August 20, 2009
Dr. Medicare

It was an in office surgery. The total bill submitted to Medicare including pre and post operation office appointments came to $5,000. Medicare allowed only 55% or $2,750. The doctor has to accept the lower amount, that's the rule. Medicare paid 80% and the patient paid the balance. This may explain why a friend of mine, when his doctor retired, had to contact three doctors before he could find one that accepted new Medicare patients.

One study puts the Medicare unfunded liability at $74 trillion, larger than Social Security and simply not sustainable. Now President Obama and most Democrats in Congress want to expand Medicare like health care to the currently uninsured and eventually sweep all Americans into a government run single payer system.

Congress, regardless of which party is in control, is by its nature incapable of crafting a healthcare program that meets the need and is affordable. Every member horse-trades to include something for his or her district, state and/or supporters. Liberals shut out conservatives and vise versa. Special interests dominate. Politics, not best business practices, good medicine or innovative ideas, prevail. Congress should set some broad, minimum guidelines for health care reform (portability, coverage for pre existing conditions, affordability etc.) then give carte blanche authority to a commission to propose implementing legislation with an up or down no amendments vote of Congress. There are pros and cons to the commission approach but it is far superior to the current rush to judgment of Obamacare. It provides an opportunity to start with a clean sheet of paper, time to evaluate ideas and tone down the rhetoric.

There are many bloggers, pundits and web sites covering the issue of healthcare reform. Below are two sites worth viewing:

http://www.washingtonpolicy.org/Centers/healthcare/index.html

http://www.takebackmedicine.com/health-care-reform-myths/

Posted by warrenpeterson at August 20, 2009 07:27 PM | Email This
Comments
1. Warren - I have mentioned in previous posts that Obama's lack of transparency with his health care propositions is his problem. As he says "There is something about August going into September where everybody in Washington gets all wee weed up!" and he is the prime wee wee'er in that arena.

If someone (your suggested commission possibly) could fully define all of the problems with health care and then apply simple problem solving techniques to each problem and then come up with the appropriate solutions based on the best solution..well then we might have an some agreeable solutions!! Oh Yes, the findings need to be totally open!!!


Posted by: Tim on August 20, 2009 07:55 PM
2. Show where the patient paid the rest, this is bogus, do your research. The Doc and Hospital lie by the Medicare payment. Check it out for once.

Posted by: Jay Brand on August 20, 2009 08:21 PM
3. I hear the term unfunded liablity. What exactly does that mean? Whats the time period? I don't think there is even 74 trillion dollars in the world? Anyone? Bueller?

Posted by: Mark on August 20, 2009 09:25 PM
4. Hmmmm - Office Surgery - Medicare Part B:

'Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)

* $135.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $135.00 deductible.)'

http://questions.medicare.gov/cgi-bin/medicare.cfg/php/enduser/std_adp.php?p_faqid=2100

I am going to have to make sure I purchase Medicare Part B supplemental insurance when I turn 65.

Posted by: Tim on August 20, 2009 09:34 PM
5. My father recently retired as a surgeon. A damn good one too. He served on his state board of medicine, chief of surgery multiple times, chief of staff multiple times, etc. He was one of the guys the other doctors sent their family to for surgery.

He was fee-for-service. Only.

He stopped doing Medicare several years ago simply because it wasn't financially viable. He'd take charity cases and/or let patients slide on bills if they were in a world of hurt but it was done at *his* discretion.

Medicare, over the 15+ years he took Medicare patients, was paying less and less for specific procedures.

That's in non-inflation adjusted amounts.

So, say Medicare pays $1,000 for an appendix removal. 15 years ago they were paying substantially more.

Medical equipment costs have gone up. Malpractice has skyrocketed. Everything has gone up...and Medicare is paying double plus extra less.

It's a real snake eating its tail problem: the doctors that you want working on you can afford not to take Medicare and the doctors who are new (and you don't want working on you) need the money.

Same thing with hospitals. They get less money for a specific procedure yet the cost to the hospital (labor, equipment, etc) keeps going up.

Posted by: WestBellevueDad on August 20, 2009 09:42 PM
6. #5: A very illustrative case of what's wrong with government-paid medicine. And to think that obama says savings with his Trojan Horse of a govt. insurance system will achieve savings by cutting Medicare payments to doctors even more! What do these democrats think--that these doctors should work for nothing? Because with these crappy reimbursements, by the time a doctor pays his staff, all the business taxes, any business loan payments, and vendors, what's left if they keep cutting back the payments?

Posted by: Michele on August 20, 2009 09:57 PM
7. ..and now we have all these car dealerships quitting the "Cash for Clunkers" clunker of a program in disgust because nobody at the federal government seems to understand that these dealers need timely reimbursements for participating in Obama's lame program. Gee, let's let these incompetents run our medical care, too! They've don't such a good job with marketing autos....

Posted by: Michele on August 20, 2009 10:04 PM
8. So Medicare only paid 55% of the billed amount -- big deal.

My experience will both Premera and Regence is in-network providers typically acceps anywhere from 33 - 50% of the billed amount as payment in full for surgery and other procedures. So how is Medicare any different from private insurance in this respect?

You gotta wonder about the poor saps who pay full price. Those would be uninsured people who want to at least try to pay their medical bills. In other words, folks who can afford it least wind up paying the most -- great system we have!

PS -- My folks and my sister -- all three on Medicare -- have never had a problem finding physicians willing to accept Medicare payment.

Posted by: scottd on August 20, 2009 10:20 PM
9. If they can't run a simple program like "cash for clunkers" efficiently, what makes an imbecile believe they can run an efficient health care system?

Answer: They Can't, and most of us know it. Obamacare is DOA.

Posted by: Rick D. on August 20, 2009 10:27 PM
10. @8. Premera and Regence negotiate with facilities what they will pay. That is the current problem between Premera and Pro-liance Surgeons. I do wish they'd work it out, because I'm going to need some shoulder surgery, and the surgeon I want is a Proliance Surgeon and I also want it to be done before Obamacare becomes the law, if it does. They have not been able to come to an agreement in over a year now. Think Medicaire is going to negotiate? Doubt it; they (government) will just continue to lower the payments for services. As a nurse, I'm not interested in taking less for the work I do now; for sure don't want to take less for what promises to be more work under Obamacare.

Posted by: Rae on August 20, 2009 10:42 PM
11. I'm a fairly educated person; I have a MS. But, I am having trouble understanding just what is on the table. I am over 65 and on Medicare and am very pleased with it. Before I became eligible my monthly premiums were nearly $700 for full coverage just for myself, my family was on a different plan and that premium was something like $300 per month. So, we were paying almost $1,000 per month for health care. With Medicare, I have Part A,B, and D, my monthly premiums are $230. And, I find the service I get from providers is the same as before except I don't have to pay a co-pay, Part B takes care of that. So what I would like to see is someone who can rise above the political hype get on TV with charts and Power Point presentations and clearly explain the present health care proposal. That seems simple enough. I think there are a lot of people out there who would agree with me. Tell us the facts, not the political hype, and let us decide.

Posted by: Fred on August 21, 2009 06:00 AM
12. I'm a fairly educated person; I have a MS. But, I am having trouble understanding just what is on the table. I am over 65 and on Medicare and am very pleased with it. Before I became eligible my monthly premiums were nearly $700 for full coverage just for myself, my family was on a different plan and that premium was something like $300 per month. So, we were paying almost $1,000 per month for health care. With Medicare, I have Part A,B, and D, my monthly premiums are $230. And, I find the service I get from providers is the same as before except I don't have to pay a co-pay, Part B takes care of that. So what I would like to see is someone who can rise above the political hype get on TV with charts and Power Point presentations and clearly explain the present health care proposal. That seems simple enough. I think there are a lot of people out there who would agree with me. Tell us the facts, not the political hype, and let us decide.

Posted by: Fred on August 21, 2009 06:01 AM
13. Warren

Given your involvement with the Seattle School Board misstatement of financial records and the quiting of the Seattle Superindent, why are your comments on Medicare and Healthcare credible

Posted by: Blue Dog on August 21, 2009 06:25 AM
14. 1200 + pages and not a noun, pronoun, verb, or adjective about the costs frivolous law suits and malpractice insurance.

Posted by: Andy on August 21, 2009 07:43 AM
15. Our beloved POTUS has guaranteed passage of this bill so all rhetoric on this is moot. We'll simply have to learn by experience. Lo siento mucho! :)

Posted by: Duffman on August 21, 2009 07:48 AM
16. But, I am having trouble understanding just what is on the table.

You're not alone Fred. The president held pep rally's to explain a bill that he himself doesn't know what is contained in it, which is why he came off as incoherent and untrustworthy to the American people.

Once bitten (Ramrod stimulus), Twice shy (Ramrod Healthcare)

Posted by: Rick D. on August 21, 2009 07:53 AM
17. Mark wrote:

I hear the term unfunded liablity. What exactly does that mean? Whats the time period? I don't think there is even 74 trillion dollars in the world? Anyone? Bueller?

