"Who does he think is going to be excited by this?"

That's easy, his campaign contributors!

Next question?

Twiggie knows that Rocket Man in the Bay Area will absolutely love the plan. He'll be here any moment to rave about it.

I'm sure those trained seals that show up to hear him speak all think it's great. He could feed them a shit sandwich and they'd call it caviar.

"You're on your own" isn't a policy, it's an excuse for not having a policy.

But what do you expect from people who think government isn't the solution? A solution? Conservatives in government see their ideology as an excuse to not do their jobs.

Must be nice. "I'm sorry, boss, but I'm afraid that's just the discredited rhetoric of management warfare. If I actually do my job, people will become dependent on me, and that's not good for them."
.

Instead just ask yourself: Does Bush's healthcare vision — shopping around, haggling over costs, second guessing your doctor, worrying over your decisions — sound like a winner? Who does he think is going to be excited by this?

Well, no one who has to shop, haggle, second guess and worry. But Bush wasn't speaking to them. He was speaking to the folks who can afford better healthcare for themselves and will be excited by the prospect of making it harder and harder for the great unwashed to obtain healthcare, thus maximizing profits for the industry.

Who does he think is going to be excited by this?

Blind worshipers at the Free Market Altar.

It solves everything, doncha know. Once the "docs" are free to practice their love, you won't need no stinkin' insurance.

Kevin,

This an interesting line of attack. You can almost see the bewildered couple in the attack add. "Consumer driven healthcare" sounds quite benign. The reality for the vast majority though is more likely to be "economically limitted health care"

Ralph

"Who does he think is going to be excited by this?"

The republican sycophants who treat every time Bush farts as a pronouncement from God.

Yeah, this is the great disconnect between people who were born with everything handed to them, and everyone else.

Bush simply can't conceive of what it's like to not have enough money, or to worry about the cost of healthcare. To him, it's just another consumer good. And if it works for toasters, it ought to work for cancer treatment, right?

The "Man of the People" strikes out again...

I would love to see some reporter ask Bush if he has EVER haggled with his doctors this way and to give an example of the great savings he achieved.

What I don't get is how it will appeal at all to people who work at Wendy's. That was a bizarre photo-op. If you work at Wendy's you can't afford to put aside money for any purpose. Is there some sort of low income entitlement in Bush's HSA plan or is he trying to sell palm seedlings to the Inuit?

Their instinct is telling them that the current system is hobbling business, and they are correct. It's just that they can't envision an alternative that replaces it. They are merely providing a way to tear down employer-provided health care with no good alternative to take its place.

Well, Wall Street is happy with this proposal. Then Wall Street funds Republican campaigns that scoff at Democrats as weak on defense and gay-agenda liberals. Who needs good policy in this system?

This shows how out-of-touch Bush is:

>>And so you — you talk to your doctor, you say, can't we find this drug at a little cheaper cost?

The answer is: No, for a patented drug that has no generic competition, you can't find a cheaper cost, unless you want to buy it from another country.

In the U.S., a patented drug is a monopoly.

"Who does he think is going to be excited by this?"

That's easy, his campaign contributors!

Next question?
Posted by: Dan F. on February 16, 2006 at 2:23 PM | PERMALINK

And morons. You forgot morons.

As a brand new father of pre-mee twins that are in Intensive Care right now - I guess I really screwed up by not "shopping around" - I made the awful decision to use the best Child hospital in my city - I must be a bad daddy.

Well, at least now you know what happened during the 14 hours Cheney waited to report his shooting. He was shopping around for the cheapest treatment for his seriously wounded pal.

This is partly just meat for the free market fundamentalists that Bush courts. You know, those people that believe with a religious fervor that there's no problem a "free market" can't solve. This argument is meant to dupe those folks (although the plan is not aimed at them, unless they also happen to be rich).

And I bet there is something of a disconnect. The "have mores," which by Bush's own admission make up his base, are often rich enough that they don't strictly have to buy insurance. A plan like this is great for them -- they a get a little tax break for some money they set aside for health care spending.

That's the most important thing to remember about Bush policy: almost everything is aimed at the betterment of the top 1%.

Bush is the reverse Robin Hood: he robs from the poor, to give to the rich.

He's appealing to people who beilieve they have high premiums because other people are wasteful. Young Republicans are frustrated that they have premums higher than their percieved annual health budget, and older Republicans likely have enough money not to care too much if they end up spending the limit on their account. It's not designed to appeal to anyone who visits a doctor, rather to people who are concerned that collective insurance helps out the sick too much at their expense.

Jon Cohn's book not yet listed on amazon with
a pubication date....sure it is soon forthcoming?

This already happens, to an extent.

The last 2 times that I went to the emergency room I subsequently received bills from various departments in the hospital. Then I got to call up various departments within the hospital and haggle over whether I actually owed the money, and what the process was if I didn't.

As far as the sell, haggling pisses me off more than any other aspect of health care. I don't get it.

If their claim of Royal powers goes undisputed, why does anyone think that anyone would attempt to contradict their assertion that HSAs will cure our Healthcare ill?

Republican monarchy for our life time. Get used to it.

The answer is: No, for a patented drug that has no generic competition, you can't find a cheaper cost, unless you want to buy it from another country.
Not true. Drugstore.com almost always has cheaper prices than your neighborhood drugstore. Canada has yet cheaper prices if you're willing to take a little risk. I know--I've been shopping around for cheaper drugs for a few years now, sans health insurance.

That said, I still think HSAs are an absolutely stupid idea.

Well, at least now you know what happened during the 14 hours Cheney waited to report his shooting. He was shopping around for the cheapest treatment for his seriously wounded pal.

Outstanding!

Does the congress have a medical savings account plan? How about the executive branch?

