Because we can't regulate any companies. Oh no. That's why our industrial food production is exactly like Upton Sinclair said it was (not saying its good, but its a far sight better than "The Jungle").

No, what I am saying is this:

You (with your PPO) and a medicare patient come in for a MRI. Medicare sets a cap on how much that doctor/hospital can charge for the MRI. So, to offset that cost, the hospital charges your private PPO (and potentially you) more to makeup the cost difference on the medicare patient.

Another big issue is the payment process by the government on these poverty plans. They have been notoriously late/under pay causing many doctors not to accept them. It's better to just setup guidelines for private insurance and have regulations for people who take the stipend for coverage.

insurance companies are fucking scum. insurance is a massive fucking racket.

when i was looking for jobs i had very little i said i wouldn't do, but one thing i said was that i'd never work for an insurance company.

I'm sure the insurance companies have their hands in the new bill as well. That might explain why the public option is so relatively small and restrictive.

A public option will kill most of the private companies. They can't compete with a public option because money costs less for the government (ie, they don't need a business loan, the government just prints more money), the government can underbid without consequence (no profit) and a public system will eventually lead to a government monopoly - not more competition. And, at that point, all we have is a government option and all its warts (as seen in Canada and the UK).

very moderate first step towards the ultimate nirvana which would be single-payer

The same thing happens with insurance companies.

Insurance companies dictate to the doctor what they will pay for treatment. Those who don't have insurance have to pay much more to cover that cost. Find out one day what the insurance company actually paid for your treatment as opposed to what they billed you.

I'm also pretty sure part of the reform for Medicare was a system for faster payments to doctors. Another thing you want in this bill that you oppose.

I thought that until I saw how few people the public option is apparently going to cover. If a middle class person loses their job, or if their employer drops health care, they'll have to pay out of pocket for a private company - they can't get the public option. (I think, my understanding of this changes every day).

You mean like set levels for how much of premiums go to medical claims, LIKE IN THIS BILL?

I realize that you really just want a single payer system, but considering that it has a 0% chance of passing, you just need to get over that.

I'd rather have private competition with a strong public regulatory layer over a one-size-fits-all single payer government controlled medical system.

Basically, more Switzerland, less UK.

I'm amused that we're going all the way back to The Jungle, which is somehow supposed to trump the very recent examples of intense corruption in the private sector.

good...because for-profit insurance companies in the healthcare space have no fucking business being in business.

are you really comfortable with your healthcare being at the whim of Wall Street and subject to corporate profits? the insurance companies now are trying to get the reimbursement rate changed to a 35% floor - so you'd be paying 35% of your own healthcare costs out of your own pocket!!

wouldn't you much rather have a not-for-profit entity overseeing it that didn't have an economic motive to minimize the amount of money spent on your care?

honestly, not trying to belittle anybody, but i don't understand how, when looking at it that way, anyone could ever pick the "for profit" option. there's absolutely no benefit to it.

You can't just buy the public option out of the blue. You have to qualify and it's a small percent of the public that do. For the most part it's just people who can't get insurance right now so you aren't stealing any business away.

Mostly because they'd rather not the government control 100% of health care. Considering there are already very successful private/public partnerships in the would out there.

You realize what the term "more Switzerland" means, yes?

Looking at it that way, sure. But you're just taking the best aspects of government and the worst of private. There's also the worst of government and the best of private. Maybe government wins out with healthcare, it's possible, but it's the complete invalidation of any drawbacks or risks that make me wonder if there's too much idealism here and not enough reality.

yeah. we'll never get good regulation like that to limit profits because too many lobbyists and senators are bought and paid for by insurance companies. so single-payer or an "anybody opt-in" public option (eventually) is the only possible solution that we'll see

But if that's the case, why not just outsource it to the current private companies we have? Less bureaucracy needed in Washington and you give the government the ability to "fire" companies if they don't meet cost/quality restrictions. Less initial capital is needed and you are putting people in a currently existing system. Why go through all the effort/cost of setting up a government system if the goal is just to cover a sliver of the current population?

It's cheaper just to set requirements and outsource it.

i don't think i'm taking the best of one and worst of the other.

i think i'm making a broad statement about each of their respective motives for providing health insurance.

because you'll never get the regulations due to all the congresspeople being bought-off

Assuming we have a federal budget, there's no difference in motives. Both want to provide the most coverage options possible by staying within budget. The difference is that the government can change the rules as we go to fit its paradigm whereas individual private companies have to meet a certain set of regulations/quality/cost or they lose patients.

