Patterico's Pontifications


Obama Announces Health Care Reform

Filed under: Obama — DRJ @ 10:28 am

[Guest post by DRJ]

Flanked by leaders of the AMA, AHA, SIEU, pharmaceutical and other groups in the State Dining Room, Barack Obama announced today a “watershed event”: An agreement by industry groups to come to the government table to reduce health care costs by 1-1/2% a year over the next 10 years for an estimated savings of 2 trillion dollars.

Noting his goal is universal medical coverage, Obama said 46 million people in America are uninsured and claimed that medical costs are responsible for half of all personal bankruptcies.

Obama did not address the mechanisms that will deliver this reduction in health care costs, other than eliminating fraud and waste and enhanced preventive care. Perhaps it will involve lower wages and profits or it could be rationed services. It seems that will be up to Congress.


185 Responses to “Obama Announces Health Care Reform”

  1. Health care reform + Obama = Health care rationing. Shout it out, Republicans, if you have half a brain.

    either orr (6c9faf)

  2. I’m one of those 46 million (source?). Voluntarily. He can keep his filthy state-imposed insurance away from me.

    brobin (c07c20)

  3. He’ll be brave and slap a federal cap on malpractice awards, despite this alienating a major source of Democratic fund-raising. Or not…

    great unknown (b751d2)

  4. The statistic about “half” of all bankruptcies being caused by medical costs is a fake statistic that has been repeatedly debunked. Obama seems to like faux statistics.

    SPQR (72771e)

  5. Looks like all Americans will get to enjoy Tricare… Ask any mil retiree about Tricare and you can get a visual of the sarcasm behind that statement

    voiceofreason2 (10af7e)

  6. You beat me to the punch SPQR (10:36 am), but here is an article that outlines some of the problems with the “about one-half” claim.

    JVW (eabe68)

  7. Ah, but SPQR and JVW—the numbers feel right!

    Isn’t that the way things are being looked at, right now?

    Eric Blair (34f123)

  8. looks like the left is going to get what they wanted…..

    and they deserve to get it good and hard.

    (it’s too bad we’re going to get it too. i’ve already survived government health care once. %-)

    redc1c4 (9c4f4a)

  9. Welcome back DRJ!

    Note that the signatories to the letter have no details as to how said savings are to be had. Note also that all prior estimates of the savings to be had by improving coordination, focusing on efficiency and embracing better technology and regulatory reform don’t come anywhere close to paying for a government takeover.

    It’s an easy way for groups like the AMA to put themselves on the side of “reform” without giving Obama much more than a talking point.

    Karl (f07e38)

  10. Great Unknown (10:36 am), I actually do think that there will be a malpractice cap on whatever bill emerges from Congress, not because Dear Leader wants it in the legislation — and certainly not because Nancy Pelosi and Harry Reid want it — but because Blue Dog Democrats will demand it as political cover for their vote in favor of a costly new entitlement.

    JVW (eabe68)

  11. When was the last time a new entitlement actually cost anywhere in the ballpark of the projections?

    JD (6994a8)

  12. JD, SPQR,

    To be scrupulously fair, the Medicare drug benefit has come in considerably under the original projections. But the reasons for this — use of generics/formulary policy, low enrollment, the “doughnut hole” — are telling, as they either would not obtain in a full takeover or point to rationing.

    Karl (065e81)

  13. Half of all bankruptcies? Uh, NO NO NO. But what do I know, I am only in bankruptcy court nearly 4 days out of five.

    Californio (9b0d11)

  14. Karl – To be scrupulously fair, had the Dems had their way, that would not be the case. Their complaints were that the program did not go far enough, and that not enough money was being thrown at this solution looking for a problem. Just sayin’


    JD (6994a8)

  15. Californio, if you haven’t seen the original source of that fake statistic, it came from a study that just counted up all the bankruptcy filings that had some medical debt of any amount in the filing and then counted that bankruptcy as “caused” by medical costs. Utter nonsense.

    SPQR (72771e)

  16. Half of all bankruptcies due to medical bills – 100% pure bunk. medical bills are unsecured debt – As long as it is unsecured debt, why waste time filing bankruptcy. (rarely is there an attempt to file suit to get debt reduced to judgment due to risk of counter malpractice claim)

    I am not saying to not pay medical bills, but clearly implausable to agrue with a straight face the medical bills are a cause of bankruptcy filing.

    Joe - Dallas (6f50bd)

  17. Must. Not. Allow. Facts. To. Get. In. The. Way. Of. Teh. Narrative.

    JD (6994a8)

  18. Welcome back DRJ! It’s good to see you here again.

    What worries me is that for all those groups to actually agree on something would require the suppression of many rights of the taxpayer. Each group, if socialized medicine is to be railroaded through, will ‘receive’ something to guarantee their cooperation, and you can bet it won’t come from any of the other groups – which leaves the only group unrepresented at that meeting – the taxpayer.

    Apogee (e2dc9b)

  19. JD,

    Agreed, which is why I added the caveat that the reasons for Part D’s performance would not obtain here.

    Karl (065e81)

  20. Karl – I think we can all agree that Barcky’s plans to pay for this, at best, amount to smoke and mirrors, and in reality, are brazenly dishonest.

    JD (6994a8)

  21. Now that the WH confirms that the projected deficit for FY-2010 will be in the neighborhood of $1.8T (…Eighteen-Hundred, Billion Dollars, for those numerically challenged…), what does it matter what it’s going to cost?
    With these kind of deficits, it is time to invest in wheel-barrow manufacturing bank-note transportation devices.

    AD - RtR/OS! (b782d3)

  22. Health care reform + Obama = Health care rationing. Shout it out, Republicans, if you have half a brain. Half? You’re too generous, given the recent statements by Darth Cheney over preferring Boss Limbaugh in the GOP to Colin Powell.

    DCSCA (9d1bb3)

  23. DRJ, is that SIEU or SEIU?

    SEIU, and thanks. It wouldn’t be blogging without corrections! — DRJ

    PCD (02f8c1)

  24. Good point, Apogee. It may be our table but Obama, Congress, and the health care folks are the ones who get to sit there.

    DRJ (b0f193)

  25. If the leaders of the AMA, AHA, SIEU, pharmaceutical and other groups were there, it’s because they want to be in the tent and have a say in how the system is crafted and shaped, rather than having government impose a system in which they’ve had minimal input. They’ve read the winds of change and have set their sails accordingly.

    DCSCA (9d1bb3)

  26. Regardless of the spelling, DRJ, I can’t help but think that it is actually pronounced “sooooo-eeee,” as in calling the porkmeisters to the trough.

    Eric Blair (34f123)

  27. Each group, if socialized medicine is to be railroaded through, will ‘receive’ something to guarantee their cooperation, and you can bet it won’t come from any of the other groups – which leaves the only group unrepresented at that meeting – the taxpayer.

    ‘Unrepresented?’ Elected officials will be in the meetings.

    DCSCA (9d1bb3)

  28. DCSCA,

    I agree they are willing to sit at the government’s table … because nationalized health care is a done deal. It’s like nationalized automobile manufacturing, where we also had elected representatives at the table.

    DRJ (b0f193)

  29. Thanks DRJ – Seeing your name on the posts gives me the same feeling as Captain James Riley of the Brig Commerce upon reaching Swearah Africa in 1815:

    ‘Suddenly, to their astonishment, the American flag rose above the town.
    “At this blessed and transporting sight, the little blood remaining in my veins gushed through my glowing heart with wild impetuosity, and seemed to pour a flood of new life through every part of my exhausted frame.”‘

    Apogee (e2dc9b)

  30. But when Energy companies sent representatives to discuss the nation’s energy policy, that was EVIL and WRONG!11!!!

    Techie (9c008e)

  31. #29- Of course executives in the big, bad, auto industry– an industry that literally was the backbone of the arsenal of democracy in WW2– asked for help from our elected officials, didn’t they.

    Would you prefer to wait a decade and have health insurance companies come hat-in-hand to the government asking to be bailed out on a scale to match the banks or else the system would collapse? A nation of 320 million people needs a national healthcare system as a viable and affordable alternative to a purely private, profit driven system. It’s long overdue.

