Patterico's Pontifications

7/28/2009

Obamacare would already be law, if not for you stupid Americans

Filed under: General — Karl @ 9:51 am



[Posted by Karl]

Public support for a government takeover of the US healthcare system continues to decline. The House Democratic leadership is looking for someone to blame, aside from themselves. The establishment media seems to be picking a scapegoat — us (and them):

While viewers may seize upon numbers that indicate the size and scope of reforming health care — 47 million uninsured Americans or costs in the trillion-dollar range — most eyes glaze over when terms like “public option” or “bundled payments” get tossed around on the air.

“It’s not only not a cable TV-friendly story; it’s not a journalism-friendly story,” said John Harwood, chief Washington correspondent for CNBC.

Harwood, also a political writer for The New York Times, explained that reporters need to first understand the intricacies and nuances of health care policy before they can then try getting the story across to viewers and readers. Last week, Harwood said, he was “trying to get [his] head around the issue of cost control” before penning a Times column.

“It’s incredibly complex to try and explain to people,” Harwood said.

“The problem with health care is that it’s so big and so complicated that the public is never really going to understand all the moving parts of this,” NPR health policy correspondent Julie Rovner said on air Wednesday.

“So the public is really always going to be sort of amenable, if you will, to demagoguery and arguments one way or the other that don’t necessarily link to what the substance is,” Rovner continued. “We saw this during the Clinton efforts.”

It would be easy to dismiss this attitude as the rank partisan bias of the lapdog press. But perhaps we should take Rovner’s “one way or another” seriously. After all, if Obamacare was smoothly sailing through Congress, folks on the Right might well be griping that the public does not understand a public plan will hide its administrative costs in the federal budget, or that preventive care generally does not save money, and that people are being swayed by the sad stories in the letters Pres. Obama allegedly reads every day (and that CNN’s John King is busy covering for the fair and balanced CNN).

The question remains: Why aren’t Americans being swayed by the demagoguery of the Left?

The answer may be that even those Americans not steeped in the arcana of healthcare policy know enough to spot obvious chicanery. When House Speaker Nancy Pelosi says that healthcare reform means a cap on your costs, but no cap on your benefits, most Americans can smell the horse manure. Most Americans know their government well enough to know it is not in the fishes and loaves business.

Accordingly when they hear that the nonpartisan Congressional Budget Office scores the House bill as a fiscal disaster, they tend to believe it. Indeed, even establishment outlets like the Washington Post and Newsweek now run op-eds essentially accusing Pres. Obama of misleading people on this basic point. As Pres. Obama, following the preponderance of the polling, has sold a government takeover as a way to cut healthcare costs, which now bothers Lefty bloggers like Ezra Klein:

Ask yourself what the administration’s one-line goal is on health-care reform. Is it “equal treatment for everybody?” Is it “if every American is guaranteed a lawyer, why not a doctor?” Is it even “guaranteed health care for everyone?”

No. It’s “bend the curve.” And the problem with “bending the curve” is that it’s a broadly testable proposition. This is, in part, why the Congressional Budget Office’s skeptical assessments pose such a threat to health-care reform. If the White House’s primary objective was health care for every American, or guaranteed care that you could keep even if you lost your job, or choice of insurance plans for every American, you could spend a bit more on health care and say you were achieving your goal. But if you say that the point of health-care reform is to save money, and then the outfit charged with estimating such things says it won’t, that strikes at the heart of the project.

Mary Katharine Ham succinctly calls it an “entire justification FAIL.”

That realization is the first step of the “internal Q&A” described by Peggy Noonan:

Will whatever health care bill is produced by Congress increase the deficit? “Of course.” Will it mean tax increases? “Of course.” Will it mean new fees or fines? “Probably.” Can I afford it right now? “No, I’m already getting clobbered.” Will it make the marketplace freer and better? “Probably not.” Is our health care system in crisis? “Yeah, it has been for years.” Is it the most pressing crisis right now? “No, the economy is.” Will a health-care bill improve the economy? “I doubt it.”

Rasmussen’s polling of likely voters tends to prove Noonan accurate on virttually every point.

Most Americans may not be policy wonks. But most Americans do understand that if you greatly increase the number of people with insurance, demand and price will usually increase. And most Americans understand that artificial price controls tend to produce decreases in quality. In an environment where the overwhelming majority have health insurance and are generally satisfied with their care, these basic perceptions have been trumping the demagoguery of the Left.

–Karl

75 Responses to “Obamacare would already be law, if not for you stupid Americans”

  1. Katrina!

    NPR more than did its part the past eight years to undermine people’s faith in government. Reapings and sowings.

    happyfeet (71f55e)

  2. What do “most Americans” do when they get an email appeal from a poor Nigerian widow who has millions of dollars she can’t get to without your help? Most Americans seem to be able to figure that out – and hundreds of other scams that arrive every day.

    Congress needs a delete button.

    Gesundheit (47b0b8)

  3. Keep in mind that there are Americans who would benefit from a health care reform no matter how bad it was:

    * Those who pay little or no taxes
    * Those with serious medical problems (and no current hope of paying for them)
    * Lawyers, bureaucrats, public sector unions, politicians (more graft for them)

    Add to that the people who aren’t paying attention, the people who will go along with the cool people (it’s hip to be a leftist), and the people who put party over country, and you might just have a majority. You certainly have a power base.

    God help us.

    JayC (203941)

  4. Beyond this, my question is:
    When does the American people’s intrinsic understanding of BS translate into electoral difficulties for corruptocrats?

    Apogee (e2dc9b)

  5. Would you like me to tell you how to reform health care ? Here are a few simple steps. One, set up a government sponsored but not government controlled entity like Fannie Mae into which health insurance premiums are paid. Two, set up a universal, national fee schedule negotiated with the major medical associations, like the AMA, the ACP, the ACC, the ACS. All the major specialties. The fee schedule will pay about 80% of the charges, for doctors or hospitals etc. The balance will be the responsibility of the patient but he can buy private insurance to cover it, sort of like MediGap with Medicare.

