Editore"s Note
Tilting at Windmills

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January 24, 2007
By: Kevin Drum

IT'S THE POLICY, STUPID....Ruth Marcus on the Bush health plan:

If George W. Bush proposes something, it must be bad. Such is the knee-jerk state of partisan suspiciousness that when the president actually endorses a tax increase -- a tax increase that would primarily hit the well-off, no less -- Democrats still howl.

....Listening to Democratic reaction to Bush's new health insurance proposal, you get the sense that if Bush picked a plank right out of the Democratic platform -- if he introduced Hillarycare itself -- and stuck it in his State of the Union address, Democrats would churn out press releases denouncing it.

Now, Marcus concedes that Bush has no one but himself to blame for this state of affairs. But at the same time, she also seems flatly unwilling to believe that opposition to Bush's plan might actually be based not on liberal temper tantrums but on the fact that it's a bad plan.

Which it is. It's true that if you look at Bush's proposal solely though the prism of tax policy, it seems fairly progressive: increased taxes on well-off people who have gold-plated health insurance combined with tax breaks for middle-income folks with private insurance. And Republicans have trained us so thoroughly to view everything as part of their long-running war on taxes that this is apparently the only way pundits are now able to see things.

That's a mistake. This is a healthcare plan, after all, and it should be looked at through the prism of health policy. And from that perspective it's a lousy plan. As Marcus herself points out, it increases the risk that "the already-teetering employer-based system will collapse as healthy individuals use their tax deduction to buy cheaper, private insurance, leaving employers with the older and the sicker."

But here's the thing: as far as movement conservatives are concerned, that's a feature, not a bug. It's a feature of the "ownership society." It was a feature of last year's HSA expansion. It's been a feature of every healthcare proposal Bush has ever offered. He wants to push the country toward "consumer directed healthcare," a euphemism for gutting the current insurance system, in which third parties pay for most medical costs, and replacing it with a system in which consumers pay directly for healthcare and insurance only kicks in if you suffer some kind of major disaster.

If you think this is a good idea, Bush's plan is a good first step toward getting there, and using it as the starting point for a compromise is a fine idea. But most liberals don't think it's a good idea or even a good direction. We want to expand routine health coverage, not shrink it. And that's why we oppose Bush's proposal: because we think it's bad policy with bad consequences. Believe it or not, that's still what motivates some of us.

UPDATE: Max Sawicky agrees but offers a small correction:

Kevin misfocuses a tad by putting the choice as between third-party payment and consumer purchase. The real distinction is group versus individual. The Bushists want to destroy group coverage in both the employer-provided sector and the public sector.

I think it's both things, actually, but this is a worthwhile distinction to understand regardless, especially since the whole conservative campaign to find ways to destroy group insurance pools is subtle and not much understood. More at the link.

Kevin Drum 1:31 AM Permalink | Trackbacks | Comments (134)

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Comments

I have a medical condition, and no company will sell me insurance. bushs plan does nothing for me.

Posted by: Richard W. Crews on January 24, 2007 at 2:16 AM | PERMALINK

Canadian-style single payer, the sooner the better.

Posted by: James S. on January 24, 2007 at 2:17 AM | PERMALINK

Yeah, Kevin I agree. But I'll add two things: 1) The tax aspect has the patina of which you speak, but kind of looks to me like a lot of the people at the lower end of the spectrum really could not benefit from the "tax breaks" and, therefore, it is another plan that looks good on the surface but really benefits those in the upper spectrum more. 2) No matter what Bush says, even if it is a verbatim "plank from the Democratic platform", how in the world can anybody believe a word he says, trust that he will enact it without bait and switching and trust that he will fund the portions that run through the government? His batting average is 0 in all of these regards. I am neutral on Marcus, sometimes good sometimes bad, but she is foolish here.

Posted by: bmaz on January 24, 2007 at 2:22 AM | PERMALINK

What's this "gold-plated" that nonsense that people keep talking about? I work as an average-joe programmer for a large multinational software company; out of the plans offered to me and my wife, all of them come within a few thousand dollars of the $15,000 limit. Once we have a child, all of the plans worth having (everything except the HMO and the oops-I-just-sawed-off-a-limb catastrophic plan) jump above $15,000 per year.

I pity my single colleagues, because the cheapest health plan that the company's made available to them is $9,240 (counting the employer contribution).

I doubt that these $7,500/$15,000 limits are going to be adjusted in step with rising health care costs -- just like the AMT, the Bush plan is going to trap more and more middle-class people each year.

And I certainly don't feel like the 'gold-plated' fat cat that I'm supposed to be -- if all that money were truly getting me 'gold-plated' service, I wouldn't have to argue with my insurance company for three months about why a paramedic visit and ambulance ride were in fact emergency transportation (and that I should then be reimbursed $300, rather than the $25.50 they were offering).

Posted by: Kevin on January 24, 2007 at 2:31 AM | PERMALINK

currently I work for an employer that pays about 2/3rds of my plan... I pay 4000, the employer pays 8000 (roughly) - so I'm under the 15k.

Under Bush's system, I get a tax benefit of 15k, but I have to pay 12k in cash for insurance... there are some years I may just gamble and take the tax benefit but not take the insurance... (or alternate insurance years)

And this is supposed to increase health coverage???? I'm getting it.

Posted by: san fermin on January 24, 2007 at 2:39 AM | PERMALINK


RUTH MARCUS: Senate Democrats complained: "President Bush's Health Insurance Proposal Amounts to a Tax Hike for the Middle Class."
This is flat wrong: According to the administration's analysis, on average, the top fifth of taxpayers would face a tax increase; the rest would save money.

Marcus is complaining that Democrats (who have watched every claim--every analysis--made by this administration turn out to be inaccurate and misleading (at best)) have a knee-jerk negative reaction to all of Bush's proposals. Meanwhile, she declares that Democratic analysis of Bush's plan is "flat wrong" on the sole basis of the "administration's analysis." WTF?


Posted by: jayarbee on January 24, 2007 at 2:41 AM | PERMALINK

Bush's plan is designed to get unions to give up comprehensive insurance coverage. It seems you really cannot go wrong imputing the basest motives to anything Bush proposes.

Posted by: Jim on January 24, 2007 at 2:47 AM | PERMALINK

Jesus Christ! What you guys have to pay, and then put up with, I swear on my Mother's eyes and my Father's grave I will never complain about Tri-Care again! Ever!

Posted by: Blue Girl, Red State (aka Global Citizen) on January 24, 2007 at 2:49 AM | PERMALINK

Ruth Marcus is training to take over the "bipartisanship for its own sake" slot from David Broder. She will be churning out columns urging "reaching across the aile" "getting something down". Getting what done exactly doesn't really matter.

Posted by: Nan on January 24, 2007 at 3:02 AM | PERMALINK

A single payer system. There is no substitute. If there was, Medicare wouldn't be the best government program ever.

It's sad. So many of the so called conservatives who support Republicans have no real money and would be wiped out by Bush's health care ideas, but they have been "persuaded" that their financial interests coincide with those of the very rich (by that I mean a net worth over $10 million).

Posted by: Rich on January 24, 2007 at 3:06 AM | PERMALINK

While I certainly understand the impulse to think about 'how will the plan affect me?', it seems to me the easiest way to see what a lousy plan this is is to think about those who currently don't have insurance because they can't afford it - the unemployed and low-wage workers.

Giving a tax deduction to people who don't make enough to pay any taxes in the first place is giving them nothing. How does giving somebody literally nothing make them more capable of paying for insurance that the can't afford now.

The barest minimum that a plan like this has to do is somehow make it easier for the currently uninsured to get insurance, One we have that, we can worry about if $15000 is too low, or what about people with pre-existing conditions (like me - I can't get insurance because I DON"T have cancer and never did, but that's a story for another day). And this plan does zero for the low-wage uninsured.

Posted by: Robert Earle on January 24, 2007 at 3:56 AM | PERMALINK

I'm in Georgia where there are about 1.2 million people living at or below the poverty level. Bush's plan gives them zip.

Also, there are 1.6 millon uninsured in Georgia (2004-2005). I seriously doubt that Bush's plan will change that stat significantly.
Source

I suppose that's why Bush parsed his words with some hyperbole (typical):

"And for the millions of other Americans who have no health insurance at all, this deduction would help put a basic private health insurance plan within their reach."
That's a real stretch..to put it mildly, IMO. Pardon my cynicism.

Posted by: Apollo 13 on January 24, 2007 at 4:44 AM | PERMALINK

Does anybody have a link to the CATO or AEI white paper that must have been the source of President's proposal? I want to look at its assumptions.

It seems to me that one goal of this plan is to encourage employers to drop health coverage. That isn't necessarily a bad idea from the standpoint of American competitiveness.

A second obvious goal is to push Americans into health savings accounts and high deductible plans. I don't like it, but since I was pushed into my high deductible plan I have had several conversations with my doctor about converting from high dollar patented prescriptions to generics. My questions have made him more aware of my need to save money. Of course, one evening last year my teenage daughter slipped and fell hitting her head. One CAT scan and a couple of x-rays later, I had used my deductible. Thousands out of pocket. The problem with health insurance is that you use it. Try negotiating price at the emergency room.

If you have a high deductible plan, a lot of money can come straight out of your pocket. There is an extended period between when you start a health savings account and when you have built up enough money in the account to cover your deductible. For most that lag might not be a problem. It has been a problem for me and at least one of my employees.

What the President's proposal doesn't address is the availability of coverage. A lot of people are simply not insurable in the private market. Some have pre-existing conditions. Others are closely approaching retirement. How are those folks going to be insured? Maybe an expansion of Medicare could solve the problem.

Another thing the plan doesn't address is the natural inequity that exists between the giant disinterested, bottom line driven health insurance company and the individual customer. Under the current system the employer can sometimes intercede on behalf of its employee and the threat of losing a large plan encourages some insurers to adopt policies that treat employees with some respect. Under the president's all private insurance approach the individual (who might never be insured again) is at the tender mercy of an insurance company with a natural desire to collect high premiums and pay low benefits.

