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Mackey and Health Care -- What the Heck?

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Let's face it: The health-care system is broken. There are very few arguing that we can continue with the status quo, and nearly everyone seems to have an opinion on how to fix this high-priced wheel that's spinning out of control. And that includes Whole Foods Market (Nasdaq: WFMI  ) CEO John Mackey.

In an editorial in The Wall Street Journal last week, Mackey, who's no stranger to controversy, broke down his eight-point plan to fix the health-care system. I've listed those points below, along with a few comments of my own. Frankly, he's got a couple of good points, but I don't agree with all of them.

Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs). How much did your doctor bill for your last office visit cost? You probably don't know (I don't) because you don't pay the bill. Most people would drink a Starbucks' (Nasdaq: SBUX  ) venti when they only need a tall if all they had to pay was the same small deductible for both -- and if their "caffeine-intake" insurance provider picked up the rest of the tab. Changing over to high-deductable insurance, where the consumer foots more of the bill, forces consumers to make wiser choices. That would likely lower health-care costs. But in my opinion, this'll only work if combined with another of Mackey's points.

Make costs transparent so that consumers understand what health-care treatments cost. To work, this has to be combined with the point above. Without the higher deductible, the consumer has no incentive to change his or her behavior. After all, the cost to the patient is the same for the "venti" and the "tall." In other words, I don't see how just handing the customer a copy of the bill is going to decrease costs.

Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits. Sounds good in theory, but giving a tax break for individually owned health insurance will cost the government money. Going the other direction, removing the tax benefit for employer-provided health insurance probably won't fly politically.

Repeal all state laws which prevent insurance companies from competing across state lines. I'm sure the smaller insurers won't be too excited, but larger players like UnitedHealth Group (NYSE: UNH  ) , WellPoint (NYSE: WLP  ) , and Aetna (NYSE: AET  ) might be able to turn higher volumes into lower margins, which might lower costs somewhat. Cigna (NYSE: CI  ) and Humana (NYSE: HUM  ) could do the same.

Repeal government mandates regarding what insurance companies must cover. I want to agree that consumers, not the government, should regulate what conditions companies should cover. But society can lower the total health-care bill by insisting that some preventative care be insured, even though insurers may not want to do so because the patient might not be a customer when the cost savings are realized later in life. By requiring all insurers to cover certain procedures, everyone wins, even the insurance companies.

Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. No one likes the idea of not being compensated for a doctor's mistake, but tort reform may be a necessary evil to keep costs under control.

Enact Medicare reform. Well, duh. You can't pay out more than you bring in for very long. But, just like Social Security reform, I don't think Americans are going to like what reform looks like.

Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren't covered by Medicare, Medicaid, or the State Children's Health Insurance Program. This solution to a government-sponsored public plan -- and Mackey's diatribe about how no one has an intrinsic ethical right to health care -- may have gotten Mackey in trouble.

Not with me, but with customers. There are reports of people boycotting Whole Foods because Mackey's opinion didn't sit well with progressive shoppers. Only time will tell how bad the damage is.

More trouble than it's worth?
I'd say so. It's not like Mackey was actually going to solve the health-care issue with his proposal, and he must have known there was potential for damage to his company from the fallout. During a recent visit to Fool headquarters, Mackey said as much when asked what he'd learned from using an anonymous name ("Rahodeb") to post on message boards: "I am a public figure. And I've got to assume that everything I say and do could end up on the front page of The Wall Street Journal or New York Times, so I can't do or say anything that would be embarrassing to the company or harmful, so I'm much more careful about what I say now."

If the Journal op-ed piece is being "careful," I'd hate to read what you really think, John.

I've had my say. Now it's your turn. What do you think of John Mackey's health-care reform policy? Is it a good solution to this complex problem or is it junk food inside Whole Foods? Or somewhere in the middle? Please take a moment to leave us a thought or two about Mackey's views -- or your own -- in the comments section below.

Starbucks, UnitedHealth, and Whole Foods are Motley Fool Stock Advisor selections. Starbucks, UnitedHealth, and WellPoint are Inside Value selections. Try any of our Foolish newsletters today, free for 30 days.

Fool contributor Brian Orelli, Ph.D., could bankrupt a company offering caffeine-intake insurance. He doesn't own shares of any company mentioned in this article. The Fool owns shares of Starbucks and UnitedHealth and has a disclosure policy.

Read/Post Comments (165) | Recommend This Article (62)

Comments from our Foolish Readers

Help us keep this a respectfully Foolish area! This is a place for our readers to discuss, debate, and learn more about the Foolish investing topic you read about above. Help us keep it clean and safe. If you believe a comment is abusive or otherwise violates our Fool's Rules, please report it via the Report this Comment Report this Comment icon found on every comment.

  • Report this Comment On August 18, 2009, at 4:42 PM, TMFMitten wrote:

    I said the same thing about Alyce's recent commentary on this topic: Anyone who pays attention to Mackey's political views wouldn't be at all surprised by his proposal. I just can't imagine this being a big deal for most WFMI shoppers.

  • Report this Comment On August 18, 2009, at 5:02 PM, mrfett wrote:

    Tort reform won't lower costs. There is no data to back that up. Just because it sounds good doesn't mean it's a solution to high costs.

    Health insurance reform is fundamentally an argument about values. If you do not believe people have a right to quality health care, then you are not going to be supportive of the government mandating coverage for all, while in the process trimming the profits of the insurance companies. The savings are going to come from insurance companies' bottom lines. That's what has people upset.

    Mackey's suggestion to throw out state laws protecting consumers of health care will certainly lead to a race to the bottom. All the companies will locate in the state with the most favorable terms, and their profits will soar while the insured continue to be dropped as soon as they get sick.

    IMNSHO, the man has zero credibility.

  • Report this Comment On August 18, 2009, at 5:34 PM, clydejazz wrote:

    Change customer behavior? What behavior are we talking about: going to the doctor when we are sick?

    We already pay much higher copays for non-generic drugs, and out-of-network doctors and hospitals, so what behavior are we supposed to change? Insurance companies add 30% to the cost of health care, and unlike drug companies, produce nothing except obscene CEO pay.

  • Report this Comment On August 18, 2009, at 5:37 PM, whatsafool wrote:

    Mackey's piece reminded me of "Let them eat cake". Well, despite what some think, this IS a big deal for most WF shoppers. I'm taking my considerable business elsewhere, because I don't want to fund Mackey's compensation. He's using it to promote an agenda that is anathema to most Americans.

    Turns out that organic produce is cheaper at Nob Hill and Trader Joe's anyway.

  • Report this Comment On August 18, 2009, at 5:39 PM, dancinglight wrote:

    Mackey's plan has a great deal of merit but like many reasonable ideas, those who may have to change are not happy. So far, his is the most free market proposal I've seen. Everything that includes any sort of government option is fascist left (as opposed to right) ideology in practice. As in all markets, companies will find their customers. Health care is a service not a right and until we treat it as such in the marketplace, we will have problems.

  • Report this Comment On August 18, 2009, at 5:42 PM, kurtvt wrote:

    Our nationwide health care approach seems completely out of wack. Why is it most insurance companies will pay most if not all of a childs "wellness" visits which is a proactive measure aimed at promoting health children. This is done so they will grow into healthy adults. Why don't we do this for the "healthy' adults? I would like to know how much $$$ could be saved if all insured individuals were offered and kept on a consistent schedule for routine doctor visits an screenings. Most of the extremely high medical costs are associated with diseases that with regular visits and testing could be if not avoided atl east detected at an early stage. This would go very far to help eliminate the dreaded $200 - $300k or more medical bill that is behind this drive for "socialized" medicine. We need reform in three areas: tort reform, medical awareness and practices by individuals and insurance companies and individual responsibility for what is actually be paid for by our insurance. I agree a couple of $250.00 lattes will make you wake up.

  • Report this Comment On August 18, 2009, at 5:50 PM, BobbyGrand wrote:

    Mackey's ideas were brilliant and simple. I've been advocating the first seven for years. The eighth caught me off guard; but I should have thought of it myself.

  • Report this Comment On August 18, 2009, at 5:50 PM, Cimoc wrote:

    I'll leave the comments on Mackey's specific proposals to others, but I give him full marks for speaking out on such an important issue. His views, whether you agree with them or not, were more thoughtful than most celebrity advocacy and whatever his politics are, Mackey runs one of the most progressive public companies currently trading. His recent OpEd is just another example of leadership.

    Beyond being the right thing to do, speaking out publically may lead to a rather weak, short-term boycott, but it will reinforce Whole Foods' image of community interest and involvement, as well as generating spin-off publicity and debate (this article being but one example).

    It's always encouraging to see someone doing the right thing -- by moving an important debate forward -- and also generating some positve results beyond the mere good karma associated with speaking out on an important issue.

  • Report this Comment On August 18, 2009, at 5:51 PM, nerd1951 wrote:

    1.) High deductible plans don't save me or my employer money. They did five years ago but as the plans got more popular the prices went up for small businesses.

    2.) High deductible plans discourage preventative health care. If I'm paying out of pocket or out of my MSA, I'm more likely to put off traetment until things get really bad.

    3.) The primary stake-holder in large for-profit health insurance companies are the stockholders and the executives. As long as this is the case, any cost reductions will not be passes to the consumers but rather the stockholders and to executive bonuses.

  • Report this Comment On August 18, 2009, at 5:52 PM, jdlazar wrote:

    I live in Austin -- home of Whole Foods, and a lot of very liberal folks. Mr. Mackey has lost my business and, I hope, that of a lot of other Austinites! That will be a big deal when their flagship store starts flagging!

  • Report this Comment On August 18, 2009, at 5:52 PM, gormunro wrote:

    Why is the USA the only developed democracy that does not have a one payer system. Perhaps because it is run by people like Mackey desperate to preserve a health care system that serves the shareholders first and the patients and, yes, doctors a distant second. And please don't be fooled by claim that every other country has sub standard medicine.

  • Report this Comment On August 18, 2009, at 5:54 PM, AuditorFool wrote:

    Mackey's plan makes sense. Everyone should have to pay full price for going to the doctor for runny noses. Insurance should only be for catastrophic incidents. Medicare does need reform that will make people unhappy. Everyone who pays health insurance should get equal tax benefits.

    If you quit shopping there because of the man's opinion then you are an idiot. The stores are great who cares what his opinion on healthcare is. I gaurantee you that if you shop at any other store you will not agree with that store's owner on every issue.

  • Report this Comment On August 18, 2009, at 5:56 PM, clydejazz wrote:

    Preventive care is a big part of the proposed public option.

    If we're using Starbucks as an example of pricing, what if the government offered you a latte that had the same features as the Starbucks latte, made by the same people, with the same ingredients, with the same quality control, but for 30% less? Would you at least be interested?

  • Report this Comment On August 18, 2009, at 5:57 PM, TMFBiologyFool wrote:


    Many doctors run additional tests/procedures that may or may not be useful. If customers are footing the bill, they will be more interested in keeping the price down.


  • Report this Comment On August 18, 2009, at 5:58 PM, AuditorFool wrote:

    If any of you think "Preventive Care" saves this country money you are wrong. High Deductible Policies and HSAs are the only way to save this country from bankruptcy. You should read the CBO report on healthcare and this article:

  • Report this Comment On August 18, 2009, at 5:58 PM, clydejazz wrote:

    When you are in pain and confused, are you good at bargaining with people?

  • Report this Comment On August 18, 2009, at 5:58 PM, MGiles3647 wrote:

    Mackey makes excellent points. It is nice to see someone take an enlightened look at the process. I will seek out a Whole Foods Market to shop there (none is close unfortunately). Those objecting to his ideas obviously have NOT read the House Bill 3200. Two suggested enhancements: Every doctor pays $120,000+ per year for malpractice insurance AND does many extra procedures to protect themselves from the army of tort lawyers out there (who incidently supported Obama and to whom he owes and is repaying by not addressing the issue) who are willing to sue anybody anytime. Since the Federal government wants to help out, have the government pay for all doctors' malpractice insurance (and regulate the dangerous doctors far more strenuously - state medical associations are largely ineffective). This would reduce medical costs by that same $120K per year per doctor (times the number of doctors in the US) and eliminate many unnecessary procedures. This would be passed on. Second, many folks are very conscientious with their budgets and expenditures until hit by a large medical expense, which wipes them out financially, often leading to good people losing their homes, etc. The Federal government should provide catastrophic insurance for all citizens through current insurance companies. Everyone would pay for their care or use their insurance up to the limit - usually $2500 per year. If above that, the government should step in and assist through catastrophic medical insurance. There are other ways to assist the 20M or so folks the Democrats mega-trillion dollar plan hopes to reach without mortgaging the country's future and destroying the medical insurance of the other 200M Americans. The horror stories coming out of England and other countries with socialist medical plans should terrify everyone. Reading the various provisions of HB3200 is a definite horror story in itself -- try it, it will take care of any thought of sleep - or support of the bill!

  • Report this Comment On August 18, 2009, at 5:58 PM, 40buick wrote:

    Tort reform is NOT a necessary evil. It's absolutely necessary.

  • Report this Comment On August 18, 2009, at 6:01 PM, starbucks4ever wrote:

    Points 1,2,3,4, and 6 make a lot of sense.

    Point 7 - depends on the kind of Madicaid reform that he wants.

    Points 5 and 8 - rearranging chairs on the deck of the Titanic.

  • Report this Comment On August 18, 2009, at 6:03 PM, trailandsurf wrote:

    Dancinglight: "Health care is a service not a right and until we treat it as such in the marketplace, we will have problems."

    Hate to break it to you, the thought that health care is a service is, and has been, the sentiment in this country which is why we are having this debate. Seems like you agree we have problems with the status quo. Therefore, maybe you should try thinking of health care as a right!

    AuditorFool: "If you quit shopping there because of the man's opinion then you are an idiot."

    Voting with your dollars is a sound practice. Why send your dollars to those that oppose your view when every grocery store in town sells organics and several other high-end markets exist to fill other needs. Maybe this will lead to a resurgence in the farmers markets where you can talk to your provider directly!

    Quite simply, Mackey is a grocer. If he wants to be a politician, then he should be prepared to take his lumps like every other politician. If you're an investor, you should decide if you want your CEO to be hawking on the political stage or tending to the business that he is paid very well to run.

  • Report this Comment On August 18, 2009, at 6:03 PM, eldetorre wrote:

    "Health care is a service not a right and until we treat it as such in the marketplace, we will have problems."