Bushco will never pass a significant piece of "meat and potatoes" legislation before he's done. He failed miserably with SS reform. This, too, will die a slow, annoying death as well.

As long as there are sufficient first term birds coming home to roost (or sitting on the the shoulders of the VP's close friends) nothing significant will change. This is typical of second terms in general, even those without lots of baggage from the first. Bushco, however, looks like an overburdened skycap cum shopping cart pushing street person.

It's wonderful, wonderful.

I can see the ads now.

"It's Discount Days at Bob's Mammary Shop. You get BOTH TITS enhanced for the price of one. And if you agree to use our DISCOUNT TIT FILLER, you can get 3 FOR THE PRICE OF ONE - you provice the third tit !!!"

Yes, medicine will soon be the same as car sales.

Isn't this what we had in the 19th century?

Specialists will love this plan. Nobody will spend money on regular checkups and preventive medicines, so people will get sicker and specialists will have more patients.

Kevin, Bush's statement is exactly the sort of thing you'd expect a "regularly guy" that you'd "like to have a beer with" would say!

But, yeah, echoing the observations of the other posters, this is Bush's awkward attempt at trying to tell voters that the blame for high premiums lies with other patients who are asking for too much health care. After a few more refinements of the message, Bush will explain, more clearly, that other people are the ones who need to pay more attention to how much things cost, not those to whom he is speaking.

This is Kabuki. Bush knows HSAs are going nowhere, but he must provide the public with "the illusion of due diligence" (my favorite quotation from "Syriana") in attempting to improve health care. Having so provided, he will then blame the Dems for blocking his "solution".

Only problem is, while his brain dead legislation waits for congress to pull its plug, he has to have some sort of sales pitch, however lame. And this is the best he can manage.

As a brand new father of pre-mee twins that are in Intensive Care right now - I guess I really screwed up by not "shopping around" - I made the awful decision to use the best Child hospital in my city - I must be a bad daddy.

Good luck. My twins just yesterday turned 16. Both learning to drive, or not as the case may be, at one time.

Amazing -- I didn't think it could happen, but Bush's arguments in favor of HSAs quoted here are so blatantly idiotic and self-defeating that not even the trolls are out on this board defending them.

I'm sure they'll be revising Bush's script on this *very* quickly. But to what?

There are 2 ways to sell it:
1) Use language like "shop around for the best price" and "more control over your health care dollars" and people will think it will save them money and that it's a good idea. I've already heard my local TV news refer to the plan as "giving consumers more control".

2) Explain that by reducing unnecessary demand for healthcare, healthcare costs will drop. This could even be true, although it's obviuosly an idealized model.

Here's a better question: why do lieral's oppose epanded HSA's? They would be a financial benefit to a large number of people. Just because it's not national health care doesn't mean it's a bad idea

It is expected, I suppose, that the professional Bush haters will jump on yet one more opportunity to argue like headless chickens over a well-thought out plan to save our healthcare system from utter ruin just because the plan is being proposed by George W. bush.

"Who does he think is going to be excited by this?"

Dan F has it right in the first post. Bush's base is excited, and his base is the "have-mores," as teece pointed out.

Executives with a tax-free account they can pump money into will be excited about it.

And unlike current retirement accounts, which are tax-postponed, these news HSA's will not be taxed going in OR coming out. AND at some point it can come out for any old thing, not just health care spending.

And incredible drain on the fisc--just what Bush and his have-more base love.

And a shoutout to kidkostar for the vision of Cheney shopping around for the best price for Whittington's health care!

Not true. Drugstore.com almost always has cheaper prices than your neighborhood drugstore. Canada has yet cheaper prices if you're willing to take a little risk. I know--I've been shopping around for cheaper drugs for a few years now, sans health insurance.

Costco has really good prices on prescription drugs (usually at least $20-$30 less) and, in California, you don't have to be a member to use their pharmacy.

That is one of the secret things drugstores don't tell you: if you're uninsured, they don't all have the same price for prescription drugs.

But it gets real old real fast having to call around to every pharmacy in town to price-compare and decide if it's worth driving 10 extra miles to save an extra $5. I was doing it for non-urgent stuff, like rosacea medication. I can only imagine trying to price-compare your asthma medication when you're in the middle of an attack.

Anybody else notice Kevin Drum has no alternative to offer?

As long as Drum and the rest of the Pelosi/Reid/Kennedy/Dean Democrats sit on the sidelines and whine about Bush's proposals, the Dems will continue losing elections.

We should call it the "shopping while vomiting" plan.

Rufus said:

"Drugstore.com almost always has cheaper prices than your neighborhood drugstore. Canada has yet cheaper prices if you're willing to take a little risk. I know--I've been shopping around for cheaper drugs for a few years now, sans health insurance."

I too was shopping around for cheaper drugs for my mother. And I didn't much difference at all for patented drugs in the U.S. Generic drugs, yes. Patented drugs, no.

I ended up buying them from Canada. Patented drugs were quite a bit cheaper from Canada.

The reason W would be pursuaded by his handlers that this is a good idea is because he has no life experience. None. His handlers take advantage of the fact that George has never seriously considered retirement income, catatrophic health coverage, access to education (vouchers! there's a solution ins earch of its problem!), mass transit, military service, or even belonging to the PTA or attending church. He simply doesn't do any of these things, and never has.

John K. Galbreath has written that the children of the leisure class are by definition more stupid than their parents because they don't have as much life experience, and George W. is 4th generation stupid! On top of that, being raised by Barbara in a family with an absent father, he also has no empathy. He can't imagine anyone else being concerned about these things either! The only things he knows about real life is what people tell him. He's surrounded by people who lie, so he repeats the lies not knowing--not having any way to know--if they're true.

