In 65 years we have gone from the "New Deal" to the "No Deal"!
Gloom and doom are inadequate tools with which to confront our future, but irrational optimism is no better than a leap in the dark. Why are we then halted between this two irrational poles? We neither need to apologize for our past nor lament our future, but to ignore either is to imperil not only ourselves but our progeny.

Professional destiny is inexorably linked with societal destiny. One cannot survive without the other and neither will prosper without the other.

In the past two hundred years, this nation has survived and prospered because of a political revolution, an industrial revolution and a social revolution. We are now in an ethical revolution testing our capacity to be comitted to a cause outside of ourselves. No enterprise of courage and compassion has long languished merely because of a want of money, unless, it also lacks vision, purpose, and industry.

People, corporations, professions, even governments fail when they neglect to seize the opportunity to serve and merely insist, instead, upon being served.

Even a purposeful entry into the future is risky. But to enter without purpose is suicidal. If our purpose is not better health for more people, we will surely fail. When our concern is for people in need and not ourselves, we will succesd, but not without mistakes, false leads, and an extended learning curve.

The role of government should and must be to make the system accountable for the rational use of resources and be capable of purging both clinical mysticism and scientific egotism which impede rather than facilitate rational therapy.

The role of government is one of facilitation and fine tuning of existing and emerging systems and the continuing monitoring of the performance and upgrading the performance criteria. Finally, the rewards and compensation should be to the care providers and risk takers, and not the bean counters. Tom

The first obvious observation is that almost everyone over 65 is on Medicare already, and people over 65 have much higher medical bills on average than those under 65.

So you can't simply extrapolate the numbers.

The second observation from years on ambulances is that there are MUCH cheaper ways of delivering the same care than the mechanisms used today

And the third observation is that preventive care would save a lot

/Bevin

I have a very difficult time understanding the ping-pong effect in public opinion. It does seem to prove that some Americans are fickle.

Last year the polls showed consistently that the majority of Americans wanted change and that health care reform was one of the major changes they wanted. They elected a president who ran on change and he has begun a very careful change process in which he has outlined a handful of principles for health care reform, convened the major stakeholders to discuss how to change things for the better within the terms of these principles, got some major commitments from key sectors and allowed the legislature to develop at least three versions of a proposed plan.

Now, in August, all of a sudden, a bunch of people are supposedly angry? And they are spouting stuff that just makes no sense at all. "Don't let the government control my Medicare." (Do they think Medicare is a corporation of some kind?) "Death panels ... it will fund abortion." (Sorry, no matter how much you search the long documents, that just is not in there.) This has all the ear-marks of a manipulated response.

Why has the opposition produced no counter plan, but just harped on what it will cost to make changes? Do they seriously want to maintain the broken system we have now? If so, why is no one making a case for doing so?

Somebody please help me understand the situation and the irrational fear that Americans seem to have of public utilities. We are the only developed country that seems to want to maintain an out-dated, more costly, less effective approach to organizing something as basic and important as health care. Is this a mass delusion of some kind or is there a rationale for doing this?

Monte, it's the fear of the unknown: and much has been driven by demagogues taking advantge of the ingnorance of many; such as the ignoramus who shouted "Don't let government take away my Medicare" which only demonstrates its effectiveness of inciting fear. How many times must it be repeated that if anyone is happy with his insurance he may keep it. The only problem is that when it is connected to your work and you lose your job, there goes the health insurance. There has to be a better way. Unfortunately, the loudest voices have only been negative, offering no counter argument.

It is the fear of the unknown coupled with the lack of clear consistent talking points by the reformers. In addition, there is a probably healthy distrust of politicians in general and Obama is no exception.

I am a big Obama supporter and a big supporter of health care reform and even I have to roll my eyes a little when I hear there is going to coverage for all with no tax increase for most Americans and we are going to get to keep our same coverage if we like it. I'm sorry but it is quite likely that if there was a gov't option, my husband's work would switch to it and we can only go with what they decide - we have no choice in coverage. We get one option only. Now personally I think the gov't option would be fine and I'm not scared of it but it is a tad misleading to say that everyone gets to keep what they have if they are happy with it. Not exactly. They will be told by their employers what they will get (just like now) and there is no way to prevent employers from switching.