The plan doesn't seem to provide an incentive for the millions of poor and working class people who don't have health care to buy insurance. Unless the tax benefit is in the form of a subsidy check (sort of like the earned income credit) I don't see their incentive to engage in the program. They aren't paying tax anyway.

The plan has to be indexed. If it isn't we will be in a health care crisis in about 3 years as premiums continue to far out strip income. My high deductible plan now costs what my last “gold plated” plan cost a couple of years ago. Fifteen thousand might sound “gold plated” now, but unless we do something to contain costs it won't in 2012. Then again, maybe that is exactly what we will want.

Last night Hillary said that she was afraid the plan was intended to move money from the hands of hospital providers into the hands of insurance companies. Somebody ought to ask her source for that view. Maybe it was a hospital lobbyist whose clients don't want to contain costs. Cost containment measures are not generally embraced by hospitals and other providers. Maybe the President has put some cost containment measures in his plan that we don't yet know about.

You know, instead of writing this plan off as DOA, Democrats ought to do something different. We ought to examine it very carefully to see if it might offer a first baby step to universal care. It would be easy for the Democrats in Congress to make a counter proposal addressing its obvious shortcomings. Some of those counters might make the insurance company sponsors cringe, but heck that is why we are a democracy. The administration is absolutely without any real experience in negotiating. Building a popular compromise more favorable to the American people than the insurance industry ought to be easy.

I still want to read the President's proposal in the original German.

Posted by: Ron Byers on January 24, 2007 at 4:48 AM | PERMALINK

The proposal is another load of crap. The insurance industry sees the writing on the wall and is doing its damnedest to use its allies in government to delay the vengeful backlash that is the product of years of ripping of the country.

It's high time Congress pulled this snake's fangs. How about Congressional hearings with sworn testimony from lobbists and leaders of the industry for starters? The collusion between the insurance and pharmasuedical industry has stunk to high heaven for years. The rampant inflation in the whole health care industry is in no way justified by the slow incremental progress in the quality of health care since the 70's.

Posted by: joe on January 24, 2007 at 5:16 AM | PERMALINK

Why do Beltway-based journalists like Ms. Marcus continue to pretend that George W. Bush still retains a semblance of credibility regarding public policy? Is there some compelling circulation strategy on the part of the Washington Post, by having its reporters and columnists treat their readers like a bunch of grade-schoolers who are incapable of understanding issues?

Posted by: Donald from Hawaii on January 24, 2007 at 5:24 AM | PERMALINK

Kevin, this is one of your best posts ever. Ditto the comment by Ron Byers. Single payer insurance for all is never going to happen. A lot of people like what they have. That is what killed HilaryCare. People are afraid of losing their health insurance and it doesn't matter whether they lose it by changing jobs or because someone from the gummint comes in and says, "I'm here to help." Of course people hate their insurance companies, but how many people would actually trade their current insurance for an unknown government plan? Any successful proposal is going to be marginal. If Hilary has anything to say about it as a Senator from NY, it will be expensive, good for hospitals, and bad for doctors.

Posted by: jimbo on January 24, 2007 at 5:34 AM | PERMALINK

"That isn't necessarily a bad idea from the standpoint of American competitiveness."

Looking at health care from "the standpoint of American competitiveness" is as misguided as looking at it from the standpoint of tax policy.

I mean, a proposal to amputative all your limbs and sell them to the Chinese for stir fry isn't necessarily a bad idea from the standpoint of American competitiveness. But it's a bad idea for a number of other reasons, including that it's bad health care policy.

Posted by: rea on January 24, 2007 at 5:41 AM | PERMALINK

I didn't know that the grandfather of 24's Kiefer Sutherland was none other than the founder of Canada's health care system, Tommy Douglas.

But even more amazing to me, just three years ago, Douglas was voted "The Greatest Canadian" of all time.

Hmm, but I thought Canada's health care sucked -- at least if you listen to many supposed experts here in America??

Posted by: Grey Matter (at Blogspot) on January 24, 2007 at 6:30 AM | PERMALINK

Marcus quoted one and only one economist, Jason Furman. DeLong has a link to Furman's first look at the actual plan. It's hopeful, but not rosy, and comes complete with two pages of recommendations that amount to a face, heart and brain transplant.

http://delong.typepad.com/sdj/2007/01/a_first_look_at.html

http://www.urban.org/UploadedPDF/411412_firstlook.pdf

Posted by: jerry on January 24, 2007 at 6:41 AM | PERMALINK

Ron Byers,

The AEI paper I believe you're looking for is Evaluating Effects of Tax Preferences on Health Care Spending and Federal Revenues although it may not be the single source for Bush's plan (PDF available at the link).

Posted by: Apollo 13 on January 24, 2007 at 6:41 AM | PERMALINK

Apollo13
I will read the AEI paper. It doesn't look like anything extensive, so it should be quick.

rea

You are aware that our current employer based health payment system is based on an ancient quirk of the tax code. http://www.tpmcafe.com/node/28629

You are also aware that companies like Ford and General Motors are at a competitive disadvantage because of their high cost of health insurance. That health insurance is expensive because their employers are older and as a result not as healthy as the employees of their competitors when based in America. Those American companies are also trying to compete with those foreign based companies with universal health care. We stand to lose lots and lots of our last remaining good jobs overseas if we don't act on health care.

You are also aware that lots of folks find themselves locked down in a particular job unable to advance because they have a pre-existing condition. If you are not you should be.

NO, our system has to move from being employer based if we are going to remain competitive with the rest of the world. Overall an employer based system isn't fair to either employees or shareholders. There is simply no good reason basic health care should be tied to employment. Not a single reason. The sooner we untie the two the better.

The question is how are we going to cut the knot.
The President has made a modest proposal. He wants to have a legacy. I say we jump all over the opportunity. I don't care if we give Bush his legacy so long as we obtain Universal Health Care. Once the nose is in the tent there will be no going back.

Posted by: Ron Byers on January 24, 2007 at 7:29 AM | PERMALINK

I think you're missing an important point.

A lot of people way overuse health care.

My dad's a doctor. From the time I was a kid he trained me... going to a doctor for a headache, a cold, a flu, cuts that stop bleeding with an ordinary bandage and pressure, or scrapes and bangs that don't break bones or have you seeing double is a waste of your time, the doctor's time, and everyone's money.

I see a doctor (excluding a dentist) an average of once every 4 - 5 years. Last two times were a broken foot and a nasty mole that I was afraid was pre-cancerous. The only time I ever saw a doctor for a flu was a few weeks after a hard sleeper trip in a Vietnamese train when my flu didn't go away for three weeks and I decided I might have tuberculosis.

But I see other people who seem to visit a doctor for headaches, colds that last a week, cuts and scrapes that can be self medicated, minor sprains, etc.

And most of them are doing it on insurance.

I'm not sure how much these types of people are pushing up health care costs compared to the catastrophic disease and injury victims, but it's got to be part of the equation.

So I think a general policy of having reasonably high deductibles so people don't go to a doctor unless they really need to makes a lot of sense.

Posted by: Mike Friedman on January 24, 2007 at 7:43 AM | PERMALINK

So I get a $7,500 tax credit per year to cover health care. My pre-existing illness makes me have to spend $6600.00 per yr on premiums; a minimum of $480 on drug co-pays which could increase significantly if other issues arise; $280 in dr visits, $300 for out patient treatments; $80 testing for a total of $7700. That’s if my health doesn’t change.

It will change. In fact, I am fighting a condition that will kill me, probably in a couple of years. I can expect increasing regular costs and sooner or later another long-term hospitalization.

I need help for my monthly medical expenses which at present add up to a minimum of $650 per month. The drs, my rent, the pharmacy, my electric bill will not wait for a possible January tax refund.

So pardon me if I am not doing back flips.

(Also posted at http://www.proctoringcongress.blogspot.com)

Posted by: Keith G on January 24, 2007 at 7:46 AM | PERMALINK
He wants to push the country toward "consumer directed healthcare," a euphemism for gutting the current insurance system in which third parties pay for most medical costs and replacing it with a system in which consumers pay directly for healthcare and insurance only kicks in if you suffer some kind of major disaster.

If you think this is a good idea, Bush's plan is a good first step toward getting there, and using it as the starting point for a compromise is a fine idea. But most liberals don't think it's a good idea or even a good direction. We want to expand routine health coverage, not shrink it.

Excuse me, but isn't the whole point of insurance that it is supposed to be for major disasters, not life's every day lumps and bumps?

If you want to have a program that covers routine costs and incidents that's fine... but don't call it insurance because it isn't.

Posted by: Mike Friedman on January 24, 2007 at 7:48 AM | PERMALINK

Mike Friedman:

Actually, I thought the purpose of insurance was to pool risk and pay for it by pooling and investing premiums. The point of a deductible is to discourage you from filing a claim for minor damage (or minor illness) like, say, your toaster catching on fire, but it shouldn't solely be there only to pay if your entire house burns down. Then again, people have different levels of risk. I'm 52, Type 1 diabetic, one bypass, history of hep C, asthma, pneumonia, and GERD. I go to see my doctor if I have a cough and a fever because I don't want to end up in the hospital for 4 unpaid days (no sick time in my company) or fight with insurance over short-term disability, which only kicks in after 7 straight days of absence from work. I'm sole breadwinner in my household and let me tell you, here in the Northeast, $60K a year really doesn't stretch that far, not if you want to own a home, drive a car, pay your taxes. Oh, and eat. So by pooling risk with other, presumably healthier people, I can afford medical care and not have out-of-pocket expenses eat me alive. You might say I'm having you healthy ones subsidize me, and you'd be right. But I'd be equally glad to do the same for you if the situations were reversed. That's why they call what we live in a community, or even a society. We're all in this together. Except for the poor shlubs we've decided don't deserve a share.

Posted by: Dano on January 24, 2007 at 8:14 AM | PERMALINK

http://www.prospect.org/deanbaker/

President Bush’s Health Care Plan and Social Security

The initial response to President Bush’s new health care proposal indicates that it is unlikely to go very far, but it is still worth considering its implications. The basic principle is reasonable, even if it does little or nothing to address the real problems of the country’s health care system: it equalizes the tax status of health insurance regardless of whether it is purchased through an employer or by an individual worker.

