, 2006 at 6:49 PM | PERMALINK

...With such a price regime, the US pharmaceutical companies would have to reduce their investments...
Posted by: contentious on January 3, 2006 at 6:18 PM | PERMALINK

Necessity is the mother of invention. Not guaranteed 15% ROI.

Profit motive will not yeild cures. Only treatments.

God Money's not looking for the cure.

With construction booming (see my earliest post), with the energy program getting under way, with the tort and bankruptcy reforms taking effect, and with fuel prices having plummeted about 33% from their highs because of market adjustments, I bet that the voters will on the whole be more satisfied with the Republicans than with the Democrats.

Too bad the drug companies can't invent a drug that cures denial.
Housing sales in November - down 11%.
Natural Gas prices - up 40%.
contentious denial of reality - up 100%!

Posted by: Osama_Been_Forgotten on January 3, 2006 at 6:50 PM | PERMALINK

Who pays the difference, or makes up the costs?Posted by: tbrosz on January 3, 2006 at 6:34 PM | PERMALINK

The drug company CEO's yacht dealer? Who gives a crap?

Posted by: Osama_Been_Forgotten on January 3, 2006 at 6:52 PM | PERMALINK

I think liberals are just cheesed off that this program came out with a Republican stamp on it instead of a Democratic one.

That's a laugh and a half. I imagine tbrosz already has a list of the Democrats that voted for it, just so he can pretend later on that the blame for the disaster is bipartisan.

And isn't it cute the way the libertarian faith in the free market vanishes when the government does the negotiating?

I'd say shame on you, tbrosz, but that post was just too funny.

Posted by: Gregory on January 3, 2006 at 6:59 PM | PERMALINK

Senate and House members should give up their medical benefits as a show of support of their voting for this bill. They should live by the laws they pass.

1-2-3-4

Posted by: Salome on January 3, 2006 at 7:02 PM | PERMALINK

Gregory:

The term "negotiate" is being tossed around here quite freely. When I negotiate with somebody, I don't bring a gun to the table. The government does. Or are you assuming the pharmaceutical companies can just walk away from the table if they don't like the deal?

"Negotiate" means the government sets the prices, period.

Posted by: tbrosz on January 3, 2006 at 7:10 PM | PERMALINK

Who pays the difference, or makes up the costs?

Who gives a crap?

And there you pretty much have liberal economic theory in a nutshell.

Go do some research on where the vaccine manufacturing companies went, and why.

Posted by: tbrosz on January 3, 2006 at 7:12 PM | PERMALINK

Pat:

He stuck the list of plans on a dartboard and he and his mother joined hands in prayer before throwing the dart.

Bob

Posted by: rmck1 on January 3, 2006 at 7:12 PM | PERMALINK

tbrosz:

They're all manufacturing Viagra now.

Bob

Posted by: rmck1 on January 3, 2006 at 7:14 PM | PERMALINK

The Medicare law is the qunitessential quid pro quo document. It should be thrown out in its entirety because it is illegal. It is also both stupid and venal.

Posted by: Mazurka on January 3, 2006 at 7:15 PM | PERMALINK

tbrosz:

Thanks for helping supply that the evidence that healthcare is a non-negotiable captive market and is not optimally allocated by free market solutions.

Bob

Posted by: rmck1 on January 3, 2006 at 7:17 PM | PERMALINK

The only solution:

B-52 runs over Hartford, Connecticut.

Seriously.

End the private healthcare industry.

Bob

Posted by: rmck1 on January 3, 2006 at 7:19 PM | PERMALINK

End the private healthcare INSURANCE industry, that should have read.

Bob

Posted by: rmck1 on January 3, 2006 at 7:20 PM | PERMALINK

When I negotiate with somebody, I don't bring a gun to the table. The government does.

Well, I have to hand it to you, tbrosz, that level of paranoia is making you sound more like a real libertarian.

Or are you assuming the pharmaceutical companies can just walk away from the table if they don't like the deal?

Do you have any reason -- other than your well-known pose of cynicism -- that justifies your evident assumption that they can't?

Yes, tbrosz, the government's large purchasing power gives them leverage. But somehow other industries -- defense contractors, and dare I say, aerospace contractors -- manage to make a profit from their dealings with Uncle Sam. Yes indeed, tbrosz, if pharma couldn't make a buck selling to Medicaid, they wouldn't.

Again, your sudden pooh-poohing of fundamental market forces is most amusing, tbrosz.

Posted by: Gregory on January 3, 2006 at 7:21 PM | PERMALINK

Bob:

No, you were right the first time. There really isn't any difference.

Posted by: tbrosz on January 3, 2006 at 7:22 PM | PERMALINK

tbrosz:

What would make you think that fee-for-service medical care wouldn't exist?

Wouldn't be very popular with a single-payer system, but the choice would certainly remain for those who could afford it, or for inexpensive proceedures.

Bob

Posted by: rmck1 on January 3, 2006 at 7:25 PM | PERMALINK

Just when you think that tbrosz cannot possibly twist this into his usual moronic slant, lo and behold, he comes along and writes the most senseless post one more time.

Posted by: lib on January 3, 2006 at 7:31 PM | PERMALINK

I've been helping my mother-in-law through this process. What a nightmare! I thought I'd fiqured out a methodology to it and therefore a way to determine which plan would save her the most then I discovered co-payments. Each insurance plan and company had a different level of drug co-payment. This meant that her expensive drugs would have a very high co-payment. And the nice part: the insurance companies could drop or charge a greater co-pay for her expensive drug with 30 days notice and she could not change companies within the same period. The whole thing was obviously written for insurance companies not American citizens.