And when we hear that there will be universal coverage without hearing a clear plan for paying for it, we get suspicious.

Not to mention quite a few people, myself included, are uncomfortable with the amount of debt we are racking up. I understand the need for the stimulus and all that but I'd feel better knowing we are actually going to pay for the health care changes rather than piling on even more debt. I would rather be taxed to pay for it personally although I know politics wouldn't let Obama do that.

These are all substantive issues that Americans could be talking about and insisting our gov't address but instead we have to listen to wingnuts scream about death panels. I really hate that the Republicans have become such a disaster because it would be nice to have some good, thoughtful challenges. We would have a better product at the end instead of compromise consisting of throwing out paying for end-of-life consultations. Unfortunately the Rs are simply bound and determined to defeat any sort of reform. Never mind what is good for the American people. What craziness.

Beth
Add to your comments the way the dem's go about passing the bill.
No body had read the bill. No one had debated the bill and Obama wanted to ram it through in 2 weeks?
What a putz!

Also as we all know, proposed legislation is a document in flux. On Aug 27 Monte can say there are no death panels but that WAS in the version Obama and the dem's tried to ram through before the Aug. recess.

How about the dem's tackle tort reform so redundant/unnessisary testing and its associated costs can be eliminated? Where are the dem's on that?

Rather than a forced change why dont they start a new plan where those who want to, can? Let everyone else see how it plays out along with its financial impacts and then decide to join or not?

When the frame of the debate starts with Obama trying to ram this through congress and the bill and its lack of debate and context IS the subject, it is patently stupid to say, what do republicans offer as an alternative?
An alternative to what? Nobodys even read it yet! You should all get on your knees and thank republicans for resisting ill concieved and rushed legislation for not being rubber stamped by a Activist President and congress.

It is also the weakest possible arguement on the subject to refer to those opposed as if they had the same familiarity with the subject of health reform as did the retiree who said keep the government out of my medicare.
Medicare has been around along time and helped many people but it was a ponzi scheme from the beginning and many economists say it is one of the largest factors in the expense of health insurance today by cost shifting the burden onto those with private insurance.

Michael said,

"Also as we all know, proposed legislation is a document in flux. On Aug 27 Monte can say there are no death panels but that WAS in the version Obama and the dem's tried to ram through before the Aug. recess."

If you want to call the gov't paying for people to voluntarily meet with their own doctor to discuss end of life issues and make their wishes known before they are terminally ill "death panels" then I guess it did.

Let me tell you, having just gone through my father-in-law dying I couldn't be more angry at the Rs for lying about what was in that bill. It is downright immoral to frighten old people that way and scare them and their families away from a service that can make dying easier on everyone. I don't know if you have had to care for a close older relative who is dying but knowing what their wishes are before the chaos starts is a good thing.

"How about the dem's tackle tort reform so redundant/unnessisary testing and its associated costs can be eliminated? Where are the dem's on that?"

Every study that has been done on this issue says that this is a very small part of the problem - somewhere between 1-2% of health care costs. As the daughter of a neurosurgeon (the specialty along with OB that has the highest premiums) I am sympathetic to doctors' concerns. However, the profession has also done a poor job of weeding out incompetent doctors. They cover for each other like cops. It would help if we could develop a system that allows for the doctors who really do go way beyond an occasional mistake to get taken care of while limiting the punishment for those who are only human.

I think another part of the solution is universal care. People who are harmed by medical mistakes may find it difficult to get insurance afterwards. They sue for medical expenses because they don't have any other way to pay for it. Reforming insurance so that people do not have to sue the doctor and could still get cared for would help.

Finally, on that topic, I still don't think that unnecessary tests are going to go away if doctors are no longer sued as long as doctors have a financial incentive to order them. I don't think most doctors are money grubbing but nor do I think they are any more immune from normal justifications when given the opportunity to make a whole lot of money. In other words, they are no better or worse than the bankers or insurance companies or anyone else who we don't exactly trust to always spend our money wisely.

So forgive me if I'm not "down on my knees thanking the Rs." It's one thing to make substantive challenges and quite another to make up stuff and lie about it. This is a conversation our country needs to be having but you can't talk with people who aren't dealing with reality.