Basically, an unfunded liability is when you promise to pay out (liability) without the identified resources to do so.

The Government has promised to pay out $74 trillion more in benefits than either the cash reserves or tax income that is has committed to the project. So in essence it's said "we'll pay out the money even though we don't have it and we don't know where we will get it".

Posted by: Shanghai Dan on August 21, 2009 08:00 AM
18. A few points on the Medicare "skimping" on payments issue:

1. This is an example of why those in favor of the public plan want it. There belief is only through a public plan limiting payments will one drive down or keep a cap on medical costs. Private insurance companies have no direct incentive, they just pass the costs onto the employer (in most cases). In fact private insurance companies gain more profits from higher medical payments.

2. The fallacy in point 1 is that one can drive down health care costs by limiting payments. This is what the public plan proponents have failed to prove. It is also an area, interestingly enough, that the Republicans are not "hitting" them on. Could it be all the insurance companies contributions that are silencing this argument?

3. Regard to overall costs, someone has to pay. So Medicare limits payment, this just means that the costs are passed on in the system to someone else. This is the same with emergency room being treated as an urgent care facility. The costs are passed on. There was an article recently in the News Tribune about Premera and in it they acknowledged that individual premium participants are subsidized by group plan participants. What this means is that the group plan participants (employers) are paying some of the costs for individuals. There is a reason why insurance companies are against the exchange and everyone buying insurance through the exchange, it is because they can't subsidize one group on the backs of others. We all pay in the end. Either it is directly or indirectly. If companies end up paying the additional passed on costs, they pass it right back onto their customers in higher prices. It is time to stop this merry-go-round and get the true costs out in the open. This is why I do support the Exchanges, but don't care either way about the public plan.

Posted by: tc on August 21, 2009 08:33 AM
19. In response to tc ..

Your are absolutely correct, fees that medicare does not cover are passed on. My mother has medicare part A and a private policy for medicare part B. She just received notice that her part B policy was going up 25% because medicare was reducing its payments on part A.

To qualify as a part B provider you have to agree to cover costs that part A does not cover.

So here we see the government (Part A Medicare) claiming to reduce costs but the medicare recipient has to pay for additional coverage under Part B while at the same time continuing to pay the same rate to the government for Part A.

My fear is that this is the process that a government plan will take - reduce benefits - claim cost savings - and blame the private sector for high costs!

Posted by: Borderland on August 21, 2009 09:19 AM
20. Fred @ 11 and TC @ 18:
First of all Fred, I want to clarify a point by TC. When he says "passed on" what he means is that the hospital (which my wife manages an outpatient faculty of) increases the cost to "regular" insured patients to cover the loss of revenue from Medicare payments. It is called "cost shifting". Because Medicare pays a sum for a procedure does not mean that is what it costs. Medicare payments never cover the cost of a procedure and is paying less every year. The way they do that is this: A hospital needs to have government approval for many things that they do (or want to do). The Feds simply say that if they do not take Medicare payments, they are prevented from being certified for doing certain procedures. They are locked out of a market that could be lucrative if they don't accept Medicare. So they take Medicare and we all pay the shortfall when we get sick.

As to Medicare and your premiums. Medicare is now spending more than they take in premiums, even at the reduced rates. At present they are working against the "trust fund" of past tax collections and it will be all used up in a few years (2012 now if I remember correctly but it keeps getting closer). So, the premiums you are paying now do not support what you are using. At some point that will have to stop. They will have to get more money from somewhere. Either you have to pay more or they will have to tax somebody else more OR they will have to deny care. Or a combination of all three. There is no other way.

If you wish to educate yourself about single payer systems, the facts are all over the place. The Wall Street Journal has a couple of articles every day. Articles with real information unlike the Seattle Times. The facts are that in states where single payer has been adopted, the point of bankruptcy comes pretty fast. It took Maine only five years to were costs are spiraling out of control AND the 128,000 uninsured there is now down to 124,600. Not exactly a ringing success. The Maine experiment has been cited as what ObamaCare will be. In counties where they have single payer, all systems are under stress with huge wait times in years for common procedures we get in weeks of days. Some procedures are not available at any cost (this is cost containment government style).

The real crime here is that a real solution is so easy and quick to enact. To wit:

1. Make insurance portable (attached to the person and not the business) and a commodity that can be purchased across state lines.

2. End state insurance mandates.

3. Tort reform. Either "loser pays" or cap pain and suffering to a reasonable amount (or both of these).

4. Make medical insurance premiums fully tax deductible.

5. Make Medicade a temporary bootstrap minimum coverage for the working poor.

These simple reforms could be enacted by Congress in hours if not two days and the effects could be measured in months if not sooner. Remember, the ObamaCare plan would not kick in for two years (after 2 years of taxing needed to start it).

One thing I do not understand. If 85% of the people in the United States like their health care, why is Obama and the Democrat congress so intent on doing what 85% of the people don't want done? Doesn't that make anybody wonder?

Posted by: G Jiggy on August 21, 2009 10:39 AM
21. Time to evaluate ideas and tone down the rhetoric.

Lets look at some sage liberalism at it's best:

"I want a compromise between capitalism and communism. Socialism seems to be that happy medium, to me. Some people like the term Compassionate Capitalism, instead of socialism, which is okay with me." - Compassionate Capitalism

Or as tc writes,
"This is why I do support the Exchanges, but don't care either way about the public plan."

Need surgery but can't afford it?
Split the difference and have a nurse practitioner do it on the side. Need health care but can't afford it? Hand the system to our government and let them decide. Seems to be that happy medium eh? Besides, socialism is what we use when we establish local Fire Departments right? How can that be bad.

With ObamaCare we can have the benign Fire Dept style socialism without the National Socialist style Nazism, right?
Besides, as Pudge seems to say, Germany's National Socialism called Nazism was under that Hitler guy and our National Socialism will be under Obama. World of difference. Not to worry.

Right you bet.

Posted by: Amused by Braindead Liberals on August 21, 2009 10:49 AM
22. Hey - This is not a pudgy thread (thank God!). Let's eave him out of it.

It's been funny as heck to watch the libs scramble to recover momentum on this dog. They have pulled every dodge, every scam, and every underhanded tactic in order to keep it alive.

Yes duffman - they very possibly will shove this Obamination up all of our collective azzes - for no other reason than that they can - but there are at least a couple of dhimmis that recognize how ferocious the backlash is going to be.

Obamacare won't work; it can't work. And they know it. And they know that the American public knows it as well.

There will be a terrible price to be paid for ruining the healthcare industry, and driving the economy even further into the hole.

Posted by: Alphabet Soup on August 21, 2009 11:26 AM
23. Warren,
"the current rush to judgment of Obamacare"??
"President Bush on Wednesday [February 9th 2005] indicated he would address Medicare's finances after completion of Social Security reform".

Frankly, when a problem is allowed to fester for 4 years, calling a serious (albeit flawed) attempt to fix it a "rush" is disingenuous.

Now, there is a correlation between rushed legislation and the Medicare unfunded liability.
Remember the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - the biggest expansion of an entitlement program in nearly 40 years?

Richard Foster, the chief actuary at the Centers for Medicare and Medicaid Services, the top independent Medicare cost analyst, revealed he had been threatened by the Bush administration that he would be fired if he told Congress the true cost of the policy.

Maybe Obama and the Democrats will try and pull the same BS Bush and the Republicans did. But the unfunded Medicare problems we face today are significantly larger because of the Bush administration's "overhaul" of the Medicare program.

Posted by: MikeBoyScout on August 21, 2009 12:06 PM
24. @22 Alphabet Soup on August 21, 2009 11:26 AM

"There will be a terrible price to be paid for ruining the healthcare industry, and driving the economy even further into the hole."

If the economy is going further in to a hole, how do you explain U.S. stocks surged to 2009 highs on Friday?

It certainly appears that those with significant skin in the game see it differently.
Perhaps the assumption that government for the people, by the people and of the people can't do anything right is....wrong.

Posted by: MikeBoyScout on August 21, 2009 12:33 PM
25. Off topic: Nickels concedes!!!

Posted by: mike336 on August 21, 2009 12:42 PM
26. "Off topic: Nickels concedes!!!"...and has requested a transfer to the snow-removal department of the City.

Posted by: Duffman on August 21, 2009 12:45 PM
27. MBS @24 Actually analysts at CNBC say gains in the market correspond to drops in Obumbles popularity.

Posted by: mike336 on August 21, 2009 12:58 PM
28. Off Topic - Nickels loses his dime!! :-)

Posted by: Tim on August 21, 2009 01:02 PM
29. Seattleites turn on a dime, give Nickels no Quarter and cash in his remaining political currency.

Like Pennies from Heaven!!

Posted by: Dollar Bill on August 21, 2009 01:12 PM
30. @27 mike336 on August 21, 2009 12:58 PM,

Would that be the same network that the Daily Show's Stewart skinned alive for their prescient market analysis and advice?

