The Health Reform Witch Hunt

Earlier this week, Congressmen Henry Waxman and Bart Stupak sent letters to 52 health insurers requesting a host of information, including salaries and bonuses of top executives, costs of conferences and retreats, and the margins on the companies' products.

The subheading of the letters might as well have been, "Show us why you can't deal with a government-sponsored public plan," because that's what this witch hunt seems to be about.

That's right -- witch hunt
It's funny how the government seems flabbergasted by companies in a capitalistic society making money during a crisis. They did a similar thing when they hauled in executives from ExxonMobil (NYSE: XOM  ) , Chevron (NYSE: CVX  ) , and other big oil companies to answer questions about the supposed gobs of money they were making when oil prices spiked.

I'll help you out, Waxman and Stupak. The answer is, "Yes, insurers make money, but it isn't all that much."

The real reason health-insurance premiums are so high is because medical costs are high. Around $0.82 of every dollar that customers pay goes toward medical costs. If insurers misjudge those costs, they eat the mistake until premiums can reset.

The part that doesn't go to doctors and drugs pays for staff, buildings, advertisements, and the like. By the time you get to the bottom line, there's not a whole lot left. Check out the net income margins for some of the largest health insurers:

Company

2006

2007

2008

UnitedHealth Group (NYSE: UNH  )

5.8%

6.2%

3.7%

WellPoint (NYSE: WLP  )

5.4%

5.5%

4.1%

Aetna (NYSE: AET  )

6.8%

6.6%

4.5%

Cigna

7.0%

6.3%

1.5%

Humana (NYSE: HUM  )

2.3%

3.3%

2.2%

Source: Capital IQ, a division of Standard & Poor's.

So a not-for-profit government program might be able to shave 5% off the price of health insurance, assuming the government can work as efficiently as the private health insurers. But that's debatable, considering the state of the U.S. Post Office compared to UPS and FedEx (NYSE: FDX  ) .

A witch hunt for whiners
Even though health insurers aren't making that much relative to their revenue, I don't actually feel sorry for them, because frankly, their complaints about a public plan seem a bit overdone. I'm not convinced it'll going to cut into their margins all that much.

Health insurers make some of their income by investing customers' premiums in corporate bonds. For instance, nearly 3% of Aetna's revenue over the last four quarters came from interest and dividends.

The company had some capital losses as well -- haven't we all? -- which raises the question: Will the public tolerate losses in a public plan through investment in corporate bonds, or will the plan be stuck funding the government's overspending by buying T-bills? The latter probably won't bring in nearly as much income, reducing some of the savings it'd reap from its nonprofit status.

Health insurers also need to take a cue from George Michael, and have some faith that they'll be able to compete. Innovative programs can reduce medical costs and help drive profits. For instance, Humana's Medicare Advantage case-management program has reduced the number of patients who need to be readmitted to a hospital within 30 days of being discharged, down to 11%-12% from the 20% that traditional Medicare experiences. Assuming such case management is cheaper than having the patient in the hospital, the difference in the costs is pure profit.

Even if health insurers need to charge slightly more than the government-sponsored public plan to make a profit, I'm not sure that's the worst thing in the world. Some seniors in Medicare pay extra to be in Medicare Advantage programs, and I suspect that many Americans would be willing to pay a little more to avoid being in a government-run program.

What do you think? Should insurers be hung out to dry, or has Congress gone too far? Let us know in the comment box below.

FedEx and UnitedHealth are Motley Fool Stock Advisor recommendations. UnitedHealth and WellPoint are Inside Value selections. United Parcel Service is an Income Investor recommendation.

Fool contributor Brian Orelli, Ph.D., doesn't own shares of any company mentioned in this article. The Fool owns shares of UnitedhHealth and has a disclosure policy.


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  • Report this Comment On August 20, 2009, at 4:05 PM, SigFinDoc wrote:

    First off, it is not constitutional for the government to create a government sponsored health plan.

    Secondly, the congress and Obama have no idea what they are doing.

    The above figures are nice but these are "net income margins"? Of course then all the salaries are paid before this number comes out. These companies make a LOT of money. Don't kid yourself.

    You want reform in healthcare? Address the problems with the drug companies, the healthcare insurance companies, government interference in healthcare, tort reform, and you will have done a lot to control costs.

    To say that doctor costs are the bulk of the issue is like saying that the corner gas station is raining in the profits every time a gallon of gas goes up $0.05. The guy (or gal) running the station makes little profit off the gas regardless of the price it sells for.

    Wake up America, before we are standing in line to be told we cannot get the test we want because the government has determined that you don't need it.

  • Report this Comment On August 20, 2009, at 4:18 PM, stan8331 wrote:

    The reality of our situation is that the rest of the world is becoming more competitive with us on a daily basis. The explosive growth of China has been staggering, and they are not alone. We simply cannot afford to continue devoting our current percentage of GDP to healthcare. America is still the greatest economic power in the world, but we are no longer a giant amongst mortals. If we fail to make dramatic cost reductions in healthcare, we will spend ourselves into bankruptcy.

    If we do drastically reduce the percntage of GDP devoted to healthcare, it's inevitable that some of the winners in the current system will hit hard times. I'm sorry, that's life. If we change nothing and migrate our way toward becoming a third-world economy, we ALL lose. Even the folks who are deeply invested in the current system.

  • Report this Comment On August 20, 2009, at 4:55 PM, mdtopper wrote:

    SigFinDoc has it right. Obama and Congress have NO IDEA what they are doing.

    If you think hammers are expensive when the Pentagon buys them for $680 each, wait till you see how much an MRI machine costs in the government run program.

  • Report this Comment On August 20, 2009, at 5:00 PM, moredocm wrote:

    How does spending another trillion result in lower health care costs. It's like saying that if we pour more money into social security we will somehow decrease the amount it ends up paying out?

    Health Care COSTS is where it's at. Getting costs under control ought to be the goal of congress. Focus on building efficiencies into the current system--and everyone agrees that the current system could stand a little make over. Tackle tort reform. Let insurance companies compete across state lines. Modernize and link the technical infrastructure across the entire system.

    Come on Congress. Do the obvious things first, people!

    By the way, anyone in Washington working on the economy, or is that all better now?

  • Report this Comment On August 20, 2009, at 5:05 PM, blackxactofool wrote:

    We are to actually believe reported net financials from businesses? Are you joking? How many Enrons and Madoffs do we believe in a capitalist society? If a person does not have the right kind of job, that person has no insurance coverage because it is too expensive. Capitalists don't care. Their system is based on greed. It's a better system than Communism, but it has ignored the basic needs of taxpayers. Taxpayers installed a majority party to get the job done, and it's going to happen. Whine, groan, whatever, but if the Capitalists can't provide a basic support for taxpayer's, they only have themselves to blame. They had eight years, they blew it.

  • Report this Comment On August 20, 2009, at 5:06 PM, actingdida wrote:

    Why compare a government health care plan with the post office or ups? Why not compare the possible efficiency with an existing health care plan that actually does well, it's called medicare. Excuse me but before I was an American citizen, I was a Scot. I have spent half my life with a National Health system, and half in America. Trust me, cost is one thing but peace of mind is priceless

  • Report this Comment On August 20, 2009, at 5:08 PM, marginjim wrote:

    It isn't my understanding that the health reform plan calls for the government to run hospitals or radiology clinics. I thought they were just going to pay for the services, like insurance companies do today -- and like Medicare does already. If that's the case, then health care providers can attest that MRI services cost a whole lot less when Medicare pays for them.

    re SigFinDoc's commen about the constitutionality of a government run health plan: Isn't that what Medicare is ?

    re. "Has no idea." Cute comment. Useless in a discussion of such an important subject.

  • Report this Comment On August 20, 2009, at 5:08 PM, anoldengineer wrote:

    In a conversation with my doctor several years ago, I asked him what his malpractice insurance was. He is a GP in a large group of GP doctors with an excellect reputation for care - ie no known malpractice cases. He said it ran about $100K to $125K per year.

    At 2000 hours a year, this is $50-$60 per hour just to cover the insurance.

    The major way to make health care affordable is to get the lawyers out of health care and make the stae medical board police their own for the few bad apples.

  • Report this Comment On August 20, 2009, at 5:09 PM, eldetorre wrote:

    If you think hammers are expensive when the Pentagon buys them for $680 each.

    You have it wrong. Hammers are that expensive because mostly Republicans believe in awarding no bid contracts.

    Furthermore it is Republicans and conservative Democrats behind the effort to STOP the government from getting competitive pricing from big pharma.

    I do however agree that reducing costs should be the first and foremost goal. The reality is however is that the insurance industry is a cartel. Reduced costs would only increase their profits.

    As another writer already stated, the net income is started after paying out all those bloated executive salaries perks etc. The Government has every right to seek the information requested since profitability is an issue that the insurance companies are raising.

  • Report this Comment On August 20, 2009, at 5:17 PM, modeltim wrote:

    Not surprised to see MF join the chorus of right wing mis-informers waxing on about a Democratic "Witch Hunt". I subscribe but I hardly ever agree with your politics. Tell me how anyone can justify the salary of

    United Health Group CEO William W McGuire who made in 2005: 124.8 mil and has made 342 mil over the last 5 years? I'm sorry but nobody's worth that. Health insurers are greed, sociopathic monsters who are out for only one thing: to make more money than is anywhere near conscionable at the expense of denying the little people with bs like "pre-existing conditions".

  • Report this Comment On August 20, 2009, at 5:17 PM, Boomerchef wrote:

    I beg everyone who wants to get information that is not propaganda - to go to PBS.ORG and review the last four weeks of Bill Moyers Journal. It will take time, but what you will get is from the highest levels of corporate health insurance executives to health care professionals - explaining why our costs are so high and what it is going to take to bring them down.

    Please add this important body of knowledge to your own discussion of health care reform!! It is worth your time - unless you don't have time to be confused by facts. This isn't "left" or "right" folks. This is insiders telling it as it is.

  • Report this Comment On August 20, 2009, at 5:19 PM, mysnowy wrote:

    ITo think that the government can run any program efficiently is to ignore experience. Tort reform is probably the most immediate prospect for cutting costs. Statistics show that the uninsured are not all needy people, but for those who are, there are ways to make reasonable health care available, and options which are consistent with a free market should be thoughtfully explored. It is important to allow competition between insurance companies across state lines. Britain's socialized medicine was instituted during World War II, and dismantling an inefficient government-run system is next to impossible.

  • Report this Comment On August 20, 2009, at 5:19 PM, AuditorFool wrote:

    The left will do whatever it takes to move anyone out of the way of their liberal agenda. Just look at the people who are boycotting Whole Foods bc the CEO said ObamaCare was not what we needed. I wish I could boycott the gubmit whenever I didn't believe in what they were doing. I would say..... um...... not paying social security..... um....... not gonna pay for your ObamaCare either......

    Look how successful the CEO of Whole Foods is at running a large organization and doing it while really caring about his employees. I trust him over Obama, anyday. He have never seen him with any agenda except helping people. Obama's agenda is power.

  • Report this Comment On August 20, 2009, at 5:19 PM, Scoobrs wrote:

    As a nation, we can no longer afford the fifty-five percent health care premiums American corporations must pay beyond what the rest of the world pays. Thirty percent of the cost of medicine covers not health care, but administrative expenses. This means underwriters deciding who not to cover, actuaries setting prices, plan administrators negotiating with patients, providers, and employers, attorneys defending lawsuits, lobbyists buying Congress, executives lying to Congress, and the list goes on. In one particular year, the CEO of UnitedHealth earned one dollar of every 400 spent in America, which clearly cut into shareholder profits. Since the advent of HMOs in 1970, the number of medical administrative professionals in America has increased a stunning twenty-six times. None of these people serve to increase the amount of medical care available and none of them exists to protect the consumer or preserve choice between doctors.

    In addition to administrative waste, we have also have a fifteen percent billing fraud bill to share, according to the Government Accountability Office. Most of this fraud would be caught under a single-payer system because clear patterns would emerge when there is only one insurance payer checking bills for everyone. Most insurance companies simply pay fraudulent charges since they already spend too much profit arguing about charges with providers.

    On top of administrative waste and fraud, every American must pay additional money to cover uncompensated care in every medical bill and insurance premium. This cost comes from both the uninsured and 62% of all bankruptcies in America (which stem from medical costs).

    After all is said and done, America has the most expensive and most Socialist system in the world. We pay more than double what any other country pays per capita. Even our federal, state, and local governments, which pay 60% of medical costs, pays more than any other nation which covers every citizen.

    A public plan is not a descent into a Socialism, but a possible escape valve from a public subsidy welfare state. As James K. Galbraith once said, "The only tolerable form of socialism in America is socialism for the rich." Our existing health care payment system does not preserve price competition and capitalism, but extinguishes it through economies of scale. The insurance provider who expunges the most or signs up the fewest unhealthy Americans always wins. From a national productivity perspective, this is damaging our economy in multiple fashions.

    Perhaps the strongest argument for national health care is that it is the only evidence-based solution which tackles both the cost problem and quality problem, while reducing rationing. According to the World Health Organization, America ranks 37th in the world in terms of the main measures of health care quality, losing even to Cuba, which was decimated by an embargo and a Communist government.

    Certainly, some so-called Constitutionalists argue that government health care could be unconstitutional. I would argue that Alexander Hamilton intended exactly such uses of the preamble's term "general welfare" when he suggested that even public schools might someday be considered part of the "general welfare." The U.S. Supreme Court has continually upheld the Hamiltonian view for centuries.

    Remember, economic Socialism can only be measured in terms of how much we spend in public resources. By that measure, American healthcare is more Socialist than France, China, Cuba, or any other nation on Earth. Starting in 2011, even Mexico will have a cheap, single payer system and American corporations will relocate to capture cheap labor and cheaper healthcare unless we act soon.

  • Report this Comment On August 20, 2009, at 5:22 PM, mwarnold2000 wrote:

    "We simply cannot afford to continue devoting our current percentage of GDP to healthcare. America is still the greatest economic power in the world, but we are no longer a giant amongst mortals. If we fail to make dramatic cost reductions in healthcare, we will spend ourselves into bankruptcy."

    If you think we spend a lot now, how much do you think the Government will spend if go to socialized medicine? Governments don't produce, they consume. They are inherently inefficient since the worker bees have no fear of being fired and the CEO's don't have to worry about turning a profit.

    Every single Government agency loses money, Social Security is currently 4.4% of GDP, and will hit 6.2% of GDP in 2034. Medicare is currently 3.2% of GDP and will hit 11.4% in 2083. By the end of the window, these two programs alone should equal or exceed total federal spending in a typical year today. That's before counting interest on the national debt, and all of the other functions of government.

    In order to pay for this deficit, the Social Security tax would have to rise from 12.4% today to 14.4% permanently. The Medicare payroll tax rate would have to rise from 2.9% today to 6.78% permanently.

    That would raise the FICA tax rate from 15.3% today to 21.2% going forward. This rate of tax would be especially harsh on the self-employed, who have to pay both halves of FICA themselves.

    Now take that times 5 or more and we have our socialized healthcare, which by the way will be way worse than any of you have currently.

  • Report this Comment On August 20, 2009, at 5:23 PM, MAcDScientist wrote:

    This plan does not pull the plug on grandma. BUT, as long as the costs of new drugs, new tests, and new procedures grow at a rate faster than the GDP, then it is inevitable that health care will be rationed in the future. When new drugs, tests, and procedures are introduced, doctors are obligated to use them when appropriate. Each new drug adds to the total health care expenditure. Health care cannot become larger than GDP (or even approach it.) To prevent this, governments will have to ration health care.

  • Report this Comment On August 20, 2009, at 5:25 PM, dacook6150 wrote:

    The oil companies were a bad choice for examples of questioning profitable corporations. While the oil companies were making huge profits during the sky gas prices last year they were also, and continue to receive government subsidies. So yes, congress should be asking subsidized companies why they are charging such high prices to consumers while taking their hard earned tax dollars.

  • Report this Comment On August 20, 2009, at 5:31 PM, jmp01 wrote:

    Our current system of health insurance is tied to employment. It deprives individuals of the freedom to quit their job and sell their skills in the open market, especially if they have a preexisting medical condition.

    How profitable will insurance companies be once the government is forced by popular opinion to mandate policy portability and coverage of the infirmed? Maybe free trade advocates should welcome Uncle Sam's entrepreneurial enthusiasm. Maybe it's time to Short insurance carriers and drug companies. Maybe it's time to to use some common sense and venture into the new world of medicine for the sake of society, or dare I say "socialized medicine"?

  • Report this Comment On August 20, 2009, at 5:32 PM, Scoobrs wrote:

    "If you think we spend a lot now, how much do you think the Government will spend if go to socialized medicine? Governments don't produce, they consume. They are inherently inefficient since the worker bees have no fear of being fired and the CEO's don't have to worry about turning a profit."

    You're right. If our government ever earned a visible profit, you would see protests in the streets asking for a piece of the money. Governments aren't supposed to earn profits. They're supposed to spend efficiently so that their citizens have enough infrastructure to earn their own profits. If a so-called conservative can trust government to fight and win a war, how difficult can it be to manage the purse strings better than a for-profit insurance company which exists only to avoid paying for costly care and to earn percent premiums above whatever obscene amount they spend?

    Medicare, not counting Medicare Advantage, has only a 1.5% overhead like most other single-payer systems in the world. There isn't even a single non-profit health co-op in America that can match that price.

  • Report this Comment On August 20, 2009, at 5:32 PM, mothrala wrote:

    I understand that as a society we are highly mistrustful of government for many reasons. But, does anyone really believe decisions about individual healthcare should be made soley by Wall Street corporations? With the number of people in the U.S. now unemployed, uninsured, or uninsurable in our current system it seems rather obvious that it is not working. The government is supposed to work for us, providing services to us with our tax money. Why can't we make this happen?

  • Report this Comment On August 20, 2009, at 5:35 PM, daduck37 wrote:

    As usual the government is out of it's element into an area they know nothing about. Their healthcare plan doesn't really address the uninsured that don't have resources to pay for healthcare. This entire plan is about more control over the voters. The whole scam about buying inurance over state lines is about federal

    control over insurers who are currently regulated by the states. An insurer is going to charge according to the costs in the area of the insured. Premiums are calculated on the cost of claims plus expenses to provide the policy. No magic there. We need to scrap the current ideas and get real

  • Report this Comment On August 20, 2009, at 5:36 PM, baybrowser wrote:

    Being opposed to “ObamaCare” does not imply that those opposing it are satisfied with the status quo. The issue is the kind of reform, not reform itself.

    We have a social security and medicare debt of between 50 and 100 TRILLION dollars, the estimated amount dependent on assumptions. The annual level of revenue received by the government to cover its operations is under 3 trillion, a drop in the bucket compared to our debt, and none of the revenue is available to pay down debt. In fact, we invariably spend more each year than we take in. It’s clear that we’re facing a monstrous problem which is continuing to grow rapidly and has been ignored far too long. Even more depressing is the fact that the 50-100 trillion dollar debt does not take into consideration other major liabilities such as government pensions. Also, within several years, and that time span is shrinking even as I write this, the government’s revenue from social security tax will be less than outgoing payments to recipients. From that point on the excess outlay will begin contributing to the annual deficit instead of (inappropriately) hiding part of it.

    There is no choice but to focus on reducing rather than increasing costs. A thrifty approach may not be an exciting prospect for politicians, particularly those with big agendas and/or those wishing to buy votes, but we have no choice. Obama should be held to his campaign pledge that “we must stop kicking the can down the road”. The biggest can by far is the one containing our debt.

    Both the house and senate health bills need to be discarded, or radically revised. The CBO has declared that ObamaCare will result in a one trillion dollar increase over the next decade, with little or no hope for cost reductions even in the second decade. The senate bill is apparently even more costly.

    Obama’s earlier claims that preventive medicine will result in significant cost savings is a myth. While preventive action is desirable, and may reduce overall costs for those who would have otherwise required serious medical intervention, the savings in those relatively few cases would generally be offset by the additional costs incurred for the vast majority who would have done well without general preventative care. (There are credible studies on this point. See also Krauthammer’s column, August 14 Washington Post related to this issue.)

    The costly prescription drug benefit added during the Bush administration, with little or no consideration for cost coverage, is hardly justification for more of the same. President Obama’s claim that health insurance reform can be largely financed by “eliminating waste, fraud and abuse” may provide modest savings. But, eliminating fraud and abuse from government programs, while laudable, has been promised many times in the past by many politicians, and rarely amounts to much. “Waste” is another matter. Since Obama and his party assert that there will be no rationing, and care will continue to be fully provided for the elderly, demented, etc., how much waste is there? The democrats have made it clear that they won’t even consider tort reform (although we all know this is just one of our politicians’ untouchable honeypots). If there is significant waste we ought to be able to identify it beforehand and provide the estimated savings.

    There appear to be simpler revisions to our existing health care situation that involve no increase in government intervention and also hold out the promise of reducing rather than increasing health costs. Conservatives from more than thirty states recently met in Chicago and came up with some recommendations. (See Washington Times (August 19) article “Keep hallmarks of health care” by Frank Donatelli. One of the most obvious changes needed to provide competition among insurers would be to give both firms and individuals access to out-of-state carriers. In fact, state government restrictions have circumvented the free market (probably a violation of interstate commerce) in the case of health insurance. Auto insurance can be purchased from any insurer in the nation, so why not health insurance? John MacKey (CEO of Whole Foods) in an August 12th WSJ editorial, has a list of health reform recommendations, which addresses this one, among others. In another area, John Cochrane (professor of finance at the University of Chicago) has an editorial in the WSJ (August 14) entitled “What to Do About Pre-existing Conditions”.

    It is folly to believe that there is a meaningful way to set up a fair cost comparison between a federal government insurer and private carriers. Any company in the private sector handling a large project must necessarily have an accounting system in place that accurately allocates ALL attendant costs to that project. On the other hand, accurate accounting of government project costs is probably impossible. The cost of labor related fringe benefits, including sick and vacation leave, medical coverage and pensions, may often not even be considered part of the project cost. The same goes for various overhead expenses such as office space, security, human resources, accounting, legal, and PR functions. Even if that support and overhead could be identified, it’s not likely that other attendant costs associated with each of those support activities would be included. There is also the possibility of ad hoc support from other government groups, where, again, the cost would be difficult if not impossible to track – assuming that this kind of support can even be identified. It is not realistic to expect government unions or management to cooperate in identifying any of these nebulous costs because government jobs will be on the line. (The Post Office has been processing billions less items for the past few years and has not yet laid off anyone. (and 80% of its costs are labor related). The current idea being considered, introduction of a nonprofit co-op to “provide competition” to keep other insurers honest is a weak substitute for the real and much simpler change – just permit all firms and individuals the option to purchase insurance from out-of-state carriers. It’s pretty obvious that the only reason for this “competitive co-op” concept, is to serve as a place-holder, to facilitate later migration to a single payer system.

    The 46 million “uninsured” figure frequently quoted by Obama and others, includes 10 to 20 million uninsured immigrants, millions who are actually qualified for Medicare or Medicaid who have not bothered to even registered for it, millions who are between jobs, and millions who can afford to pay for health insurance but have opted out. Providing health care coverage for illegal immigrants will not only increase costs, it will undoubtedly further encourage illegal immigration. The democrats insist that illegals wouldn’t have access to insurance because heir proposed policies include a requirement to provide a social security number. But one need only look at their actions; they have over-ruled any attempt by republicans to require a more serious validation process.

    These and other recent commentaries on health policy by thoughtful citizens should have made it crystal clear by now that it is foolish to rush health reform legislation. The health crisis was a long time in the making - both parties caused it - and radical revisions shouldn’t even be on the table until all less costly solutions have been ruled out. Our recent debacle with “expanded home-ownership” should be kept in mind. Even the simplest and most well-intentioned policies can turn into unmitigated disasters.

    Finally, inasmuch as members of both the senate and house have indicated no desire to become participants in the health reforms they are busily designing for the rest of us, perhaps these politicians should give more serious consideration to the concerns and feedback being provided by the actual plan participants.

    I hope some of you you get around to reading this.

  • Report this Comment On August 20, 2009, at 5:39 PM, taborek wrote:

    Hear an interview with Cigna's former head of public relations, Wendell Potter: http://www.pbs.org/moyers/journal/07102009/profile.html

  • Report this Comment On August 20, 2009, at 5:41 PM, authorauthor wrote:

    As we talk about heath insurance reform, get out there on the internet and read stories about the insurance carriers who are supposed to be paying for the health care of civilian contractors wounded in Iraq and Afghanistan— covered under the Defense Base Act versus normal workers compensation insurance. After all, we now have more contractors in these war zones than military. One of the carriers is AIG. Despite the fact they have been bailed out by our government, they apparently are nonetheless avoiding paying the bills such insurance is to cover. Having once worked as a contractor clinical social worker in a mental health clinic overseas, who was involved in a freak accident within months of leaving after five years in this position, I’ve experienced such illegal treatment first hand not from AIG, but from CNA. The thing is, I was older and had resources to survive their period of non-payment. I also knew how to fight them. Since most people do not, I had wanted to delve more into this issue in my newly released self-help book, "The Post-Traumatic Stress Disorder Relationship," but the publisher edited it out of the book. Anyway, I believe there are some bad apples out there that need to be better regulated. Furthermore, it appears they have been making higher than average profits because they avoided paying those expenses the insurance was supposed to cover. By the way, who do you think will be paying for the care of these wounded after the insurance carriers have failed to honor their contractual agreements?

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

    "First off, it is not constitutional for the government to create a government sponsored health plan."

    Do you have a ruling by the Supreme Court you can refer to, or is this just something you read on the internet? Sure, you can start with a false premise and then make any conclusions you want to, but in order to be taken seriously, you can't be this far out on the fringe.

  • Report this Comment On August 20, 2009, at 5:43 PM, marymaryhadalamb wrote:

    Your analysis of net profit margins doesn't reflect the very high compensation levels of insurance executives. William McGuire former Chairman and CEO of UNH transferred over a billion dollars from the company to his pockets. Even after paying himself over a $100 million a year, he found it necessary to alter his stock option issue dates to sate his greed. I could cite others. HCA had to pay over a billion in fines after overbilling Medicare. Health insurance companies bring nothing to the table except higher costs.

  • Report this Comment On August 20, 2009, at 5:43 PM, alexry wrote:

    I've been the benefactor of the health care system of Germany and Canada. I'm sick and tired of all the distortions and lies perpetrated by many of the naysayers of reform. We rank 36th in the world as far as our status of our health. We have clearly the most expensive system in the world. I suggest that all thos members of Congress who are critisizing reofrm should be dropped from the government options and pay for their own healthcare under the so-called geat free market system. Its thes free market gurus that got us in this mess. Isn't nice how those who are in power always manipulate the masses?