Posted by: MRB on January 3, 2006 at 7:34 PM | PERMALINK

Hey tbroszie,

Can you please explain to us poor folk cursed with common sense how all these different insurance agencies competing for seniors with minutely-distingished plans and chapters of fine print help to create a *market efficiency* that would lower the cost compared to a single entitity that could pool all risk across the country?

Or should I just file that one under government does it = BAD, private sector does it = GOOD?

Because it sure looks to me like all this private insurance competition is merely creating waste, redundancy and excessive paperwork.

Bob

Posted by: rmck1 on January 3, 2006 at 7:43 PM | PERMALINK

Go do some research on where the vaccine manufacturing companies went, and why.

What a fucking moron.

Vaccines cannot be run on a capitalistic basis, and SHOULD NOT.

A government agency, run by intelligent Democratic scientists, should determine which vaccines are made available. The costs should be low, since prevention is much cheaper than cures. Even stupid moron repukes like tbrosz would figger out that getting vaccinated would be a good idea.

Health care cannot run by capitalist approaches. As a worker in the health care system, I see this FIRST HAND.

Posted by: POed Liberal on January 3, 2006 at 7:50 PM | PERMALINK

Bob:

Because it sure looks to me like all this private insurance competition is merely creating waste, redundancy and excessive paperwork.

Yeah, you sure don't see any of that dealing with the government. Maybe you think paperwork will all go away if the government is handling it all?

POedLiberal:

A government agency, run by intelligent Democratic scientists, should determine which vaccines are made available. The costs should be low, since prevention is much cheaper than cures. Even stupid moron repukes like tbrosz would figger out that getting vaccinated would be a good idea.

And who's liable if the vaccine has problems, which is one of the main issues with private manufacturers?

Posted by: tbrosz on January 3, 2006 at 8:05 PM | PERMALINK

"Negotiate" means the government sets the prices, period.
Posted by: tbrosz on January 3, 2006 at 7:10 PM | PERMALINK

No, idiot.

The drug company implicitly ALWAYS brings a gun to the table. Pay what they demand for the drug, or you die. Period. Simple as that.

"Negotiate" means you and I, and my mom and your mom, get together and pool our market power against the drug companies to set prices. One monopoly against another. If the drug company doesn't like it, the drug company can forfeit its government-granted corporate charter, and it's government-granted patent protection, and go somewhere else and do business. And another player will step in to fill the void in the market - which will happen as long as there is demand for a product, and that product exists.

And who's liable if the vaccine has problems, which is one of the main issues with private manufacturers?
Posted by: tbrosz on January 3, 2006 at 8:05 PM | PERMALINK

Effectively nobody's liable now, so since neither system solves this problem, it's a moot argument.

Posted by: Osama_Been_Forgotten on January 3, 2006 at 8:29 PM | PERMALINK

Definitely venal.

The Prescription bill forbids the government to be able to negotiate prices. So what are the results?
1) Drugs on patent will cost US patients more than virtually anywhere else in the world.
2) Your private health plan administrator is empowered to alter the prescription from your doctor and substitute a different drug. "It's just as good".
3) access to newer or more expensive drugs is cutoff unless you are willing to go to war with the health plan...try finding a private plan that allows Gleevec to be prescribed.
4) If access to newer drugs is allowed, the copays are quite steep, and may even follow a variable scale depending on the number of times you refill.

Then there is the whole generic drug world. While generics drive down prices, they aren't always made the same way as the original, and the regulations allow considerable variation between and among generics and the original, and even among generics. So if your provider has fallen in love with the generic from company x, because of price, you may pay for it with your health.

So instead of getting the best drugs at the best price, you get that for which your plan pays. And of course, there is no thing as a regular retail price for outside of plan purchases, there is the rape and pillage, ridiculous price.

Figure it out. The reason it is so complicated is so the patient is distracted while all the myriad of hands reach out to grab a piece of the price pie.

We've lived with Harry and Louise medicine for long enough.

Posted by: RickG on January 3, 2006 at 8:36 PM | PERMALINK

The drug company implicitly ALWAYS brings a gun to the table. Pay what they demand for the drug, or you die. Period. Simple as that.

Actually, it's worse than that - if you can't afford your cumadin prescription, then you don't die. You have a stroke, and the finances of your family are drained and you live as a cripple for another 10 years, while the republican busybodies force life-support-at-gunpoint on you, for the profit of healthcare provider corporations like HCA, in which senator Bill Frist freely trades stocks while whoring for the universal, government-enforced right to persistent-vegetative-state.

Posted by: Osama_Been_Forgotten on January 3, 2006 at 8:38 PM | PERMALINK

tbrosz:

> "Because it sure looks to me like all this private
> insurance competition is merely creating waste,
> redundancy and excessive paperwork."

> Yeah, you sure don't see any of that dealing with the government.

We actually have the most efficient federal government in the
industrialized world, contrary to the right-wing mythology.
We get more bang for our tax buck than any country in the G8.

> Maybe you think paperwork will all go away
> if the government is handling it all?

It's not a question of opining whether; it factually will. What
else would you expect when you eliminate the hundreds of private
insurers and replace them with a single-payer system? You visit
doctors' offices, right? Ever notice the filing cabinets and the
clerical staff? Ever asked doctors about negotiating health plans?

