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Tilting at Windmills

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January 23, 2006
By: Kevin Drum

DOUGHNUT HOLE HELL....Speaking of making healthcare more complicated, Michael Hiltzik has another column about George Bush's Medicare prescription drug debacle today:

Let's consider how this system will work in practice, using the drug Actonel, a once-a-week pill routinely prescribed for elderly patients to combat osteoporosis, as an example.

Of the 48 commercial Medicare drug plans offered in Southern California, three don't cover Actonel at all; their enrollees will have to pay full price. Twenty-eight plans require prior authorization. The remaining 17 plans cover the drug, no questions asked.

That's not all. There's wide variation in how much each plan charges for a month's supply. Most price it around $500, or $125 per pill. One lists a month's supply at $470. Blue Shield lists it at $602....[But] any patient can purchase a month's supply of Actonel from drugstore.com, an online pharmacy, for $67.99, cash spending slightly more for a year's supply than some plans charge for a month.

The column is mainly about the absurd and cynical "doughnut hole" built into Bush's prescription drug plan the result of policymakers who don't actually care about healthcare policy combined with lawmakers who don't care about anything except pretending that their plan costs less than it actually does. In other words, it's the toxic intersection of incompetence and venality.

Read the whole thing.

Kevin Drum 12:27 PM Permalink | Trackbacks | Comments (91)

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Comments

Are you sure he got the dosage right. The 5mm is cheaper than the 30mm...

Just goes to show. socialized medicine never works.

Posted by: McA on January 23, 2006 at 12:34 PM | PERMALINK

"the toxic intersection of incompetence and venality."

Good one Kevin.

Looking at the drugstore.com retail price of 67.99 I assume their cost is somewhere between $34.00 and $55.00.

My question is, how many of us have or work in a business, niche or industry where prices can be so wildly and venaly (sp) marked up? It's over 2000% for a broadly marketed ,albeit niche, drug at Blue Shield.Assuming we are comparing equal dose pills.

Talk about stealing from widows. Venal indeed.

Posted by: joeiscoffee on January 23, 2006 at 12:41 PM | PERMALINK

OK, it's either "Donut" or "Doughnut." We, as a society, need to pick one already.

Other than that, good post. Unsurprising, but the point needs to be hammered in.

Posted by: Viserys on January 23, 2006 at 12:41 PM | PERMALINK

Most price it around $500, or $125 per pill. One lists a month's supply at $470. Blue Shield lists it at $602....[But] any patient can purchase a month's supply of Actonel from drugstore.com, an online pharmacy, for $67.99, cash spending slightly more for a year's supply than some plans charge for a month.

What incompetence? Sounds to me like the insurance industry just got a fantastic return on their GOP campaign investment (and their lobbyists did one heckuva job writing the bill) and an open spigot to the U.S. Treasury. For their part, Big Pharma just got huge, guaranteed sales at list price. There's a reason that Tom DeLay and the boys rammed this one through Congress, and it wasn't concern for the health of the elderly.

Posted by: R. Porrofatto on January 23, 2006 at 12:42 PM | PERMALINK

Let's consider how this system will work in practice, using the drug Actonel, a once-a-week pill routinely prescribed for elderly patients to combat osteoporosis, as an example.

Translation: let's cherry pick the strangest example I can find, and then stovepipe that information right to the DNC.

Posted by: Al on January 23, 2006 at 12:56 PM | PERMALINK

The whole thing sucks. My mother (dual eligible) will end up paying more per month. She was originally automatically signed up in a plan by Medicaid. I checked the plan out on the web site - which was terrible to navigate - and found out her expensive arthritis drug was not covered. We did manage to get her in a better plan but she now has a monthly premium of $29 a month plus co-pays.

Another thing not well know - there is a whole class of drugs (benzos) that are not covered by law. My mother has taken Librium for 25 years and it is not covered by any of the plans. So she will have to pay for it out of pocket. Why they would not pay for her Librium (a few dollars) and will pay for her Effexor (very many $$$$) is beyond me. But last year her doctor tried to get her off the Librium and she almost ended up in the hospital. The psychiatrist said "Let her take the damm Librium". So now she/we will be paying for it. I figure, based on the new "premium" she will be paying, plus co-pays, plus the Librium... she will be out about $30 more a month, not a small amount for someone on Social Securit and Medicaid.

I have seen very little coverage on this unknow part of the bill. But it will have a huge impact on people with mental health issues.

Posted by: JWC on January 23, 2006 at 12:56 PM | PERMALINK

"Just goes to show. socialized medicine never works."

Elected Republican : "Look at me!! I'm fucking everything up with my terrible ideas!! Look how bad the government is at everything!!"

Republican Voter : "Wow, he's got a point. Get your torches and pitchforks -- let's go burn down the Capitol."

Elected Republican : "Can I come too? I'm a lobbyist now."