    DCSCA (9d1bb3)

  32. How long have you been an anti-capitalist, DCSCA? Since college or is it a recent discovery?

    DRJ (b0f193)

  33. DRJ – A warning. I don’t know if you’ve been following the threads recently, but you can read my opinion of the fellow who commented at 12:11pm here.

    He’s behaving right now, but trust me, multiple miggs will revert back to his standard operating procedure.

    Apogee (e2dc9b)

  34. I thought half of all bankruptcies were caused by men who beat their wives on Super Bowl Sunday.

    Bubba Maximus (456175)

  35. purely private, profit driven system.

    Explain this then, if you would please.

    n 2003, of the roughly 3,900 non-federal, short-term, acute care general hospitals in the United States, the majority—about 62 percent—were nonprofit. The rest included government hospitals (20 percent) and for-profit hospitals (18 percent)

    Via Wikipedia citing this GAO Report (

    Techie (9c008e)

  36. #33- Do you oppose choices? When you post a letter, you may use FedEx, the USPS or even UPS to send snail mail. Or opt out and go electronic.

    DCSCA (9d1bb3)

  37. Apogee,

    I haven’t followed recent DCSCA debates but I remember him from the past. I like debate and I tolerate most banter, but I have a shorter fuse than I used to for personal attacks on my threads. Commenters of every persuasion are advised to keep that in mind.

    DRJ (b0f193)

  38. #34-

    Bud: HOT AIR.

    DCSCA (9d1bb3)

  39. DCSCA,

    The mail is a regulated monopoly in which FedEx and UPS are allowed to compete in specified areas. That may be a good example of what will happen in healthcare, but it isn’t capitalism.

    DRJ (b0f193)

  40. Obama did not address the mechanisms that will deliver this reduction in health care costs

    The precise mechanism is that somebody else will be paying for your health care costs!

    And when costs are spread out over the entire US population, the young people of America–yes, those same drug and alcohol-impaired meatheads who voted en masse for Obama in the first place–will be paying way more than their rightful share for older people’s health care. It’s the same concept as social security!

    Is this a great country, or what?

    Official Internet Data Office (d07e83)

  41. 5/11/2009 @ 12:56 pm

    Proving my point exactly.

    Apogee (e2dc9b)

  42. Obama did not address the mechanisms that will deliver this reduction in health care costs

    A wizard did it.

    Techie (9c008e)

  43. If conservatives could make a coherent, rational argument against a national healthcare system other than ranting ‘socialism’ and ‘it doesnt work’ when it has in varying degrees of success in other lands, then it’s worthy of debate. Otherwise, the debate will be couched in fear and scare tactics just like the effort was blocked. Regardless, a nation of over 320 million people can no longer pretend it is the America of Daniel Boone, John Wayne, frontier individualist who can thrash out an existence in an interconnected world. The population of the U.S. is close to double what it was just in 1955/1960 and Americans simply have to think fresh and differently. The healthcare system has to be fixed and President Obama is smartly seizing the moment. It wont come around again— until the system finally collapses.

    DCSCA (9d1bb3)

  44. Americans simply have to think fresh and differently.

    And if you don’t, it off to the re-education camps with you, you filthy running-dog lackey of the capitalist ruling class!

    Official Internet Data Office (d07e83)

  45. If conservatives could make a coherent, rational argument against a national healthcare system

    It would help by you starting to make one FOR it.

    Techie (9c008e)

  46. Good Allah. This one is tedious.

    JD (06f82d)

  47. Maybe DCRAP could start out by showing where in the Constitution it finds health insurance as a role of the government. Then, it can outline how it plans to actually pay for the system, not the smoke and mirrors and deficits farther than the eye can see. Then, it can show us all how we should expect better service than the DMV, or where government has proven to be more efficient than the private sector.

    JD (06f82d)

  48. #40- You may want to look at how the postal system was pressed to operate. It began to go adrift when it was ‘privatized’ and pushed to become profitable. Simple postage stamps were a nickel for decades and jumped a penny or two in the 1960s and only began to soar when the postal service was pressed to be profitable, even allowing for other costs, from the 1970s on. When NASA was pressed to be a ‘profit center’ in the Reagan days, you ended up with Challenger. There are certain basic, highly regulated services government must provide to maintain a framework for capitalism to flourish. Even fire fighting. And still there are enclaves in California that opt to contract for private fire fighting firms. Schools. Public and private. The voodoo of Reaganomics and witches brew of conservatism is that you can privatize everything. It’s madness. Cable systems were ‘deregulated’ with promises of cheaper costs and the opposite occurred. Seems every cable system on Earth is a la carte, except in America. And so it goes. A solid, afforadable, basic national healthcare system seems a smart move for a progressive country like the U.S. and in the long run, will make America a stronger, healthier nation.

    DCSCA (9d1bb3)

  49. Surely, the government will manage the money required for a NHS-America with the same prudence and foresight with which they’ve managed Social Security……………..

    Techie (9c008e)

  50. #45- Majority rules. Freedom of choice so if you choose to move into an interrment camp (Americans call that Texas)feel free to pull up stakes. They want to secede anyway.

    DCSCA (9d1bb3)

  51. ASPCA knows that because it used to work for NASA, NSA, SeeBS, and a host of other industries. Ironic that the privatized parts of the postal service (FedEx and UPS) are exponentially more efficient and actually profitable than the USPS, who incidentally, just announced another rate hike which will ensure their solvency for at least 6 more days ….

    JD (06f82d)

  52. Now it is lying and distorting about Texas, again …

    JD (06f82d)

  53. When NASA was pressed to be a ‘profit center’ in the Reagan days, you ended up with Challenger

    And when NASA had basically a blank check during the race to the moon, you got Apollo 1 and almost Apollo 13.

    Your point?

    Techie (9c008e)

  54. Techie – You should well know by now that it does not have a point, it just serves to lie, obfuscate, distract, and otherwise hijack threads.

    JD (06f82d)

  55. DRJ – I like debate and banter as well, but this is something different. For example:

    Techie — 5/11/2009 @ 12:46 pm provides evidence that his major assertion is incorrect, yet receives no response other than generalized accusations aimed at ‘conservatives’. This isn’t an isolated incident. As I said, it’s standard operating procedure, and it’s not debate or banter, it is the poisoning of both.

    My reason for drawing this one out is due to the fact that I respect the efforts of Patterico, Karl, you and other posters in the formulation of posts that are interesting and timely. The repeated efforts at sloganeering and the inability to engage others, IMO, insult your and the other posters’ efforts and debase this site.

    Apogee (e2dc9b)

  56. Frak. Just frak. The news out of the White House gets worse and worse.

    Vivian Louise (eeeb3a)

  57. Yes. Yes. Continue to blast Texas. That’s right.

    Most discourteous of you, Miggs.

    Apogee (e2dc9b)

  58. Now we know that ASPCA is cool with internment camps for almost half the country. Because “we won”.

    JD (06f82d)

  59. In #37, DCSCA actually incorrectly describes the legality of mailing a letter via services other than USPS.

    Ordinary mail aka “snail mail” may not be transported by Fed Ex nor UPS.

    Not a surprise of course.

    SPQR (72771e)

  60. DCSCA, #49 is also factually incorrect, as the Challenger accident was the result of an engineering decision made long before Reagan was elected. That of using segmented solid fuel boosters.

    Something I’d expect anyone who worked for NASA to know.

    SPQR (72771e)

  61. Commenters of every persuasion are advised to keep that in mind.

    Comment by DRJ

    I’m afraid that your advisory requires that said commenter have a mind. One troll that has been much in evidence lately would have trouble passing the Turing test, I believe.

    Mike K (90939b)

  62. Techie, I hadn’t realized that only 18% of hospitals were for-profit. Thanks for that link.

    I’m a firm believer that we need to connect “paying for” insurance and medical care to consumers, or we will never see costs come down. There is no government program that will outperform the free market. Look at lasik – lots of competition, very little insurance coverage and prices have come down substantially. As someone here noted recently, we have no car insurance crisis, and people have to buy that themselves, even mandated by gov’t to do so.

    carlitos (aa025a)

  63. #54- And when NASA had basically a blank check during the race to the moon, you got Apollo 1 and almost Apollo 13. Indeed, ‘Go fever’, deadlines and a poor private contractor were at fault. Corrected, too, and quite fast by today’s standards. And 13? Corner cutting in testing procedures. Perfection is not the natural state of human affairs.