Little Creek:

"Anybody else notice Kevin Drum has no alternative to offer?"

Basic public choice theory: the alternative to any policy proposal is the status quo.

In this case, allowing employers to deduct (most of?) the cost of providing health care to employees from the employer's taxes.

Thanks for playing. It's not like the president has this WHOLE NEW BIG IDEA - people should see doctors!

I know how to get my drugs cheaper....order from Canada.

Oh wait, they are not taking my shipments before they come across the border.

What an ass he is.
There is no way to lower your drug prices, except to get them somewhere else. Unless you have medicare partD. I hear they are charging more than Drugstore.com for some drugs. And that prices went WAY up when these private plans started.

Bush is hazardous to Americans' health.

I have to admit I don't even know how much many of the tests and drugs I am ordering for patients cost. You'd think that information would be easy to get, but it's not. In a busy urban ER, my job is to exclude life-threatening problems, and to discharge everybody else (95%) as quickly as possible. I do not have time to listen to social concerns, personal problems, or any complaints that can be managed by a primary doctor. To counsel a patient about his or her financial decisions would simply break the system.

"Here's a better question: why do lieral's oppose epanded HSA's? They would be a financial benefit to a large number of people."

Because "HSAs for some and normal insurance for others" will drive the young and healthy into HSAs, which means the "normal insurance" group will consist of the sick and the elderly. Which kind of defeats the risk-sharing purpose of health insurance.

Also, because HSAs encourage people to cut health care costs whenever possible, and people are notoriously bad at figuring out what preventative care is cost-effective, one likely outcome of HSAs is that massive numbers of people will skip physicals, blood tests, etc. Meaning a lot more of them will get sick than currently do.

The current plan: we all pay through a system of distributed risk-management, and I get health care whenever I'm sick.

Bush's plan: whenever I feel sick, I have to make several phone calls, get put on hold by doctors, pharmacies and insurers for hours on end, and pay for it myself. "It's your money, you're responsible for routine medical expenses" -- meaning that if I don't have enough money, those routine medical expenses will go unmet.

You're right, it does sound tempting when you put it that way....

HSA's could be a useful means of acquiring healthcare,just not here. Try calling around to various hospitals in your area (assuming there's more than one) and ask for a price quote for,say, a liver screening. After you've been told that the hospitals don't know what that test costs because it depends on which insurance you have,you'll have some idea of the problems with HSAs.
To implement them,the currently hidden process of bulk negotiation with a limited # of insurance plans,will have to devolve to a process of individualized negotiating which hospitals,labs and doctors will view as necessitating a quote sheet. The trouble is hospital cost accounting really can't handle that level of detail.
What sort of intermediary will such a market require?
HSAs will be a great idea for fund managers,a potential nightmare for providers and users.

I understand this is a simplistic statment. The average saving rate in 4th quarter 2005 was negative -0.07 per cent, where will the monies come from to fund this.

BigRiver: No Alternative?

Choice #1 is the clear winner -- Bush's Alternative #2 sucks toilet water compared to the do-nothing alternative.

The alternatives offered by the other industrialized contries are better, as Kevin has pointed out.

People like medicaid, medicare, and social security -- they need fixing and expansion to cover the people that have been paying for them and relying on their continued exisitence since their inception.

What's wrong with single-payer? Is it just that it doesn't appeal to those who Bush is targeting?

Health care is one area where the "heavy hand of government" makes so much more sense than "free market solutions" (although Bush and his cronies don't really believe in truly free markets).

This idiotic HSA idea, pisses me off, because it is based on several flawed assumptions, including:

(1) That all human behavior is predicated on what the tax consequences of that behavior are. In other words, people will change their behavior because it helps them save a little on taxes [FOOLISH].
(2) That people working at Wendys and the like have one single dime to put away for their health care [FOOLISH]. As craigie and others have pointed out, the poor don't save money, because they don't have any left to save after they pay their bills!
(3) That the health care crisis in this country is caused by people seeking routine medical treatment (e.g. check-ups, flu, minor injuries, etc.) [FOOLISH] Health care costs are astronomical due to the heroic and extremely expensive costs related to children in the first six months of their life and old people in the last six months of their life. Take out those costs, and we do not have a crisis.

A lot of this gets down to moral and ethical questions that Bush and his ilk refuse to address: Do we spend millions to keep very premature babies alive? Do we spend millions to give an 80 yr. old man a heart transplant? Do we spend millions to keep brain dead people like Terri Schiavo alive indefinitely?

Until we honestly confront these difficult decisions, the costs of health care in this country are going to be a big, big problem. It's very, very easy for the far-right to take the simple-minded position of saying "all life is sacred" (unless you happen to be a Muslim, of course) and walk away and let society figure out how to pay for keeping human beings alive that 100 years ago would have died a natural death. Any damn fool can do that. We need to be asking ourselves - "Who do we allow to die, when the costs of keeping them alive are prohibitive?" This is the sort of thing we need to be talking about - not about whether I can get a tax break on the $1,000 that I squirrel away to pay for my Lasik surgery.

Now here's what Bush is trying to sell: When you get sick, you should spend a lot of time shopping around for doctors to find one you can afford. You should put off tests that he recommends if they're expensive. You should haggle over the cost of drugs as if you were buying a used car. And when you get home you should worry about whether you made the right decision or not.

I'm not sure that I understand this the same way as Kevin suggests.

If there was some financial incentive involved, I could choose to use a medical clinic (or whatever the correct term is for those "chain" medical offices surrounded by a parking lot) instead of a private doctor for selected types of medical problems.

I could choose to buy prescriptions from a Costco or Walmart if I knew that I was saving money (today I pay the same copay regardless of where I buy scrips).