    Set up a two tier participation. Some doctors, say 50%, will accept the fee schedule as payment in full. The rest reserve the right to bill more than the fee schedule allows but that is a private matter and patients who choose more expensive specialists must pay the difference. They call that the “Market” and that is the biggest stumbling block to a Democrat reform.

    How do you get doctors to accept the fee schedule ? One way would be to say that those who do so will have their student loans forgiven year by year. For older doctors, the same amount would be deposited into a pension account. Eventually, the government might consider how to deal with medical school tuition.

    Freedom of choice would be allowed except that choice might cost more. If you like Kaiser style HMOs and many people do, you have the option to join and pay the premium out of your fund.

    For the very poor, the 20% deductible would be paid by government welfare funds. For catastrophic diagnoses like cancer and diabetes, the health plan would assume all costs for that diagnosis for the rest of your life. You would have to pay the same for unrelated health issues.

    The health Fannie Mae would be governed by a board of trustees made up of patients, providers and employers since many contributions would come from employer health plans deductions. It would not be a federal program like Medicare run by a federal bureaucracy.

    Hospitals and doctors would be free to participate and private hospitals would be paid the same as public. If I wanted a more expensive insurance plan to pay for more care than the health Fannie Mae plan paid, I could pay more. Some people will do so.

    Decisions about the indigent and those who choose to go uninsured would be worked out piecemeal. All doctors and hospitals would publish their charges in the waiting room or admitting department and they would be available on the internet. Pharmacies would provide drugs with the cost paid partly by the health plan and partly by the patient. For generics, the co-pay might be 10% or $10. For expensive patented drugs, the payment from the plan would be the same as the generic less co-pay but private insurance could pay more. The rest is up to you.

    The key would be freedom of choice and market mechanisms to keep costs down. There would be a national basic plan (or set of plans) that paid a basic fee schedule. Costs could be budgeted. Patients who chose to pay more could do so.

    Could something like this work ?

    It’s worked pretty well in France for 64 years. They have the best health care in the world and it costs about one-third less than ours.

    Mike K (2cf494)

  6. JayC – One possible exception to your group would be Those with serious medical problems, as they will pay the ultimate price much faster than the rest of us.

    They may be giving the healthcare debate greater attention than you think.

    Apogee (e2dc9b)

  7. So let me get this straight, we are going to ruin a system that mostly works, kill the golden goose of R&D that makes US drugs and health care the envy of the world (really that is true) for one that will probably work less well, so we can insure illegal aliens and others unwilling to buy their own insurance (who are getting medical care now anyway).

    Why not just focus on getting illegals and uninsured on some sort of program (or verifying they can self insure and are not deadbeating hospitals and ERs) and penalize them if they don’t? Such a plan would be almost certainly have to be subsidized, but the penalties/costs could be made non discharable in bankruptcy and could be assessed via payroll deductions. And if illegals leave over it, well goodbye.

    That would costs a fraction of reforming the entire system.

    Joe (a32cff)

  8. You know, if you think about it, Democrats have good reason to think Americans are stupid. After all, they control both Houses of Congress and the Presidency.

    Ag80 (99168f)

  9. Mike’s version is of course too simple for the gov’t scaremongers and the MSM to countenance – why do they only point to Canada (!) as the probable example of what this “reform” will look like, rather than a country like France’s (or the Netherlands)? Because the former allows massive gov’t intervention into over 1/6 of our economy, while the other doesn’t even come close. The public intrinsically understands this dynamic, despite the caterwauling from the Left that insists otherwise.

    Dmac (e6d1c2)

  10. Nice to see Journalist who not a clue about economics accusing others of being stupid.

    This is why I routinely route for certain folks to simply “go away.”

    HeavenSent (01a566)

  11. #5, Mike — not to burst your bubble but what you describe already exists.

    People are excruciatingly ignorant on how this industry works. No surprise the volumes of stupid assumptions people make (like Barack) on this issue.

    1) All Poor People are covered today — Medicaid.
    2) All Uninsured get health care today — ER or Private MDs
    3) Most uninsured are so b/c THEY DON’T WANT TO PAY FOR HEALTH CARE, not because they can’t.
    4) All MDs have negotiated reimbursement which are driven by the Medicare Fee Schedule.
    5) All insurance plans have utilization review for MDs.

    It is like reinventing the car with two wheels and expensive weight transfer technology. What is the purpose? 4 wheelers are not too bad and pretty safe.

    HeavenSent (01a566)

  12. Dmac, what I posted is a bare outline but I think the Canadian program is popular because of language and proximity. I know that Elliot Fisher, at Dartmouth and who is quoted in comments about the Obama plan, has written papers with young researchers in Canada and they share many ideas.

    We have gone much farther down the path toward managed care, well beyond France which is still largely fee for service except in big cities. I pose the question because so many assume that the cost problem is fee for service. It is not. It is open ended reimbursement. The Democrats want to control cost without market mechanisms, like fixed plan payment. That requires a command economy but that’s where they are coming from anyway. Look at comments on left wing blogs (and I include David Frum’s more and more). I don’t think cost can be controlled without a market mechanism.

    MIke K (2cf494)

  13. What would be the side effects of laws making it a crime to charge too much for health care?

    Michael Ejercito (833607)

  14. heaven sent, only female and child poor are covered by Medicaid and most Medicaid money goes to long term care, not acute care.

    ER care is very wasteful. When I ran a trauma center, I convinced the hospital to encourage pediatricians to set up an after hours clinic. It got a lot of people out of the ER and gave better service. It was easier on the pediatricians once they figured out the “kids care” could serve as a call physician.