Posted by: Donkey_Punch on January 23, 2006 at 12:56 PM | PERMALINK

All of the many things that have happened since the last election showing everyone who cares to see just how corrupt & incompetent this administration & Congress are, I think this has the most potential to turn votes towards the opposition party and that's saying a lot post-Katrina. The K Street Project, Scooter Libby, even Iraq are abstracts for a lot of people. Not being able to afford medication you used to have access to because of a Republican drug benefit drives the point home pretty clearly.

Posted by: Nathan on January 23, 2006 at 12:58 PM | PERMALINK

ZombieAl has at least half a point here. The Democratic Party will be nuts if they don't make this newest Republican disaster a key issue in the upcoming elections.

Posted by: tam1MI on January 23, 2006 at 12:58 PM | PERMALINK

"In other words, it's the toxic intersection of incompetence and venality."

Probably a rather apt description for everything that has happened in Washington D.C. since 2001, isn't it? It would be a safe tag line to end every post with, Kevin.

Posted by: steve duncan on January 23, 2006 at 12:59 PM | PERMALINK

Just goes to show. socialized medicine never works.

The nice thing about being an ideologue is that you never have to think, the thinking has already been done for you. As an ideologue, you are able to continue in a lazy mental rut forever, or at least until your ideology causes a disaster that affects you personally.

Posted by: Another Bruce on January 23, 2006 at 1:04 PM | PERMALINK

What Kevin's post illustrates is the massive flaw in private health insurance. Listen up tbrosz.

Unlike other forms of economic activity, heath insurance is not subject to market controls. People don't buy it because its something they like, they buy it because it is something they need. Because the insurance companies really do not, structurally, CARE what health care actually costs (they only care whether the premiums and investments on those premiums can cover those costs) you see drug pricing like this.

This is how we spend more and get less in terms of the healthcare. There is a lot of profit for non-doctors, not only non-doctors but actual non-CARE in our present system. Too much, not in the sense that I begrudge anyone a living, but in the sense that its a moral failure to allow the number of unisured which we currently allow.

Posted by: hank on January 23, 2006 at 1:14 PM | PERMALINK

One of President Warner's first priorities should be to kill this obscene bill.

Posted by: Hedley Lamarr on January 23, 2006 at 1:14 PM | PERMALINK

I should add that ideology eliminates the need for thinking because it usually reduces complex phenomena down to simple formulas. In this case socialism = evil, capitalism = good.

Posted by: Another Bruce on January 23, 2006 at 1:16 PM | PERMALINK

More proof of the utter failure of modern American conservative thought (if you can call it that). Trickle-down economics is a failure. Privitization schemes - failure. Tinkering with Medicare - failure.

It is so painfully obvious that these jokers don't know what they are doing that only the stupid and those who refuse to acknowledge reality can still support these tired old schemes...

Posted by: Stephen Kriz on January 23, 2006 at 1:16 PM | PERMALINK

Doughnut Hole is a euphemism for Poison Pill.

Doughnut holes don't kill people. Poison pills do.

Poison pills are used to prevent hostile takeovers. The federal government should take over full responsibility for financing health care but Bush and company are hostile.

Holes happen. Poison pills are planned. Don't euphemize.


Posted by: Ross Best on January 23, 2006 at 1:19 PM | PERMALINK

This is the medical equivalent of the no downpayment, low interest (for the first year) mortgage loan.

Everyone's happy until the interest rate changes or the co-pay threshold is reached.

With a mortgage, you might get foreclosed.

But what happens when you can't afford the medicine?

Posted by: WD on January 23, 2006 at 1:24 PM | PERMALINK

Not being able to afford medication you used to have access to because of a Republican drug benefit drives the point home pretty clearly.

Especially among senior citizens who actually vote in large numbers.

Posted by: Ringo on January 23, 2006 at 1:27 PM | PERMALINK

OK, it's either "Donut" or "Doughnut." We, as a society, need to pick one already.

Yeah, we finally settled on catsup, right?

Posted by: Ringo on January 23, 2006 at 1:29 PM | PERMALINK

Yeah, we finally settled on catsup, right?

I think that's a gray, er a grey area.

Posted by: Another Bruce on January 23, 2006 at 1:32 PM | PERMALINK

Doughnut should be the choice.
the other is lazy

Ketchup is spelled the way it should be pronounced.
Cat sup is not.

Posted by: lilybart on January 23, 2006 at 1:35 PM | PERMALINK

I was prescribed a small tube of effudex. Walgreen's wanted $138. Affordable Rx (Canada) charged me about $25 postpaid.

This is the difference between a governement that gives a shit about its people, and one that doesn't. Guess which one is the former.

What's going on with big pharma and the MPDBP is the abortion fo the century.

Blue states: time to secede.

Posted by: bebimbob on January 23, 2006 at 1:35 PM | PERMALINK

My local Kroger pharmacy - not one of the cheapest but cheaper than Walgreen's and CVS - wanted $73.99 cash. Costco wanted $67.27.

Both were for 35mg 4 packs (one month's supply).

Methinks we are seeing some serious gouging here.

cgm

Posted by: Charles M on January 23, 2006 at 1:45 PM | PERMALINK

The underlying critique is surely correct, but I am 90% sure that the pricing difference is due to different dosing. Drugstore.com says 30 35mg pills cost something like $470 - a "20% savings". I bet you that is the product being priced by the Medicare plans, even if that isn't the correct one-month quantity.