Similarly, I might choose to defer certain types of tests if it meant I could pocket the money saved.

So, bottom line, if there were a financial incentive for me personally to make choices, I MIGHT make those choices. But, under my current insurance system, there is no financial incentive for me to consider doing so.

These types of choices seem much less complex than the scenario that Kevin suggests.

this is the exact same pitch my employer gave us when they announced the 2006 health plan.

we get an HSA that we get to spend away before a standard insurance plan kicks in. the insurance is actually a high-deductible plan, but the HSA (which is funded by the company) counts against that deductible - so we don't actually pay the deductible out-of-pocket. oh, and it costs more than last year's plan. and given the trend, i expect that next year the HSA will be smaller and we'll be stuck picking up more of the deductible.

anyway, they used the exact same terms: this HSA gives us control over our own spending, choice about our healthcare, the ability to make decisions. i was awe-struck, listening to the presentation; i kept thinking: why the fuck do i want to have to shop around for the cheapest surgery i can find? why do i want to have to worry about pricing doctor's visits? why do i want to tell the doctor which lab he has to use to process my bloodwork? why is any of that better for me than paying my co-pay and walking away ? hell, if i'm going to have to do all that, what's the point of having insurance anyway?

i might as well opt-out completely and just buy my own HSA and high-deductible policy, just like what W is pushing. funny how that works...

It sounds exactly like the Medicare drug benefit plan, which I am wading through, trying to find the best policy for my mother with Altzheimer's. And let me tell you, it's a hum dinger.

He can't see that this isn't attractive because
1) he knows nothing of personal responsibilty having been handed everything since his upper-class birth
2) he is incapable of empathy

Ignore the 'cheaper doctor' aspect. The rest sounds good to Bush and his cohort because shopping around is how they do health care. If they need angioplasty or a bypass, they call their friend the doctor or someone who's been through it and ask "Who's the best?", and "What new treatments should I ask for?".

If their kid is born with a serious problem, they call on their network of acquiantances to find the best doctor in the country and take their kid to her.

And when they think about health care, they can't believe that most people just go to the first doctor and follow the doc's recommendations. Ordinary people don't have the initiative and market sense to find the best health care. Not everyone can have the best doc, of course, but ordinary people could use the same approach to find the *cheapest* treatment...

Who does he think is going to be excited by this?

Insurance companies -- you know, the ones that torpedoes Clinton's health care proposals (to which, let's not forget, the Republicans felt no obligation to offer an alternative).

Similarly, I might choose to defer certain types of tests if it meant I could pocket the money saved.

You might, but, humans being the notoriously poor risk-assessors that we know they are, especially when it comes to their own health ("who, me? I'll never get lung cancer!") the most likely outcome of this will be that you will indeed get sick, but you'll catch it much later than if you'd gotten the early tests and therefore you'll be much sicker and your treatment will cost much more in the long run. So yeah, you'll save the hundred bucks for the test, but you'll pay $100,000 for the operation and hospital stay. It's the ultimate save a penny, lose a pound scenario.

Stefan: So yeah, you'll save the hundred bucks for the test, but you'll pay $100,000...

No, everyone in whatever insurance group will pay the $100,000. That is why what seems like a good idea to save money from an individual's point of view actually ends up costing all of us money. The inability to look at the effects of individual decisions on group is the common failure of thinkers(?) like GWB.

"Who does he think is going to be excited by this?"
Answer: Republican MBA students without families who believe they will never get sick.

No, everyone in whatever insurance group will pay the $100,000.

Yeah, assuming your insurance will even cover that procedure. If not the hospital will bill you directly and, when you can't pay, eventually the cost will be passed along to all taxpayers.

Republican MBA students without families who believe they will never get sick.

Uh, I think phleabo already mentioned them.

Good thing our troll showed up to remind us that there is at present no system of any kind to deal with this problem and that Bush is the first to deal with it.

Man, what a leader!
.

I think HSAs will replace employer provided health insurance just like 401ks replaced pension plans. For many of the same reasons. And businessmen were a driving force behind the changes.

I still maintain that the biggest benefit is in giving people an incentive to live healthier lives. That's what universal care doesn't seem in my view to take in account. If we don't get people living healthier health care will be a huge expense.

Who does he think is going to be excited by this?

People who want to keep a little of their own money and retain a little more control over their own lives.

Middle class swing voters, perhaps.

Somebody asked why liberals are opposed to improving HSAs. I am a liberal, and I am not opposed to improving them. I am opposed to thinking they are the solution to the healthcare crisis.

If we do nothing, more and more of you are going to find yourselves with HSAs. You will want the improvments.

So he wants to make shopping for a proctologist just the same kind of fun, rewarding experience we all enjoy when it's time to buy a new car? And he thinks we're going to see that as a good thing?

This argument doesn't even make sense on its face. Individual consumers are not going to drive down health care prices negotiating individually. The only chance of driving down costs would be through collective bargaining strategies and I am quite sure that is something to which Republicans will be manifestly opposed.

Chad, I wouldn't want a bypass surgery operation even if I knew it were free. Poor health can incapacitate someone, force them to miss work while they undergo an operation and cut their lives short. The Bush-supporters are saying, "but what they really need to face is the prospect of bankruptcy. That will convince them to exercise more and watch their cholesterol."

Chad, I wouldn't want a bypass surgery operation even if I knew it were free. Poor health can incapacitate someone, force them to miss work while they undergo an operation and cut their lives short. The Bush-supporters are saying, "but what they really need to face is the prospect of bankruptcy. That will convince them to exercise more and watch their cholesterol."

Of course employers will love to have all of their employees "take personal responsibility" and buy into their own HSAs.