    Think about what the govt of Scotland did today so they could get oil from Lybia? Just like the health care critics who are all benefactors of the present system.All of you critics of reform or only interested in your own greedy desire to maximize your profits from the stocks in these companies. Health care should not be a for profit based system. I guess all you whyners are still in love with good old Bernie Madoff. An honorable former head of the Nasdaq.

  • Report this Comment On August 20, 2009, at 5:44 PM, ozzfan1317 wrote:

    I agree the health care companies make way more than you realize its time for a public option I feel it is a nessacary evil.

  • Report this Comment On August 20, 2009, at 5:45 PM, bartdz wrote:

    Here's my double question about health care financing:

    1) What is the current number of people who go bankrupt every year due to medical expenses alone? And:

    2) What is the correct number that should go bankrupt every year due to medical expenses alone?

    Please explain your answers.

  • Report this Comment On August 20, 2009, at 5:51 PM, warm4h2c wrote:

    One point made in the article concerning financing of a government health plan brought up a very sore point with me regarding Social Security in general, and that is that the whole thing is backed up by government bonds. Who pays the interest on those bonds? All the tax payers in the USA. Will they then also be charged premiums? Does the FICA tax constitute a double taxation? The suggestion that financing such entitlements with private sector investments seems to be anathema to 95% of US taxpayers and seniors and others who depend on Social Security, and would depend similarly on any government health insurance. It seems to me to be a very bad idea to base the financing of another massive entitlement on the government's already strung out ability to tax, rather than putting the burden on the ability of Americans to produce (which yields those corporate dividends and preferred stock interest that we love so much, and should because these are the rewards of all of our work). If these systems, governed by financially savvy folks, were to very gradually enter the markets for these kind of securities, the rewards would soon become so self evident that we would all wonder why we never allowed this to come about before. Thank you for listening.

  • Report this Comment On August 20, 2009, at 5:53 PM, shirleycrosbie wrote:

    We have yet to see a government program that runs well or efficiently. It is, of course, imperative that we find a way to fund affordable health care for all citizens. Many are fortunate (and hardworking) enough to afford a decent health insurance plan. Others that are also hardworking legal citizens do not have employer paid health insurance & cannot afford a private plan. That does not suggest we throw out everything that has been achieved to date & let the government set up one more inefficient, wasteful program that decreases the quality of all health care.

  • Report this Comment On August 20, 2009, at 5:53 PM, chamyr wrote:

    Everyone (including the FOOLS) are overlooking the obvious. The insurance companies regardless of their

    bottom lines are bleeding us dry. They do not need huge glossy palaces on multi acre sites for there offices. Their CEO's should not receive low to mid

    8 figure salaries plus perks and bonuse for doing very little. We should not have added layers of " benefits management" corporations such as CVS/Caremark sucking up millions in salary and costs to save money for the insurers. We should not have the

    "non profits" such as Blue Cross California paying huge salaries and sending off their surpluses to another entity. With the bloated salaries, wasteful overhead no wonder the profits are slight ! Wake up people ! This waste and egregious profiteering is taking place not just with 3 or 4 big corporations but with entities seperately established state by state .

    There are numbers of groups/corporations in every state. Multiply 30 to 100 milllion (or more) in executive salaries by 51 (each state) and you have a big budget item not paying for any medical treatments

    or medicine. Throw the rascals out and spend the money on real healthcare and we won't have to

    ration health care..

  • Report this Comment On August 20, 2009, at 5:53 PM, baybrowser wrote:

    As far as I can tell, each person is venting without bothering to read any of the other opinions.

    (it doesn't really take that long, if you're interested in educating yourself.)

  • Report this Comment On August 20, 2009, at 5:55 PM, chaztv55 wrote:

    Not to waste space here please see my article: Small Businesses Don't Side with Big Greed on Health Care Reform: http://chaztv.squarespace.com/?SSScrollPosition=4788

    www.wordswillnever.com

    If the medical insurance companies' profit aren't part of the problem, we'll l'll be darned! But that doesn't mean the system is working. Small Businesses/small groups, are getting soaked. Sometimes I hate the Fool's pro big business bias. Why don't you stick to picking stocks. You have no idea what others that are not rich like you are facing.

  • Report this Comment On August 20, 2009, at 5:55 PM, rmg7 wrote:

    Profits come from denying patients their treatments. These people are the worst of the worst. Please see again testimonies exposed in the movie Sicko. The US needs to learn that health care is a basic human right. The rest of the world sees it that way.

  • Report this Comment On August 20, 2009, at 5:56 PM, digbydiehl wrote:

    I do not understand why you allow your generally useful reporting on financial matters to be infiltrated by a stooge for the insurance companies. I have been horrified to see how gullible and badly informed many of my fellow citizens seem to be. But I expect a much higher standard in Motley Fool. I am disappointed and disgusted.

    Sincerely,

    Digby Diehl

  • Report this Comment On August 20, 2009, at 5:58 PM, rlippin100 wrote:

    so why are the private insurers fighting so hard if they will have the advatage of being so efficient?

  • Report this Comment On August 20, 2009, at 5:59 PM, chaztv55 wrote:

    Not to waste space here please see my article: Small Businesses Don't Side with Big Greed on Health Care Reform: http://chaztv.squarespace.com/?SSScrollPosition=4788

    www.wordswillnever.com

    If the medical insurance companies' profit aren't part of the problem, we'll l'll be darned! But that doesn't mean the system is working. Small Businesses/small groups, are getting soaked. Sometimes I hate the Fool's pro big business bias. Why don't you stick to picking stocks. You have no idea what others that are not rich like you are facing.

  • Report this Comment On August 20, 2009, at 6:02 PM, calkeefer wrote:

    The health insurance industry has been a big FAIL when it comes to controlling costs. They have no incentive to control costs because they get a percentage of the revenue. Besides nobody is talking about taking over the health insurance industry, the worst that will happen in this bill is a viable public option. As you pointed out UPS and Fedex have been quite successful at competing with the post office. But neither company will try to deliver mail to every single address in the US six days a week like the post office. Its simply not economical for a single company to invest in that kind of infrastructure without raising prices astronomically . But mail delivery is a vital part of our economy. Every other single modern economy in the world has taken out the insurance middleman. When trying to compete with a government plan, insurance companies can target the wealthy that never get sick. Right now those are the only people than can afford their system.

  • Report this Comment On August 20, 2009, at 6:02 PM, mariposakait wrote:

    The Democrat's healthcare reform has nothing to do with reform, it has to do with power. In CA, NEITHER of our senators NOR Pelosi are having any town hall meetings. They don't want to hear what the people think...they don't have to. They have all the power at this point, so don't worry, eldetorrie, the Republicans cannot stop anything now.

    Just to inform you, I don't think that the big pharma will be "forced" to do anything, since they are HUGE contributors in funding O's bill. They seem to be on YOUR team, btw.

    "Barack Obama's chief White House adviser is collecting millions of dollars from his former public relations firms as they sign lucrative contracts with coalitions recently created to push the president's agenda.

    After arriving at the White House as top political guru, David Axelrod filed a required financial disclosure form that shows he will receive $3 million in installments over the next five years in a buyout with AKP&D Message and Media, and Ask Public Strategies.

    The bottom line: Axelrod is essentially on his old firms' payrolls as he sits in the Oval Office as the closest confidant to the president. Advocacy groups know that when they are hiring AKP or Ask Public they are helping those companies stay profitable and make good on the $3 million.

    AKP, which shares Chicago office space with Ask, is now getting contracts from major groups assembled to push Obama's massive health care agenda. They include Healthy Economy Now and Americans for Stable Quality Care. Their million-dollar media blitz is financed in part my the giant pharmaceutical industry which has a big stake in how the White House -- and Axelrod -- craft a final health care bill.

    Press reports say pro-Obama groups will spend $150 million on media ads. AKP's website does not list those groups on its client's list, which includes trial lawyers, the largest single contributor to the Democratic Party.

    ...The release notes that the White House negotiated an agreement with the drug lobby (the Pharmaceutical Research and Manufacturers of America) to get its political support."

    I sure wish that more of your team would get informed and stop listening to the pablum they feed you in the media...you'd probably discover that WE are on the same team and you've been a mushroom for too long.

    Kait

  • Report this Comment On August 20, 2009, at 6:09 PM, driller101 wrote:

    To those who say they don't want the guvment to be making their health care decisions, I say ok, I guess it's better for the insurance companies to be making those decisions? Right. The insurance companies have all the incentive in the world to deny claims, and they do.

    To those who point out all the horror stories associated with the universal health care that exists in the rest of the civilised world (the systems in various countries are not identical), I say almost all those countries are democratic and none have ever voted to do away with universal health care.

  • Report this Comment On August 20, 2009, at 6:09 PM, jpsauvage wrote:

    My experience with United Healthcare appears to be the rip, rape, and run pattern for the entire healthcare industry. Being self-employed, I was forced to provide my own (single, male) insurance. From June 1996 through December 2008, my premiums went from $94/month to $820/month, a 773% increase in 12 ½ years, in spite of raising the deductible and converting to a PPO (losing a doctor in the process). A regression analysis of my premiums (paid quarterly) yields:

    y=9E-15x^9.3638 with r^2 of 0.95

    where y = monthly premium

    and x is age in years

    Using that formula, my 91-year old father, without Medicare, would be paying $19,875 per MONTH for insurance!!

    In 2006, Dr. William McGuire (UnitedHealth CEO) demanded and got a compensation package in excess of $1.5 BILLION. Part of this outrageous package included being able to illegally backdate stock options. The Feds stepped in, fined him several hundred thousand dollars, and made him resign his position. Poor soul! - he only got a $1.1 BILLION severance package (the largest golden parachute in the history of corporate America)!

    I maintain that advertising for prescription medication serves absolutely no other purpose than to sell more drugs at a higher price. Banning the advertising would certainly moderate health care costs, but it will never happen because my legislators are bought and paid for and the pharma companies are essentially untouchable.

    The pharma companies have done an incredible job of building empires that rival those of the robber barons at the close of the 19th century and insulating them to the extent that the robber barons never dreamed of:

    • They got legislation changed to permit advertising.

    • Advertising content has been pushed far in excess of ethical boundaries.

    • It is intuitively obvious to anyone watching television that commercials for prescription medication far outnumber any others.

    • The advertising revenue generated almost guarantees that none of the media will be the first to present an expose’ of pharma company operating procedures and tactics.

    • What is the size of the pharmaceutical lobbying effort?

    • Just like the tobacco companies providing help to quit smoking, the pharma companies are advertising low-cost drugs for those who cannot afford them. The publicity far outweighs the cost of the program and it only takes a few grateful people, or their friends, on a jury to minimize compensation for adverse side effects.

    I really want to know how much viagra/levitra/cialis has been sold because of the “disclaimer” accompanying the advertising (“in case of an erection lasting more than four hours, call 911 and ask for kryptonite”).

    We are inundated with instructions to “Ask your doctor if XXXXXX is right for you”. If I should be so gullible, my doctor will always write the prescription, unless there is an obvious medical reason not to, because I will probably go elsewhere if he/she does not. However, being a responsible physician, he/she will insist on follow-up visits to monitor the effects of said prescription. The pharma companies win big time, physicians are rewarded for writing the prescription, insurance rates increase, and the rest of us continue bending over for the soap. The current Michael Jackson circus is a case in point.

    “Ask your doctor if a free sample of XXXXXX is right for you”! This is the same tactic used by drug dealers on the street (“Wanna feel good little girl?”). Obviously both the pharma industry and the drug dealers have learned their marketing skills from the tobacco industry - give out free samples to get the individual hooked and then charge all the traffic will bear. The word “egregious” leaps to mind.

    I maintain that prescription drugs have maimed, crippled, and killed orders of magnitude more people than have abortions and guns combined and that the pervasive advertising of prescription drugs is a major contributing factor. I think it is only fair that we should grant the firearm manufacturers advertising parity with the pharmaceutical industry. Take an ad:

    • Do you fear for your life and the lives of your loved ones?

    • Have you or your loved ones been assaulted recently?

    • Has your residence been burglarized recently?

    • Has your vehicle been vandalized or stolen?

    • Have you lost faith in your government’s objectives and ability to protect you, your loved ones, and your property?

    • If you can answer “yes” to any of these questions, ask your local sheriff if a GLOCK is right for you.

    • As with any firearm, there is the possibility of serious injury and/or death. Tell your law enforcement practitioner if you have delusions of grandeur, fits of blinding rage, overwhelming depression, hatred of minorities, or dislike of authority.

    If you are Pro-Life and/or Anti-Gun while advocating the advertising of prescription drugs, you are a hypocrite!

    I cannot think of a better example of ethical bankruptcy on the part of corporate America than the “Viva Viagra” commercials. Advertising for the ED drugs is very deliberately aimed at the very fragile male ego, with the specific objective of setting a perceived performance standard that cannot be achieved without the medication.

  • Report this Comment On August 20, 2009, at 6:10 PM, tednerry wrote:

    I have dealt with private insurance companies for all of my professional life and have found that finding reasons to reject just claims for service is the single constant. The current system is a disaster that the health insurance companies are largely responsible for and they cannot be relied upon to correct it. We pay far more for health care than any other industrialized country yet, by every measurable standard, we experience the worst results. We need the government involved and I wonder how many of the screaming naysayers out there would react if we took away their Medicare or their VA care. That government managed care they love. I believe we need a federal alternative to force the private companies to compete for our business. That's the American way, isn't it? We need to change an enormously expensive system that both makes us less competitive internationally and is killing our people.

  • Report this Comment On August 20, 2009, at 6:14 PM, lart80207 wrote:

    Anyway you cut it or dis-information about it, if a public corporation is making a profit from the misery of others, that corporation does NOT have the interests of the patient in mind, only the pocketbook of the investors. For profit corporations with investors taking profits, will always find the cheapest way to screw the patients and the medical staff.

  • Report this Comment On August 20, 2009, at 6:15 PM, smaulcap wrote:

    Where are all the "good Christians"? The good Christians tell us the US was built on Christian values.

    I got mine, now you go get your own...is not a Christian value. Hey good Christians....don't forget your golden rule. What would Jesus do? Would Jesus say, screw 'em! Let 'em eat cake? I don't think so. America has the best health care system? That's a crock. It's the best only if you can afford the best. The people with the money need a taste of poverty, and the taste of a 4 hour emergency room wait with their child who has a 102 degree fever. This is about the haves and the have not's. The people with health insurance, don't give a dam about the people without health insurance. Hmmm....there goes that greed thing again. Also, it's a great anti Obama thing. Isn't it? Oh c'mon now, you know it's a great "let's destroy Obama thing." Don't worry, you don't have to admit to it.

    Oh, and by the way. Wake up!...America was built not on Christian values. It was built on greed, the virtues of greed. Greed and Christianity are polar opposites, oil and water. They do not mix. Christian countries take care of their children and their needy citizens. Greed countries....well, they just let 'em eat cake. And, drop dead.

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

    I will not claim that I read all 1,036 pages of HR 3200 but I did scroll through and read much of it. If you have a little experience with health insurance as an employer the read of the Bill discloses that it has good points and very bad aspects. But most importantly it jumps out at you that we are being lied to across the board, especially by Mr Obama. Our President's intent is to intentionally mislead the public or he is very naieve about the real healthcare world, I suspect a large portion of both.

    Being a senior I read the "death squad" language with great interest. Having some experience with providers who will take advantage of situations where people do not have a living will I can see the benefit of the periodic reviews. But it is NOT entirely at the option of the individual as Obama tried to make us believe. The review is triggered by a Doctor who is paid for the Review (does anyone believe it will not take place?) WITH THE INTENT to decrease the treatment levels as we grow older. I entirely agree that I will reach a point where I am not worth the maintenance but please stop lieing about it. Those such as Palin should stop going to the other extreme also. This BS does neither us, our country or health care any favors.

    The people who have a complaint are those of us that HAVE insurance, not the other way around. The druggies and aliens (illegal or not) walk into Emergency Rooms, after abusing their bodies most of their life and receive the same or better care than I, albeit much more expensive than my coverage, and walk out without paying one cent for the care or in premiums. (It is interesting to note that aliens who are in the country legally DO receive benefits, just not aliens who are here illegally, this was also misrepresented by Obama.) Why should a non-citizen receive benefits at no cost? Our rates are extreme because each of us Payers must pay a portion of the cost for these non-payers. This is not addressed so the same situation will continue. If we can review a level of coverage for seniors should we not review the level of coverage for non-citizens?

    However the scariest part of HR 3200 is that is establishes very few specifics. There is advisory group after group, panel after panel that will be established to set benefit levels, etc, etc. Why arem't our politicians and our news media telling us about this hazard? The bereaucracy that will be built is mind boggling. Obama was correct in comparing the USPS to UPS and Fed-Ex, but not in the sense presented. Are we to believe that healthcare, the actual CARE itself, and the cost will be better with someone like Barney Frank in charge? The heads of the groups will be donating to the coffers in multiples of what we experienced with Fannie and Freddie. While thinking about that, think about how powerful a co-op will be in that regard.

    This drive to fix a messed up system is sure to make a non-workable system out of a bad one. Stop politicking Obama, you have been elected. Lead the country if you have it in you. Believe it or not, there are serious, intelligent people against your paln for this "change" and you are our President also.

  • Report this Comment On August 20, 2009, at 6:20 PM, mahe67 wrote:

    Although I am a believer in free market capitalism, I am not quite sure that public insurance companies are the best way to run the health insurance system. These firms are forced to increase shareholder value by increasing revenue (by finding new 'good risk' clients) and cutting cost (mostly by avoiding 'bad risks', or finding ways to kick these folks out of their policies). That leads to a situation where the people most in need of insurance, simply can't get it. The 'just go to the emergency room' solution is in my opinion shameful and very expensive for all the people actually paying for health care!

    Therefore, everybody who is not covered under a non-discriminatory group plan, e.g. employment based insurance, may face a big problem finding/keeping health insurance. On the other hand, being insured by your employer keeps you (and your family) at the mercy of having a job - paying the COBRA premiums when you don't have an income is hardly a solution. Wouldn't it be nice to have a well regulated kick-a.. single-payer system, that includes everyone and cuts cost by its low overhead and sheer negotiation power? We could take the best of the Canadian, British and French systems while avoiding the mistakes they may have made along the way. Most of the cost could be paid by employers through pre-determined rates, leveling the playing field between the GMs (too much) and Walmarts (too little) of these world. Just a thought ...

  • Report this Comment On August 20, 2009, at 6:28 PM, ApplesandOranges wrote:

    The problem with insurance is as follows ---AIG or Medicare or Social Security... They all are insurances that are being bailed out/funded by the USA taxpayers. How is this healthcare plan any different? Unless congressmen and senators are willing to be grouped with common people on choices of medical benefits and retirement plans, they will not find solutions to these problems as they aren't problems for them....Social Security or Federal Pension.....Maybe when they find people who can manage and not their good pals to run these things, there will be solutions...until then..we wait.

  • Report this Comment On August 20, 2009, at 6:32 PM, theHedgehog wrote:

    warmnup says: "It is interesting to note that aliens who are in the country legally DO receive benefits, just not aliens who are here illegally, this was also misrepresented by Obama."

    This is, itself, a misrepresentation. Some hospitals are required by their state to take all comers. The poorer you are, the cheaper your care is. The bill is passed on to the state and appears in our tax bills. No hospital is going to watch you die in their hallway because you're an illegal alien or simply can't prove your status.

  • Report this Comment On August 20, 2009, at 6:33 PM, richmacmf wrote:

    A government run Health Insurance Company doesn't have to worry about profit! They can lose money and just keep getting public funding. It is an uncompetitive unaccountable "business" that can kick Private Enterprise in the butt and out of business.

  • Report this Comment On August 20, 2009, at 6:35 PM, remeberwhen wrote:

    I am old enough to remember when doctors were the richest guys around and our medical care was the best in the world. Health care insurance was also that.

    Now, none of that is true, and the whole matter of health care is totally politicized. Since we are no longer getting the same quality of health care and the doctors aren't making the money, where did it go? Who is left in that picture, the insurance comapanies- middlemen who have sucked the money out of the system, and as far as I can tell they have added no value.

    At the same time, doctor I know have gone out of business, and I am aware of horror stories in which insured persons were denied necessary medical attention or medicine and suffered for it. Obama's mother is not an unusual case.

    So, who are the culprits in the health care dilemma, and what of the news stories starting to emerge that insurance may actually be behind and supporting much of the public demonstrations?

    There should be no profit motive in managing health care. Logically, that would draw money away from doctors and our health care to the insurance companies, which is exactly what has happened.

    We are the only major country which does not have public healthcare. It not only burdens our people, resulting in an incredible number of bankruptcies, but it burdens our businesses, which can't compete against other countries where businesses need not bear that burden.

    Let me give you some firsthand insight into government controlled healthcare. I have an excellent insurance policy. When I hit 65, they forced me to switch to Medicare. Guess what, nothing changed. The insurance is now secondary and Medicare is primary. I see the same doctors and get the same service, and I no longer pay the co-pays that my insurance introduced recently.

    It's nonsense that government sponsored healthcare is unconstitutional. Cite some law for that. What do you think Medicare and the Vetrans Administration do? They provide the best healthcare and are extremely efficient. Overall, those on Medicare are very satisfied with the system. Forget the mumbojumbo intended to promote the insurance companies and look at real life.

    Wake up! It's time we got something good for our taxes. Don't our people desrve the security that they won't be driven bankrupt because of a medical emergency? As a minimum, the public option should be available as a safety net.

    Actually, it amounts to giving MORE options to the us, not fewer. If you really believe that the government can't handle this (despite the evidence to the contrary) you shouldn't oppose the public option. The goverment's failure will only prove how right you were. What are you afraid of?

  • Report this Comment On August 20, 2009, at 6:37 PM, MKArch wrote:

    Excellent article but you forgot the largest advantage the public company will have over the privates and the reason it will force them out of business. The public option will cover more than it's funding can support but will make up the difference with government borrowing. I agree more efficient private insurers might be able to compete with non profit but I don't think they will be able to compete with government subsidized losses.

  • Report this Comment On August 20, 2009, at 6:39 PM, glenster1111 wrote:

    When I started to read the comments on this article, I felt that my worst fears about MF were now a reality; it's a community that is now dominated by the right-wing demagogues who can't seem to synthesize a single original conclusion in their tiny, fear-wracked little minds.

    What a sad cliche - the pro-laissez faire capitalist, railing against the entitlement programs that have successfully kept their grandma and grandpa out of abject poverty (ohhhhh, yeah, right, they were just lazy so-and-so's who didn't know how to save a penny because they were too busy drinking themselves into poverty while sitting in the back seat of the Cadillac they bought with their welfare money). Just stop it already, and GROW UP!!

    I've been an active capitalist, investor, and entrepreneur for the last 20 years of my life. I was one of E-Trade's earliest customers (pre-www, when you had to dial directly into their modem lines and enter your trades by DOS-like character entry). When I first encountered MF, ohhhh, so many years ago, I thought, cool, here are two smart brothers who have a fresh take on all of this investing stuff, somewhat akin to Peter Lynch, but with a funnier, more experimental style. They were neither "conservative" nor were they "liberal"; they were just focused on wanting to find out what made the market tick. It was refreshing, exciting and fun. But since they've grown into something less personal, and the community of people around them has grown with them, I have sensed the right-wing CNBC types setting up shop here, and it has really dissappointed me.

    Fortunately, as I read further into the comments, I began to realize that there were, still, thinking, open-minded people here, in the MF community, and I felt a little better.

    Come on, MF, keep the conversation open and the bullies at bay. This used to be a place for learning, now it's just turning into the same crap that's going on in the August townhall meetings all over America.

    Soooooo trite and tiring.....

  • Report this Comment On August 20, 2009, at 6:42 PM, porshguy wrote:

    Take a $10 bill and a letter to FedEX and you will get 5 day service and $0.44 change. Take the change and a letter to USPS and you will get the same thing. As with health care most people who use FedEx don't pay the bill so a 22x difference in price doesn't matter to them.

  • Report this Comment On August 20, 2009, at 6:46 PM, branchre wrote:

    The government can handle it but they are less efficient than most businesses. If this option is going to attract these uninsured, without government subsidy, it will have to be much less than the private plans, which it cannot be without a big government subsidy. If it is so much less expensive why should I keep my private plan? This whole exercise is just a ploy to take over the entire system by the government. The Arabs have a saying, "let the camel get his nose in the tent and he will soon be all the way in". That is the objective of Obama and his lackies, the route the socialists took in Canada, Britain and much of Europe, and they are now financially bankrupt or well on the road. There is no fundamental "right" to health care, only a right to earn it on an equal basis with others. If you bought beer or texting or whatever, instead of medical insurance that was your choice, not us taxpayers. We give liberally to charities who help people like you, much more than the liberal politicians who are only looking for you vote and, as taxpayers, we should not be shackled with the result of your bad choices..

  • Report this Comment On August 20, 2009, at 6:53 PM, julez1 wrote:

    theHedgehog wrote:

    warmnup says: "It is interesting to note that aliens who are in the country legally DO receive benefits, just not aliens who are here illegally, this was also misrepresented by Obama."

    This is, itself, a misrepresentation. Some hospitals are required by their state to take all comers. The poorer you are, the cheaper your care is. The bill is passed on to the state and appears in our tax bills. No hospital is going to watch you die in their hallway because you're an illegal alien or simply can't prove your status.

    All true but you failed to take it to the end result. Because the government only reimburses the provider a fraction of the billable costs. That in turn causes the provider to raise the cost of the service provided to those that will pay 100% (private insurance) to offset/ subsidize the shortfall cerated by the gov. That is what is driving up our premiums and procedure costs. And we pay at both ends- taxes and premiums- read it and weep.

  • Report this Comment On August 20, 2009, at 6:57 PM, theHedgehog wrote:

    remeberwhen says: "What do you think Medicare and the Vetrans Administration do? They provide the best healthcare and are extremely efficient. Overall, those on Medicare are very satisfied with the system."

    I'm pretty happy with my VA healthcare, as well. The only major thing I've had done was an endoscopy, but they did their job well, and they were cheerful about it. Sure, you can dredge up some pretty bad cases if you look at the VA hard, but OTOH, it took a very angry phone call to my HMO to get a hernia surgery approved while I was still working. Nothing's perfect, but it seems to me that expanding the type of care I get from the VA to cover all Americans who can't currently afford the gold-key stuff can't be a bad thing.

    Speaking of the 50 MILLION Americans who can't afford healthcare - I wonder how many of them are in these raucous Town Hall meetings ranting against public healthcare. Actually, I don't. The figure is either zero, or so close to that as it doesn't make a difference. And, yet, that's about 15 PERCENT of American citizens.

    One more thing: I pay the same for the gas in my care that you do. So, why would you think that I should pay more for healthcare? This whole issue is about the rich keeping their entitlements while the poor get an empty bowl.