Of course a tax break matters much more to taxpayers in high income tax brackets than to low-wage workers with little or no tax liability. But, President Bush has something for low wage workers also. Under his plan, a worker who buys a family plan would pay no payroll tax on her first $15,000 of income. Since the combined employer/employee tax is 15.35%, this would mean a substantial tax break even for low wage workers. (It’s not clear from the proposal if workers would get the employer-side payment refunded.)

But, there is a flip side to this tax break. If workers pay less money into Social Security, they would also get less back. To take an extreme case, imagine a worker whose pay averages $20,000 a year. Currently, this would salary would get this worker $11,000 if she started collecting benefits at the normal retirement age. Under President Bush’s proposal, the worker would only be credited with $5,000 a year towards her Social Security benefits, getting her $4,500 a year when she retires. This is a big difference.

As I said, it seems unlikely that President Bush’s health care plan will go anywhere. However, insofar as it is taken seriously, the media should explore all its implications, especially its implications for the Social Security benefits of low wage workers.

--Dean Baker

Fuckin' brilliant, eh? Force low income people to choose between over-priced for profit health insurance now or SS benefits later.

Hell of a trade off there, Bushie.

It's an just another egregious swindle aimed at lower income Americans. Snake oil and mirrors.

Posted by: MsNThrope on January 24, 2007 at 8:16 AM | PERMALINK

"our system has to move from being employer based if we are going to remain competitive with the rest of the world. Overall an employer based system isn't fair to either employees or shareholders. There is simply no good reason basic health care should be tied to employment. Not a single reason. The sooner we untie the two the better"

The good reason to continue to tie health care to employment is that as matters presently stand, health care is tied to employment. That's a bad system, but it's better than not having a functional system at all.

"The sooner we untie the two the better" is nonsense unless your proposal is to replace the current system with something that works at least as well.

Replacing the current employer-based system with a single payer system would be great for American competitiveness, and great for American health care. The Bush plan, however, is to wreck the present system and tell everybody that they're on their own in this brave new world. That result ought not to be acceptable to anyone.

To wreck the present system in the hope that something better will magically arise out of the rubble, without actually having any plan to create something better--well that's just foolishness. It's like invading a country and overthrowing a dictator, without having any actual plan for what follows afterwards . . .

Posted by: rea on January 24, 2007 at 8:23 AM | PERMALINK

What exactly is a "gold-plated" health insurance plan? Can you give us an example of such a plan and name the groups that subscribe to same?

Posted by: Hedley Lamarr on January 24, 2007 at 8:45 AM | PERMALINK

Shorter rea,

I have always had health care paid by my employer. I don't want to change until you give me something better.

Real progressive thinking there, rea. You sort of remind me of the old story about the frog and the pan of boiling water.

Anyway, who ever said anything about magic. It is called hard work and planning. It is also called politics--you remember old fashioned politics, "the art of the possible." A little imagination is needed anytime you want to move social policy. For the greater good the first step might mean divorcing health care from employment. It is going to happen anyway. We might as well have it happen as part of a solution.

Engaging the President's proposal doesn't lead to the President's proposal being enacted into law, it leads to a conversation about the problem. That leads to something being enacted into law. We have control of the house and senate. We have control of what is passed.

Posted by: Ron Byers on January 24, 2007 at 8:47 AM | PERMALINK

Hedley

"gold plated" is a phrase somebody in the administration decided to employ to demonize people with good health insurance plans in the minds of people who just wish they had good health insurance plans.

Posted by: Ron Byers on January 24, 2007 at 8:52 AM | PERMALINK

Can anyone cite a single example of the US overthrowing an entrenched bureaucracy, short of bullets flying?

It took a war to get rid of slavery. Vietnam required massive urban rioting. Desegregation took lots of that as well, but it's questionable if anything very much changed in the deep urban ghettos. Those great Warren Court decisions of the 1960's & '70's? Many of them negated by subsequent events (think abortion).

Even if gold-plated single-payer passed overwhelmingly, was eagerly signed by the president, was taken up by all 50 state govenors & even had the overwhelming support of Wall Street, we might still reasonably expect it to be attacked mercilessly in courts across the country. Until it was beaten to a bloody pulp.

The present system will continue until it collapses, one way or another. The only questions are when, and if it will drag the rest of the economy along with it.

Posted by: Dave of Maryland on January 24, 2007 at 8:53 AM | PERMALINK

Since the basic idea of insurance is a shared risk pool, Bush's notion of "consumer directed" healthcare is a step toward the elimination of insurance: the people who need it won't be able to get it, and the people who will be able to get it won't need it. You would think this would eventually eliminate insurance, because without shared risk pools, the only people insurers would be willing to insure are those least likely to need or buy it. You would think this would make insurers, at least those thinking of their enlightened self interest, want larger pools. You would think.

Posted by: anandine on January 24, 2007 at 8:54 AM | PERMALINK

Conservatives don't get that the main reason why liberals dislike Bush so intensely is because we think his policies are bad. It's like with the Iraq War, we weren't opposed to it because we hated Bush and wanted to see him fail, we were opposed to it because we thought we'd wind up in a bad situation (albeit a situation that is still better than the one we're actually in now).

Republicans I think know that this is a plan that just about anyone other than diehard conservatives will dislike otherwise they wouldn't hide behind focus group-inspired euphemisms like "the ownership society," and instead would come right out and tell people that for most individuals it means they'll pay more for their health insurance and the companies they work for will pay less. Something tells me this isn't a plan most Americans are up in arms demanding.

Posted by: Stuart on January 24, 2007 at 8:57 AM | PERMALINK

My dad's a doctor. From the time I was a kid he trained me... going to a doctor for a headache, a cold, a flu, cuts that stop bleeding with an ordinary bandage and pressure, or scrapes and bangs that don't break bones or have you seeing double is a waste of your time, the doctor's time, and everyone's money.

Coming from a man who probably talks to a doctor at least once a week . . .

I think you've just described 1.2% of our nations health care costs.

Also, if you are in a vulnerable population (lung disease, sever asthma, elderly, immunosuppressed) and get the flu, please go in as early as possible. They now have anti-virals that will keep you from racking up giant medical bills weeks later. Better yet, try and go in even earlier and get the flu vaccine. It's no where near a complete solution but it is definitely cost effective for people at risk and people who associate closely in large communities (universities, etc.).

Mike Friedman, how long would you wait to see the doctor (or talk to your dad) if you had trouble urinating, had blood in your stool, started getting unexplained night sweats, or just felt lethargic?

Posted by: B on January 24, 2007 at 8:59 AM | PERMALINK

It's not a HealthCARE plan it's a HealthINSURANCE plan.

People need healthcare not insurance.

Posted by: SFOtter on January 24, 2007 at 9:00 AM | PERMALINK

rea

I have just reread your posts attacking me. I think you have misread me. I am not a proponent of the President's plan. It doesn't address the basic problems. It damages social security. Frankly it is not going very far.

I am a proponent of getting something done on the issue of health care. As a small business owner I don't see any reason for me to make healthcare purchase decisions for my employees and their families. The issues are just too complex and the decisions are too personal. As a small employer I find myself at a disadvantage in the market place. My pool is just too small to insure I get the best pricing.

It is time to change the dynamic. If we just continue talking about the problem, we will just continue talking.

I suggest we use the President's proposal as a springboard for something much more comprehensive and much better.

Posted by: Ron Byers on January 24, 2007 at 9:00 AM | PERMALINK

I pity my single colleagues, because the cheapest health plan that the company's made available to them is $9,240 (counting the employer contribution).

This is precisely the type of situation that's so wrong about our current system, and that the Bush plan, albeit in a most tepid and inadequate manner, tries to address.

When you go to buy life insurance there are typically dozens of possible plans you can buy, with a significant array of features and price ranges. But most of us only have one or two (or at most three or four) choices when it comes to health insurance. If none of those offered by our employer fit the bill, hard cheese. It doesn't make sense. We'd be much better off if a) everybody was insured and b) everybody had on their consumer's hat when it came time to deciding which plan makes sense.

Thing is, even a switch to single payer (which I would agree would be a net improvement over our current system) would not get rid of the need for cost controls. All single payer countries, just like the non-single payer USA, face bigtime challenges when it comes to controlling costs. Because the USA doesn't have a top-down system, the only way to get some cost control into the picture is to shift to a system where we're not all playing with other people's money when it comes to our healthcare decisions.

Now, the line I always hear in such discussions is: "But I don't want to worry about making decisions when I need healthcare, or when someone in my family does!" I couldn't agree more -- nobody wants people to be stressed out when they're ill. But that doesn't mean people ought not to be asked to make decisions before they're ill, ie, when they're deciding which plan to purchase. People should be asked to think about such questions as: how much of a deductible am I comfortable with?; do I really need a private room if I go to the hospital?; how burdensome would it be to pay out of pocket for my own prescriptions, or for routine checkups?; etc.

If we could combine this sort of approach with a few needed reforms (1. a national market for health insurance with national standards; 2. mandatory community rating; 3. government reinsurance of preexisting conditions; 4. mandatory universal coverage with subsidies to the less affluent; 5. portability requirements for all policies to gradually sever the link between employment and insurance; etc.) we'd have the best of both worlds: Euro-style universality and security with American-style access, speed and choice.

Posted by: Jasper on January 24, 2007 at 9:02 AM | PERMALINK

Here is the administration explanation and selling of the plan:

http://www.whitehouse.gov/stateoftheunion/2007/initiatives/healthcare.html

Note: The plan is ONLY designed to "fix" an issue of "penalizing" people without employer-provided insurance.

The proposal does NOT fix other problems that have been identified. Nor does it adequately fix the problems it is designed to address, unless the insurance costs are added to EITC payments.

Posted by: bakho on January 24, 2007 at 9:04 AM | PERMALINK

Mike Friedman, you are on to something:

If you want to have a program that covers routine costs and incidents that's fine... but don't call it insurance because it isn't.

Health insurance has never been insurance in its most pure and technical form. As it developed form the early days of Lloyd’s, insurers underwrote the risks of discrete events during a defined time frame. An example being a ship going out on a one year trade mission in the 1660s.