    Why is healthcare considered less of a right than a national highway system?

    "Everyone should have to pay full price for going to the doctor for runny noses.'

    And what? If they can't afford to they die? Catastrophic incidents will happen because people can't afford to go to the doctor on a regular basis.

    The problem is that all of the "solutions" just improve the bottom line for the insurers. There is no guarantee that costs savings will make it into the pocketbooks of consumers. The insurance industry is a cartel. The other cartel is the AMA which artificially limits the number of doctors in the field.

  • Report this Comment On August 18, 2009, at 6:05 PM, clydejazz wrote:

    The health statistics for middle-aged white males are actually better in England than in this country. So much for horror stories.

  • Report this Comment On August 18, 2009, at 6:07 PM, btsweber wrote:

    The best thing I did for me and my business was to switch to a HSA and high deductable plan. The combination of contributions to the HSA and insurance premiums was less than the cost of my old HMO plan with more flexibility. We don't carry dental insurance and now I can pay my dental bills out of the HSA with pre-tax money in addition to covering the cost of my deductibles.

    The big eye opener for us was when we started to see the costs for procedures and tests that would be routinely paid by the HMO without us ever seeing a bill. Someone asked what point there is to knowing the cost of your healthcare. Well, we now talk to our doctor more about what tests are being ordered, what they're for, and if they're truly necessary. We're much more involved and aware of what we're consuming.

    Most of our encounters with the healthcare system are not emergency situations. We're getting blood pressure checks, cholesterol checks, the occasional colonoscopy. There's time to think about what needs to be done and where. If I can save $200 by having my colonoscopy done at the hospital an hour away rather than at the local hospital I would probably make the trip. If you could save a bundle of money having your MRI done at 2 AM rather than during the day you might opt for that. You'd sure shop around if you were buying a refrigerator, why not for your health services. If hospitals knew people were cost conscious when scheduling procedures, do you suppose they'd start competing for business on price?

  • Report this Comment On August 18, 2009, at 6:10 PM, lmhinds100 wrote:

    Steve Burd, the CEO of Safeway has been promoting a similar plan on Capitol Hill but to no avail. Mackey and Burd are indeed proposing reforms to our healthcare system albeit free market reform proposals. The socialists on Capitol Hill and their supporters are not interested in reforming the broken system. They want to "nationalize" it so that it is "free" for all. Adding more people to the broken system without fixing it as Obama Care (really Pelosi Care) is proposing will bankrupt the country. The cost of healthcare in the US is over $6000 per person per year. It is by far the highest in the industrialized world. The venal politicians should focus on understanding why this is so and proposing reforms to reduce the cost before piling on more cost. The merit of Mackey's proposal is that it will force the consumer of healthcare to manage and thus control the spiraling cost of care.

  • Report this Comment On August 18, 2009, at 6:11 PM, Sunshyne43 wrote:

    I have been, and am still, mystified by the statement that seems to be behind this push for a national healthcare system -- that we have uninsured people in this country who cannot get healthcare services. Our federal government already funds Community Health Centers that are tasked with providing quality healthcare to all regardless of their ability to pay. These federally funded community health centers are located all over our country, even in Alaska. Our last President, George W. Bush actually got our legislators to fund a tremendous number of centers to make sure that no one was left out of the system. So now why is Congress determined to ignore that program and start another one to address the same problem? I suspect it would be cheaper to give larger grants to the existing health centers so they can serve more people than it would be to fund a federal health insurance plan.

  • Report this Comment On August 18, 2009, at 6:14 PM, obie1kanobe wrote:

    Why can't we skip all the BS about heath care.

    - Rationing (especially at end of life) is the only solution to the approaching old age of baby boomers.

    - Coverage for pre-existing conditions can ONLY work if there is mandatory insurance for everyone via a tax on all income and capital gains.

    - The insurers aren't any more guilty of raping us than are doctors and hospitals.

    - Malpractice insurance costs as much as most doctors take home in earnings. Tort reform has to be part of the solution.

  • Report this Comment On August 18, 2009, at 6:14 PM, baybrowser wrote:

    Perhaps the dedution, for both sponsoring firms and individuals, should be a requirement for a higher deductible. Not too long ago I understand that a participant (on average) paid about half of his/her medical cost. Now the individual pays only 10%.

    My wife and I currently pay a total of about $800 per month for Medicare coverage (we're retired !). We can't even opt out of that program and self insure. Why not give us the option of a $5k or $10k deductible? It would cost us less, and we'd help control medical costs because we'd be obligated to pay out of pocket the first $5k or $10k. That mechanism supposedly helps control costs for everybody.

    Tort reform is the democrats' honey pot. Since they're not at all bashful about claiming we have a healthcare crisis, shouldn't they be willing to sacrifice a bit in this area?

    Mackey's healthcare plan for his employees is a great way to also help control costs. They have a higher deductible which reduces company costs significantly, and the company then makes a donation (as I understand it) to each employee's wellness fund. The employee ends up paying the first $2500 out of pocket (with $1800 help, so it's only $700). Also, the employer contribution builds up over time to the extent not used.

    Health care insurance should NOT be included as part of the initial health care plan/reform. That component should be delayed until later, and be included as part of an overall solution to (illegal) immigration issues.

  • Report this Comment On August 18, 2009, at 6:16 PM, AuditorFool wrote:

    We are not in some healthcare meltdown like the Dems are leading us to believe. This country has one of the longest life expectancies of any country in the world. Especially when you take away murder and car accidents. Also, how many of the uninsured the Dems speak of our 20 something professionals who don't think they need it or illegal immigrants?

    Take a drive through some government subsidized housing.. They drive nicer cars than I do. I saw people walking around with Ipods. They have 52 inch flat screens. How about they get a cheaper car, cheaper television, ditch the ipod and playstations and get a high deductible insurance plan?

  • Report this Comment On August 18, 2009, at 6:17 PM, baybrowser wrote:

    oops.. In Baybrowser, last paragraph is referring to illegal immigrants. That's really a separate problem and health coverage for them should be an integral part of an overall policy towards illegal immigrants.

  • Report this Comment On August 18, 2009, at 6:20 PM, baybrowser wrote:

    The argument that tort reform won't reduce costs can't be right. Not only would jackpot justice lawsuits be better controlled, doctors themselves admit to all sorts of defensive procedures to ensure they can't be "one-upped" in court later by a dapper lawyer (think John Edwards)

  • Report this Comment On August 18, 2009, at 6:20 PM, atodde wrote:

    Health statistics in many industrialized nations is better. To think the USA has the best medical care/system in the world is ludicrous.

    The reason for people declaring bancruptcy because of medical bills "with insurance" is alarming.

  • Report this Comment On August 18, 2009, at 6:22 PM, swrussel wrote:

    How's this for a tort reform: when we have single payer health insurance like the rest of the civilized world, abolish the collateral source rule.

    Result: the insurance companies get screwed again. Having lost their role as useless middle men in health care, they will then lose their absurd premiums for medical malpractice insurance.

    Med mal cases will be restricted by the market to deaths and permanent disabilities. There will be no "nuisance value" cases, because medical bills--no longer a factor--are the biggest damage centers. Those special damages are used to figure general damages, "pain and suffering." Wipe out the special damages and make the general damages a crapshoot with no standards, and the med mal dragon is slain without cutting off the truly horrible cases nobody wants to cut off.

    Just by tweaking that one little rule...AFTER we get single payer.

    Let's not hold our breath.

  • Report this Comment On August 18, 2009, at 6:22 PM, baybrowser wrote:

    ON the argument that throwing out state laws on controlling insurance companies resulting to a race to the bottom - that doesn't computer. State requirements would be replaced by requirements standard to all states.

  • Report this Comment On August 18, 2009, at 6:24 PM, omkolluri wrote:

    Insurance companies need to face competition - co-ops or public option would facilitate. Failing that their major incentive would be drive costs down by covering fewer services. Notice that while many banks have gotten themselves into trouble by transforming themselves into gambling casinos (for which we the taxpayers foot the bill) the same cannot be said for credit unions which are in effect co-ops. While frivolous lawsuits certainly drive costs higher for malpractice, giving doctors incentives for outcome or evidenced based care is a step in the right direction. Many hospitals such as the Cleveland Clinic, Dartmouth Hospital and mother examples such as those in Montana and other similar examples demonstrate this is possible.

    There is a tendency to privatize and deregulate everything. All this does is create the type of problems we now face. Another word for unbridled free markets is "CHAOS." Such a system does not work anymore than a totally controlled market. Contray to popular opinion, the US has a reasonably regulated market (or had it until the latest debacle). Little wonder people all over want to invest in the US. Regulation is not all bad. ALL life is Darwinian. If we do not watch it, we will grow antlers like the Moose. Great for winning battles as individuals but collectively will fall prey to some unknown predator - which could be you and me.

  • Report this Comment On August 18, 2009, at 6:25 PM, baybrowser wrote:

    The government paying for wellness (preventative medicine) is, in general, a money loser. There has been credible research on this. It's the law of large numbers. It pays for the person who would have otherwise come down the affliction, but that's offset by the upfront cost for the 100s or 1000s of others who would not end up with that affliction without preventative medicine.

  • Report this Comment On August 18, 2009, at 6:26 PM, AuditorFool wrote:

    Why would anyone like single payer if the single payer was the government? Who would like to go to a DMV or Post Office type place to get healthcare? Look at Medicare/caid and Social Security. Why would Universal Healthcare be any different?

  • Report this Comment On August 18, 2009, at 6:26 PM, amt77 wrote:

    Thanks Fool for shining the light on this. I for one hadn't followed Mackey's philosophy's (like most shoppers) and had only begun shopping there in the last 2 years - so I am a customer they picked up a while ago, that they are now losing. The movement for voting with your dollars is in it's infancy, but growing. Mackey comes off WAY TOO RICH for his own good with points like that last one: "Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren't covered by Medicare, Medicaid, or the State Children's Health Insurance Program." By his own admission there are MILLIONS who are in of insurance, does he really plan to fill that gap with donations from him and his rich friends? I think maybe he should have checked with them first...

    I joined the Facebook group for the Whole Foods Boycott and I think you SHOULD TOO!

  • Report this Comment On August 18, 2009, at 6:28 PM, trailandsurf wrote:

    "Take a drive through some government subsidized housing.. They drive nicer cars than I do. I saw people walking around with Ipods. They have 52 inch flat screens. How about they get a cheaper car, cheaper television, ditch the ipod and playstations and get a high deductible insurance plan? "

    Yep, AuditorFool, you have it all figured out. It's the poor people that are the problem here. You're right on. The last time I drove through the projects I was amazed at mansions I saw there. Limo's picking people up. Armani suits everywhere. It's the liberal media making up all that stuff about crime to keep the middle class unaware of how glorious the projects really are. Meanwhile all the media does is villify all of the honest, wall street banking types so that the middle class stays distracted from the real problem.

    Sounds like you should stop listening to Rush and actually drive through the projects and see for yourself...

  • Report this Comment On August 18, 2009, at 6:30 PM, 102971 wrote:

    I agree with gormuro. We are one of the very few countries in the western world that does not have a government sponsored scheme. That's not socialism - it's praticality.

    One point that Mackey, nor for that matter have I heard or read it elsewhere, is that we are the ONLY country in the world that allows pharmaceutical companies to advertise direct to the patient. Practically every other TV ad is for some form of new medication. This is costing billions of dollars and who is paying for it? In the final outcome WE are. Also the patent protection period in this country is far too long. I read only last week that when a new drug is introduced to the market it takes 42 DAYS for the pharmaceutical company to recover the whole of their deevelopment cost. Let me repeat that - 42 DAYS. Most of the most"popular" drugs like Plavix and Lipitor can be purchased in Canada in generic form because the patent in that country has already expired. Why not here?

  • Report this Comment On August 18, 2009, at 6:32 PM, baybrowser wrote:

    Keep in mind that the "47 million uninsured" is a political quote.

    That includes illegal immigrants (12 to 20 million), and millions who are in fact qualified for Medicare or Medicaid and don't even registerfor it. It also includes millions who happen to be between jobs (it's a point in time survey). Some will admittedly remain unemployed for longer. It also includes millions who are, generally, young and able to afford health insurance and have made a conscious decision to spend their money on other things.

  • Report this Comment On August 18, 2009, at 6:34 PM, swrussel wrote:

    I just noticed somebody above bragging on US life expectancy.

    We are number 50. That's to brag about?

    Our health care system violates iron laws of the market.

    1. Every dollar to an insurance company goes to an entity with a profit motive to deny treatment rather than provide it.

    2. The two single payer systems most users like, Medicare and the VA, cost too much because they contain only the elderly and the already injured. The more diverse the pool the lower the cost.

    By fighting the market in these ways, our system gives us the highest cost in the world and number 37 in effectiveness unless you just go by life expectancy, which makes us number 50.

    "Reform" that buys insurance for the currently naked is economic lunacy. The only good thing about it is that it might save lives, and I cannot in good conscience vote against it because I have health insurance....but I still believe it's bad policy. A windfall for the insurance middlemen. Crazy.

    Single payer is the only sane alternative.

    You say government can't manage anything? That's to say we are dumber than all of Western Europe, Canada, Australia, New Zealand, Japan. Even China has single payer on the drawing board. Even Mexico has national health care good enough for American ex-pats, but it does not offer universal coverage. Everybody can manage health care at a reasonable cost but us?

    Why is that? Something in the drinking water?

  • Report this Comment On August 18, 2009, at 6:35 PM, baybrowser wrote:

    The statistic on drug companies recovering their money on a drug in 42 days after they introduce it is completely bogus. They likely had several researchers working on that drug for years before it was introduced. Even more expensive is the numerous ongoing research for drugs that never get out of the lab - or if they do, the worse possible result - they find out later that there is a bad side effect and the lawyers eat them alive.

  • Report this Comment On August 18, 2009, at 6:36 PM, richmacmf wrote:

    There is a lot of truth in his comments, even though they might upset some who don't want to face the truth.

    Capitalism made us the greatest country in the world with the highest living standard in the world. Our poor live better than most of the world.

    The movement towards socialism of the last 60 - 70 years is accelerating and is going to kill the greatest country in the world.

    Elitism of the liberal left needs to be stopped.

    Hard work and accountability and capitalism work. Too much government and socialism don't.

    I have a brother who has never paid any taxes or contirbuted to American society and a few years back had a heart attack that should have killed him. He had to be treated by a state hospital and was saved. He had no health insurance and was a society outsider all his life and proud of it. Our society took care of him anyway.