Posted by: MikeBoyScout on August 21, 2009 01:15 PM
31. Off topic: Rumor has it that Mayor Nickels has already been offered a position at National level by POTUS Obama. He will head up the new Department of Urban Technology for Snow Removal.

Posted by: Duffman on August 21, 2009 01:20 PM
32. Who's John Stewart? His name is Stuart Leibowitcz...another self hater.

Posted by: Dollar Bill on August 21, 2009 01:29 PM
33. Another fine Investors business daily cartoon today by Michael Ramirez. Let's call this "healthcare" boondoggle proposed by Obama and the Democrat's what it really is...A trojan donkey

Posted by: Rick D. on August 21, 2009 01:43 PM
34. One thing that nobody has mentioned is that the Obama administration has bought off the insurance industry, the AMA and big Pharma to keep them quiet about this monster. Big business loves big government because they can buy the influence that they want and get in on the ground floor of pig-trough-patronage.

And they said that Bush was a "corporatist". As Obama, Pelosi and Reid blame them for the cost problems with his left hand, he does the "wink, wink, nudge, nudge" with the other.

The only losers here are the people.

Posted by: G Jiggy on August 21, 2009 01:48 PM
35. And then there is always the cost. We here in Seattle know how that works. Sound Transit being a pretty good example. So what about ObamaCare? Over at wonderlandjack.com there is a little graph on cost estimates of government health care programs. From Wonderland:

"So if there's one thing that is an absolute certainty, it's that governments underestimate costs and REALLY underestimate health-care costs.

For instance, in 1965 the House Ways and Means Committee estimated that Medicare Part A would cost about $9 billion a year by 1990. In actuality it ended up costing $67 billion a year by that point.

So when the Congressional Budget office estimates that Obama health-care will cost $1 trillion over 10 years, what they really mean is $5-$10 trillion."

Bear in mind that the program that most resembles the Obama plan, the Maine plan or the Massachusetts plan, have only been around a short time, are going broke, and still have as many uninsured as when they started. And isn't that who all this monkey motion is supposed to help, the uninsured?

ObamaCare is like amputating a hand for a hang nail.

Posted by: G Jiggy on August 21, 2009 02:37 PM
36. BSboy sez: Perhaps the assumption that government for the people, by the people and of the people can't do anything right is....wrong.

You've got the whole horse-cart thing twisted upside down bogus boy. The markets are struggling to survive despite the intrusions of a government that turned its back on the people a ways back...

Posted by: Alphabet Soup on August 21, 2009 02:43 PM
37. Hey BLUE DOG @#13,

Use your own contact info for posting on this site - NOT that of other people or organizations.

Way NOT cool.

info@seattlerepublicans.org

Posted by: Whoever You Are - Use Your Own Contact Info on August 21, 2009 03:02 PM
38. Hey, BoyScout, the Wall Street Journal has a nice article on what big government has done for recessions Big Government, Big Recession. It's got numbers and everything.

From that: "[snip] recessions have become longer as the U.S. government (and the Fed) became larger, more expensive, and more involved in the economy. Foreign countries in which government spending accounts for about half of the economy have also suffered the deepest recessions lately, while economic recovery is well established in countries where government spending is a smaller share of GDP than in the U.S.

In short, bigger government appears to produce only bigger and longer recessions."

Mix in the politics of patronage that has infected every facet of Washington DC from Obama to K Street and you have a corruption machine unmatched in modern politics.

Posted by: G Jiggy on August 21, 2009 03:15 PM
39. Oh, and I also wanted to add:

"[snip]. . . corruption machine unmatched in modern politics, all financed with your, and our, money."

Posted by: G Jiggy on August 21, 2009 03:19 PM
40. @36 Alphabet Soup on August 21, 2009 02:43 PM,

Yeah, you're right. We're going in the hole and struggling to survive.

Stuff like Existing Home Sales in U.S. Jump to Two-Year High
and
Major economic forecasting firms have increased substantially their third-quarter GDP projections and actually reduced their unemployment rate projections as a result of the overall macroeconomic impact of this program [Cash for Clunkers]
have nothing to do with it. It just looks like it is getting better.
Those suckers who bought the S&P 500 at the bottom and are sitting on a 50% ROI are not nearly as smart as you.
Thanks for that horse and cart analysis! Very sound!

Posted by: MikeBoyScout on August 21, 2009 03:32 PM
41. Mike BS,

Now plot the DJIA in EUR or GBP. You'll find essentially no change throughout the year. Perhaps the rally is less of a rally and more of a devaluation of the USD?

Posted by: Shanghai Dan on August 21, 2009 03:46 PM
42. @38 G Jiggy on August 21, 2009 03:15 PM,

Interesting article. Read it this morning.
Tell me, when the cock crows in the morning is he causing the sun to rise? Or does it just appear that way?

Nevermind. A recession has nothing to do with losses in aggregate demand and therefore government fiscal policy is irrelevant. It is all about the carts and the horses. Alphabet Soup straightened that out @36.

pssst, don't read these Economics Books! They never even mention the carts and the horses.

Posted by: MikeBoyScout on August 21, 2009 03:53 PM
43. @41 Shanghai Dan on August 21, 2009 03:46 PM,

And you really have no idea why plotting the DJIA in EUR or GBP shows essentially no change throughout the year?

Maybe you, Alphabet Soup and G Jiggy can come up with a policy about these pirates and the Global Warming?


Posted by: MikeBoyScout on August 21, 2009 04:02 PM
44. MikeBS,

I know why it's flat; because the USD is dropping in value. Considering that the DJIA is composed of multinational corporations, a good chunk of their "value" is their overseas holdings. The rest of the world is telling us they're worth about the same as they were 8 months ago; it's only the Obamassiah who's trying to play it up as a miracle and growth of the US economy.

For a global commodity - or multinational corporation - you need to look at the value in a basket of currencies to get the true value. If we went by just the nation's own currency, we'd see Zimbabwean companies dominating the world as they are worth quadrillions and quadrillions of dollars!

Posted by: Shanghai Dan on August 21, 2009 05:55 PM
45. @44 Shanghai Dan on August 21, 2009 05:55 PM

"you need to look at the value in a basket of currencies to get the true value."

Well before you get around to building your
Shanghai Dan basket of currencies
how about you entertain us with your analysis of

The Big Mac index and An alternative Big Mac index.

Posted by: MikeBoyScout on August 21, 2009 06:37 PM
46. Well Obama did his Friday bad news dump before heading off to an undeserved vacation. Office of Management and Budget says 10 year projected deficit to be 9 Trillion, vice 7.

Posted by: Mike336 on August 21, 2009 07:39 PM
47. Mike BS,

Do you not understand the cost of living (Big Mac Index) versus the valuation of securities? Seriously?

Posted by: Shanghai Dan on August 21, 2009 07:45 PM
48. Mike 336,

Remember the Obama Administration condemning the CBO as "overly pessimistic" for predicting 9 trillion in deficits, and the White House claiming only 7 trillion?

Guess who was right...

Of course, the CBO also points out a $240+ billion deficit ($50 billion a year) for the health insurance reform. And once again the White House said "wrong!" I bet we'll see the CBO correct once again...

Posted by: Shanghai Dan on August 21, 2009 07:49 PM
49. Duffman, LOL!

Posted by: Michele on August 21, 2009 08:40 PM
50. One study puts the Medicare unfunded liability at $74 trillion, larger than Social Security and simply not sustainable.

Holy fucking cow. No wonder America will not survive. We just don't have the guts to stop spending our wealth away on this entitlement bullshit. Cull the elderly now!

Posted by: Crusader on August 21, 2009 11:08 PM
51. Warren, I couldn't agree with you more on everything but one issue. Requiring insurers to cover pre-existing conditions, unless one has had continuing prior coverage (no lapse in insurance although possibly with a different insurer)is akin to requiring an insurance company to insure your house as it is burning down. Why should an insurance company be required to cover you simply because you just found out you have cancer? A person buys an insurance policy hoping to never have to use it not because they know they will, and insurers are gambling that usage will not be necessary.

Posted by: Virginia S on August 22, 2009 06:59 AM
52. Warren, I couldn't agree with you more on everything but one issue. Requiring insurers to cover pre-existing conditions, unless one has had continuing prior coverage (no lapse in insurance although possibly with a different insurer)is akin to requiring an insurance company to insure your house as it is burning down. Why should an insurance company be required to cover you simply because you just found out you have cancer? A person buys an insurance policy hoping to never have to use it not because they know they will, and insurers are gambling that usage will not be necessary.

Posted by: Virginia S on August 22, 2009 07:02 AM
53. Medicare reimbursement rates are different in each state, WA is on the lower side and most Dr's in private practice (note, Private Practice is different from groups affiliated with hospitals) do not take Medicare patients. My family Dr. in Bothell had to stop taking Medicare several years ago, they are a practice of 10 and were within 3 months of bankruptcy because it was costing them $20 out-of-pocket each time they treated a Medicare patient.