    Hedge

  • Report this Comment On August 20, 2009, at 7:00 PM, JGViser1 wrote:

    Torte reform would make the biggest sustantive impact on health care costs. Take the dollars that now flow from the ABA to political campaigns, multiply it by ten and that shoul approximate the savings we would see in the elimination of unnecessary CYA medical tests and malpractice insurance premium reduction.

  • Report this Comment On August 20, 2009, at 7:01 PM, mahe67 wrote:

    branchre wrote:

    There is no fundamental "right" to health care, only a right to earn it on an equal basis with others.

    Please tell that to s.o. born with Multiple Sklerosys or childhood Diabetis. Is it really such a bad thing, when people having all the choices in life pay into a system that profit the ones that need our help? Does Christianity have to stop at the pocket-book?

  • Report this Comment On August 20, 2009, at 7:03 PM, EBerg13 wrote:

    I am insured and for the most part have always been. And I get my prescriptions filled from Canada Drugs because our plan with UHC (and we are a HUGE company) has lousy drug coverage and I can pay less sans insurance in Canada than here. . When my doctor hands me a coupon for the latest and greatest drug (and I face a $125 co-pay) I can see right through the "need" for me to have this particular antibiotic for my bronchitis to the incentives being paid him by big pharma. On the other hand, my handicapped adult daughter has the "inferior" public health plan (medicaid/medicare) and pays nothing for her drugs (though I doubt they would let a doctor get away with the most expensive drug treatment out there, and on one should except in a dire emergency). I had to call the government plans (state and local) and discovered they are prompt, friendly and know what they are talking about.

    So how would I reform health care? High co pays, upfront transparency of costs, the ability to shop outside of network for better deals, and the rolling over of health savings accounts from one year to the next so people don't need to lose their own money if they don't use it up.

    And yes, I want a government option...actually, I want my daughter's plan.

    If everyone had to have insurance and everyone paid a premium for it, I don't think it would be much more than we are paying now -- it might even be less.

  • Report this Comment On August 20, 2009, at 7:04 PM, catsavy wrote:

    Our health care is expensive because we have all the bells and whistles to medical technology ,and we demand our Drs use them .Go to Canada then. .There you can get an MRI in 8-10 months for a pre-existing problem or new ,matters not.Oh and they close their doors at 4;30pm .Many radiologists have gone private and are building their own practices with MRIs.You pay $500 and up or you wait in line.Canadians complain that you are buying your MRI.Why should they care if your going private bumps them upin the waiting line?In the US ,you can get an MRI at 9pm ,maybe later. In Canada the technology for MRI is not as advanced.Most provinces buy used machines from the US. A town with equal population Can vs US will have 1/5 the diagnostic availability in Canada.What kind of outrage will you have then.I have experienced all this first hand and it is only getting worse in Canada.I have no stock in healthcare so you needn't get huffy about what i support.

  • Report this Comment On August 20, 2009, at 7:07 PM, rlcardo55 wrote:

    With socialized medicine we won't have to worry about the high costs of new procedures and new drugs BECAUSE THERE WILL NOT BE ANY, we all go to work because we hope to earn money (i.e. make a profit in what we have in so far as time, talents, and energy). drug companies are not going to pay for expensive research if they do not believe that some of the products of their efforts will bring them a return on investment.

    As far a CEO pay goes, it's not the governments business, However, if drug company shareholders don't think their CEOs are worth their salaries, they should petition the Board of directors to 1) limit CEO and other executives compensation and/or 2) get a new CEO. In a free market, their are other talented people who may do a good job who would take less in salary. I think a CEOs pay should be half paid in stock (not stock options) so he has a real interest in making his company grow.

    One last point the WHO statistics show the USA as number 1 in satisfaction with timely and effective health treatment. The two biggest factors related to life expectancy are deaths from auto crashes and from homicides. How about stiffer penalties for texting while driving?

    Everyone in the US health system does not get the same treatment is true but anyone can go to an emergency room for treatment...so everyone can get treated. Do you realize that after we have Obominal-Care, Government officails will still get the Elitist version.

  • Report this Comment On August 20, 2009, at 7:08 PM, nemaline wrote:

    Interesting. This is a relatively new article and how many postings do we have, with a rare posting that favors the health care bill. 'Nuff said!

    Health care needs no "reform,", just a truly, and I mean truly, free market.

  • Report this Comment On August 20, 2009, at 7:12 PM, theHedgehog wrote:

    One of the most foolish arguments against socialized healthcare was where someone stated that Dr. Steven Hawking (yes, that one) would have died had he been stuck in such a system. As it turns out, Dr Hawking is a professor at Cambridge University. Which is in the UK. You know - where they have socialized healthcare.

    Hedge

  • Report this Comment On August 20, 2009, at 7:13 PM, halbiz wrote:

    When someone loses his job, if he had great coverage, he can't afford the COBRA cost. If he had lousy coverage, he now has nothing. If he had pre-existing conditions he probably will go bankrupt sooner. If he applies for any job he can find just to get health coverage, is this the best our "great" system can do?

    We pay twice as much as other developed countries and get much less, and certainly no guarantee against pre-existing conditions and catastrophic costs. Rationing? We have it already, its just not transparent or fair. Bureaucrats now decide what gets covered, they just happen to work for a "competitive insurance company" and have an incentive program to deny coverage. They get bonuses for higher profits from such denials.

    We need coverage, not dependent on where you work. Contrary to popular opinion, most people do want to work, but having health insurance should not be the primary reason to work at Company A vs. Company B. As a small businessman, I hated it when I had to let someone go, knowing they and their family could soon be bankrupt from medical bills. They may not have been perfect for my position, but they were still people and families that deserved a chance to start over without living a healthcare nightmare.

    America, get with the program and become a civilized society!

  • Report this Comment On August 20, 2009, at 7:20 PM, sykco53 wrote:

    the problem is that there are so many insurance companies and each one of them has its own rules and regulations about how claims should be filed, who is entitled to what and how much it costs in each state, add in the different billing processes, deductibles, co-pays etc.then take this and multiply it by 50 states, each with different statutes, and what you have is a very top heavy process which actually costs a fortune and does absolutely nothing to benefit the patient.

    Having experienced first hand the system in Britain (where incidentally if you don't want to use the health Service and you have the money - you can pay to have it done privately at your own expense) the Doctor in the village where my mother lived had (3) doctors, (2) nurses and (1) receptionist to handle everything (about 4000 people live in the villlage or close by). In my current location in Florida, my Dr Office has 3 doctors, 6 nurses, 2 receptionists, and office manager, a billing manager and I don't know how many other ancillary staff who file and sort and try and deal with the frustrations of patienets whose policies change with the weather at the whim of the profit driven Insurance Companies.

    The biggest differnce I see between the 2 systems is that in britain people do not go bankrupt because they are unfortunate enough to have poor health or need medical treatment. I have read comments in various locations that everyone has a choice about purchasing healthcare, and that it should be earned, try telling that to the parent of a child who has none and whose child is stricken with cancer.

    I'd be more willing to listen to those politicians who are against universal care, if they would forego their heaviliy subsidised option - funny how it's OK for them to use tax payers money for themselves, but not OK for the people who are paying the taxes.

    As for universal care leading to bankruptcy, we have just experienced what "professionals" can do at the helm of the nations financial institutions and we the people have no say in who those leaders are - at least with government involvement, we have the opportunity to throw the Bums out every few years if we don't like what they are doing.

    For me I'll take take the public accountability of the government over the Private Greed of the Free Market anyday when it comes to health.

  • Report this Comment On August 20, 2009, at 7:25 PM, obie1kanobe wrote:

    Why are doctors, hospitals, lawyers, and the government being spared demonization? They are as responsible for high costs as are insurance companies. The whole post WWII system makes no sense!!!!

    - Coverage of routine doctor visits is not insurance. Insurance is for non-predictable costs.

    - All medical expenses should be tax deductible.

    - People that demand antibiotics for colds and the flue should have to pay all the costs.

    - Viagra and birth control should not be covered by insurance.

    - Doctors and hospitals should be required to post a "menu board" of their charges.

    - Health care should be portable.

    - Coverage for pre-existing conditions only works if coverage is required. Otherwise it makes no sense to pay for coverage until you're sick.

    - Some sort of rationing is a fact of life! The question is "How it should be rationed?"

  • Report this Comment On August 20, 2009, at 7:26 PM, notgilstratton wrote:

    There should be no doubt about the insurance companies ability to compete with a public plan. Here in California we have a public option for Workers Compensation Insurance. It's called The State Fund and it provides workers comp to small businesses at a much lower rate than the private insurance companies. As a small merchant for many years, I took advantage of this as the rates from the private insurers was much too high. So do most small companies. The larger employers actually do better with the private firms, and so that is where the seperation occures. It works just fine and everybody comes out ahead. Additionally, we should keep in mind that while the health insurance companies try to maintain the medical loss ratio at around 78%, leaving a gross margin of 20 to 22%, Medicare operates on 3% operating costs. Of course they don't have to maintain those marble and glass monuments, fleets of private jets, outlandish corporate salaries or multi-million dollar lobbing firms to do their bidding in D.C.. They also don't have armies of folks who's only job is to find ways not to pay claims. So, yes, private insurance could compete, but they might have to change the way they run their businesses. We all just might benefit if that happened.

  • Report this Comment On August 20, 2009, at 7:36 PM, fepeter wrote:

    My concern is whether the government will compete fairly agains private insurance comapanies or will it be a subsidized plan that drives private insurance out of business. The small business that I work for would probably be forced by economics to drop the existing private insurance and sign up for the public plan if it was just 1 or 2% cheaper.

    Remember that when Medicare was passed in 1966, the congressional budget office projection of 1990 costs were $12B. The actual costs were $107B. My guess is that public healthcare insurance costs would increase about the same.

    Another question I have is what is the President's healthcare reform expected to accomplish and what elements of the proposed legislation will accomplish that. All I see is a big bill (all seem to be over 800 pages) that no one can figure out.

    We need to state the specific problem to be solved, the proposed solution, an analysis of alternatives, and the potential unintended consequences of the proposed action.

    re: eldetorre on $680 hammers. No it was not single souce contracts. The cost was driven by extensive procurement regulations that required extensive testing, documentation, and packaging. The regs are from DFARS (Defense Federal Acquisition Regulation Supplement and FAR (Federal Acquisition Regulations) that were put in place over many years by congress (both parties). Most DFARS and FAR clauses (together over 3 ft of documents) have a reason for existing, but are often applied indescriminately or incorrectly.

  • Report this Comment On August 20, 2009, at 7:37 PM, mtracy9 wrote:

    When the head of Medicare is making $150,000 a year and is providing better service than the private insurance industry CEO who is making $12 million a year, it's time to take another look.

  • Report this Comment On August 20, 2009, at 7:38 PM, mtracy9 wrote:

    Medicare is a single-payer (socialist) system, popular with the American people, yet Republican politicians are loath to admit it (hoping their du.mb constituents wont notice), because is would undermine the Republican argument for opposing current health care reform.

  • Report this Comment On August 20, 2009, at 7:39 PM, mullinkay wrote:

    To my way of thinking, the further the Govt. stays away from trying to run a health care program, the better off the general public will be. Yes, we need to hold health care costs down. Tort reform would be a good start. Untold billions are spent each year on medical tests ordered to prevent law suits, and many billions more are paid out by the medical profession in the way of liability insurance payments.

    These additional tests and very expensive premiums cure nothing. Also, it should not cost a drug company a quarter of a billion dollars to bring a new drug to market. It makes one wonder how many lives are lost each year because the drug company can not afford to try to get a new drug on the market. A large part of the cost that the individual pays for a drug is due not only to the huge cost of it's development, but also to the cost of bloated legal settlements that the drug company pays from time to time.

    I do not hear much from either side of the isle on tort reform. It seems as though the fox has made claim to the key to the chicken coop, and has no desire to relenquish it. As about 80% of the people sitting in Congress are tort lawers, I would imagine that they are protecting thier own intrests. In this circumstance, it would take someone of rare moral fiber to propose a change. It would seem that too many of them show more interest in fathering illegitimate children or in the persuit of a good bottle of scotch than in meaningful reform.

    It is easy to blame the medical profession, the drug company, or the insurance company, but they have to play with the cards that are dealt to them, and the dealer is not always kind. Anyone complaining that the insurance and drug companys make too much money should buy themselves a whole raft of stock in either or both. Or try to scrape up the first months premium that they would have to pay as an MD after spending years in school with a huge student loan to pay off.

  • Report this Comment On August 20, 2009, at 7:40 PM, bobs14 wrote:

    I agree with stan8331 comments. The economy will be helped by efficiently run public health care. I beleive it will control skyrocketing healthcare costs paid to insurers. And the gov't can run it efficiently as proven by their running medicare.

  • Report this Comment On August 20, 2009, at 7:41 PM, mtracy9 wrote:

    The Medicare program operates with just 3% overhead, compared to 15% to 25% overhead at a typical HMO. Provincial single-payer plans in Canada have an overhead of about 1%.

  • Report this Comment On August 20, 2009, at 7:42 PM, mtracy9 wrote:

    Interesting that France's health care system is rated #1 in the world. And the French pay only half of what Americans (ranked #37) pay. No wonder the neo-cons at Faux News don't like the French.

  • Report this Comment On August 20, 2009, at 7:45 PM, mtracy9 wrote:

    When the head of Medicare is making $150,000 a year and is providing better service than the private insurance industry CEO who is making $12 million a year, it's time to take another look.

  • Report this Comment On August 20, 2009, at 7:49 PM, julez1 wrote:

    mtracy9 please state your sources as I would like to review them

  • Report this Comment On August 20, 2009, at 7:52 PM, danteps wrote:

    Medicare is barely adequate care and only "works" because it is buttressed by the private system.

    Hospitals are going out of business in this environment, socializing medicine will insure many more go bankrupt.

    Enjoy supporters of Obama-care.

  • Report this Comment On August 20, 2009, at 7:54 PM, tcalea wrote:

    Comparing health care in France or Canada or Great Britain to the US without mentioning tort reform, lawyers and malpractice is either being ignorant, disingenuous, or just plain hiding facts to get your liberal point across.

    As for govt run health care, the first comment is right on.....they dont know what they are doing. Obama made a big mistake when comparing the USPS to Fedex and UPS. They also dont want others to know what they are doing.....the democrats want control, and are lying to get it. They are not telling the public this.

  • Report this Comment On August 20, 2009, at 7:58 PM, tcalea wrote:

    the current system doesnt need to be destroyed.....according to some, by making insurance compete across state lines, costs will come down. Plus people who move wont lose coverage.

  • Report this Comment On August 20, 2009, at 8:03 PM, warmnup wrote:

    For the record: Medicare runs only a very small portion of the Medicare program. It is largely run by United Healthcare and the like, other HMO's. The Medicare Govt run segment is the part that is always being cheated and has the astronomical over runs, including paying the people to run down the cheaters.

    In my previous post I made a statement about illegals not receiving benefits, in reality I know they do. I was referring to the statement by Obama that illegals will not receive coverage BUT HR 3200 clearly states that it is ONLY illegals not non-citizens. These people who work the system will always receive free treatment, even if and especially if the Reform passes. Point is we were being misled intentionally by our President.

    Reading this Blog is an education in itself. It is amazing how many people do not have even a vague understanding of the system or the intenet of the Reform.Then there are those of us who understand just enough to be dangerous, unfortunately that includes our President.

    I tried to read the Blogs and determine which commenters had looked at the actual proposed Bill. I decided it was very few.

  • Report this Comment On August 20, 2009, at 8:13 PM, porshguy wrote:

    Sorry to repeat re FedEx:

    Take a $10 bill and a letter to FedEX and you will get 5 day service and $0.44 change. Take the change and a letter to USPS and you will get the same thing. As with health care most people who use FedEx don't pay the bill so a 22x difference in price doesn't matter to them.

  • Report this Comment On August 20, 2009, at 8:16 PM, porshguy wrote:

    Competing across state lines will be a race to the bottom as companies will HQ in the state with the least consumer protection.

  • Report this Comment On August 20, 2009, at 8:21 PM, theHedgehog wrote:

    warmnup says: "I tried to read the Blogs and determine which commenters had looked at the actual proposed Bill. I decided it was very few."

    There isn't actually a proposed bill yet, so you haven't read it, either.

    It's also interesting to note that Grassley has stated publicly that no matter what compromise is reached, even if HE is instrumental in reaching that compromise, He Will Vote Against It. At least he's being honest about his dishonest dealings. I guess.

    Hedge

  • Report this Comment On August 20, 2009, at 8:38 PM, toshara wrote:

    I'm one of the uninsured. I run my own small business (two people), I don't qualify for either Medicare (not old enough) or Medicaid (too many assets), I haven't opted out of having insurance and yes, I could afford it if it was reasonably priced. The problem is, I can't get insurance through the business because it's too small. I can't get personal insurance because some bureaucrat somewhere decided that I'm too big a risk somewhere in the future, regardless of my state of health. What insurance might be available to me is way too expensive unless I want to spend down all my assets and spend my old age in poverty. I'm not alone. 'Preexisting conditions' remove insurance possibilities for anyone who moves, changes jobs, or works for themselves. I know dozens of people in the same fix I'm in.

    I do not understand why health insurance should be a for-profit business where decisions about health care are made by someone who is not my doctor (looking back to a time when I was employed and and insurance and the company authorized a multi-thousand dollar procedure that did not fix the underlaying problem, but denied the $80 real cure).

    I do not understand why millions of dollars in lobbying fees essentially buy the politicians we as taxpayers employ.

    I do not understand the millions spent on advertising drugs to suck people into treatment they may or may not need.

    I do not understand the economics of stock options, back dating, and all the rest of the scams run in high financial systems. No one on this earth is worth $100 million a year, no matter what he does (unless he/she can end wars, heal the sick, cure societal ills and wash windows on weekends and runs the company all by him/herself).

    We as a country have a serious problem. Unfortunately, between the talking heads, the rabble rousers, the special interests, and the general level of common sense/knowledge of the average American, I seriously doubt we're going to fix it. Oh, well, countries die all the time, even ones that have been around longer than we have.

  • Report this Comment On August 20, 2009, at 8:44 PM, tincanman99 wrote:

    There is nothing unconstitutional about a government health plan. Among the purposes of the constitution, as stated in that document itself, is "to provide for the general welfare."

    The profit margins of health insurance companies would not be so small if their chief executives were not routinely collecting (not "earning") ten million dollars a year and if they did not spend millions on advertising and on lobbying against health reform.

  • Report this Comment On August 20, 2009, at 8:52 PM, dsteines wrote:

    Yes we need health care reform but I have a difficult time believing the government can do it efficiently. I believe the role of government is too oversee and regulate the industry. As an example: the problems of excluding preexisting conditions and of dropping people for certain conditions needs to change and all the government has to do is pass a law to this effect.

    I wonder how much money would be saved by Medicare if Medicare would allow people to be treated at home instead of having to be admitted to a nursing home ( for 100 days of medicare coverage) following a discharge from hospitals? Whether it be for home intravenous antibiotics, rehab etc . I believe there are some managed care groups who get money from federal programs to manage the health care of their customers and their goal is to keep their customers in their own home and out of hospitals and nursing homes.

    Figures lie and liars figure. Both sides throw out numbers that are hard to verify but they use to make their points. I heard a report on Pres Lyndon Johnson that he did not want the true cost of medicare to be known because it would not have had a chance to become a program. I am sure Pres Bush grossly under-reported the cost of the Medicare Part D program - Both programs, I believe are good programs for the recipients. And like it or not, rationing is taking place in both programs.

    Why not expand the medicaid and medicare programs to cover most of the uninsured and regulate the things that need fixing?

    I would be willing to trust our elected officials to determine my health plan if they would have to get their health plan from the same choices I will have.

    How much research and innovation comes from countries that we are being compared to? How about comparing life styles - example: Apparently France is #1, but they have no large supermarkets so food is gotten from farmers markets and they walk all over instead of driving like we do.

    How much federal money is now being given to research and drug companies ?

    I think a lot of concern is out there because there is not specific bill proposed that says anything concrete - when the government puts something together it is lengthy ( example IRS).

    Something needs to be done for the poor and those losing their insurance due to job loss and it is going to cost money. I have not heard any politician suggest removing the cap on salary for medicare taxes ( he probably would not get re-elected), but that would ensure the wealthy would pay more to help fund this.

  • Report this Comment On August 20, 2009, at 8:58 PM, theHedgehog wrote:

    dsteines says: "Why not expand the medicaid and medicare programs to cover most of the uninsured and regulate the things that need fixing?"

    This would probably be the best solution. We already have the law on the books. Medicare works. Just expand it and be done with it.

  • Report this Comment On August 20, 2009, at 8:58 PM, xetn wrote:

    Maybe we, the citizens, should send a demand letter to all of congress, demanding the same information from them. It seems to me that they are all incompetent, free-spending crooks.

    I am not a big fan of big corporations because I believe it leads to inefficiencies, and executive excesses. But I don't believe for one minute that government can even come close to keeping costs down.

    Now, Obama is comparing government health reform to the post office:

    http://www.bloomberg.com/apps/news?pid=20601039&sid=aJ01...

  • Report this Comment On August 20, 2009, at 9:00 PM, bishobo wrote:

    I am a believer in free enterprise. There are cases where it does not work properly and I also beleive that our health care system (if you can call it that) is out of sorts.

    To have meaningfull reform to the extent it controls costs there must be a multiple faceted approach.

    Make individuals responsible for their own health where they can control behaviour

    - Quit subsidizing poor health habits (we all know what those are)

    - Reward good health behaviour results - proper weight, blood pressure, & etc.

    Provide some control for health premiums - I believe insurance companies find a way to work together for their collective benefit.

    - are there other methods for premiums and health care choices where insurance companies are not involved - HMOs, etc?

    So I feel health care must be from the individual being help accountable for their health decisions and from the health care industry being help accountable for health care premiums (cost).

    We should not be willing to blame insurance companies for our poor health we engaged in behaviour that resulted in our poor health and therefore our increased usage of health systems and care. We must have incentives built into health care and the associated costs to the individual.

    My 2 cents worth.

  • Report this Comment On August 20, 2009, at 9:06 PM, photocrawf wrote:

    I agree with hedgehog, we already have a Public Option; expand Medicare and Medicad to include all uninsured folks. then work on streamlining the health care delivery system.

  • Report this Comment On August 20, 2009, at 9:21 PM, markosaur wrote:

    Why should a large portion of what we pay for health care go to advertising, marketing and lobbyists? For the public good, science should be applied to determine the most effective treatments, not who has the best salesmen or lobbies doctors and hospitals most effectively or what procedures are most profitable. When big pharma comes under pressure to cut costs, they claim lower profits will dry up their R&D budgets, but what they don't reveal is that the public funding to schools paid for much of the R&D that they then profit from. Why not cut out the middleman?

    Most surveys of Brits as well as Canadians show majority support of their single payer systems. And wait times to see a doctor are LONGER in the U.S. now than in Germany. Britain, and Australia (and tied with Canada) except for elective surgery.

  • Report this Comment On August 20, 2009, at 9:21 PM, ihacvet wrote:

    I certainly agree with mysnowy : "To think that the government can run any program efficiently is to ignore experience." And I agree tort reform is key to controlling costs of healthcare. Through Motley Fools I have followed and invested in numerous biotechnology companies the past 15 years (some in their infancy). I have no ties to them, no family working for them, etc. I would love for medications to be cheaper but that's really not possible unless we want many of them to declare bankruptcy. If you truly know what it takes to bring a drug idea from its start to finish, you could better appreciate the cost we pay for medication. It takes unbelievable spending in R&D to take a drug from idea to testing to market and that's the few of dozens that are actually found to be hopeful and beneficial. Time, research, failed trials, successful trials, and production cost!, cost!, cost! It is why we are the biotechnology and drug leader in the world. It is called "success in the free world" It is really not that difficult to see if you follow biotechnology and drug manufacturing. We don't need European, 3rd world country or Canadian healthcare. We need the best and that's American---- with some true fine tuning. Let's not dismantle the house for a minor remodeling job.

  • Report this Comment On August 20, 2009, at 9:26 PM, nemaline wrote:

    Anyone who thinks Medicare is such a fine system, you should talk to all of the physicians who feel screwed for reimbursement (my wife, one of them, who goes to see a patient in the hospital and makes $20 for a visit), and doctors groups who are now refusing Medicare. Not to mention the debt the country is in from Medicare. It ain't working too well, despite what is popularized in the media.

    Having just been billed by an auto mechanic with a hell of a lot less training and sacrifice than my wife, he made a heck of a lot more money for his time.

    Please help me name a government system that is more efficient and provides better service than the private sector. And why do we want to fund this?

    Not to mention, did anyone read Warren Buffett's op-ed to the NYT? We are spending out of control. Now is not the time for a $1.5 trillion healthcare plan....

  • Report this Comment On August 20, 2009, at 9:28 PM, markosaur wrote:

    Part of the reason the U.S. auto industry fell apart is because they were competing on price against countries whose industries did not have to spend huge sums to provide health care for their workers because their government provides that.

  • Report this Comment On August 20, 2009, at 9:33 PM, dibo528 wrote:

    I'm going to say something really scary to all the ultracapitalists -- I mean the ones who believe in unbridled, laissez-faire capitalism. We are going to get health care reform and there will be a public option.

    http://www.youtube.com/watch?v=7QwX_soZ1GI&feature=chann...

  • Report this Comment On August 20, 2009, at 9:36 PM, ldbattles wrote:

    Healthcare reform is a must..Also inorder for it to work

    Tort reform will be necessary.. I question the malpractice

    insurance charge of 100--125 K for a GP.. There is not a GP in this country that pays this or could afford to..

    Posting such information, just lessens the true benefit of these discussions. How is reform to be done is the BIG question. The goverment is not knowlegable enough or

    keen enough to carry this out. Again look at our postal system. Good services will not be free...Cutting unnecessary test and expensive radiological studies must be done. Defensive Medicine is expensive and needs to be studied and dealt with honestly. Tort reform

    is as necessary as Healthcare reform. Without both

    there is no workable solution. I have been in the Medical

    Professon for nearly 40 years and know something of where the real problems lie.

  • Report this Comment On August 20, 2009, at 9:38 PM, robertf36009 wrote:

    I didn't finish reading the article. I skipped most of the comments as well. I did however read HR 3200 and most of the Kennedy sponsored resolution. Private insurance will not be allowed to compete at all. On page sixteen of HR 3200 it clearly delineates how it will be eliminated. New hires will not be allowed to join a current employers plan. This will ultimately leave only the current employees on it. Through attrition and aging the plan will eventually become prohibitively expensive and cease to exist. The Kennedy proposal accomplishes the same objective with a five year plan on page fifty four. There are numerous portions of the bill aimed at ensuring that the government will be the only player. Should this bill pass with the "Government option." sell your health care stocks at once.