    I have no idea what Obamacare is trying to "fix". To me it is just more effort to grow government power and control to the long term detriment of the people of America for the benefit of the ruling proletariat = "community organizers".

  • Report this Comment On August 18, 2009, at 6:36 PM, Lorenzo107 wrote:

    We also have an HSA plan that we pay out of our pocket. First $4000 per year for the two of us is ours. After that most is covered. We set aside the $4000 in a tax deferred account to pay for the deductible and other misc costs. We love it as its much cheaper than the "full coverage" plans. And it includes a small amount of first dollar coverage for "well care" that covers physicals, blood pressure and cholesteral screening etc. By the way, all 3 of our recent plans we have included this "well care" feature. My suspicion is that most do and most people don't even know it.

    My concern is that the congressional clowns will ruin it for everyone. Doesn't anyone out there find it scary that our government sees nothing wrong with ramming thru a 1000+ page health care reform bill that they did not read?

    I would support health care reform if it were thoughtful, the true costs and how they would be paid were known and understood and all of congress, past, present and future were subject to whatever plan was developed. If it's not good enough for congress it certainly not good enough for my family.

  • Report this Comment On August 18, 2009, at 6:37 PM, Gardnermiles wrote:

    If you heard the commentary on the French Health Care System you would have learned how a well run system operates. A doctor receives the 911 call and analyses what action is required. A doctor is also in the ambulance. They are equipped like a hospital and often remain at the scene for an hour. The doctor assess's if necessary the best hospital for this specific condition. This system bears looking into further and at least the patient is well cared for as further treatment plans are being implemented.

  • Report this Comment On August 18, 2009, at 6:38 PM, Coreygranny wrote:

    Mackey's plan has a lot of merit. Consumers need to know what they are paying for, and how much they are paying. He left out a vital part of health care reform. We need to reform the pharmaceutical companies. Drug costs are the fastes rising costs in the health care industry, and teh pharmaceutical lobby is way too powerful. There is no safe drug. They all come with a laundry list of toxic side effects, and the drug companies are making additional drugs to deal with these side effects. And then there is the bureaucracy of the insurance companies. HMO administrators make way too much money while they deny healthcare to those who need it. Mackay is definitely on the right track.

  • Report this Comment On August 18, 2009, at 6:38 PM, baybrowser wrote:

    It's easy to manage "single payer" by its very nature.

    However, that means - instead of having a 107 trillion medicare and social security debt, you have people waiting 6 months to several years for an operation.

    If you're young and healthy that's not a problem for you. If you end up with breast cancer, or prostrate problems, or any number of other problems and your next appointment is the middle of next year, you lose your sense of humor quickly.

  • Report this Comment On August 18, 2009, at 6:39 PM, HeyPacketMan wrote:

    Tort reform most definitely will affect costs of providing medical care and therefore the insurance premiums we all pay directly or indirectly. I don't see how anyone who has ever run a business could deny that. Insurance is a cost of doing business and like all costs, it is ultimately born by the consumer. If the consumer can't or won't pay the cost, several low margin providers will be forced to exit the field. Studies have shown these low margin suppliers disproportionately are the ones serving the poor. A reduced supply will set the price point higher so those that remain can charge the few who can still afford to pay a higher fee from which they can pay their higher liability insurance.

    This is not a new phenomenon. We have a clear example of this dynamic form the last decade.

    American small aircraft manufacturers like Cessna, Beech and Piper had ceased or severely curtailed domestic production due to staggering legal bills. They were getting whacked by judgements for defects in planes made in the 1950s and 1960s. There was almost no innovation in airframe or engine design because each such improvement was fresh turf for future lawsuits. Their costs were not being born by the marketplace and sales had tanked.

    The liability bar had effectively killed an entire industry.

    In August 1994, with the backing of organized labor, president Clinton signed into law a tort reform (the General Aviation Revitalization Act) that provided an 18 year statute of repose for manufacturing defects. While it didn't address the core problems with unlimited liability and nuisance lawsuits, it provided enough oxygen to revitalize a broken industry that provided high paying jobs for skilled, union labor.

    Tort reform is absolutely necessary to lower the cost of medical care.

  • Report this Comment On August 18, 2009, at 6:40 PM, baybrowser wrote:

    Ask your local senators and congressman if they're going to join this health reform plan they're dallying around with - for the rest of us !

    (don't bother ... they ain't --- they have a much nicer plan)

    Should they even be the authors of our plan?

  • Report this Comment On August 18, 2009, at 6:41 PM, sfrigr wrote:

    Overall, I give his plan a B. That's better than most and sure better than your critique. Sounds like he stood on principle and didn't try to just go along with what might pass. Good for him. I go to Whole Foods now for everything and just bought stock.

  • Report this Comment On August 18, 2009, at 6:41 PM, AuditorFool wrote:


    "I just noticed somebody above bragging on US life expectancy.

    We are number 50. That's to brag about?"

    That is when car accidents and murders are left in. We are world leaders in those areas and should not be included in a healthcare discussion.

  • Report this Comment On August 18, 2009, at 6:44 PM, baybrowser wrote:

    on the "French plan", I just read where Sarkozy and company are experiencing serious cost problems.

    Google it.

  • Report this Comment On August 18, 2009, at 6:44 PM, plange01 wrote:

    healthcare is broken but unfortunately so is the rest of the country that is now in its 8th month of a depression. with unemployment at 20% and so many people out of work plus 1,750,000 forclosures so far this year we have more important things to deal with.we need someone running the country who will get people back to work and into homes.hopefully that will be obama but if he continues to work harder at being a celebrity and making headlines then we will have a midtern election....

  • Report this Comment On August 18, 2009, at 6:45 PM, grantrobertb wrote:

    OK- I think most EVERYONE agrees for the need for reform. I am not surprised that the bill for Health Reform has currently stalled. I am neither for it or against it. In fact, I am almost clueless as to its merits?

    In my opinion one problem is that our President has not done a good job SELLING his ideas for reform. Granted he did not submit the legislation, but if he is supporting it, give us some bullet points as to what we are buying: "If we change X then we will improve our lives by Y". Paint me a picture. Show me the menu in large letters. Don't just repeat 1000 times, "if you like your health plan, you get to keep it". We are more sophisticated than that.

    Also, let's ask simple questions on what reform should look like. First, let's ask, who should pay for MY doctor visit. I think it should primarily be ME. Having said that, I do believe in some form of Universal Coverage.

    BUT what if we said that MOST people will be responsible for X amount on their doctor and hospital bills -- again MOST people. Then we could say that anything up to $2000, MOST people would be responsible for in a given year. For those who are at a certain income level, we could then say that we as a society would cover or help cover the $2000 amount.

    Over $2000, Insurance, should cover completely -- period. That is what insurance is for. Yes insurance should have the right to question cost, but DOCTORS should have the primary authority -- just as Judges have the primary deciding authority in our Judical system.

    Just as Judges are over-ruled by higher courts, there should be a system in place for patients and insurance companies to question medical costs after the fact. If it is found by a panel (board) of medical professionals that procedures ordered by the doctor and/or hospital costs are excessive and unnecessary, then there should be a mechinism by which Insurance can recoup monies paid to the hospital or doctor AFTER THE FACT (without going to court). This would give the doctor or hospital an angel on the shoulder whispering, "this is subject to review, can you justify it later".

    Let me back up a bit, however. I think I prevention is key to this healthcare dilemna we are in. This has certainly been mentioned in the overall discussion of healthcare reform. I did say that I think MOST people should be responible for a higher deductible, BUT I think it is all our best interest if either government, or insurance allows for one FREE annual check-up per year. This would give no one an excuse not to see the doctor, AND the early detection could save us Billions in the long-run. By the way, in France, you are REQUIRED to have one physical per year -- a good idea in my opinion.

    So that is my thinking out loud for the day... cheers all!

  • Report this Comment On August 18, 2009, at 6:46 PM, Jedowning wrote:

    I am a physician, and have studied our health care system and those of a number of other countries which are more or less government run. Every country which has national health care is running in the red, and rations care, usually by long waiting times for anything except primary minor care. They are fine if you are not very sick, but a problem often if you have a complicated disease.

    No single reform will make a significant difference, but the combination he recommends would almost certainly help a lot, and not cost us or our children as taxpayers a huge amount.

    Look at the fact that both Social Security and Medicare are both headed for bankruptcy, and yet our politicians just will not address those. We can't keep spending more than we are taking in in taxes for much longer without causing serious inflation, which is a terrible tax on everyone.

  • Report this Comment On August 18, 2009, at 6:49 PM, baybrowser wrote:

    The "co-op" option to ensure competition is a "copout".

    It's not necessary if you can access the "out-of-state" insurance companies. You do this now for your auto and life insurance. That's part of the reason that competition hasn't been as good as it could be.

    (But out of pocket expense has to go up considerably to keep medical charges honest, and tort reform is an absolute necessity)

  • Report this Comment On August 18, 2009, at 6:50 PM, MisterRogers wrote:

    Why can't health insurance be more like car insurance? You pay for gasoline, regular maintenance, and oil changes out of pocket. You can pay for an optional warranty to cover major repairs. Your insurance only pays in case of an accident.

    We have a culture that expects insurance to pay for every detail of health care. That means that even the most routine doctor visits are padded with costly paperwork and bureaucracy. Furthermore, we have a system that requires you to pay for an expensive doctor visit just to get access to medicine. In many countries, you can buy antibiotics over the counter without a prescription. Right there, that saves the consumer significant time and money, especially the uninsured.

    Outside of a metro area like New York City, you cannot survive in America without a car. You would have no way to get to work. Basics like grocery stores and pharmacies are easily several miles away (without sidewalks). Second to your health, having a decent car is the most important thing in America. Yet, car insurance is not bankrupting us. No one goes to the poor house because he wrecked his car. You don't hear horror stories about people who can't afford oil changes. And, it's a privatized system.

  • Report this Comment On August 18, 2009, at 7:13 PM, Mungbork wrote:

    Mackey is correct in assuming that healthcare is not a right. It's an obligation. One way that the success of a society can be judged is by how well it feeds the poor and heals the sick. The values of our country at this point in time are such that we are still split on whether it is o.k. to leave part of our population dangling with respect to health care. We aren't going to get health reform that works until we have better agreement that caring for the sick (and this means all of the sick) is something that is important.

    It's a mistake to assume that insurance companies by themselves are the cost culprits in the health care system. Were the insurance carriers removed from the equation, costs would still be likely to escalate unless some basic changes in the internal incentives of the system were changed. For example, physician ownership of labs and ancillary services has a tendency to drive the cost of these services upwards since the physicians benefit financially from referrals to these services. The mere fact that payment to providers (physicians, ancillaries, hospitals) is most often on an incremental fee for service basis drives cost upwards, as the providers are paid for performing more services, more procedures, and not for maintaining health or improving a condition.

    Consumer awareness of the true cost of their health care services might have a slight effect on the overall costs, but its not like this information is unavailable to them right now. The "billed" charges of providers are always displayed on the "Explanation of Benefits" sheets sent to consumers by their insurance carrier after each service, along with the amounts paid by the insurance carrier. The insurers somewhat disingenuosly list the differerence between what the consumer paid and what the provider billed as "savings" they have achieved for the consumer.

    As evidenced by the continuing barrage of propaganda in the media about both sides of the health care debate, one of the biggest issues facing health care reform is the ignorance and gullibility of the American public. How else can one explain the ready acceptance by many of statements in the media professing that the proposed plan is going to require elderly citizens to kill themselves? The health care delivery system, as well as its payment system is complicated, and so is insurance. Its a lot easier to react to propaganda, or in Mackey's case, to propose a solution reflecting one's preconcieved ideology than it is to deal with facts and evidence.

    There are locations in the U.S. where both quality and cost are much better than the norm. One way to find our way out of the health care dilemma is to examine what is going on in these locations, and try to reproduce what works. The Dartmouth Medical School has been researching cost and quality nationwide for many years and has published much of this information in the Dartmouth Atlas :

  • Report this Comment On August 18, 2009, at 7:21 PM, Belight wrote:

    Congress should have to subscribe to the same plan they finally legislate. This would bring a whole new thought process to the actions they are contemplating. The elitist who are running our country are out of touch with the people's needs. All they are concerned with is getting votes for re-election...a scary group to be making such "quality of life" decisions for us all.

  • Report this Comment On August 18, 2009, at 7:24 PM, Mungbork wrote:

    One more thing:

    Mr Rogers above is absolutely correct about the issue of having to pay for an expensive Dr. visit just to get antibiotics. Recently, on a trip to Ecuador, I developed bronchitis, and all I had to do was to walk into the pharmacy and ask for a Z-pak, which cost $5 for a several day's ( 5 or 7, I can't remember) course of meds. That was the total cost, and that was the total treatment - all cured. Total time to cure - 5 days. In the U.S., the course of treatment would have looked like this: 1) a visit to the Urgent Care Clinic or Primary Care Physician ($125+ retail), which resulted in; 2) a prescription for a non-effective, but just as expensive ($75+ retail) antibiotic (physician's explanation - "let's try something first that won't escalate the resistance of the bacteria"); 3) a return visit a few days later because I'm still sick ($125+); 4) a chest x-ray ($100+ retail); 5) a prescription for a Z-pack, which is what I suggested in the first place ($75+ retail). Total retail bill - $500+. Total time to improvement - 10 + days.

  • Report this Comment On August 18, 2009, at 7:26 PM, mysay2 wrote:

    I would not disagree with any of Mackeys points but some are more useful than others. Particularly tort reform. But several major things are missing. 1. We need to prevent for-profit corporations giving us the run-around on approving & payment for procedures that our doctors have ordered. Example: HMOs can randomly decide to decline 25% of all claims or procedures on certain days. I've had this happen & a friend that used to work for a HMO admitted that this is done. When asked what justification to use, they were told "make something up" (shocking isn't it?). Personally, I would trust a Kaiser type of organization to administer my health coverage rather than United Health Crooks. 2. We also need to eliminate abuse of emergency rooms. People without coverage mob our emergency rooms for a case of the sniffles because the law will not allow an emergency room to turn a person away if they cannot pay.