Posted by: Careful on January 23, 2006 at 1:51 PM | PERMALINK

I'm assuming McA is a member of the NRA since drugs don't come in millimeters. But that's a cheap shot that I could not resist. The facts are availabe at this url: http://www.medcentercanada.com/en/search/drug-actonel/

The price: $13 for 35mg. More proof that the Right Wing lives in an alternate fact universe (James Fallows would say).

Posted by: Hank Browne on January 23, 2006 at 1:59 PM | PERMALINK

484 dollars that is what I have to pay for health ins. the only way I can pay for this,Is to not fund my IRA,what do you do?

Posted by: scott on January 23, 2006 at 1:59 PM | PERMALINK

A few years back, after the generic version of a drug I take mysteriously became unavailable and the price of the brand name quadrupled, I went searching on the net for alternatives. I now get a 3 months supply for about 1/3 the price a months supply costs locally, from Thailand. It is labeled, sealed, and dated, every bit as good as the local product.

Posted by: Michael7843853 G-O in 08! on January 23, 2006 at 2:00 PM | PERMALINK

Whether it's a donut, a doughnut, or a bagel, has anyone associated with this plan ever explained what the hole designed into the system is for? That is, what is it supposed to accomplish?

Posted by: Curious in Chicago on January 23, 2006 at 2:01 PM | PERMALINK

I always thought that the purpose of the hole in a donut was to prevent a gooey, undercooked center.

Posted by: Nate on January 23, 2006 at 2:10 PM | PERMALINK

...In other words, it's the toxic intersection of incompetence and venality.

Single payer health care! If we put politicians in charge of our health care, that will be the last we see of incompetence and venality, right?

Please, people. Take a hard look at how business is done between the government and military contractors. Think.

Posted by: tbrosz on January 23, 2006 at 2:13 PM | PERMALINK

It's no surprise that the launch of the Bush Medicare prescription plan has been a fiasco. After all, it was designed to fail...

For the full story, see:
"Medicare's Prescription for Failure."

Posted by: AvengingAngel on January 23, 2006 at 2:17 PM | PERMALINK

tbrosz:With an interested public, who decides to politically kill any party who is involved in that corruption, that will end awfully quick.

All it'll take is the Republican party to be literally destroyed...so..if it sounds like a good idea if we can get rid of the corruption, can we count on you as being part of our team?

Posted by: Karmakin on January 23, 2006 at 2:26 PM | PERMALINK

a scam just as large as the prescription benefits package is the annual automatic conversion of the SS cost of living increase into a greater Plan B deduction. Our expenses go up, in large measure because of the medical bills, but who gets the money? -- the doctors. go figure.

Posted by: native dancer on January 23, 2006 at 2:28 PM | PERMALINK

"If something is worth doing, its worth doing right."

Guess that's a "Value" the Republicans missed.

Posted by: Jake on January 23, 2006 at 2:30 PM | PERMALINK

Curious in Chicago--

When the bill was being passed, deficit hawks in the Republican party were freaking out over its cost. The donut hole was an actuarial trick Republicans and their pharma lobbyists in Congress came up with to make the benefit cost less.

Note that they didn't save money by doing what the Democrats wanted to do, by doing what the VA currently does, and doing what every other nation on Earth currently does, which is to cut into the profit margins of the most profitable industry on the face of the earth--pharmaceutical companies.

The donut hole was created for no reason other than to lower the overall costs by screwing over seniors rather than pharma's profit margins. There is absolutely no policy logic behind it at all.

Posted by: theorajones on January 23, 2006 at 2:31 PM | PERMALINK
Not being able to afford medication you used to have access to because of a Republican drug benefit drives the point home pretty clearly.

Especially among senior citizens who actually vote in large numbers


Well, gee whiz. It looks like this is how the administration deals with pesky old folks who lobbied against the Piratized Social Insecurity scheme. Isn't that why Abramoff was chairman of all those astroturf organizations? To kill off old farts who can't afford the new Republican Healthcare? Posted by: Peter on January 23, 2006 at 2:33 PM | PERMALINK

I always thought that the purpose of the hole in a donut was to prevent a gooey, undercooked center. - Nate

I know it is in a bagel, but a bagel is a heavier dough. Not so sure with doughnuts.

In a Republican drug plan the hole is to insert their penises into, so they can screw you.

Posted by: Eric Paulsen on January 23, 2006 at 2:36 PM | PERMALINK

AS you know, tbrosz, government does many things very well. Health care, which is a universal need, like fire protection, seems like an excellent candidate for public management. Meanwhile, private capital is having a hard time with e.g., baseball, a much less complicated business. There is peripheral money loss in government because of greed, sure, but it rarely reaches the level of, oh, Steinbrenner, except in cases like Abramoff's.

Posted by: Ace Franze on January 23, 2006 at 2:40 PM | PERMALINK

Ok, here's my $64 question. Now we've got it, how can it be undone and I don't mean getting congress to act, but rather if they act.

