Carol Shea-Porter was accosted (there's no other word for it) by nutcases in her town hall events over "tort reform" recently. (I'm ashamed, btw, that such ugliness exists in New Hampshire. I'm also ashamed such stupidity exists in NH.) From everything I've read "tort reform" is not, in fact, a factor in high insurance premiums, except as an excuse used by insurance companies to up their prices.

I'd call it a McGuffin -- something used as a prop to call attention away from the fact that the Republicans lack any coherent alternative plan.

But if there is some merit to tort reform -- except for, of course, further limiting the redress that "the little guy" has against big business (itself a dangerous thing given the current Supreme Court & its slant toward Big Business We HEART You) -- I'd like to know.

Nixon's silent majority has been replaced with Limbaugh's vocal minority.

Us: "Don't sell your crazy around here, we have enough!"

GnOPe: "More crazy? Yes, please! Can we get an extra big helping?"

You seem to miss the point but I'm sure you do get it. The HR3200 bill is a skeleton that will be filled in with thousands of regulations determining what the rules will be. There is simply no "there" there. The bill is not a program for health reform but a program for an enormous bureaucracy that will make rules voters will never get to vote on. That is why Republicans, if they know what is good for them, will oppose it.

The public has lost trust in this administration and in Congress on this issue. That is why the legislation is an albatross now around the Democrats' necks. They might ram something through but, the way this bill is structured, the taxes begin a couple of years before the health "reform." The 2010 election will be determined largely on what the Democrats do now. If they ram something through, it will be repealed like catastrophic Coverage was repealed. Remember that one ?

A wise course would be to start over but the left, as illustrated here, will not let them.

My local paper is carrying this thing called "PolitiFact" from the St. Petersburg times where it fact-checks health care claims. They have rated a Barbara Boxer statement about the costs borne by the insured to treat the uninsured as "barely true" due in part to a dispute between foundations which have studied the issue, one of which concluded that costs are also borne by doctors and hospitals. (Good thing doctors and hospitals get that money that falls down from the sky. Whew!) Meanwhile, they have rated statements from Michael Steele as "pants on fire" with the notation "The VA does not encourage suicide."
We have reached the point of "fact-checking" whether or not the VA encourages suicide. You know, I AM beginning to believe these crazy conspiracy theories about Republicans just wanting to kill this bill.

Republicans would immediately respond with, "It's not good enough."

Hell, they'd say that if Dems reduced their plan to a $5-off coupon for everyone on their next visit to their family doctor.

Bradley, and these other "bipartisan" Dems are fucking morons who obviously don't have two brain cells to rub together.

I suppose the point behind the Tort Reform push is that doctors would no longer feel compelled to prescribe expensive tests and treatments just to cover themselves against lawsuits, and would instead do so only when the medical problem warranted it.

The quiestion: if that's true, would it actually help lower health care insurance costs?

"rules voters will never get to vote on"

Mike, is the idea of representative democracy new to you, or are you under the impression that federal legislation is regularly voted on by voters?

Seriously, it's only 1:30 but this is the dumbest thing I've read all day. If the Republicans want a different plan, then they need to bloody well write their own dang plan. They did it for the budget in about twenty minutes, it had lots of little balloons with words like "freedom" in it and colorful pictures, too.

Something overlooked here is that Nixon didn't have to worry about currying favor with Big Business, primarily because he turned the tables on them and instead of accepting campaign contributions as bribes for doing what Big Business wanted, he turned it into an extortion racket in which he was shaking these businesses down whether they liked it or not. So he got the political money he needed, without having to give them the policies they wanted.

Perhaps Obama should look into something like that for all the "centrists" and Blue Dogs, so they will be beholden to him instead of the lobbyists who pay their salaries.

Bill Bradley has never impressed me re: strategic thinking. His presidential campaign was atrociously naive.

Yet I like him as a person, as many do. But this is not a guy who really gets the game, I think. There is plenty of evidence of that. Tort reform is about defunding and defaming one block of liberal donors, that's about it.

I campaigned for Bradley in Iowa and New Hampshire in 2000.

I read this op ed and came to the conclusion Bill Bradley is a dufus.

He's like Captain Queeg in the Caine Mutiny, trying to relive the great accomplishment of his youth. Queeg wanted to relive the investigation of the missing strawberries; Bradley wants to relive passing the Reagan tax bill.

Bradley must be spending so much time on corporate boards he doesn't have the mental energy to pay attention to politics.

A wise course would be to start over but the left, as illustrated here, will not let them.

Mike is right. If a modest bill with an insurance exchange that has a small public option to cover those presently uninsured is too much for the Republicans then the Democrats should go balls out and create a single-payer system that wipes out insurance companies and saves Americans craploads of money otherwise being wasted in bloated administrative costs, marketing expenditures, and profits for CEO's.

Mike has supported a single-payer system for years and has written about it on his blog. Mike, would you care to elaborate more on how we could design a single-payer system and gain Republican support, while convincing Americans of the wisdom of it?