Stefan,

Actually I believe that Mary M, Cheney's aide, did check for cheaper hospitals. However, they were limited. Outside of Christus Spohn Memorial, there is a Children's Hospital. But the one they wanted and which was the cheapest, Banfield, was closed on weekends. However, their PetSmart store was open.

So he wants to make shopping for a proctologist just the same kind of fun, rewarding experience we all enjoy when it's time to buy a new car?

yeah, we'll all drop by the Dr's office to look around, inspect their glove and swap supply, talk to the staff, hang around "just looking" for an hour or two, maybe give the 'scopes a test drive. we'll do this at three or four doctors' offices before deciding we'll just skip it until next year.

"This is Kabuki. Bush knows HSAs are going nowhere, but he must provide the public with "the illusion of due diligence" (my favorite quotation from "Syriana") in attempting to improve health care. Having so provided, he will then blame the Dems for blocking his "solution".

Only problem is, while his brain dead legislation waits for congress to pull its plug, he has to have some sort of sales pitch, however lame. And this is the best he can manage. "

HSAs are already law. An HSA is coming to your company soon. You guys missed the debate on this one.

Cleek and others are correct. While this is an idiotic plan, it appeals exactly to those who are convinced that a great swarm of the vast unwashed are driving up their costs of everything. It appeals to all the young people who say that social security is immoral because you have an obligation to save for your own retirement and that no one owes you money.

It's use of choice and empowerment language is the same sort of appeal used by adverts that do the 'you make the call' or 'take control' riff. And it appeals to the idea that you are smart and you can find a deal that other's can't so you will get a leg up on others cause you found the best deal.

I've seen this thinking at work. My son-in-law is absoluely convinced that if he spends money on discount CD's he is better off financially than if he doesn't buy any at all. He counts up savings as profit to himself. And ignores the cost.

s/swap/swab/g

As usual--

us libruls say "this plan will fuck us."

Chad says, "No it won't."

us libruls say "Chad, you are full of it" and proceed to show him why.

Chad says "Too bad, you're fucked anyway" and imagines this means he won the argument.

Why am I not surprised???

It is expected, I suppose, that the professional Bush haters will jump on yet one more opportunity to argue like headless chickens over a well-thought out plan to save our healthcare system from utter ruin just because the plan is being proposed by George W. bush.

Nope, that's just icing on the cake.

If I'm seriously ill, I want the quality of my healthcare and treatment to be the most important considerations -- not bargain-hunting!

OTOH, if YOU'RE seriously ill... knock yourself out shopping at Eazy Bob's Cheapo Health Mart.

(headless chickens argue? must be a side effect of the bird flu. makes 'em cranky.)

Stephen Kriz at 3:18 p.m.

I usuallly don't find much on which to agree with you, but your comment, about where a lot of the costs/inflation arise, is dead on; and it isn't just the right that refuses to deal with this reality honestly. Almost no one wants to face up to the fact that any public/private healthcare system will have to ration healthcare to actually reign in the costs. Indeed, many commenters here, with a straight face I assume, promise that universal healthcare will provide most everyone with at least the level of healthcare they receive today, while providing that same level of coverage to all of those who did not have health coverage before, while at the same time reducing the % GDP consumed down to the level of that of Canada.

No one really wants to face reality- to control the cost escalation, someone will have to have healthcare withheld from them.

Someone somewhere pointed out that the campaign ad writes itself: "Bush thinks the problem is that you have too much insurance and it's too easy for you and your children to see a doctor. If you agree, vote Republican."

Many of the reasons people are correctly giving as to why this is a bad idea also apply to school voucher programs.

Ted

I have no problem with bargain hunting or getting the best deal on medicines. I simply acknowledge the reality that insurance companies are best-suited to make these negotiations. That is, after all, what I pay them for-- so that they, not I, do the legwork necessary to agree who will get paid how much and when. They have more buying power than I do.

Yancey, having "healthcare withheld" is sort of a loaded term. When I need an operation or I'll die and I don't get it, that's a matter of health care being "withheld." When my insurance company says that they'll pay for a procedure that is known to work but will only partially cover a procedure that has no overall benefit for patients who go through it, that's not having health care "withheld" from anyone.

I still maintain that the biggest benefit is in giving people an incentive to live healthier lives. That's what universal care doesn't seem in my view to take in account. If we don't get people living healthier health care will be a huge expense.

Except, of course, that all statistics show that other comparable modern societies that have universal care (basically everyone besides us) live healthier lives and enjoy greater health than we do (when measured by such factors such as infant mortality, life span, incidence of obesity and heart disease, etc.), and for much less than we spend, to boot. But why drag facts into it....

This is such a stupid idea.

Normal people are going to haggle with their doctor? Rich sons of bitches might do that, but normal people will not. Doctors are respected--you think people who trust a man with their life and their kids' lives are going to be comfortable saying to him, "oh, by the way, I think you're ripping me off."

Americans don't like to haggle to begin with. You think we're going to treat doctors like we treat car salesmen? You think people are going to want to? You think doctors are going to let them?

Man, these ads are going to ROCK!

"When you get sick, you should spend a lot of time shopping around for doctors to find one you can afford. You should put off tests that he recommends if they're expensive. You should haggle over the cost of drugs as if you were buying a used car. And when you get home you should worry about whether you made the right decision or not."

Where does he live? That's what most people have to do now. It's called "managed care." Only people with the more expensive PPOs get sick and "just go to the doctor." Everyone else has to get a referral and a permission slip.

The Bill/Hill. plan of the 90s was criticized because, God forbid, the GOVERNMENT was going to be making clinical decisions. Well, guess what, instead we've got INSURANCE EXECUTIVES making clinical decisions.