Still a very idealistic view of government. On the individual level, they're just looking to advance their careers, just like those in the private sector. Corporations are tainted by profit-seeking, government is tainted by politics. Neither are looking out for your best interest.

You sound like someone who wouldn't trust the government....

And, as someone who works for the federal government, I think we do a Hell of a better job regulating abuses than we do in running things.

LOL! Priceless :D.

Though one of their gigantic failures is regulating medicaid fraud. Seriously, if you commit medicaid fraud for less than say $50k, nobody will bat an eye.

Btw, one thing. I know there have been some on the left who yell, "Why can't we be on your plan" to Congressmen and the like... y'all do know that the federal plan is through insurance providers right?

The Federal Employees Health Benefits Plan is basically like any other employer. The US Government negotiates with insurance companies for a number of different health plans and then offers them up to government employers for them to pick the one that works for them.

So for those who believe the federal government has a self-funded plan. That isn't the case. Even the federal government realizes it is better to be an insurance broker and provide individual workers with a choice than a one-size-fits-all.

pretty much what Steve said here.

Will Obama's plan address that? I don't see the public option as true competition anymore, since it's apparently uber-restricted.

Currently, private insurance subsidizes many of the Medicare costs and Medicare is massively over budget. The only reason it is currently running is because it has unlimited funding and government resources.

If it were a private company in its current state, it would be filing for bankruptcy. So, you can throw around 5% vs 20% or any numbers cherry picked, but that's the cold reality. Medicare spending has grown from $250 billion in 2002 to $440 billion in 2007 without significantly increasing the number of people covered. If a private company had a 75% increase in costs over 5-6 years without significantly increasing the revenue coming in, it would be out of business. Right now, Medicare amounts to 16% of our entire federal budget and you act like it's some kind of roaring success.

When you can print money, you can cover up all kinds of cost issues. I just don't want to see Medicare (covers 43 million people) on a 300 million person scale. That has a chance to setup a debt we will never be able to pay off and kill our economy.

Based on 40 quarters of "premiums". I'm betting if private insurance had that much built up cash that they were mandated to spend on care, they'd have much higher approval ratings too, I'd bet.

Of course, even then Medicare is in danger of running out of money (being, like Social Security, the beneficiaries getting paid for by the future beneficiaries). It's a retirement health plan based by current working Americans. As much a ponzi scheme as Society Security. You think a single payer or public health plan is going to have that much cash?!!

Exactly. At some point we may want to realize that we have a massive debt and need to do something about. Health care is something important and needs to be done, but not at the expense at leaving us permanently in massive debt up to our eyeballs.

I don't understand that part very well, but I like what I've read about it. (though still can't figure out how much of an "option" the public option is - how many people are allowed to buy in, and how much will it cost). Facilitating choice is an easy reform with zero drawback or risk.

I've heard all these people say the "public option" will keep "insurance companies honest" on price and coverage (with limitless resources and not caring about debt, I guess you can cover everything and keep the price low, but I digress)... if its SOOO restricted as I've heard here, how is it going to keep anything honest as the spin is?

It is quite assuredly a Ponzi scheme. It's the definition of one. Current beneficiaries get paid by those who are promised benefits in the future. Not saying that's a bad thing, but its a Ponzi scheme.


And I'd rather not have the government become the sole health provider and try to institute a one-size-fits-all policy, but have various heavily regulated insurance companies provide choice to individuals.

That's because medicare sets cost. What you're basically saying is that their costs haven't gone up much, but their spending has increased from $250 billion to $440 billion in 5 years. You really think this is a good thing and model for a public health care system?

If you extrapolate spending on medicare to 300 million people, you get a cost of roughly $3 trillion. That's equal to our entire federal budget for 2009.

Government doesn't have to worry about making profits and impressing shareholders. You're better off hiring some gurus who ran health insurance companies and have them run the government plan but in a non-profit setting.

Private companies don't really lose patients. They are virtual monopolies in most regions. Tough to lose a customer when you're the only game in town. Especially if that insurance is tied into the company you work for.

You don't seem to understand that insurance companies do the same thing. They all have deals with the hospitals where they have set the price they will pay for procedures. Next time you're in the hospital, find out what you were billed and what your insurance company actually paid from that bill. It's astounding.

You mean the Healthy Americans Act, by Wyden (D-OR) and Bennett (R-UT). I actually prefer this bill. Very much so. For one it is revenue neutral as the CBO has evaluated it.

Also, it has no public option ;).

LOL - so this "Lewin Group" that is providing all the facts and figures to anti healthcare reform Republicans - is a subsidiary of a wholly-owned subsidiary of United Health (2nd largest healthcare corporation in the country).

No bias there though, right?