Good or bad, the old system is now history, and I for one can't see how they'll put Humpty Dumpty back together again, or overhaul the current plan.

Posted by: Jake on January 23, 2006 at 2:40 PM | PERMALINK

Good point about the Kroger and the Costco pricing - In the Northwest, Kroger owns Fred Meyers, or as the locals call it, Freddies - FM will match any Costco price. The Washingtonians come over to Oregon in droves to buy prescriptions at Costco.

Posted by: thethirdPaul on January 23, 2006 at 2:47 PM | PERMALINK

So why do we need any gov. both sides seem to agree they can't do anything right.Healthcare Natl. sec. WMD ,Iraq,Iran North Korea,SS,Campaign finance,ect.ect.ect.

Posted by: scott on January 23, 2006 at 2:47 PM | PERMALINK

So anybody? I have to pay 484 dollars a month for healthcare, the only way I can afford this is to not find my IRA what do you do?

Posted by: scott on January 23, 2006 at 2:49 PM | PERMALINK

"Note that they didn't save money by doing what the Democrats wanted to do, by doing what the VA currently does, and doing what every other nation on Earth currently does, which is to cut into the profit margins of the most profitable industry on the face of the earth--pharmaceutical companies.

Posted by: theorajones on January 23, 2006 at 2:31 PM"

Is there any official data on the profit of pharmaceutical companies? Is this assertion - that they are the most profitable industry on the planet - factually true or is it just speculation?

Posted by: Brazil Connection on January 23, 2006 at 2:51 PM | PERMALINK

George Bush's Medicare prescription drug sounds like a "get rich(er)" scheme for big Pharma. If only all the old foggies have enough to make big Pharma even more wealth then they are now.

--a years supply from an online pharmacy for $67.99, cash. Wow - it was cheaper for senior citizens without Bush's new plan.

Bush is a compassionate conservative all right - he felt a lot of compassion for big Pharma if none for nations elderly.

Posted by: Cheryl on January 23, 2006 at 2:58 PM | PERMALINK

If we put politicians in charge of our health care, that will be the last we see of incompetence and venality, right?

When are we going to see the last of tbrosz' straw man arguments?

Posted by: Gregory on January 23, 2006 at 2:59 PM | PERMALINK

I say cut our Poltico's from the free med care then see what happens.

Posted by: scott on January 23, 2006 at 3:02 PM | PERMALINK

Try having a condition like Lupus or Rheumatoid Arthritis and see what the drugs cost. Even after one of my medications went off patent it still costs better than $300/mo. The really great part of this was a voluntary program the department offered a years or so ago which wanted people to go off the medication they were successfully being treated with and switch to another suggested by Medicate. It was
less effective according to my rheumatologist and cost $1200/mo. I would guess the drug manufacturer was behind that gem.

Posted by: jojo on January 23, 2006 at 3:03 PM | PERMALINK

"I say cut our Poltico's from the free med care then see what happens.

Posted by: scott on January 23, 2006 at 3:02 PM"

I might be wrong, but if your country is like mine in this respect (I believe it is) I seriously doubt your important 'politicos' depend on a government-funded health insurance plan.

Posted by: Brazil Connection on January 23, 2006 at 3:11 PM | PERMALINK

The Washingtonians come over to Oregon in droves to buy prescriptions at Costco.

Why would they do that? We Washingtonians do frequently go to Oregon for many purchases to save nearly 9% in sales tax, but prescriptions aren't taxed.

Posted by: Nemo on January 23, 2006 at 3:22 PM | PERMALINK

Send your senators and representatives this message now.

Vote NO on confirmation of Alito or I boycott GOP contributor Dominos Pizza.

Send it from here.

http://www.usalone.com/cgi-bin/petition.cgi?pnum=147

Posted by: maximus on January 23, 2006 at 3:26 PM | PERMALINK

I think this is just an error. A month's supply is 4 tabs. That's shocking at $70/month, but 30 tabs would cost $500 and be good for a 7 1/2 month supply. I suspect the price listed is for 30 tablets rather than a one month supply.

Posted by: J Bean on January 23, 2006 at 3:31 PM | PERMALINK

Is there any official data on the profit of pharmaceutical companies? Is this assertion - that they are the most profitable industry on the planet - factually true or is it just speculation?
You could always read their own annual reports. You'll even find out things like: they spend more on advertising than they do on developing new drugs, and bringing them to market. Isn't the excuse for very high profit margins "well, they spend a lot developing the drug?" Wouldn't a more realistic excuse be "well, they spend a lot bribing congress and doctors?"

Posted by: Peter on January 23, 2006 at 3:37 PM | PERMALINK

Brazil 100% covered for life.How about yours.

Posted by: scott on January 23, 2006 at 3:48 PM | PERMALINK

The donut hole was created for no reason other than to lower the overall costs by screwing over seniors rather than pharma's profit margins. There is absolutely no policy logic behind it at all.