    DCSCA (9d1bb3)

  64. DCSCA, #64 the point is that your claim was rebutted. Again.

    SPQR (72771e)

  65. Is it ever anything other than mendoucheous?

    JD (06f82d)

  66. I do not know what to think about this until Boss Limbaugh and Hannity tell me what I think.

    I just heard a song with a chorus that went “God is great, beer is good, and people are crazy”.

    JD (06f82d)

  67. The statements coming from the White House do not inspire belief that they have a well thought-out plan. There are too many comments about saving money, for example. There is no chance that a single payer plan will save money.

    Another typical canard is that preventive medicine will save a lot of money. I have been in this business for a very long time and neither high quality nor preventive medicine save money. That is why it has been impossible to get the for-profit HMOs to adopt them.

    Most preventive medicine is public health, not personal. Better water supplies, immunization (currently widely attacked on the left), smoking, alcohol, drugs, obesity are all major factors and almost none are part of individual care. Maybe obesity but, aside from bariatric surgery, almost nothing works. A lot of it is cultural. For example, a lot of the childhood obesity increase is in Hispanic children who are here in greater numbers than 30 years ago. Nobody, of course, will talk about that.

    I favor a national health care reform plan based on the French System. I fear that what we will get from Obama will resemble Canada, one of the worst of all national health plans which, among other things, bans private practice. It actually makes it a crime. Some of this is now going on in Medicare. Physician visits are limited. Some geriatric specialists have tried to add more visits paid privately by the patient and have been prosecuted. I was at the American Geriatric Society meeting in Chicago two weeks ago. In one of the sessions, a woman geriatric specialist, the only one in her area of central Iowa, has now completely dropped out of Medicare because of the restrictions. She is total private practice and is making a living because the patients who need her are willing to pay and the Medicare program won’t. She was unable to do both, see some Medicare and some private.

    Ironically, geriatric and home care physicians, currently very badly treated by Medicare, are saving tons of money for the program by keeping frail elderly people at home and not in hospitals and nursing homes. Will Obama and his clones see that ? I doubt it. He thinks big and has no real world experience.

    Mike K (90939b)

  68. In #37, DCSCA actually incorrectly describes the legality of mailing a letter via services other than USPS.

    Ordinary mail aka “snail mail” may not be transported by Fed Ex nor UPS.

    Not a surprise of course.

    Comment by SPQR — 5/11/2009 @ 1:39 pm

    SPQR, I have not made up my mind on DCSCA. But I have on you.

    Not a surprise of course that you would twist what DCSCA was saying in #37.

    He/She was answering DRJ’s question at #33 as to how long DCSCA has been an “Anti-Capitalist” (He/She is not of course).

    It had nothing to do with “the legality of mailing a letter via services other than USPS” as you put it.

    It had more to do with a socialized alternative competition to Private Health Companies.

    He/She was merely drawing a comparison to the way we mail our important documents. You have choices (not very anti-capitalistic you see).

    You’ve just joined the ranks of “Spinner”.

    Nice to know you’ll have company eh DJ?

    Oiram (a1ed40)

  69. #61- Wrong spork. Weak design was indentified very early on but correction was deemed too costly a down time against schedule pressures with pre-sold cargo manifests. Tt was marked an acceptable flight risk among many, to be ‘fixed’ at a later date. Too late. Same with ta tile patch kit, on the boards in 1979 and never pursued until Columbia.

    #60- Spork, learn to read. And by the way, when you mail a USPS Express Mail letter, guess what, it goes by FedEx depending on the city. The USPS has a contract with them. Ask a postmaster in a big city sometime about it.

    DCSCA (9d1bb3)

  70. I promised I wouldn’t do this, but just to add to the lulz for our newly-returned blogger,

    Seems every cable system on Earth is a la carte, except in America.

    That statement is distinctly lacking in evidence. I know for sure that there are cable bundles in the UK, or you have to buy SKYTV bundles. AND pay the government your annual BBC fee for every television you own.

    Also, back to health care – “…purely for-profit system…” LOL 🙂

    carlitos (aa025a)

  71. #50- =yawn= If the boot fits, wear it. Did Texas cry “secede” yet this week or has Governor Perry asked for Federal aid from those nasty Yankees to the north instead. Hard to keep track.

    DCSCA (9d1bb3)

  72. Express Mail = Snail Mail

    There is a catchy ad campaign. Should put the USPS into the black in no time.

    carlitos (aa025a)

  73. Oiram – Where am I spinning? Be specific.

    JD (06f82d)

  74. Oiram – a socialized alternative competition to Private Health Companies

    And do you believe that the people responsible for the health industry regulations will allow actual ‘competition’? Especially if losing the competition means losing their jobs?

    Apogee (e2dc9b)

  75. I am serious. Since that one comment that Patterico elevated to a post, has ASPCA been honest about anything?

    Mike K – I actually agree with you about France. But I do have concerns over any system that allows over 15,000 people to die from summer.

    JD (06f82d)

  76. #72 a typo post. Intended for #58- =yawn= If the boot fits, wear it. Did Texas cry “secede” yet this week or has Governor Perry asked for Federal aid from those nasty Yankees to the north instead. Hard to keep track.

    DCSCA (9d1bb3)

  77. DCSCA, you asked for a coherent rational argument against a single payer system. Fine, let’s play.

    There are 5 major drivers of cost in health care.

    1. Intensity of services – The nature of health care in the U.S. has changed dramatically over the past century with longer life spans and greater prevalence of chronic illnesses. This has placed tremendous demands on the health care system, particularly an increased need for treatment of ongoing illnesses and long-term care services such as nursing homes.

    2. Prescription drugs and technology

    3. Aging of the population – Health expenses rise with age and as the baby boomers are now in their middle years, some say that caring for this growing population has raised costs. This trend will continue as the baby boomers will begin qualifying for Medicare in 2011 and many of the costs are shifted to the public sector.

    4. Administrative costs – the often cited belief that Medicare is more efficient is nonsense. Medicare’s costs do not reflect the costs of management, setting policy, or collection of funds, either through taxes or borrowing.

    5. Research – the US does more basic science and clinical research than any other country. In fact, the top 5 US research hospitals each do more clinical research than any other COUNTRY.

    Now, let’s look at who’s uninsured. The most common number is 46 million, although there’s a lot of fudge there. A quarter are in the country illegally -and there is no other country in the world that believes it’s their solemn duty to pay for health care for citizens of another country. A quarter could qualify for current programs, but haven’t bothered. A quarter could buy their own, but prefer not to. So you’re left with about 10 million people – out of 310 million.

    To quote David Gratzer, “Why is health care so different from other sectors of the economy? Simply put, consumers don’t pay for health care the way they pay for most other goods and services…Americans – whether privately insured or publicly covered – tend to be over-insured, and thus less sensitive to prices. And so we come to a paradox: American health care is so expensive because it’s so cheap. That is, with Americans paying just 14 cents out-of-pocket for every health dollar, they have little incentive to economize on health expenses. Americans have access to the most technologically sophisticated system in human history – yet pay pennies on the dollar out of their own pockets. The upshot? A health care system that is heavy in cost but not necessarily strong in satisfaction and uneven in quality.”

    Final thought to a very long post:

    Engineers often quote a slogan: “Quick, cheap, and good – pick any two.” For health care, this should perhaps be modified to “accessible, cheap, and good.” Experience in other countries with universal coverage is mixed at best, and represents significant compromise in care, whether in the form of waiting lists for non-emergent surgery, access to technology, or freedom in selection of caregivers.

    orthodoc (8ddac8)

  78. orthodoc – Thank you for the comment. Since MikeK is also a physician, do you agree or disagree with him regarding the French system?

    Apogee (e2dc9b)

  79. Nice try, Oiram, but it remains that DCSCA does not understand the factual basis for his own analogies. Hilariously so.

    DCSCA, no, I’m not wrong about the shuttle design problem with the segmented solid fuel boosters. The problem of gas cutting of joints was known in the ’70’s as a result of experience with the solid fuel boosters in Titan IIIC’s. The cost cutting that changed the reuseable liquid fueled lower stage to partially reused solid fuel boosters had occurred long before the Reagan administration.

    Express Mail is not snail mail. Learn something about the topics you so boldly opine upon someday.