  • Report this Comment On August 18, 2009, at 7:35 PM, Mungbork wrote:

    I guess I have one more comment:

    to MySay's point about trusting a Kaiser type of organization - organizations like Kaiser are of the type that are often cited in the Dartmouth Atlas as locations where cost and quality are at their best (there are exceptions). The reasons may be that all of the services/procedures/ancillary providers are under the same umbrella, and all are incented by the performance of the organization as a whole, rather than by fees from incremental services. In other words, the providers get paid according to how well the organization as a whole performs (in terms of both cost and quality) rather than according to how many procedures they perform, or how many referrals they can send to the CT scanner they own.

  • Report this Comment On August 18, 2009, at 7:38 PM, texastar1 wrote:

    Mackey's plan makes a lot of sense.

    Many aspects of his proposal are similar to what several Congressmen have advocated. Time to stop talking and start acting...I am concerned that there is too much politics in this game and the stakes are very high to let this opportunity slip away. Regardless of one's political affiliation, we all agree that the current health care system is broken and needs a permanent fix!

  • Report this Comment On August 18, 2009, at 7:42 PM, pbtoau78 wrote:


    Acute bronchitis without comorbid pulmonary disease shouldn't be treated with antibiotics in most cases. If anything you certainly are contributing to antibiotic resistance. If you thing self medication is a valid reform you may want to stay out of this debate all together.

  • Report this Comment On August 18, 2009, at 7:44 PM, ecoloney wrote:

    Our system is broken. It only needs less government involvement. Canada's system is broken - that's why so many of them must come to the USA for treatment. UK's system is heavily damaged. Both Canada and the UK are trying to get away from their socialist medicine.

  • Report this Comment On August 18, 2009, at 7:44 PM, MORK000 wrote:


  • Report this Comment On August 18, 2009, at 7:44 PM, ecoloney wrote:

    Our system isn't broken. It only needs less government involvement. Canada's system is broken - that's why so many of them must come to the USA for treatment. UK's system is heavily damaged. Both Canada and the UK are trying to get away from their socialist medicine.

  • Report this Comment On August 18, 2009, at 7:53 PM, TMFWysocki wrote:

    Tort reform (read, medical malpractice damage caps) won't have a significant impact (or, perhaps any impact) on health care costs if California is any indication. It has had medical malpractice damage caps on pain and suffering since the 1970s, and like most everywhere else in the country healthcare costs have continued to escalate.

    Mackey's "proposals" won't help much, if at all.

  • Report this Comment On August 18, 2009, at 7:53 PM, Mungbork wrote:

    the chumley:

    whether or not its a valid treatment, the second example (in the US) is a real-life example, as well as the one from Ecuador. The issue isn't whether I'm self-medicating, its comparing the cost of the two treatment tracks. In the US, my actual treatment described above cost over $500 retail. When I went to Ecuador, I simply went to the pharmacy and asked for the meds that had worked the last time in the U.S. for the same condition. And it cost $5.00.

    Whatever you want to call it, and whether it was bronchitis or not - both treatment tracks worked. Did the Urgent Care doc also get it wrong?

  • Report this Comment On August 18, 2009, at 7:58 PM, jerryguru69 wrote:

    I think Mr. CEO is sort of on the right track: a few marginal, administrative changes is probably all it takes to get healthcare back on the right track. However, it is hard to see how his specific proposals are going to make much of a difference.

    What worries me about this whole healthcare debate, is that no one has clearly defined the problem. Until you do that, a solution to this amorphous problem will never work. Consider this brilliant analysis of the problem (ahem):

    1) illegal immigrants. They suck up just as many healthcare $$$ as regular citizens, but, by and large, are not paying into the system since they are working under the table. Here in Calif., anyway.

    2) uninsured. Has anyone considered these 10M’s of folks do not have health insurance by choice?

    3) monthly cost of premiums. Here, I mean if you are buying it on your own, and not through your employer.

    4) % of GDP. I have heard numbers like 1/6 (about 15%). That is way too much.

    5) defensive medicine and malpractice insurance.

    6) geriatric care. When the controversy about “death panels” emerged, it seems that the bulk of healthcare $$$ happens in your last year of life.

    Each of these problems is mutually exclusive, and so are the solutions.

  • Report this Comment On August 18, 2009, at 8:00 PM, Mungbork wrote:

    2nd example, also from Ecuador. Spouse went to clinic, saw primary care Doc. Cost: $5.00. Got tetracycline prescriptions: $2.00. Got better.

    If you think that patients don't know what's wrong with them some of the time, and what will help them, you are wrong. Part of the physician culture in the U.S. is about preserving the boundaries of guild knowledge. Hence the emphasis on "following Drs' orders", rather than on providing consultation to a patient.

    That doesn't mean, by any stretch of the imagination, that patients don't need Doctors - of course they do. But, its important to give the patient credit for having a mind, and for being aware of what is going on in their bodies. That's a necessary collateral to Mackey's noise about HSA's and giving consumer's more knowledge of the true costs of their health care. If you want responsible consumers, you have to acknowledge their ability to be responsible for their health.

  • Report this Comment On August 18, 2009, at 8:01 PM, mtracy9 wrote:

    To reform the system, you need to introduce some real competition into the current private health insurance industry racket, in the form of a public option.

  • Report this Comment On August 18, 2009, at 8:01 PM, mtracy9 wrote:

    Canada's progress toward a national health care system came at the provincial level, led by the Co-operative Commonwealth Federation's Tommy Douglas when he served from 1941 to 1960 premier of Saskatchewan. The universal, publicly-funded "single-payer" health care system that Douglas developed in Saskatchewan proved to be so successful and so popular that it was eventually adopted by other provinces and, ultimately, by Canada's federal government. For his efforts, Douglas would be hailed in a national survey as "The Greatest Canadian" of all time.

  • Report this Comment On August 18, 2009, at 8:01 PM, MJH09 wrote:

    I thought the article was terrific. What a shock to see it was from the CEO of a "greenie" company. While some of his customers are leaving in protest, I will be going in support. That was brave of him to try to advance the debate, and it was great to see a business person putting into words what a lot of small business people think!

  • Report this Comment On August 18, 2009, at 8:02 PM, TallMartin wrote:

    Amen to grantrobertb. I have never understood why health insurance has come to mean health maintenance. That is not how insurance is supposed to work. You don't buy auto insurance so the brakes on your car will be fixed and the oil will be changed. Nor do you buy homeowners insurance to protect you in case you need a new paint job. These are things which normal, responsible people budget for. Insurance protects you in the event of a catastrophe, and thus the costs for that insurance are kept to a minimum. A high (or even medium) deductible plan would greatly reduce the costs of premiums as well as simplifying the day-to-day process of routine medical care.

    True, there are some who would not be able to afford the deductibles, but certainly the majority would. The government does not need to get into the business of taking over ALL responsibility for health care from the American public. If some employers want to give "Cadillac" type plans to their employees, more power to them. But the government should be looking to provide catastrophic insurance for those who have no other options, not a massive, micromanaged all encompassing plan like the one that is on the table.

  • Report this Comment On August 18, 2009, at 8:12 PM, pbtoau78 wrote:


    If you suggest we open our pharmacies to dispense meds for anyone that walks in and asks for them you not familiar with the consequences of what you suggest. I've had people die in front of me in ER that took drugs in the name of self medicating. These are things I won't forget, because they are senseless and preventable. Pharmacies are not autozone's. Drugs are not dispensed by a physician because they are harmless. But if you want to go by simple economics then, yes, 5 dollars is cheaper than 500. Way to simplify it. In additon, how much of that $500 do you think a physician actually sees? I think you'd be shocked.

  • Report this Comment On August 18, 2009, at 8:14 PM, nosodog wrote:

    Single payer is the only real option that will dramatically decrease what this country spends on health care. As that seems unlikely the only other option that has a chance is a public option combined with strong regulation.

    The real fix to our problems are to get donations (bribes) entirely out of politics. We currently have few honest politicians in our government and very little will change until we get real voter accountability back into our system of government.

  • Report this Comment On August 18, 2009, at 8:21 PM, Paulusbd wrote:

    This whole health-care debate is very frustrating. I agree with many points in the article, such as bill transparency, a high deductible, and certain must-cover doctor visits. There are a few points I don't agree with. Right or Privilege arguments aside, health care is absolutely needed. The question is what is the most cost-effective and beneficial way to do it. Any way we do this, it is coming out of our pockets, as it should. People should contribute their fair share into the society they live and participate in. This includes services. Services such as preventative medicine and screening should be available to every one, as should basic care such as treating colds and minor emergency costs. I, as a tax-payer, would be wiling to contribute to a fair system providing these services to everyone. I believe this is where things get really dicey, deciding where to draw the line for this type of service. The fact of the matter is that it health care is expensive and someone has to pay for it. I really don't like the idea of `people who have more` should do it because they have more. I worked my way up from dirt-poor to being in the middle class and I don't like having to pay for everyone else at gun-point. If I had a choice in the matter, I would gladly do it. But when forced to do it, you get to resent it.

  • Report this Comment On August 18, 2009, at 8:21 PM, mtracy9 wrote:

    Canada's progress toward a national health care system came at the provincial level, led by the Co-operative Commonwealth Federation's Tommy Douglas when he served from 1941 to 1960 premier of Saskatch.ewan. The universal, publicly-funded "single-payer" health care system that Douglas developed in Saskatchewan proved to be so successful and so popular that it was eventually adopted by other provinces and, ultimately, by Canada's federal government. For his efforts, Douglas would be hailed in a national survey as "The Greatest Canadian" of all time.

  • Report this Comment On August 18, 2009, at 8:22 PM, pbtoau78 wrote:


    I'm not sure what you do for a living, but as a physician I can assure you that 4 years of medical school and 5 years of 60-80 weeks is not trivial. I wouldn't walk to an engineering site and start picking out which valves and transducers to use. If there is one thing I have learned it is the complexity of the human body and the effort and dedication to understand it. Yes you feel the symptoms, can describe them in words but it's naive to thing the diagnosis ends there.

  • Report this Comment On August 18, 2009, at 8:23 PM, mtracy9 wrote:

    As long as insurance industry CEO's are getting their $12 million dollar salaries, I'm happy.

  • Report this Comment On August 18, 2009, at 8:32 PM, nogrthinker wrote:

    Tort reform? How about taking the money out of it, and bring criminal charges for 'mal-practice.' The penalty? Loss of medical license for a period commensurate with the negligence.

  • Report this Comment On August 18, 2009, at 8:43 PM, nogrthinker wrote:

    Tort reform? How about taking the money out of it, and bring criminal charges for 'mal-practice.' The penalty? Loss of medical license for a period commensurate with the negligence.

  • Report this Comment On August 18, 2009, at 8:45 PM, Smallworld0 wrote:

    Unless there is something in the health care reform bill to regulate that NO ONE can be denied health coverage because of a pre-existing condition, there is no reason for reform. When people can be spit off the insurance rolls - that they dutifully paid into - because they got sick....uhhh, wasn't that why we bought health insurance to begin with???...there is NO reform. And, I really like how someone like Mackey who, of course, has a gold plated health insurance package - until DOA, unlike most of us who will lose our health insurance when we retire or lose our jobs - can just spout off health care rhetoric, knowing he personally will never have to worry about it. Just like the members of Congress.................

  • Report this Comment On August 18, 2009, at 8:47 PM, pbtoau78 wrote:

    True negligence should be severly punished. However most malpractice suits don't involve true negligence of a medical provider and some are outright frivolous. Trial lawyers in areas without caps sue for exhorbanent amounts in hopes of settling for someless less, but still lucrative. The cost is passed on to MDs in their malpractice insurance. I pay around 7000 a year (which to some is a deal) although I have never had a claim against me. Some specialists I know pay 60000 a year! Could you imagine paying that in your job? The consequence is passed on to the consumer. In addition defensive medicine is practiced. For example if you knock your head and pay a visit to the ER you'll likely get a CT scan although every other history/physical indicator points the MD away from needing one. It's that 1 in 5000 chance that something is missed that scares them thus everyone gets one. Guess what

  • Report this Comment On August 18, 2009, at 8:51 PM, Windowseat wrote:

    That Markey would be so unworldly, so unaware to announce that the working poor should depend on charitable donations for health care makes me wonder what kind of business he's running. Does he think that people are taking dirt-level jobs for the fun of it? Doesn't he have the tiniest understanding of what life is like at the bottom? And remember; these are people who have jobs. They aren't looking for a handout. And there are plenty of people in America, and on the Fool, whose attitude is "then let them die, and decrease the surplus population."

    Someone said earlier that health insurance should only cover catastrohic illness. This is clearly a healthy person who is totally unaware of what some people live with in terms of long-term illnesses like heart disease, diabetes, asthma and a number of other problems. I had cancer. I'm in remission. In order to stay in remission, in order to keep the cancer from returning, I take one pill a day, and those pills are expensive. I couldn't afford them on my current salary. Apparently I'm supposed to stop taking them, so that I can again suffer through the very expensive procedures that cancer requires.

    What I'd like to see would be a national grouping. You could choose your insurance company, and choose your level of care, and your doctor, but you could get the lower price for health insurance that large groups receive.

  • Report this Comment On August 18, 2009, at 8:52 PM, holisticfool wrote:

    We will never ever solve the health care problem unless we change its primary focus. The system is now committed to enriching the drug companies and top hospitals. Research on therapies that might cure diseases quickly and inexpensively is simply not funded. Clinical trials of such therapies will never be successful.

    I would like to propose a very effective beginning step for solving the health and health care problems in this country of ours. First, we must change the present FDA into the FDA that should be. The FDA must regulate food and drugs in a way that is in the best interest of the American people, not in the best interest of the companies that happen to be in the food and drug business. If this could be accomplished, the benefit would be huge.

    To qualify as real food, a substance presently sold as food should be at least as nutritious as the cardboard box in which it is contained. Minimum standards for nutrition should be established and enforced. If it is not real food, it should not be sold as food. Every infectious disease is caused, or made more damaging, by nutritional deficiencies. In schools, dietary improvements have improved discipline, study habits and test scores.

    Anyone on government assistance should not be able to waste this support by buying non-food items like cokes, chips and cheetoes. The food stamps or similar support should be used only for the purchase of real food.

    Information on supplements, known to FDA but presently suppressed, should be disseminated to the public. First of all, everyone should be aware that that there are a number of vitamins, enzymes and minerals that have a profound effect on the immune system. Selenium, at 200 micrograms per day, has been shown to reduce the incidence of several cancers by 50% or more. Experiments in China showed that selenium added to table salt reduced Hepatitis B & C by nearly 60%. In Africa, those countries that have high levels of selenium in the soil have little HIV Aids or cancer. The FDA excuse will be that this has not been proved by clinical trials. Of course not. They will see to it that there are no such trials, at least no honest ones.