The only thing you're left with is the boogie man of "oh-if-the-
government-does-it-it-will-completely-suck. Like Medicare and
Social Security "completely suck." You can argue disincentives
to be efficient in a libertarian theoretical vaccuum all you'd like,
but bottom line, with one standardized system for all providers
and a reasonable -- not overwhelming -- variety of options, the
amount of paperwork efficiency created would be monumental.

All you have going against this is made-up right-wing anti-
government voodoo. Harry and Louise have left the building.

Bob

Posted by: rmck1 on January 3, 2006 at 8:53 PM | PERMALINK

Bob:

Go to your local medical provider and ask him about the paperwork involved in dealing with Medicare. Let me know what they say.

I've been over this many times here, and don't see any reason to beat it to death yet again. What we have now in the U.S. is half-assed government/private system that's neither fish nor fowl, and I fully expect in the next ten or fifteen years that we will move to a fully nationalized system. I expect it to run as well as state-owned industries across the planet have, which is not that well. But after Medicare and Medicaid got their noses under the tent, there probably isn't any other route.

When large-scale medical decisions are made politically, I don't expect much improvement over medical decisions made economically.

Posted by: tbrosz on January 3, 2006 at 9:10 PM | PERMALINK

I expect it to run as well as state-owned industries across the planet have, which is not that well.

tbrosz' grousing about socialism is just so cute, given that looney libertarians like him remind me of nothing so much as die-hard Marxists, grumbling that their faith in their pet theories never quite pans out in real life.

Notice how tbrosz stopped short of claiming that a fully private system would be better? He just chants, as always, "government bad, private sector good."

Which is wierd, given that tbrosz' own paychecks come from Federal tax dollars.

Posted by: Gregory on January 3, 2006 at 9:13 PM | PERMALINK

I think the hostility toward all things government (except the military) runs very deep among these guys. Rove is the soul of the Bush administration and I know where his hostility originated. Over the same issue that made the Red States so hostile toward government (even when their ideology hurts them financially and otherwise).

The issue is race. My generation, especially in the South, was split over race and civil rights. The anger toward the federal government was palpable the whole time I was growing up. Many in the South began identifying with the Republican Party due to this issue. This anger, over time, grew into a permanent hostility toward the federal government and the Democrats who forced school integration and other changes.

So, Kevin gets it right on this issue. Venality. These guys do not care if the federal government goes down, except for the military. I couldnt count how many times Ive heard that exact sentiment expressed.

Think Im exaggerating? Consider this fact. When John Kennedy was shot, I was in junior high school. The principal made the announcement over the PA system. The reaction among my fellow students? Wild, and almost universal, cheering in all classrooms. Kennedy was the devil who was trying to force the black man down our throats.

This is what we learned from our parents.

Posted by: little ole jim from red country on January 3, 2006 at 9:18 PM | PERMALINK

When large-scale medical decisions are made politically,

tbrosz is here no doubt referring to the GOP's decision to design the prescription drug benefit so as to hand out billions of dollars to its political benefactors in the health insurance industry.

Posted by: brooksfoe on January 3, 2006 at 9:21 PM | PERMALINK

We get more bang for our tax buck than any country in the G8.

Bob, this might make an interesting talking point as a way of countering Republican anti-government fanaticism with a breed of patriotic pro-government Democratic jingoism, but what is it actually based on? Or are you referring to the fact that since our tax dollars are so much more likely to go to the Defense Dept. than are those of citizens of other G8 countries, we literally get more "bang" for our tax bucks?

Posted by: brooksfoe on January 3, 2006 at 9:25 PM | PERMALINK

Despite the rantings of the mentally incompetent, it is well established and recognized that the administrative costs of Medicare as a percentage of the total outlay for the program are mush less than the management overhead spent by private insurerance companies.

Posted by: lib on January 3, 2006 at 9:28 PM | PERMALINK

tbrosz: when you say the government brings a gun to the table you are really and truly indicating your attitude toward the government.

You don't like it. You emphasize the negative aspects of it and have no faith in the fact that the government is truly us. Everything done by the government is one big negotiation.

To the degree that influential players try to be dictatorial (DeLay, e.g., the way this legislation was passed), this get nasty.

People who are good at democratic politics (small "d") work to achieve consensus and managed to pass legislation that has real support. Thus, it last for a time.

This legislation rammed through, it is poor, and it will not last.

Posted by: little ole jim from red country on January 3, 2006 at 9:29 PM | PERMALINK

Gregory:

Frankly, I don't know how we'd get to a private system from here any more.

I do know that every universal entitlement proposed by starry-eyed leftists throughout this country's history has started out as a well-meaning proposal for a safety net for our most needy citizens, and ended up as a massive program with millions utterly dependent on it. And in every case, costing orders of magnitude more than even the most pessemistic projections at the time they were proposed. I expect nothing different from nationalized medicine. But since the Left learned nothing from previous experience, I expect they'll learn nothing from that, either.

I work in the space field, Gregory, and while some of my paychecks have come from NASA over the past thirty years in this business, most have been from private investors in private space companies.

NASA, a perfect example of a government program, has accomplished much, but has spent enormous amounts of money on politically-motivated projects in the process, and spent billions on things that should have cost millions. Right now, the private sector is finally finding its feet in this field, and in twenty years, I expect the most work in space to be accomplished by the private sector.