    SPQR (72771e)

  80. Mom Blogs – Blogs for Moms…

    Anonymous (5fa9a5)

  81. They are not really reforming healthcare, as our actual care is world’s better than the rest of the planet. They are “reforming” health insurance, or rather, the delivery system for the care.

    JD (06f82d)

  82. Tap dancing. Get that man a cane and a straw boater…

    mojo (8096f2)

  83. By the way, a link on why preventive medicine doesn’t save money. That doesn’t mean it isn’t a good idea.

    Mike K (90939b)

  84. Mike K., have you noticed how everyone has completely forgotten that those evil HMO’s were originally a Democratic concept to improve health care decades ago. Now they are the Democrats boogy-man.

    SPQR (72771e)

  85. More DuckCrap….
    “…Simple postage stamps were a nickel for decades and jumped a penny or two in the 1960s and only began to soar when the postal service was pressed to be profitable…

    Actually, the prevailing rate that I remember was 1-cent for a postcard, and 3-cents for 1st-class mail (don’t you remember the “penny post-card”?).
    And, all of these Post Office/Postal Service reorginizations were undertaken by Congresses under the full control of the Democrat Party, prior to 1994.

    AD - RtR/OS! (b782d3)

  86. A history of postal rates in the United States…

    AD - RtR/OS! (b782d3)

  87. Re: #78 As you said – approx one quarter of the uninsured dont buy health insurance but can afford insurance. I for one can easily afford health insurance, but choose not to because the cost of full health care, doctor visits, hospital stays, prescription drugs etc are far less than my cost of premiums (even with a very high annual deduct $10k)- why pay for health insurance when the risk of health costs exceeding the premiums is less than 5%

    Joe - Dallas (6f50bd)

  88. As with other plans coming out of the WH, there is the distinct feeling that the more they claim it will save, the more leery we become. Where are the solid numbers and specifics? The particulars seem much more difficult and nebulous than the overall grand scheme. But one without the other is, well, nothing. (And I keep remembering Hillary’s healthcare debacle).

    but I have a shorter fuse than I used to for personal attacks on my threads.

    This is good news and it’s about time. There is a fine line between gracious tolerance and submitting oneself as a target. Serious people giving serious thought to a post and subsequent debate and discourse by default will not be making personal attacks. If they are then that evidences anything but seriousness, rather instead a childish self-centeredness which deserve nothing in return but a time-out in their little chairs.

    Dana (4a6e8c)

  89. Dana – 5:14 – I second the motion. Debate can get dicey, and people’s emotions can get the best of them, but a constant inability to engage in anything other than attacks is not worthy of tolerance.

    Apogee (e2dc9b)

  90. I’ll raise you one more, Apogee: while an inability to engage in anything other than attacks is not worthy of tolerance, it also stands to reason that if one continues to tolerate such behavior directed at them and even attempts to engage them, they too are complicit in the pathology!

    Dana (4a6e8c)

  91. Just a thought:
    Today’s announcement from the WH that the current deficit will be $1.8T…
    That matches the entire Federal spending in FY-2000.

    I’m sure glad that the Best & Brightest are leading us into Hope & Change!

    AD - RtR/OS! (b782d3)

  92. AD – Why must you be so racist?

    JD (06f82d)

  93. #80- I’m not wrong about the shuttle design problem with the segmented solid fuel boosters. =yawn= yes, spork, you are. But it’s off topic and nobody mentioned the Titan except you. A bit anal, aren’t you. Care to buck and wing to another problem to cover your butt as well? And surprise, Express Mail does go by Fedex outta LAX to most key cities. Interesting contract. Ask the postmaster. I did. Interesting rationale. Only you seem to equate snail mail with Express Mail.

    DCSCA (9d1bb3)

  94. #85- For the benefit of the uneducated, and AD – RtR/OS, a penny postcard is a different entity from ‘simple postage stamps.’ My, the conservatives are anal today. Waiter! Bran muffins for the right all around today.

    DCSCA (9d1bb3)

  95. Begging you all to ignore this guy

    carlitos (aa025a)

  96. Foghorn @94 – Wrong again. You introduced the subject of the Challenger to the thread in comment #49.

    daleyrocks (5d22c0)

  97. DCSCA,

    Orthodoc left a lengthy comment for you here that you’ve ignored. Please respond to Orthodoc’s comment before you post any more comments.

    DRJ (b0f193)

  98. Several people went to much effort to post comprehensive comments and rebuttals to the inanity that ASPCA has been posting, and rather than respond in kind, it regales us with tales of calling the posmaster, and its expertise in all things NASA.

    JD (06f82d)

  99. Hey, DRJ—welcome to TrollFest 2009. I’m interested to see your approach to dealing with this sort of thing.

    Eric Blair (262ccd)

  100. Carlitos – I would ask only that instead of attempting to persuade the commenters to ignore the rantings, you attempt to persuade DRJ to do something about it.

    I’ve already pointed out why argument with what Dana so eloquently agrees is a ‘pathology’ is completely ineffective.

    Apogee (e2dc9b)

  101. DRJ is apparently faster acting than my typing skills.

    Apogee (e2dc9b)

  102. Actually, DRJ, I just saw your response to TrollFest 2009. I hope it works out.

    Dana’s post made me think of a concept from the Evil 1980s:


    What do you think, Dana?

    Eric Blair (262ccd)

  103. ASPcA disappeared quickly, huh?


    JD (06f82d)

  104. #98- Quite the contrary and how tartfully rude of you to single me out. You’ll note upon careful reading that several of your regulars tend to sling some nasty plates of hash my way which at times requires a quick mop-up. I’m sorry I’m not on YOUR schedule for responses. Since orothodoc left a thoughtful, lengthy post it DOES require some thought to read, process and respond as it is an attempt to converse, albeit with a conservative bent. Or would you prefer more hash slung. It’s a thoughtful position he presented. Still, upon first reading, one has to suspect the motives of any physician proposing the administration of a basic public healthcare system that might actually be a threat to a private system and reduce possible earning potentials. But upon reading the response he’s saying- 1. Americans are overmedicated, right? 2. See number 1. 3. Baby boomers. The world does not revole around you, healthcare et al., 4. Costs. Lets get some real world costs- When a 500mg Tylanol costs $22 in a ER and a bottle of the same OTC pills are $5 for 200 at CVS, something is wrong. Same with $900 for a 2 mile ambulance ride. Basic stuff. 5. Research. Now that a valid area to discuss and I am a strong advocate of same as my late grandfather worked with Jonas Salk to get funding for the Salk vaccine. But does United Airlines charge for R&D costs to Boeing when you buy a plane ticket? Or are is the Wright Brothers estate paid a fee? Doubtful. A lot of funding for research is couched in government grants and not just the private sector. and the U.S. is not the only nation that conducts medical research. My own nephew is involved in microbiology research at Scripps and his research is chiefly funded by a government grant.

    I will agree that the cheaper, faster, better engineering anthem is not a wise dictum to follow, as it was mediocre at best in the dan Goldin days at NASA. But the astronomical healthcare costs might be couched in nothing to do healthcare itself, but the legal system- ie., malpractice. Regardless, I see nothing for private health providers to fear from a universal healthcare system that delivers affordable healthcare to all Americans. And for the record, O do not have health insurance. I gave it up. I never had to use it, thank God, but the premiums tripled between 2000 and 2007, so I dropped it. Too damn costly. And that’s what President Obama wants to address.

    DCSCA (9d1bb3)

  105. Yes, JD, although I expect a ‘response’ filled with references to radio hosts, political generalities, NASA and the postal service. In effect, an incoherent version of “No! You’re wrong!”

    Apogee (e2dc9b)

  106. I knew I forgot something – name dropping.

    Apogee (e2dc9b)

  107. “tartfully?” What an asshole.

    carlitos (aa025a)

  108. DRJ, see #104. More hash to mop up.

    DCSCA (9d1bb3)

  109. DRJ, please feel free to boot him. He is testing you. You stated the rules, and he is seeing how close he can get to getting tossed.

    It’s a game to him. Please don’t play it.

    Eric Blair (262ccd)

  110. DCSCA,

    Tartfully rude — sounds rather bittersweet. I don’t think of myself that way but Who knows? As for singling you out, I try to read all the comments on my threads and I respond as I see fit, just as I suspect you do.