When I turned 65 this year he suggested that I go to the Dr's at Evergreen Medical Center. They are a public hospital and the Dr's there receive $120,000 a year from WA state Taxpayers as a subsidy for treating Medicare patients.

I had Blue Cross through retirement benefits however they sent me a letter 3 months before I turned 65 telling me that If I did not take Medicare they would drop my coverage. I had to send them copies of my Medicare Care to prove I was covered. My (before 65) Blue Cross was great and paid 90%, now it only pays 90% of what Medicare doesn't pay. It doesn't pick up anything if it is not covered by Medicare, including any of the deductible.

Medicare is fine for office visits and routine care, but you are in real trouble if you need surgery. My husband had to have prostrate surgery and he had to get a "3rd" policy in order to be covered. So, he now has Medicare, Retirement Insurance and a 3rd supplement policy (that costs an additional $160 a month).

Medicare has not increased reimbursement payments in 10 years. Under Obama Care they are going to cut out Medicare Advantage plans which now cover 10 million Seniors. Advantage cost little to nothing so for those on a limited fixed income it's all they can afford ... they will have to either go without or pay another $150 or more per month for a new supplement. And Obama says he will use the cost savings from dropping Advantage Plans to pay for insurance for those that do not now have insurance.

Obama has increased the monthly cost of Medicare and will not be giving a cost of living adjustment to Social Security recipients for the next several years.

Posted by: Sandy on August 22, 2009 09:18 AM
54. The commonly and universally used threshold definition of a healthy American economy uses three economic indicators. 1) Unemployment (6.5% maximum), 2) Inflation (CPI) (below 3%), and 3) Economic Growth (GNP) (adjusted for inflation) at minimum 2% or above.

Currently unemployment is "adjusted" at 9.4%, current CPI is at a negative -0.2% in Jul 2009, and the real GDP decreased at an annual rate of 1.0 percent in the second quarter of 2009 after a 6.4% decrease in the first quarter 2009.

The liberal "boy" Obama can tell everyone that the recession is over, but the facts about our American economy don't agree.
Lagging indicators are those we must worry about because they dictate what we can afford at any given time.

Posted by: Amused by Liberals on August 22, 2009 11:53 AM
55. As Reo, Tom Price (R) - GA said in his rebuttal to the POTUS's weekly address, the President has been playing fast and loose with the facts and needs to start telling the truth, if he wants to get an honest debate.

Fat chance that will happen !

"The Obama Administration - Leadership in a vacuum"

Posted by: KDS on August 22, 2009 11:59 AM
56. So, fellas, Medicare has unfunded obligations.
And you're complaining that Medicare doesn't provide enough reimbursement. What is the right wing proposing to do about this?
Delay the age of eligibility?
Restrict benefits a/k/a rationing?
Increase contributions that is, raise taxes?
eliminate the whole program?
let the problem fester long enough so that the program can be eliminated, and in the process, stymying all democratic efforts to fix it?

seriously, it's nice to identify a problem, but even nicer is to propose a solution.

Got one? Let's hear it.

Btw saying "let's have a commission and do what they say" is a way of not telling us what the solution is.

And, it wouldn't work, because congress can't pass a law saying congress won't pass a law in the future...so anything a commission did do, congress could undo, later.

say you have this commission. what is the conservative point of view as to what to do with medicare?

Posted by: Torture Lawyer on August 22, 2009 01:14 PM
57. seriously, it's nice to identify a problem, but even nicer is to propose a solution.

The Democrat party has yet to do either.

Posted by: Rick D. on August 22, 2009 01:30 PM
58. Tortured Lawyer,

The last time the GOP attempted to reform Medicare the Leftist Slavery Party lied to scare the elderly, and threatened filibusters to stop any legislation.

So, how about you guys present a solution? You didn't like the solutions put forward when the GOP was in control of Congress, so what do YOU propose? The GOP's not in control...

Posted by: Shanghai Dan on August 22, 2009 02:07 PM
59. Dan: The last time the GOP attempted to reform Medicare we got Medicare Advantage, a program that costs the govt 14% more per patient than traditional Medicare.

We also wound up with a hugely expensive prescription drug program that forbade the govt from negotiating for lower prices for the drugs it was paying for.

Heckuva job, guys...

Posted by: scottd on August 22, 2009 02:36 PM
60. Scottd,

Then tell us what you'd do. Please!

Posted by: Shanghai Dan on August 22, 2009 02:56 PM
61. Dan: I'm still waiting to hear about the solutions you mentioned that the GOP put forward. What were they, Dan?

Posted by: scottd on August 22, 2009 03:37 PM
62. We know the GOP doesn't have solutions, scott. It's not even worth wondering aloud what they were. Medicare Advantage is a failure. The health reform plans all end that ridiculous subsidy to insurance companies. In that sense, the first democratic "solution" is stopping wasteful GOP spending enacted under Bush.

Medicare can save $600bn over the next decade by focusing on outcomes of hospital care rather than the actual visits. Everyone agrees these are smart changes.

Another smart change is creating an independent group of experts to send up and down Medicare changes to congress so there is no chance for undue lobbying for a vote. This worked with the the base closure committee in the 90s. Republicans disingenuously attack this commission, even though it's simply a more structured version of their MedPAC idea signed into law under Bush. This commission could decide, for example, to move away from fee-for-service.

And that's the secret: the best way to contain health care costs is moving away from fee-for-service.

In terms of reimbursement rates, the House bill rightly prevents a 20% drop in rates coming next year. Of course, congress approves a bill to prevent this drop each year. But it should be fixed permanently. Partisans like Dan ding this inclusion as health reform's huge cost. So, for him, it's not about solutions.

Does this health care bill fix Medicare? No, not entirely. But it delivers cost savings and sets up the framework to improve Medicare. But, note, this bill is not called the "Medicare improvement bill." It's about health care for the rest of the country, too. For all the complaining about the length of the bill, it sounds like some of you want everything under the sun to be fixed by one stroke of the pen.

Fun is reading the GOP partisans say that Medicare pays too little and should pay more, and Medicare is going bankrupt and should pay less. That is some truly sober analysis. Thanks, guys.

Posted by: John Jensen on August 22, 2009 04:46 PM
63. Medicare has not increased reimbursement payments in 10 years.

Sandy, that is simply not true. You must have heard wrong.

Posted by: John Jensen on August 22, 2009 04:48 PM
64. Advantage cost little to nothing so for those on a limited fixed income it's all they can afford ... they will have to either go without or pay another $150 or more per month for a new supplement. And Obama says he will use the cost savings from dropping Advantage Plans to pay for insurance for those that do not now have insurance.

Sandy, sorry to hammer on you, but this is another misunderstanding. Medicare Advantage is not a supplemental insurance plan. It is a replacement for Part A/B coverage. The difference is that it costs the government more to provide. Seniors who leave Advantage of their own choice will not "go without," they will simply receive standard Medicare benefits which cover most hospitals and most doctors. People who have Advantage would still be smart to have supplemental insurance, since -- again -- advantage is not supplemental coverage.

I see no reason why the government should give extra money for private insurance companies to provide the same service as Medicare Part A/B. If the private sector can do the same stuff for cheaper, sure -- why not? But if it costs more? That's not a good deal for taxpayer money.

Posted by: John Jensen on August 22, 2009 05:01 PM
65. My sister worked in an old folks home run by a very large religious institution. She needed an operation to replace those little bones in he ear. She told the government this, and it obtained the right specialist, and it paid for the operation. At the time because her work was basically for a big charity, and she earned the minimum wage, she had not made any special contributions for this health care; she received it for free. She was also a foreigner at the time. This was in Austria in the 1970s. So this is the socialistic, "liberal equals nazis" kind of nationalized health care some of the rightists on this site deride as one step away from gulags, communism and loss of freedom. Funny thing. that Austrian national income per capita is doing pretty good and has done so in the four decades since. And, they have elections. You might have noticed. I think in the last few elections their hard right party has even been growing a bit....so no one can complain about loss of freedom. Many of us Americans go over there for tourism, and guess what, no nazis and no stalinist govt. agents arrest anyone. Some of us go over there to go skiing and it's a pretty happy place. And no, I haven't ever heard of masses of them having to come over here for health care. I'm sure there's been a few, naturally, but really, there's no big exodus and since they have elections and center right party and conservative party and far right party....well, the voters just seem to keep that health system in place. And imagine, why they even let it serve aliens and foreigners who went over there to empty bedpans and do work any Austrian could have done! The world didn't come to an end.
I should also point out that this is the nation where they have a whole school of economics, I do believe it's called creative destructionism, it celebrates how the market makes technical progress thru competition, etc., you know the story. Well the voters over there even being exposed to that have this national health care system that paid for my sister's highly specialized ear operation. And no, she didn't turn into a welfare dependent lazy cheat just because she got this big freebie.