That cost number is very misleading. In that time they added prescription drug coverage. It didn't go up that much just due to inflated costs.

Watch out you Canuck bastards, David Vitter is out to destroy you.

That market share report is interesting. It has meant everything in the states I've lived in in recent years, #4 and #6 on that list. Prices have gone through the roof and up every year because there's essentially one supplier in the state. It's horrendous.

He's not out to destroy them, he's out to stop us for having to subsidize the pharmaceutical industry.

All that shows is people don't want to lose what they have and they fear the government is trying to take it.

Funny...I was thinking the exact opposite thing...how I've lived in # 33, 41, & 42 (mostly #42) over the past 15+ years of adulthood.

For those that disagree with allowing for inter-state competition between insurance companies...what is the feared scenario(s) of this? And is that not correctable via new regulations?

Good article clarifying that Obama's claim that you can keep your current insurance if you want to do so isn't as accurate as he'd lead you to believe...........

Keep Your Insurance? Not Everyone. | FactCheck.org

I don't have much fear that businesses will start shedding their insurance plans, especially with all the restrictions on the public option. Why don't businesses shed health plans now when they don't face a fine?

I understand that concern but similar to the way mant (most?) companies are incorporated in Delaware...why can't states also insist that insurance companies offering policies in their state must also adhere to their own regulations? Or if that isn't plausible enough (or loopholes still exist), why not federally mandate this?

I definitely see the issue with lack of competition but also don't see why we can't try this step first.

It's a cultural requirement and it's needed to be competitive. If you are faced with having no insurance at job X or making less money in a worse environment with insurance in job Y, 90% of people will choose job Y.

If there is a public option companies can use for cover culturally/politically and save money by dropping care, many will look at that. A lot of companies would love to drop coverage right now but it's not a realistic option given the stigma attached to not having it.

A good point in MBBF's linked article is the fear that some current plans won't be "good enough" and it will cost even more to meet new government regulations. Depending on the scope of these requirements, some companies may just punt on providing health care as getting a short-lived penalty for not providing coverage is better than providing coverage and realizing you don't cover a certain thing and getting a fine/penalty for that.

But in theory...doesn't the public option need more businesses to actually be able to drive down costs? Otherwise...what leverage does a public option have to set rates and mitigate inflationary costs if it doesn't have a competitively large base of clients?

I think that must be a part of any state-to-state option. Still, I really see no downside to this and it won't cost much. This again comes down to why aren't we doing some very simple/cheap things to impact cost (opening state-to-state competition, looking into medical malpractice reform, improve health information technology and care-provider infrastructure). All these things are fairly simple to institute and will cost a fraction of any of these plans in congress. Plus, they would almost certainly amount to more cost savings than the $800 billion monster being bantered about.

But the current public option restrictions will exclude many workers if they are dropped from their coverage, so those cultural requirements will still be in place.

I'd be fine opening up restrictions if there was also a trigger for a public option if cost increases aren't being effected.

The minimum standards for employer health insurance are necessary, because without it, employers would be able to avoid the fine for dropping coverage, by switching to cheap plans with insanely high deductibles that would result in basically no health care coverage at all.

I am so glad I waited until now to vote.

Bad - sold us out


Where is our president when a convicted terrorist leader personally responsible for the death of hundreds if not thousands is allowed to go free!

I guess that big yellow streak running down his back is not paint. Grow a set Mr. President!!

I am kind of ashamed of my country right now.

I must have missed something, or am being stupid. Which convicted terrorist leader did Obama allow to go free?

I'm assuming he thinks Obama is responsible for releasing the Lockerbie bomber?

Most people with a decent job would not qualify for the public option anyway. This idea that the public option would steal people away from the private option is just silly since the requirements are so high to qualify. The public option is really setup for those who can't get or can't afford insurance, something that isn't stealing precious customers away from the private health care monopoly.

That is correct. We should have taken him at the airport. He should never have been allowed to fly home to a hero's welcome.

Very sad day for America.

That's what I figured, but I wanted to cover my bases.

NewIdentity, your take on the situation is reasonable and factual.

I think you mean Senators Olympia Snowe and Susan Collins, both R-ME.

I agree. In fact, I'm willing to predict that getting a bill to pass the Senate will more-or-less require getting Olympia Snowe to agree to it. Go Maine!


West Germany springs to mind.

At Glasgow airport? We should commit an act of war against one of our allies? Or perhaps at Tripoli, so we could get into another skirmish with a Middle Eastern country?

NewIdentity = missed the boat

i wonder if newidentity thinks he was being held in an American prison under American law?

