Dems Agree to Drop Government-Run Insurance Option

But health insurance stopped acting like traditional insurance a long time ago. Car insurance covers you in the event of an accident, it does not cover routine maintenance even though that routine maintenance could help avoid an accident. Life insurance (really should be called death insurance) pays money to your family in the event of your untimely death, but it does not provide preventative care to help you live longer.

I think he is arguing for health insurance to return to a concept of allocating risks in exchange for a premium: you pay a premium to cover the event that you have a serious injury or disease, and nothing else. He does not want to pay a larger premium so that he can see a doctor any time he wants. Of course, he can obtain the result he wants for himself through a high deductible policy with an HSA.

I personally like my high deductible policy because I am healthy and I have the funds to max out the HSA every year, but I am not convinced that limiting insurance to just major health problems is the answer for everyone. I think there would also need to be a mechanism for people to obtain low cost preventative care and care for minor injuries and illnesses. As I see it that can only happen through physicians accepting substantially less income, an expansion of who can provide that care (e.g., nurse practitioners taking care of people with migraines and other lesser emergencies), the government supplementing the cost, or a combination.

 

Uhh you are the one who stated I was creating lies when I said buying insurance was mandatory. Why do you think I've been harping from the beginning? Do you think people who can not afford insurance now are going to pay this tax or run out and buy $300 premiums?

 

Yes, this is exactly what I saying and most understand it. The bigger issue is that even though I can find something like that, it still doesn't solve the exorbitant costs for minor instances.

 

So if you are happy with a cheap, catastrophic only plan (which are pretty heinous for public health and controlling costs, overall, but table that) which are available now, why are you arguing that we need "HCR" at all?

Also what is your solution for when you become older and experience normal, aging related health problems? Are you content with paying for these out of your own pocket? Because it is going to be very, very very costly. And they will not be covered by your $100 catastrophic plan.

 

Republicans cave on Filibuster

Senate Republicans have agreed to end their filibuster of health care reform “early Christmas Eve morning, allowing for a vote on the package at 8 a.m.” Sen. James Inhofe (R-OK) told the Oklahoman that “the vast majority” of Senate Republicans supported ending the filibuster in order to go home for the holiday. “We’ve had all the fun we’re going to have” debating the bill, said Inhofe.

 

This post is addressed to the individual posting as Clutchfans.net user "MojoMan".

The quoted sentence contains errors, please correct them.

 

Wacked out crazies are everywhere!

via TPM --

Tea Partier takes down Christmas tree to protest passage of health care reform. Asks others to follow.

No, this is not an Onion story. On C-SPAN's call in show this morning, a woman named Bunny from Parsons, Kansas, said she was so disappointed by the Senate's health care vote that she took down her Christmas tree. And it seems like her call was not a prank.

It wasn't just Bunny's tree that went. "I have taken my Christmas wreath off my house. I have taken all the lights down," she said. "This is supposed to be a nation under God, and it isn't. They absolutely have ruined Christmas."

You can see C-SPAN host Peter Slen, no doubt trained to deal with the occasional eccentric caller, **** his head ever so slightly as Bunny breaks the news.

"So you took down your Christmas tree because of the Senate health care bill?" he asks, with a hint of incredulity.

"I certainly did. And I would like to see every light in the nation go out, especially in the White House," Bunny replies.

She also explains that members of Congress are sullying "God's holiday for the birth of his son" and that she opposes the bill so fiercely because its death panel provisions will unleash a "genocide"on seniors.

http://www.talkingpointsmemo.com/

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Obama will lose in 2012, and the dems are in for one $h!tty midterm elections. I don't know whether to feel happy or sad. On one hand, the very people who betrayed my unwavering support will be out of office, on the other hand, those ape$h!t republicans will replace them.

Screw politics. And it should be a lot of fun paying 19% of my income on mandatory insurance. Somehow they managed the spin a "reform" bill to a bailout of the insurance companies. Brilliant

 

I must have missed the part in my Bible where God says "Thou shalt not reform health care."