Bush should just stay home and keep making those speeches about terrorists. It's the only thing he's had any success with. (The speeches, that is, not the terrorists).

Here's MountainDan on the Iran thread:

Anybody surprized Kevin Drum doesn't take a stand on Iran's nuclear program??

Kevin Drum is the mirror image of the Pelosi/Reid/Kennedy/Dean wing of the Democratic party. Never lay out an agenda. Never take a stand that requires courage. Use any and all events to point out Bush's failures.

And here's BigRiver, on this thread:

Anybody else notice Kevin Drum has no alternative to offer?

As long as Drum and the rest of the Pelosi/Reid/Kennedy/Dean Democrats sit on the sidelines and whine about Bush's proposals, the Dems will continue losing elections.

I report, you decide.

Stefan,

No one has really shown that the healthcare system is the cause of Americans' poor diets. I still don't see how universal healthcare is going to stop people from stuffing themselves every Friday night at the steakhouse, or eating lunch every day at McDonalds.

Yancy, I don't pretend that a single payer health care system is going to solve all the problems, but I do think it has a better chance of managing the problem of rationing in the future. Sure: care will be rationed. There are limited healthcare workers and an aging population, not everybody is going to get a million dollars worth of quadruple bypasses and replacement joints. I do want everybody to get casts for broken bones, and HSAs do absolutely nothing to help that, and in fact hinder it by separating the risk pools.

The people who will always be able to choose and afford the insurance that will cover a bypass or hip replacement want out of the risk pools of people that will need to go to the ER to for basic care, and HSAs are a mechanism to do just that.

Almost no one wants to face up to the fact that any public/private healthcare system will have to ration healthcare to actually reign in the costs. Indeed, many commenters here, with a straight face I assume, promise that universal healthcare will provide most everyone with at least the level of healthcare they receive today, while providing that same level of coverage to all of those who did not have health coverage before, while at the same time reducing the % GDP consumed down to the level of that of Canada.

Well, since most evidence suggests that's true, unless Americans are just nationally incompetent at delivering healthcare (a possibility that I suppose can't be ruled out), that's a perfectly reasonable thing to suggest.

The particular hybrid system the US has is, by every evidence, incredibly cost inefficient compared to almost every other system in the developed. So there is no reason to believe that a system could be designed which would both improve service availability and decrease total costs.

You seem to assume that all systems must be equally efficient so that any reform is zero-sum. This assumption is contradicted by all evidence available.

"old Joe does it for X"

Wall, uh gyiss I'd go with ol' Joe, he does it fer me. Cuz X were a great band, as I recall. An he has jus the purtiest way a puttin' things.

Yancey:The argument made by most proponents of a single payer system, is that you can easily lower the % of GDP spent on health care through the elimination of duplicate beauracracy. From speaking to people who have actually worked with the current framework, I have no doubt that this argument is correct to some degree. Will it be enough? I don't know. Although I think a combination of eliminating the paperwork combined with a national malpractice insurance program should keep costs under much better control than they are currently.

"I still maintain that the biggest benefit is in giving people an incentive to live healthier lives. That's what universal care doesn't seem in my view to take in account. If we don't get people living healthier health care will be a huge expense."

Funny how countries with universal health care have healthier populations than countries without it though. It's as if you assumptions aren't valid.

You nailed it, Kevin.

Lately I have been very careful about being sure that doctors write my prescriptions carefully to maximize reimburements under my coverage. It can make a big difference in your cost- the amount you order at a time, for what period of coverage, right to substitute generics, etc.

Generally, I've found that doctors don't really want to be bothered with this and I have to make myself a bit of a pain-in-the-ass to get them to do it. And its the busy doctors themselves who you have to deal with. Nurses, assistants, etc. usually can't write prescriptions or make any significant medical decisions.

How many people are really going to be confortable negotiating the little financial details of their medical treatment with their doctors. Not many, I'll wager.

watch the angles.

we already know bush is in the pocket of the health insurance industry and the pharma industry. he's not going to seriously back anything that risks reducing revenues for either of those backers.

so what's he really doing? is he replacing serious health care reform with a straw dog? or is there a wrinkle to this we haven't seen yet?

I do like the idea of the commercials...

After all the haggling, I sure hope I don't get a lemon.

Or maybe I can talk the doctor into taking $10 for writing me a scrip without an office visit.

Or maybe if I hold him to his $50 quote for fixing my sore shoulder, he will do a good job of setting the unforseen broken collarbone.

And how is it going to work from the doctor's side?

A prix fixe menu of potions and services?

Are they going to spend time on the other side of the haggling? Or $20 bucks gets you 5 minutes and an aspirin, $50 gets you other, think of what a hundred would do?

Bringing the market back into the public/private dog's breakfast that's our current system was something that should have been dealt with years ago.

IMO, health savings accounts in their current form aren't really going to do it. Too little, too late. The key would have been making it easier at the beginning to find insurance outside your employer.

Personal health insurance should have been made completely tax deductible thirty years ago. Even now, this would help. I'm self-employed, and health insurance costs became fully deductible in the past few years. Give an employee a reasonable option to buy his own insurance compared to what the company offers and then you'll have something. Not an easy thing to do, since companies get all kinds of price breaks not open to individuals.

In any case, you should be "shopping" for insurance, providers, and health plans before the fact, not after. You look for family doctors, treatment centers, and drug plans before you get sick, not after. If health savings accounts work for this, fine, but I don't know if they do as currently envisioned.

Government health care, where the market is completely removed from the system as far as the consumer is concerned, sounds great. But Yancey has it right. The inevitable result of unfettered demand and limited supply will be rationing and price controls.