So chill out folks whatever system we get, even if the public option is a stepping stone to socialized medicine, relax. You'll like it.

Posted by: Torture Lawyer on August 22, 2009 05:27 PM
66. scottd,

Apparently you cannot use Google? Try searching for "Bush reform Medicare proposals".

But that's old history - your Slavery Party is in control. How is it going to reduce costs? Not just slow the growth, but REDUCE costs?

Why focus on the past, other than deflect the lack of vision for the future?

Centrifuge John,

Can you back up any of your claims? Any references? We know you have a long history of just making stuff up...

Can you, scottd, the tortured lawyer, MikeBS, or any leftist tell me what the plan is to REDUCE expenditures on health insurance? Not just slow the growth, but actually reduce?

This is your baby, your plan, your goal, you justify it. Make the case - how does it actually reduce dollars going out?

Posted by: Shanghai Dan on August 22, 2009 05:34 PM
67. Wow lots of comments. Guess everyone's bored by summer by now.

1. Rick D: "The Democrat party has yet to do either."

Rick, you're correct. However, the Democratic party did not write the post above that started this thread, and don't you think both parties should offer a solution?

I asked you guys for yours. don't you have one?

Btw please use proper grammar it's called the Democratic Party.

2. "58. Tortured Lawyer" ha ha ha so original on the name thing. this is the 3,000th time that's been done and we get it.
"how about you guys present a solution? You didn't like the solutions put forward when the GOP was in control of Congress, so what do YOU propose? The GOP's not in control..."

Hey dude, the Democratic party should offer a solution. Right you are. But I asked you, what is the right winger's solution?

Got one?
3. Points out that GOP gave us "Medicare Advantage, a program that costs the govt 14% more per patient than traditional Medicare.

We also wound up with a hugely expensive prescription drug program" -- in other words, we get programs that shovel money to big pharma.

"that forbade the govt from negotiating for lower prices for the drugs it was paying for."

So hey, conservatives, do you still think we should have laws that ban the government from negotiating lower prices? what's your solution?

4. "Then tell us what you'd do. Please!"

Um, why yes, both parties should propose a solution. What is the conservative solution?

Part of the democratic solution would be to repeal that law that prohibits medicare from negotiating.

Conservatives: do you agree or not? Yes or no?

5. "Dan: I'm still waiting to hear about the solutions you mentioned that the GOP put forward. What were they, Dan?"

Still waiting, Dan et al.

6. "stopping wasteful GOP spending" yup, but to be fair, we are talking about reforms inside medicare.
"focusing on outcomes of hospital care" -- yes that would be part of the Democratic Parrty solution. It seems the GOP opposes this calling it death panels, thus opposing the entire notion that resources are limited and things like science and knowledge should play a part in what we do.

"an independent group of experts to send up and down Medicare changes to congress" could help but really we're asking what woudl conservatives say those changes should be?

"moving away from fee-for-service."

YES, that's obvious. That's part of the democratic plan, conservatives. What's your plan?
"In terms of reimbursement rates, the House bill rightly prevents a 20% drop in rates coming next year. Of course, congress approves a bill to prevent this drop each year. But it should be fixed permanently. Partisans like Dan ding this inclusion as health reform's huge cost. So, for him, it's not about solutions."

Wow, very substantive. STill waiting for GOP solutions.

"it sounds like some of you want everything under the sun to be fixed by one stroke of the pen."

Hey, I already told them how to do that ("The US govt. hereby picks up all medical costs" and gave a nice simple 4 paragraph law, for some reason they didn't buy it!

7. "your Slavery Party" always the childish ad hominems, ignoringthe GOP's ultra racist strategies, failure among blacks, etc. Pretty childish, right?

"Why focus on the past, other than deflect the lack of vision for the future?"

Um, dear buddy, you still ain't telling us what the conservative plan is to fix Medicare. You could do it quite simply by saying "we're for eliminating medicare..." apparently y'all don't got the principles to say that! You don't answer because you have no answer, I suspect. If you have the answer, by all means, tell us.

"Can you, scottd, the tortured lawyer, MikeBS, or any leftist tell me what the plan is to REDUCE expenditures on health insurance? Not just slow the growth, but actually reduce?"

Not really. I didn't jump up this morning and pick this issue...someone else did. They complained about medicare and the problems we all agree it faces. I said, okay, yes, what is the conservative solution? I want to know and evaluate the conservative solution. Apparently it's a big secret.

There were many ideas put forth above from the democratic side and in general as you all know we favor either single payer or the public option to compete down the prices of the scummy insurance companies. Using your own beloved market forces of choice! So again, what is YOUR solution?
"This is your baby, your plan, your goal, you justify it. Make the case - how does it actually reduce dollars going out?"

Thru long run competetive forces in the public option, and if you're asking about single payer, um, thru the power of the government to dictate prices.

As shown int he fact that the nations with single payer systems have better outcomes and pay half as much as we do.

Generally, that's it.

Now Mr. Shanghai or any one of you, this post started with someone correctly pointing out that Medicare cost growth is unsustainable. So what is your solution?

Is it to eliminate the program?
To raise the age of eligibility?
To raise the taxes?
To have a independent commission changing the plan and taking the politics out of it, or are you guys going to cry that's a death panel and rationing?

What is your solution? What is your solution? What is your solution?

You say you are against govt. takeover of health how come you're not saying eliminate the program?

You're for Medicare, since you're not saying to eliminate it. You're for some commission to tell us how to fix it. But don't you got any answers folks, what do you thinkt he commission should do or propose to fix this problem?

By the way I have to mention again, here I go just asking an innocent question, seeking information. I don't know what your solution is. I ask you, you call me names. You change the subject. It's not very polite or welcoming. Sure, we can get into fighting and stuff but don'tyou think when someone just says hey guys, you conservatives, -- and look I even try to be careful and use the words you use, and not make up slurs and ungrammitical words like slavery party and democrat party -- i think's it's pretty fair to you on this site are conservatives or rightists...well, I just ask you your position and you don't even have the politeness to respond civilly.

Didn't your momma raise you to be polite?

Me, I was raised to never unintentionally insult someone. Do you find it insulting if someone says, "so, what is your solution to this problem that I, too, acknowledge?"

Why is there no simple exchange of information instead of the hostility and meanness?

Posted by Shanghai Dan at August 22, 2009 05:34

Posted by: Torture Lawyer on August 22, 2009 06:32 PM
68. Can you back up any of your claims? Any references? We know you have a long history of just making stuff up...

Great response, Dan. You expect me to footnote my entire post? Cite something you find questionable and I'll provide a source, sure.

But seriously, google stuff yourself. Fee-for-service is almost universally agreed to be the foot cause here. We effectively subsidize vast over-treatment (or "defensive medicine").

Posted by: John Jensen on August 22, 2009 06:58 PM
69. John Jensen "Sandy, sorry to hammer on you, but this is another misunderstanding. Medicare Advantage is not a supplemental insurance plan."

No problem John, I didn't mean to imply that the Advantage plan was a supplement, only that it does cover more than straight medicare. I don't have an Advantage plan so only know what friends have told me about their experience.

The point I was attempting to making is that we have problems with existing programs i.e. Medicare, Medicade, VA and Tri-Care (military) ... I don't seen anything in the HCR bill that would fix existing problems rather it creates more new programs. They will simply create a larger government bureaucracy. The government doesn't exactly have a shinning track record of running any of these programs. And If the Advantage plan is a disaster then why not take that $400-500 billion and use it to fix Medicare.

I was perfectly happy with my existing policy and would have continued with Blue Cross but was not given that option.

As for fixes ... I agree with G Jiggy, these fixes have already been suggested by the GOP but are ignored by the liberals. We do need reform, I just don't believe that what the Dems are pushing is going to be good for anybody, especially the elderly.

Posted by: Sandy on August 22, 2009 07:20 PM
70. Tortured Lawyer,

Here's an idea - since it's a proven fact (see Centrifuge John, it's easy to link) that Medicare administration costs are higher than private costs, start by eliminating Medicare. If it's anything like the past, Medicare costs will continue to increase faster than private insurance.

So in place of Medicare, provide vouchers for private insurance. Since most seniors also have to purchase supplemental insurance to get adequate coverage, just let them buy one good plan rather than break it up over 2 or 3 plans.

Allow tax deductions for HSA contributions; that will encourage people to start saving additional funds for their own health insurance.

Eliminate the cap on the size of an HSA; that will encourage people to accumulate a very large health insurance egg like another 401K for covering costs as they age.

Those are just a few. Costs will be actually reduced, not just slowed down. Eliminate tens of billions in costs.

But back to you... What are the suggestions from the Left? How to reduce the actual expenditures on health insurance, not just slow it down? Any, any at all?

Posted by: Shanghai Dan on August 22, 2009 07:27 PM
71. Centrifuge John wrote:

You expect me to footnote my entire post?

Just a simple reference to one of your claims, such as this claim:

Fee-for-service is almost universally agreed to be the foot cause here.