Posted by: tbrosz on January 3, 2006 at 9:31 PM | PERMALINK

tbrosz wrote: "Go to your local medical provider and ask him about the paperwork involved in dealing with Medicare. Let me know what they say."

Tbrosz, go to your local medical provider and ask them about the paperwork involved in dealing with a dozen or more different health plans and insurance companies. Let me know what they say.

This was an idiotic point. Do you even bother to think before you post anymore?

"I've been over this many times here, and don't see any reason to beat it to death yet again."

Don't bother. You never have bothered to actually do any thinking on this issue; it's nothing but knee-jerk anti-government rhetoric that, like the above, is just dumb.

Posted by: PaulB on January 3, 2006 at 9:33 PM | PERMALINK

Despite the rantings of the mentally incompetent, it is well established and recognized that the administrative costs of Medicare as a percentage of the total outlay for the program are mush less than the management overhead spent by private insurerance companies.

Can any of you hold a discussion without resorting to foulmouthed and infantile insults?

That figure may be true of the Medicare offices in Washington--I have yet to see anyone actually show me a number for it--I'd bet it doesn't include the paperwork of the medical providers.

In the same way, if you subtract what companies and individuals have to spend in time and money to fill out our taxes each year, I'd bet that the overhead expenses of the IRS are pretty low compared to the tax revenue flow, too.

Posted by: tbrosz on January 3, 2006 at 9:35 PM | PERMALINK

That's a good point, little ole jim. The notion that the government "brings a gun to the table" makes the US government sound no different than, say, the government of Saddam Hussein. It's true that the government has, as a last resort, the power to use force to compel citizens who break the law. But it is, after all, a democratic government, and we voted it in.

It'd be hard to imagine describing your local town selectmen as "bringing a gun to the table" when they meet to discuss zoning regulations or trash collection. The federal government is different in many ways; but if you view it solely as a hostile power which brings a gun to the table, then you're never going to get the federal version of picking up the trash - basic social services necessary to underpinning an advanced democratic society, like education, health care and transportation - accomplished.

Posted by: brooksfoe on January 3, 2006 at 9:36 PM | PERMALINK

tbrosz: who was stopping the private sector from investing in space all those decades?

Could it be that it was a legitimate government endeavor to invest in the space program? Could it be that no other entity could have done it?

Could it be that our government is necessay to keep up competitive with other countries? Without our goverment, others would pass us by?

Posted by: little ole jim from red country on January 3, 2006 at 9:37 PM | PERMALINK

Yeah, yeah, tbrosz, your pose of cynicism is duly noted. As are the times when you abandon it to carry water for the Bush Administration.

Your attempts to disclaim your career in suckling at Uncle Sugar's teat are highly amusing, though. I note that your disclaimers have become more amd more distant with each repetition over the months...I can recall when you admitted being a government contractor. But then, honesty isn't your strong suit, is it, tbrosz?

And speaking of "politically-motivated projects," do you include and condemn the GOP efforts to funnel money to Big Pharma, as brooksfoe suggested? Surely not -- after all, the GOP gives you your tax cut in addition to their borrowing and spending binge, so you're their bought-and-paid-for scutmonkey.

Ayn Rand would be proud of you, tbrosz. So would Trotsky.

Posted by: Gregory on January 3, 2006 at 9:39 PM | PERMALINK

That figure may be true of the Medicare offices in Washington--I have yet to see anyone actually show me a number for it--I'd bet it doesn't include the paperwork of the medical providers.

You're making a baseless and evidence-free speculation here, tbrosz, which is predicated on the notion that every one of the vast number of professional analyses of America's health care system, which have universally concluded that Medicare is an order of magnitude more paperwork- and bureaucracy-efficient than private health insurance, are all stupid or mendacious.

To enter into your baseless and evidence-free speculation, however, it would seem to me that the vast majority of the Byzantine paperwork in the offices of the medical providers is in fact precisely the paperwork necessary to cope with a Byzantine network of dozens of different health insurers.

Posted by: brooksfoe on January 3, 2006 at 9:40 PM | PERMALINK

Do you even bother to think before you post anymore?

PaulB's rhetorical query begs the question as to whether tbrosz thought prior to posting before.

As I said, he's as knee-jerk and faith-based as any diehard Marxist. Funny how the loony libertarian crowd resembles them, isn't it?

Posted by: Gregory on January 3, 2006 at 9:41 PM | PERMALINK

tbrosz wrote: "I do know that every universal entitlement proposed by starry-eyed leftists throughout this country's history has started out as a well-meaning proposal for a safety net for our most needy citizens, and ended up as a massive program with millions utterly dependent on it. And in every case, costing orders of magnitude more than even the most pessemistic projections at the time they were proposed. I expect nothing different from nationalized medicine."

Q.E.D. You are, of course, ignoring the experience of such programs as Medicare and the VA medical system, as well as the insurance and health programs of every other major industrialized nation. You are equally ignoring the reality of conditions in the U.S. before those programs were initiated and ignoring the reality of just how many people have been helped by them. But reality never has intruded on that little fantasy world you've created, so why should it start now?

Posted by: PaulB on January 3, 2006 at 9:42 PM | PERMALINK

On this subject, I was expecting a spectacular display of intellectual dishonesty from tbrosz -- the fact that government funded health care will win the competition with the private sector rankles him so -- and he didn't disappoint.