I seem to recall at one of the first bi-partisan meetings Obama had with congressional leaders, he stated flat out he was willing to offer tort limitations to the republicans; he asked what they might be willing to offer in return. Response was nothing but silence.

BTW, do you notice how people advocating tort reform never suggest criminal penalties or increased regulation and transparency as part of tort reform?

They want a world where the powerful are shielded from trial lawyers when they are negligent. But the vision is to have the powerful and negligent shielded from all forms of gov't accountability too.

Apparently Bradley hasn't noticed this either. Funny how hanging out with a bunch of Wall Street corporate board members causes you to miss a whole bunch of stuff in life.

mike k: The bill is not a program for health reform but a program for an enormous bureaucracy that will make rules voters will never get to vote on.

now if only conservative pronouncements meant anything...

GOP PREDICTION HALL OF FAME:

...saddam had nukes..

...this is a mental recession..

mike k: The public has lost trust in this administration and in Congress on this issue.

GOP’s handling of health care - NBC News/WSJ Poll 8/19/09

21-percent approve.....62-percent disapprove....

"How much confidence do you have that they will make the right decisions for the country's future."

Obama 49%.....congressional Republicans 21%

- ABC/Wash. Post 8/21/09

wow...2-to-1..

gop 2009: any suckers left?

Bill Bradley has never impressed me re: strategic thinking.

I would say the same, only without the word "strategic".

Locked, loaded, and loony

Part of the answer is that the right-wing fringe ... has now, in effect, taken over one of our two major parties.

You almost expect them to mainstream assassination....

Underneath the BS of the desire for a Grand Bipartisan Compromise, Bradley has a nugget of a point. Democrats should offer medical malpractice reform, because it's GOOD POLICY. Not tort limits, not telling patients to surrender their rights to pursue corrective action in the legal system, but installation of a medical court or other system that actually gives meaningful compensation to victims of preventable adverse events in order to a) reward victims, and b) reduce such events. Seriously, nobody except the occasional trial lawyer profits by the current system, and the tort system is woefully inadequate to deal with the complexity of modern medicine.

There is a political upside too: when the Republicans oppose this, you tell the business community and the physicians, "these guys have been talking about tort reform for years, but we actually did it--and they fought us. They don't want to deliver, they just want your money."

The reason we're not going to start over with single-payer is because single payer is dead before arrival. Forget about any Republican support, you couldn't get a third of Congressional Democrats to support it and the chances of the public supporting it are also slim to none. We may do it someday, we may not, but that bike needs some training wheels. There are about a hundred different models for workable and efficient health care reform, not all of which are single payer, but none of which are like our non-Medicare/Medicaid/VA model, so it's hardly a foregone conclusion that the only effective reform is single-payer, I don't care how much mike writes about it on his blog.

Tort reform or Malpractice reform is a scam by the American RightWing.

The Institute of Medicine has reported that preventable medical errors kill as many as 100,000 people a year. It's the sixth largest killer in America. However, less than 5% of those patients who are victims of medical negligence ever even file a legal claim, 95% of that less than 5% settle out of court for rather meager amounts, and only a tiny percentage of that tiny percentage actually ever receive a jury award.

Thirty states have enacted caps on jury awards, but the caps haven't lowered or even stabilized insurance rates, and have not lowered healthcare costs, but only short-changed injured patients and enrichened insurance companies.

What finally worked in California was not tort/malpractice reform, but insurance reform that was passed by a ballot measure put forth by consumer activists.

The reforms required insurers to open their books to justify rate increases, while limiting expenses that could be passed on to consumers. It stripped the insurance industry of its exemption from antitrust laws, and gave voters the power to elect the state insurance commissioner. Only after this insurance reform passed did medical malpractice insurance premiums go down and stabilize, according to the insurance industry's own data.

There's a case to be made for negotiating over tort reform: a motivation for a good number of lawsuits is to get enough money to pay for the medical care and attention required by the damage done to victim. Provide healthcare to the victims and then you're looking at reduced payouts for lawsuits. So, there's a real temptation to use it as a bargaining chip.

But, as has been noted above, it wouldn't matter. No matter what the Democrats come to the table with - including Tort reform - the Republicans will say it's not enough simply because they cannot allow the Democrats to walk away with this big a win, and the media will back them up with their ceremonial Sunday morning tut-tuts about how in the good ole days Democrats knew how to surrender better.

Forget about any Republican support, you couldn't get a third of Congressional Democrats to support it and the chances of the public supporting it are also slim to none.

The former is sadly true, the latter is demonstrably false per numerous polls. "Medicare for all" has always polled very strongly. If we had a functioning democracy it would have been enacted log since.

I think Chocolate Thunder makes a good point on that score. I used to be extremely skeptical about the idea of med-mal reform, but I read some pretty convincing stuff that Dr. Atul Gawande has written, which is not to say that he has a solution to the problems. He has praise for the vaccine court as a solution to that problem, but admits that a parallel system for all med mal would likely be too unwieldy and unmanageable. The current system has a lot of damaging aspects, though, not the least of which is that it does not encourage providers to actually make changes and it most definitely does not encourage review of mistakes.