Really? Care to back that up, or just another point you like to spew?

We effectively subsidize vast over-treatment (or "defensive medicine").

Do you know why? Fear of litigation. So how about eliminating litigation, or capping awards - you know, tort reform? Is that a proposal of the left? Not at all. In fact, Tort reform was pushed by the GOP and President Bush, and stalled by the Democrats with a filibuster in the Senate.

Oh, did you notice the use of references, John? It's really pretty easy to do...

So you have a solution you like, it's been pushed by the GOP and opposed by the Democrats, yet you hang with the Democrats. Why is that, John?

Posted by: Shanghai Dan on August 22, 2009 07:38 PM
72. Yes, I do know why we subsidize over-treatment. It's called fee-for-service. I already said that.

The current unrestrained [fee-for-service] payment system has created a rate of volume growth that is unsustainable”
Medicare Payment Advisory Commission (MedPAC). Report to the Congress: Improving incentives in the Medicare program. June 2009. -- http://www.medpac.gov/documents/Jun09_EntireReport.pdf

"Defensive medicine," or over-treatment, happens famously in McAllen, TX. TX has tort reform in its constitution. Tort reform should be on the table, I agree. It's a problem. But no, it is not responsible for the exploding costs in health care. I get that it's a right wing talking point, but it's not a big part of the problem.

So tort reform is your single fix for Medicare? Probably tax cuts, too. Step off of your GOP talking points and do some reading, Dan.

Research on fee-for-service. Also, the health care experts who advise Mass. on its health care have UNANIMOUSLY recommended to move away from fee-for-service. And Mayo Clinic, and some HMOs, and generally almost most examples of a well-run, cost-contained hospital doesn't pay their doctors on fee-for-service, and instead pays a salary. Like I said, Google it.

You know why I don't care about citing sources anymore? Because when I did it all the time, people just doubted research anyway. I'm dealing with people who don't believe in science. Did you know we exhale CO2?

Posted by: John Jensen on August 22, 2009 08:11 PM
73. Dan: I can use google just fine. What I can't do is read your mind. Since you brought up the notion that the GOP had made some Medicare reform proposals, I was wondering what you had in mind. So I asked. As usual, you came up empty.

So, other than Medicare Advantage (which costs even more to run than traditional Medicare) and a prescription drug benefit (which adds even more to the federal deficit and specifically prohibits the govt from seeking to reduce the costs of the drugs it pays for), did you have anything else in mind when you said the GOP had proposed solutions when it controlled Congress?

Take your time -- maybe even use that google thingy you mentioned earlier. If you can mention some specific proposals from the GOP, we might have something to discuss.

Posted by: scottd on August 22, 2009 08:14 PM
74. So you have a solution you like, it's been pushed by the GOP and opposed by the Democrats, yet you hang with the Democrats. Why is that, John?

Before this point, I never said tort reform was a policy I liked. Please do not speak for me ever again. You do not understand the difference between defensive medicine and fee-for-service, and you need to learn what many people blame on defensive medicine is encouraged and paid for by fee-for-service.

Posted by: John Jensen on August 22, 2009 08:16 PM
75. It would be good if John Jensen provided an appropriate email address or a link that he supports instead of an error of:

http://www.safsa.com/

Who is John Jensen?

Posted by: Tim on August 22, 2009 08:34 PM
76. Scottd,

What will HR 3200 or the President do to lower costs? What the GOP wants is immaterial; they are not in power, nor have the ability to block legislation. It's solely in the court of Pelosi/Obama/Reid. So what's the plan? It's not in the hands of the GOP; they cannot do anything without the consent of Pelosi and Reid.

Centrifuge John,

Please do not speak for me ever again.

Promise to return the favor?

current unrestrained [fee-for-service] payment system

This phrase, with or without the parts in brackets, does not exist in your linked PDF (Adobe search didn't find it). I guess you made it up? Not surprising, really...

Is it any surprise why no one trusts what you write? Even when you use a "reference" it's a bogus one at that.

Tim,

It's what leftists do - they hide, they attack. They never propose solutions, only attack. Note how NONE of them have suggested any solutions!

The GOP put forth solutions in 2003 and 2005; the Slavery Party filibustered and stopped it both times.

Now the Slavery Party has complete control. What are their plans? No need to ask the GOP - the GOP cannot even filibuster. It's solely at the feed of the Slavers, so what do they want to do?

I guess just attack and blame... It's in their nature.

Posted by: Shanghai Dan on August 22, 2009 09:20 PM
77. #74 - It figures that you would not support tort reform in Health Insurance Reform. Most doctors would like to come after you and BO and his ilk with a pitchfork. Is this travesty known as Obamacare passes without tort reform, its only a matter of time before there will be a severe shortage in doctors in the USA, because the incentive will be sucked dry - with the fee schedule being an expansion of Medicare.

"You do not understand the difference between defensive medicine and fee-for-service,"

Suppose you explain that and also reference it in HB #3200 how it improves the present system. I am skeptical, so unless I see specifics, I;ll continue to regard you as a shill for Universal Healthcare.

Posted by: KDS on August 22, 2009 09:42 PM
78. #74 - It figures that you would not support tort reform in Health Insurance Reform. Most doctors would like to come after you and BO and his ilk with a pitchfork. If this travesty known as Obamacare passes without tort reform, its only a matter of time before there will be a severe shortage in doctors in the USA, because the incentive will be sucked dry - with the fee schedule being an expansion of Medicare.

"You do not understand the difference between defensive medicine and fee-for-service,"

Suppose you explain that and also reference it in HB #3200 how it improves the present system. I am skeptical, so unless I see specifics, I;ll continue to regard you as a shill for Universal Healthcare.

Posted by: KDS on August 22, 2009 09:43 PM
79. John Jensen - ""Defensive medicine," or over-treatment, happens famously in McAllen, TX."

Interesting because Jay Inslee has used McAllen, TX several times as his example that Tort Reform won't work. He also refers to an article in the New Yorker to back up his position. However, the article doesn't support his position.

From the article: ""McAllen, with its high poverty rate, has an incidence of heavy drinking sixty per cent higher than the national average. And the Tex-Mex diet has contributed to a thirty-eight-per-cent obesity rate". It is also a border town so I wonder how many illegals they treat? The article also said: "The primary cause of McAllen's extreme costs was, very simply, the across-the-board overuse of medicine."


What Inslee doesn't mention is that Tort Reform in Texas has been highly successful. Here is more information as to how Tort Reform Spurs Economic Growth; Aids Access to Healthcare in Texas: http://www.atra.org/wrap/files.cgi/7964_howworks.html
and a second article "Texas-style health care reform is bigger and better" from July 2009:
http://www.tortreform.com/node/533

Posted by: Sandy on August 22, 2009 09:46 PM
80. Dan: You were the one who said the GOP offered solutions for Medicare when they were in power. I was wondering what you meant by that. So far, you haven't been able to explain what those solutions were -- but that's not surprising.

If you're unable to explain your own comments, I don't see much point in continuing.

Posted by: scottd on August 22, 2009 10:14 PM
81. @80 scottd - and the Democrat solution is to bankrupt the country with $10 trillion of deficits in the next 8 years. Thanks a fucking lot! Fact is, neither party has a solution because the American people want it both ways. They want fiscal sanity + they want all their social safety nets. Can't do both.

Posted by: Crusader on August 22, 2009 10:19 PM
82. G Jiggy @20

You have some great common sense proposals!

Posted by: pbj on August 22, 2009 10:36 PM
83. Scottd -

Let's end this Democrat talking point that the Republicans have no alternative, shall we?

Senators Coburn, Burr, and Representatives Ryan, Nunes Offer a Better Path Forward on Health Care Reform

On May 20, 2009, U.S. Senators Tom Coburn, M.D. (R-OK) and Richard Burr (R-NC) and U.S. Representatives Paul Ryan (R-WI) and Devin Nunes (R-CA) introduced health care reform legislation that delivers on the shared principles of promoting universal access to quality, affordable health care, and does so without adding billions of dollars in new debt or taxes.

http://thomas.loc.gov/cgi-bin/query/z?c111:S.1099:

Posted by: pbj on August 22, 2009 10:40 PM
84. Sandy: You should read the New Yorker article you mentioned.

The quote regarding high poverty rates, obesity, etc. is not from the author of the article or one of the experts he interviewed. It is a hypothesis offered by some random police cadet the author interviewed at a local McDonald's, speculating on possible causes for the unusually high Medicare costs in McAllen. The author then throws cold water on this hypothesis -- pointing out that the incidence of cardiovascular disease is lower than average in McAllen.

One of the central points of the article was a comparison between McAllen and El Paso -- both on the border, similar size, and similar demographics. The author doesn't mention this, but both are beneficiaries of Texas tort reform. So, if tort reform is the answer, why does Medicare spend roughly twice as much per patient in McAllen than in El Paso?