It is no doubt a carefully calculated trade-off between political priorities: first, give pharma all the profits they could possibly want; second, keep deficits low enough to get the thing through congress; third, come up with a benefit that will keep most voters happy enough not to turn against them.

They did a great job with their first priority. They managed to succeed on the second priority, although they had to lie about the costs to do it. And it's beginning to look like they didn't do so well with their third priority.

Two out of three isn't bad, right?

Long-term viability and sound public policy were not on the radar. Medicare is in horrible shape financially, but NO politicians are willing to talk about it.

Posted by: Will on January 23, 2006 at 4:05 PM | PERMALINK

Karmakin:

tbrosz: With an interested public, who decides to politically kill any party who is involved in that corruption, that will end awfully quick.

We've had quite a few elections in 200 years. How's that working out?

Ace:

AS you know, tbrosz, government does many things very well.

Really? Make a list. Federal, please. Include the bang you get for the buck. Oh, and leave off police, fire protection, and all the other locally-funded and operated things that are constantly lumped in with discussions on Federal taxes and spending.

Posted by: tbrosz on January 23, 2006 at 4:14 PM | PERMALINK

Gregory:

Somebody is going to clue you in on this sooner or later. Might as well be me.

Just saying "strawman" is not in and of itself an argument. It's verbal flatulence.

To make your point, you have to make a serious argument that shows that, in fact, venality or corruption are NOT a common characteristic of politicians, and that it is invalid to introduce that as an issue when discussing corruption and greed in the medical care field.

Posted by: tbrosz on January 23, 2006 at 4:19 PM | PERMALINK

Brazil: A reference on pharmaceutical profits can be found here. Check out the links and judge for yourself how valid they are.

Posted by: tbrosz on January 23, 2006 at 4:24 PM | PERMALINK

It's verbal flatulence.

Sayeth the expert.

To make your point, you have to make a serious argument that shows that, in fact, venality or corruption are NOT a common characteristic of politicians, and that it is invalid to introduce that as an issue when discussing corruption and greed in the medical care field.

You wish, tbrosz.

My point that no one is claiming that if we put politicians in charge of our health care, that will be the last we see of incompetence and venality stands unassailed, and it's perfectly valid to point out that you're trying to change the subject with your straw man argument.

It's pleasing to know, of course, that you have nothing else to defend the mendacity, incompetence corruption of your Republican party, or to excuse your own ongoing support of these crooks. But then, we knew that.

Bottom line, tbrosz ol' pal, is that no one needs to rephrase their argument to answer your charges. Your argument itself is terminally weak and needs no rebuttal other than to point out that it's the straw man that it is. Shame on you for continuing to try to change the subject.

Posted by: Gregory on January 23, 2006 at 4:40 PM | PERMALINK

Doughnut holes: The problem with the normal deductible system is that if people know they're going over their deductible, they ignore it. You want people to care about how much the government is spending on them. But you want to make sure people get the care they need. So, instead of having the deductible start immediately, have it start higher up. That way, people have an incentive to watch how much they spend, just as they would with a higher deductible, but it doesn't cost them as much, and they'll get the basic care they'll need.

That's the idea. Of course, if people don't understand it, it doesn't do any good. Sort of like having a nuclear weapon and not telling anyone.

The doughnut hole isn't the problem, it's just easy to make fun of. The problem is that they didn't do all the work necessary to cover the duel eligibles. The fear of fraud was put before the fear of poor old people not getting their meds. Bad policy, pure and simple. Fraud can be recovered after the fact. Health can't.

Posted by: Tim on January 23, 2006 at 4:57 PM | PERMALINK

My point was that turning our health care over to the government is not going to really change the kind of problems that are being discussed in this thread. Do you honestly think that if the government is deciding where the money goes that anything is going to be that much different than if insurance companies decide?

Posted by: tbrosz on January 23, 2006 at 5:03 PM | PERMALINK

tbrosz, Medicare (like Social Security) is very efficiently administered and costs far less in terms of overhead than similar coverage provided by private insurers would. Canada's single-payer system isn't wracked by corruption either, nor is Great Britain's National Health service, nor are the national health care systems of other nations in Europe. So unless you think that politicians elsewhere are magically immune from corruption, I'd say your strawman just had the stuffing knocked out of it.

Posted by: David W. on January 23, 2006 at 5:06 PM | PERMALINK

"You believe, as I do, that every human life has value, that the strong have a duty to protect the weak, and that the self-evident truths of the Declaration of Independence apply to everyone, not just to those considered healthy or wanted or convenient," Bush told the abortion foes.

"These principles call us to defend the sick and the dying, persons with disabilities and birth defects, all who are weak and vulnerable, especially unborn children," the president said.

The president forgot to add that these principles only apply if the government, the rich, and the conservative aren't picking up the tab.

Posted by: Advocate for God on January 23, 2006 at 5:06 PM | PERMALINK

Do you honestly think that if the government is deciding where the money goes that anything is going to be that much different than if insurance companies decide?

yes--remember, the government is us. Of course, when you've programmed yourself to oppose anything involving "the government"(that is, aside from your knee-jerk defense of everything involving the Bush administration), then we know what you'll always "think".