One solution is to give everyone, or every family a choice of coverage premiums, then let him shop for the best deal. Then, when he goes to the doctor or hospital, he could instantly see what the charges are. As it is, few people ever see the bills--they are sent directly to the insurer and so we avoid ever realizing the true costs of our healthcare.

Until and unless we can shop competitively for health insurance, there will be no benefits in any program. Currently, nearly all Medicare recipients are very happy with their coverage, but it is increasing daily and will continue to rise. However, it IS a wholly-government run program, and they do it at less than half the cost of other private Medicare programs. Check the healthcare insurance company's profits and their CEOs salaries--that's where the money goes--they are FOR PROFIT businesses and the higher profit, the more for them and the shareholders. They also have the highest number of lobbyists in Washington and have put enormous amounts of money into defeating any plan that would cause them to lose business.

With a government-run insurance plan, those not presently insured at work or the unemployed could be offered a plan. Any plan tied to employment is only as good as your employment, and today, that's very unsure. Also, as employer's costs for health insurance rise, there is no ability to raise salaries, nor is the employee taxed on his healthcare benefits.

Health insurance in the U.S. is such a piecemeal affair and the fee-for-service plan is a disaster: the more services rendered, the higher the payout. There is absolutely no incentive to eliminate costly procedures; in fact, there is even cash incentive to do more CT scans, MRIs, expensive lab tests, etc. to CYA for possible malpractice suits. Tort reform is something that should be written into any bill.

The Mayo and Cleveland Clinics, and a few other smaller similar operations have worked very well by paying straight salaries--leaving no incentive for extra expensive tests, but in improving the quality of health there is incentive: fewer visits equal fewer costs and fewer payouts. Keeping people well is far less expensive than treating after health has been neglected. Ask any ER physician.

If other nations have been able to offer universal coverage to the satisfaction of most of their citizens, why should the U.S. be the last to do so. We also pay more for health insurance while have much worse health outcomes. Something is very wrong with this picture.

So forgive me if I'm not "down on my knees thanking the Rs." It's one thing to make substantive challenges and quite another to make up stuff and lie about it. This is a conversation our country needs to be having but you can't talk with people who aren't dealing with reality.

Posted by: Beth | 27 August 2009 at 3:03

So am I to assume then that you would be fine having your senators and representatives vote on bills they have not read that were assembled by activists and lobbyists?

Being coerced into voting on a bill no one including the president has read is not a sustantive challenge?

Where does your reality start then?

Michael,
I'm not saying that it is fine for my representatives to pass something they haven't read. I'm saying that the opposition offered by the Rs has been based on lies, not substantive challenges.

I don't think anything should be rushed through but it would be great if the Rs had said, "Wait a minute, let's take some time here and talk about how exactly we are going to pay, what exactly is changing, what are the pros and cons of various options etc." You know, talk about the health care problems we all face like adults. Insisting on the time to study it carefully is very different from screaming about euthanasia, "death panels," and "socialized medicine". We need someone to ask about what we already know about costs based on data and instead we get irrational fear mongering based on nothing more than made up hysteria. That's what I mean by non-reality based. Their challenges are not substantive when we would be better off if they were.

They did that. The CBO said it wont work as advertised. They confirmed the plan would drive up the deficit.
http://www.washingtonpost.com/wp-dyn/content/article/2009/07/16/AR200907...

Every time the republicans have answered your concerns.
Perhaps I have just pursued the information. Maybe it is where one gets their news from I dont know.
It just seems every substancial effort from dont pass or put through a bill no one has read to non partisan policy review is passed off as fear mongering by the democratic machine.

For goodness sake even the fiscally responsible democrats are not on board with this bill. What does that tell you?

Rep's havent needed to tell lies with a bill as poorly crafted as this one.

Since when is the CBO Republican?

I have already shared my concerns about the cost and I think there are a few R legislators who have been helpful in working on this (Snowe comes to mind.) But the vast majority of complaint has not focused on that, it has focused on distorting the bill into something it isn't. The fears aren't that this is going to cost too much (as compared to what I wonder?) but that the gov't is going to be doing all sorts of things that aren't even in the bill (and that are already being done and worse by private insurance companies anyway I would add.)