Don't our laws supersede that of the rest of the world? That was the impression I got ;-)

Yay me!

While it's absolutely retarded to blame Obama, why were we not able to extradite him to the United States to stand trial?

i'm sure the decision was made way back then to let scotland do it...probably some version of "international double jeopardy" or something applies now...

I have strong doubts that we could've gotten a conviction or that it would have held up on appeal.

When it comes to terrorism against U.S. citizens, they certainly should.

Kind of an interesting news coverage observation

The stop story on FoxNews.com:

Report: Obama to Increase 10-Year Deficit Estimate $9 Trillion - Political News - FOXNews.com

So he was about 2 trillion off the last projection.

Meanwhile, neither CNN.com, nytimes.com, nor MSNBC.com have this anywhere on their front page.

So is FoxNews too conservative for telling us this, or are CNN.com, nytimes.com, and MSNBC.com too liberal for not telling us?

It was a leak to Fox o a report to be issued next week. When the report's issued then you can wonder if there's media bias.

The AP has it too:

AP sources: $2 trillion higher deficit projected

And I initially read it on Boston.com (where it's the headline story). Boston.com doesn't credit FoxNews, but says, "senior administration official told Reuters Friday..."

Either way I think the real story is the report, not leaks about the report. I'd prefer if news organizations didn't run so many single anonymous source stories regardless of what they're about.

On a side note, do these projections assume the Bush tax cuts expire or are renewed? I can't find that info in any story.

Fair enough, it will be interesting to see how it's covered next week.

It's interesting to see it has the lead story on Boston.com (the Boston Globe's website- not exactly a bastion of conservative journalism), but isn't mentioned on the mainstream news sites. It could very well represent signficant differences of opinions about single-source news.

IT'S ALL LIBERAL MEDIA BIAS. EVERYONE EXCEPT FAIR AND BALANCED FOX NEWS CHANNEL!!!!!!!!!11

And Boston.com, Rueters, and the AP apparently.

Isn't it funny how (in general) liberals can't acknowledge liberal bias, and conservatives can't acknolwedge conservative bias?

Am I the only one that can see that both FoxNews and MSNBC have pretty notable bias?

nope! I can't speak for anyone else on the left(I like to say center but its pretty obvious when I do lean its clearly left), but its a bit difficult wading through this mess to actually get to the point of posting :)

There are definitely some things that fox seems notorious for doing that seem of a lower standard(Mark Sanford-D-South Carolina... Larry Craig-D-Idaho happens just a little too often to be an accident... does that happen with frequency with CNN/MSNBC? If so then I take it back), but on most claims of bias it seems impossible to make a claim without being blatantly hypocritical. I can't really turn on any of the 3 major news networks for more than 10 minutes without becoming seethingly angry or dying a little inside at what I see at this point. Honestly CNN annoys me the most by now... if I want to see what some random asshole on twitter has to say, I'll turn off my TV and load up twitter. I don't want to turn on CNN to see some pseudo-journalist-newsman randomly reading comments from twitter and facebook.

Errm, anyway, end rant :)


As far as the story itself, assuming its accurate, it still does point out its a long term projection and extremely volatile based on short term results. There will be more than enough data over the next 4 years to figure out how we're doing fiscally, so this isn't at the top of my list of concerns, but its a concern. At this point, with a dem controlled house, senate, and executive branch, all this stonewall up in the air bullshit is pissing me off. DO SOMETHING.

If reducing the deficit is a top priority and god knows everyone everywhere said it was during their campaigns on all sides, then do something about it. Make some tough choices somewhere... anywhere. The easiest thing any politician can do at this point to lose my vote is to just have nothing happen between now and the next election. You assholes have a majority everywhere, its going to look pretty shaky when you try to blame the other side of the aisle if all these grand plans for healthcare reform, alternative energy/lesser dependence on oil, and fiscal responsibility all go nowhere.

End that rant too I suppose

I never really saw a massive liberal media bias. I mean they do have their favorites and punching bag, but it generally seems to be about public perception and momentum. I don't think any of the major networks are anywhere near as liberal as Fox is conservative. If you've ever seen those Fox News memos from years ago, it was essentially the GOP talking points being passed down to their reporters.

There is a definite bias in both networks...with CNN committed to giving a voice to those who should never speak.

I like to consider myself a centrist for the most part...but am probably right of center. I am probably 50/50 on social issues(maybe even 60L/40R), mostly right on fiscal policy and role of government, and probably right of center on foreign policy (though I believe in cohesive foreign policy more than any philosophy).

I also find Fox News to be blatantly right leaning. I can't watch the morning show or Hannity, but will watch the occassional Beck and O'Reilly. I recognize when they make blatantly silly right wing accussations...but can stomach these because the rest of the show is typically ok.