Mike has supported a single-payer system for years and has written about it on his blog. Mike, would you care to elaborate more on how we could design a single-payer system and gain Republican support, while convincing Americans of the wisdom of it?

Posted by: trex

The French system is single payer in the sense that there is a mandate to have insurance but there are a number of funds that are not technically part of the government. The key, in my opinion, to the solution is to set a payment that is actuarially sound, then let the doctor and patient make private arrangements if they agree on private rooms, alternative medicine, extra home visits for frail elderly, etc. For those who cannot afford the extra payment there should be an option for physicians, especially young graduates, to agree to accept the fund payment in return for forgiveness of student loans. The average US graduate has over $250,000 in loans to repay. A similar contract could be signed to pay for medical school tuition. The military does it now. If the graduate chooses to go to "Sector II" as the French call it, after graduation, they repay the tuition over time.

The thing that scares off US doctors is the compulsion in both Obama's plan and Hillary's plan. For example, geriatrics specialists are dropping out of Medicare (Medicare !) because the rules do not allow them to see elderly patients more frequently than the rule allows. Elderly patients are paying cash now to have geriatric specialists see them at home. Home care is a huge part of any reform of Medicare.

I don't know if you were serious, trex, since so many of my posts here are deleted or ridiculed but you can go to "health reform" on my blog and read the rest.

Steve L., my pessimism comes in part from the fact that the more we talk about health care reform and the more watery the proposals become, the LESS support it gets. It also comes from the fact that there are also numerous polls suggesting that people like a lot of choices in health coverage, i.e. people generally like the idea of competition; and polls suggesting a majority want to be able to keep their current coverage if it works for them. It also comes from the fact that once you get past the initial polling, people will realize that there will have to be a fundamental realignment in the way health care is paid for. I don't personally think that's a bad thing at all. But people are not used to thinking of their employer-provided health care coverage as a depressing factor on their wages, even though they are. Every dime your employer has to pay for it is money that you should be earning in wages, and if it showed up every month on your pay stub as a deduction people would think about it that way. But if insured people see it as losing a "free" benefit and now they have to pay higher taxes to get health coverage, that's where I think the real difficulty comes in. Anyway, my point is that I don't think you can take polling answers and translate them in any way directly to legislation, if for no other reason than different poll results suggest different approaches.

The thing that scares off US doctors is the compulsion in both Obama's plan and Hillary's plan...

So what I take away from your take on is that the Democratic plan doesn't go nearly far enough in creating reforms -- while the Republicans aren't even serious about it at all, as they would reject your ideas out of hand. One of the reasons the bill is so complex, for instance, is to try and cater to Republicans' myriad objections to reform in general.

I know you support reform, Mike, and I was trying to goad you into saying what you usually refuse to say - that the Democrats, however imperfect their efforts -- are on the right track.

Here are two things that I would like to see from you as a partner in reforming the health care system in this country:

1) I would really like to hear you criticize the Republicans for being unprincipled obstructionists in this matter. Health care is too important to be passed over for partisan gain. Take them to task for the false memes that they're spreading, e.g. death panels.

2) When the opportunity presents itself, I would like you to explain WHY reform is so important, on this blog and your own, i.e. premiums are spiraling out of control, the number of uninsured keeps growing, the outrageous practice of recission, et al. You are a doctor and you know first hand about the limitations of the current system. And remember: Obama didn't create Medicare limitations. One of the reasons they exist is because for years Republicans have been trying to defund it.

Everyone who posts on this board would be happy with a French system or a Dutch system over what we have now, and you can help make that happen.

Steve is right: Republicans will say No, no matter what. They want, literally, nothing -- except, perhaps, to see the poor suffer, the rich get richer, and the US implode with avoidable debt and unsustainable health costs. But beyond that, CA has tort reform, has had it a while, and it hasn't lowered insurance rates in CA at all. (The whine from the right is that rates get jacked up by tort litigation.)

The reason we're not going to start over with single-payer is because single payer is dead before arrival.

I didn't have a problem with single-payer until someone pointed out to me that I, along with many other people who actually like their current health insurance, would lose it. And that would totally suck. I've had bad insurance in the past and believe that the government can do insurance decently, yet...I'm not sure I'd want to just toss out what I have right now. And I'm sure there are lots of others who think the same way.

Even as it is, conservatives keep railing against a government takeover of healthcare, and our best defense is that we're not doing it and they everyone who wants to keep their current insurance are free to do so. Yet, if we were pushing for single-payer, they'd all be right. Frankly, I think the public option is totally the way to go. If it's good, as I think it will be, I suspect we'll all eventually be in it. But if it sucks, or more likely, has hiccups at the beginning, I'll be glad to stay with my current insurance provider, with whom I have few complaints. And if we forced everyone into single-payer, the hiccups would be far more pronounced.

So I think that keeping the public option as an option was far far FAR the better course to take. Again, conservative rants against single-payer are bad enough as it is. I think things would be worse if their rants were accurate. It's best that this be optional.