  • Report this Comment On August 20, 2009, at 9:39 PM, think101 wrote:

    How is it that auto insurance is mandatory but health insurance isn't? We have financial losses from poor health just as we have from auto claims. While the two are not synonymous they are analogous. If you cannot drive without auto insurance you shouldn't function without health insurance. It's reality. Auto insurance is available to anyone who owns a car - poor risk is fronted by the private sector and pooled under a coop of private/state fund. Health coverage can be addressed in a similar manner: private sector to open it up to all Americans with a government pool for catastrophic loss exposures. Not an ideal solution but a workable one. We cannot fight this issue. The government needs to and will get involved. The problem of the uninsured is too costly not to address it. The longer we postpone acting the costlier and more burdensome it will become.

  • Report this Comment On August 20, 2009, at 9:40 PM, markosaur wrote:

    With employer-based health care I have had to change doctors because my employer changed health plans. Another time I had to change my dentist for the same reason. At one period they changed plans 3 times in 5 years. My daughter recently had to change 3 doctors when her employer switched.

  • Report this Comment On August 20, 2009, at 9:46 PM, markosaur wrote:

    Using the Post Office as an example of government-run business is rather unfair. UPS and FDX do not have to charge one flat price to deliver letters everywhere in the US, and they charge more for their service.

  • Report this Comment On August 20, 2009, at 9:52 PM, theHedgehog wrote:

    think101 mused: "How is it that auto insurance is mandatory but health insurance isn't?"

    Mostly because owning a car is optional, but living in a body isn't, nor do you get to choose the body you have - not the color, nor the sex, or even the optional features. What you're born with, lemon or not, you're stuck with it.

    Let me let you in on a little secret. I'm uninsurable. I have fibromyalgia. There isn't an insurance company that will touch me regardless of premium or deductible except when it's state mandated under a public option.

    Did I choose my disorder? Nope. So, why should I be denied a service that you can get for a low price? There is very little else in life that you and I don't pay the same price for except health insurance. Gas costs the same. Assuming I'm a good driver (I am) car insurance costs the same for those in my age group. I'm not discriminated against when I buy a TV or a car or groceries. But, health insurance? Unobtainium.

  • Report this Comment On August 20, 2009, at 9:54 PM, porshguy wrote:

    More than 20 as much for the same service (5 days coast to coast). Not to mention not having to carry tons of junk mail at giveaway rates.

  • Report this Comment On August 20, 2009, at 10:28 PM, herbs814 wrote:

    What the numbers would show is that insurers are not hiking costs nor pocketing huge profits. Their margins are slim and the risk of underpricing are great, given how government has encouraged healthcare costs to rise uncontrollably. Even if government can somehow run an efficient service (that would be a first!), there would be little savings for consumers at all... other than those from preferential tax treatment. This would be most unfair, for the government to tax private industry in order to fund their "competition" -- a competition that offers no benefit other than being subsidized by taxpayers and exempt from taxation.

  • Report this Comment On August 20, 2009, at 10:59 PM, gio1950 wrote:

    Wow foolish leader. Taking advantage of old ladies is a considered a medical sport around here. Say you have a iodine sensitive patient who needs a cyst removed. Pack the incision with iodine strips and wait for her to call back bacause she can't swallow. Set up the ears nose and throat appointment immediately, then a scope down the esophagus with another, and so on, to maximize the total number of negative test result appointments before the wound heels, but not without a new scipt from each and any concomadent effects that will likely bring her back to the office ahead of schedule.

    Oath? Ha ha ha. You want to hear about the anxiety treatment? Don't worry I have the proof.

  • Report this Comment On August 20, 2009, at 11:07 PM, oldsteve1926 wrote:

    Brian Orelli says above that about 82 cents of every dollar medical insurance customers pay goes for medical costs. I assume that is an average. He has defined the”Medical Loss Ratio” used in House Resolution 3200, the “America’s Affordable Health Choices Act of 2009,” (AAHCA).

    The propsed act says, “The Secretary” can set the MLR at whatever level he chooses, but he may not set it below 85%, according to the AAHCA. (Page 350 – Line 20) The idea is to get the maximum benefits to the patients for the premiums paid, a noble sounding objective. However, the hidden agenda is, in my view, to put the private health insurance industry out of business.

    The act provides that if an insurer’s MLR falls below the percentage dictated by “The Secretary,” a number of things then happen. First, the insurer must rebate to those enrolled an amount to bring the MLR to the number specified. Second, for three years after the provider has an MLR below 85%, the provider will not be permitted to enroll new enrollees. Third, if the provider fails to meet the MLR for five years, the Secretary shall terminate the plan contract.”

    It is clear that the Medical Loss Ratio provisions of the act are designed to drive private insurers out of business. In order to maintain profitability for stockholders with an MLR of 85% insurers will have to raise their rates. A Washington Post article in 2006 said Aetna lost 20% of the value of its stock when the MLR went up from 74.6 to 79.4%. By raising their rates to maintain profitability with an MLR of 85% or more private providers will become less competitive with either the Public Health Insurance Option or a non-profit option.

  • Report this Comment On August 20, 2009, at 11:21 PM, BruinAlum77 wrote:

    There are three players in the health care system: doctor, patient and insurer (whether private or governmental). In every case, there is a fairly symbiotic relationship between the first two parties (doctors-patients), because the goal is to heal the patient (obviously, we can find examples of unscrupulous medical practices by doctors, but these have no where near the frequency that we hear about other unethical, predatory practices such as those by anyone working in the financial industries).

    Against the interests of the first two parties is the insurer. In a for profit model, we see that every treatment authorized by private insurers results in costs paid for by prermiums, and thus a decrease in profits. The insurer relationship is therefore adversarial with that of the doctor-patient. We have ample proof of this: benefit cutting, cancellation of policies of patients who become sick, insurance companies giving bonuses to employees who cancel expensive patients' policies.

    The basis of the current health care system relationships is completely skewed against the optimal health of patients. It is almost like arguing that anythiing which the Constitution calls the "Commons" - nationial defense, police, fire and emergency response personnel, infrastructure (airports, highways, ports, bridges, hydro electric dams, nuclear power plants, etc) and public education (including all our junior colleges and state universities) - should be privatized because that will result in a more efficient use of our resources. History has proven, without a shadow of a doubt, that without the government doing the big lifting in these areas, our country would have remained a loose collection of decentralized states, with vastly different levels of development, depending on the intrinsic wealth of each county.

    If the insurer is a non-profit enterprise, what are their goals? The first, is to provide the best care available; the second is to remain financially viable. How can this not be a better role for the insurer in the health care system?

    This is just simple economics, and the reason why we stopped being a laissez-faire capitalist system after the abuses of the robber barons.

  • Report this Comment On August 20, 2009, at 11:31 PM, julez1 wrote:

    Bruinalum77

    As a member of one of the "Commons" I must bestow an unsavory fact- In troubled economic times these services are usually cut first to sometimes unacceptable and unsafe levels "to the bone". I am employed in one of the top 5 "Commons" you cite. Are you willing to have your health care dollars compete with these commons when cuts come- who will be cut to the bone? Pardon the pun.

  • Report this Comment On August 20, 2009, at 11:32 PM, drummstikk wrote:

    There's no need to diminish the role of private insurance companies. The only important goal is for every American to have public health insurance by default.

  • Report this Comment On August 20, 2009, at 11:49 PM, cmbourne wrote:

    you say " some seniors pay extra to be in Medicare Advantage plans" it is the opposite !! We sign up for Med A. plans because we save a ton of money up front.

    Traditioanal medicare pays 80% of the bill . AARP will sell me a supplement that will pay the remaining 20%. the supplement costs $200 - $250 a month.

    MA plans pay 100% of the bill. I don't need supplementary insurance. I am up $2000 -$3000 a year aand get coverage that is as good , prabably better

  • Report this Comment On August 21, 2009, at 12:13 AM, bougnoul wrote:

    It is simply amazing how Joe plumbers are all bathed in the same water!

    I hear "not a right", it is "unconstitutional", " govt has no business", "socialists &/or commies" on & on.

    These rants tell us more about the psyche of our people than they might think due.

    Why not simply follow the great characters such as Bobby Patel & Paline & ilk ; refuse to buy gov. backed anything!

    I say, let those who want to have tax deductions to cover for "medical rights" have the rights to do so. Let those help gov create such a system.

    Let those who want to buy from private insurance what Joe can buy & die with.

    That is truly American way.

  • Report this Comment On August 21, 2009, at 12:33 AM, Flvet wrote:

    You are misleading when you say, as the president does, that we can keep our current health plan. The govt plan has the maximum level of coverage, and after year #1 the proposed bill requires citizens to take the public plan if they change jobs or health plans and their new plan does not have the same benefits as the public plan. So over a period of time people will be forced to take the public plan

  • Report this Comment On August 21, 2009, at 12:44 AM, xpat2009 wrote:

    I agree with SigFinDoc and others who are concerned with the issues in the proposed health plan as well as the high costs of the president's plan.

    I don't think the proponents of the plan have even taken the time to read the document, much less understand what it says.

  • Report this Comment On August 21, 2009, at 1:01 AM, kcdaiker1 wrote:

    Isn't Medicare more efficient that private health insurance overhead wise?

  • Report this Comment On August 21, 2009, at 1:33 AM, mavrant wrote:

    It's been my understanding that insurers add as much as 20 to 25% to the cost of health care, while at the same time don't add anything to healthcare.

    As a retired healthcare provider I can tell you that they added such a burden to my practice with all their differing requirements, that I spent more time on their paperwork and such than I was able to spend with my patients. As a busines my profit margin was razor thin. I've seen outfits like Anthem boast of doubling their profits in a quarter. And that's after giving the former execss of Blue Cross golden parachutes of bocu bucks. ( I guess to sell them the company), according to newspaper accounts.

    I sure miss the contact with my patients, but I sure as heck glad to get out from under their thumb. As a retiree, I'll take the ease of Medicare any day. Their a breeze to deal with both as apatient and as a provider. They put the patient before profits. I don't think an insurance company can make that claim.

  • Report this Comment On August 21, 2009, at 2:03 AM, BruinAlum77 wrote:

    Thanks, mavrant for your comments.

    My own personal physician says the same thiing. For every appointment where I actually spend see a doctor, I've got to make calls to the insurance company to make sure I can see that particular doctor. For every service I use (doctor visit, blood work, x-ray, scans, etc.), I will get duplicate paperwork from the insurance company and each service provider, saying in large letters "THIS IS NOT A BILL," followed a few weeks later by an actual bill by the service provider, saying that my insurance didn't completely cover their fees. Then I get to go back and forth between the insurance company and the service providers to determine why I am getting a bill for something supposedly covered by my insurance.

    Private health insurance contributes absolutely nothing to improving health care; why should they even be in the equation? And for all those people who are concerned about the quality of their future care, why can't you just continue to buy your private health care plan? Nothing in Obama's plan calls for people to give up a plan they like.

  • Report this Comment On August 21, 2009, at 2:59 AM, fatcatbasher wrote:

    witch hunt is not exactly a bad idea. If we have done this to those wall street fat cats early on, we could have avoided the financial crisis brought on by their

    filthy greed. So be wise this time. I will say don't give in to those insurer fat cats and their cronnies (Depulicans) and the fatcat wannabes (Democrats moderates) and some narrow-minded beneficiaries of the current system. I feel shamful to be an american if we can not even take care of our own people ( the 45 millions without health care). I totally agree with Obama that we have waited too long for the universal healthcare. I fully support the public option to keep the private insurers in check. Without that, the insurers can charge whatever they want and discriminate on whoever they cover.

  • Report this Comment On August 21, 2009, at 5:20 AM, defridgerator wrote:

    the Hedgehog wrote; "Did I choose my disorder? Nope. So, why should I be denied a service that you can get for a low price? There is very little else in life that you and I don't pay the same price for except health insurance. Gas costs the same. Assuming I'm a good driver (I am) car insurance costs the same for those in my age group. I'm not discriminated against when I buy a TV or a car or groceries. But, health insurance? Unobtainium"

    Insurance companies, believe it or not, are about making money. To that end, they won't insure people who are pretty much guarenteed to cost them a lot of money insuring. It's kind of like gambling, the house at the casino's always win. They're gambling that the normal jo-schmo who signs up for insurance isn't going to have too many problems in his life.

    Sucks for you.

  • Report this Comment On August 21, 2009, at 7:19 AM, Brazos905 wrote:

    There are other things the government can do to make health care more affordable and insurance available before we turn our system into a failing Canadian or European system (those are going broke, as you know). Government can get out of the way, remove the restrictions on selling health insurance across state lines to open up competition (what they say they want--more competition), allow people to group up for more leverage with insurance companies, and perhaps set up state run "insurance as a last resort" similar to auto insurance or home owners' insurance when for-profit companies won't insure the person. When compared to the unreimbursed expenses of ERs, this approach surely won't be more expensive. Hospitals not having to give free service for those who can't pay might just be willing to pony up something to support this insurance fund. But don't kill the cow to get cheaper milk! In the end you won't get any milk. Not to mention we can't afford another $ trillion boondoggle.

  • Report this Comment On August 21, 2009, at 8:06 AM, HJR wrote:

    If government can do a better job of running health care, how does one explain the current fiscal crisis? Was not the fiscal part of government (banks, securities, home loans, etc.) overseen by multiple layers of government? And with decades of experience to work out the "bugs" inherent in any new endeavor. Oversight is on thing. Being in absolute charge is quite something else.

  • Report this Comment On August 21, 2009, at 8:13 AM, stopitnow wrote:

    Government needs to get out of the way! When are they going to interrogate legislators who raided the social security fund? government intervention will cost us dearly in the free market system. By the way who gets the profit from GM if they do make money?

  • Report this Comment On August 21, 2009, at 8:52 AM, donaldo15 wrote:

    The bottom line is this. There are some simple solutions to fixing healthcare without a government overhaul. This administration knows that and the American people know that. This is really about passing the far left agenda and Big government deciding whats best.

  • Report this Comment On August 21, 2009, at 9:01 AM, ziq wrote:

    So if you're correct, private health insurers have no more to fear from a public option than UPS and FEDEX do from USPS, and they should quit bitching.

  • Report this Comment On August 21, 2009, at 9:41 AM, voelkels wrote:

    I’ll agree that the U.S. government should do something about health care. Maybe they should start with the VA system. When I enlisted in 1960, we were told that the government would take care of us while in the military and even after we were discharged and have service related disabilities. Turned out that it ain’t necessarily so, just ask any vet who tries to get care the last few years - it’s a mess.

    During August 29, 2005, Hurricane Katrina came ashore with the center near the LA-Mississippi state line. Levee breaks flooded much of New Orleans including both the VA and Charity Hospitals. Four years later and both Big Charity and the VA medical centers are closed and the powers to be (or want-to-be) are still arguing about (re)building both hospitals. Tulane Medical Center, just down the block, has been up and running now for more than a couple of years. Of course, Tulane is a for profit hospital.

    While they are at it, maybe congress can also fix the problems with the Medicare and Medicaid systems.

    C.J.V. - glad I don’t hafta use the VA system - yet, me

  • Report this Comment On August 21, 2009, at 9:44 AM, llpate7 wrote:

    Thoughts concerning the health care issue:

    Why are the Dems so determined to pass HR3200 without proper bi-partisan debate? Is it because they know that the bill will not withstand rigorous debate. This is all about power.

    Some suggest readings:

    1) Atlas Shrugged by Ayn Rand

    2) The Peter Pyramid by Dr. Laurence J. Peter (The Peter Principle )

    3) The Greedy Hand by Amity Shales

    These give a good idea of out of control government power and spending

    Eagle48

  • Report this Comment On August 21, 2009, at 9:45 AM, donaldo15 wrote:

    If I am wrong why wouldnt they first consider Tort reform? Why wouldnt they open up competition so that insurers can sell across state lines? It's about choice and affordability right? Why wouldnt they pass legislation to require insurers to cover preexisting conditions if someone loses their job and needs to switch plans? Why wouldnt they pass legislation to prevent insurers from dropping someone when they get sick? Why are the administrations poll numbers dropping so rapdily?

    Your dealing with nearly 20% of our economy so stop the comparisions with the Post Office. That's a ridiculous argument

  • Report this Comment On August 21, 2009, at 9:50 AM, plange01 wrote:

    its time to put a end to the ridiculous health care plan obama spent about a week slapping together.with the US 8 months into a deression there is more important things to do.....

  • Report this Comment On August 21, 2009, at 9:55 AM, Scoobrs wrote:

    I should point out that the latest Blue Dog model for reform is healthcare co-operatives, specifically Healthpartners of Minnesota and Group Health of Washington. Yesterday, the Healthpartners CEO came out against using her corporation as a model because while co-ops may address some of the overhead costs, but it does nothing to address the rate of skyrocketing costs.

    http://minnesota.publicradio.org/display/web/2009/08/19/heal...

  • Report this Comment On August 21, 2009, at 9:55 AM, dagrman wrote:

    I'm not sure what the concern is over the impact to private insurers by a public option. Who do you think is going to administer the public option? Probably the private insurers - the same ones that administer Medicare. They'll take their fees for processsing and do just fine. And it will be the same ones who tell you today whether a service is covered or not. Big deal.

    Let's get the focus back on the real issue - making healthcare affordable. Someone what to remind me what's driving up costs? Is it the high price of malpractice insurance? Having to indirectly pay for care for the uninsured? What else? I was really hoping someone would drop all the spin and rhetoric and dispassionately analyze the problem.

  • Report this Comment On August 21, 2009, at 9:58 AM, 4wheeldrifter wrote:

    First, health care costs must be addressed. I have no answer for how to go about this. This is the equivalent of a five man team re-creating the Great Wall of China in a week.

    Tort reform? Yeah right. Only if an asteroid hits DC today and takes out all the corrupt polititicians, lobbyists, etc. THAT is the number one problem facing not only health care but every other policy decision in this country. Your pols are bought and paid for by the highest bidder. The Tort lawyers have nothing else to spend their dough on but buying protection for their bidness.

    If nothing else, it would be prudent to (somehow) do an independent study to determine where the beau coup dollars going into the health care industry actually end up.

  • Report this Comment On August 21, 2009, at 10:04 AM, Scoobrs wrote:

    Tort reform doesn't attack the root causes of the problem: wrongful judgements and malpractice premium rate hikes.

    Firstly, capping judgements does not address the problem of wrongful judgments in the first place. Better jury instructions in OB/GYN cases do. The reason why the industry is attacking a symptom instead of the root cause of rising legal payouts is because it protects large corporations like drug companies from full liability in cases of willful negligence.

    Also, the problem isn't so much rising payouts as rising premiums. From 2000-2006, malpractice premiums increased over 100% while malpractice payouts increased only 3%. The malpractice insurance corporations have increased their share of profit in recent years and haven't been held accountable.

  • Report this Comment On August 21, 2009, at 10:06 AM, andsotowork wrote:

    As an English woman temporary in France I'd just like to say that the British NHS does a great job and is free at the point of delivery. More than that I can check the success (or failure) rate of my chosen Doctor or hospital. So living in France is it better than the NHS. I would say not, France may be number one in the world but much of the NHS equates with it. If I was an American I would be ashamed that 48 million people were without health care and that many more were finding it difficult to fund. I think its time for people to see that other systems can work.

  • Report this Comment On August 21, 2009, at 10:09 AM, expatriot08 wrote:

    It is disappointing to see the amount of angry people. I know the government is not a lean efficient machine, but neither is any big business. I assure you that that big business does not have the patients best interests in mind. Why shouldn't the government have some type of coverage to keep people for going bankrupt, being excluded for existing conditions , etc.

    Lets come together and be reasonable. We can fix this in our own american way. It is so sad to see these extreme people on tv. America looks like a terrible country, we can't go on like this.

  • Report this Comment On August 21, 2009, at 10:15 AM, HSHEnterprises wrote:

    My, My. Lots of heartfelt opinion but so little data. Kind of interesting that net profits are down 21-78 percent in "08 from the average of '06 & '07. Questionable and interesting. Like to see the analysis of why. I think it is because they knew the scrutiny was coming.

    This whole fight is over the hugh cash flow that the healthcare industry throws off. Vested interests in every medically related field are out to defend their well paid lifestyles. It's everybody's God given right to have 2 or 3 expensive cars and a mansion in the Hamptons.

  • Report this Comment On August 21, 2009, at 10:20 AM, enuffofthis wrote:

    How much more government medeling in your life can you tolerate? People have somehow come to the point of wanting to be told - how,when, where and why. The more you depend on the government to do,the less we become individuals. The government is already over sized and over baring. We don't need another

    "program" costing tax payers millions more dollars with less than acceptable results. We do need to get control of health care cost. Investigate the cause and create the cure. If we just throw our hands up in the air and allow more control of our lives to go to the government,we may as well all live in a prison. Health insurance is there for major medical problems,not cut fingers and stubbed toes. Use a little common sense. That in itself would be one way to help keep the cost of insurance down. Just one small step,I know but some times it takes lots of small steps to reach a goal.

  • Report this Comment On August 21, 2009, at 10:50 AM, gesheddc wrote:

    Witch hunt? I respectfully disagree. . . Something drastic needs to be done to reign in the abuses of the the private health care insurance companies.

    The public option is a means of doing this. I recommend that people interested in this issue read the transcript of the “Bill Moyers Journal”

    program which devoted an hour to the health care issue on July 10, 2009 (see cite below).

    One point made in the show by Mr. Wendell Potter, a former CEO of Cigna, was that over the last few years, there has been allot of consolidation in

    the health industry. Aetna in particular bought up many smaller insurers. Then, in a very few years, Aetna , which had had about 21 million members after its period of consolidation, “shed 8 million members”. Mr. Potter said many of this loss of members was a direct result of Aetna’s policy to get rid of its less profitable accounts in order to make its business more profitable. “Many of [the 8 million people] undoubtedly joined the ranks of the uninsured, because their employers had been purged.” To read the whole transcript of this July 10 show, or to listen to it, go to

    http://www.pbs.org/moyers/journal/07102009/watch2.html (One may also just google the five words “ “health care” bill moyers journal “, and the very first

    entry will be the site where the transcript and pod cast of this July 10th show are to be found.)

    . . . I have not heard seriously disputed, the point that we in the U.S., as a whole,

    spend considerably more on health care than many other developed countries with public health care, and we as a nation have inferior health results. So I say, it is time to implement a public option.

    Let me also say here, that I have several times read or heard experts quoted as saying that Americans work harder than almost any other group of people. They continue to grow their

    productivity. It is therefore simply unfair, when people with middle class and less than middle class inc

  • Report this Comment On August 21, 2009, at 11:40 AM, jsamans wrote:

    Mr. Orelli finds it "funny how the government seems flabbergasted by companies in a capitalistic society making money during a crisis."

    To me, the "funny" part is that people like Mr. Orelli consider it perfectly normal that there be a profit motive attached to treating illness and saving lives.

    The "crisis" to which he refer is the crisis of Americans every day dying preventably.

    Those people can and ultimately will be your friends, relatives, and children -- maybe even you yourselves. And yet you all sit here and talk about how wonderful it is that these companies make large profits denying care to people and pocketing premiums.

    It's beyond sad. It's sick. It's an illness - one that you're self-medicating with your big dividend checks, but they won't help you when your time comes.

  • Report this Comment On August 21, 2009, at 11:41 AM, bretco wrote:

    Firstly, Brian, What sloppy writing. A witchhunt ? The Insurance indusrty IS a bunch of Devils that so deserve an investigation. Of course they are entitled to make a profit but as with any cartel they should be regulated accordingly. Their overhead bloat, their unjustified claim denials, used as a matter of course, their dropping the truly sick, their connections with the litigation industry, their lobbying machine, etc., these are greedy, blood-sucking exploiters in the spirit of Madoff and the good folks at Lehman, Citi, et.el.

    The comments from the readers are generally astute, and show the folly of Brian's posit about a witch hunt.

    The SOB's deserve to have their chestnuts roasted by Congress, along with the tort guys and all the polititical hacks taking the Lobbyist's monies.

  • Report this Comment On August 21, 2009, at 11:48 AM, donaldo15 wrote:

    Interesting comments. I thought Obama was going to change Washington (not America!). Yet I see Tort reforms are impossible and the country is more divided than ever. What a shameful mess.

  • Report this Comment On August 21, 2009, at 12:03 PM, RichardRussel wrote:

    As with most things governmental, the devil's in the details. Do we want our government to pay for abortions? Do we want our government to counsel old, sick folks as to whether or not they should end their lives? Do we want to pay for any program of this magnitude run by our federal bureaucracy? Look the V.A hospital system! Do people want some federal clerk deciding whether or not we get the surgery we might need some day.

    Our federal government can't even run a simple "cash for clunkers" program. I'm all for legitimate health care reform, but this ain't the way to go.

    We need to be able to purchase health insurance across state lines and end the intrastate insurance monopolies. We need address the issue of payments by patients to hospitals over and above what insurance companies have agreed to pay. We need the insurance companies to refuse to pay for hospital waste.

    How about more assistance to local taxpayer financed hospitals?

    Richard Myers

    Fort Worth, Tx

  • Report this Comment On August 21, 2009, at 12:40 PM, theHedgehog wrote:

    Richard Myers posing as RichardRussel mused:

    "Do we want our government to pay for abortions?"

    Is there some reason why we wouldn't? Some valid reason, that is, that's not bound to YOUR moral code.

    "Do we want our government to counsel old, sick folks as to whether or not they should end their lives?"

    I don't like to see this lie. I don't like to see it in print, and I don't like to hear it in person. Someone with the ability to get a Fool id should have more sense than to make this particular lie and have it associated with their userid. In short, this is a lie.

    There is nothing in the proposed bill that counsels people on ending their lives. Instead, there is something to counsel people on having good procedures in place when their life ends. If you can't understand that simple difference, then how can you string two sentences together with the proper grammar and syntax?

    Having a will, a living will, and designating power of attorney to a trusted individual is not counseling someone to end their life. Get a grip. Tell the truth on this one and stop perpetuating this lie!

    "Do people want some federal clerk deciding whether or not we get the surgery we might need some day."

    And the difference between that and an HMO clerk deciding whether or not you get the surgery is what?

    "Our federal government can't even run a simple "cash for clunkers" program."

    Cash for clunkers has been wildly popular. It was extended once, and will be ended on Monday. The money getting to the dealers has been slow, but the buyers seem to have done OK.

  • Report this Comment On August 21, 2009, at 12:53 PM, stonebusted wrote:

    I believe the situation is over thought. I have found a good decision is based on weakness, strength and honesty with your ownself.

    Lets look at the old concept.

    Drs usually lived in the neighborhood they serviced. If someone was sick often the Dr. would come to the house to treat the person. Insurance was practically non-existant so it was like paying the plumber or electrician. Drs generally were above average in income but nor mega paid. I suppose they had their heart in it. Technology was nothing like today's, the population was smaller and everyone was happy, unless they had an incurable. for that time disease.