    I’m glad you thought Orthodoc’s comment was thoughtful and deserves a thoughtful response. I agree. Feel free to take your time in responding further, and I hope Orthodoc makes a return visit to discuss your response.

    DRJ (b0f193)

  111. Fanciful name dropping and a nasty slur against DRJ — how classy!

    Brother Bradley J. Fikes, C.O.R. (0ea407)

  112. DRJ, see #106, 107, 108. More hash. More Spic ‘n Span.

    DCSCA (9d1bb3)

  113. ZOMG – An insta-classic. DRJ is a tart. So, ASPCa is a sexist. The rest is simply comedic gold. Salk. NSA. CBS. NASA. Von Wilder 😉 What a buffoon. It forgot Boss Limbuagh, Hannity, the Empire State Building, and 1+1=2, not 11.

    JD (06f82d)

  114. #111= 🙂 tart-bittersweet. I’m sure there’s a candy someplace in our childhoods we both enjoyed.

    DCSCA (9d1bb3)

  115. Foghorn –

    “Regardless, I see nothing for private health providers to fear from a universal healthcare system that delivers affordable healthcare to all Americans.”

    But in the first paragraph of your comment you said:

    “Still, upon first reading, one has to suspect the motives of any physician proposing the administration of a basic public healthcare system that might actually be a threat to a private system and reduce possible earning potentials.”

    You need to finalize a narrative and stick with it instead of contradicting yourself within the same comment. People sling hash at you because you don’t make sense, lie, and make shit up.

    daleyrocks (5d22c0)

  116. Co-dependence works.

    I’ll address DCSCA directly because it makes me nuts when people talk about someone as if they aren’t here ‘listening’: I remember DCSCA that you wrote a lovely comment on the Ann Coulter eulogy for her mother. I was moved by the thoughtful quietness, intelligence and depth of your insight. It was most unexpected and yet a pleasant surprise. So it’s always a bit disappointing and very puzzling to know you are that person but would rather be this instead. Disappointing because you’ve got a lot more on the ball than settling for being a troll and puzzling because seriously, what a waste.

    Dana (4a6e8c)

  117. Apparently, DRJ, this is his blog and you’re simply a guest here. Oh, and his ‘schedule’ is also apparently none of your business.

    As to the response – absolutely incoherent. About as lazy an effort as could be slopped together to prevent excoriation. Not only were the ‘responses’ simply mischaracterizations of the questions, they were dismissive in a way that screams of covering an inability to actually address them.

    This should not be so difficult.

    Apogee (e2dc9b)

  118. But does United Airlines charge for R&D costs to Boeing when you buy a plane ticket? Or are is the Wright Brothers estate paid a fee? Doubtful.

    As my dear old friend Pauli said to me about such gibberish, “That’s not right, it isn’t even wrong.”

    Brother Bradley J. Fikes, C.O.R. (0ea407)

  119. 112.– Yes, and effectively used, too. Thankfully you and your children dont have to fear polio today.

    DCSCA (9d1bb3)

  120. Dana – I like talking about ASPCA as if he’s not around because he craves attention. He doesn’t like it if you ignore him and talk to others, especially about him.

    Sorry if it annoys you. I can stop or cut down on it if you would like.

    daleyrocks (5d22c0)

  121. 1+1 does not equal 11, Fikes. Go back to Boss Limaugh and get some new thoughts and talking points.

    JD (06f82d)

  122. “Quite the contrary and how tartfully rude of you to single me out.”

    DCSCA, I have placed you in moderation.

    #1: DRJ made a request of you and you did not comply.

    #2: You called DRJ rude.

    Your next approved comment will a) comply with #1 and b) apologize for #2.

    If neither a nor b is met, you will not have another approved comment.

    Patterico (cc3b34)

  123. That’s fine, daley (#121), it’s just not my style…

    Dana (4a6e8c)

  124. “But does United Airlines charge for R&D costs to Boeing when you buy a plane ticket? Or are is the Wright Brothers estate paid a fee? Doubtful.”

    I think everyone who read that is more stupid for having done so. Once you have read something, you unfortunately cannot unread it.

    daleyrocks (5d22c0)

  125. Dana – it makes me nuts when people talk about someone as if they aren’t here ‘listening’

    The level of pathological dishonesty he shows precludes my interaction. I’ve pointed out his rants and inability to communicate rationally. These issues effectively render him absent from the debate, regardless of your intent to engage him.

    Apogee (e2dc9b)

  126. Apogee, it’s awkward for me to talk about someone else when they’re in the room, and I have no expectations.

    About as lazy an effort as could be slopped together…

    I liked this immensely: a good reminder to me to think first, (second and third) and then maybe comment! No slop here. 🙂

    Dana (4a6e8c)

  127. Sorry, daleyrocks,
    It was a perfect piece of inanity that cried out for a closer look. So here’s the unspoken part of what I wrote:

    Of course, airline passengers do ultimately pay Boeing’s R&D costs. After all, Boeing doesn’t give the planes away, it sells them to the airlines. And the airlines recoup the cost of buying the planes by selling tickets to the passengers.

    Well, that’s supposed to be the business model anyway, but only Southwest seems to be consistently good at it.

    Brother Bradley J. Fikes, C.O.R. (0ea407)

  128. Well, that’s the end of DCSCA…

    Scott Jacobs (90ff96)

  129. Also, I think it would be a lovely gesture if, upon failing the task Patterico set for him, we get to find out who the hell he is.

    Scott Jacobs (90ff96)

  130. You reichwingnutters are just following orders from Boss Limbaugh.

    JD (06f82d)

  131. Dana – with you, there’s almost never any slop. That being said, I don’t expect perfection from anyone (largely due to my inability to attain it). I do, however, expect a level of decency that is indicative of a coherent viewpoint. Someone holding a piece of broccoli to their eye and exclaiming that they are concealed from the outside world gets old very fast.

    And your link to the Coulter Eulogy was brilliant, and altered my impression of his capabilities. How that level of decency and coherence can vanish on a dime, unfortunately, still speaks to me of disorder.

    I cannot say this enough: I value the work of Patterico, DRJ, Karl, Jack, etc., and childish, inane and worthless charades meant to distract and feed pathologies demean the discussion, which I view as an affront to the posters’ efforts.

    Apogee (e2dc9b)

  132. Scott Jacobs – Well, that’s the end of DCSCA…

    If true, what a gift.

    Apogee (e2dc9b)

  133. Don’t be too sure, Scott; my guess is it will probably make some tepid apology, calculated to be the minimum acceptable. It just can’t stand being shut out from all of us having fun here.

    Brother Bradley J. Fikes, C.O.R. (0ea407)

  134. Oh, c’mon, Scott. You know who he is:

    Eric Blair (262ccd)

  135. And despite the troll infestation, I do mean fun.

    A great blog host with guest hosts who give us well-written, informative posts. And a commenter community with quick neural synapses.

    I can see why malcontents would be jealous and want to harm the excellence they themselves cannot reach.

    Brother Bradley J. Fikes, C.O.R. (0ea407)

  136. It’s apparent DCSCA has a history here but he’s in moderation and will probably be there for some time, so let’s not worry about that right now. In the meantime, I’d like to talk about socialized (or quasi-socialized) medicine since it looks like that’s what we’re going to have. DCSCA says he is uninsured so I can see why that would appeal to him. I can also see how people who have high medical costs and/or pre-existing medical conditions would agree, and I sympathize with that perspective. It’s pretty hard to worry about long-term health care issues when you can’t afford care in the short-term.

    Nevertheless, I worry about the factors raised by Orthodoc’s comment, especially the notion that socialized medicine will impair research and result in rationing of health care. It’s like Europe but perhaps worse, since America is so geographically large that it may be only the metropolitan areas that will have access to specialized health care.

    DRJ (b0f193)

  137. DRJ,
    You should check out the work of Dr. David Gratzer, who has done some excellent work on how the free market can solve the problems of access and cost for health care. Gratzer has debunked some myths about American health care, such as the supposed crisis of the uninsured.