I have heard the proposal offered of, if you're a Democrat you can have the public option and if you're a Republican you can't. What's not to like?

1) I would really like to hear you criticize the Republicans for being unprincipled obstructionists in this matter. Health care is too important to be passed over for partisan gain. Take them to task for the false memes that they're spreading, e.g. death panels.

THis probably isn't enough for you but the Republicans have lost almost as much credibility as the Democrats. I even looked at the Modern Whig Party for alternatives. You folks have commented on the fact that Republicans are not much more popular than Democrats. A lot of us were unhappy with what happened to them after they got into power in 1994. On the other hand, there is an old rule in politics not to interfere when the opponent is committing suicide.

2) When the opportunity presents itself, I would like you to explain WHY reform is so important, on this blog and your own, i.e. premiums are spiraling out of control, the number of uninsured keeps growing, the outrageous practice of recission, et al. You are a doctor and you know first hand about the limitations of the current system. And remember: Obama didn't create Medicare limitations. One of the reasons they exist is because for years Republicans have been trying to defund it.

I think I have done that on the blog. The biggest reason is because costs are out of control, especially in Medicare. I think one of two ways to get control is to allow balance billing. There are lots of physicians dropping Medicare and what Obama is doing won't help that.

Two, we have to get away from the employer-based system. One reason, aside from tax subsidies, is that employed people as a group are healthier. Notice that the French set up plans by occupation. CNAMTS is for all salaried employees. There are other plans for white collar workers and agricultural workers, etc. They also allow private insurance which Obama and Hillary would not. I think a lot of my objection is about control. Canada banned private practice and insurance and 25 years later the hottest development in Canada is private practice even though it is technically illegal.

Why does HR 3200 ban private insurance ? Why not say that, if an insurance plan meets the minimum standards, it is legal ? That is what I mean about control.

Everyone who posts on this board would be happy with a French system or a Dutch system over what we have now, and you can help make that happen.

Posted by: trex

The Dutch have now gone back to private insurance.

Anyway, read the blog posts about the French system and I will be happy to discuss it.

I'd be OK with the Dutch (or Swiss) system. It's very inefficient (in terms of total national health care expenditure) compared to other European models but would still be a big improvement over what we have now.

There's a small catch though. It could NEVER pass, or be successfully implemented, in this country. The right and the insurance lobby would scream bloody murder over the extremely tight regulations and the forced revenue equalization that are required to make this model work. If it somehow managed to pass despite that, regulatory capture and subsequent reversion to basically what we have now would quickly ensue.

Why does HR 3200 ban private insurance ? Why not say that, if an insurance plan meets the minimum standards, it is legal ? That is what I mean about control.

Mike K - Not that I want to step into this debate (too late), but...how does the bill ban private insurance? I've never heard that before and I doubt you have any reliable source on that.

Of course, I clicked on your link above and see that you've essentially outsourced your facts to sources which folks here wouldn't deem the least bit reliable. Quoting the WSJ on Dr. Emanuel's papers is a complete joke. Frankly, I see no point for why you'd bother arguing with us here when you're using sources which none of us consider credible. There can be no possible agreement between us when your reality differs so much from our own.

But you've been told that HR 3200 is an "empty shell" so you'll repeat it as much as possible and imagine it makes you the cleverest person around.

Mike K, your plan is very wise. Does it bother you that no Republicans in Congress have adopted something similar to it?

In a choice between a thoughtful supporter like you and the insurance lobby, does it look like every Republican has spurned you (and others with thoughtful plans) in favor of shilling for insurance companies and partisan warfare with the Democrats?

The Dutch have now gone back to private insurance.

You're being misleading. Private insurance in the Netherlands is:

1) Regulated by the government to ensure competition

2) Guaranteed for everyone

3) Effectively transportable

4) Has modest subsidies available for individuals

5) Is socialized for elder care, hospice care, and care of the mentally ill

6) Forbids charging premiums on children under 18

7) Allows choice of a new insurer once every year based on cost or perceived level of care, which really drives competition

8) Forbids higher premiums in a given policy for preexisting conditions and high-risk persons

These are all conditions that most Progressives in this country would love to see. In fact, these are the kind of reforms that possibly even Blue Dogs could get behind.

Why won't you actively support this reform, instead of waiting for your opponent to "commit suicide" so that Republicans -- who will never, ever support any meaningful reform -- come back into power. Is it because you love tax cuts and wars more than caring for the sick?

In a choice between a thoughtful supporter like you and the insurance lobby, does it look like every Republican has spurned you (and others with thoughtful plans) in favor of shilling for insurance companies and partisan warfare with the Democrats??

Yes, and that makes me angry but if the choice is between people's lives/health and the health of the Republican party I have to go with the party.

I hate having to make this choice but I need and deserve lower taxes and the Democrats don't deserve to have a political victory over this.

You folks have commented on the fact that Republicans are not much more popular than Democrats.

In fact, we've commented on the fact that Republicans are far less popular than Democrats, as measured by every single poll out there. You just lie a lot because it hurts your spongy old brain too much to accept most facts.