    There was an insurance called major medical for really expensive treatment, but not everyone had that.

    Here come Mr. Greed. Unions had been active in getting workers fair wages and treatment, generally. A little greed, but what the hey, greed is a human trait. The professionals of the world realized that if %s were taken off contributions they could get rich. Of course what was left after the skim needed to go toward something and medical care was a good place to start along with pension funds, political action funds and on. The bigger to contribution the more skim $$.

    Health care money was skimed by the union lawyers, accountants, then to the insurance companies. Under the skim system there is no incintive to control cost. The more spent the larger the skim. They need an MRI. Send (2) bill for (3).

    Drs., never fools, see this and say give to me too.

    Goes back to the problem with the country: Lawyers, unions, and hucksters. Barack has no more chance than Jimmy Carter did.

    As for me! Gimme, gimme, gimme.

  • Report this Comment On August 21, 2009, at 1:28 PM, RDH65 wrote:

    Why are we even talking about Health Care "Reform" at this time when our deficit is growing out of control and our economy is sinking into oblivion? Now is not the time to be adding another $1 Trillion program and that number is probably very conservative, remember Medicare was supposed to cost far less then what it ended up costing. Nor is this a time to raise taxes on anybody, we need the capital in the private sector creating jobs where people can pay for their own health care instead of looking for a government handout. I put "reform" in quotation marks because every time the government uses reform, it always seems to end in bigger government and less freedom. You want to lower costs? Two words - Tort Reform! You say that countries like Mexico and Cuba spend far less of the GDP on health care then we do? Guess what, they don't have costly lawsuits driving up the cost of malpractice insurance for their doctors.

  • Report this Comment On August 21, 2009, at 1:30 PM, RetiredGamer wrote:

    really, I just want health care. I don't care where it comes from. The problem is that free market, a company takes the most profitable route. In the case of health care that route can (and does) kill people. I don't care about the politics... I just don't want to be unable to afford access to basic medicines that I could probably get just fine in a developing nation. Regardless of the outcome of this mess, we need to be able to get people penicillin, flu shots, etc... right now, those things aren't even available to everyone.

  • Report this Comment On August 21, 2009, at 2:01 PM, theHedgehog wrote:

    RetiredGamer has it right when he says: "really, I just want health care."

    Although, I'd put it this way: "really, I just want health care without having to file bankruptcy after a major health event". Because, dear reader, if you lose your health insurance and then need major surgery or get cancer, bankruptcy and poverty are probably in your future.

  • Report this Comment On August 21, 2009, at 2:07 PM, crokay wrote:

    Basic comprehensive medical care should be provided to every citizen. This is the standard of care one could expect to receive over a normal life span. This care would start with the “standard care guidelines” used ten years ago, or new standards established by the world health organization. These standards would be reviewed and revised by each medical specialty, with an oversight board to provide equality for each specialty. Defining the program, would make it cost accountable. It would also prevent patients demanding the latest and most expensive treatment when older effective ones are available. The cost of the program provided by the government could be tagged to a percent of our GDP. This would guarantee sustainability. The elimination of Medicaid, Medicare and other entitlement programs, along with dramatic savings from coordinating and simplifying administrative costs, could make this economically achievable. Medical practice emphasizing preventative medicine with early diagnosis may add to the savings. This program could be administered with minimal increases in cost or impact to the existing tax structure. A fee for service- single payer-private physician model should provide care universally. Medical care beyond the basic guidelines would be ones own individual responsibility. This additional coverage could be provided by private insurance, HMO”s, PPO’s, or Veterans Hospitals. Eliminating the cost of basic or “generic” care would make this type of insurance available and affordable to almost everyone.

    Eliminate the “concept” of malpractice. Malpractice and defensive medicine account for more than 13% of each dollar spent for health care. The cost in stress and anxiety is even greater to physicians in their daily practices. Eliminating this would bring back hundreds of qualified physicians to treat higher risk situations for which they were trained, and for which we have a desperate need. It would also eliminate billions of dollars lost to “defensive medicine” (estimated to be over 100 Billion dollars a year).

    Every medical procedure carries a risk. These risks can not be completely eliminated and although rare, injury or disability is a fact of any medical treatment. Instead of litigation, there should be pool from which all injured patients would be compensated equally based on the injury or disability incurred. This “injury pool" would be funded by physician assessments based on their specialty.

    Complications of various medical treatments are well documented in the medical literature. A compensable injury could be defined as results that lie one or two standard deviations outside the expected norm. These expected results could also be used as a basis for predictive modeling of compensation.

    The right to sue is guaranteed by the constitution, but if people are treated equally and fairly, cases going to trial will rapidly fade. There will always be a large area of legal medicine. With this plan emphasis will shift from destructive to creative methods of medical care delivery.

    The basic coverage must include standards for quality of care. With the threat of legal action diminished, I believe quality will improve. Physicians would be expected to recertify at regular intervals, oversight rules would be stringent and discipline would be applied through established mechanisms with independent input.

    This is a two tiered system of care witch may seem like an anathema to some, but providing the highest level of care to the largest segment of our population at a definable and sustainable cost should overcome any potential criticism

  • Report this Comment On August 21, 2009, at 2:11 PM, Webvent2001 wrote:

    Read Neil Cavuto open letter to Mr. Waxman

    below:

    Dear Congressmen Waxman and Stupak,

    What a pleasant surprise. Here I thought you were too busy crafting a health care reform package, but you took the time to write me. My bad, assuming you were too busy crunching numbers to pay for this without going on a witch hunt, seeking numbers that really have nothing to do with this.

    Regardless, I'm happy to comply.

    But while we're needlessly rifling through our records, readily available for you on the Internet, would you mind doing the same? Because we've had a devil of a time finding your records on the Internet or anywhere else. Specifically, Congressmen, when you ask about our corporate retreats, might we inquire about yours? When you demand to know how we got to those retreats, may we ask which of your private planes got you to yours? And when you're asking us to account for policy premium money spent, might you be so kind as to forward the same information about the considerably larger taxpayer sums you've been spending?

    Or, perhaps, Congressmen, might we put all this nastiness aside if you merely accept the enclosed check as a down payment, if you will, on our industry's new ad campaign supporting your reform efforts?

    We know that seemed to do the trick for our golfing buddies in the drug industry. They had told us this would be so much easier. Silly us for quibbling.

    Again, Congressmen, I'm sure we can work something out. After all, who has time to check paperwork, when a simple check will do?

    Right?

    Sincerely,

    Lucifer Life,

    Chief Executive,

    Evil Health Insurance Corp.

    P.S. We regret to inform you that regardless of the above, there simply is no coverage for pre-existing political weenies. But we'll do our best to find something suitable for your slimy condition.

  • Report this Comment On August 21, 2009, at 2:30 PM, altohorn60201 wrote:

    Boy are you wrong on this one. Insurance companies make their money on turnover. The more uneccessary work done the more they profit no matter how narrow their margins. For example read Atul Gawande's editorial in the New York Times last week, identifying high and low efficiency areas in the US. A western community of 300,000 people had 62000 CT scans in one year as I remember. An incredibly dangerous radiation exposure and don't tell me they were all clinically indicated or that premiums in that community didn't more than cover the cost to the insurance companies.

    I am an American surgeon working in the NHS in the UK and we deliver better care, less rationing than I experienced in my practice in Chicago at less than half the cost. Why do people assume that insurance companies will be more accoutnable to their needs than their elected representatives?? Yes a long overdue witch hunt.

  • Report this Comment On August 21, 2009, at 2:32 PM, 0BamaSocialist wrote:

    Keep in mind that while the gov't is requesting confidential information from the insurers that are expected to "compete", the gov't OWNs AIG and has no intention of generating competition, only CONTROL. If they control all insurers, they control your healthcare and thus they control you and guess what? According to the public option guidelines, you do not qualify for medical service. Please contact your local senator or politician to schedule a doctors visit. We're sorry your doctor has resigned. You will need to visit one of the public option clinics and maybe you'll get to see a gov't nurse. Good luck!

  • Report this Comment On August 21, 2009, at 2:34 PM, SoInteresting wrote:

    I just have a few questions:

    Where are the funds going to come from to pay for this?

    Can someone tell me why people should not pay for a service. If you do not think that health care should have a cost and that it should be free - remember the saying that "you get what you pay for".

    IF it is really "only" going to cost a Trillion or so dollars as reported by the CBO, then why not just use that money to simply build and run 1 or two hospitals in each state just for people who are uninsured. Seriously. If a Hospital costs an estimately $10M-$20M to build, and you put 2 in each state (3 if necessary) and let's say it averages out to 100 hospitals in the USA, then we are looking at a building cost of $2 Billion. Even if the hospitals cost $50M to build, then we are looking at "ONLY" $5Billion.

    So what if the 45 Million uninsured paid a flat fee of $100 (per $1000 NET income) as a premium per year, and let's assume that the average income of uninsured is 30,000, then the premiums recieved by the uninsured would be $3000 per person [Let's assume that there is only an additional $20 per $1000 net income to add family memembers). For a family of 5, you are looking at $4800 per YEAR.

    If you multiply that times 45 MILLION uninsured (assuming that number is correct) then you get $21.6 Billion a year in funds to operate those hospitals. Let's say then that the government, as the goverment will, subsidizes the operating expenses to the tune of another $20 Billion, then you have $40Billion to run 100 hospitals.

    By my calculations, my idea (which isn't by any means brilliant, costs "only" $5 Billion to start plus $20 Billion per year, which is only $105 Billion in 10 years - which is only 1/10th of the cost proposed by the governemnt and preliminarily estimated by the CBO.

    *****************

    On a final note, I notice that very few of the advocates for the Health care plan proposed are actually quoting the BIlls. Can anyone explain to me what the bills state.

  • Report this Comment On August 21, 2009, at 2:40 PM, dymty wrote:

    Do the numbers quoted in the article include monies paid for lobbying? Bloomberg seems to be saying that there are six healthcare-related lobbyists per congressman. I'm sure they don't live on peanuts and free air. And I'm sure that advertising will place an unfair burden on private insurers competing against a public plan.

    Also, I didn't see anything in the bill that stated that the government was getting into the medical equipment procurment process.

  • Report this Comment On August 21, 2009, at 2:51 PM, theHedgehog wrote:

    SoInteresting wrote: "On a final note, I notice that very few of the advocates for the Health care plan proposed are actually quoting the BIlls. Can anyone explain to me what the bills state."

    Nope. But, on the other hand, most of the rhetoric from the hatist side has little to no foundation in fact, and is fundamentally only obstructionist in nature.

    We will eventually see what is in the bill. It won't contain any "kill granny" clauses or any of the other rubbish that the obstructionist right continues to rail about. Will it pass? Our children and grandchildren hope so.

    Hedge

  • Report this Comment On August 21, 2009, at 3:33 PM, mmagyar wrote:

    The health care debate is one where everyone should take responsibility for the state of our healthcare system. Good health starts with the individual and the life style one chooses. From my own experiences, I have seen many live foolishly when it comes to a healthy lifestyle. They have insurance and don't have to worry about the costs so they do what ever feels good without considering the consequences of the choices in regards to the foods they eat, and how they live morale life styles. We want more and more from our health sytems but do less and less to stay healthy and expect everyone else to subsidize for it. I find it disturbing that those with pre-existing conditions cannot get healthcare on their own without paying through the roof. I am always frieghtened when the governement gets involved in our lives. There are always more problems and inefficiencies with constant cost increases and no one is held responsible for bad decisions.

  • Report this Comment On August 21, 2009, at 4:14 PM, Cherbonnier wrote:

    Take a look at total dollars (US dollars adjusted for purchasing power parities (PPPs)) spent per capita for advanced countries to see how screwed this country's citizens are:

    http://www.oecd.org/dataoecd/46/4/38980557.pdf

  • Report this Comment On August 21, 2009, at 4:55 PM, Irishlace wrote:

    First - for Waxman to send out a letter to insurance companies requesting this information, smacks of intimidation. I hope, just for that fact alone, the insurance companies don't knuckle under, and fight the request. Second - how about a few answers from our government - like - how much was the luau that was just throw for Congress hosted by Mr. & Mrs. O - replete with dancers, chefs, and copious amounts of food flown in from Hawaii, (how's that carbon footprint story working for them)! It's okay for Congress to party on our nickel - but not anyone else? Why did Pelosi need a new jet....she couldn't use her predecessor's? How much did that cost? Why does Congress need 8 NEW Gulfstream jets? Never heard of teleconferencing some of those meetings - to cut down on the carbon footprint - especially when the American public is being called on to scrape what the gov't deems "clunkers" to help green our environment? And WHY - are we giving $2 billion to Petrobras to drill in their own backyard? How about giving the American public some answers?

  • Report this Comment On August 21, 2009, at 5:15 PM, theHedgehog wrote:

    Once you've lost the debate on health care reform what's left to do? Move the goalpost.

    Well done.

    Hedge

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

    1. Son-in-law denied the proper antiobiotics for a bone infection. Now has a permanent disabling condition which will require continuous treatment the rest of his life. Cost for the latter much more expensive than treating the initial problem effectively.

    2. Insurance companies set the rates for malpractice using the same lying tactics being used for health insurance, etc. (No I'm not a lawyer or involved in the medical industry) They should be asked about their accounting practices which hide the profits made from moneys set aside but not reported for "potential" law suits.

    3. I'm appalled at the behavior at town meetings. Is this the America I was brought up in? Perhaps parents and our education system and some of our legislators need to teach and show young people about free speech, treating respectfully those with different ideas, listening to opposing points of view in hopes of learning something, etc. I say "young people" because I fear it's too late for those who are older, but definitely much less mature.

    4. Those who want to ensure that Obama is a failure as a president (and they have stated so publicly) have stirred those who don't understand they are being manipulated. What has this country come to? And can it be saved?

  • Report this Comment On August 21, 2009, at 5:58 PM, artbros wrote:

    "We have met the enemy and they are us."

  • Report this Comment On August 21, 2009, at 6:12 PM, bmialone wrote:

    This article/essay is a load of baloney and so ignorant about successful healthcare models we can look out outside of our own borders, in countries with high standards of living.

    Yes, medical providers themselves are very much a part of the problem, but the insurance industry made record profits in 2007 and 2008, so they aren't suffering, at all.

    I want to know how much the head of Regence BlueCross/BlueShield makes since it is supposedly non-profit, yet still tries not to cover my 23-year-old son for simple and infrequent medical costs despite raising the premium we pay for his policy multiple times in only three years!

    Furthermore, the only reason medical insurance companies aren't keeping more for profits is because, out of the blind pursuit of ever higher profits, they've become so inefficient it boggles the mind. The only way companies can be That inefficient and still survive at all is by gouging the consumers, squeezing even more out of us to save their sorry behinds.

  • Report this Comment On August 21, 2009, at 8:58 PM, MaryHALamb wrote:

    CEOs of health insurers make most of their big bucks from Stock Options and not by drawing it out of the company's income and profit. Stock price increases that are passed onto the CEOs via options do not cause health insurers to raise premiums to cover these payouts.

    The reason that premiums rise is that costs rise, use rises, fraud rises, lawsuits are epidemic. Insurance premiums are a function of doctor costs rising, test costs rising, drug costs rising, hospital costs rising and lawyers.

    Look at your bills from doctors and hospitals and see what you would pay if you didnt have insurance ... $70 for an ACE bandage? ... insurers act as buying groups to keep costs down by pre-negotiated rates.

    And who ever goes to the doctor and says "How much will this cost? ... or ... "Is there a cheaper way?" ... No one. So you get the bill with the $70 ACE bandage and say "So What" ... " Insurance will pay".

    The white coat "perfect" doctors and providers get away with murder. And why are so many doctors relatively rich? Being a doctor in the USA means being rich.

    BTW .. Germany has a combined public and private approach ... it works ... ya know why? ... Doctors make a fraction there than they do in the USA .. in fact German doctors go to practice in Sweden and UK on weekends to augment their income.

    So Doctors going to take a huge paycut? Hospitals going to stop charging $1500 for being mostly ignored, havinbg your vitals taken eventually and not otherwsie being treated?

    Going after the Insurers is a Witch Hunt because it is easy ... they are a part of the problem but just a part ... and probably not even close to the biggest part.

  • Report this Comment On August 21, 2009, at 9:18 PM, whippoboy wrote:

    Purely from personal experience I cannot say enough bad things the health insurance companies. Mine is UHC. At age 55 I have experienced a wide range of insurers and I am cynical. However, I have been stunned by the blatantly unethical and dishonest behavior of this company. I have repeatedly been told that there are no records of phone calls, no receipt of faxes, and basically that my pursuit of claims just never occured. They have even managed to deny treatment by network providers. And,yes, I have contacted insurance regulators, who admit that are overwhelmed with complaints and that a claim of only 1-2K is not enough for them to bother with. Furthermore, I have talked to former insurance company providers who say that they were explicitly trained to continually deny claims. So UHC and others have hit on a highly profitable strategy; put as much burden as possible on the weakest links in their pursuit of payments. As one of my doctors told me "they prey on the elderly, sick, and weak."

    Unbridled capitalism is not always the answer: 10 years ago a doctor told me that "you are a perfect candidate for hip replacement surgery." Of course, it would work for him since he was a surgeon. I did not have the surgery and I am still playing tennis.

  • Report this Comment On August 22, 2009, at 8:57 AM, sails2 wrote:

    Without change our economy will be less competitive and that, I am sure we all agree, will lower our standard of living. Major business organizations support change as does groups like the AARP.

    Those who say everything is fine and we should keep the government out of it probably have had little experience with the health care system. My wife and I have.

    My wife had early stage breast cancer last year. Our insurer initially would not approve the radiation plan her doctor wanted to use. We have one of only two such plans he told us. Yesterday I got a call from the hospital telling me that she had not met her deductible yet this year. I asked them to check again. Of course we had. Talk about inefficient!

    I have had to call the insurance company regarding just about every major claim we have had. Our claims are now "red flagged" as a matter of course.

    We pay twice as much for health care as our competition (Canada, the EU). The results we see are not as good (life expectancy, infant mortality etc.). A car built in Canada accross the river from Detroit has a $600 cost advantage based on the lower cost of Canadian health care. We have to compete for the sake of our children and grand children if for no other reason.

    In business we watched the competition to see what we could learn (retired now). Just what is wrong with doing the same regarding something like health care? The President has talked about examples of "best practices." Should we not consider some of these for a segment of our economy as big as this?

    What is wrong with Senator Snow's idea of a trigger point for the health insurance industry: "If they do not meet a set of specified goals, then we are allowed to select Public Option on steroids."?

  • Report this Comment On August 22, 2009, at 9:28 AM, nogrthinker wrote:

    Medicare 'Advantage' insurance? Really strange. I have a plan through AARP, and that's probably why I haven't torn up my AARP card, but the extra insurance is costing me NOTHING? The plan is actually subsidized by the government. It's sort of like 'Medicare squared.' I doubt that most people on Medicare are even aware that there is an 'Advantage' option that doesn't require them to pay extra in premium. Is it ethical or moral? I don't know, but I've got it.

  • Report this Comment On August 22, 2009, at 1:18 PM, Beanfarmer wrote:

    Earlier this week, Congressmen Henry Waxman and Bart Stupak sent letters to 52 health insurers requesting a host of information, including salaries and bonuses of top executives, costs of conferences and retreats, and the margins on the companies' products.

    Sounds like McCarthyism to me. As you note, in a capitalist society we expect and even congratulate our public companies for earning a profit.

  • Report this Comment On August 22, 2009, at 5:33 PM, danlucas wrote:

    Many do not realize we cannot continue with the same broken health care system. Many working Americans cannot afford healthcare. Those not working probably do not have health insurance. Where do these unfortunate souls show up when ill?? At county hospitals tat we all pay for. many of these castastrophes could be prevented if we had some option for those that truely cannot afford coverage.

    Another area that is underpublcized is tort reform. Many docs play defensive medicine, meaning they order costly tests, not because they are necessary, but because of fear of being sued.

  • Report this Comment On August 22, 2009, at 7:40 PM, theHedgehog wrote:

    danlucas wrote: "Many working Americans cannot afford healthcare."

    It's not just "many", it's about 50 million.

    "Those not working probably do not have health insurance. Where do these unfortunate souls show up when ill?? At county hospitals tat we all pay for."

    If they are unfortunate enough to have any assets, a major medical event will bankrupt them. The medical provider will come after any and all assets that can be attached. And, if you think that your primary residence is beyond their reach, you'd better check your state laws. You may find that only a nominal amount of your worth is judgment proof.

  • Report this Comment On August 22, 2009, at 8:33 PM, CHRIS73DAVIS wrote:

    The American electorate is so policy ignorant, it actually believes it will receive future benefits from two entitlement programs whose combined actuarial deficit is 3x current GNP. This isn't even worth debating - while, meanwhile, Nancy Pelosi is assuring the ship of fools it can take on 50m more passengers!!

    23 out of 24 OECD nations have already addressed the healthcare issue and have all arrived at the same solution: RATIONING. The Democrats are doing everything they can to obfuscate this mathematical reality: they cannot possibly deliver today's benefit menu to tomorrow's seniors.

  • Report this Comment On August 23, 2009, at 1:50 PM, KVoce2 wrote:

    I disagree with the author's statements about government run plans being inefficient. Look at the overhead costs for Medicare compared to private insurance and they are a mere fraction. Sure, insurance companies should make a profit, but at the expense of human beings?? That's what's happening in this country. The vast numbers of uninsured people (not products....PEOPLE), are largely the result of purges initiated by the insurance industry to boost profits. This is a human rights issue. Health care should be a right, not a privilege. Government run programs in other developed countries care for people efficiently, and no one is left out. Stories of rationing in those countries are just that: stories. Rationing of health care and waiting lines are a fact in THIS country, not others. We face a national rebellion by the uninsured masses if something is not done.

  • Report this Comment On August 23, 2009, at 2:09 PM, wolfman225 wrote:

    Please. Before you start on how "efficient" government programs are using Medicare/Medicaid as examples, check out the actuarials. The programs are GROSSLY underfunded and unsustainable. Their future unfunded liabilities dwarf the projected federal debt! And we all know how accurate the U.S. Government is with it's financial projections. As for your claim that stories of waiting lines, rationing, and denial of care in other countries being "just stories" Could you provide proof (other than your opinion)? Do you have any documentation that the claims of people who have dealt with the nightmare that is nationalized healthcare are, in fact falshoods?

    The United States has the best healthcare available anywhere on the planet. Unfortunately for the whineys who want everything to be "free", the best costs money. Without the "outrageously excessive profits" you decry as somehow immoral, none of the innovation that has greatly benefited people the world over would have come to pass. A single new drug/treatment can take decades and billions of dollars to create. That money has to come from somewhere.

    As for the "national rebellion by the uninsured masses", we can start by sending some 12-15 million of them (illegals) back home. Most of the rest can afford insureance, but CHOOSE NOT TO.

  • Report this Comment On August 23, 2009, at 3:03 PM, ET69 wrote:

    As a geriatric doctor let me throw my 2 cents in regarding the big picture. The idea that you can run a healthcare system rationally based upon freemarket capitalism is an oxymoron.Until you take the profit OUT of the system and nationalise all the pharmaceutical and insurance companies and the private hospitals , clinics and medical staffs, including doctors-you will not have a rational healthcare system.

    In addition, with the exponential growth in medical advancements and the ability to prolong life the costs will explode under any system you have. We must address end of life issues and just how much money and resources we intend to spend on prolonging life, especially the last couple of years of life as that is were the bulk of our expenditures go.

    Lastly as long as you have a capitalist system running health care -lawyers will be a bane to rational medicine.

  • Report this Comment On August 23, 2009, at 3:48 PM, Howard1ii wrote:

    Unfortunately, certain congressmen, like Waxman & Barney Frank, are only looking for sound-byte material, so they can get themselves on the national news. They will not use the small margin %'s, they will only throw out the bigger revenue and profit numbers (ignoring these companies' investments, payrolls, taxes, and other costs), and most Americans do not have a clue how these businesses work.

    Too bad more people are not "Fools," who will take the time to try to understand what is really behind these statistics.

  • Report this Comment On August 23, 2009, at 6:17 PM, ejhauck wrote:

    The late senator Patrick Moynihan [a Republican from an era when Republicans worked on a bi-partisan basis] often said that while you are entitled to your own opinion, you are NOT entitled to your own facts.

    Your declarative that the government is inefficient is NOT a fact (though under the Bush admin, it came close). The fact is that Medicare (which, by the way, is a public option for the elderly), and most single payer systems of other nations have significantly lower admin costs than our private insurance plans.

    The figures you give on private insurer net income margins would be more meaningful if we had regulations to insure these numbers are credible. After Enron and Bernie Madoff, how much faith can we place on these reports? Consider the example of the prior CEO of United Health Care who was recently rewarded with a retirement package worth $1.1 BILLION!!! How is that for efficiency and reducing costs?

    Your own example of the post office, UPS, and Fed Ex, prove that private agencies can compete with the public option IF they run an efficient operation. Why are private insurers so afraid of the public option if the government is allegedly so inefficient? Perhaps private health insurers need to be more efficient and a public option would force them to do so.

    Finally, the government is not providing health care - it is providing health insurance that pays for health care delivered. All this nonsense about socialized medicine confuses the two. Medicare [and the public option] does not run hospitals or employ a staff of clinicians to provide health care. Consequently, we are not talking about efficiencies in health care delivery - but about efficiencies in health care insurance.

  • Report this Comment On August 23, 2009, at 8:22 PM, golfer1A wrote:

    If we end up with America's Affordable Health Choices Act of 2009 being pushed by the Obama administration, be prepared to experience rationing since the annual funding must be passed each year starting in year 1 and will continue annually forever.

    Below is taken right from the House Ways and Means bill pending passage...page 71, 72 and 73

    C) APPROPRIATIONS FROM THE TRUST FUND.—

    IN GENERAL.—Amounts in the Trust Fund are appropriated to provide funding to carry out the reinsurance program and shall be used to carry out such program.

    BUDGETARY IMPLICATIONS.— Amounts appropriated under clause and outlays flowing from such appropriations, shall not be taken into account for purposes of any budget enforcement procedures including allocations under section 12 302(a) and (b) of the Balanced Budget and Emergency Deficit Control Act and budget resolutions for fiscal years during which appropriations are made from the Trust Fund.

    LIMITATION TO AVAILABLE FUNDS.—The Secretary has the authority to stop taking applications for participation in the program or take such other steps in reducing expenditures under the reinsurance program in order to ensure that expenditures under the reinsurance program do not exceed the funds available under this subsection.

    This is exactly what is happening in Canada, funding has been reduced each year during the past 2 years due to the economic conditions.