    Brother Bradley J. Fikes, C.O.R. (0ea407)

  138. I will actually miss it. About once out of every 250 comments, it says something interesting, or even thought provoking. It quickly returns to form after that, unfortunately. I wish there were more here that disagree, but in an honest manner. So many, especially recently, are simply arguing with a caricature of those evil homophobic racist conservatives, a caricature that exists only in their head, spewing out the latest meme of the day from Olberman, TPM, Media Matters, etc …

    JD (06f82d)

  139. DRJ,

    Don’t bet on having socialized (or quasi-socialized) medicine just yet. For one thing, Congress hasn’t figured out where the money comes from — and unlike the financial bailouts, really can’t get away with not figuring that out.

    I’ll post my analysis of today’s photo-op and the latest developments in the House tomorrow.

    Karl (3bf5f8)

  140. DRJ – I asked Orthodoc his opinion of the French system outlined by Mike K, but I am assuming that Orthodoc is actually out there helping people and not on the internet as much. That is a discussion (between two intelligent medical professionals) for which I would like to be a fly on the wall.

    What worries me is the constant ‘angle’ of this administration (and much of DC) that the appearance of an act equates with the act. This country has great health care, and really doesn’t need it to be altered. The problem seems to be with the allocation of payment responsibility, and the numbers relating. The two are often conflated, however, which speaks to me of a looming problem. Everyone who isn’t high understanding that top down command and control systems could never possibly ‘run’ health care in any efficient manner. This is the disaster of which I worry.

    The need to ‘give away’ ‘free’ medical care is the problem. If citizens paid even something for their care, then more accurate measures could be put in place as to the necessary allocation of funds. Orthodoc is right, the system as it is now is dysfunctional due to the lack of interconnect between fees and services.

    Apogee (e2dc9b)

  141. DRJ, Mike K. (whom I confusingly call “Dr. K.” since he is an MD) has written a number of posts on his blog regarding the enormous mess we have with medical insurance. He convinced me, with data, that the French “hybrid” model may well be worth considering.

    I won’t steal his thunder, but what Dr. K. says makes a lot of sense. Maybe he will post the links.

    Socialized medicine generally does result in rationing. That has pretty much been the pattern. Folks who like the idea of socialized medicine tut-tut about it, saying that the many stories are scare tactics, but I notice that they aren’t living under that regime. Or they are young and healthy. Me, I hear too many horror stories—like kidney transplants being denied to people over 55. Maybe it is true, maybe not. But I know that Canada ships people down here for some medical procedures, and Dr. K. has some horror stories about medicine in Canada as well.

    I hope he has read this far on the thread and contributes.

    There is also a book well worth reading on this topic, though it comes at the subject from a Libertarian/Capitalist perspective (though I am not a Libertarian like my colleague Bradley Fikes).

    The Cure: How Capitalism Can Save American Health Care, by David Gratzer. It has an introduction by the late Milton Friedman, so it is worth your time, regardless of how anyone feels about the subject.

    I slip copies to the premeds on the sly, since the current Premedical Committee literally tells the premed students during mock interviews that the Cuban system is superior to our own. Really and truly.

    Eric Blair (262ccd)

  142. Of course those industries are cooperating with Barcky. After seeing the way that Teh One and his henchmen attacked and intimidated the Chrysler creditors, they have to be concerned about the blow-back should they not go along with Teh One.

    JD (06f82d)

  143. Heck, Bradley, you beat me to it with the Gratzer book!

    Eric Blair (262ccd)

  144. Bradley,

    That’s an interesting link. I know it sounds like I’ve given up on free market health care. I haven’t, but I have the feeling most Americans have.


    I look forward to reading your post. I’ve said it before and it’s still true: I learn something from you everyday.

    DRJ (b0f193)

  145. DRJ, I highly recommend the Gratzer book.

    Just remember how many people take Michael Moore’s “Sicko” seriously. Remember how he kept talking about “free” health care?

    It’s not free. It’s just that people don’t pay for it directly. The money has to come from somewhere.

    Unless it is borrowed from our grandchildren, I guess.

    Eric Blair (262ccd)

  146. JD – I will actually miss it.
    Since this is a medical discussion, I will tell you to take two aspirin and comment in the morning. You are obviously taken with the swine flu, bubonic plague, the vapors, and Ebola Zaire concurrently, and need plenty of bed rest. Hallucinations such as these are quite serious.

    I get your point, however, and I would say that it is my feeling that the ‘trolls’ are partly responsible for the lack of more intelligent and coherent commenters who disagree. This is an intelligent, fun and thoughtful site, and we already have some good dissenters. As the wheat field said: “If you ban them, the good ones will come”

    Apogee (e2dc9b)

  147. Eric Blair,

    I’m not trying to be disagreeable, especially since I suspect there is very little in life you and I disagree on, but I believe the mood is such that America will soon have a form of socialized health care. In addition, I think people’s desire for socialized medicine will increase in the near future. The more turbulent and uncertain the economy gets, the more people will want a health care system that they believe will be there to take care of them.

    I suppose it’s similar to predicting the stock market, which makes me the bear market forecaster. I hope I’m wrong but that’s where I am right now.

    Thus, instead of coming up with reasons why we shouldn’t adopt socialized medicine, I admit I’m more interested in thinking about what it will be like once we get there.

    DRJ (b0f193)

  148. Eric Blair,
    I mentioned the Gratzer book to Mike K. a while back, but don’t think he’s read it yet. Maybe he’ll give it a spin. It would nicely compliment his own book, which ends with health care economics.

    Brother Bradley J. Fikes, C.O.R. (0ea407)

  149. Well, if PCMCIA can be booted for lack of coherency as well as disrespect for basic politeness to those disagreed with, can the other troll be far behind?

    I might even come back and participate again. (Not that I’m of great value, but I enjoyed reading the blog and comments until the trolls got free rein and polluted every argument.)

    steve miller (6264b2)

  150. I wouldn’t mind books complimenting their peers as long as they keep the volume down.

    steve miller (6264b2)

  151. but I believe the mood is such that America will soon have a form of socialized health care.

    It’s interesting to read all the comments and our president’s ‘plan’. The underpinning on his part (and his administration’s and perhaps the majority of the public) is due in large part (or perhaps a precursor to) a dramatic change in thought re health insurance: it is no longer considered a privilege but rather a right and all citizens are entitled to it… there has been such a dramatic change in thought and yet it crept in incrementally.

    The unintended consequences will be telling – and costly – to see played out.

    Dana (4a6e8c)

  152. “JD – I will actually miss it.”

    Dude, how’s your program?

    daleyrocks (5d22c0)

  153. Eric, I haven’t thought of that show in AGES!!!

    Thank you!

    @DRJ; I find it odd that DCSCA is uninsured, and I do believe he’s a columnist somewhere. Unless I’m mistaken.

    As for rationing, it is absolutely inevitable if we do as Pres. Obama wishes. Right now, the cost of medical proceedures helps keep demand down. If you remove cost, what we can reasonably call “infinite demand” will occur, and since the supply will not increase by equal measure, and since cost can not become a factor, the controling body (the govt) will have to limit access.

    Over 80? No new hip for you.

    Heavy smoker with a crap diet? No access to bypass surgery.

    It is absolutely inevitable, and the hardest hit by this will be the elderly due to “short life expectancy” and “quality of life” concerns. Just you watch.

    Scott Jacobs (90ff96)

  154. Apogee – As always, good points. No, I am not sick 😉

    I would note that my pleasant engaing easy-going temperment has been less so recently. I have been short and abrupt with some non-mendoucheous types, primarily due to the constant barrage from the mendoucheous types. Couple that with my trying to quit smoking and drinking soda, and it is not a good combination.


    JD (06f82d)

  155. Comment by steve miller — 5/11/2009 @ 10:00 pm

    I dunno. I don’t think most trolls are dumb enough to insult DRJ right outta the gate…

    Scott Jacobs (90ff96)

  156. DRJ, you are never unreasonable from where I read your words. And I don’t really mind when people disagree with me. Heck, the one thing I am less sure of as I grow older is my own certitude.

    One thing that I feel passionately about is that, over the last thirty years, Big Government has pushed a passive, dependent, group identity mindset on the public. I see it in my classrooms. Folks seem to accept things as being true based on feelings, without looking at the facts.

    Like the “the Cuban medical system is superior to our own.” In one case, the person pushing this crowed about Cuba having a lower infant mortality rate than here. The reason was not very noble: in Cuba, women with difficult pregnancies are pushed very hard to terminate the pregnancy. Here, we try everything. Hence the statistic.