Mike K, do the Republicans deserve a political victory on health care based on what they are offering? Based on how they've conducted themselves?

PUH-LEEEEEEEEEZE !!

The Republicans ARE NOT GOING TO COMPROMISE !!
What part of THAT doesn't Bradley understand ?
The Republicans ARE NOT GOING TO COMPROMISE !!

SCREW THEM !!

Get a Democratic Bill !!
Push it through wil RECONCILIATION !!
It ONLY TAKES 51 VOTES !!

WHY IS OBAMA A COWARD ?
Use RECONCILIATION to Pass HCR !!

We won't even need Ben Nelson or Evan Bayh to do this

WHY IS OBAMA BEING SUCH A COWARD ??

HELP ME !!
I've fallen off the BAND WAGON !!

Mike,

"The biggest reason is because costs are out of control, especially in Medicare."

You have that backwards.

Costs in Medicare are rising at 2% above the underlying inflation rate, but the costs in for-profit private-sector health insurance are rising at THREE TIMES the underlying inflation rate.

The runaway costs are in the private-secotor, not government-run health insurance.

"Why does HR 3200 ban private insurance ?"

It doesn't.

The vast overwhelming majority of the plans under HR 3200 would be private-sector.

Mike K, do the Republicans deserve a political victory on health care based on what they are offering?

I was talking about what the Democrat Party deserves in general. You lefties are naive about politics. There are winners and there are losers and if a few thousand people have to die and a million have to go bankrupt every year to put the better party in power, that's just collateral damage.

Freedom has a price. You've got to learn to look at the greater good like Republicans do. But far be it from me to interrupt you while you're flailing around.

Krugman: I’m not saying that reformers should give up. They do, however, have to realize what they’re up against. There was a lot of talk last year about how Barack Obama would be a “transformational” president — but true transformation, it turns out, requires a lot more than electing one telegenic leader. Actually turning this country around is going to take years of siege warfare against deeply entrenched interests, defending a deeply dysfunctional political system.

If Krugman is correct, then politics will have to get "partisan" according to the following definition:

Partisan: A member of an organized body of fighters who attack or harass an enemy, especially within occupied territory; a guerrilla.

JoeFriday had it right. Tort reform has been enacted in an overwhelming way already. Here in North Carolina, you can't get a lawyer to represent you in a med mal case because it has been made so expensive by the insurance industry and health care megalopoly they can't break even unless it is a sure thing--and those cases settle long before it gets to a suit. Bradley is way out of touch with the times.

Malpractice reform would require the participation of both Judiciary committees in the reform effort and would be dead on arrival in either.

So no, not going to happen. In a health care reform debate where we could get $33 BILLION a year from having everybody get living wills and $200 MILLION a year from Malpractice reform, I know which I'm willing to focus on.

You've now gone back to the spurious "Mike K" posts so I guess our discussion is over. Dr Biobrain doesn't like my sources. OK. The Netherlands, I think, over-controls health insurance but they have gone back from a single payer system.

Anyway, maybe we can have a discussion after 2010. I am giving a talk to the Saddleback Republican Assembly on my ideas for reform next month. Somebody seems interested.

I am giving a talk to the Saddleback Republican Assembly on my ideas for reform next month.

Next MONTH? You just made me blow seltzer through my nose. You folks are johnny-on-the-spot, aren't you?

Somebody seems interested.

A quick google reveals the SRA to be a group of local teabaggers (membership: 54) who are panting for a theocracy. And you're not embarrassed to be bragging about this? It makes your life sound so...small and shriveled.

shortstop, I thought you might like to attend. Certainly, the presence of "teabaggers" should attract you.

I give lectures on medical history to lots of groups (not all in the US) and they asked if I would explain some ideas about health reform. They are actually a local group that has been around for many years and are an official Republican organization. Not quite what ACORN is to Democrats but they do represent a political group that seems interested in new ideas, a concept that may be foreign to you.

Dr Biobrain doesn't like my sources

Well, you made a specific claim that the house bill outlaws private insurance -- and that's patently, provably false. Read it. It creates an exchange of private insurers and a public option.

You tried to pass along a falsehood and got called on it. THAT'S why you get mocked. If you want us to take you seriously, know your facts when you enter the debate and don't mock us for not knowing what we're talking about when you haven't studied up.

So again: it looks like we're really on the same side in this debate. The only thing holding us back from working together is, what? It's hard to tell. For a brief moment you loved the French system but now you seem to have abandoned it. You exalt the Dutch system one moment and then say that its overregulated -- when, in fact, it was recently rated the best system in Europe for both patient satisfaction and objective measures of care.

Why is it overregulated? Because if we were to adopt such a system here it would bug Republicans for the level of government involvement as it disproves a pet theory of theirs?

What all this is demonstrating is that you are not a serious debater. What you really want to do is beat libs over the head. You'll love or hate any health care system if it will allow you to do that.

Thanks for the info, Mike! When would you say you started saddlebacking?

No, trex, you and Mike are not on the same side. What we believe is only half the story. What we do with that belief is where character shows.