Posted by: yawn on January 23, 2006 at 5:10 PM | PERMALINK

"Enjoy your hole!"

Posted by: Jack on January 23, 2006 at 5:30 PM | PERMALINK

My point was that turning our health care over to the government is not going to really change the kind of problems that are being discussed in this thread.

And my point that the kind of problems discussed in this thread are, as Kevin points out, unique to the mendacity, incompetence and corruption of the Republican Party.

Your pose of cynicicm and your feeble attempts to change the subject -- I notice you seem to drop your implication that your argument wasn't a straw man; of course, well you should, as "turning our health care over to the government" is not at all the subject at hand -- is a feeble defense, tbrosz.

In fact, given that the Republicans are uniquely to blame for the Medicare mess, throwing the bums out makes it quite likely that their "mistakes" -- which, as many have noted, are all too deliberate -- won't be repeated. Of course, that means no more tax cuts for you, which is why you're carrying the GOP's water. Shame on you.

Posted by: Gregory on January 23, 2006 at 5:36 PM | PERMALINK
My point was that turning our health care over to the government is not going to really change the kind of problems that are being discussed in this thread. Do you honestly think that if the government is deciding where the money goes that anything is going to be that much different than if insurance companies decide?

Well, yeah, I think that the stakeholders to whom government is responsible has different interests than the stockholders to whom insurance companies are responsible. Why do you ask?

Posted by: cmdicely on January 23, 2006 at 6:05 PM | PERMALINK

SS is the greatest run program there is,Untill politcians decided to fund the goverment so the rich could get tax breaks.otherwise SS would be billions in the black.

Posted by: pssst on January 23, 2006 at 6:43 PM | PERMALINK

It occurs to me having read this far that what the Democratic party needs is not only better marketing, but a good set of super-secret incremental plans for getting stuff done.

The Republicans have no trouble chipping away at whatever it is that they claim to be "against" -- it seems like the Democratic equivalent ought to be slowly working towards what we are "for."

So, I think again, the best way towards universal health care is a slow expansion of Medicare to lower age brackets. We all know it would work.

Not only that, but it would have the added benefit of not putting the entire for-profit health care administration business out of business at one swoop. That needs to be some sort of transition, anyway.

Posted by: hank on January 23, 2006 at 7:00 PM | PERMALINK

It won't happen until GM or Ford goes down the tubes, and that is in the offing. Over $1500 of every American car is for health insurance for the employees. On the average econobox, that's a 10% markup.

Posted by: Global Citizen on January 23, 2006 at 7:37 PM | PERMALINK

tbrosz--
Politicians are ALREADY in charge of our health-care system, as you are well aware of, despite your chaff-fest above. They are ALREADY in cahoots with the insurance interests. The question is never whether to put politicians in charge of such and such a sector, by definition, in a democracy the peoples' representatives are in charge of every sector of the economy. With very few constitutional limitations, they can decide to regulate or not to regulate, to subsidize or not to subsidize. The decision NOT to take a specific overt governmental action is just as often the result of corruption and collusion with private interests as is the decision TO take a specific action. Six of one and a half dozen of the other.

The idea that increasing government "involvement" in the economy (whatever that means---actually some form of state power is pervasive everywhere anyway, the question is what kind of state power is used and for whose benefit) will increase corruption is not supported by anything except libertarian dogma. It is a statement that makes no sense, except by cleverly occluding the different between "politicians" (as in the current bunch of elected officials we have) and the staff of the regulatory agencies that would actually be the people enforcing the rules.


Posted by: kokblok on January 23, 2006 at 8:13 PM | PERMALINK

There is no policy reason for the donut hole.

You don't "encourage responsibility" by preventing people from taking prescription medications once they've demonstrated a need for a lot of medications. Because 99% of the time, these are the people with congestive heart failure and delusional schitzophrenia and cancer, who when they stop taking their medications becuase they can't afford them, end up in the frigging hospital!

And saying "pharma is the most profitable industry in the US" isn't hyperbole. Pharma has been the most profitable industry in the US for just about ever. This is a well known and unchallenged fact health policy (and, frankly, investment and business) circles.

http://www.kff.org/insurance/7031/ti2004-1-21.cfm

Please note that these stats are compiled by the notorious leftists at Fortune magazine, clearly to advance their political agenda of socialized medicine.

((Full disclosure: I hadn't realzied that in '03 pharma had a bad year and got edged out by banks and mining/oil companies. But no worries, by '04 they were back on top. I think '06 is gonna be AMAZING for them.))