What we call health insurance is a different animal altogether and I wish and hope that we can leave that paradigm behind and move to something that is both more logical and more humane.

Fifty years ago, personal income or job type did not have a huge impact on medical prognosis. The various types of pulmonary, heart and vascular disease and most cancers would kill one within a defined time no matter what.

We now live in a society that has the resources to, if not cure than at least, successfully manage the above mentioned conditions. Yet millions of Americans, most of whom through no fault of their own, become disabled or die prematurely from these and many other health problems.

Our country has it with in our grasp to end this great tragedy and do it in such way as to not excessively burden anyone, but we are not doing so. This is arrogant, self centered, and inhumane. On the societal level, it is jam backed with bad karma.

Posted by: Keith G on January 24, 2007 at 9:05 AM | PERMALINK

What exactly is a "gold-plated" health insurance plan?

The people with the best health care I know are state employees (in specific states). I think FEHB isn't that bad either if you are receiving a senator's pension to assist in paying off the premiums of the better plans.

Which I think raises a larger point. If you want good healthcare, you have to be proactive like members of congress and state legislators. Vote to give it to yourself.

Posted by: toast on January 24, 2007 at 9:12 AM | PERMALINK

Jasper

Good post. Insurance centric, but a good post.

My problem with insurance companies is that universally they are happy to take your premiums, but delight in denying coverage whenever possible. They are big, impersonal and don't have the consumer's best interests at heart. At least with the government we elect politicians who want to make sure we are happy so they can keep their jobs.

Assuming we decide to use insurance companies to manage our health care payment process, how do we protect ourselves from their predatory instincts?

Posted by: Ron Byers on January 24, 2007 at 9:17 AM | PERMALINK

I am one of those people who gladly announces that any proposal from W, mainly impacting the non-politically-connected masses will be ignored and dismissed by me.

Whenever he's feeling the heat about any of his many failures, he tries to switch attention to another issue.

When it comes to health care issues, I'll wait for the democrats proposal or any other entity that I still have a modicum of respect for and evaluate it.

If W proposes it, it's B.S.

Posted by: Carolyn Williams on January 24, 2007 at 9:20 AM | PERMALINK

The more I hear/read about this plan, it strikes me as ultimately a tax break for businesses. It will cause the collapse of company offered plans. Why not just pay your employees what you pay for their healthcare now. The big benefit to companys is that they can reduce a lot of overhead associated with buying and administering these plans. Hence the "tax" cut. But employees out in the marketplace will command nowhere near the purchasing power of corporations. I'd bet that even with the government tax benefit to individuals, all in it's a losing battle for the majority of families in this country.

Posted by: john on January 24, 2007 at 9:25 AM | PERMALINK

she also seems flatly unwilling to believe that opposition to Bush's plan might actually be based not on liberal temper tantrums but on the fact that it's a bad plan

Well, duh -- since it's a bad plan, it's death to discuss it on the merits. The Republican M.O. since bush got into office is to presume that whatever Bush proposes is the only way to accomplish whatever goal, and that opposition to Bush's plan prompted by so-called "Bush Derangement Syndrome," oppostion to the goal (as opposed to Bush's specific plan), or both.

It's bullshit, and an inherently dishonest form of policy debate. The WaPo op-ed page should be in the business of exposing this dishonest discourse, not printing colums that exemplify it.

Posted by: Gregory on January 24, 2007 at 9:30 AM | PERMALINK

This is a textbook example of "punditistic" thought. The overwhelming need is to generate commenrary extrusion-product; the danger is in generating commentary extrusion-product that is demonstrably uninformed about technical matters; the correlary to which is that mastering a sufficient number of technical matters to generate genuine substantive commentary, as opposed to punditistic commentary extrusion-product, is hard work and may even require years of study in a discipline where smarter people get to shoot your ideas down if they're not sufficiently grounded in the discipline.

So what one does is reach for one of a prefabricated set of commentary templates and fit various word-signals from whatever present case you're examining into it. Here the template is, "Democrats are just going to dislike anything Bush says." A completely unexceptionable frame: it's true, they are. But to a person who actually wanted to produce analytical commentary, as opposed to extruding commentary-product, that would be a given, and too obvious to be worth noting. The real issue would be, are those objections substantively correct.

To the punditistic mind, that is a dangerous minefield. So focus on the obviously true, but trivial point, "Democrats will object whatever he says!"--a frame already well tested by other commentary extruders--which allows you to adopt a sophisticated sounding, world-weary pose, which sounds like you actually know something about stuff, even though it doesn't require you to know anything about stuff, hit the "extrude" button, microwave for 5 minutes on "low," et voila, you're a pundit.

Posted by: DrBB on January 24, 2007 at 9:32 AM | PERMALINK

> that opposition to Bush's plan might
> actually be based not on liberal temper tantrums

So when Grover Norquist states that he wants to castrate all Democrats, then conspires with Tom DeLay and Jack Abramoff in an attempt to do so, that is "good tough politics".

But when liberals figure out what is going on and refuse to participate, that is a "temper tantrum"?

Bit confusing that distinction is.

Cranky

Posted by: Cranky Observer on January 24, 2007 at 9:40 AM | PERMALINK

but bush's plan makes a hell of a lot more sense if you look at it not as a health care plan, but as a system to save social security. just let the sick die off and presto! no social security problem.

Posted by: snidely on January 24, 2007 at 9:44 AM | PERMALINK

What bothers me most about "analysis" like this is that they don't understand that Democrats fully realize that Bush doesn't mean most of what he says. Many times we aren't laughing/dissing the proposal itself as much as reacting to something that we know he is unserious about and has no intention of doing anything about.

Posted by: ET on January 24, 2007 at 9:45 AM | PERMALINK
…the only way to get some cost control into the picture is to shift to a system where we're not all playing with other people's money when it comes to our healthcare decisions.

Jasper, I am not sure what you mean by this.

Are you addressing the notion that some folks make personal choices that may lead to eventual medical problems?

If this is the case, I suggest that you step back and view this from a broader perspective. If John Doe does not manage his weight successfully and is becoming obese, we know that he will face health problems that are easily predictable.

I have talked with friends who are of the opinion that they should in no way help shoulder the burden of mitigating John’s health issues, after all it’s his fault (assuming John suffers from no other conditions that might lead to obesity).

While I understand the basic principle, I find it short sighted. As a society, we should make it relatively easy (with appropriate co-payments) for John to get into an outpatient program that will assist him with the social, psychological and medical needs to manage his weight.

To do otherwise is to ensure a greater social cost later. We know that his obesity in all likelihood will lead to heart disease, high blood pressure and diabetes. Treating these chronic and acute illnesses and paying disability benefits would be far more expensive. A thinner John, able to work, can continue to help support his family. Once John is disabled or dead, we get to do this.

Posted by: Keith G on January 24, 2007 at 9:58 AM | PERMALINK

"I suggest we use the President's proposal as a springboard for something much more comprehensive and much better."

The president's proposal is a springboard to hell, and designed to be so.

Now, if you want to "use the President's proposal as a springboard for something much more comprehensive," and start by scrapping the President's proposal, that might be something. A first step in the wrong direction, however, does not provide a good basis for problem-solving

Posted by: rea on January 24, 2007 at 10:00 AM | PERMALINK

rea

You remind me of a certain President who refuses to talk with the Koreans, Iranians and Syrians because they are all bad people.

Didn't we win the election in November? We control the discussion. At the end of the day we will emerge with a real solution where everybody wins.

Posted by: Ron Byers on January 24, 2007 at 10:04 AM | PERMALINK

I haven't yet had the time to apply my sharp analytical skills to the Bush proposal, but any proposal that starts from the premise that the current system encourages people to select gold-plated plans is unworthy of my attention.

Posted by: gregor on January 24, 2007 at 10:06 AM | PERMALINK

Gee thanks DrBB. Your obvious time in a microwave was well spent and has led to the educational benefit of all us proletariat.

Posted by: bmaz on January 24, 2007 at 10:13 AM | PERMALINK

Speaking of healthcare . . . did anyone else see Cheney pop a pill last night?

I don't see a reference in the news, but I see he was popping pills during the Edwards debate in 2004. His staff claimed it was a breath mint, but evidently he swallowed it like he did last night. Someone should tell him that it work better if he didn't do that.

http://www.washingtonpost.com/wp-dyn/articles/A40570-2004Oct17.html

Posted by: rewolfrats on January 24, 2007 at 10:13 AM | PERMALINK

A lot of people way overuse health care.

That is easily taken care of by a combination of modest co-pays and the fact that few of us have the luxury of skipping work to see a doctor. I might also add that making doctors and ERs the gatekeepers of prescription drugs contributes to this. It might seem extravagant to go to a doctor when you have a cough, but that's the only way you're going to get Guaifenesin with codeine.

The last thing we want is people avoiding going to the doctor, because that might cause problems to fester until they become much more expensive. Finally, hardly anyone seems to have the problem of having "too much insurance." By contrast, the problem always seems to be that insurance companies will either deny coverage or be so slow in reimbursing health care providers that I end up with a bunch of collection notices on my desk for failure to pay.

This Republican plan is easily defeated. All the Democrats have to do is go to their constituents and say, "Bush things you get too much health care too cheaply."

Posted by: Tyro on January 24, 2007 at 10:19 AM | PERMALINK

"That is easily taken care of by a combination of modest co-pays and the fact that few of us have the luxury of skipping work to see a doctor."

But what's "modest" to a millionaire isn't necessarily "modest" for us. In fact, we know that they can't be trusted to define "modest."

I think we should be taxed enough to make it "free" and Cover Everyone.

Posted by: katiebird on January 24, 2007 at 10:27 AM | PERMALINK

For those who had the good fortune to miss it or still can't believe what you heard, here are the Top 10 Highlights of the 2007 Bush State of the Union...

Posted by: AngryOne on January 24, 2007 at 10:29 AM | PERMALINK

To do otherwise is to ensure a greater social cost later.

I'm guessing that maybe as many as 30% of Americans don't believe there is such a thing as 'society'. And if you remind them that 'society' includes people very different from them, that number will climb further.