You're on the side of backing meaningful healthcare reform, knowing that single payer is the best choice but recognizing that right now a public option is the best we can hope for. You say what you say because you truly care about the lives of the 18,000 who die each year from lack of health insurance, the many tens of millions who suffer needlessly and sicken because of no or inadequate health insurance, the million (mostly with insurance) who go bankrupt each year because of unpayable medical bills, the tens of thousands who are dropped annually by private insurers when they get sick, and the millions who are stuck in jobs they'd like to leave because they can't afford to lose the insurance.

Mike is on the side that knows all that but doesn't mind the bodies needlessly piling up if it means not conceding a point to the Dems.

You're on the side of humanity and reason, in other words. Mike is on the side of petty vitriol, lying and abject professional misconduct. Money over life. No principle, only party.

trex, I can't find the section of the bill right now but it stipulates that a worker who leaves his job and must get new insurance can ONLY get the "coop" policy. They cannot buy a health insurance policy other than through the government coop.

I have no problem with the coops but they are suspect because there are reasons why the government plan may set mandates that are the product of lobbyists, not logic. I spent years in the CMA's commission on legislation and watched the California mandate load grow. This is what is driving premium rates so high, not "profits" since the majority of health insurers in this country are non-profit.

A healthy 25 year old should be able to buy a stripped down policy that might, for example, also insure him for future events that would make him uninsurable. Many of these insurance products could be created in a free environment. Right now, for example, California has mandated that every workers comp patient is entitled to a trial of acupuncture. There are almost no criteria except the condition has lasted three months.

If you want access to acupuncture or yoga as a covered benefit in a health insurance policy, you should be able to get it and pay the necessary premium. That doesn't mean that everybody has to have in their policy.

Basically, I think insurance should cover unforeseen but predictable events, as it once did. You could then buy a prepaid "insurance" plan, although that's not insurance, and pay extra. Maybe you like HMOs. Maybe you want a medical IRA plus a $2000 deductible plan. Many of the "retainer practice" developments are examples of prepaid care. You pay a small medical group $100 to $200 a month for all the primary care you need. That is a rapidly growing segment of medicine.

I think these should all be options but, the way I read it, the HR 3200 bill doesn't allow that. That's what I meant.

Sadly, the political situation has deteriorated just as the author writes. The Republicans are unwilling to engage in any rational policy debate. They actually have turned into the party of "no."

What's happened to the Republican Party reminds me of the rise of the National Socialist Party in Germany in the 1920s -- yes the N*zis for those who don't know history). A pure ideological party built on hate and fear. A party totally against socialism (kind of ironic given the party's name) How ironic today that the Republicans would simultaneously accuse President Obama of being H*tler and being a socialist -- for never the twain have met.

Then again, thoughtful analysis, facts, accuracy, and rational thought have been banned from the Republican Party this century. That's what happens when a band of extremists take over a major political party.

Mike,

"I can't find the section of the bill right now but it stipulates that a worker who leaves his job and must get new insurance can ONLY get the 'coop' policy. They cannot buy a health insurance policy other than through the government coop."

You cannot find that section of the bill because it does not exist.

Through the proposed Healthcare Exchange, one can CHOOSE from numerous for-profit private-sector plans, several non-profit private-sector plans, and a government-run plan. This is patterned after the Healthcare Exchange our federal Senators and Representatives ALREADY have.

If you are lower-income and require a subsidy, you can use that subsidy to purchase a for-profit private-sector plan, a non-profit private-sector plan, or a government-run plan with the Public Option.

Your choice.

Joe since you are familiar with the bill, maybe you could give me the section. I read it a couple of weeks ago but cannot find my link. As I read it, only the coop sanctioned policies would be allowed.

Joe since you are familiar with the bill, maybe you could give me the section. I read it a couple of weeks ago but cannot find my link. As I read it, only the coop sanctioned policies would be allowed.

It's Section 102 part 1, and it doesn't say that people have to buy public policies once their insurance expires, rather it says that they cannot get the old, grandfathered policies they have been in but must purchase new public or private ones through the health exchange.

Heritage and Michelle Bachmann intentionally mislead people about this portion of the bill, which is probably why you don't understand it correctly.

This bill sounds better and better, doesn't it?

The only healthcare plans that would be phased-out and no longer available for purchase are the old existing plans that will not have all the new consumer protections, such as not being able to discriminate against anyone with a preexisting condition, not being able to cap benefits so you can no longer go bankrupt, no rescission of coverage after you get sick, or not being a portable plan, etc.

Who would still want to buy them ?

Who would still want to buy them?

All the proud non-Marxists?

Thanks for the link Joe. It said what I thought it said:

Individual private health insurance means coverage that someone buys on his or her own from a private company. In other words, it's for people who can't get coverage through work or some other group, and the rates tend to be much higher.

Under the House bill, companies that offer insurance to individuals will do it through an exchange, where the government sets minimum standards for coverage. The new regulations require insurance companies to accept people even if they have previously existing conditions and to provide a minimum level of benefits, among other things.

That minimum level of benefits is the lobbyist's delight. The premiums will be higher, not lower.