    Negotiated reimbursement determined by Medicare is the problem. The rates are falling and the system does not publish honest charges nor does it let doctors balance bill. If patients were paying their own bills (In France they pay first and get reimbursed later), there would be far less utilization review. When DRGs came in, hospitals instantly stopped marketing extra services to patients. Incentives matter.

    I actually negotiated capitation rates for surgeons with a very anti-surgery IPA about 15 years ago. It was interesting to see all the internal incentives the GPs had and to figure out how to capitate surgeons without screwing somebody. When we finished and had capitated surgery, back surgery dropped 40% with no effort to control utilization. It’s a long story and maybe I’ll do a blog post on it sometime. The surgery fees are now well below what they were then. We based capitation on average payout for surgery the previous year and updated by number of subscribers. The pot was divided by the number of consultations each surgeon saw, not procedures. Back surgery dropped but general surgery did not. Draw your own conclusions.

    I know all about UR as I do that now. Mostly for workers comp, which is a sea of waste and corruption. But also for HMOs. There are better ways to do it.

    MIke K (2cf494)

  15. It is important to know how the American health care system got to where it was.

    Remember that it was built on the foundation of wage and price controls that were first imposed in the 1930’s.

    (Socialized medicine in Europe started when the Allied military forces provided medical care to the survivors of World War II. Civilian bureaucracies then took over.)

    Michael Ejercito (833607)

  16. Is it the most pressing crisis right now? “No, the economy is.” Will a health-care bill improve the economy? “I doubt it.”

    Which is why this is such a stoopid issue for Obama to fail on. If there is a side issue that needs solving soon, and will help the economy in the long run, it is finding a long-term replacement for oil. But no, we got the useless cap-and-trade-and-rent-for-me bill, which was worse than doing nothing.

    I suspect any insurance reform bill that is passed will not only not be fairer, not insure anyone currently uninsured who deserves insuring, not be remotely transparent, understandable or workable, and not save money. And be worse than doing nothing.

    But it will be lauded as a success, like the last one. And when it fails, not of the blame will attach to Obama.

    *sigh*

    Kevin Murphy (0b2493)

  17. It’s not only not a cable TV-friendly story; it’s not a journalism-friendly story,” said John Harwood…”

    Translation: This is an unusually hard issue for us to carry Obama’s water on…

    No. It’s “bend the curve.” And the problem with “bending the curve” is that it’s a broadly testable proposition.

    Translation: We will be caught in lies by the public, moreso than usual, should we try to shamelessly laud Obama’s position on this issue with our usual gusto and suspension of skepticism…

    And, so it appears that the press is thinking exactly along the lines of Karl’s lede…

    Nice post, as usual…

    Bob (99fc1b)

  18. I think that’s very nicely said Mr. Bob.

    happyfeet (71f55e)

  19. #14

    Medicaid covers anyone not covered by Medicare who the US government defines as disabled regardless of age. This system is badly abused because the “disabled” also receive cash payments or as it is better described as “crazy” money. This is because of the large number of applicants who managed to scam the system by acting like Prof Gates.

    How anyone could expect the US government to control costs and provide efficient and effect service given its record on social security and medicare must have a unique grasp of economics and healthcare.

    So unique that I urge those of you that approve and support Obamacare to contact the Nigerian investors who have a unique healthcare opportunity for those of you with the necessary cash to invest.

    Thomas Jackson (8ffd46)

  20. Karl asked, “The question remains: Why aren’t Americans being swayed by the demagoguery of the Left?”

    It’s because Americans voted for Hope and Change, but got disillusionment and double talk instead.

    He says one thing and does another. Obama has failed to deliver what he promised during the campaign. Few Americans are willing to continue to follow a leader who has abused their trust and insulted their intelligence.

    Obama says his plan to expand health care won’t increase costs and won’t result in either rationing or a decline in quality. But, everyone with the brains of a crab apple knows that isn’t true, and that’s why the Democrats can’t sell another big lie.

    Ropelight (bb3af5)

  21. The comment thing is really frustrating. Safari shows 2 comments for the past hour. Firefox shows 9. I hope you get it fixed. The post shows 19 comments and the “most recent” shows the last comment but, when you click on comment, the most recent changes. It’s pretty weird.

    MIke K (2cf494)

  22. Most of Noonan’s questions are questions asked by policy wonks and not by normal voters. How many voters can define ‘free’ marketplace and how many actually care? Since when did normal folks start worrying about the deficit? Or objecting to Congress doing something because it wasn’t as important as something else (for example, no outpouring of criticism because Congress is pushing for an NCAA football playoff; certainly that can’t be as important as fixing the economy?).

    Obamacare is in trouble because most people feel they will lose under the plan. Right or wrong, informed or not, they believe it will be harder for them to see their doctor, that someone else is going to make it harder for their doctor to do what needs to be done and that the bill at the end of the day will be higher.

    And this holds a lesson for the GOP. When issues get personalized, voters tend to object as more get hurt than benefit. When the GOP fights with terms better suited for a Sunday talk show than a town meeting, the GOP loses. For example, name one issue that the GOP raised about Sotomayor that resonated among the public as a whole?

    And as an aside, I love to see politicians and their media acolytes bash as stupid the very people who were smart enough to vote for them in the first place. Per the joke, it is amazing to see how dumb the public got in just 9 months.

    steve sturm (369bc6)

  23. Good news ! All the comments show in Opera so maybe it is browser dependent. FWIW.

    Mike K (2cf494)

  24. Mike K,

    1. I think the comment problem is a function of Super-cache, which Pat uses b/c his server seems to have problems with heavy traffic.

    2. If you rely on France’s medical insurance alone, 25 percent of French doctors will refuse to treat you. Wouldn’t necessarily bother me, but you’ll never see the Left mention it — or accept it.