As you noted, the author concludes: "The primary cause of McAllen's extreme costs was, very simply, the across-the-board overuse of medicine." But this wasn't caused by obesity, drinking, poverty, or illegal aliens because these factors are equally present in El Paso. It also wasn't caused by fear of lawsuits, because Texas has tort reform laws. It seemed that the overuse was caused by doctors in McAllen ordering more tests and procedures because they had a financial stake in the providers of these services -- something that was less likely in El Paso.

Posted by: scottd on August 22, 2009 10:49 PM
85. pbj: I was asking Dan to explain his claim that the GOP had offered solutions to the Medicare problem when they controlled Congress.

I appreciate your attempt to help since Dan seems to be ducking the question, but I don't think Coburn's bill was what he had in mind since it doesn't address Medicare specifically and it wasn't offered when the GOP controlled Congress.

But who knows what Dan was thinking? Let's let him explain himself, if he can....

Posted by: scottd on August 22, 2009 11:00 PM
86. Scottd - I don't really care what the GOP did or did not do when they were in power. I am talking of the here and now.

"I appreciate your attempt to help since Dan seems to be ducking the question, but I don't think Coburn's bill was what he had in mind since it doesn't address Medicare specifically and it wasn't offered when the GOP controlled Congress."

Obviously Scott, you simply dismissed it without even reading it. It does indeed address Medicare:

TITLE V--FIXING MEDICARE FOR AMERICAN SENIORS


Now please go to the link and read it before coming back and dismissing it. Isn't this what all you liberals demand of us? Quote me specifically (and link to it) what about the Patient's Choice Act you think won't work and why.

Here is the link (again):

http://thomas.loc.gov/cgi-bin/query/z?c111:S.1099:


Posted by: pbj on August 22, 2009 11:12 PM
87. I challenge any proponent of HR 3200 to tell me why they think it will reduce costs. The Congressional Budget Office has stated that this plan will increase costs. I can post the link if anyone has doubts. Since cost reduction was to be one of the main selling points of the plan, why should we go with it if CBO says in fact it will increase costs?

Posted by: pbj on August 22, 2009 11:17 PM
88. pbj: Great -- but what was Dan talking about? That's what I want to know!

Regarding the here and now -- we'll have another election in a little over a year. How about if the Republicans run on their Medicare reform ideas and see how they do? They didn't seem to do so well last time -- maybe their ideas will be more popular now!

Posted by: scottd on August 22, 2009 11:31 PM
89. Scottd,

See post 66 for instructions. The GOP had tort reform passed, and then your idiot Slavers in the Senate filibustered it.

President Bush presented changes for Medicare; the Slavery Party filibustered and killed it. Just like they're spiking HR3400.

The fact you don't like the answer doesn't eliminate the existence of the answer.

So how about you answer? What's the Democrat solution to Medicare? Any answers?

Posted by: Shanghai Dan on August 22, 2009 11:32 PM
90. PBJ,

He'll never answer, because he HAS no answers. The standard demo-idiot line is to refer to the past, blame and dodge. Never any solutions, only blame.

Come on scottd, I've answered, now you answer: what's the solution to reduce Medicare costs?

Posted by: Shanghai Dan on August 22, 2009 11:34 PM
91. Scottd -

Apparently you lack the basic skill to read and use google. I certainly found several reports of Bush propsing Medicare Reform. Here is one that was publishied in the British Medical Journal - a "peer reviewed" (I hear you liberals like) publication:

>b>Bush proposes Medicare reform
Fred Charatan

All Americans should have a good health insurance policy, so that they can choose their own doctor, rather than just rely on the state to dictate the coverage they are eligible for, President Bush told the American Medical Association earlier this month.
He was outlining proposals to reform the Medicare system for less well off people, including a new higher level of provision for those who wanted it. In doing so, he contrasted his vision with what he described as "government run healthcare ideas, the ideas in which the federal government decides care . . . rations care . . . dictates coverage." Such a system, he said, would "stifle innovation, stifle quality, and run up the costs on the patients of America."
Mr Bush said that under his scheme, which has yet to go through the House of Representatives and Senate, elderly people who were happy with the current Medicare system would be able to stay in the system and get help for prescription drugs. They would be given a discount card that would reduce the cost of prescription drugs by 10% to 25% Elderly people on a low income would receive an annual subsidy of $600 (£375; €545) to pay for prescription drugs.
But, he said, there would be an option to go for a higher level of cover for those who wanted it.
"Seniors who want more coverage will be able to choose an enhanced form of Medicare. This option will include full coverage for preventative care, a comprehensive prescription drug benefit, protection against high out of pocket costs, and extra help for low income seniors to be able to get the drug benefit."
Competing healthcare plans would provide this additional coverage, he suggested.
"Seniors who want the kind of benefits available in managed care plans, including prescription drug coverage, will have that choice as well. This option would place seniors in an affordable network of doctors, provide drug coverage, and allow seniors to keep their out of pocket costs to a minimum," he said.
Mr Bush also outlined additional payments for doctors operating under the Medicare system: "Effective this past Saturday, instead of a 4.4% reduction in Medicare payments, docs will receive a 1.6% increase. This increase is a sign of confidence in our doctors. And I hope that all of you will show your confidence in Medicare by staying in the system. Medicare needs you. Our seniors need you."
American Medical Association president Dr Yank Coble said, "The AMA agrees with President Bush on the need to modernise and improve Medicare so that America's seniors have more options and enhanced benefits in regard to their health care. The AMA supports the administration's desire to make prescription drugs more affordable for low income seniors and believes a prescription drug benefit for all seniors is long overdue."

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1125471

Posted by: pbj on August 23, 2009 12:09 AM
92. Dan: I ran the search you suggested; here's what came up in the first two spots:

"GOP Embraces Medicare to Kill Healthcare Reform" -- but they were talking about the present, not proposals made when the GOP was in power.

Next up:

"Where is Bush's Plan to Reform Medicare?" Is that what you had in mind?

Look, this isn't hard. You've said that the GOP offered solutions that would fix Medicare when they were in power but they were filibustered by the Democrats. I'm trying to figure out if you're just BSing us again, or if there's something to it. All you need to do is tell us what you meant. But you can't seem to do that -- so maybe it's just more BS from you. I really don't know, but it's hard to discuss this any further if you can't explain what you've written so far.

pbj: Thanks for the article quote. Here's a key phrase from your excerpt:

"Bush said that under his scheme, which has yet to go through the House of Representatives and Senate"

So, no legislation. Dan says the GOP offered solutions but they were filibustered. What was he talking about? Only Dan knows -- and he isn't saying...

Posted by: scottd on August 23, 2009 08:31 AM
93. Valiant effort, pbj, but scottd will ignore it. The mantra is that the GOP and President Bush "did nothing" when the reality is that the Slavers consistently blocked any reform at all.

For the Slavery Party, politics trumps the welfare of the nation every single time. Witness this current thread; rather than offering solutions, it's all about "well what did Bush do?"

Posted by: Shanghai Dan on August 23, 2009 08:41 AM
94. Scottd,

Spoon feeding time? The bill lost a lot of the meat in order to break the filibuster of the Democrats.

Posted by: Shanghai Dan on August 23, 2009 08:48 AM
95. Dan: Check what I've written. I never said the Democrats have a solution for Medicare but the GOP doesn't. I never said the GOP or Bush did nothing.

You're the guy who said the GOP had solutions that Democrats filibustered. I was just wondering what those solutions were -- so I asked. And asked again, and again...

I'm still waiting.

Posted by: scottd on August 23, 2009 08:49 AM
96. And they're posted. But why the focus on the past? What are you Slavers going to do now that you're in control? "We Won" is the mantra of the Left, what are you going to do?

Or is the idea to focus on the past, and ignore the future?

Posted by: Shanghai Dan on August 23, 2009 08:51 AM
97. Dan: Now I am really confused.

You said the GOP offered solutions that would fix Medicare when they were in control -- but Democrats filibustered and defeated those solutions. I've asked what you meant by that. After dancing around you finally gave us a link to an article that tells how Republicans were able to push through a bill that gave us the Medicare prescription drug benefit.

So, now I'm confused. It sounds like the Republicans got their legislation through -- so what were the solutions that Democrats stopped? The article doesn't say, so I still don't know what you are talking about and, I suspect, neither do you.

How did the prescription drug benefit "fix" Medicare? It seems to me that it has added additional costs to government, but it prevents government from negotiating with suppliers to reduce this costs. Is this the kind of GOP-led solution you meant?

Posted by: scottd on August 23, 2009 09:03 AM
98. Scottd,

Always living in the past, I see?

What are your solutions? What are they? There is a GOP bill out there - HR 3400 - that is being ignored by the Slavery Party leadership. Obama and his acolytes are talking of going it alone. Great - what is the path, what is the solution?

Any solutions at all, or is it all politics and attacks with you?

Posted by: Shanghai Dan on August 23, 2009 09:07 AM
99. Dan: You are a slippery fellow, so I've found it's best to stick to one topic at a time with you because you usually attempt to change the subject when you get into a tight spot.