To be sure we were reading the bill correctly, we turned to an independent health care analyst at the nonpartisan Kaiser Family Foundation. The foundation has analyzed the major health care proposals, including those of the Republicans, providing point-by-point analysis .

Jennifer Tolbert, the foundation's principal policy analyst, told us that Page 16 doesn't outlaw private insurance. "There will be individual policies available, but people will buy those policies through the national health insurance exchange," she said.

The House bill allows for existing policies to be grandfathered in, so that people who currently have individual health insurance policies will not lose coverage. The line the editorial refers to is a clause that says the health insurance companies cannot enroll new people into the old plans.

The IDB editorial has caught the attention of some of the bill's most direct supporters. Rep. Henry Waxman, a California Democrat who is guiding the legislation through Congress, wrote a letter to the publication saying the editorial was "factually incorrect and highly misleading."

The conservative Heritage Foundation also said the editorial misread the legislation, writing on its Foundry blog, "So IDB is wrong: individual health insurance will not be outlawed." Heritage believes that the new regulations will be so onerous as to drive private insurance out of business "which is effectively the same thing." But that is a substantially different argument than what the editorial said.

We simply disagree on what the effect will be but I was right about the policy. Outside the coops, private insurance will be banned. That is the same policy that Hillary had in her program.

To reiterate a point from last week, Obama, Pelosi, and Reid could hold a press conference today, offering a reform package with no public option, no tax increases on the middle class, no "death panels" or "death books," no funding for abortion, no coverage of undocumented immigrants, no rationing, no additional debt, and some "malpractice reform" thrown in,

The Democrats would never pass such a thing. Obama, Pelosi and Reid would be denounced by a majority of Democrats.

That minimum level of benefits is the lobbyist's delight. The premiums will be higher, not lower.

That's funny, because right now premiums as a percentage of income are already higher in the U.S. than anywhere in the world under a private insurance system, and it is already the lobbyist's delight. They lobby to keep any government intervention from lowering costs, while at the same time an increasing share of premiums go toward profits while benefits shrink and people are dropped from the system.

This is what is driving premium rates so high, not "profits" since the majority of health insurers in this country are non-profit.

False. Only forty percent of people enrolled in private insurance plans are served by non-profit providers. Interestingly, of the largest insurance fraud cases over the last twenty years, 19 of 20 were perpetrated by for-profit providers. [source: nonprofithealthcare.org]

So to sum up, right now an enormous and ever-growing chunk of premiums paid by Americans goes to profits for health care providers who are in turn shrinking coverage and benefits -- and the cost of those premiums are currently doubling every ten years for the privilege of being being screwed.

trex, I didn't think we were going to agree on everything but I support a national plan with a few provisions that do not exist now. For example, the French have private insurance but the basic plan is a sort of coop. That would be OK but I don't consider government sponsored coops to be what I am interested in. they could set the rules, for example, but I fear they will not be member controlled in HR 3200. Also the French legal system may reduce the issue of malpractice although in California the MICRA act pretty well keeps premiums controlled.

The key, to me, is to allow the patient free access to all sorts of alternatives, including private insurance not connected with a government "coop" with mandated benefits. The French do that, HR 3200 doesn't.

I thought it would be illuminating to post some of the testimony of Wendell Potter, former Cigna executive turned whistleblower on the industry:

On effectively canceling people's coverage by raising their premiums:

An account purge so eye-popping that it caught the attention of reporters occurred in October 2006 when CIGNA notified the Entertainment Industry Group Insurance Trust that many of the Trust’s members in California and New Jersey would have to pay more than some of them earned in a year if they wanted to continue their coverage. The rate increase CIGNA planned to implement, according to USA Today, would have meant that some family-plan premiums would exceed $44,000 a year. CIGNA gave the enrollees less than three months to pay the new premiums or go elsewhere.

On why they cancel them -- because they are profit-driven and not health-care driven:

The Energy and Commerce Committee’s investigation into three insurers found that they canceled the coverage of roughly 20,000 people in a five-year period, allowing the companies to avoid paying $300 million in claims.

A study conducted last year by PricewaterhouseCoopers revealed just how successful the insurers’ expense management and purging actions have been over the last decade in meeting Wall Street’s expectations. The accounting firm found that the collective medical-loss ratios of the seven largest for-profit insurers fell from an average of 85.3 percent in 1998 to 81.6 percent in 2008.That translates into a difference of several billion dollars in favor of insurance company shareholders and executives and at the expense of health care providers and their patients.

On why they hide access to their balance sheets:

Unless required by state law, insurers often refuse to tell customers how much of their premiums are actually being paid out in claims. A Houston employer could not get that information until the Texas legislature passed a law a few years ago requiring insurers to disclose it. That Houston employer discovered that its insurer was demanding a 22 percent rate increase in 2006 even though it had paid out only 9 percent of the employer’s premium dollars for care the year before. It’s little wonder that insurers try to hide information like that from its customers.

As this information shows, the current system is unfair, unreliable, corrupt, and geared to deny coverage in order to survive. It's not worthy of the American people.