If putting everyone on the same mediocre level of "good enough" care is better than excellent care for some and no care for others, fine. Maybe you can make a good case for that. But let's not pretend that we're all going to be getting all the high-tech and cutting edge health care goodies we want for nothing while costing the providers less than they charge now.

"Except, of course, that all statistics show that other comparable modern societies that have universal care (basically everyone besides us) live healthier lives and enjoy greater health than we do (when measured by such factors such as infant mortality, life span, incidence of obesity and heart disease, etc.), and for much less than we spend, to boot. But why drag facts into it...."

"Funny how countries with universal health care have healthier populations than countries without it though. It's as if you assumptions aren't valid."

But did they get healthy after the universal health care or are they the type of people who will complain about genetically modified foods and pay more to eat well. If you know everyone is healthy for the most part, then you are less resistant to instituting healthcare for all.

Nobody's excited about Bush's plan, but we'll be seeing them written into the budget shortly, if it hasn't already been done. It's Bush's way to futher save the insurance companies.

"I still maintain that the biggest benefit is in giving people an incentive to live healthier lives. That's what universal care doesn't seem in my view to take in account"

That make no sense. The poorest people in American society, those with the least access to health care, are more likely to be obese and to be smokers. Wealthy people with the most access to good, comprehensive health care are also the most likely to be slim non-smokers who eat nutrient-dense food such as vegetables and exercise regularly. Gee, you could almost conclude that the ability to afford health care inspires people to live healthier lives!

But did they get healthy after the universal health care or are they the type of people who will complain about genetically modified foods and pay more to eat well. If you know everyone is healthy for the most part, then you are less resistant to instituting healthcare for all.

After Chad, after. This is everyone in Western Europe, everyone in Canada, everyone in Japan and Australia and New Zealand -- the poor, the working class, the middle class, the rich. Or are you asserting that everyone in those countries are the sort to "pay more to eat well" while Americans are lazy half-assed swine? Is it really your argument that Americans are weaker than those other countries?

Maybe we should adopt the "Cheney's Run" health care plan instead -- get to 78 and we shoot you. Saves on all that life-prolonging technology.

The liberals on this thread who think nothing will come of the HSA initiative are very wrong. They will replace employer-funded insurance. As another poster pointed out, it will be just like the move from pensions to 401Ks. If Bush's proposals get passed, all it means is that people will have better HSAs.

This is going to be reality, so you better get used to it. And those who think people won't buy into it are wrong. People have accepted their pensions disappearing, and they'll accept this. It'll be marketed as consumer choice, taking personal responsibility, and stopping others from exploiting the health care system. And America will respond to that language. And in any case, most people won't have a choice.

Well, at least now you know what happened during the 14 hours Cheney waited to report his shooting. He was shopping around for the cheapest treatment for his seriously wounded pal.

Brilliant.

"BigRiver" is an insult to a great Johnny Cash song.

But Yancey has it right. The inevitable result of unfettered demand and limited supply will be rationing and price controls….Posted by: tbrosz

If putting everyone on the same mediocre level of "good enough" care is better than excellent care for some and no care for others, fine.

Most countries with single-player have a private system running in parallel. People can purchase health insurance to receive benefits of both systems. I live in Australia, and got my knee ligaments fixed at a clinic that treats Olympic athletes and professional sportspeople from around the world. And I didn't pay any more than my $80 or so a month health insurance.

And if the top level of healthcare is poorer in these countries, prove it. The statistics showing the advantages of single-payer have been shown plenty of times; show us a comparable set of statistics showing its disadvantages. Otherwise, you're just blowing hot air.

Except that, for some strange counterintuitive reason, that isn't the case in any country having single-payer health care.

That's not entirely true. Single-payer countries have "rationing" and "price controls". So, of course, do countries with other systems. Its just a matter of what method exists to allocate limited resources and set the price.

Ultimately, Yancey and tbrosz are arguing the "government intervention is always inefficient" line, even though the features which, in theory, make "free markets" efficient are notably lacking in the healthcare field, and, further, the empirical evidence shows that single-payer systems are more efficient.

But its an article of faith with them, so facts that contradict it are lies invented by the devil (or, in this case, "liberals") to mislead the faithful. Its no more rational than Young Earth Creationism.

Can't you see the counter:

"So Little Timmy had a headache and a fever. We didn't want to spend more than we had to so we shopped around, found a doctor and saved about $10! He told us we needed some tests and we looked around some more, finding a place to do it for 25% less than the doctor’s quote about a week later. The tech told us Timmy had an earache but the doctor was busy and couldn’t see our son for another week. We asked the doctor for some kind of help and the doctor proscribed some penicillin. We looked for the best price for the 20 pills the doctor said he would need, and we waited 3 more days to get a good deal from the Presidents Day sales.” Camera pulls back, a hospital bed with a small child hooked up to every machine know to man. “The doctors at the emergency room told us yesterday that the minor infection that could have been treated with a single shot 2 weeks ago, now they tell us that it has become spinal meningitis. Timmy may never walk again. All unnecessary if we hadn’t wasted time having to look for good prices or had a decent medical plan.” Camera closes on the father again. “The visit to the emergency room also wiped out our entire Healthcare Savings Account, and we’re broke. I have a decent job but we got nothing left, we’re probably going to wind up having to sell the house just to pay for Timmy’s care. And the worst part… his little sister Janie started coughing this morning.”

Now keep this in mind: if the dad above can’t or wont pay for the hospital stay, what happens? First the patients that can pay will find that their costs will go up to cover it, meaning that after a short while fewer and fewer can afford to pay in a never ending spiral. In areas where hospitals are scarce or in poor areas of major cities, the government will have no other choice but to step in and pay either through current dysfunction welfare system or block grants. These funds will not only have to pay the shortfall but all the associated costs of demanding the funds in the first place (you don’t think the lawyers and lobbyists are working to get this cash for the hospitals for free do you?). This requires some source of funds even if this means a surcharge on current active health insurance policies, raising insurance costs, causing more and more businesses to simply give up on the idea of providing traditional insurance. And this is already happening even with the current insane system of health “insurance” we have now. So the bottom line is do we plan a move to a single payer system or do we simply do it via a vastly more expensive default fait-accompli.