So, just a reminder: The current topic is your statement that the GOP offered Medicare solutions when they were in control but the Democrats stopped them. I'm still wondering what you meant -- or maybe you just made that up.

I might be interested in talking about possible future solutions once we clear this current matter up. But if you can't explain what you've already written, I don't see how introducing new topics can be fruitful.

or is it all politics and attacks with you?

I don't think I've made any political attacks. I've just asked you to clarify something that you wrote. Seems reasonable to me...

Posted by: scottd on August 23, 2009 09:27 AM
100. No scottd, you're twisting the conversation. The conversation is about this thread - a $74 trillion unfunded liability with Medicare. And the current Congress and White House ignoring it, offering no solutions.

You want to change the subject, and I can understand why: the intellectual vapidity of the Left is plainly obvious to see. No solutions offered.

What are the solutions of the current Congress? That's what was asked by Warren. We've seen occasional forays at fixing Medicare in the past only to see it dragged down by the type of finger-pointing and politics you apparently are enamored with.

What are the solutions, scottd?

Posted by: Shanghai Dan on August 23, 2009 09:31 AM
101. Dan: I don't see how I'm twisting the conversation. Here's what you wrote @58:

You didn't like the solutions put forward when the GOP was in control of Congress,

And here's what you wrote @89:

President Bush presented changes for Medicare; the Slavery Party filibustered and killed it.

I've just asked you to tell us what those changes were. I don't see how that's twisting the conversation.

At this point, I'm not expecting a cogent response from you, so I won't be responding any further unless you can tell me the specific changes you were referring to, changes to fix Medicare that were proposed by the GOP when they were in power and stopped by Democrats.

It's just not possible to debate someone who runs away from his own arguments.

Posted by: scottd on August 23, 2009 09:43 AM
102. Scottd,

I assume you're intelligent, you can look at the changes in the bill that allowed the overturning of the filibuster by the Democrats.

Now, do you want to get back on topic? What is this Congress going to do to address the Medicare finacial disaster? Anything, anything at all?

Posted by: Shanghai Dan on August 23, 2009 09:47 AM
103. you can look at the changes in the bill that allowed the overturning of the filibuster by the Democrats.

I assume you've already done that, so how about saving us some time and just pointing out what was dropped that you think would have fixed Medicare? Besides, even if I went through the exercise you've suggested, I would still be guessing about which specific changes you thought were important.

I can't read your mind, Dan. Why don't you just tell us what you meant? Until then, sayonara...

Posted by: scottd on August 23, 2009 09:59 AM
104. Until then, sayonara...

Yes, run away, dodge the whole point of this thread, try to obfuscate and deflect.

The Slavery Party - as you exhibit - has no solutions. Only attacks, deflection, and finger-pointing.

Run, run away!

Posted by: Shanghai Dan on August 23, 2009 10:05 AM
105. Scottd, "Sandy: You should read the New Yorker article you mentioned."

Obviously I read it or I couldn't have been quoting from the article. The article is here: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=1

"The quote regarding high poverty rates, obesity, etc. is not from the author of the article or one of the experts he interviewed. It is a hypothesis offered by some random police cadet the author interviewed at a local McDonald's,"

.... you need to read the article again, yourself. The statement on obesity and alcohol were not quotes. All the cadet said was: ""Just look around," the cadet said. "People are not healthy here."

You didn't comment on the fact that the State of Texas has a high success rate with Tort Reform, you (and Jay Inslee) picked out a single town as an example ... as Jay Inslee has said in both telephone town hall meetings, "the article in the New Yorker on McAllen, Tx is an example of why tort reform will not work". Why?

Scottd said: "It also wasn't caused by fear of lawsuits, because Texas has tort reform laws. It seemed that the overuse was caused by doctors in McAllen ordering more tests and procedures because they had a financial stake in the providers of these services -- something that was less likely in El Paso." ...

Exactly, so why is Jay Inslee using it as his primary example that tort reform doesn't work? That article doesn't support that position.

As for GOP's who have recognized and support other options to HCR ... you can look at our own state.

"Doc Hastings said:" Doctors, hospitals, and emergency rooms that serve our communities are being hurt by ever increasing insurance rates - so much that the American Medical Association has declared Washington a "medical malpractice crisis state." Congressman Hastings supports common sense reforms to reduce frivolous lawsuits that are driving up the cost of health care for everyone and causing doctors in Washington state to limit services.

The plan Hastings supports would reduce doctor's insurance premiums by placing a responsible cap on non-economic damages. At the same time it would protect patients' full and complete compensation for economic damages - including the loss of past and future wages, lifetime rehabilitation, and medical and drug costs. It would also increase the share of lawsuit awards that go to injured patients, while decreasing the amount that could be claimed by lawyers."

IMHO it is probably the part about decreasing the amounts that lawyers receive, that make this undesirable to liberals.

Posted by: Sandy on August 23, 2009 10:13 AM
106. ... you need to read the article again, yourself. The statement on obesity and alcohol were not quotes. All the cadet said was: ""Just look around," the cadet said. "People are not healthy here."

You're right, Sandy. Thanks for the correction -- I'll try to read more carefully next time.

But the article still points out that rates of cardiovascular disease are lower than average in McAllen and it makes a matched comparision to El Paso, a similar city with similar lifestyles but roughly half of the Medicare costs as McAllen. Why is that? I don't think it's tort reform -- both towns are in Texas.

Exactly, so why is Jay Inslee using it as his primary example that tort reform doesn't work?

Of course, I don't know why Jay Inslee (or maybe his aide?) suggested this article, but it might have something to do with the comparison between McAllen and El Paso. If tort reform were the answer, you would think both towns would have low Medicare costs. Instead, McAllen is one of the highest in the nation.

That article doesn't support that position.

Yes, it does. (see above)

Posted by: scottd on August 23, 2009 10:31 AM
107. That article doesn't support that position.

Scottd: Yes, it does. (see above)

I don't see your logic Scott, you are still comparing one single city out of the entire state that reduced cost because of Tort Reform. So, maybe the Dr's there are a bunch of crooks, who knows ... If it works in 99.9% of the state, one town can not declare the entire state as a failure.

You didn't respond to the articles I posted links for that showed the over all positive results achieved by Tort Reform for the State of Texas.

Posted by: Sandy on August 23, 2009 11:26 AM
108. I don't see your logic Scott, you are still comparing one single city out of the entire state that reduced cost because of Tort Reform. So, maybe the Dr's there are a bunch of crooks, who knows ... If it works in 99.9% of the state, one town can not declare the entire state as a failure.

Here's the logic: McAllen has tort reform and it has some of the highest Medicare costs in the country. If tort reform is the solution to high Medicare costs, why doesn't it work in McAllen?

McAllen is just an example. It supports the argument that tort reform won't fix rising Medicare costs, but it doesn't conclusively prove that argument -- and I never said it did.

I also didn't say the whole state is a failure. I really don't know -- I just haven't seen any evidence that Medicare costs have been significantly reduced on average in Texas as a result of tort reform.

You didn't respond to the articles I posted links for that showed the over all positive results achieved by Tort Reform for the State of Texas.

Thanks for the links. I'm not necessarily against tort reform -- I just don't think it would do enough to reduce costs to "fix" Medicare -- so I think harping on this issue is a distraction. According to the article, the five largest insurers were able to save physicians $50M in premiums in 2005. That's great, but it's not much compared to total Medicare spending in the state.

The articles also list other benefits of tort reform in Texas -- but they don't demonstrate a significant reduction in healthcare spending or costs. Without those reductions, I don't see how tort reform can be an important part in solving Medicare's problems. It certainly hasn't done much in McAllen.

Posted by: scottd on August 23, 2009 12:12 PM
109. Scott - refer back up to post #20 from G Jiggy ... tort reform is not a stand alone solution. It is one of many supported by conservatives.

As for fixing Medicare, why not let Obama use his tax the rich ideas to support Health Care Reform to fix Medicare, Medicare and VA instead. Then once he fixes what already exist and stabilizes those programs, he can come up with new government programs. Obama's Health Care Reform isn't about fixing anything, it's about power and government control over our lives.

Posted by: Sandy on August 23, 2009 01:00 PM
110. refer back up to post #20 from G Jiggy ... tort reform is not a stand alone solution. It is one of many supported by conservatives.

@20 proposes five things, but tort reform is the only one that could possibly count as a possible solution for Medicare -- the other four items address issues related to other insurance programs. Since this thread is about Medicare, I don't want to spend time talking about reform ideas that relate to other types of health insurance -- maybe on another thread, some other time.

Obama's Health Care Reform isn't about fixing anything, it's about power and government control over our lives.

If you really believe that, I don't think I'm going to be able to talk you out of it.

Posted by: scottd on August 23, 2009 01:10 PM
111. That you refuse to admit the fact that Obamacare is all about acquisition and consolidation of power reveals everything one needs to know about you.

You are dismissed...

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