    Karl (fa7301)

  25. The Sotomayor issue that got traction is the race spoils system and then came the Gates story. Nobody talks about it because they don’t want to be called racists but it is there, nonetheless.

    People can figure out when they are being lied to. It may take a while, which is why Obama is in such a hurry, but they figure it out. His biggest mistake was the stimulus bill because that gave the show away.

    Thank God.

    Mike K (2cf494)

  26. I’m not sure I agree with the proposition that the “health care system is in crisis.”

    I would agree that it is too expensive and that some reform is warranted, however, what is the crisis?

    The alleged “50 million” uninsured? a) I don’t believe that figure. b) for the actual number of uninsured, once you take out

    – illegal immigrants,

    – young people who chose not to be insured by chosing jobs w/o insurance (bartending, waitressing, etc),

    – the homeless [these people used to be insured b/c most of them are mentally ill and they used to be institutionalized];

    – criminals / drug addicts,

    We are not left with that many people who have no coverage at all that need to be covered by the gov’t.

    I also don’t agree that healthcare is a “right”. Medicine and medical services are a product, just like food, housing, heat, etc. If health care is a “right” that gov’t must provide b/c it is essential to life then why is food not such a right? Why isn’t housing? Heat? Or any other material thing? (By the way, when did rights become something that gov’t gave you, rather than something the gov’t could not take away?)

    I think we fall into a socialist/liberal trap when we start from the assumption that gov’t is somehow responsible for ensuring that everyone gets medical treatment.

    Monkeytoe (e66874)

  27. you can defeat the evil supercache in any browser if you think about how … not sure how on a berry though

    happyfeet (71f55e)

  28. steve sturm,

    I know you’re committed to your “people don’t care about the deficit” talking point, but poll after poll shows people do care about the deficit. Indeed, Rasmussen, CNN and NBC/WSJ all show that people rank it higher than healthcare reform. And it’s the Tea Party people — for whom the deficit is the big issue — who are swamping the rallies organized by SEIU, MoveOn, etc.

    That being said, I do think support is eroding as more people figure out that they are likely losers under the bills currently under consideration. But the deficit plays even there, as it’s that math that tells everyone that their taxes are likely to go up.

    Karl (fa7301)

  29. It is like reinventing the car with two wheels and expensive weight transfer technology. What is the purpose? 4 wheelers are not too bad and pretty safe.

    I think Obamacare is actually worse than that. It’s like trying to reverse engineer a 2009 Gallardo using a 1910 Ford Model T, then running the engine using unicorn farts and rainbow mist.

    The Democrats health plans are the pinnacle of magical thinking in the political realm.

    KingShamus (4fabb2)

  30. Mike K,

    Medicaid covers ALL POOR. Medicaid via SCHIP pretty much covers all POOR and MIDDLE CLASS families.

    With respect to ER, frankly the problem is not people going to it …. it is the fact Gov.t allows Hospitals to bill very high rates in exchange for the “you must serve them giveaway.”

    System today provides GREAT CARE FOR THE POOR AND UNINSURED — at least in comparison to every other country on the planet.

    For Christ Sake, a Medicaid Patient gets transplants, free nursing home care, etc … fast … WTF do you get in Canada without waiting on line for months?

    HeavenSent (01a566)

  31. There is no health care crisis.

    There is an “ingratitude deficit” and “entitlement inflation” however.

    Drop the cell phones and cable — buy better health care insurance instead.

    HeavenSent (01a566)

  32. Karl: I think voter concerns about the deficit are akin to concerns over earmarks: bad as an abstract or if it is for others, ok if they’re for me or for causes I support. Concerns about the deficit don’t keep (most) Republicans from supporting tax cuts, nor Democrats from expanding welfare or hiring more government workers. Interesting that Obama also thought people were concerned about the deficit, as he has characterized much of his plan as necessary to stabilize the federal budget… only to find out they care less about that than they fear losing their doctor and having to pay more.

    And I know you’re committed to your Tea Parties, but I hope you don’t believe they’re representative of voters as a whole. Congress sure doesn’t. They’re noisy and certainly dedicated to their cause but without the numbers to sway a vote.

    steve sturm (369bc6)

  33. steve sturm,

    I think your characterization of people’s selective care about the deficit is partially correct. But I also think it has value to an essentially populist segment of the electorate as a symbol of governmental dysfunction, which makes the changing poll numbers mentioned a useful marker. In any event, in this context, the deficits are mentioned in the main post to illustrate why the the administration’s cost-cutting pitch simply does not sell.

    Similarly, I would not argue that Tea Partiers are representative of the electorate as a whole. But they are another indicator of that segment of the population I just mentioned — the sort who would have voted for Perot once upon a time. Also, as I noted yesterday, there has been the suggestion that Obamacare stands a better chance than Clintoncare did because there is a lack of organized opposition from the populist Right. I would argue that the Tea Partiers have taken up some of that function. If SEIU, HCAN, etc. organize rallies for Obamacare, and get swamped by Tea Partiers, there is something of a demoralizing effect on the Left, much like the protesters who showed up for Hillary’s bus tour back in the day. It is also a visual cue for what the cited Rasmussen poll shows — strong opponents of Obamacare greatly outnumber strong proponents. You may think Congressmen don’t care about that sort of thing, but in a swing district, I would not be so sure.

    Karl (fa7301)

  34. Karl: I think your reference to Perot is apt, as much of his support came from people united with anger at the status quo but with no consensus on the cure. I believe the same holds true for the Tea Partiers: they don’t like the deficit but are all over the place on how to eliminate it. Likewise, they may share an anger at intrusive expansive government… but only to the extent it intrudes on them, with much less concern about government affecting others (for example, someone I know hates intrusive government but is for seat belt laws and restrictions on smoking). As such, these are people who, as a group, can’t be pleased… which makes it pretty hard for Congress to talk to these people in anything other than generalities.

    steve sturm (369bc6)

  35. Obama’s increasing lack of credibility in his vague pronouncements about “his” reform, in contrast to CBO analysis and Obama’s own unfamiliarity with the actual legislation is getting through to the ordinary person. I’m seeing references to it among those who do not follow politics ordinarily.