There's a reason why there are a number of studies showing that the more homogeneous a country is, the greater the support its citizens have for a generous social provision.

The only social provision that covers (nearly) every American is Social Security, and when that was rolled out, it passed only because a.) we were in the depths of the Depression and b.) it excluded domestic servants (blacks) and most agricultural workers (blacks).

This is a nation, still, where fifty million people would volunteer to live in a cardboard box under a railroad bridge and live on sparrows cooked on the end of an old curtain rod, if they only could be guaranteed that the black-gay-Mexican-immigrant-Other in the next box over doesn't even get the sparrow.

Posted by: Unimpressed on January 24, 2007 at 10:30 AM | PERMALINK

but bush's plan makes a hell of a lot more sense if you look at it not as a health care plan, but as a system to save social security. just let the sick die off and presto! no social security problem.
Posted by: snidely

I realize you're being snarky here but, no. It's yet another shell game based on yet another poorly disguised attempt to divert billions from SS directly into the hands of Wall Street via the insurance industry. And by encouraging people to rob themselves at the same time by hollowing out their future benefits under SS.

Meanwhile Healthmark just announced that its profits are up 23%. Health insurance currently consumes nearly a quarter of all 'health' expenditures by denying care not by providing it.

Posted by: MsNThrope on January 24, 2007 at 10:31 AM | PERMALINK

About the taxing of benefits proposal: Seriously, if a person's income is X per year, and your employer is paying out Y for health insurance that a person with X + Y income would normally have to shell out of their "income" (whether or not the same exact amount of Y, just consider the principle of thing), isn't it only fair that the first person pay taxes on the total effective income X + Y that they are getting? Why should some workers pay less taxes than others by the subterfuge that their employer pays for some services directly instead of paying them more to begin with, for them to pay out of "their" pockets? Don't most of us complain about not taxing options and exectutive perks as income, etc? Fair play? Forgive me if I'm missing something.

Posted by: Neil B. on January 24, 2007 at 10:34 AM | PERMALINK

Over at The DailyKos, Senator Durbin "blogged" his State of the Union response.

And buried deep in the comments he made this honest remark about his goals (click on my name to go to the comment):

"Taxing health insurance benefits suggests we have too much of it. I have never heard that argument. How about this alternative? Setting a national goal of reducing the number of uninsured by 50% over the next five years? That will put us to work to staunch the bleeding and find a cure. The tax code may be a piece but certainly not the whole answer."

Cover 1/2 in 5 years!

Is he serious? I appreciate his honesty, but I think that's a pretty puny plan.

Still, it explains why so many people say Cover Everyone isn't going to happen. If we can't convince our friends, how can we convince the enemy?

Funny that we can have Postal Service for everyone, but not Health Care.


Posted by: katiebird on January 24, 2007 at 10:42 AM | PERMALINK
It's true that if you look at Bush's proposal solely though the prism of tax policy, it seems fairly progressive: increased taxes on rich people who have gold-plated health insurance combined with tax breaks for middle-income folks with private insurance.

Um, no, sorry. Even looked at solely through the prism of tax policy its not at all progressive. Its a tax on middle-income folks with decent health insurance to fund a tax break that will go mostly to relatively well-off contractors and capitalists who already can and do purchase personal insurance.

And Republicans have trained us so thoroughly to think of everything as part of their long-running war on taxes that this is apparently the only way pundits are now able to see things.

Apparently, they've done that so well that even notionally liberal pundits like you that can look beyond tax policy still parrot the Republican propaganda uncritically (right down to the "gold-plated" description of employer health plans that cost more than $7,500 per year) when discussing tax policy and things related to it.

Posted by: cmdicely on January 24, 2007 at 10:45 AM | PERMALINK
Excuse me, but isn't the whole point of insurance that it is supposed to be for major disasters, not life's every day lumps and bumps?

No, the point of insurance is to manage risk, not only to manage the risk of major disasters.

My car insurance covers fairly minor damages and liabilities. My homeowner's insurance does too. Why would I want less from the insurance on my body than that on my car or house?

Posted by: cmdicely on January 24, 2007 at 10:49 AM | PERMALINK

Talking to my wife on the way to the office this morning she tells me she wants to hear more about the President's proposal. I explained that it wasn't much, and it had many flaws, but she responded by saying "its a start." I smiled. That was my thinking until I started reading all the snarks on this blog.

Folks, there is no reason to trust the President. His proposal was apparently devised by some tax fairness ideologue over at the American Enterprise Institute.

On the other hand, "it is a start." Nancy are you listening. The ball is in our court and that is exactly where we should want it.

Posted by: Ron Byers on January 24, 2007 at 10:55 AM | PERMALINK

"On the other hand, "it is a start." Nancy are you listening. The ball is in our court and that is exactly where we should want it."

This is very true. But I'm afraid that we've got very few friends up there.

Posted by: katiebird on January 24, 2007 at 10:57 AM | PERMALINK

cmdisley

If we are stuck with an insurance run model, why should I susidize your $500 deductible when I am willing to pay a $2,000 deductible. Just asking?

Posted by: Ron Byers on January 24, 2007 at 10:59 AM | PERMALINK

"one, two, a thousand Fallujahs".

It will take a very long time for Americans to wash the Iraqi blood off of their hands.

When Bush invoked the 'radical Shi'a' in his speech last night, I became quite distressed, knowing that total war will be the outcome of his policies. Even though I do not look forward to having my living standard fall by half (I hope that is all it will fall), I do look forward to the end of US military hegemony, which could be the outcome of America's aggression in the Middle East.

It is easy for me to be optimistic that America will have to end its militaristic ways after defeat in the Middle East, but the Iraqi mothers will experience more horror than I will ever be able to imagine. I can only hope that W. Bush will be brought to justice for the terror he has brought to the world.

Posted by: Brojo on January 24, 2007 at 11:01 AM | PERMALINK

This is very true. But I'm afraid that we've got very few friends up there.

Posted by: katiebird on January 24, 2007 at 10:57 AM

I thought Democrats won in November. It is our job to grab our representatives by the scruff of the neck and tell them we want health care reform now.

Posted by: Ron Byers on January 24, 2007 at 11:01 AM | PERMALINK

Senator Durbin's idea is one Democrat's plan:

"Taxing health insurance benefits suggests we have too much of it. I have never heard that argument. How about this alternative? Setting a national goal of reducing the number of uninsured by 50% over the next five years? That will put us to work to staunch the bleeding and find a cure. The tax code may be a piece but certainly not the whole answer."

Posted by: katiebird on January 24, 2007 at 11:06 AM | PERMALINK

The conservative agenda is to undermine the security of the middle class. They started with the poor because no one defends them but their aim has always been to knock down the decadent middle class. This means shifting the tax burden and risk to the middle class families away from the rich and from any kind of collective risk sharing. This goes for childcare, education, healthcare, and everything else. This is being advocated not just to increase the national wealth owned by the un-taxed rich but to create a conservative society where people have to rely on family and local community for support. This may have had a prayer in 1950 when the US manufactured half of the world’s goods but now in a time of global labor arbitrage, which also benefits the richest of the rich, this will only result in deeper class divisions and many people falling out of the middle class as they find it impossible to compete in the international market.

The Gini index, which measures income inequality, for the United States is similar to that of China and Iran. It is not the result of secular forces.

Posted by: bellumregio on January 24, 2007 at 11:12 AM | PERMALINK

Katiebird

The Republican ideologues believe sincerely that millions upon millions of people abuse the health care system by over using it. All the talk about "gold plated" plans and taxing amounts in excess of some arbitrary number is intended to stop this abuse, but, of course, as usual the good old boys at the AEI elevate a minor problem to the level of prime cause. Most high premium plans are high premium plans because there is something about the insured that makes him or her a higher risk. Maybe, like me, he is over 50. Or maybe like my sister in law, she is a diabetic. Maybe he or she doesn'twork for a firm with 100 employees. All of those things can drive up health insurance costs significantly. Lots of the so called "gold plated" plans are owned by older, less well people. A new tax break isn't going to make them younger or healthier.

Posted by: Ron Byers on January 24, 2007 at 11:17 AM | PERMALINK

ABC News the note calls the Marcus piece a "must read" and makes it the lead story:

"But it will help if you inhale Ruth Marcus' must-read op-ed in the
Washington Post if you want to understand that single most important
dynamic shaping Iraq policy, the legislative agenda, and the 2008
race.

"Writing under a "The Knee-Jerk Opposition" header, Marcus smartly
keys off of the dead-on-arrival attitude that Democrats have about
Bush's health care plan LINK, but the larger points are these..."

http://abcnews.go.com/Politics/TheNote/story?id=156238

Posted by: TomT on January 24, 2007 at 11:17 AM | PERMALINK

If you read Ms. Marcus's column, she states that (a) Democrats are right to distrust Bush due to Bush's past behavior, and (b) Bush's plan has huge flaws. Yet she still comes to the conclusion that Democrats are deserve blame for criticising Bush's proposal.

Posted by: Pocket Rocket on January 24, 2007 at 11:20 AM | PERMALINK

Americans don't overuse healthcare, although they probably overuse expensive emergency departments for primary care. The cost of the healthcare system in the US is high because the prices are high, not because we demand more healhcare than other developed countries.

See: Anderson GF, Reinhardt UE, et al "Its the prices, stupid: why the United States is different from other countries. Health Affairs 2003;22(3):89-105.

Second, we need to look at coverage within a context of a two-tiered system. A single payor system would cover everyone at a decent minimum level. Employers or individuals could augment this coverage, thus keeping a market for insurance companies, keeping an employee benefit for companies that want it (at lower cost than currently available), and enabling "gold plated" policies for people who can afford them.

Posted by: jb on January 24, 2007 at 11:21 AM | PERMALINK

Ron, I don't know what I said to make you think I support Bush's plan at all.

I totally agree with everything, everything you say (except I'm both over 50 & diabetic myself.)

The point I guess I failed to make is that if the best Democratic Senator Durbin can do is to come up with a plan that might get 1/2 the currently uninsured covered in 5 years -- then we (who want to Cover Everyone) don't have many friends up there in Congress.