The last time I checked, there are no provisions in the Bible, the Koran or the Torah regarding passage of a health care bill.

This woman is nuts. She says that the passage of the health care bill shows that this is not a nation under God, and then completely fails to explain how or why this goes against God.

I have said it many times over, as a society we are doomed.

 

I bet that kooky lady who ruined her son's Xmas is prayin for palin.

Actually, this will probably be one of his stronger points when the bill finally kicks in around 2011.

My bet is that if he loses, it won't be because of the healthcare bill.

People forget easily.

 

You're absolutely correct. This health care bill will have no effect until 2014, so once he signs this crapfest into legislation, it will be all but forgotten until then. This next year worries me a bit on what Obama will try to pass once he gets this hurdle through the hoop. After 2010, with republicans in office, hopefully the public will get a break from the bickering and fighting in politics.

 

If Republicans win a bunch of seats in 2010 on the backs of two years of just yelling and screaming a bunch of angry nonsense, what makes you think that would *decrease* the amount of that garbage in politics?

 

I felt more reassured after reading this NewYorker article by Atul Gawande. Then again, the rational detachment with collecting raw data on people's lives from different pilot programs would likely be different than raising crops and livestock...I'd hope.

http://www.newyorker.com/reporting/2009/12/14/091214fa_fact_gawande?printable=true
It's lengthy but worth reading. The 2nd half:
[rquoter]
There are, in human affairs, two kinds of problems: those which are amenable to a technical solution and those which are not. Universal health-care coverage belongs to the first category: you can pick one of several possible solutions, pass a bill, and (allowing for some tinkering around the edges) it will happen. Problems of the second kind, by contrast, are never solved, exactly; they are managed. Reforming the agricultural system so that it serves the country’s needs has been a process, involving millions of farmers pursuing their individual interests. This could not happen by fiat. There was no one-time fix. The same goes for reforming the health-care system so that it serves the country’s needs. No nation has escaped the cost problem: the expenditure curves have outpaced inflation around the world. Nobody has found a master switch that you can flip to make the problem go away. If we want to start solving it, we first need to recognize that there is no technical solution.

Much like farming, medicine involves hundreds of thousands of local entities across the country—hospitals, clinics, pharmacies, home-health agencies, drug and device suppliers. They provide complex services for the thousands of diseases, conditions, and injuries that afflict us. They want to provide good care, but they also measure their success by the amount of revenue they take in, and, as each pursues its individual interests, the net result has been disastrous. Our fee-for-service system, doling out separate payments for everything and everyone involved in a patient’s care, has all the wrong incentives: it rewards doing more over doing right, it increases paperwork and the duplication of efforts, and it discourages clinicians from working together for the best possible results. Knowledge diffuses too slowly. Our information systems are primitive. The malpractice system is wasteful and counterproductive. And the best way to fix all this is—well, plenty of people have plenty of ideas. It’s just that nobody knows for sure.

The history of American agriculture suggests that you can have transformation without a master plan, without knowing all the answers up front. Government has a crucial role to play here—not running the system but guiding it, by looking for the best strategies and practices and finding ways to get them adopted, county by county. Transforming health care everywhere starts with transforming it somewhere. But how?

We have our models, to be sure. There are places like the Mayo Clinic, in Minnesota; Intermountain Healthcare, in Utah; the Kaiser Permanente health-care system in California; and Scott & White Healthcare, in Texas, that reliably deliver higher quality for lower costs than elsewhere. Yet they have had years to develop their organizations and institutional cultures. We don’t yet know how to replicate what they do. Even they have difficulties. Kaiser Permanente has struggled to bring California-calibre results to North Carolina, for instance. Each area has its own history and traditions, its own gaps in infrastructure, and its own distinctive patient population. To figure out how to transform medical communities, with all their diversity and complexity, is going to involve trial and error. And this will require pilot programs—a lot of them.
Pick up the Senate health-care bill—yes, all 2,074 pages—and leaf through it. Almost half of it is devoted to programs that would test various ways to curb costs and increase quality. The bill is a hodgepodge. And it should be.