    But in a larger sense, many folks today have forgotten a critical equation: freedom times security equals a constant. The more freedom, the less security. The more security, the less freedom.

    The SF writer Larry Niven was the first person I knew of to write that down, but it may be much older.

    It’s similar to the engineering rule that I read in one thread today: good, fast, cheap—pick any two. But Michael Moore said that we could have “free” health care. And Tylenol costs 22 bucks a pop in the ER. And there are sick children everywhere. And…and…and…the press pushes very hard on this. How it feels. Not the facts.

    You are probably right that we will get some form of socialized medicine in this nation soon. But I doubt that our experiences will be different from the UK or Canada.

    And the sad, sad part to me is that the politicians who put it into place will never use that form of medical care. They will get something better. As usual, the politicians (and this is wholly nonpartisan) very much want other people to sacrifice. Sacrifice isn’t for the aristocrats.


    Eric Blair (262ccd)

  157. Scott, you seem pretty young for Rocky and Bullwinkle. But I am glad that you enjoyed the link.

    Eric Blair (262ccd)

  158. Dana – it is no longer considered a privilege but rather a right and all citizens are entitled to it…

    What’s interesting is that the concept of ‘insurance’ must be changed for this to come to fruition. Insurance costs something – think Blackjack – but the idea of a ‘right’ is something that exists separate and above external influence – and in every other sense commands the removal of external barriers, not the granting of services. For health insurance to be a right necessitates that it is no longer ‘insurance’, but the legal coercion of goods and/or services.

    Whatever happens, it will be the same system as we have now. The wealthy and connected will have access to superior health care, because there will be a market for it, and an understanding between elites. The poor will have to make due. For it to morph into something that actually works would require the realization of the founding fathers’ vision of equal opportunity coupled with accountability.

    Apogee (e2dc9b)

  159. DRJ – I’m in agreement with a number of the commenters above that a large part of the debate is over cost shifting. When employers try to shift some of the cost increases onto the employee portion of health insurance premiums or modify copays or deductibles to reduce premium increases, people allof a sudden get sticker shock over how much medical care and insurance actually costs. People who become unemployed and begin paying their own premiums under the provisions of COBRA face the same things. Union contracts with small or no copays face strong resistance to changing those items when they are suggested at negotiation time.

    We have plenty of medical care in this country. The question seems to be who should pay for it. The left seems to view it as a right. Properly priced insurance over time should be like a bank – some years the insurer comes out ahead because the insured doesn’t use the policy much, other years the insured comes out ahead. If the interests of both are aligned, nobody should be ripping the other off. Since the left seems to have a fundamental difficulty understanding capitalism, it’s not surprising they see socialism as the answer.

    daleyrocks (5d22c0)

  160. As usual, the politicians (and this is wholly nonpartisan) very much want other people to sacrifice. Sacrifice isn’t for the aristocrats.

    That’s very Randian of you. And I mean that as a compliment, btw. Obama tells the shivering D.C. plebes they need that flinty Chicago toughness, then retreats into his orchid-climed Oval Office.

    Brother Bradley J. Fikes, C.O.R. (0ea407)

  161. Bradley – Thanks for mentioning Boeing and the planes. That was a direction I did not think worth pursuing with that individual. One of his relatives probably helped design a bunch of those planes, doncha know.

    daleyrocks (5d22c0)

  162. The Bozo Show… Introducing the young to the classics!

    Scott Jacobs (90ff96)

  163. Scott – I thought Hax/Bunkerbuster was the alleged journalist, not Walter Mitty.

    daleyrocks (5d22c0)

  164. Who can tell the difference anymore?

    Scott Jacobs (90ff96)

  165. Yes, bunker/Hax was the journalist, although it wasn’t keen on its profession being known.

    I can’t imagine why.

    Brother Bradley J. Fikes, C.O.R. (0ea407)

  166. Where is Glenn Greenwald, when you need him.

    Or his sock puppets, anyway.

    Eric Blair (262ccd)

  167. Bradley, I sent you a great Jonas Salk story, BTW.

    Eric Blair (262ccd)

  168. daleyrocks – a large part of the debate is over cost shifting

    Agreed, but the shift is also from the ‘uninsured’ to the insured, as the law requires treatment for any patient, insured or not. It is also the uninsured who rack up quite a considerable amount of the cost, (as attested by my friend who runs an E.R.) which must be shifted to the insured – hence the evil 22.00 tylenol capsule.

    What things cost, the reasons for the cost, are available, but not sought out because for many trying to ‘help’, this isn’t about health care.

    It’s about controlling a large segment of the economy, with all the perks that go with it.

    Apogee (e2dc9b)

  169. “Agreed, but the shift is also from the ‘uninsured’ to the insured”

    Apogee – I understand and agree, but insurance trage groups have signalled a willingness to be flexible if the younger, healthier postion of the uninsured cohort is forced to participate in any plan and not just those uninsured due to preexisting conditions. Again, I think there’s a fundamental understanding out there of how insurance is priced, especially group type policies.

    daleyrocks (5d22c0)

  170. daleyrocks – I may not have been clear – I agree that the insurance industry knows costs. My worry is that, like taxes, whole income groups will be exempt from paying anything, which, AFAIC, is the problem now.

    Apogee (e2dc9b)

  171. since the current Premedical Committee literally tells the premed students during mock interviews that the Cuban system is superior to our own.

    It would be the height of gall for anyone in such a group, or throughout the medical community in general, to claim that a Communist nation’s healthcare system is so glorious and beautiful when he or she boasts a salary that isn’t exactly communistic—ie, very modest, very proletarian.

    For doctors and top-echelon nurses in America who are big fans of the left — who look dreamily at politicians like Obama and the idea of socialized medical care — I say step up to the plate, put your money where your mouth is, and help curb the high cost of medical care. You can begin by significantly reducing your own wages and tossing out most of the perks (eg, a nice house, a nice car, a nice stereo, nice HDTV, nice cell phone, etc) you’ve collected along the way.

    Mark (411533)

  172. Great Salk story, Eric!

    I saw Salk in the early 90s, speaking at a biotech event. It’s amazing what he did with the Salk Institute in attracting great researchers.

    Brother Bradley J. Fikes, C.O.R. (0ea407)

  173. Lots of academic docs assume that a change to a government program will not affect them economically, and they may be right. I have done some analysis of health reform and have a list of posts, including an analysis of the French system, which I think has promise as a model for us. I’ve been reading about the Obama proposals and will do another post soon. If anyone is interested in my thoughts, go to the blog and “health reform” as a category.

    Mike K (90939b)

  174. Eric, Apogee, and daley,

    I agree with what you’ve said and this may be repeating it. If so, I apologize but it helps me think things through.

    I worry that Congress and Obama will push us even further toward a two-tiered health care system — an elitist, dual system of government health care and doctors/medical centers that cater to people who can pay. Not only would this perpetuate an inefficient allocation of costs, I’m afraid it would also result in undesirable social costs.

    Could it be worse than full-blown socialized medicine? I have no idea, but I’m reminded of what has happened to our public schools. Those who could afford it moved to good school districts and/or paid for private schools, leaving the majority to languish in under-performing public schools. The poor suffered with a dismal education while the middle class and wealthy bore a heavy economic burden. It’s a lose-lose, and I’d hate to see America go down that path with health care.

    DRJ (b0f193)

  175. I’m interested, Mike K. I’ve read your posts before but I think it’s time to read them again.

    DRJ (b0f193)

  176. Obama did not address the mechanisms that will deliver this reduction in health care costs

    Of course, not. And why would he? After all, if someone who should have known better, who should have been less disengenous about such things (ie, Mitt Romney) is going to play a cynical, manipulative game — then you can be sure the guy currently occupying the Oval Office is going to be ten times — no, make that a thousand, or a million, times — worse.

    Wall Street Journal, March 27, 2009:

    Praise Mitt Romney. Three years ago, the former Massachusetts Governor had the inadvertent good sense to create the “universal” health-care program that the White House and Congress now want to inflict on the entire country. It is proving to be instructive, as Mr. Romney’s foresight previews what President Obama, Max Baucus, Ted Kennedy and Pete Stark are cooking up for everyone else.