Posted by: katiebird on January 24, 2007 at 11:26 AM | PERMALINK

Katiebird,

I didn't think you supported the President's plan.

I want to know why Durbin thinks the best we can do is get 1/2 of the currently uninsured covered in 5 years. Did he say?

Posted by: Ron Byers on January 24, 2007 at 11:29 AM | PERMALINK

Well it is not Bush. The Republicans sit in the Heritage Foundation and in the Cato Institute and think up ways to bamboozle Democrats and the American people. They have spent the last two decades cooking up progressive-sounding proposals, which, upon analysis, turn out to be another move in their political ascendancy or part of the great risk shift. They do this slowly and under the radar and with every move the opposition thinks it is not that bad or “it’s a start”. It is a start all right.

How many bad cars do we have to buy from these folks before we realize they are no just lemons but loaded with explosives?

Posted by: bellumregio on January 24, 2007 at 11:29 AM | PERMALINK

Bellumregio

I agree the wingnut think tanks are full of crap, but where do we start?

The President laid out a deeply flawed utterly unfair health care reform. It sounded like something though. I haven't seen a damn thing proposed by the over cautious democrats have you? Last I looked the people gave Congress to the Democrats in the hope they would do something other than bitch and complain. Don't deny the good because it isn't perfect. This plan isn't good, but it is now time for the Democrats to propose a plan that is.

Posted by: Ron Byers on January 24, 2007 at 11:34 AM | PERMALINK

Hi Ron,
No Durbin dropped that comment into his DailyKos Diary (I can't put a link here) last night and never elaborated on it.

The diary was filled with Health Care comments but that was the only time he said anything specific. And he didn't reply to the replies.

While I don't like the answer, I am thrilled to see his lack of interest in this crisis so clearly stated. Now we know that we can't just assume that a Good Democrat is on our side.

Posted by: katiebird on January 24, 2007 at 11:36 AM | PERMALINK

Ruth Marcus: If George W. Bush proposes something, it must be bad.

The first sentence is pretty accurate. In all fairness there is another possibility: he's not serious, and is just blowing hot air for a speech. In practice though their is little difference.

Such is the knee-jerk state of partisan suspiciousness

Uh, oh, the MSM "lets be fair and balanced".

This clown has been president for 6 years and screwed up everything royally. AFAIK he's screwed up pretty much everything in his entire life. Why, exactly, should I waste even 5 minutes evaluating one of his "proposals"?

Posted by: alex on January 24, 2007 at 11:36 AM | PERMALINK

Ron Byers, I am not sure what you mean by this:

If we are stuck with an insurance run model, why should I susidize your $500 deductible when I am willing to pay a $2,000 deductible. Just asking?

Most insurance policies I have seen involve the trade off of:

Higher deductible – lower premiums, or

Lower deductible – higher premiums.

Posted by: Keith G on January 24, 2007 at 11:46 AM | PERMALINK

"one, two, a thousand Fallujahs".

Sorry, wrong thread.

Any Guckert Mouth Fucker plan on healthcare will result in the elimination of healthcare for many people and increased profits for insurance companies.

When Democratic Congresspersons stand and applaud what the Guckert Mouth Fucker says, I become disillusioned with their Party.

Posted by: Brojo on January 24, 2007 at 12:04 PM | PERMALINK

Yet another plank in the Continual Repukeliscum Assault on the Middle Class. Rather than providing an across-the-board plan, Bush's idea is to soak the middle class to pay for the poor.

What a nice idea for his class, the rich fat Repuksliscum.

Posted by: POed Lib on January 24, 2007 at 12:05 PM | PERMALINK

I'm 47. Last October I had a stroke.

Fortunately, my (non-union) employer offers very comprehensive health care for very little (relative) cost to the employees.

And, fortunately, my employer is insanely profitable and culturally directed so that this is unlikely (for the time being) to go away.

But, should I be forced to get most health care in the "free market"; which of Bush's cronies is going to take care of my son when I'm dead or broke because I can't afford the policies?

Posted by: Lettuce on January 24, 2007 at 12:07 PM | PERMALINK

Those who hanker for a single payer plan like Canada's may want to read
Heading to Emergency room? Bring lunch, maybe a pillow, too
Most end up waiting 7.4 hours, study shows
http://www.canada.com/ottawacitizen/story.html?id=f534dc73-5ac5-4d87-b210-32e584b93ea9&k=0

Like most of you, I am pro-choice on abortion. I don't want some government bureaucrat deciding who can have an abortion or when.

However, unlke most of you (including Kevin) I am broadly pro-choice. I don't want a government bureaucrat to control all the other medical procedures.

Posted by: ex-liberal on January 24, 2007 at 12:15 PM | PERMALINK

A bit from Delong:

And, of course, Ruth Marcus hasn't done her homework. She doesn't understand the Bush proposals. An example: She copies a Republican talking point:

The deduction would... [leave] 80 percent of those with employer-sponsored coverage unaffected.

The deduction would indeed worsen the finances of only 20% of those with employer-sponsored coverage in 2009. But it would worsen the finances of about 50% of those with employer-sponsored coverage in 2019. And 90% of those with employer-sponsored coverage by 2030.

Posted by: bellumregio on January 24, 2007 at 12:16 PM | PERMALINK

May recent kidney stone cost 12k in ER visits and 21K in surgery. Insurance paid. Under Bushs' plan, would 33k be enough of a "health crisis" for insurance to kick in? I hope so. What about a system were the gov covers the sick and uninsurable and insurance co cover the healthy? Part of the messive profits the insurance companies make would be taxed to augment the gov care. Don't we already do this with retired folks. Do basically, all the worst cases would be paid for by the gov and they could negociate prices down.

Posted by: the fake fake al on January 24, 2007 at 12:18 PM | PERMALINK

Of course you are right. As usual cmdicely was correct. My point was that if cmdicely wants to have a lower deductible to pay for minor illnesses and pains then he shouldn't ask the rest of us to provide him with a tax deduction. I envision universal health care as having a moderate to high co-pay to force responsiblity on the beneficiaries. If comdicely wants to pay for a supplimental policy to cover the minor aches and pains, then he should do it on his own dime.

Posted by: Ron Byers on January 24, 2007 at 12:23 PM | PERMALINK

Bureaucracy is considered the most efficient and effective way to deal with administration, according to a famous sociologist. Governmental bureaucracies are more fair than capitalist bureaucracies because the impartial enforcement of the law/rule is pursued rather than the more limited point of view of increasing a return on investment.

Posted by: Brojo on January 24, 2007 at 12:25 PM | PERMALINK

"I envision universal health care as having a moderate to high co-pay to force responsiblity on the beneficiaries. "

Because being sick isn't bad enough?

I think we should have a high enough Medicare tax to Cover Everyone and everything that Congressmen get today.

Make it "free"

Doctors can figure out a way to not see people who aren't sick.

Posted by: katiebird on January 24, 2007 at 12:26 PM | PERMALINK

I have seen people wait that long to be seen at Research Medical Center in Kansas City, ex-lib. On a regular basis. And RMC is a for-profit HCA facility.

I have also seen people shuttled out the door of their ER, only to be admitted to North Kansas City or St. Luke's later in the day with strokes and MI's. One employee was in an auto accident, and booted out with a broken bone that was never x-rayed by the ER staff.

If the problems you fear were not universal, you might have a leg to stand on. Emergencies are triaged and given a priority. Coronary before constipation, in other words.

For-profit healthcare is a much larger tragedy in this country than waiting to see a physician in Canada.

Posted by: Blue Girl, Red State (aka Global Citizen) on January 24, 2007 at 12:31 PM | PERMALINK

What I find most depressing about this article is Ruth Marcus. I mean, here we have someone who is far from a flaming wingnut, writing in a publication that is far from a flaming wingnut rag, and still the depth of her analysis is "it involves raising taxes, so liberals must be for it, right?"

Because, you know, liberals always like taxes. As many taxes as possible. On as many people as possible. For any reason anyone can think of.

Sheesh. Lord, give us some smarter idiots. Please.

Posted by: Wilbur on January 24, 2007 at 12:31 PM | PERMALINK

Bush's scheme is merely another tax cut for the wealthy. As everyone not named Ruth Marcus understands, a tax break does little to nothing for an overwhelming majority of Americans with no insurance, because the poor pay little to no income tax. So who does the plan favor? Those buying their own insurance, ie, wealthy, trust fund Americans. I'm not against tax breaks for those buying private insurance, as long as they decline employer-based plans to do it!

The gold-plated nonsense is just so insulting and ignorant. Employers buying into a health insurance pool pay largely based on how many employees they subscribe. Therefore, smaller companies pay significantly more than larger companies. In effect, Dumbya is punishing those who work for smaller businesses, because they happen to pay more in premiums than employees working for corporations. It is total idiocy.

Posted by: MeLoseBrain? on January 24, 2007 at 12:33 PM | PERMALINK

"Those who hanker for a single payer plan like Canada's may want to read Heading to Emergency room? Bring lunch, maybe a pillow, too
Most end up waiting 7.4 hours, study shows"

ex-liberal: When I had my heart attack here in the USA, I sat nearly 4 hours in chairs in the ER. My mother has had stretches of 7 and 10 hours in the ER while in intractable pain. Is your point that ERs are lousy places to get medical attention if you walk in on your own, or do you see the Canadian system as somehow contributing to the problem rather than a lack of staffing? And why be so scared of a bureaucrat controlling procedures? Insurance company bureaucrats drive many medical decisions now, and I don't see them as more benign than the government.

Posted by: Dano on January 24, 2007 at 12:35 PM | PERMALINK

Seeing as how I just did my taxes for 2006, i decided to check to see what Bush's plan would mean to me vis'a'vis my tax bill. The result: an actual tax cut of roughly $300 dollars versus the twelve month total for premiums at $90/month (I have no dependants,etc.) that I currenlty pay for private insurance which equals $1,080. Oh, i almost forgot that $500 deductable..not much help to me in the long run.