The bill tests, for instance, a number of ways that federal insurers could pay for care. Medicare and Medicaid currently pay clinicians the same amount regardless of results. But there is a pilot program to increase payments for doctors who deliver high-quality care at lower cost, while reducing payments for those who deliver low-quality care at higher cost. There’s a program that would pay bonuses to hospitals that improve patient results after heart failure, pneumonia, and surgery. There’s a program that would impose financial penalties on institutions with high rates of infections transmitted by health-care workers. Still another would test a system of penalties and rewards scaled to the quality of home health and rehabilitation care.

Other experiments try moving medicine away from fee-for-service payment altogether. A bundled-payment provision would pay medical teams just one thirty-day fee for all the outpatient and inpatient services related to, say, an operation. This would give clinicians an incentive to work together to smooth care and reduce complications. One pilot would go even further, encouraging clinicians to band together into “Accountable Care Organizations” that take responsibility for all their patients’ needs, including prevention—so that fewer patients need operations in the first place. These groups would be permitted to keep part of the savings they generate, as long as they meet quality and service thresholds.

The bill has ideas for changes in other parts of the system, too. Some provisions attempt to improve efficiency through administrative reforms, by, for example, requiring insurance companies to create a single standardized form for insurance reimbursement, to alleviate the clerical burden on clinicians. There are tests of various kinds of community wellness programs. The legislation also continues a stimulus-package program that funds comparative-effectiveness research—testing existing treatments for a condition against one another—because fewer treatment failures should mean lower costs.
There are hundreds of pages of these programs, almost all of which appear in the House bill as well. But the Senate reform package goes a few U.S.D.A.-like steps further. It creates a center to generate innovations in paying for and organizing care. It creates an independent Medicare advisory commission, which would sort through all the pilot results and make recommendations that would automatically take effect unless Congress blocks them. It also takes a decisive step in changing how insurance companies deal with the costs of health care. In the nineteen-eighties, H.M.O.s tried to control costs by directly overruling doctors’ recommendations (through requiring pre-authorization and denying payment); the backlash taught them that it was far easier to avoid sicker patients and pass along cost increases to employers. Both the House and the Senate bills prevent insurance companies from excluding patients. But the Senate plan also imposes an excise tax on the most expensive, “Cadillac” insurance plans. This pushes private insurers to make the same efforts that public insurers will make to test incentives and programs that encourage clinicians to keep costs down.

Which of these programs will work? We can’t know. That’s why the Congressional Budget Office doesn’t credit any of them with substantial savings. The package relies on taxes and short-term payment cuts to providers in order to pay for subsidies. But, in the end, it contains a test of almost every approach that leading health-care experts have suggested. (The only one missing is malpractice reform. This is where the Republicans could be helpful.) None of this is as satisfying as a master plan. But there can’t be a master plan. That’s a crucial lesson of our agricultural experience. And there’s another: with problems that don’t have technical solutions, the struggle never ends.

Recently, I spoke with the agricultural extension agent for my home town, Athens, Ohio. His name is Rory Lewandowski. He is fifty-one and has been the extension agent there for nine years. He grew up on a Minnesota dairy farm, and got a bachelor’s degree in animal science and agronomy from the University of Minnesota and a master’s degree in agronomy from the University of Wisconsin. He spent most of his career in farm education, including eight years in Bolivia, where, as a volunteer for the Mennonite Central Committee, he created demonstration farms in an area where the mining economy had collapsed.

I had a vague childhood memory of the extension office, on West Union Street, near downtown Athens; kids in my school used to go to 4-H meetings there. But I had no idea what the agent really did. So I asked Lewandowski. “I just try to help make farming better in Athens County,” he said.
Athens is a green, hilly county at the edge of the Appalachian Mountains, and the farms there are small—an average of a hundred and fifty acres, Lewandowski said. There are six hundred and sixty of them, with, he estimated, as many as a hundred kinds of produce and livestock. His primary task is to help farmers improve the productivity and quality of their farms and to reduce environmental harm. A hundred years after Seaman Knapp, the difficulties have changed but they haven’t gone away.