    SPQR (5811e9)

  36. The American people are not clamoring for government to reform our health care system or for government to run our health care system.

    1. If they were, it would not be brought up for legislation only once every 20 or so years.
    2. If they were, respected universities, institutions and think tanks would have been working on it and have put their imprimatur on “a plan” before now.
    3. If they were, it would not be so “hard” to get bi-partisan votes and it would be done by now.

    This is not to say that structural changes are not needed (such as tort reform, insurance portability, and new rules to govern pre-existing conditions). But this administration shot their credibility wad with the stimulus, the budget, and cap trade. The American people are too smart to trust government with their families’ lives and healthcare decisions.

    Elizabeth (1cb352)

  37. Why is the demagoguery of the Left failing on health care? Because it is too brazen. The Democrats tried to relate it to the poor little people by throwing out incoherent talking points one after another that allegedly had something to do with the average citizen’s health care experiences – and the average citizen noticed that what they were saying doesn’t match up at all with their health care experiences. That’s why the polls are sinking. You can fool people only so far.

    chaos (9c54c6)

  38. Medicaid covers ALL POOR.

    If you are correct, the program has changed since the last time I was involved. The only way adult males were eligible was if they were eligible for SSI or had a catastrophic disabling medical problem. It was basically a program for women and children and for nursing home elderly.

    My concern is that all the government programs will run out of money in my lifetime and the only action I see being taken is to add beneficiaries.

    I think my suggestion would change the programs to become self sustaining. This country can support a health care system that costs 13% of GDP indefinitely. Remember, people spend as much on alternative medical stuff that is useless as they spend on hospitalization. Of course, what they spend on hospital care is very hard to determine because the retail prices that everyone complains about are grossly inflated, perhaps by as much as 80%. By that I mean the actual price paid may be as low as 20% of what the bill says.

    Mike K (2cf494)

  39. “for the actual number of uninsured, once you take out…”

    One dynamic working on O’s favor is all the newly unemployed boomers and Gen X’ers who are accustomed to better-than-average health care. Sometimes I think a public option could even help me, should I get laid off, but under the current bill that wouldn’t kick in until 2013 anyway so big deal.

    cassandra in MT (5a5d33)

  40. […] at Protein Wisdom describes what we are all seeing: The answer may be that even those Americans not steeped in the […]

    Flopping Aces » Blog Archive » Support For ObamaCare Decreases….MSM Blames The Ignorant American People (e7cd22)

  41. Mike K said:

    People can figure out when they are being lied to. It may take a while, which is why Obama is in such a hurry, but they figure it out. His biggest mistake was the stimulus bill because that gave the show away.

    Mike K hit the nail on the head. When any intelligent person steps back a really listens to and reads what the President and Dems want to do, that person has to be taken aback.

    There is an urgency to the President’s actions, because that is the strategy of his actions. He has to transform U.S. society before that society catches on to what he’s doing.

    The lefties used to always say that Bush, Cheney and Rove would suspend the Constitution and install themselves as dictators because, you know, they are Republicans.

    Oops, didn’t happen.

    But now, I think we’re beginning to see who the real totalitarians are. Look at the President’s friends, associates, advisers and czars. I’m afraid things are going to get ugly real soon.

    Ag80 (99168f)

  42. Drop the cell phones and cable — buy better health care insurance instead

    That is exactly what I did. I downgraded my cell phone plan, dropped the cable pay channels, and it opened up enough cash to pay for most of my monthly health insurance premium. Eating home a little more also saved dining-out expenses, and this covered the rest of my premium. And, all of this was easy. It works!

    Joe M (2567f8)

  43. You ungrateful vermin should just sit back and accept what your moral betters want to do to you.

    JD (a74281)

  44. What would be the side effects of laws making it a crime to charge too much for health care?

    Based on previous experience with price caps, the price of health care would rise immediately to that point and stay there, regardless of market forces.

    North Dallas Thirty (416e07)

  45. Obama screwed the pooch on this one. He should have:

    1. Focused like a laser on the economy. Passed a stimulus bill that “stimulated” RIGHT NOW…not in 2010. A bill that kept unemployment down.
    2. Held off on the assinine Cap & Trade bill. The only thing it accomplished was to convince swing voters that this congress is radical Left…and incompetent to boot.
    3. A success on the economy in 2009 would have given Obama the credibility and cover to take on Health Care in late 2009.

    The congress’ credibility is shot, and Obama’s ratings (on the issues) are tanking. Voters are rejecting the Health Care bill because they don’t believe what the Dems are promising and because it’s increasingly clear they aren’t competent.

    JohnR (f39142)

  46. 2. If you rely on France’s medical insurance alone, 25 percent of French doctors will refuse to treat you. Wouldn’t necessarily bother me, but you’ll never see the Left mention it — or accept it.