My personal fear is that costs are going to driven up by too many concessions to the insurance, drug and health care industries. Cost isn't going to come from being too "socialist" it's going to come from not being regulated enough. Giving those industries most of what they want and covering fewer people (like we do now) is less expensive than giving them most of what they want and covering a lot more people.

As for the Blue Dog Ds, there are several possible answers only some of which pertain to costs. Some are in conservative districts and don't think they can get reelected. Following the money trail can be enlightening:

"A look at career contribution patterns also shows that typical Blue Dogs receive significantly more money -- about 25 percent -- from the health-care and insurance sectors than other Democrats, putting them closer to Republicans in attracting industry support."
http://www.washingtonpost.com/wp-dyn/content/article/2009/07/30/AR200907...

I think at least some of them (not totally bought off by the insurance companies) would be on board with the bill if it did address cost concerns better and it would be a better bill if it did. This is not a final product.

I didn't infer the CBO was republican. I inferred that even non partisan estimations agree with republican and fiscal thinking democrats.
If any lying was done it was by Obama promising a chicken in every pot and that the wealthy would pay for it all.

When has any congressman read an entire bill on which he's voted. None, except perhaps those who wrote it, and even then, there are some many added costs that no one can honestly say they have read it all.

I'd appreciate a link to your proof, other than that, that would be one persons opinion.

From last month's Boston Globe (online)

It is not unusual for legislation to be put to a vote just hours after the text is made available to lawmakers. Congress passed the gigantic, $787 billion “stimulus’’ bill in February - the largest spending bill in history - after having had only 13 hours to master its 1,100 pages. A 300-page amendment was added to Waxman-Markey, the mammoth cap-and-trade energy bill, at 3 a.m. on the day the bill was to be voted on by the House. And that wasn’t the worst of it, as law professor Jonathan Adler of Case Western Reserve University noted in National Review Online:

“When Waxman-Markey finally hit the floor, there was no actual bill. Not one single copy of the full legislation that would, hours later, be subject to a final vote was available to members of the House. The text made available to some members of Congress still had ‘placeholders’ - blank provisions to be filled in by subsequent language.’’

This is not news, it has been known for years that many bills reach the floor for vote without any one reading most of it. Think of all the "earmarks" that are added, plus the "midnight votes" for congressional raises, etc. Their staffs are SUPPOSED to read all bills, but there is no mandate to do so.

There haven't been midnight congressional raises for years since they passed a bill that said they would always get raises unless the actually voted to not get a raise!

Most salient in the article is the hubris of the Obama administration since Cap and trade, the stimulus bill and health care were all his babies. An unprecedented new low for how government should be run.

Who knew that running the most transparent administration in history actually meant telling people to sign on the dotted line and they would write the contract later.

"I will also hold myself, as President, to a new standard of openness(unless it has to do with legislation or bad news or if I just dont feel like it.)" - President Barack Obama, January 21, 2009

Michael,
I think we are talking past each other about this. You seem to be saying that the Rs have been responsible in their attempts to defeat the health care bill and haven't been misrepresenting what is in the bill. I have to disagree - I think they have and not just a few on the fringe (which is expected) but most of Rs involved. I don't think we are going to see eye to eye on that one.

Problem is that Congress has 5 plans in the works now, and it's not clear which might be in the ascendancy. I think we have to trust our elected representatives to sort it out--there's no point in having a big debate and getting all heated about something that is just a hypothetical.

Many of the things that have been said about the plans in the works are outright lies, most notoriously the garbage about "death panels".

Most of the stuff you hear about the horrors of socialized medicine is lies, too. Not that there are not problems, but for every horror story you can find for socialized medicine I'm sure you can find ten more from our own system.

My brother-in-law, a very conservative man, lived in the UK for 9 years and has nothing but praise for their system.

My predecessor as chair of Mathematics at Andrews, Ken Thomas, died recently in Scotland, and his wife said that the NHS did everything possible for him and his comfort in his last days.

My friend who lived a while in Denmark had nothing but praise for the care given his wife at the birth of their child.