Posted by: Gregory on January 3, 2006 at 9:44 PM | PERMALINK

tbrosz wrote: "Can any of you hold a discussion without resorting to foulmouthed and infantile insults?"

When you act like a mindless partisan moron, you get called a mindless partisan moron. Deal with it. If you don't want to be called names, stop writing such idiotic dreck and start doing some real thinking. Your knee is jerking so badly, I'm amazed that you can even type.

"That figure may be true of the Medicare offices in Washington--I have yet to see anyone actually show me a number for it--I'd bet it doesn't include the paperwork of the medical providers."

In other words, the number conflicts with your view of reality, so rather than adjust your view, you'll simply mindlessly cling to your fantasies.

Posted by: PaulB on January 3, 2006 at 9:46 PM | PERMALINK

has started out as a well-meaning proposal for a safety net for our most needy citizens, and ended up as a massive program with millions utterly dependent on it.

Umm...isn't that kind of the idea of a social safety net? That the indigent, impoverished, and otherwise dependent, should be on it? Are we now supposed to be bummed that so many seniors are on Social Security, rather than eating dog food and dying early in tin shacks, like they were before SS existed?

It strikes me sometimes that what conservatives hate most about social programs is simply that they remind them that the poor, the old, and the sick actually exist.

Posted by: brooksfoe on January 3, 2006 at 9:47 PM | PERMALINK

You are equally ignoring the reality of conditions in the U.S. before those programs were initiated and ignoring the reality of just how many people have been helped by them.

Of course, PaulB. Two things matter to tbrosz:

1) tax cuts for tbrosz
2) government funded contracts for tbrosz

(And, on that subject, notice how he spouts dire warning about Big Pharma ceasing research if not granted a fat profit margin, yet cheerfully ignores the fact that the private sector is only now following on the billions of dollars the government invested in space exploration? Ho ho!)

Like I said, Ayn Rand would be proud, tbrosz.

And no, that isn't a compliment.

Posted by: Gregory on January 3, 2006 at 9:48 PM | PERMALINK

Gregory wrote: "the fact that government funded health care will win the competition with the private sector rankles him so -- and he didn't disappoint."

Yup. On another thread, he made much of the fact that at least one study was estimating that 10% of the Medicare funding was lost to fraud and waste. Or at least he was until I pointed out that according to at least one study, the percentage of private insurance and health care money lost to fraud and waste was ... 10%. Funny how that works.

This flies so much in the face of the little fantasies he has concocted for himself that he just cannot bring himself to deal with it, just as he could not bring himself to actually discuss Social Security accurately.

Posted by: PaulB on January 3, 2006 at 9:48 PM | PERMALINK

Gregory:

I've posted my biography here, along with websites for the companies I contract with. I don't see a lot of that from anyone else.

What do you do for a living, and who pays your check?

brooksfoe:

Maybe you're right. I have yet to see anyone actually quantify this, and only know what kind of complaints my doctors have had. I would appreciate any link you have to one of these analyses you mention.

It does stand to reason that eliminating a lot of our choice would eliminate a lot of complexity. Kind of like if we had only one car dealer in the U.S.

Posted by: tbrosz on January 3, 2006 at 9:49 PM | PERMALINK

tbrosz:

> "Go to your local medical provider and ask him about the paperwork
> involved in dealing with Medicare. Let me know what they say."

I've talked to a few doctors about it. And while nobody who
performs actual work likes to do any kind of paperwork, I've heard
less gripes about Medicare/Medicaid than I have about the enormous
plethora of private insurance plans. Whatever criticisms you might
have about Medicare reimbursements or any aspect of it in specific
cases, at least it's a known quantity. Study it once and you've
learned it. In contrast, every private plan is a country unto itself.

> I've been over this many times here, and don't see any reason to
> beat it to death yet again. What we have now in the U.S. is half-
> assed government/private system that's neither fish nor fowl,

Right. And there's a reason for this, tbrosz. Because despite
the full-court press by the AMA, despite all the demagoging about
"socialized medicine," nobody wanted to see Grandma bankrupted
by doctors. If medicine could be fully privatized in a morally
acceptible way, it would have been. But it can't be. It's not a
free-market commodity. We have no choice but to have healthcare.

> and I fully expect in the next ten or fifteen years
> that we will move to a fully nationalized system.

I pray you're correct, but I'd be a fool to doubt the power of the GOP
and the AMA to keep the demagogurey going with nightmare visions of
drab government offices wherein soulless bureaucrats summarily deny
people healthcare options. Harry and Louise is a powerfully resonant
nightmare scenario. It will be a monumental fight, and the Hillarys
of the world do us no favors by trying to preserve private insurance.

> I expect it to run as well as state-owned industries
> across the planet have, which is not that well.

Government healtcare insurance is not an industry;
healthcare providers, drug and medical equipment makers are
the industry. It's an administrative regime. It need make
no profit. All it needs to do is set rules and track claims.

> But after Medicare and Medicaid got their noses
> under the tent, there probably isn't any other route.

I forgot the immense power of the healthcare insurance lobby,
which will surely kick into high gear to save their own existence
if a single-payer system starts to make any headway in Congress.

> When large-scale medical decisions are made politically, I don't
> expect much improvement over medical decisions made economically.

I do; there's far more accountability and potential to appeal bad
decisions. Medical decisions based on resource allocation are
always extremely difficult and morally frought. I'd much rather
have a politician's face attatched to them than some private-
sector bean counter accountable only to a board of directors.