All I know is that when my blood gasses go south, I want Dr. House.

The AMA backed this putz, and you can bet your ass that i will be on the phone peppering doctors' offices about costs. You should too. Between you and 30 smartass friends you should be able to get 30 estimates from every doctor in town. Just calla nd say, "how much for a hernia operation. How much to remove 200 shots of birdshot from my eye?"

Normal people are going to haggle with their doctor? Rich sons of bitches might do that, but normal people will not.

For sure, some people will make better use of their HSAs than others. for Republicans and conservatives, that's an advantage of HSAs; for Democrats and liberals that's a disadvantage. but it doesn't have anything to do with rich sons of bitches. Self-efficacy cuts across class lines.

Last time you had to go to the hospital for surgery or whatever, did it occur to you to ask, in advance, what the price would be? In some cases, you can do that. But in most cases, they'll calmly tell you that they have no idea what the price will be. There are simply too many variables. They don't know in advance how many of what kinds of tests your doctor will feel compelled to order. They don't know what kind of complications will come up in your surgery.

So imagine a world in which you tried to shop your surgery. You call up several surgeons and ask their prices. If they want your business, they'll give you an estimate. Mr. Bush will be happy!

Just one teensy problem though: Upon what basis can you compare the estimates you get from different surgeons. You aren't a doctor. You don't play one on TV. You have far less expertise in medicine than in auto mechanics, and you already don't know how to shop around for car repairs.

With one mechanic, you get a story that your timing belt has to be replaced. Another tells you that you've blown a head gasket. A third, the low bidder, tells you that all you need is a tuneup. Do you trust the low bidder?

If you have trouble shopping car repairs, imagine what happens if you need to shop medical care. Imagine further that you need the answer NOW, because you're having a major medical incident and you must have surgery within the next hour or you'll die. What happens if you're unconscious? Who makes these decisions for you?

My current medical insurance isn't great, and it does nothing to combat the $10 charge for an aspirin, but at least the emergency room folks can dig into my wallet and find out what coverge I have, so there's no question about my ability to pay.

I agree this "salesmanship" is assinine, I also agree that this issue is the best arrow in your quiver; but can't the Dems do better? Gephardt offered the only legitimate alternative I've seen in recent years, and he was treated like he farted in the elevator.

How pathetic to read these smug, self-congratulatory responses from people like republicrat that just ooze this "I have got it all figured out and it's just like Ayn Rand said" attitude.

Health care is too important to be so prideful and hard-headed. We could have universal health care for all in this country by raising taxes by tiny increments. Instead, we have a higher infant mortality rate than Cuba, due to these tax cut fetishes that conservatives suffer from. We have the money to pay for the best health care in the world for every American citizen. We just don't have the will for self-sacrifice.

How sad.

Gee whiz Kevin, Bush is a MORON, what else do you need to know??? I mean, why even ask the question???

Why do you assume Bush thinks this is a politcal winner?

We could have universal health care for all in this country by raising taxes by tiny increments. Instead, we have a higher infant mortality rate than Cuba, due to these tax cut fetishes that conservatives suffer from.

You might want to recalculate that. For universal health care, even assuming we lower health care costs (which I still have never seen broken down) to what Canada spends per capita, we're looking at about a trillion dollars moved out of the private (largely employer-paid) insurance system into the Federal government.

One assumes that employers no longer having to pay for insurance would somehow be balanced by increased business taxes on those same employers (haven't seen numbers on that, either.)

That would probably be the simplest solution, and the money would still flow from roughly the same sources. Only difference would be that instead of running through competing insurance companies, it would be run through one of the largest government bureaucracies on the planet. Good luck with that. Remember the Defense Department and the Space Shuttle.

If you raise general income taxes by that amount, a lot of people are going to get screwed.

Large corporations burdened with massive employee benefits are probably going to come out smelling like a rose. Not sure about small businesses.

Somebody really needs to look into the details, and nobody ever does. How will the pharmaceutical companies operate under price controls? Other providers?

As an aside, it's amazing how people who wouldn't believe Bush if he said the sky was blue will believe Castro's numbers on infant mortality.

But its an article of faith with them, so facts that contradict it are lies invented by the devil (or, in this case, "liberals") to mislead the faithful. Its no more rational than Young Earth Creationism.

Indeed. For decades, we heard that our healthcare system was and is vastly superior to all others. Now that the idea somewhat less tenable, what with 36 other countries's health care systems (all with some sort of national health insurance or healthcare) ranked by the WHO as better than ours, and whose populations are healthier by most every standard than ours, we'll hear how our new system of HSA's and personal responsibility, etc. is vastly superior.

So it remains breathtaking that all those stupid, stupid, stupid people in Spain, Italy, Ghana, France, Cuba, Macedonia, Great Britain, Quebec, Czech Republic, Liechtenstein, Sweden, Ireland, Iceland , England, Chile, United Kingdom, Switzerland, Pakistan, Poland, Wales , Belgian , Canada, Hungary, Finland, Denmark, Croatia, Scotland, Slovenia, Japan, Israel, Korea, Turkey, Germany, Morocco, Northern Ireland, Norway, Thailand, Russia, Costa Rica, Australia, Netherlands, Estonia, South Africa, New Zealand, Luxembourg, and every other industrialized country just haven't yet grasped the superiority of the H