    In Massachusetts’s latest crisis, Governor Deval Patrick and his Democratic colleagues are starting to move down the path that government health plans always follow when spending collides with reality — i.e., price controls. As costs continue to rise, the inevitable results are coverage restrictions and waiting periods. It was only a matter of time.

    They’re trying to manage the huge costs of the subsidized middle-class insurance program that is gradually swallowing the state budget. The program provides low- or no-cost coverage to about 165,000 residents, or three-fifths of the newly insured, and is budgeted at $880 million for 2010, a 7.3% single-year increase that is likely to be optimistic.

    The state’s overall costs on health programs have increased by 42% (!) since 2006.

    Like gamblers doubling down on their losses, Democrats have already hiked the fines for people who don’t obtain insurance under the “individual mandate,” already increased business penalties, taxed insurers and hospitals, raised premiums, and pumped up the state tobacco levy. That’s still not enough money.

    So earlier this year, Mr. Patrick appointed a state commission to figure out how to control costs and preserve “this grand experiment.” One objective is to change the incentives for preventative care and treatments for chronic disease, but everyone says that. It sometimes results in better health but always more spending. So-called “pay for performance” financing models, on the other hand, would do away with fee for service — but they also tend to reward process, not the better results implied.

    What are the alternatives? If health planners won’t accept the prices set by the marketplace — thus putting themselves out of work — the only other choice is limiting care via politics, much as Canada and most of Europe do today.

    The Patrick panel is considering one option to “exclude coverage of services of low priority/low value.” Another would “limit coverage to services that produce the highest value when considering both clinical effectiveness and cost.” (Guess who would determine what is high or low value? Not patients or doctors.) Yet another is “a limitation on the total amount of money available for health care services,” i.e., an overall spending cap.

    The Institute for America’s Future — which is providing the intellectual horsepower (we use the term loosely) for reforms like those in Massachusetts — argues that the cost overruns prove the state must cap how much insurers are allowed to charge consumers and regulate their profits. If Mr. Patrick doesn’t get there first, that is. He reportedly told insurers and hospitals at a closed meeting this month that if they didn’t take steps to hold down the rate of medical inflation, he would.

    Even the single-payer cheerleaders at the New York Times have caught on to this rolling catastrophe. In a page-one story this month, the paper reported on the “expedient choice” that Mr. Romney and Democrats made to defer “until another day any serious effort to control the state’s runaway health costs. . . . Those who led the 2006 effort said it would not have been feasible to enact universal coverage if the legislation had required heavy cost controls. The very stakeholders who were coaxed into the tent — doctors, hospitals, insurers and consumer groups — would probably have been driven into opposition by efforts to reduce their revenues and constrain their medical practices, they said.”

    Now they tell us.

    Mark (411533)

  177. Good to have you back DRJ.

    daleyrocks (5d22c0)

  178. […] Obama’s “watershed” photo-op with industry groups on healthcare “reform” was anything but a watershed. Keith […]

    The Greenroom » Forum Archive » Government Heatlhcare Takeover: State of Play (e2f069)

  179. Someone holding a piece of broccoli to their eye and exclaiming that they are concealed from the outside world gets old very fast.

    Funniest comment of the day, and it rings true as well. The next time anyone accuses this blog and it’s commenters as being intolerant, I will gladly point them in the direction of the banned Troll, and list for them how many rants it was allowed to post over the past few months, without any warnings of banning or requests to change it’s content – free inanities. In short, it was allowed to dominate many threads via it’s threadjacking, and the less of that we see in the future, the better.

    Dmac (1ddf7e)

  180. The Patrick panel is considering one option to “exclude coverage of services of low priority/low value.” Another would “limit coverage to services that produce the highest value when considering both clinical effectiveness and cost.”

    This is a fallacy that most reformers visit at least once. About 20 years ago, when I was still involved in medical politics, the state of Oregon had as governor an ER doc who was pretty smart and he decided to modify the Medicaid program to try to get some order of priorities. The problem was that one liver transplant would cost as much as hundreds of simple health checks and so on.

    They got a consulting firm to draw up a way to rank health interventions (a health bureaucracy term that is common) from the least cost effective to the most. They used criteria of commonness and cost to try to do the ranking and ended up with a list that ranked the common cold as #1 priority of Medicaid.

    Oops !

    They had to go back and start over with new criteria. It isn’t easy and I think they may finally have abandoned the effort. One big problem Canada got into was the concept of what will appeal most to voters. That turned out to be free office visits to GPs so the GPs offices in Canada are full of worried well while sick people get short shrift. If Canada had allowed private care, they would have had an outlet that made some of the absurdities obvious but they didn’t. That’s why, I think, your concern DRJ about two-tier medicine, while well intentioned, misses the value of the parallel systems.

    The government program can do the basic things like accident care, routine illness that can be quantified (heart attacks, broken hips, appendicitis) and well baby care. The less obvious things, like geriatrics, plastic surgery, and more controversial things like chiropractors and acupuncture, should be left to private care. If it is advertised on TV, it is probably optional and should be private.

    If you start covering the optional stuff, costs quickly go out of sight. I do utilization review for workers comp and the fraud and abuse is amazing. Trying to mow down some of the weeds is a full time job and the dodges change every few months. The latest is sale by the doctor’s office of compounded pain medications at grossly inflated prices. It appeared about 9 months ago and some compounding pharmacy got the idea of marketing this stuff. You can buy three 15 gram tubes of capsaicin cream (the stuff that makes chili peppers hot) on for $20.00. The compounding pharmacies sell this to doctors to sell to workers comp for $500 a 60 gram jar by adding a couple of other topical drugs, some of which are not FDA approved for topical use. The insurance companies are asking us for reports on whether this stuff is appropriate. It’s not but the theory seems to be that enough slips through that it pays for itself with a profit.

    Healthcare is full of this sort of thing. Lobbyists get legislatures to include things like dance therapy in MediCal in California. I have seen cases in which carpal tunnel syndrome was being treated with “out of body experience” therapy. I talked to the woman who was doing this treatment and she was, I think, serious but a nut. The state was paying for it.

    That’s why you have to have some scientific criteria. Go to a pharmacy. Look at what is on display. The insurance and Medical payments for scientific drugs is so poor that pharmacies have gone big time into health foods and all sorts of “alternative treatment.” I don’t blame them but I don’t want taxes paying for it. There are powerful advocates for this nonsense. The wife of one of the founders of a big computer company in Orange County has donated a lot of money to UCI to start a program on “research” on alternative medicine and the department of full of chiropractors and acupuncturists who will, no doubt, find lots of evidence that they can publish in their own journals.

    Anyway, this health plan will be full of politics because the advocates of science are not very political. The French are far more practical. No BS. They get 85% of their electricity for nuclear power. No bullshit. They will talk nonsense to us but at home they get the job done. That’s why I like their health plan as a model, not to clone but for a model of something that has been working well for 50 years.

    Mike K (90939b)

  181. We got freakin’ Tinker Bell for President. Wish real hard and we’ll have savings.

    SPQR (72771e)

  182. “DRJ – I asked Orthodoc his opinion of the French system outlined by Mike K, but I am assuming that Orthodoc is actually out there helping people and not on the internet as much. That is a discussion (between two intelligent medical professionals) for which I would like to be a fly on the wall.”

    Thanks – you give me more credit than warranted, probably.

    There are some changes that would be needed to import the French system, but it’s probably reasonable to look at seriously.

    France’s state-subsidized medical system is considered liberal because doctors and dentists establish private practices, and patients, who are free to choose their own providers, are reimbursed by the state. According to the OECD, publicly funded insurance covers approximately 80% of costs, with out-of-pocket or private insurance equally covering the rest.

    I like the idea of patients having some skin in the game financially. If nothing else, it makes patients aware of what their care actually costs. As a patient, if I knew that my softly indicated MRI was going to cost me $100 bucks out of pocket, I might forgo it if the doctor was pretty clear about the diagnosis without it.

    As a physician, I’d be happier knowing that my patients don’t think that I actually make what’s on the bill – the “charge” of $skillions is actually reimbursed at 50 bucks! Whether they think my services are worth the 50 bucks is another issue.

    orthodoc (aa5b89)

  183. Thanks – you give me more credit than warranted, probably.

    That you doubt you are due as much credit as was given is usually – in my mind at least – a fair indicator that you are due at least that much credit.

    Scott Jacobs (90ff96)

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