    Comment by Karl

    Karl, I think this is a misapprehension of the French system. It allows balance billing but requires display of all fees before treatment. If someone goes to a doctor in France and asks if he will accept the fee schedule as payment in full and he says no, that is part of the system ! It’s a feature, not a bug,

    From my analysis:

    In 1997, 99.6 % of physicians were in Sector 1 or 2. Of these, 74% were in Sector 1, 83% of GPs and 62% of specialists. The Sector 1 physicians are contracted with the NHI and are paid from the negotiated fee schedule ( NGAP ), which is revised annually. By agreeing to the fee schedule, Sector 1 physicians become eligible for pension and sickness benefits. Sector 2 physicians may set their own fees but do not have the pension and sickness benefits. The additional fees, above the national fee schedule, are the responsibility of the patient. When this reform was established in 1980, Sector 2 became popular, especially with specialists, but initially only 7.5% joined Sector 2. By 1997, Sector 2 had 57% of physicians and access to the category was limited. This may have been the result of Sector 1 fees not keeping pace with inflation. In 1998, 51% of physicians were specialists (49% GP) and 75% of GPs were in private practice. Specialists were more likely to be employed by clinics and teaching hospitals but 68% were still in private practice. Many medecine liberale (fee-for-service) GPs are practicing in cabinets liberaux, a one physician office with a small staff. Group practices are more common in urban communities. Many GPs list themselves as medicins de famille or family doctors and care for entire families. The fee for one of these visits is quite modest, about 11 pounds sterling in 2001.

    Thus, the Sector 2 physicians are 25% and do not accept the national fee schedule as payment in full. That’s how a market works. If you want to go a Sector 2 doctor, you must pay his/her fee, then the NGAP reimburses you for that amount, not the higher fee of the sector 2 doctor. This is how we control costs. No coercion but the rationing effect of price. If you want a BMW, it costs more than a Ford.

    For this country, I would suggest forgiveness of student loans for Sector 1. Medical school in France is free.

    Mike K (2cf494)

  47. Obama’s minions and advisors have always contended that, come hell or high water, they’d never make the same mistakes on health care reform like Clinton did – and their arrogance and lack of hard reality checks shows more every passing day. Clinton got rolled by his own party, mainly because the incumbents up for re – election during the mid – terms were scared sh-tless if that monstrosity had passed. It’s not a whole lot different this time around, except that Clinton had advisors who had the stature via their long tenures with him that they could say to his face when he was full of it. Obama has no one of a similar stature within his administration, and it shows.

    Dmac (e6d1c2)

  48. Off topic, but every day that Karl posts is a good day. Reasoned, calm, factual, and overwhelmingly persuasive stuff- every time. Thanks!

    MTF (17058c)

  49. Mike K., would that Frenchish plan include disassociating health insurance from employers? Because doing that, opening up the tax benefits of buying insurance outside of work would open up insurance to a lot more people. Selling it like car insurance is sold is another idea.

    I read something Thomas Sowell wrote a while ago about how wealthy people get better health care than poor people in the same way wealthy people get better cars than the poor. Do I need a car that goes to and fro without break downs? Yeah. Do I need a car with leather seats that heat up when I’m cold and has little tiny froufrou wipers on the headlights? Not so much.

    Vivian Louise (c0f830)

  50. The French system seems to be a sort of hybrid. The largest fund is the salaried workers, CNAMTS, many of whom are union members. The fund has a board that includes employers, who collect payroll deductions, union officials, doctors representatives, and other “stakeholders.”

    The basic reform in France was the Securite Sociale, similar to our Medicare program in 1965. One of the proposals for reform has been to adapt Medicare to the entire population. One way to do this would be to use the existing health insurance industry as the French use the mutuelles, to handle copayment and administration. Health insurance in the US is not really insurance. Employers use insurance companies to administer self-payment programs. Insurance companies have become “administration service organizations.” This is not that much different from the non-profit CNAMTS, which has a board composed of employers, unions and physicians. One difference that may be necessary is to get rid of the adversarial role of the Federal Trade Commisson toward doctors and their organizatons. Any fee negotiation has been banned for 30 years and that inhibits any attempt to deal with for-profit HMOs which are destroying the medical profession, especially in California were they are triumphant. Poor care and bankruptcy for medical groups has been the legacy of for-profit HMOs.

    In a followup I amend the use of the term Medicare, which I did not mean to be a single payer like Canada. When I was in the Air Force, Medicare was the military dependents’ health care. In Australia, it was the national insurance program that was ruined by Labour in 1986.

    I do mean a fund, like Fannie Mae or SCIF, the California workers comp carrier. It would become the central insurer and the employers would no longer have to manage the plans. France, like Germany, has a multiple of plans and you can join one. It is NOT tied to employment even though payroll deduction funds the plan. SCIF may be a better example as it covers all employers’ employees.

    A big factor that makes this work may be the French legal code, which is very different.

    Mike K (2cf494)

  51. […] Harwood, also a political writer for The New York Times, explained that reporters need to first understand the intricacies and nuances of health care policy before they can then try getting the story across to viewers and readers. Last week, Harwood said, he was “trying to get [his] head around the issue of cost control” before penning a Times column. Health care talk sinks Obama press conference ratings (h/t: Patterico) […]

    Single Payer crash and burn Re: 6 months « Chockblock’s blog (725c82)

  52. The readers/commentators on this site are so much smarter than a former editor of the Harvard Law review. You guys rock. Keep your opinions coming; I really (really) value them.

    Seattle Slew (e9f1c0)

  53. You always bring such good-faithed discussion, Seattle Slew. You are such a contributor.

    JD (355e34)

  54. Slew, were you referring to the editor who never wrote a peer reviewed article ?

    Mike K (2cf494)

  55. That being said, I do think support is eroding as more people figure out that they are likely losers under the bills currently under consideration. But the deficit plays even there, as it’s that math that tells everyone that their taxes are likely to go up.

    Comment by Karl — 7/28/2009 @ 12:41 pm

    I read somewhere today that Obama has already lost 2/3 of the seniors who see quite plainly there is nothing good in the reform for them, in fact, much the opposite. Most people are happy with their own health care so Obama had to frame his argument in terms most would find compelling, they chose an argument they couldn’t make. After the stimulus sham, people are skeptical and rightly so.