I’d caught Lewandowski in his office on a Saturday. He routinely puts in sixty-five to eighty hours a week at his job. He has a five-week small-ruminant course for sheep and goat producers; a ten-week master-gardener course; and a grazing school. His wife, Marcia, who has written two knitting books, handles registration at the door. He sends out a monthly newsletter. He speaks with about half the farmers in the county in the course of a year.
Mostly, the farmers come to him—for guidance and troubleshooting. He told me about a desperate message that a farmer left him the other day. The man’s spinach plants had been afflicted with downy mildew and were collapsing. “He said he was going to lose his whole crop by the weekend and all the markets that he depended on,” Lewandowski said. He called the farmer back and explained that the disease gets started with cooler temperatures and high humidity. Had the farmer been using overhead watering?
Yes, he said, but he had poked around the Internet and was thinking about switching to misting.

Not a good idea. “That still leaves too much moisture on the leaf,” Lewandowski said. He recommended that the farmer switch to drip irrigation, and get some fans in his greenhouse, too.
The farmer said that he’d thought about fans but worried that they would spread the spores around.
They will, Lewandowski said. “But you need wetness on the leaves for four to six hours to get penetration through the leaf cuticle,” he explained. If the plants were dried out, it wouldn’t be a problem. “You’ve got to understand the biology of this,” he said to me.

He doesn’t always understand the biology himself. He told me about a beef
farmer who had been offered distiller’s grain from a microbrewery, and wanted to know whether he could feed it to his cows. Lewandowski had no idea, but he called the program’s beef extension expert and got the answer. (Yes, with some limits on how much he put in a ration.) A large organic farm called with questions about growing vegetables in high tunnels, a relatively new innovation that the farm had adopted to extend its growing season. Lewandowski had no experience with this, but an extension agent in Wooster, Ohio, was able to supply information on what had worked best elsewhere.
“You have to be able to say, ‘I don’t know, but I can figure that out for you,’ ” Lewandowski said.

If he could change one thing about farming in Athens, I asked, what would it be? “Grazing management,” he said. “Think about how the grass grows in your lawn. A grass plant needs at least a few days after a mowing to grow.” If you mowed your lawn every day, the grass would become thin and patchy. That’s what happens when farmers leave their animals out in one big pasture—which is what most small farmers do—or rotate them too slowly. In his grazing school and in demonstrations, he asks farmers to keep their animals in a given area for only a few days, then move them to a section where the grass is eight inches tall and has reached its highest nutrient value. This way, the pastures won’t erode, and the cattle will grow better, yielding higher-quality meat and more of it. The technique requires discipline, though, and extra work, and farmers have been slow to give it a try.
I asked him if he has had any victories. All the time, he said. But he had no illusions: his job will never end.

Cynicism about government can seem ingrained in the American character. It was, ironically, in a speech to the Future Farmers of America that President Ronald Reagan said, “The ten most dangerous words in the English language are ‘Hi, I’m from the government, and I’m here to help.’ ” Well, Lewandowski is from the government, and he’s here to help. And small farms in Athens County are surviving because of him. What he does involves continual improvisation and education; problems keep changing, and better methods of managing them keep emerging—as in medicine.

In fact, when I spoke with Lewandowski about farming in Athens, I was struck by how much it’s like the health-care system there. Doctors typically work in small offices, with only a few colleagues, as in most of the country. The hospital in Athens has less than a tenth the number of beds that my hospital in Boston has. The county’s clinicians could do much more to control costs and improve quality of care, and they will have to. But it will be an ongoing struggle.

My parents recently retired from medical practice in Athens. My mother was a pediatrician and my father was a urologist. I tried to imagine what it would be like for them if they were still practicing. They would be asked to switch from paper to electronic medical records, to organize with other doctors to reduce medical complications and unnecessary costs, to try to arrive at a package price for a child with asthma or a man with kidney stones. These are the kinds of changes that everyone in medicine has to start making. And I have no idea how my parents would do it.