Posted by: BJS on January 24, 2007 at 12:41 PM | PERMALINK

Blue Girl and Dano -- ER waiting times in the US do not average 7 hours. Sure, there are some examples where the waiting time was long, but our ER service is a lot quicker than Canada.

Americans pay a lot more for health care than Canadians. Shorter ER watiing times is one of the things we get for our money.

Posted by: ex-liberal on January 24, 2007 at 12:43 PM | PERMALINK

Over the last 50 years, we have tried the Repukeliscum vision of "You're on your own, and don't bother me" for health care.

It is a MISERABLE TOTAL FAILURE.

And for the waits in ERs, I was punched in the eye last october by a bunch of morons high on meth or something. I went to the ER with my insurance, bleeding like crazy, with three minor fractures of the orbital structure. I waited 5 hours for my 30 stiches. That's the profit driven health care system - a total failure.

Posted by: POed Lib on January 24, 2007 at 12:45 PM | PERMALINK

"ER waiting times in the US do not average 7 hours"

Maybe it's just Kansas City then, because my experiences at the Shawnee Mission Medical Center are all in the 7 hour range. That's not all in the waiting room -- they usually get you into an examination room. But you're still waiting.

Posted by: katiebird on January 24, 2007 at 12:47 PM | PERMALINK

"Giving a tax deduction to people who don't make enough to pay any taxes in the first place..."

Except, of course, for all the taxes they do pay: SS, Medicare, Sales, Property, etc. None of which are affected by income tax deductions.

Posted by: jefff on January 24, 2007 at 12:48 PM | PERMALINK

but our ER service is a lot quicker than Canada.

Prove it.

Posted by: Blue Girl, Red State (aka Global Citizen) on January 24, 2007 at 12:50 PM | PERMALINK

And by the way - what good is quick service if you are booted out in the midst of an MI or a CVA? Hmmm?

Posted by: Blue Girl, Red State (aka Global Citizen) on January 24, 2007 at 12:58 PM | PERMALINK

unlke most of you (including Kevin) I am broadly pro-choice. I don't want a government bureaucrat to control all the other medical procedures.

Ah, we can always count on "ex-liberal" for dishonest phrasing. "ex-liberal" seems to take special delight in the lie by omission -- in this case, that insurance company bureaucrats control many decisions about medical procedures. Of course, since private insurance would surely exist even after the inevitable move to single payer, if "ex-liberal" truly prefers to have decisions controlled by those whose profit motive lies in not paying for health care, he/she/it would be welcome to it.

Posted by: Gregory on January 24, 2007 at 12:58 PM | PERMALINK

"I envision universal health care as having a moderate to high co-pay to force responsiblity on the beneficiaries. "

The problem with that is that health care is wierd. It isn't like buying clothing, cars, or CD's. We want people to get MORE preventative care, not less. People who consume more care than they need are very rare, people who consume less care than is optimal are the majority. One of the main problems with the US system of healthcare is its failure to provide regular preventative care in favor of far more expensive corrective care. Comprehensive and stable insurance encourages people to get preventative care.

Preventative care is far more effective for the money than corrective care, however the profit motive of the private insurance industry is not aligned to this. Giving preventative care is a waste of money for them, they are just keeping people healthy who will almost certainly eventually switch to some other insurance provider (particularly medicare) which will reap the benefit.

Posted by: jefff on January 24, 2007 at 1:01 PM | PERMALINK

Golly ex lib you really are in nutso land. Here in Houston, it is not uncommon during the height of flu season to have ERs placed on drive-by status. There's no 7 hr wait, you can't even get in the door.

What's more, you are not being rational in the least if you think that a bureaucrat in a profit driven corporation is going to be any more thoughtful or humane than that menacing government worker that you are so worried about.

Note how the courts have had to slap State Farm around to get them to live up to their commitments to hurricane victims.

But then, you know that. You are just being an ass.

Posted by: Keith G on January 24, 2007 at 1:03 PM | PERMALINK

ex-lib, I think I take such delight in handing you your ass and pocketing your genitals because you remind me so much of my stepdad. Cranky old prick who just can't agree with anyone on anything, ever.

Posted by: Blue Girl, Red State (aka Global Citizen) on January 24, 2007 at 1:08 PM | PERMALINK

Ok, this is simplistic, and overly so at that, I am sure. It is also not a novel suggestion on my part. But why not expand Medicare to everyone of all ages. Doctors still get paid, although maybe not quite as much, but still a very lucrative income. Patients still have choice. Most aspects of private market based competition economics still apply to the process, i.e. each provider decides his own office location, cost negotiates his labor, supplies et. Providers benefit from not having to subsidize non-paying patients with their paying ones, so, overall, they may be just as well off as they ever were. Lastly, individuals that want additional (Premium Gold Plated!) coverage can buy supplementary policies like Medicare members have for years. The effectiveness of this system, relatively speaking, has been demonstrated over a long period of time. I know that there are many of you out there who know a lot more about this than me and are chomping at the bit the carve this idea up. That is why I set it forth, I genuinely want to know. We have to do something, this is the best I have so far. Thanks.

Posted by: bmaz on January 24, 2007 at 1:11 PM | PERMALINK

Has George W. Bush ever earned an honest dollar?

Has George W. Bush ever been broke?

Has George W. Bush ever been sick and broke?

He has lived his whole miserable, destructive life with cause disconnected from effect. He cannot comprehend what it means for normal people to cope with the dangers and difficulties of their lives while he thinks up ways to make them worse.

This man shouldn't be allowed anywhere near health policy.

Posted by: clem on January 24, 2007 at 1:18 PM | PERMALINK

katiebird, blue girl, me. How many people on this board are from KC?

Posted by: Ron Byers on January 24, 2007 at 1:20 PM | PERMALINK

Ron, That seems very strange to me. But cool -- I wonder if we could work on developing a local Single-Payer Educational program together?

Posted by: katiebird on January 24, 2007 at 1:26 PM | PERMALINK

bmaz I like it. How much do we increase the medicare tax? Right now it is 2.9%.

By the way I really do like expanding medicare. Medicare allows for participants to purchase supplementary plans to cover the "gold plated" services. It covers most serious cases. It is already in place. Doctors and hospitals know how to use it. It achieves my goal of divorcing health care from employment. Lots of good things going for it.

Posted by: Ron Byers on January 24, 2007 at 1:26 PM | PERMALINK

Unholy Moses is one of us, but he is on the housing thread.

Posted by: Blue Girl, Red State (aka Global Citizen) on January 24, 2007 at 1:29 PM | PERMALINK

Political Animal Meetups!

Posted by: katiebird on January 24, 2007 at 1:35 PM | PERMALINK

I agree with bmaz' idea as well. The system is in place and it works. Utilize it.

Posted by: Blue Girl, Red State (aka Global Citizen) on January 24, 2007 at 1:36 PM | PERMALINK

I also agree with bmaz's plan:

I think that one powerful, outspoken hero could change everything. It's not like it would be that hard.

We've got the agency: Medicare. Just raise the tax. And add everything that's covered in our Congressional plans. And

Cover Everyone.

Tweak if necessary.

Did I leave something out?

Posted by: katiebird on January 24, 2007 at 1:42 PM | PERMALINK

i propose that this discussion needs to be coninued, but up on the newer "Stealth Conservatism" thread, which is basically about the same subject and we need to all be on the same page. So to speak.

Posted by: bmaz on January 24, 2007 at 1:49 PM | PERMALINK

Single payer sounds like it would make America healthier and richer. Don't we need that to stay competetive in the world?

Posted by: ferd on January 24, 2007 at 2:02 PM | PERMALINK

ex-liberal: Those who hanker for a single payer plan like Canada's may want to read Heading to Emergency room? Bring lunch, maybe a pillow, too Most end up waiting 7.4 hours, study shows

So, ex-thinker, did you get that link from this morning's TPM, or are you a regular reader of the Ottawa Citizen?

With all due deference to that publication, instead of relying on its summary of the CIHI study, you could go to the Canadian Institute for Health Information site.

In a 2004 international survey, nearly half of Canadians polled (48%) said they waited two or more hours to see a doctor on their last visit to an emergency department, while only 36% of those surveyed in the UK, 34% in the U.S., 29% in Australia and 27% of those in New Zealand reported having to wait that long.

Hmmm, 2 of the UHC countries are worse than the US, and 2 are better, and none of them spends more than 2/3 as much of its GDP on healthcare as the US.

BTW, the Brits are now doing much better:

In 2000, the National Health Service (NHS) in the United Kingdom proposed benchmarks for ED visit times in England. All patients, regardless of triage level, were expected to spend four hours or less in the ED. Initially, 80% of patients met this target. By June 2006, 98% of hospitals in the NHS were reported to be meeting the benchmark

So the US is probably 2nd worst now.

Hmmm, 5 countries, 4 w/ UHC, US is only 2nd worst. Wingnut conclusion: UHC sucks!

Posted by: alex on January 24, 2007 at 2:05 PM | PERMALINK

Right now I subsidize all you old, sick people since I am young and healthy. I see a doctor maybe 4 times a year and that is generally to get a my prescription for sinus meds renewed. Even though you boomers deserve to be sick since you spent your youth ingesting large quanities of booze/drugs and have way way to much freaky sex, I am okay with paying more so you can get your Ciallis prescriptions renewed. Why? Since I am going to stick your kids with the bill for my new knees in about 25 years.

Posted by: fine with me on January 24, 2007 at 2:36 PM | PERMALINK

The length of time you wait to see a doctor in an emergency room is a poor way to judge the quality of a healthcare system. Last time I went to the emergency room I waited 90 minutes for someone to treat a couple of dislocated fingers. I assume people who had less serious injuries/illness waited even longer. Seems to me that is the way the system should work in an EMERGENCY room.

Posted by: Ouch on January 24, 2007 at 2:49 PM | PERMALINK
If we are stuck with an insurance run model, why should I susidize your $500 deductible when I am willing to pay a $2,000 deductible.

Why should the people who are happy enough to do without "insurance", per se, and instead prefer to cover their own costs through savings (which, if you've got enough assets and no cash flow issues so that even fairly unlikely unexpected costs are not a real problem, is economically rational for the super-rich) subsidize anyone?