Bob

Posted by: rmck1 on January 3, 2006 at 9:53 PM | PERMALINK

Oh, and one more thing, tbrosz:

Can any of you hold a discussion without resorting to foulmouthed and infantile insults?

...says Mr. "You leftists are rooting for America to fail in Iraq"? The irony is killing me!

I disagree with some here, tbrosz, but in my book you've exhibited far, far too much intellectual dishonesty -- just for example, failing utterly to name anyone you could characterize as "rooting for America to fail" -- "it's obvious," you said; how pathetic! -- to merit any sort of courtesy at all.

Personally, I had your number way back when you couldn't explain why Republican borrowing and spending is less irresponsible than Democrats spending the same amount and paying for it with taxes. You merely huffed and predicted that the Dems would tax and spend to some absurdly maximalist level -- totally ignoring the markers the GOP is leaving with the Chinese, of course. After all, those IOUs fund your tax cuts, right?

How dare you presume to be worthy of courtesy, tbrosz. You owe many, many apologies before it can even be considered. Yet as you repeatedly demonstrate, you have no shame, do you? Anything to carry water for your tax-cutting, deficit-mongering GOP pals, right?

Posted by: Gregory on January 3, 2006 at 9:54 PM | PERMALINK

And who's liable if the vaccine has problems, which is one of the main issues with private manufacturers?

What an incredible bozo.

You would think that someone who professes to be a repukelinazi would learn something, just once.

You set up a pool. You require people to sign a statement, to accept the risk. INFORMED CONSENT.

There are known risks. They are statistically predicatable.

The main issue is to PREPARE for the risks. I know that to a repukelimoron like yourself preparation is not a possibility, since a bowel movement may come at any time, and disrupt things. But for sensible Democratic statisticians, this kind of thing is pretty simple.

Posted by: dataguy on January 3, 2006 at 9:57 PM | PERMALINK

I've posted my biography here, along with websites for the companies I contract with. I don't see a lot of that from anyone else.

Well first of all, Kevin did have that big introduce yourself thread, but even then, so what? Like that excuses your deceptions and dishonesty?

What do you do for a living, and who pays your check?

None of your business, tbrosz, and stop trying to change the subject. From where I stand, my points about your hypocricy and dishonesty stand unrebutted.

Posted by: Gregory on January 3, 2006 at 9:57 PM | PERMALINK

It does stand to reason that eliminating a lot of our choice would eliminate a lot of complexity. Kind of like if we had only one car dealer in the U.S.

Ah, tbrosz simply can't resist straw man arguments, can he?

Posted by: Gregory on January 3, 2006 at 9:58 PM | PERMALINK

brooksfoe:

> Bob, this might make an interesting talking point as a way
> of countering Republican anti-government fanaticism with a
> breed of patriotic pro-government Democratic jingoism, but
> what is it actually based on? Or are you referring to the
> fact that since our tax dollars are so much more likely to
> go to the Defense Dept. than are those of citizens of other
> G8 countries, we literally get more "bang" for our tax bucks?

Heh, no. Not meant ironically.

I wish I could remember. It was something I learned from a
sociology prof back in the late 80s. I don't remember who exactly
did the study, but it was based on a survey of people's attitudes
in the G8 countries towards the services they received from their
governments, as well as an analysis of how tax resources were
allocated. In a way it wasn't entirely fair; there were some
apples-and-oranges comparisons, and it's also hard to decide at the
end of the day just what exactly counts as a government benefit of the
government resources that aren't allocated directly to individuals.

But nonetheless, the overall conclusion was striking. For all our
complaining about the federal government, we get back far more of
what we pay into it in taxes than do the major industrial nations.

Again, I wish I could be more specific.

Bob

Posted by: rmck1 on January 3, 2006 at 10:06 PM | PERMALINK

It does stand to reason that eliminating a lot of our choice would eliminate a lot of complexity. Kind of like if we had only one car dealer in the U.S.

Look. There are balances and tradeoffs in anything in the world. Almost all of the national health-insurance systems in other industrialized countries, which are all - ALL - two to three times as efficient as the US's in delivering public health per dollar, accommodate some measure of choice. Canada is I believe the only system that really has banned private coverage, or has until now.

But there is a point at which greater "choice" becomes meaningless, and worse, becomes a smokescreen behind which companies can hide their actual control of the field in which you make your little decisions. Think of the meaningless distinctions between GM sedans that get called Buick or Lincoln; or of Gateway's recent baffling decision to rebrand all its laptops under separate home, small-biz, and corporate model names even though the underlying computer is still the same; or of the proliferation of different flavors of mutual fund issued by individual brokers in the late '90s, so you could imagine you were investing in "telecomms" or "East Asia", when basically your money was inevitably just doing whatever the fund manager wanted it to do. What happens with health-care "choice" is that insurance companies are able to bamboozle and hoodwink customers with an infinite variety of plans whose relative merits are virtually impossible for average customers to assess. This does not make people feel secure and confident in their choices; it makes them feel confused and exposed.

The point of greater choice is greater control. You could give the pilot of an F-16 individual command over each of the plane's control surfaces, and in a sense this would offer him greater "choice"; but it would be meaningless, and the plane would quickly go into a spin. The fly-by-wire system makes all those choices for him, but it gives him the only real choice that matters: control over where the plane goes. Sure, we will probably want an element of choice in our health insurance system. Choice of which doctor to see, for instance, or the option to purchase additional insurance for whatever we're nervous about. But we also need a basic simple plan for everyone to ensure they don't spin out, crash and die. Or, say, go without their vaccinations, you know?