I work in an academic medical group in Boston with more than a thousand doctors and a vastly greater infrastructure of support, and we don’t know the answers to half these questions, either. Recently, I had a conversation with a few of my colleagues about whether we could accept a bundled payment for patients with thyroid cancer, one of the cancers I commonly treat in my practice as a surgeon. It seemed feasible until we started thinking about patients who wanted to get their imaging or radiation done elsewhere. There was also the matter of how we’d divide the money among the surgeons, endocrinologists, radiologists, and others involved. “Maybe we’d have to switch to salaries,” someone said. Things were getting thorny. Then I went off to do an operation in which we opened up about a thousand dollars’ worth of disposable materials that we never used.

Surely we can solve such problems; the reform bill sets out to find ways that we can. And, in the next several years, as the knowledge accumulates, I suspect that we’ll need our own Seaman Knapps and Rory Lewandowskis to help spread these practices county by county.

We’ll also need data, if we’re going to know what is succeeding. Among the most important, and least noticed, provisions in the reform legislation is one in the House bill to expand our ability to collect national health statistics. The poverty of our health-care information is an embarrassment. At the end of each month, we have county-by-county data on unemployment, and we have prompt and detailed data on the price of goods and commodities; we can use these indicators to guide our economic policies. But try to look up information on your community’s medical costs and utilization—or simply try to find out how many people died from heart attacks or pneumonia or surgical complications—and you will discover that the most recent data are at least three years old, if they exist at all, and aren’t broken down to a county level that communities can learn from. It’s like driving a car with a speedometer that tells you only how fast all cars were driving, on average, three years ago. We have better information about crops and cows than we do about patients. If health-care reform is to succeed, the final legislation must do something about this.

Getting our medical communities, town by town, to improve care and control costs isn’t a task that we’ve asked government to take on before. But we have no choice. At this point, we can’t afford any illusions: the system won’t fix itself, and there’s no piece of legislation that will have all the answers, either. The task will require dedicated and talented people in government agencies and in communities who recognize that the country’s future depends on their sidestepping the ideological battles, encouraging local change, and following the results. But if we’re willing to accept an arduous, messy, and continuous process we can come to grips with a problem even of this immensity. We’ve done it before. [/rquoter]

 

According to other prognostication the World will end in 2012 so no worries.

I take it you aren't paying for health insurance now? Keep in mind even if your employer pays for it that is money that they could've paid to you so you are indirectly paying for health insurance even if its employer provided.

 

That's a great article. There are two parts of this bill I absolutely love:

1. The voucher system that allows you to convert company health care to an individual plan of your choice. This is absolutely critical in that corporate health care is absolutely horrible in the grand scheme of things because the consumer is disconnected from the provider. Your employer has different interests than you, so the free market is unable to provide you the best insurance for you. Opening this up has real potential to create better insurance plans.

2. What the article mentions: experimenting with new ideas. The real solutions for health care are going to be outside the box. They are going to involve entirely new ways of doing things, from eliminating pay-for-service to reforming information systems. The more of these things, the better. In a way, this is how welfare reform was done and it was extremely successful.

Ultimately, I'd have liked to have seen the bill JUST be these pilot programs, give them two-three years, and then revisit the whole thing to implement a nationwide system. I'd have been happy to push universal coverage down the road and entirely focus this bill on exploring new cost control strategies, but that was never going to happen. Hopefully we'll hit on some of these and be able to implement them widely a few years from now.

 

I also want to say that it sucks that 6 months after the tea party stuff, Democrats STILL are horrible on messaging about this stuff. They really should be talking more about these types of innovations, rather than the public option and $900B and stuff like that.

 

I know I've said this before but

STOP TALKING ABOUT THE UNINSURED, NOBODY CARES ABOUT THEM


They can be so out of touch, these representatives from these conservative states and districts that you are barely winning are the people keeping these progressive initiatives in this bill to a minimum are doing it for a reason. and they still don't get it. keep the liberal talk to a minimum, talk about cutting costs.