    Be aware of a "Wolf in Sheep's Clothing"

  • Report this Comment On August 23, 2009, at 9:17 PM, PrincetonAl wrote:

    "Health insurers also need to take a cue from George Michael, and have some faith that they'll be able to compete."

    The goal is to eliminate the competition, and replace it with a nearly single payor government system. So I don't know why they would have faith.

    Beyond that, ask the majority of Hospital CEOs what percentage of their Medicare costs are paid for by private insurance. I would be shocked if it is ever less than 8% - 10% ... I have seen a number go on the record stating this.

    So ... have faith in competition when you subsidize 10% of a competitors costs? And that's before you start to wield all kinds of regulations and other options to your benefit to hobble the competition (and does anyone believe they won't try?)

    Boy, would I love to have that kind of a leg up. I would eat my competitors for lunch ...

    Honestly, I have read a number of Motley Fool posts now on healthcare ... and most of them strike me as analytically lacking, without grounding in a number of key facts.

    Increasingly I wonder where the money goes in this service - because if these articles represent the quality of analysis on the stock picking side, mediocrity reigns.

    Unimpressive ...

  • Report this Comment On August 24, 2009, at 4:45 AM, chasrn56 wrote:

    With respect to the Constitutionality of a government plan for health care: baloney!

    Now for the meat of this issue.

    Yes, insurers make money. They do so two ways: a) they bet you won't get sick and, b) they deny claims.

    Hospital costs rise so fast because administrative costs are too high and hospitals are not compensated for treatment they render. This is due to the uninsured and those denied claims asserted above. In other words, YOU are paying for the uninsured already and YOU are paying for those denied claims. You are also paying for paid claims - all in the form of higher premiums and deductibles.

    If you think that there will be rationing of health care with government plans, take a look at denied access now. If this isn't a rationed system, I'll eat the next insurance policy without salt. How many stories do you need to hear about patients who cannot have a treatment or surgery because there is no one to pay for it?

    As to the ridiculous notions of abortion funding and granny death groups, get real! Either look at facts and look at the system you currently have or shut up. This especially goes for the propaganda machine out there trying to scare us into fighting the inevitable.

    I am a registered nurse of some long experience. I watch this folly play out every day. I am also an investor of nearly the same length of time. I have even made money on health insurance equities, but that money isn't enough to pay a hospital bill.

    If there is not a public option to the proposals listed for this bill, then it should be abandoned. Proposals to force the public into mandatory health care coverage, without a public option, give the private insurers a captive audience. I would rather do nothing and let the system become completely unaffordable so that the public option becomes as obvious as it ought to be now.

    How far down the ladder do you want America's ranking in health care, among industrialized nations, to go? Where are we now? 16th? 30th?

  • Report this Comment On August 24, 2009, at 8:47 AM, cajallen wrote:

    Another reason for the small profit margins is the exorbitant compensation paid to executives by these healthcare insurers. $15 million ? $10 million ? The salary is only $500K. The rest is bonus. Something is wrong here also.

    No more WAR. Spend it on healthcare. Feed the world. Oh what a concept.

  • Report this Comment On August 24, 2009, at 10:01 AM, fxrfxr wrote:

    Here I am on Monday morning and my patient's mother is demanding an expensive test she doesnt need. And the public wonders why it is so expensive? Please help me Obama, as you seem to have the answer to everything......

  • Report this Comment On August 24, 2009, at 1:13 PM, theHedgehog wrote:

    chasrn56 wrote (and it needs repeating in case you missed it the first time):

    "If there is not a public option to the proposals listed for this bill, then it should be abandoned. Proposals to force the public into mandatory health care coverage, without a public option, give the private insurers a captive audience. I would rather do nothing and let the system become completely unaffordable so that the public option becomes as obvious as it ought to be now."

    Do as I did and write your congress critters. Tell them that you do not want to be put in the position of paying a government mandated fee (aka tax) to a private entity. If you have to pay a tax, it should go to the government.

  • Report this Comment On August 24, 2009, at 2:08 PM, jesterboomer wrote:

    Actingdida has it right. I grew up with government run universal healthcare and:

    - it provides peace of mind;

    - is much more efficient;

    - provides better medical care to most;

    - has better quantifiable outcomes;

    - is less expensive.

    Actually cost is not very important since nearly all healthcare $ remain in the US and grow GDP.

    I believe strongly in capitalism but not when it comes to healthcare. Your greatest helthcare needs will come when you are the most vulnerable.

    Private insurance companies have had their chance over the past decade and blown it! Current healthcare pricing mechanisms are chaotic.

  • Report this Comment On August 24, 2009, at 5:35 PM, vialactea wrote:

    People can argue either way as much as they want, and they actually do, but to me it doesn’t seem right that people that are suffering can’t get medical treatment because they have no money. That is inhumane.

    I’m a strong believer in capitalism, but for me this is wrong. I’ve been in public hospitals (in Europe) in which very humble people, mostly elderly, but also children, get some comfort for the miserable state they find themselves into at times. I can’t imagine being a father that is unable to get his suffering children treated because of lack of money.

    Fortunately, I’ve worked hard and saved consciously and presently I’m nowhere near such a situation, but I don’t think anyone should be. If you are a child, why should you be penalized in something as important as your health just because your parents lack the drive, capacity, ability, frugality, or whatever it is that made them not have the money required to get proper medical treatment. These children already suffer serious disadvantages in life, but in my opinion their health shouldn’t be one of them.

    I don't know about you, but I don't mind paying for less favored people, for whatever reason, to be able to get healthcare.

  • Report this Comment On August 25, 2009, at 1:06 PM, actuary99 wrote:

    As an actuary who analyzes healthcare costs for a living, I think people who view insurance companies as evil entities are being simplistic idiots.

    Insurers deny claims that aren't covered in the insured's plans. Have you ever gotten a claim denied? I haven't. On an important side note, I have actually researched what my policy covers.

    There is no reason an insurer should have to insure any risk that will result in a loss to them. No one complains that banks aren't making enough loans to people who won't pay them back. Yet when a health insurer denies coverage to a person they will likely lose money on, they become the scum of the earth?

    If there is some moral obligation to cover what we call "bad risks", then the obligation sure as hell does not belong to public, for-profit companies.

  • Report this Comment On August 25, 2009, at 1:41 PM, theHedgehog wrote:

    actuary99 says: "If there is some moral obligation to cover what we call "bad risks", then the obligation sure as hell does not belong to public, for-profit companies."

    Well, at least you are starting to get at least a glimmer of understanding of the problem.

    We do have a moral obligation to make health coverage available to all. (That "pesky" provide for the common welfare clause.) As a result, for-profit companies need to be taken out of the equation.

  • Report this Comment On August 25, 2009, at 2:34 PM, vrpirata wrote:

    Wow! a lot of replys. Hard to read them all.

    1. We are the country in the whole world that spend the most (as % of GDP) in health care: http://allnurses-central.com/world-news-current/comparing-ja...

    http://www.photius.com/rankings/total_health_expenditure_as_...

    2. Our Health Care System ranks LOW (37) when compare to other countries, and even LOWER (72) in performance: http://www.photius.com/rankings/healthranks.html

    http://www.photius.com/rankings/world_health_performance_ran...

    3. Yet, we are the only western country that doesn’t cover all of our population, and our life expectancy when compare to other countries is also LOWER (24): http://www.photius.com/rankings/healthy_life_table2.html

    Conclusion: Our current system is broken, is inefficient, and is getting worst. Why? Because the % of population we don't cover is growing, yet the cost (% GDP) is also growing. We are living a lie where a bunch of lobbying is done and money spent to keep us afraid of a change.

  • Report this Comment On August 25, 2009, at 7:55 PM, kozmo0 wrote:

    Quality health care, let alone health care for all (or for most), will always take a back seat to a publicly traded, for-profit health care organization’s guiding principle of increasing shareholder wealth. If an initiative has the potential of increasing shareholder wealth, they implement it; if it doesn’t, they won’t. As a shareholder, I want the organizations I invest in to adhere to this principle.

    On the other hand, I’m in favor of quality health care for all and it appears that the only kind of plan that can accomplish this is a plan not driven so feverishly by profit. A public option may be an acceptable option…it’ll also awaken the healthcare industry out of its complacent slumber and force them to be more efficient and effective.

  • Report this Comment On August 26, 2009, at 3:40 PM, Taurcer wrote:

    I see nothing wrong with a public option for medical insurance. If it provides the best value (as defined by cost and service) to the customer then the number of people using the public option will increase and if the for profit insurance companies provide a better value then their numbers will increase. This is the heart of competition and drives inovation in this country. I don't know why the insurance companies are afraid of competition. I have heard it said that the public option will have an unfair advantage which will allow it to undercut prices. This is a false argument. If price was the only factor involved then we would not have Macy's, Nordstrom, Saks 5th Ave or Niemen Marcus stores selling clothing since Walmart clothes are much less expensive. However, customers look at more than price and I suspect this will be the case with medical insurance. The competition will be good for these insurance companies that in many cases have consolidated in markets until there is really no choice at all, and no reason for them to improve their prices or service.

  • Report this Comment On August 26, 2009, at 7:35 PM, dscfool wrote:

    As a physician, I can tell you that goverment insurance programs (i.e., Medicare and Medicaid) are nightmares to deal with. Many physicians I know do not accept Medicare or Medicaid patients any longer, and those that do limit it to only a few patients. These programs have a huge amount of unnecessary paperwork, reimbuse less than the cost of many office visits and procedures, and deny coverage for many treatments that would be covered under private insurance. Even so, Medicare is trillions in debt, and its total unfunded liability is estimated to be 50 - 60 trillion dollars (by the nonpartisan CBO) over the next generation. How are we going to pay for that, let alone expanding Medicare (or a Medicare-like program) to cover everyone?

    Yes, "universal care" sounds good in theory, but what we will end up with is universal access to a waiting list and severely rationed care, as they have in every country with socialized medicine (just ask the millions of Canadians, Britons, Frence, etc, who are on waiting lists for procedures that could be done almost immediately in the U.S.). The Canadian Supreme Court (not a very conservative bunch) recently ruled that "access to a waiting list does not constitute access to care." You can wait 8 months for an MRI in Canada which you can get in days in the U.S. They have far fewer MRI, CT scanners, and other technologies per capita than we do. That is why they spend so much less in those countries, and why the disease specific survival for almost every disease including cancer (prostate, breast, colon, lung, etc.) and heart disease is much better in the U.S. than in those countries. The reasons people live longer in those countries are related more to sociological issues such as poverty, obesity, automobile fatalities, and gun violence, all of which are much higher in the U.S.

    There is a chronic shortage of physicians in countries with socialized systems such as Canada and Britain. I did not go into medicine to make money, but there is no way that I can do my job with politicians and bureaucrats controlling our decisions and making the rules, which is exactly what will happen with government control.

    For those of you who do not understand how the "public option" (government run plan) will force private insurers out of business, please read the following explanation:

    Obama Kills Health Competition

    by Michael D. Tanner

    www.cato.org

    In his most recent weekly radio address, President Barack Obama denounced "willful misrepresentations and outright distortions" in the debate over health care reform. He then went on to repeat one of the most outright distortions in the entire debate: "If you like your private health insurance plan, you can keep your plan. Period."

    No, Mr. President. No you can't.

    To go straight to the chapter and verse: under Section 59(B)(a) of HR3200, the bill making its way through the House, and Section 151 of the bill that passed out of a Senate committee, every American would be required to buy health insurance.

    It is time for the president to stop spreading this particular 'willful misrepresentation and outright distortion.'

    And not just any insurance: to qualify, a plan would have to meet certain government-defined standards. For example, under Section 122(b) of the House bill, all plans must cover hospitalization; outpatient hospital and clinic services; services by physicians and other health professionals, as well as supplies and equipment incidental to their services; prescription drugs, rehabilitation services, mental health and substance-abuse treatment; preventive services (to be determined by the Centers for Disease Control and Prevention and the United States Preventive Services Task Force); and maternity, well-baby, and well-child care, as well as dental, vision, and hearing services for children under age 21.

    But that's not all. Section 1239(b) of the bill also establishes a federal Health Benefits Advisory Committee, headed by the U.S. surgeon general, which will have the power to develop additional minimum benefit requirements. There is no limit to how extensive those future required benefits may be.

    If your current health insurance doesn't meet all those requirements, you won't be immediately forced to drop your current insurance for a government-specified plan. But you would be required to switch if you lose your current insurance or "if significant changes are made to the existing health insurance plan."

    More critically, for the 70 percent of us who get our insurance through work, those plans would all have to satisfy the government's benefit requirements within five years.

    More likely, your employer will simply find that the increased cost and administrative burden is not worth it, and will dump you into the government-run "public option."

    The Lewin Group, an independent actuarial firm, estimates that under the House version of the bill, as many as 89.5 million workers will simply lose their current employer-provided plan and be forced into government-run insurance.

    Seniors, too, could lose their current coverage, at least the 10.2 million seniors currently participating in the Medicare advantage program. That program offers many seniors benefits not included in traditional Medicare, including preventive-care services, coordinated care for chronic conditions, routine physical examinations, additional hospitalization, skilled nursing facility stays, routine eye and hearing examinations, and glasses and hearing aids But the House bill cuts payments to the Medicare Advantage program by roughly $156.3 billion over 10 years.

    In response, many insurers are expected to stop participating in the program, while others increase the premiums they charge seniors. Millions of seniors will likely be forced off their current plan and back into traditional Medicare.

    Finally, the bills would all but eliminate Health Savings Accounts (HSAs), currently used by nearly 10 million Americans. Section 122 of the House bill and 311 of the Senate bill set minimum payout levels for any insurance policy. Insurance payouts must cover 70 percent of claims under the House bill and 76 percent under the Senate bill. And the bills also prohibit any deductibles or co-payments for preventive care.

    But virtually none of the high-deductible insurance plans in existence today, and required to accompany an HSA, can meet such a standard. They are simply not designed to work that way. The result will be that a plan designed to those specifications would offer few if any advantages over traditional insurance and would not be competitive in today's markets.

    As a result, insurers warn they would stop offering high-deductible policies.

    Any way you look at it, under the bills currently before Congress, millions of Americans will be forced out of their current health insurance plan, even if they are happy with it. Period.

    It is time for the president to stop spreading this particular "willful misrepresentation and outright distortion."

  • Report this Comment On August 26, 2009, at 9:08 PM, vrpirata wrote:

    dscfool I disagree with you. Have you live outside USA? , well I have and for many years and I'm a witness of how bad is here in the USA.

    Look at the stats, we rank low when compare to other countries and we are the #1 country that spend the most (%GDP).

    If they can provide better care for everybody and for less money (%GDP), then why we cant?

  • Report this Comment On August 27, 2009, at 2:05 AM, thomdd1959 wrote:

    We are all tired of the Whitehouse trying to sell us health care reform. You know, I know and the American people know this is really about more government power and control. Our biggest problem has become our government! Stop! Just stop all this nonsense!

    The only real financial crisis of the U.S.A. is hiding in the audit of “The Fed Scam”!

    Audit “The Fed Scam” bills HR 1207 must pass in The House and S 604 must pass in The Senate immediately! Any Representative or Senator that does not vote in favor of and support these bills or tries to “water-down” or stall these bills is clearly a Traitor and “Sold Out” the United States of America!

    “Few men have virtue to withstand the highest bidder.” --George Washington

    Does our government think that we are now here to serve them? Are they out of their minds?

    Some of our leaders today have acquired a very “twisted” view of their roles. Do we now have those who can no longer handle the power we entrusted them? Why have they abused and taken advantage of us? Do they no longer think they are accountable to us and believe they can do whatever they please? Our “public servants” have developed a “spirit of insubordination” and have gotten way out of control! This has to stop right now! This is ridiculous! If they do not want to listen to and serve us wholeheartedly, we no longer need them! “We need to do a major house cleaning immediately! Enough is Enough!

    It’s time for “We the People” of the U. S. A. to get VERY ANGRY!

    We need to keep a real close eye on all our government “public servant” employees. Our government was set up to serve U.S. and we no longer want any secrets about our money. We no longer want any misguided governmental arrogance directed at us!

    This Is A Very Public Matter!

    We demand real transparency, with open books and plenty of civilian watchdog czars. Government czars are an insult to the intelligence of the American people! Many of are entrusted government employees are a total disgrace to U.S. They only care about their own best interests!

    The most conniving, low life, manipulators in all of history put “The “Fed Scam” together! Since its inception in 1913, “The Fed Scam” has helped to devalue our dollar by 95%. During the recent economic crisis, it has poured TRILLIONS of dollars into the economy with no oversight, has made secret agreements with foreign banks and governments, and has refused to tell Congress or the American Public who is getting our money. They have the power to print it, but it is not their money! This is our money! They are blood-sucking thieves!

    End “The Fed Scam” Now! We must never again allow private banks to create or control our money! Why should we pay interest on our money! We must never again allow our “public servants”, to keep any secrets about our money! Our big mistake was to trust our government. They can not be trusted! History has taught us this, over and over again. We have been warned over and over again. Why do you think we have so many economic problems now?

    “Congress can revoke central bank’s charter ‘at any time’” --Ron Paul

    http://www.tomdavidd.com/blog/

    Anybody who supports “The Fed Scam” is clearly a Traitor to “We the People” of the United States of America!

    “We can all commiserate forever about how bad things have been, are, and will continue to be. But I don’t think that we can afford to wait for elections in order to have our say about putting a stop to this madness. Enough, already! Let’s start talking treason, prison, and death penalties for all malefactors in government who subvert, ignore, skirt and otherwise trash the Constitution of these United States of America. Those who have sworn to uphold the Constitution and have then ignored their oaths of office are guilty of perjury and malfeasance in office.” –Stephen A. Langford (personal communication to this author)

  • Report this Comment On August 27, 2009, at 12:22 PM, dscfool wrote:

    vrpirata:

    I have not lived outside the U.S., but I have studied other countries' health systems, and the U.S. is much better by every measure except infant mortality (which is related to poverty and social issues, not the quality of the healthcare system) and overall life expectancy (again, determined much more by things like obesity, alcoholism, and guns, all of which are far worse in the U.S.). When these factors are controlled for, the U.S. is far better. Why do you think that millions of Canadians, as well as people from Europe and all over the world, come to the U.S. for treatment?

    When it comes to comparing apples to apples, for example, survival rates for specific cancers, including the most common ones such as breast, prostate and lung, the survival rates are much better in the U.S. In Great Britain, for example, the survival rate for prostate cancer is about half that in the U.S., and most cancer patients do not even get treated by an oncologist (only 40% do), whereas almost 100% do in the U.S..

    People in these countries are only happy with their system when they are healthy and feel that they have the security of free medical care. But when they actually become sick, the approval ratings drop substantially (a recent Stanford study showed that only 30% of patients are happy with their care in most socialized medicine countries). These countries provide cheaper care by rationing and denying advanced treatments and drugs to many patients. So they do not provide better care.

  • Report this Comment On August 27, 2009, at 7:17 PM, leecee125 wrote:

    This article states that,” Around $0.82 of every dollar that customers pay goes toward medical costs”, [i.e. docs, drugs & hospitals]. That means that 18% goes to insurance company operating costs, overhead & profits.

    US Medicare & Senate health plans, & most ‘National’ [‘Socialized Medicine’ ?] plans [in Canada, UK, Germany, France, etc.] pay only about 4-6% overhead.

    That’s a very significant savings of about 12% of TOTAL US Medical costs, - and not the less-significant 5% savings the author claimed in the article.

    He also states that Health insurers, “ ‘Innovative programs’ can reduce medical costs and help drive profits. For instance, Humana's Medicare Advantage case-management program has reduced the number of patients who need to be readmitted to a hospital within 30 days of being discharged, down to 11%-12% from the 20% that traditional Medicare experiences”.

    There are precious few examples of insurers developing ANY substantive “Innovative programs” that add value to health care. Their approach is to cherry pick, and only insure young healthy people, -& dump the rest on to taxpayer programs.

    There are numerous examples of competent & effective programs that can cut an additional 25% from the cost of our healthcare costs. But, health insurance companies have a dismal record of identifying & realizing any meaningful, innovative programs that significantly improve care or reduce costs.

  • Report this Comment On August 28, 2009, at 9:39 AM, peterbailey wrote:

    Uh, no, I don't agree with you at all. Medicare has an overhead of about 4%. Insurance companies have in the 20s and 30s. I am personally for a Medicare for all program, for all Americans. Period. It's not just the insurance companies, though. They are not criminals. The pharmaceutical companies have a lot to be blamed for, too. I'm completely disgusted watching TV and seeing ads for arcane drugs that I have no idea are for. And, those ads cost many millions.

    Obama is not the problem. Ignorance is.

  • Report this Comment On August 28, 2009, at 9:40 AM, mmilczarek wrote:

    You are forget one minor detail when reporting net revenue. Insurers are simply passing money. So it is effectively an 18% overhead charge on health care.

    Throw in the fact that the business model simply juggles money around between the insurers and the government, and that the insurers deliberately drive off high risk people into government supported plans (whether low income, medicare, or the emergency room) and you have a disaster.

    The industry is totally FUBAR. My daughter had a operation that would have cost me $250,000 if I had paid in cash, it cost $50,000 through my insurance. Name me another industry that raises the price by 5X if you pay cash?

    My health insurance premiums have risen 500% in 14 years, my deductible has gone from $100 to $3000. Name me one other industry that has seen that kind of inflation in the last two decades.

    The system needs to be torn down completely and started over.

  • Report this Comment On August 28, 2009, at 9:48 AM, franklinomics wrote:

    If President Obama wants Health Care to be Universal, He Should Look to the Moon - http://tinyurl.com/healthcarevision

  • Report this Comment On August 28, 2009, at 9:56 AM, carolejacoby wrote:

    Using simple logic and common sense, why would any of us cast a vote of confidence toward Government run health care? Instead, first consider what the Government has done to our;

    Social Security

    Medicare Care

    Medical

    Postal Services

    Bank Bail Out (where is that money)

    Stimulus package (loaded with waste and has done nothing to stimulate the economy)

    Cash for Clunkers (The dealerships are still waiting to be paid because the Government was not set up for this program before the put it in place)

    etc.

    etc.

    You get the point. Why would we believe these people possess any common sense or reasonable ability to govern anything? Anyone, including our President and Congress who would press for a vote to be taken on a health care bill to be passed when no such bill is yet in place? Vote in favor of something yet to be drawn up that could and does contain laws negative to the best interest of the American People. The one submitted in the 1000 page draft was joke on all of us.

    The town hall meetings speak volumes. Americans are fed up and not going to take it anymore. It is not just the health care bill, but that coupled with all the other foolish bills and ignorant Legislators are crippling this country. They are incapable of doing anything right but let me ask your readers to give me any thing this Government has done right. If we managed our lives and our pocketbooks in the same manner, we would all be bankrupt and many are because they did make the same poor decisions.

    Wise people would never trust their lives and their finances to this bunch. The poor, trusty, needy folks who cannot reason for themselves are willing to turn over everthing to a bunch of idiots sitting in Congress, both our States and Federal. We see how all the people who trusted their money to the likes of Bernie and other investment scoundrals faired. They didn't exercise common sense or logic either, blind trust is a foolish thing to do for any of us.

    I look forward to receiving comments from those who can show me a successful run government agency. And for this, we taxpayers pay their salaries and pensions for life, all the other perks such as cars, insurance, etc.etc. and executive health insurance. How stupid can we be?

  • Report this Comment On August 28, 2009, at 9:57 AM, teb6318 wrote:

    Medicare? Going broke. Medicaid? Broke. United States Post Office? Broke. Amtrack? Broke. Social Security? Running on IOUs. Cash for Clunkers? Broke. In all of them, participants have no choices - they either participate on the government's terms or they don't. The government taxes you on Social Security whether you participate in it or not. Does Bill Gates need Social Security? No, but he's taxed on it anyway. Medicare? Same deal.

    An some want to turn their health over to the US government? Are they simply stark, raving mad? Or just plan stupid?

  • Report this Comment On August 28, 2009, at 9:58 AM, RogerRam wrote:

    The goal is a national health service - at any cost. It is like a religion - either you believe in socialism or capitalism and your expectations are based on faith - not past experience. The public Option is simply a first step. It can (and certainly will) fail financially, but the liberal politicians now in charge will prop it up and put the private companies out of business - regardless of the claims to the contrary. Once established and unable to make ends meet, who could stop the government bailout for the sake of those covered?

  • Report this Comment On August 28, 2009, at 10:04 AM, Vas64 wrote:

    The article claims that insurance companies spend 82% of revenues on medical costs. While I don't have exact numbers (and I suspect getting such numbers is the exact reason for the witch hunt), I find it hard to believe that it is nearly as high.

    My personal experience with insurance companies is that they spend most of their energy on finding ways not to pay claims. I have a high deductible plan where I pay $3K in deductible costs before the insurance (Humana) starts paying anything. Everything goes well until I hit this $3K number (and with 2 small children I do that within the first 6 months of the year). From then on, it becomes an ongoing exchange of letters where I have to prove all soft of things to them in order to get reimbursed. I am a private contractor and at my billable rate I find that I could have made thousands more if I didn't have to deal with these pesky issues. Now I can only imagine that for every hour I spend fighting insurance company, they have to spend just as much time working hard on trying not to pay the claim. This time that is spend by them to fight me is also paid out of my premium. Now there is another side to the story. Doctors, too, apparently have to deal with insurance companies and work hard to get any money out them.

    The experience of working with insurance companies is so bad, that I would gladly get rid of the insurance altogether replacing it with catastrophic insurance, in case I need $200K for a heart surgery or something like this. Unfortunately, somehow doctors tend to charge people who pay cash and do not use insurance companies up to 3 times as much for the same service. This is something that completely escapes me. In any other business, cash would be the king and would give you a discount compared to another form of payment that would create lots of additional costs to the vendor/doctor (like I said, doctors have to spend a lot of time dealing with claims, and avoid such costs is worth something). Apparently this is not the case in healthcare. This fact is so counter economic that the only plausible explanation I can find for this is that the doctors are not allowed to charge less for their services than what is covered by insurance. Presumably the terms imposed by insurance companies are such that the insurance has to get a discount no matter what and if a doctor charges you less, then the insurance company would have the right to pay even less.

    It is mess...

  • Report this Comment On August 28, 2009, at 10:06 AM, nosliw3 wrote:

    A public-option healthcare plan is not un-Constitutional, not mandatory, and, sadly, not likely to get passed. There are too many monied interests that do not want the plan - the pharmaceutical companies and insurance companies that have been bilking the American public for decades will not see their cash cow throttled. In reality, there is no 'health care' system...it is 'symptom/disease management', because the medical/pharma industries have no interest in curing anything, only in providing 'treatments' which provide them huge profits. As for the article which inspired these comments...'margin is what you make it'. Just ask Arthur Andersen.