I suspect that most of the negative stuff you hear about national health care plans comes from the insurance companies or those in their pay. If you ask me, they deserve to be put out of business.

Michael says Obama's administration represents "an unprecedented new low for how government should be run".
He has it exactly backward. Obama is a brilliant man grappling with incredibly difficult problems and we should praise him for trying, even though he may not solve all of them. We ought to pray for him, too.

Don

Elaine,

Realistically bills don't get read in their entirety by congressmen and senators, that would be impossible, and not particularly necessary. The problem with "reading the bill in its entirety" is the very technical language and form with which they must be constructed.

In the actual bill, every few sentences there is a reference to some part of the US code, and to actually "read" it one would have to stop and look up all the references.

The essence of the bill is made available in comprehensible summary form by qualified staffers, and that is what the legislators read and rely on. The system actually works quite well.

All this howling about bills being so long that nobody reads them is a bit misplaced, it would seem. The legislators know what they're doing as long as they have the summaries. It also works this way, I think, at the state level. My son worked for a time (before being elected to the State House of Representatives) as a staffer for a Hawaii house member, and part of his job was writing such summaries.

Don

Obama is a brilliant man grappling with incredibly difficult problems and we should praise him for trying, even though he may not solve all of them. We ought to pray for him, too.

Don

Posted by: Don Rhoads (not verified) | 29 August 2009 at 11:25

Obamas solution to all problems faced thus far is spend money like a drunken sailor. A chimpanzee could have done that.

A great article in the NYTimes yesterday related how, by far, the majority of Canadians are very happy with their health plan. If those in the U.S. are equally happy with their current plans, there is nothing suggested that will be changed.

However, for the milions presently uninsured, or those who lose their jobs and their health insurance, there needs to be a plan that will cover everyone, either through employment, or that is "portable" and can move with them as they do. Currently, the states have a large say, and if a job requires a move out of state, there is uncertainty about one's present health insurance accompanying him.

Yes, we are going to have to pay more; there is no free lunch. We ARE paying huge amounts for the uninsured--we just aren't so aware. We pay taxes for so many benefits, why should healthcare be completely off the table for discussion. Our schools, our police, fire, roads and bridges the FDA and many more are currently covered by our taxes. It is only because the U.S. is the last bastion of "free enterprise" (we fool ourselves into thinking) that we balk at universal coverage. Single-payer should not be off the table as the millions on Medicare are very happy with their present insurance and in Canada it is called Medicare--for everyone.

It is in our best interest that there be free education available for everyone; that there be protection from poisons in the food and environment, that our homes and property are protected from fire, so why is healthcare not beneficial to us all. We pay much more for the ER than if each person were guaranteed one physician visit per year where preventive and instructional and medical help is offered. It may not all be introduced in one bill, but as Ted Kennedy, the master of incremantilism knew, it will be accomplished eventually.

Michael, I hope you are not making a racial slur.

Obama has been placed in a situation where he HAD to spend money like crazy--unless, of course, you believe the economists don't know anything, including Bernanke, whose area of expertise is the Great Depression. It seems to be a widely held opinion that a repeat of that event has been averted, precisely by the large-scale spending at which you are so appalled.

Would you really want to go through another Depression in this country? Unless you do, you should mute your criticism. Neither Bernanke nor Obama are fools.

Don

Tom and I may be the only ones here who vividly can remember and recall the Great Depression, when 25% were unemployed, there was no Social Security or safety net, my mother had "hobos" at her back door every day and she always gave them something to eat and they were very grateful. They rode the rails looking for work that was not to be found. People were selling apples and pencils on the streets, long lines at soup kitchens. FDR gave us hope and began the WPA,CCC and put millions to work clearing land, building roads and bridges and being useful.

Bernanke's dissertation and special study was on that depression and he knew why it happened and wanted to do everything in his power to prevent it. Some of the moves harmed some and we are now seeing the banks that were "too big to fail" are making out again like robber barons, but at least we avoided the worst effects that followed that depression.

"One way of looking at the problem is this: if you set out a trough and pour a bunch money into it, how can you complain if people belly up to this trough and starting drinking from it?" - hey, Larry Mitchel is right, isn't he? We must turn to the local medical communities, which have proved that they can I believe.