Posted by: theorajones on January 23, 2006 at 8:17 PM | PERMALINK
...Take a hard look at how business is done between the government and military contractors... Posted by: tbrosz
You may notice a similarity between Republican government, military contractors and pharmaceutical companies, i.e, easy payments and other favors to congressional members for big favors in return. Lobbyists wrote the Medicaid D bill. Consider government programs that are removed from this influence: the Post Office, Social Security, Medicare. Those work efficiently and honestly. In these three cases, they also are cheaper to administer than private companies in similar businesses because of a lack of needs for profit and because civil servants are cheaper than corporate CEOs. If you what to remove the possibility of corruption, remove corporate funds.
much different than if insurance companies decide? Posted by: tbrosz
Insurance companies are run for profit. Insurance companies make money by collecting premiums and paying less then their premium income in expenses. That means that it is profitable for insurance companies to deny coverage. That means that it is profitable for insurance companies to bribe congressional members in order to obtain favorable legislation. Posted by: Mike on January 23, 2006 at 8:31 PM | PERMALINK

The VA is another federally run health care system that is objectively quite effective and efficiently run.

Posted by: J Bean on January 23, 2006 at 8:45 PM | PERMALINK
Single payer health care! If we put politicians in charge of our health care, that will be the last we see of incompetence and venality, right? Please, people. Take a hard look at how business is done between the government and military contractors. Think.

That's actually pretty funny. Being told to "think" by tbrosz.

Quick field study-

John Q. Liberal thinks as follows: Mmmm. How does USA health care compare to other industrialized nations? Well, lets see. What numbers can I look at? % GDP spent on health care. % citizens without insurance. Avg. life expectancy. etc.

tbrosz thinks as follows: Mmmm. "Politicians" tend to be corrupt. "Gov't" is just a bunch of politicians. Gov't administered health care can't work. Boy, I sure figured that one out! Hey, that was hard work. How about a trip to Mickey D's!

Posted by: obscure on January 23, 2006 at 9:06 PM | PERMALINK

http://www.cia.gov/cia/publications/factbook/rankorder/2102rank.html

Singapore and Hong Kong are 4th and 5th in the world. Both have maximum tax rates

Capitalism at its finest!

Posted by: McA on January 23, 2006 at 9:20 PM | PERMALINK

Well. Now that McA has informed us of what MALAYSIANS think, I really feel like we are getting somewhere. Please McA. Tell us more of what Malaysians think about our policies here in the US. We are interested.

Posted by: Pat on January 23, 2006 at 9:52 PM | PERMALINK

That's an assumption the average middle class person wants to have the same healthcare as everyone else.

What assumption?

You flipping idiot.

Posted by: obscure on January 23, 2006 at 9:56 PM | PERMALINK

That's an assumption the average middle class person wants to have the same healthcare as everyone else.

What assumption?

You flipping idiot.

Posted by: obscure on January 23, 2006 at 9:56 PM | PERMALINK

Well. Ignore it if you will. But whenever universal health care comes up. Somepeople are quietly voting against it.

I'd say your middle class (which according to statistics has a median household income >US$45,000). Realise their share of the tax hike to pay for expanding government medical care - is more than what they are paying for insurance.

Denial won't get you anywhere.


Posted by: McA on January 23, 2006 at 10:05 PM | PERMALINK

Tell us more of what Malaysians think about our policies here in the US. We are interested.

Posted by: Pat on January 23, 2006 at 9:52 PM | PERMALINK

We think you should listen to us and not the French. Since they oppress their Muslim ghettos.

How would I know? You can't really speak for an entire country as an individual.

I think you should begin to wonder how come you have so many Republicans in power. And denial won't get you anywhere.


Posted by: McA on January 23, 2006 at 10:08 PM | PERMALINK

Our family's Medicare, Part "D," experience with two brand-name(not available as generics) medications: With three insurance carrier's plans we investigated, after annual deductibles of $250.00 plus monthly fees of ca. $21.00 for two of them, and a monthly fee of $35.95, with no deductible, for the third, the co-payment for one month's supply of each drug was a few bucks higher than the retail "street" prices, with no insurance whatsoever, for the very same drugs at two pharmacies and Costco.
Some reports in the press have alleged there are two Big Pharma lobbyists for every member of Congress. "You did a heck of a job, people!"

Posted by: murnien on January 23, 2006 at 10:33 PM | PERMALINK

So, the assholes have given us donut holes? Well, Does it pass the smell test?

Posted by: MarkH on January 23, 2006 at 10:45 PM | PERMALINK

Hank says: "The Republicans have no trouble chipping away at whatever it is that they claim to be "against" -- it seems like the Democratic equivalent ought to be slowly working towards what we are "for.""

Clinton called that slow working toward what we wanted "triangulation" and the far left doesn't think well of him for it. On the other hand, he did what he could under very hostile circumstances -- Republican leadership that had vowed to block whatever he proposed, no matte whether it was good for the country.

Posted by: J Bean on January 23, 2006 at 11:05 PM | PERMALINK

My personal experience and that of my friends is that we who are only taking one to four drugs are much better off paying cash on the street.

The catch for me is that if I do not sign up by May 15th, and have a heart attack a year later, needing more drugs and more expensive drugs, I will pay a 12% penalty for the rest of my life for not signing up May 15th. So I will get nothing but paying more money to medicare for no service whatsoever.

There must be millions like me who will pay to plans not back to the govt. who is putting out the money for medicare. The govt is constantly siphoning to the private sector not to making the program be more effective, efficient, and economical. All of which is doable.