Why should people who are willing to go to work directly out of high school subsidize people going to college through deductibility of student loan interest or college tuition?

The idea that the only thing that should be subsidized is something every member of the public would choose to buy in exactly that form whether or not it was subsidized is, well, bizarre.

My point was that if cmdicely wants to have a lower deductible to pay for minor illnesses and pains then he shouldn't ask the rest of us to provide him with a tax deduction.

How does a high deductible plan help people who couldn't pay the deductible in the first place? Subsidizing, through tax policy, a universal single-payer system, or otherwise, only coverage that requires a substantial deductible guarantees that the plan provides the most public benefit to the people that need it the least.

I envision universal health care as having a moderate to high co-pay to force responsiblity on the beneficiaries.

Co-pays are different than deductibles in health insurance, but how you envision universal healthcare seems pretty irrelevant, anyway, since a tax deduction has nothing to do with universal healthcare. (A 100% tax credit might, arguably, but that's not on the table.)

Anyhow, I see universal healthcare as having modest, probably income sensitive co-payments, with no "deductibles" (or lifetime benefit limits, either) in the usual health-insurance sense.

At the same time, those co-payments should also reflect the social and cost control utility of services; services with substantial preventive value that people might otherwise forgo should have limited or no patient payment where they are medically indicated to encourage them to be taken advantage of.

Posted by: cmdicely on January 24, 2007 at 3:08 PM | PERMALINK

Mike Friedman,

Try to keep up, will you. The meme "the problem is too many people see the Doctor for no reason" was last year's conservative mantra. Once people figured out this is simply not true the conservatives had to come up with a new explanation.

This year the conservative meme is "The problem is that fat cat employees with company sponsored gold-plated insurance is driving up the cost of medical care."

Because this one is vague it will longer to debunk, but it will get debunked. When that happens the conservatives will have some other 'explanation' ready.

But hey, maybe you have personal experience with these hordes of people visiting Doctors on a whim. Would you care to direct me to some of them?

Posted by: Tripp on January 24, 2007 at 3:22 PM | PERMALINK

I just started recieving social security, and before that I was on medicaid. I am a single mother of two boys, one of which is on SSI. He is five years old and has autism among other problems. I also have a 16 month old son. the very first month I began recieving my SS check my Medicaid was cut off and so were our food stamps. My five year old has to be on a special diet due to all of his disorders and my medications are not free, neither are the doctors I have to see to get the prescriptions. I am not eligable for medicare for two years and in the mean time I can't get private because it is a prior existing condition. And the money that we receive from SS, SSI is for rent, utilities, diapers, my older sons vitamins, and now I have to choose whether I want to feed my family or take the medicine I have been taking for over a year. Which by the way is for blood pressure problems, severe migraine syndrme, anxiety, PTSD, Depression, Bipolar disorder, and ADD, Hyatal Hernia. What should I do?

Posted by: Jessica Phillips on January 24, 2007 at 3:26 PM | PERMALINK

I see universal healthcare as having modest, probably income sensitive co-payments, with no "deductibles" (or lifetime benefit limits, either) in the usual health-insurance sense.

Doesn't Medicare impose a lifetime benefit limit? (I want to say it's $1,000,000, but I could be wrong). Is this ever an issue?

Posted by: anonymous on January 24, 2007 at 3:54 PM | PERMALINK
Doesn't Medicare impose a lifetime benefit limit?

I think Medicare has lifetime limits for particular types of benefits and may also have lifetime limits overall. I don't see Medicare as necessarily an ideal system, though it may (since it exists and basically works) be a starting point for a universal system.

Posted by: cmdicely on January 24, 2007 at 4:33 PM | PERMALINK

I am a proponent of getting something done on the issue of health care. As a small business owner I don't see any reason for me to make healthcare purchase decisions for my employees and their families. The issues are just too complex and the decisions are too personal. As a small employer I find myself at a disadvantage in the market place. My pool is just too small to insure I get the best pricing.

so, Ron Byers, why do you do this, if you see no reason to? or don't you? if your pool is too small, won't your individual employees' pools (one family at a time) be even smaller?

Posted by: northzax on January 24, 2007 at 4:34 PM | PERMALINK

The idea is very simple. Bush is proposing a plan that penalizes relatively more employees in the NE and Midwest--especially the high-population centers where health care is so expensive. (Average family premiums for these areas are ~$1000 more than for the SW and SE--see http://www.kff.org/insurance/7148/sections/upload/2004-Employer-Health-Benefits-Survey-Section-1-Costs-of-Health-Benefits.pdf). These areas are highly Democratic.

Since Bush is a lame duck, the fact that he proposed it is irrelevant to the 2008 election, but he hopes to hurt the Democratic-controlled congress whose members are running for President or reelection to Congress with their constituents and to label them more-or-less permanently as tax increasers.

Of course, looks like the Democrats won't bite on this particular bait.

Posted by: Jeff from WI on January 24, 2007 at 5:12 PM | PERMALINK

The crew on an aircraft carrier don't need an insurance company between them and the ship's doctor. Why should the crew of Spaceship Earth?

Put differently, what's to insure? Insurance is for things that are uncertain. Your house might burn down. You might get in an auto accident.

There is nothing uncertain about health care. 100% of everybody needs health care, and we need it all our lives, not at some random unknown time.

Any plan which involves payoffs to insurance companies is a theft for the benefit of the Republican base. Nothing more. Nothing less.

Posted by: David Lloyd-Jones on January 24, 2007 at 6:33 PM | PERMALINK

I'm all in favour of a single-payer health care system, it works well enough to kerep the majority of people healthy in Europe and Canada.

As for competitiveness though, I have to take issue with Ron Byers on one statement:

You are also aware that companies like Ford and General Motors are at a competitive disadvantage because of their high cost of health insurance.

This is simply the screen that they use to cover the real reasons. Ford and GM are at a competitive disadvantage to companies like Toyota because they build bad cars and have incompetent management.

All Japanese manufacturers and some European ones are far further down the path to next generation engine technology and design far smarter, better engineered and more cost effective cars.

Posted by: Bad Rabbit on January 24, 2007 at 10:19 PM | PERMALINK

Just a comment about Ruth Marcus's contention that Bush's healthcare tax would only hit the "well-off." I have a family of three and we are middle class (our joint income is around 100K, we have a mortgage, one car, a Toyota Camry, I'm an artist, my wife is a teacher). Yet my health plan costs — between my employer and my contributions — about $21000. It's a good plan but it's no luxury item. I am deeply offended that the $6000 above Bush's ceiling should be taxed as income. The guy ruins anything he comes into contact with.

Posted by: evan500 on January 25, 2007 at 2:21 PM | PERMALINK

Just a comment about Ruth Marcus's contention that Bush's healthcare tax would only hit the "well-off." I have a family of three and we are middle class (our joint income is around 100K, we have a mortgage, one car, a Toyota Camry, I'm an artist, my wife is a teacher). Yet my health plan costs — between my employer and my contributions — about $21000. It's a good plan but it's no luxury item. I am deeply offended that the $6000 above Bush's ceiling should be taxed as income. The guy ruins anything he comes into contact with.

Posted by: evan500 on January 25, 2007 at 2:24 PM | PERMALINK
Mike Friedman, how long would you wait to see the doctor (or talk to your dad) if you had trouble urinating, had blood in your stool, started getting unexplained night sweats, or just felt lethargic?

Well, I'd talk to a doctor immediately for anything but the "lethargic" one - the cure for lethargy is getting your butt out of bed.

Don't get me wrong - I'm not saying that we shouldn't see doctors when we have symptoms of serious stuff.

I'm saying that we shouldn't go to doctors for the little things.

And BTW, my dad gets just as annoyed if I bug him about non-serious stuff now as he did when I was 10.

Posted by: Mike Friedman on January 25, 2007 at 8:30 PM | PERMALINK

What the hell is "gold-plated" health insurance? Did this term to describe certain insurance plans exist before Bush's speech? If not, then why wouldn't you put such a simple and misleading term in quotes? By using his words without quotes, you give legitimacy to the term, and help to make his case for him. Or maybe I'm wrong and this is a commonly used name for these policies. If anyone has "gold-plated" insurance it's the President.

Posted by: Gerard on January 26, 2007 at 10:42 AM | PERMALINK

WTF, Mike Friedman? The cure for lethargy is getting out of bed?

Lethargy can be a symptom of major depression, hypothyroidism, any viral illness, and several other things.

Speaking as a healthcare provider, it's better for people to have routine physicals to keep an eye out for a preventable chronic condition (high blood pressure, for example) or one that has better outcomes (eg, lower overall costs) if caught early (diabetes, for example.) Then when the chronic condition is diagnosed, having 3-6 visits per year to manage the condition is shown to decrease hospitalization for complications. Does an MD have to do the management? No, NPs, PAs, or pharmacists can do it, with the MD seeing the patient once a year.

Having patients on the most effective medication regimen -- and ensuring that they take it -- keeps them out of the hospital, which drives costs much higher. There is published literature in managed care journals to this effect.

Posted by: C Diane on January 26, 2007 at 11:22 AM | PERMALINK

There are probably dozens of reasons to oppose Bush's healthcare plan, so I'll just mention the most obvious - it does absolutely nothing to address the problems with healthcare in the US.

Healthcare in the US way too expensive (our costs far exceed any other country's), it isn't universally available, and the outcomes aren't very good compared to other developed countries. Not to mention that if you lose your job or are chronically ill, you're screwed. Our current system hurts the competitiveness of US companies and puts all the incentives toward delaying care, when it is more costly and less likely to be successful.

To all you young folks out there - you too will get old and sick someday, so I wouldn't be so quick to resent paying into a system that you don't currently use that much. The presence of younger, healthier members in the system keeps the costs down for everyone. And, to ex-liberal, going to the doctor early and often for routine matters actually makes healthcare less costly, not more costly (see, for example, France, where routine visits are far more common, costs are much lower, and the population is healthier).

The Bush plan isn't even a good starting point for discussion. It's another poorly disguised conservative scam.

Posted by: Dave in DC on January 26, 2007 at 1:28 PM | PERMALINK




 

 

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