    I also have had this feeling that when people went to the polls in November, they voted on emotion and now they realize not only who they elected, but they also gave him a blank check with majorities in the House and Senate. I have had a few conversations with Reagan Dems who are either annoyed that Obama’s talk of benefits like they have in Congress turned into this liberal overreach. Some blame liberals in Congress others think they were totally misled by Obama. Both are true, but whatever the rationale people don’t feel comfortable going back to their business and not paying attention. They are very attuned and the more they see, the less they like.

    Mary (1dc631)

  56. Where’s the Birth Certificate?

    Xavier Cugat (9d1bb3)

  57. #52
    I think we ought to leave the care and functioning of the US healthcare system to an affirmative action candidate who has never owned, managed, nor directed a single employee in his life nor met a payroll or provided a single service to a paying consumer.

    He was after all a community activist, just like Karl Marx.

    I very much doubt that many of the readers here do not have far more experience than Presidente Zero.

    Thomas Jackson (8ffd46)

  58. To those trying to figure out who are the uninsured. Fully 1/3rd of the uninsured are eligible for Medicaid or SCHIP and have not signed up for it.

    Mike (9ecc60)

  59. Obama and his left wing Socialist supporters are following the very same policies for the Nation that have bankrupted Calif. & New York!

    California the Golden state, American future, is fast becoming the poster child for an bankrupt third world State!

    An unholy alliance of Socialist Democrat politicians, Unions, and Illegal Aliens supporters are feasting at the trough of tax payers paid benefits while taxing & regulating business and the tax paying public into poverty.

    The pandering of Left Wing Democrat Politicians to their constituency of Unions, Illegal Aliens and open border supporters, are driving business and citizens to other states & countries, while leaving the parasites & welfare leeches in an increasing bankrupt, crime ridden, dysfunctional state!

    For years California has ignored economics 101 and imported Criminals, Uneducated Peons, and poverty from Mexico, which increased Medical, Welfare, Crime, Prison, etc. & adding a estimated 10 to 16 billion per year to Calif. State expense to support the invading horde of Illegal Aliens while exporting business and educated tax payers.

    Like all Socialist & Marxist States the results have been a astronomical increase in social welfare, schooling, prison cost etc. and a lowing of Living standards, Education standards, Tax receipts & finally Bankruptcy.

    Failure to abide by our Constitution against invasion & enforce our Immigration laws and constraints on wages and benefits for public employees will result in turning the Golden State into MexiCalif and the end of the Calif. Dream and the beginning of the MexiCalif. Nightmare!

    The policies of Obama and Wash. DC Democrats are intent on following Calif. policies and are resulting in the same creeping socialist process across American.

    Amnesty & Citizenship as a reward for their invasion of the USA, will result in the rest of the USA turned into a Spanish speaking third world cesspool, modeled on Mexico and follow California into a polluted, over populated, Spanish speaking third world Nation of Crime, Corruption, Poverty, Cruelly & Misery!

    This will result in a population depending on Welfare and the Democrat party, thus assuring the lock on power for the Socialist Democrat party of the United States of Mexico!

    Black Saint (4aca52)

  60. Gee, Obama was the former editor of the Harvard law Review? then he clearly knows how to create and manage a new health care system. And, we no longer need democracy.

    If I only realized that all we needed was the omnipotent former editor of harvard law review (noting, of course, that he neither got onto the law review via grades or through the writing competition, but was voted on as a minority – and that election to editor of the law review is a popularity contest) to rule over us without the citizenry having to worry or even discuss our fate I would have voted for a harvard law review editor a long time ago.

    Indeed, since Obama is merely a former law review editor, and there is a current Harvard law review editor in place right now, should we not simply turn over the presidency to the current editor? Is the current editor not more brilliant and qualified than Obama?

    I would hate to have any Medical Doctors or Economists, or Historians, or Engineers or anyone else think that they may be able to think as logically and brilliantly as a former editor of the harvard law review. Clearly, the former editor of the Harvard law review knows all about economics, science, medicine, and any other avenue of human endeavor by virtue of his having been the editor of the harvard law review.

    thus, I will simply submit to his omnipotence and henceforth realize that whatever the One says, is absolute truth. And when the one says something completely contradictory within a few days, that too will become absolute truth. I will not question. Nor will I comment. Nor will I complain. Democracy is for suckers now that we have found a former Harvard law review editor to make our decisions for us.

    Monkeytoe (e66874)

  61. Slew, were you referring to the editor who never wrote a peer reviewed article

    I think the Horse’s Backside is referring to the individual who’s never allowed his grades to be released to the public.

    Dmac (e6d1c2)

  62. OT, but this piece is going to give me a headache I fear. Just as blog-trolls resort to misdirection and obfuscation when their points are indefensible, now too is our President…

    Behold:

    http://www.washingtontimes.com/news/2009/jul/29/obama-still-cashing-in-on-bushs-economic-failings/print/

    First, a good point regarding the oh-so-sincere “Promise of Hope-N-Change”;

    As he took power, Mr. Obama promised a “new era of responsibility” that would transcend partisan politics. “For a guy who campaigned on taking responsibility and looking forward, he spends an awful lot of time pointing fingers and looking backward,” said former Bush deputy press secretary Tony Fratto, who has begun defending the previous administration.

    And then, the retort; one that I’m sure you’ll recognize as bearing the hallmarks of The New Kind of Politics! that has come to pass in the Age of Obama;

    Democratic Party strategist Liz Chadderdon said the strategy of blaming the previous team has been effective. ‘I think Bush-bashing has been alive and well since ‘07 and, since it keeps working, why not use it?‘ she said. ‘Voters have short memories. The administration needs to remind people that things were way worse over the last four years than in the last six months.’

    And there my friends, is a demonstration of the level of intellectual honesty at work in the Democratic party…

    So how about it? I say to my friends across the aisle…

    Will they explain explain the wonders that are Obama’s policies, or, you know, resort to the usual Chicago thugishness and political hackery..?

    I wonder which it’ll be..?