    Anyone taking statin drugs for cholesterol should be told to take CO Q10 to replace that enzyme that is reduced by the statin drugs. This should help to avert future heart problems as well general muscle damage. The public should be made aware of the immune system support that comes from supplements like Astragalus, Curcumin and Reishi. Garlic extract has been shown to stop, and even reverse, plaque deposition in arteries. Imagine a world without bypass surgeries.

    The CAM amendment offered by Senator Harkin should be made a part of any healthcare reform bill. This should give alternative medicine the recognition it deserves.

  • Report this Comment On August 18, 2009, at 8:56 PM, mtracy9 wrote:

    Canada's progress toward a national health care system came at the provincial level, led by the Co-operative Commonwealth Federation's Tommy Douglas when he served from 1941 to 1960 premier of Saskatchewan. The universal, publicly-funded "single-payer" health care system that Douglas developed in Saskatchewan proved to be so successful and so popular that it was eventually adopted by other provinces and, ultimately, by Canada's federal government. For his efforts, Douglas would be hailed in a national survey as "The Greatest Canadian" of all time.

  • Report this Comment On August 18, 2009, at 9:08 PM, pgfanap wrote:

    I've been self insured for years using the combination of a high deductable plan and a standard savings account for all emergencies. I used the substantial savings in the insurance premiums to fund the savings account which has become quite significant. I practice reasonable preventative health care, and am aware of the costs of the services I require so I don't abuse them. I think Mackey is right on and I hope he uses any influence he may have in Washington to promote his ideas. Be sure to include tort reform, coverage for preventative proceedures, and national competition, Do you think, with these guidelines, the politicians could craft a bill that was short and easy to understand.... or is that asking too much of our government ?

  • Report this Comment On August 18, 2009, at 9:15 PM, GRighter wrote:

    First: I think that the proposed Government-backed health care plans are actually very good for small businesses. They create a universal solution for one of the biggest barriers a small business owner has.

    Second: I cannot believe that the CEO of Whole Foods misunderstands his own customers so much. Like you, I agree that some of his ideas have merit, but they don't begin to fix the problem. The USA has the highest cost of health care in the worlds as a percentage of GDP, with very poor results to show for it.

  • Report this Comment On August 18, 2009, at 9:15 PM, my2cents4u wrote:

    We all know that opinions are like the southern terminus of one's gastrointestinal system: everyone's got one and they all stink. Why Mr. Orelli feels the need to expound his detailed counterpoint to Mr. Mackey's common sense suggestions on TMF only exposes him as either a shill for the insurance industry or another pathetic frustrated PhD. web hack still smarting from all those multiple medical school rejections so many years ago. Or maybe he was fired from his job as bagger at Whole Foods??Either way, Mr. Orelli should stick to his main gig pumping and trashing biotech stocks; health insurance reform is beyond his reach.

  • Report this Comment On August 18, 2009, at 9:42 PM, robertf36009 wrote:

    In 2002-2003 the Texas legislature enacted tort reforms aimed at limiting outrageous malpractice awards. These measures were signed by the governor and did result in savings for Texans. Why aren't lawyers going to have skin in the game? Will their turn come when the government exempts itself from malpractice actions? If I was a young malpractice attorney or a large firm who relies on malpractice profits I would be very afraid I would prefer tort reform..

  • Report this Comment On August 18, 2009, at 9:58 PM, grahamfordummies wrote:

    The HSA proposal is on the right track, in terms of achieving more efficient healthcare utilization, but is exposed to poor compliance during the high drduction period and inefficient decisions once the maximum out of pocket is reached and patients enter the 'all you can eat' mode. Better yet, look no further than the commercial HMO model. By progressively, but modestly, increasing the patient's out of pocket obligation for prescriptions, doc visits, emergency room, inpatient and outpatient hospital visits, etc. we have seen healthcare utilization steadily decline over the last15 years. If you don't believe this, just take a look at the medical loss ratio (MLR) trends of any of the for profit commercial HMO's over that time frame.Since the target on the insurance industry;s back seems to stem from the resentment of their profitability, then send Baucus to negotiate ways to extract savings, the way he did with the pharmaceutical industry (to the tune of $80 billion), effectively leaving the formula and incentive strucure intact. Conversely, if we start regulating and mandating without understanding these complex formulas (e.g. the level of profit required to incentivize risk based capital to pursue lengthy, expensive clinical trials with no guarantee of ever seeing a penny in return or messing with the complex actuarial assumptions of a health insurer by mandating MLR minimums or dictating plan design). Does anyone else see that the very profitable Medicare Advantage (MA) program also comes with some of the richest benefits for seniors of any product on the market and are seniors aware that if this plan is successfully abolished, the senior reverts back to limited choice, high copay indemnity plans? Again, send Baucas to extract several billion in savings and everyone will stay happy. Lastly, expand the Medicaid roles to cover a vast portion of the uninsured (roughly 20 million people between 1-2x the poverty line) and tweak the design to achieve the same utilization efficiencies (here, it may only require bumping the Rx copay from $5 to $10) and acknowledge that the remaining bulk of uninsured consists of those that CHOOSE not to have insurance (roughly 16 million people) and non tax paying illegal aliens (roughly 8 million). As I believe Benjamin Graham would say 'keep it simple', fools.

  • Report this Comment On August 18, 2009, at 10:06 PM, parcheymex wrote:

    John Mackey gives a point of view that will work for

    John Mackey. Our economy is already a dumping ground for bad advice. I notice that different regions of

    the US are part of the "favorable health care zone" of

    the Dartmouth Atlas. I am living in Mexico for retirement but formerly I lived in Portland, Oregon. For about 9 years I worked part time for Kaiser Permanente as a smoking cessation group leader. Embedded in my memory of the hallways of Kaiser where collaborative professionals educated in numerous aspects of medical service (including many doctors) scurrying to meet appointments and service the needs of various forms of "sickness". I am not modest; I was good at what I did for 9 years and quite a few people "whipped" the problem of smoking. I can not say enough in praise of a "good" and/or therapeutic environment for healing AND MAINTAINING GOOD HEALTH. All of this while the remainder of our country lives within the confines of the very worst of horse and buggy medicine. Don't misunderstand my point: Kaiser has made mistakes and they will tell you. There is no way I can imagine most of the country going onto a system of medical care that will preserve consumer value the way Kaiser does. It will be very costly. If you really care about what I say; notice that many health industry related articles are promoted/written by the Kaiser family health foundation.

    A private medical practice is just too isolated to arrange or organize a complete panel of service and where ever such is tried it results in a motley approach to organized and good health care. Forcing the system into organized care will be terribly

    disorganized. I know this because I spent a few years as a health planner in Michigan and I was a failure. When I described Kaiser to the doctors in Michigan their response was: "medical soviets"!

    They are ignorant and have little idea what a therapeutic community is. I shudder to think what it

    will cost to pay for modernization in communities not

    within the Dartmouth Atlas.

  • Report this Comment On August 18, 2009, at 10:23 PM, killerpants wrote:

    To those of us who keep pushing the point that health statistics in other countries are better than ours, that's not necessarily a direct result of them having a superior health care system. There are numerous other variables that affect life expectancy and other health statistics, like lifestyle.

  • Report this Comment On August 18, 2009, at 10:32 PM, unruhg wrote:

    Absolutely fantastic! The first truely good ideas on what will actually reform health care.

    Of course our moran legislatures will never concider even one of the Mackey's points. Sad, truely sad.

    Brain's comments shows that he does not have a real good understanding of free market dynamics.

  • Report this Comment On August 18, 2009, at 10:33 PM, mtracy9 wrote:

    Canada's progress toward a national health care system came at the provincial level, led by the Co-operative Commonwealth Federation's Tommy Douglas when he served from 1941 to 1960 premier of Saskatchewan. The universal, publicly-funded "single-payer" health care system that Douglas developed in Saskatchewan proved to be so successful and so popular that it was eventually adopted by other provinces and, ultimately, by Canada's federal government. For his efforts, Douglas would be hailed in a national survey as "The Greatest Canadian" of all time.

  • Report this Comment On August 18, 2009, at 10:40 PM, hicks wrote:

    Impressed by Mr.Mackey's recognition that information is more important that subsidies (especially when the subsidy is being created by my dollar).

    Heard there might be a boycott. So I took a trip across the river to do a little shopping. Quite a pleasant experience. I'll probably be going back.

    Live free or die.

  • Report this Comment On August 18, 2009, at 10:45 PM, robertf36009 wrote:

    mtracy: Greetings. This is at least the second time you have posted that message. Douglas could be the greatest human ever. So? We aren't talking about Canada. But since you bring it up why is Canada outsourcing it's cancer patients and elderly to the U.S?

  • Report this Comment On August 18, 2009, at 11:13 PM, robertf36009 wrote:

    Strange: I can't seem to find any Canadian health insurance stocks. Any hot tips out there?

  • Report this Comment On August 18, 2009, at 11:20 PM, reliapete wrote:

    The insurance side of health care may be the biggest problem of all! After about 15 years of buying health insurance for my family and I as a small business owner I'm back to working for someone else.

    1. The first health care insurer we purchased from decided to go out of the health care business. Having paid tens of thousands of dollars with virtually no claims, you're thrust back into buying insurance from another company several years older and with more pre-existing conditions that either won't be insured or that you'll be charged extraordinary prices for. This was a high deductible policy.

    2. Bought another policy with a high deductible only to find that my alleged $4500 out of pocket expense maximum turned into about $15,000 for emergency kidney stones on an out patient basis. Then to find out if we'd only been smart enough to fake a symptom or two and stay overnight at the hospital, we'd have paid only $2,000.

    While transparency is needed on the medical side, it's greatly needed on the insurance side as well. Every policy should lay out several typical events that might happen, what the usual procedures are, and what they will cover with insurance.

    I agree with the concept of high deductible insurance the reality of nearly 15 years says that much preventive care will be neglected unless you're feeling wealthy. In starting a business I didn't feel that way for several years. If insurance companies at least offered incentives or discounts for doing well visits and pursuing healthy activities (exercise) then that might motivate more people. If not, an individual plays the same game as an insurer, the individual just doesn't get to spread the risk around.

    I just read an article in a business magazine and in most states, one or two insurers have more than 75% of the business. There's not much competition among the insurers.

    As an individual arguing with what insurers should pay, it's a losing battle. At least with a company there's more at stake for the insurance company rather than an individual policy.

    US life expectancy is much different than most other countries we'd want to compare lifesyles and earning to, yet we pay considerably more in terms of % GNP

    It's all a mess.

  • Report this Comment On August 18, 2009, at 11:24 PM, streetracer101 wrote:

    I am so sick of listening to the health care debate. Before we even begin to focus on health care, illegal immigration needs to get under control by the gov't. If we as tax payers were able stop footing the bill for these health care free loaders, a lot of our health care problems would slowly begin to right themselves. And no, I am not a racist for wanting those not paying tax out. Make those who want to be citizens legal and able to pay taxes other then sales tax and ship all the rest back.... just like Mexico, Cuba and most other countries would do to an American staying in their countries w/out permission.

    And one last thing....give Americans a chance to work those job that "no one else wants to do" and society will be surprised at how many actually want to work but can't compete w/illegal workers.

  • Report this Comment On August 19, 2009, at 12:14 AM, foolishobit wrote:


    Since this discussion truly reignited when the idea of mending health care was reintroduced it may be worth mentioning that, be it right or wrong, long ago our federal government publicly promised the very best of health care services to those individuals that it deemed most merited to receive them: the men and women who have served to defend our republic.

    Some enlightenment may be had as to the very best care that our national government is ever likely to achieve in commanding a single payer or "public option" health care system by capturing a glimpse of the care provided those very special members of our society on any given day by visiting the nearest Department of Veteran's Affairs hospital in one's residential region.

    In order to gain at least some realistic perspective regarding this "national debate", I highly recommend this action be taken at least as a day trip event, to every member of our society.


  • Report this Comment On August 19, 2009, at 12:51 AM, nimajneb11 wrote:

    For me, it was nice to see alternative solutions to a government run health insurance program, regardless of whether you agree or disagree with his points. I personally liked his ideas.

  • Report this Comment On August 19, 2009, at 1:31 AM, dc46and2 wrote:

    I wonder what the record is for most comments on an article? I bet this is up there. Oh yeah, my $.02: screw government health care, give me laissez faire!

  • Report this Comment On August 19, 2009, at 1:31 AM, dc46and2 wrote:

    I wonder what the record is for most comments on an article? I bet this is up there. Oh yeah, my $.02: screw government health care, give me laissez faire!

  • Report this Comment On August 19, 2009, at 1:32 AM, dc46and2 wrote:

    woops sorry for double post

  • Report this Comment On August 19, 2009, at 1:43 AM, ahochau wrote:

    The republicrats have spent us into the poor house over the last 50 years. Yes the promise of a single payer and everyone get great health care that doesn't cost them a thing will keep the foxes in the henhouse for another term, but we can't afford it. The government is broke. They are selling bonds to them selves to pay for the promises that get them re-elected. HR3200 is 2/3 paid for with "cost savings". Let's assume for a moment that the government can run a more efficient system, that still leave 1/3 of the program unpaid for and the piggy banks are empty.

    So how about instead of a complete overhaul of the system, look first at items that are a 0 cost, such as allowing companies to sell accross state lines. I know I work for a global company and employees in AZ have different options than employees in WA who have different options than employees in OR. This increases cost. Once the no cost changes have been implemented, measure the effect an move on to low cost options, like tracking and reclaiming the millions of dollars lost to fraud.

    The government's track record for running programs is not good. When social security was implemented the citizens were promised they would never be taxed more than 3%. When the income tax was implemented we were promised it would never be more than 10%. Thus the 2/3 through "savings" is a tough sell for me.

    I know when I was looking at HSA there were several that had low cost routine checkups, an anual physical was like $50 and regular checkups like mamograms were reasonable. Above and beyond that there were higher deductibles, but the basics were coverd. Combine this idea with the idea of being able to purchase a 10 or 20 year term policy that everyone can afford and there will be savings.

    So if you really want to reform the system, in 2010 vote for a canidate that supports term limits for congress and controlling spending. Once the congress is working for the people and not the special interests there wil be reform. Tell the politicians they have already raided our children's and grandchildren's piggy bank with your vote. Tell them we've had enough and we aren't going to take it any more.