I also watch MSNBC for the morning shows (Scarborough is good in my book), but cannot stomach Olberman or Madow at night.

Unfortunately...this is pretty much all we have to choose from.

I agree with this in general...though I think the "liberal bias" is more of a historical thing before cable news became what it is today.

9 trillion.......wonder when our money turns into wallpaper?

I think this is pretty much it.

Just sayin'.

I think we all agree that nobody can make an opinionated article or report without some degree of bias. If you agree with the slant, it's very difficult to see, if you don't agree, it's more obvious.

So when you look for bias, it's easier to see which networks, newspapers, magazines, news organizations are biased *against* you than for you. But I can assure you, that once you have identified those that are leaning away from your point of view...the rest more than likely lean with you.

This is definitely not going to help the health care push by the Democrats or the cries of 'fear mongering'. They're in the process of reinstating a guide to veterans that 'assists' them with end of life decisions. Some senators are calling for a review. It's an interesting read to say the least. Here's the "guide".........

http://www1.va.gov/pugetsound/docs/ylyc.pdf

Ah good, we're back to the outrage of the day. Here's a look at Jim Towey's op-ed in the WSJ that stated this round of manufactured outrage.

I'm just going to comment on the guide itself (mainly with respect to its very existence).

This is already the standard of care in the United States. It may not have been routinely taught in U.S. medical schools years ago, but end-of-life issues (i.e., advance directives, etc.) are now part of the curriculum which ensures that physicians are competent when it comes to being able to address these topics with their patients.

One of the most frustrating things, personally, has been seeing someone who is incapacitated in the ICU (already having coded once or multiple times, on multiple pressors, on a ventilator, with diagnostic evidence of severe quality-of-life-altering brain damage)...who does not have an advance directive of any kind, and has a room full of family members who are ripping each other to shreds over conflicting ideas about what their loved one "would have wanted."

Unless we go out of this world in a quick and unexpected way, most of us will one day reach that point. For those of us who are clear on our wishes (and who have family and friends who understand those wishes), that's great. Many of us don't want to think about that sort of thing. It's human nature. Maybe it should be though.

I bring up the end-of-life discussion with all of my patients the first time I do a "routine physical" with them. I don't promote any personal biases when I do so. No health care provider should, although I'm sure there are plenty who do. Reading that VA guide, I think the only message conveyed is that the discussion is one that needs to take place.

Then I'll tip my hat to you.


I can most definitely vouch for that. I've lost count of how many doctors we've encountered over the past decade who had a very clear & highly inappropriate agenda in those conversations.

Huh? What's your problem with this? You don't think planning for end of life decisions is a good idea?

Having experienced that type of thing from the patient's family side of things, I make a conscious effort to never do that sort of thing myself.

I've signed off on a 90-year-old who wants a "full-court press" and I've signed off on a 30-year-old who wants no extraordinary measures taken...and I can say that I've done so with no reservations. That is the person's right, and nobody else has a better understanding of their circumstances than the person himself/herself.

When did "end of life decisions" become such a boogeyman word? You would think after the Terri Schiavo ordeal that you would want people to be more educated and prepared about end of life situations, no matter where you stand on that issue.

I'm lost on what you're outraged about with this document. It seems like a resource full of options and questions that people can ask when dealing with themselves or someone they love who has to make serious decisions.

If anything, it seems like a preparation guide so that you don't get stuck in a situation where doctors are doing something against your wishes. If you had strong religious beliefs on how you want to be treated at the end of life, I think this would be beneficial.

What is it in this document that you don't like or did Michelle Malkin not cover that yet?

It is more of a religious issue. Many in that movement want to dictate how others have to live their life.

It's not that at all. It's the fear of the government being involved in those decisions and influencing those decisions based upon a cost-benefit analysis. The facts are that financially, people over the age of 65 become more a of a drain on society than they offer. People fear a government that can direct people to certain decisions because of such an analysis.

It's probably so meddling religious right people don't try and legislate medical decisions either (see: Schiavo, Terry). There is much benefit to end of life counseling (even for people my age, i.e. living wills) for all.

As long as it remains neutral counseling, I agree completely.

Why does this end of life stuff have to be in a health care bill? If it is just normal discussions that happen during routine care, then doctors will do it like they have been right? Why do you have to legislate that the conversation has to happen at the following x intervals?

They aren't legislating when it happens, but if and how often a provider can be paid for it. This had broad bipartisan support until the past few weeks when some on the right figured out they could get a lot of people riled up by lying about death panels.