Posted by: brooksfoe on January 3, 2006 at 10:13 PM | PERMALINK

brooksfoe:

Good comment. Personally, I like having a lot of control over my own choices, even if they're complicated, but you could make an excellent case that a lot of Americans might feel differently.

You do have to have a lot of confidence in the person who designs your flight control systems, though. At present, given how our government operates, I don't see turning the control system over to them as much of an improvement.

Think "military-industrial complex" in the medical field, and remember, our system would be ten times the size of Canada's. When over a trillion new dollars start flowing through the government, it's nice to think it's all going to go where it ought to. How much of our tax money actually does?

Won't matter which party is in charge--that kind of cash is going to draw a lot of flies. I'm old enough to know that political corruption wasn't suddenly invented when the Republicans got power in 1994.

Posted by: tbrosz on January 3, 2006 at 10:37 PM | PERMALINK

For the record, I didn't support ANY new Medicare prescription coverage, including Bush's, but the idea that somehow the Democrats would have done it "better" doesn't stand up to much examination. Their plan just didn't get far enough for the costs to suddenly balloon.

Posted by: tbrosz on January 3, 2006 at 10:38 PM | PERMALINK

tbrosz wrote: "the idea that somehow the Democrats would have done it 'better' doesn't stand up to much examination"

Oh garbage, tbrosz. Any Democratic proposal would almost certainly not have included that ridiculous prohibition against using the bargaining power of the federal government, which means that it would have been cheaper on a "bang-for-the-buck" basis. Additionally, it would have assuredly been far less complex. And it wouldn't have had that ridiculous "donut hole" in the coverage. And it wouldn't have rolled over and played dead to the insurance companies, the drug companies, and the medical companies.

Your sole criteria for "better" seems to be whether it cost more or not. Using that criteria, you may very well be right. But since out here in the real world, we look at more than just the net cost, it's a slam dunk case that the Democratic alternative would have been better. To pretend otherwise is foolish.

Posted by: PaulB on January 3, 2006 at 10:50 PM | PERMALINK

tbrosz wrote: "Think 'military-industrial complex' in the medical field"

Oh, you mean like Medicare? Sheesh, tbrosz...you still can't bring yourself to actually think about this, can you?

"I'm old enough to know that political corruption wasn't suddenly invented when the Republicans got power in 1994."

But too mindlessly partisan to not recognize how much the rules have changed, as has been amply demonstrated here and elsewhere, and as this idiotic bill we are discussing clearly shows.

Posted by: PaulB on January 3, 2006 at 10:53 PM | PERMALINK

tbrosz wrote: "the idea that somehow the Democrats would have done it 'better' doesn't stand up to much examination"

Go ahead, tbrosz; show us this "examination" you've done that illustrates how the Democrats couldn't possibly have done it "better." We're waiting.

Posted by: PaulB on January 3, 2006 at 10:54 PM | PERMALINK

PaulB:

"Cost more" means something. Check out this paper on what another Democratic program, Medicare, is already going to cost us. Think the program would have passed the Congress if the numbers we have now were available back then?

The U.S. needs another entitlement like a swimmer needs an anvil.

Posted by: tbrosz on January 3, 2006 at 11:06 PM | PERMALINK

I'm old enough to know that political corruption wasn't suddenly invented when the Republicans got power in 1994.

Wow, tbrosz is certainly treating us to a full show, isn't he?

Too bad tbrosz isn't intellectually honest enough to pause in his water carrying for the GOP long enough to admit that, while "political corruption wasn't suddenly invented when the Republicans got power in 1994," this scurvy bunch is particularly corrupt.

And somehow, for all his oh-so-cynical libertarian pose, tbrosz manages to give the expansion of not just Federal spending but Feder power under Bush a free pass. Funny, that. Just not very amusing.

Posted by: Gregory on January 3, 2006 at 11:20 PM | PERMALINK

Does the paper include a calculation of how much it would cost the US economy if everyone who's currently on Medicare were instead paying for private-sector health insurance? Now, THAT would be an anvil.

Or does spending magically become weightless when it enters the private sector?

Posted by: brooksfoe on January 3, 2006 at 11:22 PM | PERMALINK

Or does spending magically become weightless when it enters the private sector?

What matters, brooksfoe, is that the government doesn't steal -- excuse me, tax -- tbrosz' money to pay for private sector spending.

Posted by: Gregory on January 3, 2006 at 11:28 PM | PERMALINK

Can any of you hold a discussion without resorting to foulmouthed and infantile insults?

That's quite hilarious, coming from tbrosz.

That figure may be true of the Medicare offices in Washington--I have yet to see anyone actually show me a number for it--I'd bet it doesn't include the paperwork of the medical providers.

Yeah that's right. What you guess and are willing to bet on is more true than the facts themselves.


Posted by: lib on January 3, 2006 at 11:37 PM | PERMALINK

What matters, brooksfoe, is that the government doesn't steal -- excuse me, tax -- tbrosz' money to pay for private sector spending.