  • Report this Comment On August 19, 2009, at 2:01 AM, PoundMutt wrote:

    You wrote: "Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. No one likes the idea of not being compensated for a doctor's mistake, but tort reform may be a necessary evil to keep costs under control."


    We ALL know (or SHOULD) that we have a government OF the trial lawyers, BY the trial lawyers, FOR the trial lawyers!!!

  • Report this Comment On August 19, 2009, at 6:07 AM, greyhound44 wrote:

    I have had a high deductible ($2000. annually; 80/20 to $10,000) indemnity BC/BS health insurance policy for many years. I have never used it.

    Just received my MC (Part A and B) card effective 1 December. Would have liked to have the MC MSA option, but as I'm an expat and live outside the USA for more than 183 days a year, I'm not eligible.

    MC Part B; Part D and a MC supplement will cost me $206. a month for virtually 1st dollar coverage.

    Interestingly, The Part D (drug coverage) will not reimburse me for the Lipitor I buy from Canada (US$134.10 for 20mg #90), but will pay 3 X more for same in their US pharmacies.

    Perhaps all should look at Massachusetts' experience with mandatory health insurance - the Boston Globe has scores of articles on the cost overruns dumped on state and US federal taxpayers.

    The only way a single payer, government program will work for all wanting anything close to 1st dollar coverage is by restricting access/rationing.

    A high deductible plan makes the most sense to me personally, but until our elected officials are required to have the same coverage as mandated by HR 3200, I have no faith.

    ret MD (NBME; ABIM; ABNM; ABR w/spec comp NR)

  • Report this Comment On August 19, 2009, at 6:50 AM, xpat2009 wrote:

    I'm impressed with Mackey's thoughtful comments on health reform. And, many others have added positive thoughful comments as well.

    I don't have the confidence that our president, representatives and senators have our best interests at heart. I agree with the many that these folks have their own self-interests as their prime motivation in their attempt to cram public health care on the public.

    If public health care is so great, why is the president, our representatives and senators not in line for the services?

  • Report this Comment On August 19, 2009, at 7:06 AM, Wennejunk wrote:

    Mr Fett wrote:

    "Health insurance reform is fundamentally an argument about values. If you do not believe people have a right to quality health care, then you are not going to be supportive of the government mandating coverage for all, while in the process trimming the profits of the insurance companies."

    You are only half right.

    It IS about values.

    I think few would argue against the idea that quality health care is a right. I can support that idea. Where I balk - and so many others - is the idea that others' rights include the government taking from my pocket at will and with no limits to pay for others health care - regardless of how they live their life, their habits and values.

    Where is my right to keep my own money and spend it as I wish? To donate it to those in need for their health care - as opposed to being forced to pay for:

    - those who cannot refrain from promiscuity and contract diseases, or

    - get pregnant and demand abortions, or

    -are in the country illegally and are breaking the laws simply by being here?

    How come when it comes to others' rights and the government, it always comes down to involuntarily taking away from those who have more?

    You are right, this is about values, just not the ones you are talking about.

  • Report this Comment On August 19, 2009, at 7:16 AM, LessGovernment wrote:

    Competition, competition, competition.

    Remove the third party first pay system and change the system to where the patient has the responsibility to pay the bill and then applies for reimbursement from the insurance/government/whatever.

    Only by making the system subject to competition will patients begin to ask what will it cost and can I get the same service done at less cost.

  • Report this Comment On August 19, 2009, at 8:16 AM, groobiecat wrote:

    To the person who said "Health care is a service not a right and until we treat it as such in the marketplace, we will have problems.":

    Where to begin? Okay, let's talk about "rights." We, as a people, determine what are, and are not, our rights. Not you. Not me. But we, as a people. Other countries have determined that the health of their people is their most important resource/asset. They have determined that it is a right. To date, we here in the US have not defined it as such. One could argue merits either way, but if one agrees that a healthy populace is the core of a healthy country, then one might consider it to be a priority. Apparently not you, however.

    Okay, let's talk next about "problems." This comment actually made me laugh. Here's a flash of news for you: with the exception of Medicare and Medicaid, we *have* been treating healthcare as a marketplace service. Where have you been?

  • Report this Comment On August 19, 2009, at 8:51 AM, cfleisig wrote:

    As long as health care is tied to profit there will never be meaningful reform. Everyone in DC is tied to some lobby. Insurance companies have a very LARGE lobby and they are not really regulated either so there is no reason for them to come to the health care reform table unless it is to kill legislation that would affect their bottom lines. Unfortunately, business is only worried about the bottom line.If you have too many auto claims you are likely to be dropped. However we shouldn't equate a person's body to an automobile body. My company is worried about what health care premiums are doing to its bottom line too. Our premiums went up 25 percent this year so we are paying lots more in deductibles and co-pays. At least I have insurance, for now. Health care for all, whether single-payer or subsidized system, has become a moral imperative if we are to remain a civilized nation.

  • Report this Comment On August 19, 2009, at 9:50 AM, mamasmeeve wrote:

    I think a lot of what Mackay says makes great sense. I was alarmed years ago when we went to a card system that hides costs from the patient. And try to get an estimate for proceedures, costs etc....impossible! I have suggested to friends in the business that individuals be incentivized to read their bills looking for mistakes and overbilling and share financially in some small way for finding mistakes. There are many.

    At least this CEO is thoughtfully considering solutions instead of waiting for the government bureaucrats to make up the new rules. His passion for the issue makes me want to shop at his stores even if I don't totally agree.

  • Report this Comment On August 19, 2009, at 11:45 AM, sidecarracer wrote:

    Health care is NOT a right. Read the founding doucuments- Rights are granted by our creator -

    not the government ! Life, Liberty, and the Pursuit

    of Happiness are our rights. The "Bill of Rights"

    is to constrain government from infringing upon those


    The main thrust behind this health care "reform"

    is the same as most "entitlement" programs - to give the government MORE control over the individual. The

    more dependent someone is on you, the more control

    you have over them. Think back to your teenage years - Dad & Mom could exert control over you by

    taking away privileges, monetary support, etc. But

    once YOU were out of the house, earning your own

    living, they had much less control over your decisions,

    didn't they ??

    We taxPAYers are now supporting 4th generation welfare recipients! Welfare and entitlements have become a way of life for some folks, partly because they have no experience of anything else! When you

    take a long hard look at it, the reality of welfare is that it is very similar to the reservation system that

    was used to pacify and control the Native American

    population, only with the added effect of destroying the family unit. "Welfare" has the added benefit of

    not having geographical boundaries or constraints -

    it can be applied anywhere.

    As long as one obeys the rules, they get their check, their subsidized housing, etc. But if some government employee decides to, they can take it

    all away in an instant, so you better play nice !

    There is no such thing as a free lunch ! Somebody, somewhere has to pay for it - those of

    us who pay taxes- or our children and grandchildren...

    We, as a people, need to start weaning ourselves

    away from dependence on government for anything other than the most basic needs, like national defense, securing the borders, etc.

    Want to make health care available at reasonable cost? Allow a health care savings account of up to

    $5000/year/person/dependent with rules like an IRA.

    Also, in addition, tax deductable health care insurance with a limit on how much is deductible. This

    insurance would have the same flexibilty as a homeowner's policy or car insurance - the insured

    decides what level of deductibles and what coverages

    they want and can afford to pay for.

    Mandate that all health care insurance companies

    must offer "umbrella" type policies to cover catastrophic conditions ( these would cover medical

    expenses above a set amount.)

    Insurance companies could offer "health maintenance" options - if the insured has regular checkups & age/condition appropriate screenings

    ( at reduced cost ) , they would have a reduced premium. If the insured keeps their risk factors

    in check, they could qualify for a further discount.

    Malpractice insurance must reflect the insureds

    record - If the doctor screws up, his premiums go up!

    Let the gov't regulate the insurance companies rather than be a "nanny state." What you or I

    choose to eat or drink is none of the government's business !

  • Report this Comment On August 19, 2009, at 11:55 AM, baybrowser wrote:

    For those of you smirking about the claim of "death panels" an attorney at Painter LAW Firm points out that in some states these already exist.

    (Washington Times, Aug 19, "Death panels' exist already")

    quoted in part

    "...When a patient of family wants health care to continue but the attending physician does not, the Texas law allows a hospital committee to have the final say under the amorphous concept of 'medical futility'. Texas law only requires the hospital to provide the patient and family with 48 hurs' notice before a hospital 'ethics' committee meets and makes a decision on terminating life support. There are few due-process safeguards in the law to protect patients during the committee proceeding."

    Some of the people now smirking about Sarah Palin's earlier "death panel" claim may find themselves feeling differently if/when the plug is pulled on them or their loved ones, and they have no recourse.

  • Report this Comment On August 19, 2009, at 11:58 AM, daharkleroad wrote:

    It's interesting that most of the people here have no idea of what they are talking about. I'm currently living in Ghana, West Africa. Here you learn about what real health care and the lack of it are all about. Health care is not a right, but it should be available to everyone. Neither the Dems or the Republicans can come up with a plan that makes health care available to everyone and is not a government run plan. The fact is you don't get something for nothing. If thats the case lets all sit on our ass and let the government support us. Obviously that won't work. There is no reason we can't come up with a plan that says something like if you can't afford your own insurance and your company has no plan, you can work 1 weekend a month at the homeless shelter, or some other place. There are plenty of things and services the government provides that people could do. the result would be more things getting done for less money and resulting in lower taxes. We just have to have the balls to insist you pay for what you get one way or the other.

  • Report this Comment On August 19, 2009, at 12:21 PM, Bamafan68 wrote:

    Personally, I don't think health care is a right. People don't have a right a physician's services any more than they have a right to clothing at a department store, the services of a plumber, or car insurance.

  • Report this Comment On August 19, 2009, at 12:29 PM, drivers100 wrote:

    I think, years ago, we were all put into a drug-induced coma. It was done either by a left-wing, socialist community organizer or a right-wing, zillionaire, fascist neo-con. Or maybe they conspired ... Any way, as usual, as a society we don't start screaming until it becomes as personal as a colonoscopy.

  • Report this Comment On August 19, 2009, at 1:10 PM, tbarth42 wrote:

    Always great to see such a diversity of opinion so here's mine. I am pro public option but also pro responsibility. I have a friend from Germany. Their medical plan is based more on prevention and, if you fail to see your doctor or dentist for routine checkups, you risk losing your coverage if you get sick. This seems fair and places the responsibility of wellness on the patient. The real savings can only come about by reducing the need for more serious treatments later.

    As an example, I was diagnosed with Type-II diabetes and put on medication. First thing the doctor did was sent me to a class to learn about the disease as well as telling me to drop ten pounds. That was in January of this year. Since then, I have lost twenty-five pounds and changed my diet. As a result, my blood sugar has been well within normal bounds on the last two A1C tests, my cholesterol levels have been cut by 2/3 and I have been taken off my medication. Am I cured? Not likely. But at least by taking responsibility for my condition I have prolonged my life, improved its quality AND cut costs both to me and the insurance company (and believe me, Diabetes is freak'n expensive even with health insurance!!).

    While I would like to see everyone covered by a universal health plan, I also expect that people take responsibility for their lives. Why should anyone have to pay the costs of my addiction to junk foods and/or sedentary lifestyle? make it a contract. I do my part to stay healthy and then let the health plan cover routine checkups and tests. As long as i keep up my end of the bargain, my illness and injuries are covered.

    Finally, there is a significant economic issue for employers. I pay $3,600 as my share for my insurance and my employer pays the other $10,800. With close to 500,000 employees, that $5,400,000 a year my employer pays for health care coverage for its employees. That's not chump change and shouldn't be ignored.

  • Report this Comment On August 19, 2009, at 2:44 PM, solderwave wrote:

    The comment by mrfett, "...while in the process trimming the profits of the insurance companies. The savings are going to come from insurance companies' bottom lines. That's what has people upset." saying the new charges come out of insurance companies' bottom lines shows clearly how little this concept is thought through. Our small company struggles to pay our insurance now. I just got notice that here in Oregon, our legislature in its wisdom passed a bill that created a tax on medical premiums as a way to partially fund increased access to healthcare for uninsured. The end result is that this is being passed on from the insurance company to us, and also to those with dependent coverage since we do not pay for that. How naive is it to 1. think you can have something for nothing, and 2. that you can keep increasing taxes on businesses without people ultimately losing their jobs and owners losing their businesses? There is no free lunch - ever.

  • Report this Comment On August 19, 2009, at 3:12 PM, hershalsavage wrote:

    Okay all you self sufficient folks, I wonder if Mackey would support a small 2 cent "health care" tax (more or less) on all those Fast Food purchases. This might not be too popular in all those "obese" states but it would raise alot of money. We tax Tobacco, Alcohol, why not fast food? Would it stop all those "Gordo" folks from eating their 4 Quarter Pounders of cheese per week? Maybe, maybe not but the outrageous monthly premium I pay right now for health insurance are directly related to all those folks who continue to plug up their arteries at McD's, Burger K, Taco Bell...etc.

  • Report this Comment On August 19, 2009, at 3:16 PM, XMFScott wrote:

    I think John Mackey's suggestions make a ton of sense. And he's backing it up by actually doing it at WFMI, and it's working if I take him at his word, which I do...the WFMI employees I meet seem genuinely happy there. Transparency plus personal responsibility plus free choice are powerful together inmost circumstances.

  • Report this Comment On August 19, 2009, at 4:23 PM, DawnKW wrote:

    I think his suggestions arecertainly better than anything the current proposal has in it. Regulating the insurance industry would be the first place to start. Let people make donations to private charities for health care for the uninsured or to the individual states.

    Keep the federal government out of it, for no other reason than they are inefficient and wasteful!!!

    Somehow find a way to give incentives to the non-fat, non-smoking, exercising Americans!

  • Report this Comment On August 19, 2009, at 4:31 PM, beavsfanad wrote:

    Clearly many here do not understand what "single payer" healthcare would involve. The government would have NOTHING to do with your actual care - thus any comparisons to waiting in line at the post office or DMV (which I agree is horrible) are asinine. Doctors and their patients (i.e. "you") would make the healthcare choices; as opposed to insurance companies as is the case now with most plans. Single payer means the government PAYS, nothing else, despite the rhetoric to the contrary.