Wow.

trex, who apparently is not a physician has an excellent and wide-ranging command of the facts here. Mike K, not so much, even though it's his own field. How humiliating for him.

"Uh, uh, uh, I didn't think we were going to agree on everything" is the best he can come up with when his ignorance is stripped bare?

The key, to me, is to allow the patient free access to all sorts of alternatives, including private insurance not connected with a government "coop" with mandated benefits. The French do that, HR 3200 doesn't.

That's fine. I like that as well. But you're abandoning the good in favor of the perfect. This bill will help cover millions who don't have insurance. It will prevent people from being dropped from or refused coverage for preexisting conditions. That is a much better situation than we have now. Tweaks can and should be added in the future.

And the alternative? There is none. Because Republicans are refusing to support any kind of reform at all. I'm sure a rapprochement could be reached on some of these issues if the Republicans would negotiate in good faith. But they won't. Today Dan Barton vowed to repeal anything that might pass in the future.

So when you go to Saddleback you need to tell those Orange County Republicans to support health care reform and pressure their elected officials to do so, 'cause otherwise ain't no way it's ever gonna happen. In the meantime, get on your blog and really give them hell.

Mike,

"Outside the coops, private insurance will be banned."

That's silly.

You're getting hung-up on the Healthcare Exchange. It only functions as the current one that the Congress utilizes. They make sure all the companies offering coverage are not fly-by-night operations and meet the capitalization requirements, make sure all the plans offered meet the basic requirements, and then list them in a comparative manner so the buyer can choose.

Any private-sector company that meets the minimum requirements can be listed in the exchange.

The ONLY private-sector plans that will be "banned" (after the phase-out) are those old expiring plans that do not contain all of the consumer protections and were already superseded by a newer version of the same plan.

"That is the same policy that Hillary had in her program."

Wasn't in that plan either, not to mention they proposed Managed-Competition.

Joe, you and I disagree on the desirability of the government setting all the rules. Hillary's plan would have banned medical care outside her organizations. Canada banned private practice and balance billing. That was a terrible mistake. The NHS allowed private care in NHS hospitals until, under the second Labour government in the early 70s, the unions refused to care for these patients saying they were "jumping the queue." The specialists moved to Belgium and a Labour health minister was caught going to Belgium for a hysterectomy. When Thatcher took over, private care was again allowed. By 1983, one third of the resident of southeast England had private health insurance. Southeast England is the only part of the UK with a positive GDP.

I just don't want to see them make the same mistake here. You may say that government controlled "health insurance" will be the same as private health insurance. I don't agree. That's all.

Mike,

"Hillary's plan would have banned medical care outside her organizations."

Flat out wrong.

What the outside medical providers could not do is double-dip. They couldn't put in for reimbursement from the insurance company or government at the prevailing rate, and then turn around and balance-bill the patient. If they wanted to charge more than the prevailing rate, they would have to get it all from the patient, all in the private-sector.

"You may say that government controlled 'health insurance' will be the same as private health insurance. I don't agree."

The answer is simple: DON'T BUY IT. Buy the private-sector plans. It's all about CHOICE.

However, I don't get the resistance. The Public Option would be required to operate on premiums only, no taxpayer monies, and would also operate under the same rules as the private-sector plans.

Of course, as examples, the administrative overhead in Medicare is less than 2%, whereas the administrative overhead in for-profit private-sector health insurance corporations is 30% or higher.

Joe, you and I disagree on the desirability of the government setting all the rules.

That is what governments are for, to legislate and regulate. Private sectors do not create rules for themselves.

The examples of what happened in Britain and Canada are utterly irrelevant. They had completely socialized health systems. No one is proposing that here. I'm afraid I have to ask: are you quite insane?

I don't agree. That's all.

That isn't all. It's not that you don't agree, it's that you lack a fundamental understanding of the proposals at hand, you are confusing basic concepts like government setting minimum performance standards for private health providers with systems in which private insurers didn't even exist, and you're even confused in general about the dynamics of reform and stumped that government must play a role -- which it does in every system in the world!

It's sad to say, Mike, but you've really revealed your ignorance of this issue in this thread. I invited your opinion because I thought we might find agreement on this one issue. Instead I find you confused about the most basic concepts and facts.

Just as a sad postscript to your disjointed ramblings here, southeast England is not "the only part of the UK with a positive GDP." In fact, the GDP per capita there is not as high as it is in London, and although the area does well it has nothing to do with private health insurance and everything to do with infrastructure.

Health care in SE England is still a public health system with the ability to buy additional private insurance, something even more socialistic than the plan you're opposing -- and yet ironically it is one of the components through which the British have achieved a higher standard of living than the U.S. for the first time since the 19th century.

You have it so backwards it's not even funny. In point of fact, it's depressing. If you're the best that conservatives have to offer than they have nothing at all but screaming and distractions. You better hope that someone with even a rudimentary knowledge of the issues doesn't show up at your talk or you're going to be toast.

This site rocks!

Cool site, love the info.

Great site...keep up the good work.