I know I am a retired nurse. Health care for profit is not healthy and not good care; it is only for profit.

When you convince everyone to call their doctor for the purple pill you are advertising for more people to spend money regardless of the real condition. Some ads don't even tell you what the pill is for just consult your doctor.

Every nurse I have known personally knows of dozens of malpractice cases and has never said a word as long as she needs to make a living. I almost got kicked out of nursing school for blowing up at doctor who had scheduled so many surgeries back to back he did not have time for the anesthesia; he cut into a child of ten and I was ordered to climb on the surgery table to hold her down. No problem we will give her a drug to make her forget.

The public only sees the tip of the iceberg. They stopped primary care nursing so that no one person knew the patient. If you have a lowly person who draws only blood, one who does range of motion, one who does respiratory therapy etc. When I started nursing we did it all and we were highly educated and we wrote down: called doctor ten times with no response. It was our charting that got doctors creamed in malpractice suits. The results get rid of good nurses. They have achieved their desires.

Posted by: Yoduuuh on January 24, 2006 at 3:06 AM | PERMALINK

know I am a retired nurse. Health care for profit is not healthy and not good care; it is only for profit.

Posted by: Yoduuuh on January 24, 2006 at 3:06 AM | PERMALINK

So how come nurses joint new unions for better pay? If that for profit and bad?

Posted by: McA on January 24, 2006 at 3:35 AM | PERMALINK

Consider government programs that are removed from this influence: the Post Office, Social Security, Medicare. Those work efficiently and honestly. In these three cases, they also are cheaper to administer than private companies in similar businesses because of a lack of needs for profit and because civil servants are cheaper than corporate CEOs. If you what to remove the possibility of corruption, remove corporate funds.

Look up "Medicare fraud."

Administration cost will be a very small part of the public health care issue. What will be a much larger part is a single-payer system purchasing billions of dollars of product from health care providers which, unless they too are nationalized, are still going to be wanting to make money.

Posted by: tbrosz on January 24, 2006 at 5:00 AM | PERMALINK

...by definition, in a democracy the peoples' representatives are in charge of every sector of the economy. With very few constitutional limitations, they can decide to regulate or not to regulate, to subsidize or not to subsidize. The decision NOT to take a specific overt governmental action is just as often the result of corruption and collusion with private interests as is the decision TO take a specific action.

You know, being "in charge of every sector of the economy" didn't used to be the definition of a "democracy." My take on government corruption is that it's an outgrowth of too much government power. Maybe we should think about changing it. Putting the state in charge of all our medical care is not a step in the right direction.

Posted by: tbrosz on January 24, 2006 at 5:04 AM | PERMALINK

Part of the problem is only about 10 to 20 percent of the nurses join a union or a professional group. The nurses as an organization have been divided and conquered; they identify as holistic, or anesthesic, or surgical etc. not just as nurses. So their organizations are smaller etc.

Most strikes that I have known of -- in California-- are about cost of living increases always always always coupled with patient care issues.

Ever try being a charge nurse from 11 to 7 with 43 IVs on the floor? I had a BSN UCLA grad with three days experience quit after such a grueling night in a definitive observation unit.

In general, nurses really do want to heal and be respected for that. They are not out to make a killing only a living. They would be treated like janitors if they allowed it.

Posted by: Yoduuuh on January 24, 2006 at 6:48 AM | PERMALINK

I'd say your middle class (which according to statistics has a median household income >US$45,000). Realise their share of the tax hike to pay for expanding government medical care - is more than what they are paying for insurance.

Yeah. But you'll say anything, regardless of whether it's remotely true or not. You can't be bothered with facts, such as percentage of GDP going to health care in US vs. countries with nationalized systems.

You're an idiot, McResearcher.

But you do have one thing going for you: You can write any asinine comment you want to and some of us will feel obliged to respond because we don't want your turds left lying around.

Goody for you.

Posted by: obscure on January 24, 2006 at 8:11 AM | PERMALINK

You can't be bothered with facts, such as percentage of GDP going to health care in US vs. countries with nationalized systems.

Posted by: obscure on January 24, 2006 at 8:11 AM | PERMALINK

Neither can your voting public it seems. Or they don't trust liberal use of 'facts'.

How come universal health care keeps getting shot down again and again and again?

Explain the longer life expectancies in HK and Singapore to me again. Last I noticed Singapore had a largely private system.

Posted by: McA@y.com on January 24, 2006 at 11:36 AM | PERMALINK

How come universal health care keeps getting shot down?

Because BIG BIG money loves the system the way it is now and they hire the lobbiests to bribe the politicians to pass the laws to keep the money flowing their way. They also hire the advertising people to focus-test the slogans which sell their programs to the public, and they also hire the writers to write the stories that are passed to the media that are beamed to the public.


I nmean, geez, you can't turn on TV without seeing some purple pill ad and you can't turn around in DC without bumping into some industry lobbiest.

Posted by: Tripp on January 25, 2006 at 2:01 PM | PERMALINK




 

 

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