    Of course we're not even talking about single-payer because the conservatives have, per usual, scared intellectually lazy people into believing what they say. Check U.S. health care statistics compared to horrible "socialist" countries like, oh, Sweden or heck, even Great Britain (twice as good as the U.S.). In order to have a chance to be whatever you want to be and have a good life, which I would say is what makes America great (no?), is basic health care not essential to achieving that? I can only assume those of you saying health care is not a right also believe that education is not a right. Thank god we already have that - although it needs great improvement in order to compete globally - because I'm sure the same "socialist" cries would go up for that now.

  • Report this Comment On August 19, 2009, at 5:17 PM, papnc wrote:

    Tort reform should not be a debatable isue. Unfortunately Americans tend to ignore the "elephant in the room" when it comes to this subject since Congress and lobbyists are dominated by lawyers. Malpractice insurance in Europe and Japan is a pittance in comparison to the US and it is not believable that their doctors make fewer mistakes as a percentage of their populace than Americans.

    As far as Mackey saying that no one has an intrinsic ethical right to health care, he was clearly referring to the fact that a mandate for it does not exist in our Constitution or Bill of Rights and his observation is factually correct. Those who take exception to his statement are taking it out of context and will obviously spin it the way that supports their own ideas or biases.

  • Report this Comment On August 19, 2009, at 5:21 PM, papnc wrote:

    A personal note: I have a friend that lives in another state. She has been dealing with cancer for 3 years. It is now stage 4 and her medical costs have been tremendous, involving multiple surgeries, radiation, and many sessions of chemotherapy. She has been able to continue to work. Her personal costs have been very minimal thanks to her insurance at work. She is an employee of Whole Foods.

  • Report this Comment On August 19, 2009, at 5:32 PM, bootme wrote:

    There is a segment of American workers that get up every day at 04:00 and begin the work day. Yes, they have all that family stuff and prep work to do just to "get ready" for that commute. The small business population, I will call them, you know, they provide most of the jobs in America. They believe that they should work hard and pay their own way but they don't believe that they should pay "your way" also. So you probably won't find a lot of them believing that health care is "a right" under our constitution.

    You have noticed (I'm sure) that we are so polarized in America on this whole host of issues (abortion, gay marriage, health care, public education, the Fed, taxes, rights, privileges, blah, etc.) and we are like a swinging door, Republicans for 8 years, Dems for 8, constant bickering (I'll undo your executive orders and up you three!) and now the town hall phenomenon. I hate verbosity so let me get right to the point.

    I have grown so tired of this back and forth that sometimes I find myself wishing that we could logistically and politically divide America into the two camps (I know some will argue for more). One part of America would stick to the constitution and the other side could be the socialist welfare state. Which side are you on? I know you may have already considered this because it only requires 3 seconds of thought to realize the socialist welfare state cannot stand on its own. It has to rob the other half of America, you know, the small business side, the folks who work and make America a going concern.

    Why, all of a sudden do we have to throw grandma under the bus? Because Congress wasted the social security "nestegg" that was promised to seniors and you can bet the folks in think tanks have figured out that little Timmy and Sally are not willing to be taxed at 85% to keep the charade going. Haven't you noticed the absence of the college-aged crowd at the town hall meetings? What if the govt. "plan" to fix the problem was to reduce the population from the lower end, you know, the persons who have not paid into S.S. all their lives? Who would be at the town hall meetings?

    My argument is that robbery got us into this and robbery is not the solution. I, like you, don't have the solution and I'm tired of my own blah so, see ya 'round, Fool.

  • Report this Comment On August 19, 2009, at 7:01 PM, whereaminow wrote:

    Mackey is a genius.

    "There's no such thing as bad publicity." - P.T. Barnum

  • Report this Comment On August 19, 2009, at 10:57 PM, robertf36009 wrote:

    I agree with whereaminow. Al, Gore is a super genius. He is selling imaginary carbon credits to provide an imaginary benefit and getting the Federal government to make it mandatory. Barnum would be stupefied.

  • Report this Comment On August 20, 2009, at 12:27 AM, Annie1139 wrote:

    Couple of questions: What exactly is it that so many of you believe the for-profit insurance companies do to make health care better for Americans? Doesn't it bother you that approximately 30% of each dollar spent goes toward something other than actual health care--marketing; administration; executive salaries; shareholder profits? Do you have any inkling of how much time is spent by plan administrators at companies, individuals, and health care provider staff in dealing with all the paperwork, the differing regulations and provisions, the sheer confusion that frequently exists. As someone pointed out above, health insurance companies are NOT about providing health care but about making a profit.

    Why do so many people believe that a public option and/or single payer coverage will lead to loss of freedom? Are you telling me that all the people in Canada, the U.K. (which has the only real "socialized" health care system), France, Japan, Switzerland, and all the rest of the world's industrialized countries are somehow yearning for freedom these days? Has it ever occurred to you that a health insurance system tied to employers lessens freedom of choice in several ways--you take the health insurance offered by your employer (you may be able to choose among two or more plans if you're lucky but you can't just go out and pick the coverage you want) and, most likely, the "in-network" list of health care providers that comes with it. In addition, people often lack the freedom to change jobs or to start their own business because of the economic difficulties associated with American health insurance.

    Aren't any of you ashamed that an organization created to help bring medical care to third world countries is now running clinics in the United States? This, in the country that has proclaimed for years that it is the richest country in the world, but that now cannot take care of its residents as well as many poorer countries do. Are you comfortable with the fact that 18,000 people a year die in this country because they don't have good access to health care in the richest country in the world, the country where so many proclaim that it has the best health care in the world?

  • Report this Comment On August 20, 2009, at 1:06 AM, ahochau wrote:

    to beavesfanad:

    You stated, "Single payer means the government PAYS..." Hate to be the one to break it to you but the government is broke. There's no more money, they are selling bonds to themselves and running ponzi schemes that look Madoff look like an amature. Just like in your house, when money gets tight you have to choose what will get paid for and what won't. As a simple example, if 6 people want a pill that costs $25 and the government only has $100 left to pay with 2 people are going to go without, and the group paying the bill is going to decide which to. Of course, as we look at the governments excellent track record of running Social Security, Medicare, Amtrack, Fannie Mae, Freddie Mac, and their own bank I know it is a far strech to think they would promise more than they could deliver.

  • Report this Comment On August 20, 2009, at 1:53 AM, sebaum wrote:

    If you think that healthcare is expensive now, wait until it is free. The province of Manitoba spends 40% of its budget on healthcare.

    I am not sure how that translates into a percent of GDP. The point is that healthcare is going to be expensive no matter how you wish to pay for it. The bottom line is that no one wants to admit that the only way to save money is to ration care. Also many of the medical ills afflicting Americans are actually rooted in social problems: obesity, poor diet, lack of exercise, tobacco use, alcohol and drug abuse, violence, homelessness. Fix these and a lot of medical problems will disappear.

  • Report this Comment On August 20, 2009, at 2:33 AM, thomasblak wrote:

    Mackey is an idiot, not just for his views, but espousing them as well.

    As for health care as a service and not a right - you service your car, your body is life.

    Who are these idiots that believe that people "run to the doctor for runny noses"? With the lack of health care and the high deductables, people don't ever go to the doctor until it is too late, or worse end up in the ER where we ALL pay ten times more to try to save them from a preventable disease!!

    Every ohter industrialized (civilized) country in the world has some form of a national health care system and the facts are in: we rank 37th in the world in health outcomes - after Costa Rica!

    It takes sixty-thousand insurance policy payers paying in $1000/mo to cover the cost of the CEO of United Health Care's salary and stock options!

    I like Medicares' 3% overhead and the fact that no one there is specifically employed to "deny your coverage" compared to 25% overhead needed to pay for the above.

    Ask yourself, Where is your health care premium going?????

  • Report this Comment On August 20, 2009, at 7:23 AM, laughtrack wrote:

    Are we the greatest country or just the greediest? Check out our infant mortality rate sometime. What a bunch of BS.

  • Report this Comment On August 20, 2009, at 9:28 AM, BartSimpson888 wrote:

    Dear friends,

    Obama's movement for change in the US is collapsing -- in large part because of lies about the Canadian healthcare system!

    It's incredible, but Obama's health plan, and with it his entire Presidency, could be derailed because big corporations and the radical right manage to convince Americans that our health system is a nightmare similar to "Soviet Russia".

    We need a huge popular outcry to show the truth -- how proud and grateful we are in Canada to have a public healthcare system that works. Sign on to the message to America and forward this email -- if enough of us sign, we'll cause a stir in US media and help change the debate:

    US healthcare is run by large corporations - it's the most expensive in the world, but ranks 37th in quality, and 40 million Americans can't afford any care at all. It's an awful system for people, but corporations make enormous profits, so they're fighting to keep it. If they win and Obama fails, the Democrats could lose the Congress in elections next year. If this happens, progress on every global issue is endangered, from climate change to the war in Iraq.

    We have no time to lose. Industry lobbyists are ramping up their smear campaigns right now to make sure the Obama plan is dead on arrival when Congress meets in September. Americans are hearing a constant barrage of propaganda that Canadian healthcare is a nightmare. Let's say it ain't so below:

    Canadian healthcare isn't perfect -- but it works far better than the US system. Let's stand up to the lies, and help save Obama's movement for change with the truth about Canada's healthcare system.

    "From Avaaz"

  • Report this Comment On August 20, 2009, at 9:41 AM, plange01 wrote:

    obama and his staff spent about a week thinking up his health care plan.this is just obama trying to make headlines and be a celebrity! the US is 8 months into a depression with unemployment at 20% no one cares about health care now.our present system has problems but it they can wait .there are real problems that need attention they are just not flashy enough for our celebrity!

  • Report this Comment On August 20, 2009, at 12:06 PM, artgcay wrote:

    I believe we could immediately get reduction in costs if we allowed medicare to negotiate the price of drugs. That is why drugs are so cheap in Canada.

    There has to be a government option to compete with the insurance comapnies.

    If I could get my drugs from Canada there would be a 40 5 drop in my medical cost.

    How can we defeat the drug lobbiests?


  • Report this Comment On August 20, 2009, at 3:51 PM, done4nau wrote:

    Leaving the health care system as it is simply rewards large insurance companies who have, over the past decade sucked the financial blood out of America. Anybody remember AIG?

    I would prefer having a public option. As it is, my tax dollars cover insurance for senators and congressmen, federal employees, servicemen and families, vets, retirees, retirees of armed forces and their relatives. The CEO of this doesn't get $12 or 14 million. I like the idea of no CEO, no herd of VPs and an opportunity to have health insurance before I'm 65. I retired 10 years ago only to lose 4/5 of my IRA in 2000 (before 9/11--Thank you piper-jaffray) then I lost 2/3 of what was left in 2008. I know I deserve it for trusting people who work in the industry.

    I now can't afford the $2000 a month needed for health insurance-(pre-existing conditions) or much of anything else.

    Consequently, I curse all private insurance companies for their greedy ways. Healthcare insurance takes .35 of a dollar for PROFIT, lots for overhead, little for the customers who are forced to do business with them. I want and need a public option

  • Report this Comment On August 20, 2009, at 3:56 PM, done4nau wrote:

    Ooops hit the wrong button. I needed to edit. end of 1st paragraph. It is the Bonuses for upper level employees of healthcare insurance that have made the premiums triple over the past decade.

  • Report this Comment On August 20, 2009, at 5:07 PM, catsavy wrote:

    Those who advocate that the Canadian system is better and works have their heads in the sand.As a Canadian with all my family in Canada ,I can tell you it just isn't so.Please read the article "Canada's health care imploding" Buried on CNN ,front page on FOX.Written with the incoming president of Canadian Medical association.First of all it is not FREE .Only the truly indigent ,and Natives pay nothing.Shortage of Drs and nurses.rationed care means ,only so many procedures allowed for year.This is determined by the gov't.Don't request an angiogram in Nov ,the quota has been met.Breast cancer,your Dr will send you to the US.Now if you are a politician or CEO ,front of the line for you.Or take your vacation in Mexico ,chances are your Dr has a clinic there and you can pay a pittance for service.BTW ,Cdns are becoming just as fat,diabetic,high blood pressure,you name it as Americans.Bottom line ,no one wants to take responsibilty for their own health.Go buy a huge 4x4 truck and boat then whine you can't buy health insurance.Cdns are famous for entitlements,take heed .Once you start these programs they never go away.Social security was never intended to be permanent.People got lazy with savings and and now look at the mess.Unless you can talk to Canadians frankly about their care ,don't believe what the O administration says.And please do not ask a new immigrant.They are getting everything free! Medical ,housing ,passports,schools and if they don't like that there is no Muslim school for them they petition and get it.Be afraid ,be very afraid.

  • Report this Comment On August 20, 2009, at 5:34 PM, gloryofarioch wrote:


    [citation needed]

  • Report this Comment On August 20, 2009, at 5:42 PM, catsavy wrote:

    for mtracy9 ,please stop the cut and paste job dug up from the archives.I actually know Drs who are the descendents of Good old Tommy,and every year they work to reverse what he started.Once again it was good system at the time ,but needed to end decades ago.You might fool some of these "fools" ,but not this one.To promote a system that is bankrupting your country is the worst kind of folly.Maybe you live in the maritimes ,where the majority of the population is on the dole and you don't want to give up any of your freebies.

  • Report this Comment On August 20, 2009, at 8:25 PM, loungechair wrote:

    As regular Whole Foods shoppers, my wife and I are taking the matter seriously. We've decided to boycott for a month and then minimize our use after that.

    I am far from an expert on any of this, but here are a few of the problems I have with Mackey's article:

    He believes that when health care consumers spend their own money, they spend them more carefully.

    Yet some studies have shown that it is near-term thriftiness and not getting the care we need in order to save money actually is more costly long term.

    Looked at another way, if all of my costs are covered will I really be anxious to abuse the system?

    Will I sign up for weekly prostate exams just for the heck of it?

    Mackey advocates allowing insurance companies to fully compete across state lines. Isn't this kind of deregulation what we did with the banks in the nineties? Somehow, having just a relative few huge

    insurance companies does not fill me with optimism.

    Mackey also seems to be saying that his British and Canadian employees when given a choice between basic service and--in essence--a combination of basic and supplemental insurance opt to take the supplemental as well. This doesn't tell us anything. Most health care reform plans in the U.S. would, at minimum, allow employers or individuals to buy supplemental policies.

    Mackey fears rationing. Good fear. Unfortunately we already have it. All insurance plans ration care.

    We'll be seeing more of it if costs, including the overutilization that insurance companies seem willing to pay for, continue to climb.