Yeah, but even in theory, this doesn't all add up. Either people are on Medicare, or they're on private insurance, or they're uninsured. If they're on Medicare, they probably lack the money to go on private insurance. So we would either give them government money to subsidize private health insurance, which is more expensive, meaning we would have to tax tbrosz (and the rest of us) more heavily; or we would let them lose their coverage. Which would mean many of them would die, and/or be bankrupted, and/or receive unfunded emergency-room care, which we pay for anyway through taxes and higher insurance premiums, and which is actually more expensive than putting them on Medicare so they can get preventive treatment.

Or we could assume that if people didn't have government-funded Medicare they would all be demanding higher salaries so they could save enough to purchase private-sector health insurance, which would drive up labor costs and damage the economy. (As if anyone actually were in a position to demand higher wages these days.)

The money has to come from somewhere, and ultimately it comes out of tbrosz's and your and my pocket one way or another. The bottom line is that doing it through the government is more efficient and saves everyone money. That's the only thing there is to say here, full stop.

Posted by: brooksfoe on January 3, 2006 at 11:48 PM | PERMALINK

tbrosz is one of my most devoted servants. And he doesn't even realize it; that his one true love is Tax-cuts Tax-cuts Tax-cuts. Worship me, worm.

Posted by: Mammon on January 3, 2006 at 11:52 PM | PERMALINK

I'm old enough to know that political corruption wasn't suddenly invented when the Republicans got power in 1994.

But apparently not mature enough to ever point it out or admit to it.

What a terrible example you are to young people everywhere.

Still waiting for you to grow up, not holding my breath.

Posted by: word on January 3, 2006 at 11:59 PM | PERMALINK

Kevin don't underestimate the wisdom of senior citizens = they know exactly who caused this clusterf**k and there will be retribution at the ballot box in 2006

mark my words

Posted by: smartone on January 4, 2006 at 12:28 AM | PERMALINK

Bush explains his Medicare/NSA Spying/Victory in Iraq Plan:
People gotta understan'. 911. That's my job. Terrism. We're doin' all we can. 911. It's gonna take a long time. Terrism. It's a hard job. 911. Ya see? People wanna be free. We're fightin' evil. Oh, about 30,000, I would say. Terrists. I don't read the papers. 911. I don't believe in nation building. Hard job. God Damn Constitution. Terrism. A dictatorship - would be so easy. 911. lily-livered mutherfuckers outa here. People gotta understan'. Sumbitch. Terrists.

Posted by: Jay in Oregon on January 4, 2006 at 12:47 AM | PERMALINK

As true republicans, it is obvious that we should be much more concerned with whether gays can marry than these piddling arguements about healthcare and drug coverage. Get your priorities straightened out. Forcing brain dead individuals to continue to live is much more important than actual healthcare for the same brain dead person. Keep them alive for ever but don't make the government pay for it.

Posted by: MRB on January 4, 2006 at 1:54 AM | PERMALINK

tbrosz:

Since you pose the question of how doctors feel about paperwork requirements associated with gov't healthcare systems, and assert that your doctors don't like them, please ask those same doctors how they feel about paperwork requirements associated with private healthcare systems.

It's really pretty simple. The primary complaint doctors have with medicare is compensation, not paperwork. The program is actually pretty efficient, and contrary to what you wish to believe, it does cost far less to administer on a per capita basis than the private healthcare systems. But when you look at doctors who deal with the private healthcare bureaucracy, you find that they almost universally complain about paperwork first, and compensation only comes later. What does this indicate? Private healthcare bureaucracies cost more and generate more paperwork, and the problem is only multiplied by the fact that there are so many different such bureaucracies, serving so many different populations.

Now, if you aren't going to acknowledge the successes of Medicare and the VA system, the least you can do (as you complain about the inevitable inefficiencies of public solutions) is to point out some country where private healthcare is cost-efficient and provides high-quality health care. Any such system. Anywhere.

And while we're waiting for you to come up with one, maybe you can explain to us your belief that the U.S. did not attack Japan after the Pearl Harbor attack! It's been weeks since you made that assertion, and I've yet to see either an explanation or a retraction.

If you want people to treat you nicely in a debate, you might want to display some intellectual honesty. Just a little. C'mon, it's not so hard...

Posted by: keith on January 4, 2006 at 6:21 AM | PERMALINK

tbrosz wrote: "'Cost more' means something."

No shit, moron. But that appears to be your only criteria for the effectiveness, value, or metric of any program. Out here in the real world, we look at the whole picture, not just its cost.

"Check out this paper on what another Democratic program, Medicare, is already going to cost us."

Yup, and think of what the cost would be to those people who are on Medicare if it did not exist. You still cannot bring yourself to acknowledge that Medicare is cheaper than the alternative.

"Think the program would have passed the Congress if the numbers we have now were available back then?"

Looking at all of the numbers? Yup.

"The U.S. needs another entitlement like a swimmer needs an anvil."

When the entitlement helps as many people as have been helped by Medicare and Social Security and when the cost-benefit analysis so clearly favors those programs, yup, the U.S. does in fact need another entitlement.

Posted by: PaulB on January 4, 2006 at 2:56 PM | PERMALINK

By the way, tbrosz, we're still waiting for that deep "examination" you've done that illustrates how the Democrats couldn't possibly have done it "better." Care to actually try to back up your mindlessly partisan assertion?

Posted by: PaulB on January 4, 2006 at 2:57 PM | PERMALINK

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Posted by: KhnJxVHUvs on January 6, 2006 at 5:11 PM | PERMALINK




 

 

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