  • Report this Comment On August 28, 2009, at 10:08 AM, markofzorro wrote:

    The US is number 35 - 37 in surveys of infant mortality in the developed world. We have been very poorly served by the world's most expensive health care system.

    It costs so much because of perverse incentives for doctors to do more tests -- many of them now own the facilities where they refer tests -- an obvious conflict of interest. And we pay subsidies to private insurers and big pharma -- because Medicare is forbidden to negotiate on price.

    Our employers are less and less competitive because (for historical reasons) most people get their insurance through employers -- which means those most in need don't get insurance.

    Insurance companies ration care by denying it to the poor -- including the working poor. It is ALREADY RATIONED. We lose so many babies and mothers because they can't afford prenatal and infant care.

    The system is broken. Private insurers have not been able to fix it. We cannot afford the status quo, which is killing our competitiveness globally.

    The government runs the VA health system, which rates well on quality of care,

    The free market works well for most things, but not for medical care and prevention. In most developed countries the governments runs health care and their populations are healthier than our.

  • Report this Comment On August 28, 2009, at 10:11 AM, RetiredGamer wrote:

    After reading many of the comments and the article for a second time, I'm beginning to think that a lot of Fools have gotten lost in the numbers. If this were simply a matter of cost and profit, there would be much less to discuss. I don't want to discount numerical arguments, just point out that they aren't a be all end all like some people seem to think. here's my case:

    As a for-profit industry, the medical/insurance industry's goal is to make money, not support and maintain a healthy population. What we all want is the latter, thus we have the real problem.

    If the industry's primary way of generating income was scaled based on its ability to meet the populations needs, a number-based argument would be fine. Unfortunately what makes the most money and what serves the population best are two wholly unrelated things. If the goal of the industry was to provide the most services for the lowest cost, we'd be living in a much better world. This is the goal of socialization. If anyone's got ideas on how to achieve this goal within a strong market system, I'm sure we'd all love to hear it.

  • Report this Comment On August 28, 2009, at 10:12 AM, MacMcNeely wrote:

    This Marine Veteran speaks for me and the majority of my Marine brothers at a Town Hall Meeting.

    This video is only a little over two minutes.

    http://www.youtube.com/watch?v=_rRE5UK6NQU

  • Report this Comment On August 28, 2009, at 10:18 AM, dodge1026 wrote:

    OK...nobody has stated the obvious. If the free market can solve this problem we would not be having this discussion. The problem is that the free market has created this problem. The whole reason that we have medicare is that the insurance industry would not cover old people at a reasonable rate since 80% of all medical costs come at end of life. A public plan would cover all peoples that the insurance industy refuses to cover and also set a standard that the industry would have to meet. If you think that a government run plan would be inefficient and ineffective then why are they so afraid of it.

    Now for those people who think the US Post Office is a nightmare. You don't pay for the postal service unless you use it....how much do you think UPS or FED-Ex whould charge per letter to come to your house and pick up your outgoing mail daily? Hey, you are free to use them to do this if you want. Let me know how that works out for you.

  • Report this Comment On August 28, 2009, at 10:19 AM, phillyarchitect wrote:

    Perhaps we should rethink the fundamentals of health insurance. Our current system came into being in the 1970s with the rise of the HMOs. I remember the pitch at the time, "you pay $50 a month and all your health care is free". Prior to that you had insurance for catastrophic events like a heart attack, or broken bones, but you paid for your doctor's visits and check ups and routine procedures.

    The rise of HMOs effectively has put Insurance Companies in charge of health care. That wasn't always the case, and I don't think we should take the continuation of this current system as a given.

    I think the question that should be asked is what country in the world has the best health care system in terms of cost, and results? We only seem to talk about Britain and Canada and how awful they are. What about Germany, Denmark, Switzerland, Sweden, Japan etc.? Who is getting it right? Can we learn? I worked in Canada for six months in the 1980s, and the people there looked pretty healthy to me, and they seemed very satisfied with their system. I had to go to the hospital for a minor injury, and the responsiveness and level of care at the University Hospital in Toronto were superb. I'm still trying to figure out why that system is so evil.

    I think Obama's handling of this is flawed in that he has staked his presidency on Health Care Reform and it's such a contentious issue it's given an opening for opponents to attack him. Obama's turned himself into a target and the Conservatives will use this to try and destroy him - nothing to do with health care - just opportunistic political predation.

  • Report this Comment On August 28, 2009, at 10:22 AM, newally wrote:

    We live in Hot Springs Village, Ar. This is a village of mostly retired seniors. Yesterday there was a rally to explain the Health Care Reform bill. Over two hundred attended. About 90% were opposed to the socialized medicine proposal from the Democrats. The predominant signs seen at the rally were "Hand off my healthcare." As seniors we cannot afford this scheme and our country can't afford it.

    Has anyone stopped to think why Obama is spending so much of our money? Could it possibly be to bankrupt our country so as to open it up for a takeove by radical Islamists?

    J. Paul Newall

  • Report this Comment On August 28, 2009, at 10:24 AM, DrJoe916 wrote:

    First of all, the president and congress can indeed enact legislation mandating national health insurance. The question is "should they?" and the answer is that there are better ways.

    1. Bust the AMA "trust" and start expanding medical schools. The AMA has been keeping an unnatural lid on enrollments for at least 40 years.

    2. Move the medical system nationally to the Mayo Clinic model in which doctors receive salaries (quite good ones) or "pay for performance" rather than "pay for service."

    3. Tort reform on malpractice awards. It's way overdue and will bring down doctors' insurance bills.

    4. Ban HMOs. They have trivialized the cost of doctors' visits and increased optional office visits. It has also increased insurers' bureaucracies. Medical insurance should cover catastrophic costs -- a $5 or $10K annual deductible.

    5. Insurance companies must make policies available to all regardless of "prior conditions" and insurance policies must be nationally transportable (hence available nationally). Neither can a policy be cancelled because the holder has developed a serious condition.

    6. Ban direct advertising and promotion of prescription drugs to consumers and perks to doctors who prescribe specific drugs. It's the doctor's conclusions I want, and I want them based on his diagnosis of my condition rather than the condition of his wallet.

    The real problem with the plans in congress is not that they go too far but that their focus is insurance rather than the system itself. The system is plagued by a shortage of doctors, over-managed health care insurance plans, limited geographical coverage, and patients who want the prescription they saw on TV.

  • Report this Comment On August 28, 2009, at 10:24 AM, berger1938 wrote:

    God help us if we are captive to a health care system run by the Government. Health care reform should focus first on reducing health care costs and second on who provides the insurance. Control of health care costs must start with tort reform. Doctors and hospitals are prescribing drugs and tests just to protect themselves from malpractice law suits. Not an evening goes by without at least two TV commercials from ambulance chasing lawyers soliciting people for class action lawsuits against a drug company or medical device maker. Wonder why our worthless Congress doesn't address this issue. Could it be because they are all Lawyers?

  • Report this Comment On August 28, 2009, at 10:32 AM, dodge1026 wrote:

    In respose to NEWALLY....please tell me that you understand that MEDICARE is a government run socialized medical program. You are against the very thing that you are trying to defend. AS seniors the only reason you even have health care is because the Democrats have given you socialized medicine.

  • Report this Comment On August 28, 2009, at 10:33 AM, ryanhodge wrote:

    As a lawyer I have not idea how anyone could think its not constitutional to have a state run health care plan. Thats what medicare and medicaid are. Such a notion is simply wrong.

    The problem is not the profit that insurance companies make, the problem is that we have socialized the risk and privatized the profits and that is wrong. AIG was bailed out by republicans and democrats and it was for the good of the country but it still meant that the risk of loss was socialized. The american people did not benefit by getting any of the privatized profits.

    Medicare provides medical care with a 3-5% overhead cost. Thats less than 25% of the overhead of private insurers. Health care providers have overhead of 20-30% just in the money collection department because of the myriad of hoops they have to jump through to get paid by insurance companies. Of course each different company has their own set of hoops and once the doctors figure out the hoops, the hoops change.

    The system now is broken and ludicrous. Whats wrong with government run health insurance? No one complains about a government run military or a government run police force or a government run fire department. There is nothing inherently evil about govt run health insurance or government run medical care If the Brits dont complaint and the Canadians dont complain it can't be that bad. We can debate all we cant if there system is as good as ares but we are not talking about night and day. We are talking bare subtle shades of gray that result in increased or decreased medical risks that are measured in the tenths of a percent.

    The govt does a decent job with social security. The problem is bitter old men who imagine a world as it never was that say this change is bad. They have no facts to back it up. They have no new solution that is feasible. Just more whiny Rush Limbaugh naysaying that at the end of the day only lines the pockets of the famous naysayers while the fools that listen continue to get the shaft and have not figured out that they are getting the shaft because they are so busy listening to Rush tell them otherwise.

  • Report this Comment On August 28, 2009, at 10:34 AM, chasemate wrote:

    I't will be interesting to see how much the government raises the cost of medicare this year. With a freeze on Social Security benifits, the net result could be an increase on taxing the middle class and poor. What fools we are to believe the government ever did anything with efficiency in mind, or could really be trusted to come up with a cost effective system.

  • Report this Comment On August 28, 2009, at 10:36 AM, alanjwest wrote:

    Most of the pro-business comments fail to look at the big picture. It is not anti-business to recognize that our system is broken by any reasonable measure. That is, relative to other nations, we spend much more (as a % of GDP) on health care and do not have favorable outcomes as measured by the overall health of the population.

    This indicates the need for significant reform.

  • Report this Comment On August 28, 2009, at 10:46 AM, Eagle68 wrote:

    It's interesting to me that so many people are afraid of the government denying them a medical procedure, but don't mind an insurance executive getting paid millions of bucks to do the same thing.

  • Report this Comment On August 28, 2009, at 10:47 AM, baybrowser wrote:

    Most of the problems with our existing system can be solved without radical change. We need to cut costs. The CBO says it'll cost trillions over the next two decades. They're unbiased. Obama & his comrades aren't.

    We need a free market in terms of health insurance. It's not even close. The government can do something about this. Individuals (and firms) need to have access to out-of-state insurers. Now they're constrained to a limited number (just a couple in some states). The states have in fact probably violated the commerce clause by doing this.

    We need tort reform across the board, but particularly in the health care area. The democrats want everybody to sacrifice, but notice that (1) no politicians are willing to give up their elitist plan, and no democrat is willing to sacrifice by going after their honeypot of litigation lawyers.

    With numerous insurers available (after reform) we need nationwide requirements that deal with the pre-existing condition issue. There are nonprofits carriers out there.

    We need a health savings plan for everyone.

    Most importantly, we need the politicians on the same health plan. Nothing like a little incentive for these people to behave!

    Dealing with illegal immigrantion is a separate problem. Right now it's part of the democrats mantra - 47 million uninsured. That count includes not only illegal immigrants but also those who can afford insurance but are gambling by using their money for other purposes; it includes those who are between jobs, so this subset basically changes every time the survey is taken - probably no a problem for most of them. It also includes millions who are actually eligible for medicaid or other programs who have not registered for them.

    Notice that none of these changes would create much of a problem for anyone---that's because it doesn't require the feds to step in as an insurer (presumably to offer "competition"). Why is Obama and his leftist backers so intent on this one item?

  • Report this Comment On August 28, 2009, at 10:54 AM, ewasserman wrote:

    Don't you think we already have rationed healthcare? If you don't have insurance, then you don't get healthcare. Insurance companies have the ability to deny you coverage and can even drop you all together. That really sounds like rationing to me.

    You've got to get to 100% coverage before you can make meaningful cost reduction. Without 100% coverage, the easiest way to reduce costs is to drop people when they become expensive. You also have the advantage of taking premiums from people that aren't sick and really don't need insurance yet, and it's easier to keep them healthy if they can go to the doctor without worrying about paying for it.

    High deductible plans with HSA's isn't the answer either. There is no way I'll be able to save $600,000 in my HSA for when I get real sick when I'm old and have an extended hospital stay.

  • Report this Comment On August 28, 2009, at 10:56 AM, plhovsepian wrote:

    Insurance companies are not about health care. They are about the bottom line, PROFIT! In a capitalistic system those in power, those with education thrive. Those born into privilige thrive. As we seen, many of the rest struggle; like 47 million without healthcare and thousands more added every day. Private health insurance companies have not done a good job in cutting costs and eliminating waste because they have had no incentive too! Our society is moving away from a capatilistic system on health care because it doesn't work. The present system is a mess! Every American deserves access to health care at a reasonable cost.

    Paul

  • Report this Comment On August 28, 2009, at 10:59 AM, snowmon wrote:

    Most are barking up the wrong tree here.

    Consider the fundamental problem:

    Why is it that technological innovation consistently lowers the cost of production for every good, from food to electronics to home building to financial services, but not health care?

    What is distinctive about the health care market that disrupts this natural progression dating back to the beginning of civilization itself?

    1) Health care is a highly regulated industry; Those whining about a "failure of the free market" are missing the fact that health care is the least free of any market even close to this size.

    2) Health care is almost entirely a 3rd-party payor system. This is the classic "tragedy of the commons" problem- all of the actors in this system have incentive to draw the most from the common pool. No one in the system has any incentive to contain costs, because such costs are not borne directly. Even the health insurers have little incentive, since they are simply middle-men, who pass the costs along in the form of higher premiums. They only get burned if costs inflate faster than expected during a contract period (usually one year). After that, they just adjust accordingly.

    One only has to look at the health care goods that are not covered by insurance to see how spending other people's money distorts the market; Consider the free market health products you buy at the pharmacy- do dental care products have double-digit price inflation most years? Have toothbrushes and toothpastes improved over the years? I see a wealth of choices and innovation going on here, but prices do not soar- if you just consider electric toothbrushes, for example, prices have fallen and quality is up. How about plastic surgery, dental implants, and corrective eye surgery. Costs have come down and quality has improved for all of these BECAUSE they live largely in the free market, outside of the corrupt 3rd party payor system.

    I live in Mass where we have a "universal" healthcare program. We also have the HIGHEST healthcare costs in the nation, and the program is bankrupting the state. People at the national level seriously point at the Mass system as a model for a national system! Hello. This is one of those stark naked emperor situations.

  • Report this Comment On August 28, 2009, at 11:02 AM, WJ1942 wrote:

    The article misses the point entirely. First of all, for-profit insurance is not the proper funding mechanism for providing medical services to members of a society. It works well in the Property/ Casualty field where losses are fortitious and not catastrophic in nature. Relative to medical services, no one escapes the need for medical services. With respect to Property losses, not every house burns down, and the probalble losses are finite and quantifiable. Even in Property and Casualty insurance, catastrophic losses are generally considered to be unisurable, i.e. floods. Such catastophic losses are better handled through government pools.

    With respect to the delivery of medical services, the only ones that should profit are the doctors, nurses and other medical technicians that acually provide the required service. There is no logic in paying for underwriters, claim adjusters, and other administrative costs that have nothing to do with the direct delivery of medical services to members of a society. Additionally, profits and dividend payments to shareholders of a for-profit insurer are logically absurd in that they divert monies paid for medical service, limit delivery of medical service and increase cost to the consumer. For-profit insurers are simply a pimple on the ass of progress relative to the delivery of medical services and should go the way of buggy whip manufactures. They bring nothing to the table.

    The only proper solution is to develop programs that will increase the supply of doctors, nurses and other medical techicians. Additionally, a single payer funding mechanism for medical services should be established along the lines of Medicare for all members of society. Finally, the medical consumer, where possible, should be responsible for the first $5,000 of medical costs annually, which could be funded through a pre-tax Health Savings Account. In instances where this is uaffordable, govenment help should be available. The cost of the program would be funded through taxes levied on the public, as well as companies.

  • Report this Comment On August 28, 2009, at 11:10 AM, CRSDoc wrote:

    This round of health care reform NEEDS TO BREAK THE BACK of the healthcare insurance industry in this country, plain and simple. Cold, hard business principles (staying accountable to Wall Street) become unethical when sick patients are involved.

    Negotiated LOWER payments for fee-for-service care, for inpatient care, for Rx meds...EVERYONE needs to take a haircut here, people. Including patients who think every ineffective, expensive treatment is his/her God-given constitutional right.

    I say this as an MD practitioner, researcher, and most importantly as a patient.

  • Report this Comment On August 28, 2009, at 11:13 AM, tokdoc wrote:

    By labeling this a "witch hunt" you are doing a disservice to me and millions of Americans who ARE, yes ARE, exploited by the insurance companies brutally, with millions more being brushed aside and ignored, when they need health care. As a physician attending county and public free clinics, it is more than clear who the "third world" country is: the US. We hurt ourselves immeasurably and foolishly (yes, it is best to be careful with that word, if you are speaking true ignorance, as you have in this article!), by ignoring ALL of the reasons we do so poorly, including handing over health care to people who do not care about anything but profit. It is YOU, the profiteers, that are the problem, so you who are the witches who need a good trial. So let the trials begin, though there really aren't witches, just criminals, to be found and removed or at least constrained from doing their damage.

  • Report this Comment On August 28, 2009, at 11:15 AM, ibd123 wrote:

    The point is that if the Dems get a public option health insurance policy put into law it will be the most popular program since Social Security. That will mean we will not see another GOP president for 30 years. The only GOP president after Social Security passed was Gen Ike and either party would have taken him. the Dems lost in 68' only after loosing a war.

    This issue is not politics as usual, the GOP is fighting for its life. We can only hope that America wins in stead.

  • Report this Comment On August 28, 2009, at 11:21 AM, MauroS wrote:

    As a Canadian living in the States, this debate is laughable.

    Whenever anyone points out the flaws in the so-called plan, they are jumped on as right-wing extremists. The most often questioned issue is cost and the best answers from the proponents of the government option are either extremely vague or full of qualifiers which even the CBO doubts.

    If you want to know how such a plan is going to be paid for, PLEASE Google "marginal tax rates Ontario" to see what percentage of your salary is going to have to be taken to pay for this "free" health care (and when you look at those numbers, don't forget provincial and federal sales tax on *almost everything* you pay for, including professional fees as an example, there is no 'married filing jointly', and you can NOT deduct your mortgage interest). I'll give you a hint: A couple making $100,000 jointly pays roughly $28,000 in Ontario and $11-$15,000 in the US - less if they have a mortgage to deduct.

    The oft quoted 47 million uninsured (in itself a bogus number, as baybrowser pointed out) is the basis for the funding requirements. Seriously, does ANYONE not think that number will balloon? Regardless of what one makes, but particularly for those that *are* paying premiums but are struggling to do so, if there's a 'free' option, why not take it?

    And then there is the elephant in the room: tort reform. If Obama wanted to contain costs, why NOT start with one cost that has been *proven* to limit overall cost of care in states that have implemented reforms? Oh, yeah, wait, I know the answer: because senators and reps are either members of the bar or in the pocket of the ATLA. Can there be any other reason?

    Again, turn to your friend Google and search "Ontario wait times". The AVERAGE WAIT TIME for a diagnostic MRI in Ontario is *105 days*, CAT scan *47* days.

    And then there is this one for the hospitals in the Toronto area (Population 3 million+). They don't report their wait times - it just says NR. Why?

    [quoted in full from the government page]

    "NR: Not required to report. The hospital provides this service, but did not receive extra funding to provide additional treatments this year, and therefore is not required to report wait times."

    Read that carefully.

  • Report this Comment On August 28, 2009, at 11:24 AM, Elmer104 wrote:

    WJ1942 is absolutely correct. Increasing the supply of Doctors, Nurses and other health care providers would solve many of our problems. Also, I would be more comfortable with government run programs if they would put more emphasis on eliminating fraud. Most fraud issues can be detected with software. A national program to deliver standard electronic claims and medical records would enable fraud detection in addition to reducing costs. With that in place, most other problems would disapear. As an aside, Insurance companies are never at risk. The plans they administer are usually self insured by the employer. Reinsurance contracts absorb losses that are above a calculated rate. The cost of reinsurancve is built into the premium.

  • Report this Comment On August 28, 2009, at 11:25 AM, thunderfoot206 wrote:

    "First off, it is not constitutional for the government to create a government sponsored health plan."

    Wrong. Sorry but the much debated General Welfare Clause of the Constitution refutes that statement. Congress does have the power to tax and does have the power to decide what is in the best interest of the general welfare of our nation. So the government does have that power. You have the power to vote for someone that would not use that power if they were in Congress. That is all you have.

    I on the other hand, support the intrusion by my government into financing our health care. We don't need any more evidence to come to the conclusion that private insurance is a disaster. I support the idea of capitalism for providing commodities, but maximizing profits by actively trying to deny health care is what health-care for profit has yielded. In addition, our business is at a competitive disadvantage because their international competition are not similarly burdened.

    Finally, arbitration by health panels is the best way to deal with malpractice costs.

  • Report this Comment On August 28, 2009, at 11:27 AM, wcwong wrote:

    http://www.pnhp.org/facts/singlepayer_faq.php#bureaucracy - The United States has the most bureaucratic health care system in the world. Over 31% of every health care dollar goes to paperwork, overhead, CEO salaries, profits, etc. Because the U.S. does not have a unified system that serves everyone, and instead has thousands of different insurance plans, each with its own marketing, paperwork, enrollment, premiums, and rules and regulations, our insurance system is both extremely complex and fragmented.

    The Medicare program operates with just 3% overhead, compared to 15% to 25% overhead at a typical HMO. Provincial single-payer plans in Canada have an overhead of about 1%.

    * Car insurance is required and yet we don't have these debates about that. Why aren't we revolting over socialized car insurance?

    * My opinion is that insurance, as a for-profit, is stupid from a consumer point of view. It makes it a natural dis-incentive for you to have your claims paid.

    * This is another example of the corporations taking over America. Read that carefully. True capitalism where there is competition is a great thing. Creation of monopolies and corporations colluding for their own benefit is NOT capitalism and is NOT good (unless you happen to be lucky enough in one of those monopolies that is being PROTECTED by the government).

  • Report this Comment On August 28, 2009, at 11:27 AM, abcyz wrote:

    Oh what a tangled web we weave when we first pratice to decieve.

  • Report this Comment On August 28, 2009, at 11:31 AM, lamcileo wrote:

    Please no Government health care! I grew up in the Panama Canal Zone, the Canal which has been a gold mine to Panama was always a loser to the US when they ran it!

  • Report this Comment On August 28, 2009, at 11:36 AM, Bianca209 wrote:

    I too am highly offended by the misuse of the term "witch hunt" and the fact that I have been e-mailed a reference to this article not just once but twice. I believe that a key role of government is to protect the welfare of its citizens including setting up policies that make health care universal, comprehensive and affordable. Insurance companies won't do it because their goal is to make profits not to provide for the common welfare. Every other capitalist industrialized country has been able to do this without the resort to the kind of right wing hazing that is currently taking place. If there is a witch hunt taking place, it is by the Right wing who are once again distorting the truth on behalf of the insurance companies. For another side to the debate, read these articles:

    http://www.truthout.org/082009B

    http://www.truthout.org/082309Z

    http://www.truthout.org/082709A

  • Report this Comment On August 28, 2009, at 11:44 AM, SmallWords wrote:

    With a name like SinglePayerSally it's a bit hard to take you seriously as an investor instead of a person with a one track mind. This is after all a forum about analyzing companies for the sake of making increasing capital by loaning it to companies that will use it to make a profit.

    As for you being offended by the term 'witch hunt,' who cares? I don't care if someone calls me a pinko jew-hating gay communist. Instead of railing about another vast right wing conspiracy (which ironically is used just as often as the right rails about liberal media bias) try talking about what is good and bad about health care as it currently exists.

  • Report this Comment On August 28, 2009, at 11:48 AM, bugsy98 wrote:

    Medicare IS A GOVMERMENT RUN plan and of all insurance plans out there it is one of the most effitient ones...nobody is complaining about medacare...everyone climbs aboard at age 65...even you nay sayers and fear mongers...and no one is crying to shut it down...the public option would essentialy allow you to buy into medicare perhaps on a sliding scale based on income. its a great idea don't be so afraid of change.

  • Report this Comment On August 28, 2009, at 11:52 AM, piperflyer wrote:

    How much I pay for my health care, who I see, or what procedures I have done is not any business of any of you, individually, or collectively (i.e. gov't). So all you guys wanting to put big brother into the picture can go pound salt. How much we all individually pay for medicine does not make it the business of the government.

  • Report this Comment On August 28, 2009, at 11:52 AM, fogahead wrote:

    We have to stop talking about Dem's vs Rep's. State of current healthcare system is costing the nations businesses dearly and its people their lives & fortunes.

    Even if this push fails, economic impacts of no change are not sustainable for business.

    Reduction of healthcare costs as % of GDP is going to ultimately boost American business competitiveness.

    Think about it. Employees are usually the #1 cost of any business. Its why you get to get laid off when things go bad. Oh, and loose healthcare too. Funny how that works. Oh you're sick? Well double sorry to you then. Don't wait for the "Get Well" card.

    Seriously, Healthcare reform is a seriously Foolish thing to do.

  • Report this Comment On August 28, 2009, at 11:57 AM, dscfool wrote:

    I find it highly amusing when people quote that gov't programas such as Medicare have just "4% overhead costs." Those are government provided numbers that are hihgly biased and reflect only direct adminstrative costs spent on paperwork done in the offices of Medicare. It completely ignore the fact that the gov't wastes at least 50 cents of every dollar that it takes in in taxes as the money works its way through the bureaucracy (this is actually a generous estimate, the GAO estimates that most gov't programs only operate at 20% efficiency!). No private company would survive if it wasted over 50% of its income. The gov't can only do this because it can keep robbing taxpayers to pay for it, selling more debt (which we are already drowning in), and by printing more money (which we pay for through inflation).

  • Report this Comment On August 28, 2009, at 11:58 AM, abcyz wrote:

    common sense question 1. How do you add a millon or so charity cases to the system without increasing the taxpayer cost?

  • Report this Comment On August 28, 2009, at 11:59 AM, duanexxxx1953 wrote:

    I just want you to clarify something for me! I can't recall what year but it toojk place , isn't the United States Postal Service a private corporation? Isn't it true that there is currently no connection between the US Goverrnment and the USPS? Would someone who knows please pass on the pertinent information regarding the USPS and the government of the USA.

  • Report this Comment On August 28, 2009, at 12:11 PM, piperflyer wrote:

    You know, it's really weird how you can get everyone all riled up, and everyone gets blinders on, and starts thinking that it has to be done, and arguing more over how much it's going to cost rather than, in a free society, if it should be done at all. BTW -- I'm sure if you looked reallly hard for the figures, the Soviet Union probably had zero overhesd on its healthcare system.

  • Report this Comment On August 28, 2009, at 12:12 PM, mernunez41 wrote:

    After many years of being member of The Motley Fool, after having purchased several subscription services, doing several seminars, I am ending my subscriptions and I am getting out.