  • Report this Comment On August 20, 2009, at 8:37 PM, papnc wrote:

    I just listened to a live interview with a former President of the Canadian Medical Association. In summary, he states: Of the current 33 million Canadians, 5 million have no family doctor (required to get treatment under their nat'l health svc. Over 1 million are on a waiting list for surgery; over 1 million more are on a wait list to see a specialist to see if they qualify for surgery. 40% of the Canadian budget is for health care. 70% of Canadians carry private insurance in order to get drug coverage or to be seen for a heart attack wh. is not covered under Nat'l Health Svc.

    FYI in our state (NC), 85% of insurance premiums received are paid out in claims.

  • Report this Comment On August 20, 2009, at 10:12 PM, NYscones wrote:

    Mackey has good points and I'm glad he made them, unlike insurance,hospital and medical associations that cave in to the President's plan, which by any reasonable standard, cannot be said to work nearly as well as what we have.

    Words matter; Obama says "reform" when he means destroy and rebuild from scratch. Remember his comment about rebuilding the structure of the American economy? If he weren't POTUS, that would be hysterically funny. Let's take measured steps to solve portability and coverage issues, not throw Grandma out with the bath water.

    Brian , when you say "giving a tax break for individually owned health insurance will cost the government money", that's scary. Where does the money come from? It's our money, not the government's. Let's start to solve the portability problem with this step.

    Medical Savings Accounts start to address the issue of cost transparency; what will this test or procedure cost? In no other transaction in our lives do we consent when we don't know the price (except when in the clutches of a really slick con man, but that's another discussion). I have an MSA and spend it very carefully except at year end since there's no rollover. MSAs with rollover would allow people to put aside money tax free until needed for medical expenses, thus lowering the cost of insurance since deductibles could be higher.

    On the quality of US healthcare, given that life is imperfect, where do people from around the world who need timely and advanced medical care go? England, Sweden, Cuba, Canada? No, no, haha and no. Where will they go if one-payer care in any form is enforced here?

  • Report this Comment On August 21, 2009, at 1:19 AM, tugger76 wrote:

    I just want to say thank you for the thoughtful dialogue offered in the comments above. It is so refreshing to read 'opinion' without others attacking or name calling.

    I work for a " big bad insurer;" I'm no executive just a middle class citizen trying to earn a living. One thing that I want to yell to the world is that we Americans are just about as unhealthy as they come. I look at claims reports day in and day out, and contrary to the " record profits" I keep hearing about, I see BIG loss ratios on medical employer groups. TO be honest I rarely see a LR below 70%. I'm sorry, but it's downright foolish to think that insurers are making so much money on us fatties.Its the investments that keep us solvent. Which reminds me to point out a study that just came out from the CDC about the obesity rate in this country; a whopping 60%. Another study shows that 70% of all chronic disease has its roots in obesity. Can I please get a shout out for personal responsibility? This is a huge burden on the healthcare system. There is no excuse. Let's start the reform with us. Be the example, get off the couch, turn off the boob toob and take care of thee. THEN and only then can we really point the finger.

  • Report this Comment On August 21, 2009, at 8:00 AM, Celtics17 wrote:

    Time to pick up some groceries at Whole Foods :)

  • Report this Comment On August 21, 2009, at 11:18 AM, ArmaCano wrote:

    An average annual payroll deduction for a family man with two kids for health, life, dental, vision, and disbililty is around $7,000. Average salary in retail is probable $12.00 per hr. How does one support a family, pay a mortgage, send his kids to college, save. Figure it out. Let Mackey, Walmart, Homedepot, Lowes, and every other retail company pay their employess a minimum of $25 hr. Most retail employees live at a poverty level with slave wages. Let Mackey put his money where his mouth is. Wonder why we're in a recession. Most Americans are poor. Mackey's employees can't afford to shop at Whole Foods. Something has to done. Anything...then just sit on your hands and praise Jesus, and god Bless Amer'ica like the prior administration.

  • Report this Comment On August 21, 2009, at 1:16 PM, LALibertarian wrote:

    As a fellow Libertarian, shopper and stock holder of Whole Foods I applaud Mr. Mackey!

  • Report this Comment On August 21, 2009, at 1:25 PM, tylee100 wrote:

    I took debate classes in college. One primary method of refuting good opposing arguments (when all else failed) was to use an "ad hominem" attack. Which didn't attack the ideas presented but rather attacked the individual presenting them. That seems to be what many readers are doing. So you stop shopping at WF because you disagree with him? Huh? A better approach would be to clearly indicate what points you disagree with and why. Then back that up with references and stats. These kind of personal attacks are easy to see through and are a poor substitute for real thinking.

  • Report this Comment On August 21, 2009, at 1:31 PM, guiron wrote:

    Where I work we don't have the option of a medical savings account, but we do have high deductible insurance. I pay around $400/mo. for it. And I'm in the income bracket where expenses of a few thousand dollars are pretty devastating, which means anything other than minor medical issues are still devastating. For those who think HSAs and high deductible insurance are the answer, try doing it on $12/hr. with a chronic medical condition. There are many millions of us who are paying through the nose and who are still at high risk of financial ruin through health problems.

    Despite what the insurance industry's defenders might be claiming, the system we have is really not working, and we're the only advanced nation not to have figured it out. Why anyone would want to defend insurance companies is beyond me. We really should be more concerned about how we're prioritizing the well being of corporate interests over the people whose health and lives are at risk, and who suffer and die because of the rationing of actuaries driven by profit.

    We should not allow people to suffer and die on the profit motive. Capitalism drives some industries to be competitive, but when the services provided are so expensive they can only be paid by insurers, it's clear who the real client is, and it's not the patient. And that's why a private insurance-based, profit-driven health care system can't work, because the insurance company's interests come first by design.

  • Report this Comment On August 21, 2009, at 7:05 PM, mals wrote:

    Mackey is a Fool!! I'd like to boycott WF, but I never shop there anyway. It is too pricey for me. I go to Trader Joe's for my organic shopping needs. The public option is very viable, is highly desirable and we must have it. It is a crying shame that in the richest and most powerful country called USA, we have 40 million+ people without isurance. As Bill Maher said, we have republicans with empth heads like Palin wanting to lead this country to ruin.

  • Report this Comment On August 21, 2009, at 9:52 PM, Gardnermiles wrote:

    Fiftyone years ago the U.S. started it's talks for Health Care. Most other industrialized nations hadn't given it a thought. Now most nations have Health Care and we do not. With all nonsense from various media sources we will probably not implement Health Care for another 51 years. The American nation is being thrown so many conflicting reports it's almost a wonder that we are even functioning. It's a good thing that every now and then some sage grabs the rudder and gets us back on track. There's so much misinformation; yet every Tom, Dick and Harry tells us they know the right answer. Give our President the benefit of the doubt and I'm sure we will fare fine.

  • Report this Comment On August 21, 2009, at 11:08 PM, ardmore55 wrote:

    I served as a company's CEO for 25 years and oversaw the purchase of health insurance for about 250 people. We always purchased insurance from companies who worked well with our hospitals and doctors. The Blues in our state priced their services in 5 regions. Because of good experience, what appeared to be normal usage, our region offered the lowest price. We covered the premium of all employees and a portion of their family plan cost.

    As new concepts were introduced, the company and the employees tried different plans designed to reduce growing costs and provide desired services. We even tried self-insurance for a period of time. Of course we did purchase policies to protect the company in the event of major cost overruns.

    Each year we would compare the amount paid in to the amount paid our and claimed for administration.

    In a period of 15 years, we only experienced 1 year in which costs exceeded premiums due to 2 major medical procedures.

    I believe our employees used their health insurance wisely and not wastefully. If given the right leadership, significant incentives, an understanding of what was their true cost and what they could do to control them, everyone could receive better and cheaper health care.

    Our costs were often affected by being lumped into large government or school plans where the additional demands were never truly priced.

    I agree with much that has been written.Let's change our perspective and make a more functional system where the consumer understands the costs involved and is rewarded for good management of their health care dollar.

  • Report this Comment On August 21, 2009, at 11:40 PM, bto1 wrote:

    I do believe tort reform will save money in several ways. Tort reform does not limit the right to sue, does not limit compensation for lost wages or medical expenses. It does place a reasonable cap on awards for intangible issues. Tort reform would lead to lower malpractice costs (proven in those states that have tort reform) which then lowers overall costs. Tort reform would lead to less 'defensive' medicine. The fear of losing ones life savings inevitably leads to defensive testings. Just saying that we need less defensive medicine but we can sue you for everything is not enough. The fact that the present administration will not even introduce these measures is just politics and reduces the credibility of their effort.

  • Report this Comment On August 22, 2009, at 10:15 AM, davisbare wrote:

    "Tort reform won't lower costs. There is no data to back that up. Just because it sounds good doesn't mean it's a solution to high costs."


    Health insurance reform is fundamentally an argument about values. If you do not believe people have a right to quality health care, then you are not going to be supportive of the government mandating coverage for all, while in the process trimming the profits of the insurance companies. The savings are going to come from insurance companies' bottom lines. That's what has people upset.


  • Report this Comment On August 22, 2009, at 11:32 AM, PrincetonAl wrote:

    Brian, Oh, Brian, what a hack job this article was. This is what I joined the Motley Fool for? Thoughtful analysis? I don't know where to start, but I'll hit a couple obvious ones ...

    "Repeal government mandates regarding what insurance companies must cover."

    There may be some minimal level of what must be covered, but beyond that ... yes, this does make sense. If anyone thinks that there isn't a correlation between the states with the highest level of mandated coverage have the highest costs, they are wrong. If anyone things letting the acupuncture lobby mandate coverage for acupuncture is the way to lower costs by having everyone covered for acupuncture lowers costs ... or that government mandates aren't subject largely to manipulation by lobbyists, isn't that close to the issue.

    "Repeal all state laws which prevent insurance companies from competing across state lines."

    This isn't about large versus small, this is about the insane and inane state level regulations. Force the states to compete on their regulatory regimes. Stop with federal mandates and return to a states rights model where they can compete.

    Why does it make sense if I live in on the border of a state in a town with the same demographics as right across the river, I pay 30% more for my healthcare because of an arbitrary regulatory regime? I can drive across the river and buy food, cars, just about anything else ... but not insurance.

    And this makes sense why? The current government regime is so dead-set against this because ... competition to drive down prices is bad? Because it exposes that government regulation is driving up prices?

    "Tort reform a necessary evil"

    What, limiting the power of fat cat attorneys from extorting money is a necessary evil? Tort reform doesn't limit your ability to receive reasonable recompense. It limits turning lawsuits into a lottery ticket. And we all pay for it, way way beyond just the headline costs despite what the defenders of big payouts for trial lawyers who have contributed mightily to the current party in power to keep it that way. Follow the money as they say ...

    By the way, almost every other country that has nationalized medicine, has some sort of tort reform in place. Why do we think we are going to contain costs in our system by leaving out cost controls that everyone else puts in?

    Our "give every special interest a slice of the action" approach could also be called the "worst of all ideas combined" ... and we may well rue the result.

    Mackey has progressive ideas, and he is worth listening too, just as he has achieved in other areas of employee benefits, I would give his thoughts a very good listen before readily dismissing ...

    An approach based on principles of freedom and choice, properly designed, will give this country a shot at something better than the rest of the world, instead of expensive and worse than the rest ...

  • Report this Comment On August 22, 2009, at 1:36 PM, IRS706 wrote:

    Why does not Mackey call for telling doctors they can not have a financial interest in any outfit that performs test which they recommend or in any hospital?

    This same issue had an article on how the profit incentive affects foreclosures, why does it not affect doctors?

    When I go to the doctor, I don't feel disappointed if I am not stuck with a large needle for a blood draw, sent to the little room with a cup or worse yet, have to go to another area and wait 30 minutes for the test, yet I am suppose to need a financial incentive to question my doctor's suggestion.

    Every time Medicare and/or my insurance company pays a medical bill, I get a statement telling what they paid. Ignorance of the amount involved is not the problem, the financial incentive to doctors is.

  • Report this Comment On August 23, 2009, at 2:53 AM, 2rationality wrote:

    Most people completely missed the fundamental aspect of this bill and that is the violation of individuals. McKay being in trouble for saying no one has the right to healthcare; well that is true. We cannot preach having right to something yet violate others rights in order to achieve "our right." Right to healthcare is neither moral nor rational. There is no morality or rationality in stealing.

    If the goal is to reduce cost and increase efficiency. Then why does it cost so much? Why is it neccessary to increase taxes permanently? If government intervention in healthcare was such a brilliant and workable idea then medicare and medicaid would just doing "dandy." Well excuse me..its bankrupt. So can anyone tell me if there's a government engineered program that's actually NOT bankrupting the country? No, of course not. And you WANT MORE intervention? Has anyone remember the housing crisis courtesy of government intervention? The short memory of american people are part of the reason why this country is going down the tube. NO one has the right to healthcare, including me.

  • Report this Comment On August 23, 2009, at 8:38 PM, chappellgrant wrote:

    I'm not sure the tax form revision would accomplish much. I personally know people who can well afford insurance coverage, but don't purchase it because they consider themselves healthy and are unwilling the part with the cost of coverage. Since I don't see it my duty to help those people, I would not contribute.

  • Report this Comment On August 25, 2009, at 9:39 AM, gevmfool wrote:

    As a nation we are actually paying for two systems. The health care system of doctors and hospitals that help us stay well. Then we are also suporting the health insurance industry. The Insurance people do absolutely nothing to keep us well. In my doctors case he has a staff of six, two to do health insurance and the rest help him with patients. 1/3 of his office is not helping keep me well, the system needs to be fixed.

  • Report this Comment On August 26, 2009, at 12:57 PM, Woodman77 wrote:

    I totally agree that the consumer needs to know what the costs are. I think most people are somewhat careful about their medical costs before their deductible limit is reached. Once that limit is reached, then many people have tests or procedures that are "niceties" but not "necessities" performed because they are deemed as free money now.

    The main problem with health care is the doctors and hospitals charging outrageous fees. They charge these outrageous fees for many reasons: lawsuits (some warranted, some not), insurance companies paying less for tests/procedures so the doctors schedule more tests/procedures than necessary, and making those with insurance pay much more because doctors/hospitals cannot recoup these costs from those without insurance.

    Did you know that if you pay most medical providers with CASH then your bill will be about 50% LESS than if you make the provider run your bill through your medical insurance company?

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