    Bob (99fc1b)

  63. It’s really very simple…WE CAN’T AFFORD IT!

    Rusty (8b91ca)

  64. […] the moving parts of this,” NPR health policy correspondent Julie Rovner said on air Wednesday.  Others suggest that the public is not being swayed because they “know enough to spot obvious […]

    Morning Report, July 29 « Evangelical Gateway (84499b)

  65. In the category of “really terrible news” is this report of a “deal” to bring the Waxman health care committee wangling to a vote. The economy stinks already; can’t you folks just back off already?!

    MTF (17058c)

  66. Mike K 7-28-09, 10:37AM,

    How much does a Frenchman pay into the national health plan that you describe. Are the payments labeled insurance premiums and collected via payroll deductions or is it funded out of general revenues paid for by income taxes?

    Stu707 (0981d5)

  67. FWIW, Voters with two brain cells will reach out and spit on their Congressman for voting on this deal.

    Personally, if I saw a politician getting beaten to death I might actually post it on Youtube with play by play. Prepare for Soylent Green kids. And forget about innovation and all those wonderful new technologies to make your life better.

    HeavenSent (01a566)

  68. Actually Slew, I both won Moot Court and was on law review at my law school.

    Enough to know that neither qualifies one to be President. More importantly, neither represents any experience worth squat at all.

    SPQR (5811e9)

  69. Let’s do a back of the envelope calculation on how much it would cost to insure the 47 million people in America who have no health insurance, but first let’s look at the number itself. It includes 12 million illegal aliens whose presence is not lawful, so let’s take them out. Now we’re at 35 million people. Half of them have the money to buy insurance, but choose not to do so. Okay, they get to go to the emergency room with a credit card, or the community hospital sends them a bill. Now we are at 17.5 million.

    What does health insurance cost? When I retired, I could have taken my insurance with me but I would have had to pay my part and my company’s part too. Had I or a member of my family had some pre-existing factor, I could have paid $6,000 per year and retained full coverage under COBRA. That figure is for a family of 4, so annual individual rates are about $1,500. Covering 17.5 million people at $1,500 each is $26.25 billion. $26.25 is a rough order of magnitude estimate, but we are being told by the CBO that the costs are $100B to $200B per year. What’s up with That?

    Before we destroy the best medical care system in the world and replace it with a medical version of AMTRAK, we should slow down and have a rational, open discussion about the impact of nationalizing American medicine.

    arch (b12226)

  70. Can’t have everything, guys. Let this happen. If it fails, then wag the finger. If it succeeds, well, you’ll have little to say.

    Vince Collaso (1475c4)

  71. WTF is that supposed to mean, Collaso?

    SPQR (26be8b)

  72. By the way, seniors ought to be worried about where Obama and his cronies will take our healthcare system.

    Here’s an extract from an article on the New York Post about Rahm Emmanuel’s brother’s opinions about the kind of changes he envisions:

    Start with Dr. Ezekiel Emanuel, the brother of White House Chief of Staff Rahm Emanuel. He has already been appointed to two key positions: health-policy adviser at the Office of Management and Budget and a member of
    Federal Council on Comparative Effectiveness Research.

    Emanuel bluntly admits that the cuts will not be pain-free. “Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely ‘lipstick’ cost control, more for show and public relations than for true change,” he wrote last year (Health Affairs Feb. 27, 2008).

    Savings, he writes, will require changing how doctors think about their patients: Doctors take the Hippocratic Oath too seriously, “as an imperative to do everything for the patient regardless of the cost or effects on others” (Journal of the American Medical Association, June 18, 2008).

    Yes, that’s what patients want their doctors to do. But Emanuel wants doctors to look beyond the needs of their patients and consider social justice, such as whether the money could be better spent on somebody else.

    Many doctors are horrified by this notion; they’ll tell you that a doctor’s job is to achieve social justice one patient at a time.

    Emanuel, however, believes that “communitarianism” should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those “who are irreversibly prevented from being or becoming participating citizens . . . An obvious example is not guaranteeing health services to patients with dementia” (Hastings Center Report, Nov.-Dec. ’96).

    Looking forward to a health care system where the government decides if you are “worth” caring for?

    SPQR (26be8b)

  73. In the past year 15 of 18 major drugs were introduced by American drug firms. Because of Europe and Canada’s socialized medical policies their drug industries no longer are major players.

    Once Obama introduces his vision of healthcare where will the new drugs come from?

    Thomas Jackson (8ffd46)

  74. How much does a Frenchman pay into the national health plan that you describe. Are the payments labeled insurance premiums and collected via payroll deductions or is it funded out of general revenues paid for by income taxes?

    Comment by Stu707

    They have several health plans, as I understand it. One plan is funded by payroll deductions (CNAMTS). Others are funded by contributions. Then there is CMU, which is general fund supported. Those who are poor, and many British expatriates who do not want to go home to the NHS, are funded out of general taxes. It is a multifactorial program as ours is. My point is that we could adopt the same system with variations that correspond to our own circumstances.

    It is not a one-size-fits all like the Obamacare plan we are debating. The possibilities are many. What we don’t need is a program in which all have to accept central planning. The key is that it allows a market approach. If you want more than the basic plan, you can choose to pay more.

    Doctors are starting to drop out of Medicare and are offering services paid by the people who want to choose their own limits. What I don’t like is the idea that individual choice is illegal.

    MIke K (2cf494)

  75. Mike K

    They have several health plans, as I understand it.

    I oppose an Obama style one size fits all approach. I favor a system that provides for maximum choices for willing buyers and sellers of medical services.

    I’m trying to evaluate the French style system that you favor. I understand that you are not advocating an exact copy of their system but one modified to meet our own social and economic conditions.

    What is the payroll deduction for the CNAMTS plan?

    Stu707 (0981d5)


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