    I don't like the kind of capitalism you are pushing. My grandfather immigrated from Spain to Colombia, built a very profitable supermarket business. But never forgot to pay his employees well, to provide them with health care even years before the time the government started imposing this obligation partially on the employers, to provide them aid for other needs like education for their children, housing, etc. He was loved by hundreds and despised by other merchants who called him "communist". It seems this, and "socialist" are the favorite epithets the greedy use on the people who feel responsible for others. I know you can make lots of money as you take care of your fellow men.

    A country which wants to take care of all its citizens cannot leave their health care in private hands because greed is a too powerful human instinct. How much denied health care do you think represent the millions of dollars the CEO of United Health Care has pocketed in the last 5 years? We'll never know. Insurance companies can do hundreds of different business and take their hands of health care. People in Europe, Australia, New Zealand and Canada are very happy with their Universal Health Care Systems operated by their governments.

  • Report this Comment On August 28, 2009, at 12:14 PM, jnrife wrote:

    It is my personal feeling that overpriced health care in America began in the mid 50’s with the advent of employer provided health insurance. In the beginning the insurance was cheap and employers were quick to give their employees the best perk they could. The result of this was that most employees felt that the best of health care was essentially FREE – after all, the insurance premiums were paid for them and they could get the best health care in the world for little or NO out of pocket cost. Employees cared nothing about the cost of the insurance and nothing about the cost of the care – it was free to them. In other words, the health care industry had free reign to recommend costly procedures and raise prices as much as they wanted all because there was little if any market pressure to keep costs contained.

    And now, especially in the last 10 years, employers are beginning to say “Enough is Enough” – and they are beginning to cut back resulting in insurance with higher employee contributions and higher deductibles and co-pays. And many employers are beginning to drop the plans all together. The result is that more and more Americans can not afford health insurance or health care.

    What is the answer to this dilemma? I think it is to BAN employers from providing health insurance to employees. Let’s ask the employers to give all those employees the raise necessary to allow them buy (and deduct the cost of) their own insurance. Let’s ask the insurance companies to insure everyone as if it were one huge pool. No pre-existing conditions, no dropping people from coverage.

    What would the result be? A level of competition that has never been seen before. Consumers making decisions to lower their own health costs (Health Savings Accounts, accepting lower cost alternatives, looking for the best bargains). Companies beginning to compete for those consumer dollars by giving better care for less.

    I have heard people argue that consumers should not have to look for the “best deal” when seeking health care services (if I have a heart attack I don’t want to have to grab the Yellow Pages and call around for the best price). However, I believe that, over time, this competition would work. The best example I can think of that demonstrates what a bit of competition can do to lower health care cost is that of Lasik eye surgery. Because it is not covered by insurance, there has been a natural improvement in the delivery of this service and a significant lowering of the cost over the past 10 years (and probably better outcomes).

    I hear everyone say we spend too much on health care in America, but it seems that the proposed solutions to the high cost are like putting a band-aid on a stab wound. Nice idea, but it probably won’t work. How about getting a little competition back into health care?

    PS: Doctors wouldn’t like it. Hospitals wouldn’t like it. Insurance companies wouldn’t like it. Pharmacy companies wouldn’t like it. So… will it happen? NO because these industries control the lobby dollars in Washington.

    PSS: Yes some still will not be able to afford basic health care – let’s develop local community clinics that provide REAL (preventive and urgent) health care at a reasonable cost (staffed by lower cost providers) and provide services on a sliding scale.

    PSSS: Yes some will still not be able to afford catastrophic health insurance – let’s give them a government subsidy – we do it with housing, food, education, etc. – we could do it for catastrophic insurance.

  • Report this Comment On August 28, 2009, at 12:26 PM, gkirkmf wrote:

    For those who think that the market, combined with a catastrophic health insurance program (about $50,000) just might solve our insurance cost problem.. I recommend that you read this article in the Atlantic Monthly (Sept) if you need further convincing.

    It is a real eye opener, and well worth reading.

    http://www.theatlantic.com/doc/200909/health-care

    By the way, american health care killed my father also.

  • Report this Comment On August 28, 2009, at 12:29 PM, NoHype wrote:

    Brian Orelli said: "It's funny how the government seems flabbergasted by companies in a capitalistic society making money during a crisis."

    Dr. Orelli seems to be coming from the point of view that the only "good" motive is a profit motive. I realize we're discussing this issue on a site dedicated to maximizing individual profits.

    I think his basic error in reasoning comes from conflating capitalism (an efficient system of commerce) with republican (small "r") governance. Even if we assume that our current commercial system has not devolved into the monopolistic monolith that Adam Smith cautioned against, we cannot assume that markets are the most efficient delivery mechanism for goods and services that are not discretionary. In short, nobody shops around for an ER while bleeding profusely.

    His use of the oil companies as an example is telling. Oil is a non-optional commodity in today's world. So is health care. And so is water. Food is a little different. The sources are somewhat more flexible and we can afford to spend time shopping amongst those sources (unless, of course, a single entity owns all of the means of food production).

    A tried and true method of dealing with non-optional goods and services is to put them in public trust and give everyone a stake in the outcome. Our infrastructure is a great example of this (the commons).

    We would find it exceedingly unfair for taxpayers to underwrite a highway system and then hand it over to private companies to "manage" at a profit. Yet, this is what we do with our health care system. Taxpayers underwrite the massive research done at universities, foundations, and non-profits and then the results are handed over to for-profit organizations so they can bilk the rest of us out of our cash via monopolistic practices.

    The argument that the government (i.e. "us") can't run an efficient health care delivery platform is specious at best. We currently run one of the world's best and most efficient systems under the Veterans Affairs Administration.

    It's too bad Dr. Orelli can't see beyond his blind spot (faith in markets at all costs) in order to objectively evaluate various options available to us under our republican form of governance.

  • Report this Comment On August 28, 2009, at 12:31 PM, Batman45 wrote:

    I am a single realtor living in Boston. I pay Blue Cross $644 a month for health coverage. I am very pleased with the no nonscence covereage they provide. I keep hearing how the puplic plan will lower costs. Does that mean that I could get the same coverage I get from Blue Cross for less money?

    Does it also mean that for everyone who goes on a public plan someone on a private plan will pay more to subsidise them? I do not get it and our politicians never answer anything directly.

  • Report this Comment On August 28, 2009, at 12:54 PM, bricrter wrote:

    What is being proposed is an *optional* health plan, bought at your sole discretion, which is available on the open market, and competes with all the other plans out there.

    It's a new insurance company, and it's run by the government, and you don't have to buy the damn thing.

    That's it. Period. You like it? Buy it! You don't like it? Don't buy it! Go buy another plan!

    All this talk about Canada and the UK is just incredibly pointless, since the current bills-- and any bills likely to make it-- are not proposing anything even remotely resembling the Canadian or British systems, or even most countries' socialized systems.

    The plan in *all* the bills under consideration in the House and Senate, and the one which has always been promoted by the President, is not "socialized medicine," and it is not a "government takeover". This isn't the plan: never has been, and never will be. Nothing like that has been proposed by the President at any time. Nor does it contain some secret plan for a government takeover, or death panels, or anything like any of this gibberish.

    "How would it control costs when we're spending money on it? You can't save money by spending money!!!" I keep hearing.

    Ever heard of a company buying a new computer system for invoicing-- upgrading it to improve efficiency? Or spending money on employee retraining for that new computer system? Or cutting costs by constructing a new office building which consolidates all regional offices?

    I know, it's unheard-of: investing in infrastructure now-- spending money up front-- which improves efficiency down the road.

    How will it cut costs? The answer is this: it will cut costs because there will be an efficiency of scale that simply cannot be achieved by any other means other than a very large organization-- one, say, as large as the government. The more folks who are covered under a plan, the lower the costs will be. And this will be a very big insurance company, many times larger than the others. Therefore it will be able to offer its services more cheaply.

    It's funny, you know? You can put a man on the moon, but you can't get a government program that spurs investment, technological and engineering innovation, and still manages to manages to return money to the econ--

    ---oh, RIGHT. That *was* a government program. The space program... the one that gave us the Mars rovers. You know-- the ones that exceeded their estimated lifetimes by-- what is it now?-- 15-fold?

    Again, this will be a governent-run company which competes on the open market for your consumer dollar. That's what it will be: it will not be a government takeover of anything. And it isn't a secret plan for a government takeover, either.

    You don't like the US Postal Service? Fantastic! Go use FedEx or UPS! That's the idea here. Now, most people use the USPS. And, yes, everyone pays taxes to keep it going. Why? Because it's infrastructure that any civilized industrial nation can't do without. Just like a healthcare system that's reasonably functional. Right now, you've got one that isn't. And if you look around, you've got EVERY SINGLE COUNTRY IN THE INDUSTRIALIZED WORLD-- and then some-- paying less for, and getting more from, their healthcare systems.

    Why? They all understood that they couldn't afford not to have the advantages of the economy of scale that only a government can provide. No private corporation is big enough to do it.

  • Report this Comment On August 28, 2009, at 1:02 PM, Julia1234 wrote:

    First of all, it is UNCONSTITUTIONAL. Secondly, there are better ways to fix it. Here are a few:

    • Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs)

    • Repeal all STATE LAWS which prevent insurance companies from competing across state lines.

    • Repeal GOVERNMENT MANDATES regarding what insurance companies must cover.

    • Make costs transparent so that consumers understand what health-care treatments cost.

    *TORT REFORM!!!!!!!!!!!!

    Government has a 100% track record of overspending for everything, even Medicaid. All the happy gov. health supporters from other countries are ignoring the fact that AMERICA's free market is what they feed off of. Once it's gone, we all suffer together. The fallacy that insurance companies will be competing with the gov. "OPTION" needs to be ousted. It is IN THE BILL that once insurance companies raise their rates in order to compete, they will be forced out. If you hate big insurance execs, and big fat cat capitalists, just wait to see what we get with big fat cat government power hungry bureaucrats! (hand in hand with their one or two hand picked big insurance corps) We will no longer be free to change companies then. Here comes the mother of all those evil HMO's the very same people demonized the past eight years.

  • Report this Comment On August 28, 2009, at 1:04 PM, theHedgehog wrote:

    In more broader terms: the socialization of the health care system equals the democratization of health care.

  • Report this Comment On August 28, 2009, at 1:05 PM, theHedgehog wrote:

    Julia, you're babbling girl. Time to take your meds.

  • Report this Comment On August 28, 2009, at 1:08 PM, MECOX wrote:

    I CONFESS TO BEING DUMBFOUNDED BY THE QUALITY OF THE DEBATE..THE STAGGERING MYOPIA AND REFUSAL TO TAKE ON BOARD KNOWN FACTS, BECAUSE IT THWARTS "PERSONAL IDEOLOGY".. YES THE US NEEDS ITS OWN SPECIFIC SOLUTION...BUT CLEARLY WHAT IT HAS IS NOT WORKING..AS IS EVIDENT WITH THE AIRLINE INDUSTRY, MOST OF THE AUTO INDUSTRY, THE ROAD/RAIL SYSTEM, THE CITIES INFRASTRUCTURE..ETC..AMERICA SPENDS TWICE THE OTHER TOP 18 COUNTRIES PER PERSON AND WHAT DOES IT GET? BRILLIANCE AT THE VERY TOP THIN LINE, MASSIVE SPEND ON PEOPLE IN THEIR LAST TWELVE MONTHS AND BOTTOM OF CLASS IN MOST OTHERS.. CANADA/FRANCE/ AUSTRALIA/THE UK ALL HAVE MORE EVEN BALANCED SAFETY NETS AND MATURE GROWNUP SYSTEMS..THOUGH ALL COULD BE IMPROVED..ALL I HEAR IN THIS COUNTRY IS KEEP GOVERNMENT OUT, EVEN THOUGH MEDICARE APPEARS TO BE DECENT AND HAS LOW BUREAUCRATIC COSTS

    MY DAUGHTER WAS IN A SERIOUS CAR CRASH TWO YEARS AGO...90% OF HER INJURIES WERE MISSED BY THE FIRST HOSPITAL...THE NURSING CARE THEREAFTER WAS INFERIOR TO THE UK..YES ITS UNFAIR TO TAKE ONE PERSONAL EXAMPLE, BUT IT WAS HARDLY REASSURING..I HAVE MADE IT CLEAR THAT I WOULD WISH TO BE TREATED IN ENGLAND IF I BECAME SERIOUSLY ILL.. AND TRUST ME, I ADMIRE VAST AREAS OF THE US LANDSCAPE..BUT MOST OF THE COMMENTATORS ABOE NEED TO RESIDE ABROAD AND GET A DECENT COMPARISON..THE HARD FACTS FROM CANADA SHOULD SUFFICE..BUT ITS CLEAR FAR TOO MANY PEOPLE WONT FACE THE FUTURE AND IN 30 YEARS TIME MAY REALISE HOW FAR THE US HAS FALLEN BEHIND IN MANY AREAS AS A RESULT OF UNINFORMED THINKING

  • Report this Comment On August 28, 2009, at 1:11 PM, kitharris1 wrote:

    a government run health care plan is a terrible idea. do you really trust a congress that is throwing money around like a drunken sailor (my apology to sailors). they have no concept of staying within a budget. many of them have bankrupted at least one business. do we really want a guy who has never had a business related job (president obama) in charge of our health care. the bottom line for me is: if this is such a good plan, why aren't the president and the congress willing to be under the same plan? are they special? i sure don't think so! wake up america! it's time for us to put people in government who will do the right thing. socialism works until you run out of other people's money! i'm tired of paying for everyone else. i can not afford any more help from the government!

  • Report this Comment On August 28, 2009, at 1:11 PM, jdlyall wrote:

    Lots of people here seem to think that provision of medical services/insurance by the government is unconstitutional. Huh? Medicare is unconstitutional? The VA hospitals and clinics, Indian Health service are unconstitutional? SCHIP must go, sure. Throw out medicaid, the market will provide, just like it has the past two years. Let us have financial improvisation in the health insurance market. That's the ticket!

  • Report this Comment On August 28, 2009, at 1:16 PM, theHedgehog wrote:

    jdlyall,

    I suspect that those who are shouting "unconstitutional" about the nationalization of healthcare are those same fringe group members who shout "unconstitutional" about income tax, paper currency, etc. They have no real idea about what the constitution is, much less what it says.

  • Report this Comment On August 28, 2009, at 1:23 PM, gret3 wrote:

    First, to request a choice between the alternatives "should insurers be hung out to dry, or has Congress gone too far" is leaning a bit in the direction of the Fool's particular take on the situation, isn't it? I expect a little better from the Fool. But from a scan of the responses you have received it looks like your readers have thought this through themselves - good job Foolish Readers!

    Second, a single payer plan is NOT a communist or socialist plan. The former is a plan that is publicly funded and privately delivered where the latter two plans would be wholly owned (funded and delivered) by the government. I really wish that opponents of single payer would get that straight - its not that hard.

    Third, am I correct in assuming that your net income statistics are AFTER expenses that would simply not be applicable to a single payer program such as advertising, extensive cross billing, multimillion dollar executive salaries and bonuses, and, excuse me for bringing it up, political contributions? I think I am correct and I wonder, for all of these additional "expenses" that are incurred by private insurance and ultimately factored into the insurance premiums paid by their insureds (who are taxpayers, right?), what contribution or benefit the private insurers really provide? What exactly do they do for taxpayers above and beyond what a single payer system would provide?

    Fourth, aren't we unnecessarily burdening American business with a system where so much of private health insurance is born by employers and then expect them to compete in a global economy against foreign businesses who don't have to factor this huge expense into their budgets?

    And the last point I would like to make, although certainly not the last point that could be made on this issue - is healthcare a commodity like oil, designer handbags or widgets? Should a profit be made from human suffering? Sure we all want to prosper but at what price - our souls? We should ask ourselves who we want to be first and how much money we can make second. I don't think the two are necessarily mutually exclusive.

    Sure, this system wouldn't be perfect but the good thing about being the last major industrialiized country to go to at least an option for a single payer system is that we can learn vicariously from those who have wisely gone before us. Like the Roman Empire we can take the best of what other cultures have developed (and what we have learned from our own Medicare) and incorporate them into our own while at the same time improving upon what has been done before.

    Please check out Rep. Anthony Weiner’s bill HR676 as an alternative to HR 3200.

  • Report this Comment On August 28, 2009, at 1:27 PM, klarom wrote:

    Instead of debating the minor pros and cons of Obama’s Health Plan, let’s go to work on replacing the current fascist system of so called private health care with a true system of free choice without Government controls. Information is available through the Americans for Free Choice in Medicine <www.afcm.org>. We have to examine the whole system of Government coercion. And what we will find out is that the Government has so grossly mismanaged an entire industry that it has to be banished from health care entirely. Government does not provide health care. Only individuals do. And it’s precisely these individuals that are being attacked. The most vicious attacks are presently directed towards all providers, but most pointedly the health insurers who are being scapegoated for rising health care costs.

    There are Federal laws and State laws that have resulted in hamstringing the entire health insurance system with byzantine rules that are neither consistent nor open to consumers’ inspection. Only the costs get added up. Insurance companies would write policies that suit your individual needs, if these laws did not specifically forbid them to do so. This would cost less than half of what you're paying now for insurance either through your employer or on your own as the case may be.

    Each time that you visit your doctor, there is always a third party with you in the room. Do you want the Government to muscle its way even further into what is your most private matter, your health?

    The answer is not a compromise! In any compromise between Good and Evil it's always evil that wins. What we need is assert our inalienable Rights the Life, Liberty and the Pursuit of Happiness. It’s time that we truly assert these Rights. They have been compromised on long enough by our Government. We don't need more controls! We need Freedom from Government Coercion! The whole debate about healthcare is merely a smoke screen and just one aspect of the much larger issue that we are indeed slipping into tyranny and dictatorship. Wake up Americans before it’s too late and before we have lost all of our freedoms.

    Let’s stop this Big Brother Law! Let’s go for liberation instead!

    Enjoy afcm.org.

  • Report this Comment On August 28, 2009, at 1:32 PM, NoHype wrote:

    Mecox wrote: "I CONFESS TO BEING DUMBFOUNDED BY THE QUALITY OF THE DEBATE..THE STAGGERING MYOPIA AND REFUSAL TO TAKE ON BOARD KNOWN FACTS, BECAUSE IT THWARTS 'PERSONAL IDEOLOGY'"

    Aside from being taken aback by the all-caps shouting, I'm surprised more of us don't understand the emotional component of political reasoning: http://news.yahoo.com/s/livescience/20090826/sc_livescience/....

    The opponents of reform understand this all too well. They tap into people's fears to keep the game rigged in their favor. And why not? We should not expect individuals and organizations who profit to stand idly by and *not* rally to protect their windfalls.

    If the stakeholders in a reformed system would wrap their minds around the fact that the debate is not rational, we'd make more headway (albeit much messier) in winning hearts and minds.

    Our very constitutional system was created specifically to deal with this reality (mob rule is rarely fair or effective). If we were to stop cowering every time a commentator like Dr. Orelli threw sand in our faces and hit back with the caricature of the Greedy Corporate Welfare Queen (today's Robber Barons), we'd start to make some headway.

    Facts are for policy wonks and bureaucrats.

    Images, Icons and Straw Men will never be excised from political debate. It's how our minds work. Stereotypes exist because our minds need mental shorthand to think and react quickly to environmental inputs.

    It would do us well to remember this when countering fear tactics from the stakeholders in the current system.

  • Report this Comment On August 28, 2009, at 1:32 PM, drdave44 wrote:

    WJ1942 and ET69 are right on. Healthcare insurance companies make huge profits at the expense of patients and providers.

    The simple truth is: No system will EVER work where profit motive encourages limiting reimbursement of the providers with the premiums paid by the patients in order to increase the bottom line for stockholders and enrich the company. Insurance executives, flying around in their private jets, provide NO goods nor services except that of transferring resources from payer to provider. Beyond profits, the obscene salaries and perks they receive, at the expense of the providers that DO do the work, are unconscionable.

    Equally obvious, the attorney-controlled federal government with it's deference to the trial lawyers lobby, is not truly interested in reforming health care cost. While managed care's attempt to limit cost by denying services and rationing compromises physicians ability to provide the best care, the defensive medicine practices required to protect themselves against frequently frivolous litigation will continue to increase costs unnecessarily. The "health-care crisis", which is, of course a misnomer; ("Third Party Reimbursement plus Out-of control Legal System Crisis" is more accurate), could be easily solved without compromising patient care by the following:

    1. Make all insurance companies Non-profit (as they are in Europe). The 20-30% taken off the top by insurance would more than cover the un- and under-insured patients.

    2. Limit the Insurance CEO's salary to that of the highest paid physician covered.

    3. Tort reform: Limiting contingency (No attorney can get more than the patient from a malpractice award) and loser to pay attorney fees and costs in frivolous cases rather than extract "go-away" settlements.

    (4). Other changes that would help include increasing the reimbursement for primary care physicians and providing incentives for patients to see PCPs rather than self-refer. 90% of American patients need primary care and 10% need specialty care; however, the converse exists: 90% go to specialists and 10% to generalists. Of course, PCP's are pathetically underpaid compared to procedure-heavy specialties.

    SImplifying the reimbursement process to free providers of the enormous administrative burden requiring up to 30% of their time would also help.

    Many colleagues would opt for a single payer system if it were not administered by the federal government which has long demonstrated incompetence in fiscal management. BTW, Medicare limits overhead by severely limiting reimbursement to the extent that no provider can survive without other means. It is ludicrous to think that expanding this insolvent and complex bureaucracy will ever be an improvement.

    Of course, my simple cure could never be implemented due to the simple fact that special interests rather than ordinary citizens control the government of our country. Big pharma, for profit insurance companies and trial lawyers will always prevail unless the present system changes.

  • Report this Comment On August 28, 2009, at 1:35 PM, theHedgehog wrote:

    I shudder to think what kind of fringe group afcm.org is. I wonder where the money (*cough RNC cough*) comes from.

  • Report this Comment On August 28, 2009, at 1:38 PM, theHedgehog wrote:

    Ah, cool, this thread has now made it to the big time: saturation bombing by the moneyed groups. Let the entertainment begin.

  • Report this Comment On August 28, 2009, at 1:39 PM, kstarfury wrote:

    If private insurers really are efficient business and/or the government truly is terrible at everything it does, then having a few discussions in congress is fairly meaningless in the long run. Private insurance will win, government will be provent to be ineffective.

    That we are even debating this shows that no one is honestly convinced that either extreme is correct.

    I'll tell you this - I have 100% government run health coverage (and it's coverage, not insurance) and I am extremely satisfied with it. I have never had to pay a co-pay, never been denied coverage, and had doctors that seemed more motivated to perform their craft than to move a certain volume of clients. No issues with wait times in line be it at the pharmacy or how quickly a referral gets to a specialist practice.

    Frankly, how well (or not) the insurance industry is compensated (and if it does well over time) is not nearly as important as whether people are properly cared for. Health care is an instance where profit motive and the purpose of the institution is at odds. Could you imagine a for-profit military, for-profit police, or for-profit fire department?

  • Report this Comment On August 28, 2009, at 1:43 PM, runnindoc wrote:

    Less third parties in the room when I see a Medicare patient than Blue Cross. No magic number of precertified visits, foolish formulary moves, etc. What actually ARE the upper mgmt salaries for United and Blue Cross? Does anybody want to say their talent etc. is worth $100 mill a year when with 14 years of education after high school then 15 years of practice, I make 80k as a board certified physician?

  • Report this Comment On August 28, 2009, at 1:46 PM, MrsCathyGF wrote:

    Good Lord ! Has ANY article gotten THIS many comments before ? People do NOT want the gov't running their health care. That is clear. I don't care how many paid Obama hacks push around the average citizen, they cannot ignore it. Reps are getting baraged with the fact that people DO NOT want the gov't running their health care.

  • Report this Comment On August 28, 2009, at 1:51 PM, jcb1948 wrote:

    This is written as if it should be obvious to everyone that the private insurers will be able to out-perform the government. But given repeated statements by various Democratic officials that the "public option" is intended to segway to single-payer.

    As long as the feds underwrite it, the public option can be far cheaper than private insurance which, as long as the feds control regulation, can be forced to get more and more expensive.

    Conservatives and insurance companies don't object to competition but to the trojan horse.

  • Report this Comment On August 28, 2009, at 2:02 PM, kstarfury wrote:

    veryverda,

    You are incorrect. That one group is louder at shouting does not mean they represent the whole.

    What makes no sense to me is the belief that the status quo is acceptable. Try having cancer treated as a pre-existing condition while shopping for health insurance. Or being out of work due to the economic downturn.

    Yup, people like that definitely don't deserve health coverage.

    The title of this article is most exciting and effective in getting people stirred up, so bravo for an effective way to get people involved. What concerns me, though, is ease with which even members of the MF community are so easily manipuilated.

  • Report this Comment On August 28, 2009, at 2:07 PM, Longgonetoo wrote:

    I have probably traveled the world more than 99.9% of Americans have. My business is an international business. We are an American business owned by an American but we have stayed out of America for several reasons and one of the most difficult things about competing in America is the fact that in order to employ American citizens our health insurance makes it difficult to use them on a worldwide basis. For example, the premium paid for my insurance until it's renewal last year was just over $600/month. In one felt swoop, the premium went to $2100.00/month! That's over $25,000.00/year for one person! It's insanity that you people who do not want a goverment plan trust an insurance company. They are not your friend. They want you to die if you get sick!

    I could tell you all of 3 cases where that was exactly what happened. With my mother, my wife and one of my best friends. I absolutley hate health insurance companies and wish they no longer existed.

    I would bet that everyone of you who is against this will get on to Medicare when you reach age 65 nand would never stay with a private insurer unless it was provided in a retirement package. If you say otherwise, you are either not being honest or you are just plain stupid.

  • Report this Comment On August 28, 2009, at 2:10 PM, bkwoolery wrote:

    Your claim that insurer's pay 82% of every dollar towards actual healthcare is a little high, its' actually less than 80%, and falling as they clamor to meet WS expectations. The problem is another 10% or more is wasted on the providers' side dealing with the insurance companies - so we might peg that against them as well for a total inefficiency of 30%+. Now take Medicare at 3-5%. Which is the better business model?

    Insurance companies aren't in business to provide healthcare, they are in business to provide a feeling of security (often baseless, as seen by the last time these clowns testified and each in turn refused to stop rescinding policies of people who had the misfortune of getting sick).

    Stop defending these guys. We are all in this together and healthcare should be fundamentally about people, not profits.

    I am a single-payer advocate, as should you be as well if you really have any economic sense. And there are plenty of Republicans in our camp, it's not just pollyannaish liberals (ask David Brooks, for example).

  • Report this Comment On August 28, 2009, at 2:17 PM, theHedgehog wrote:

    veryverda says: "People do NOT want the gov't running their health care. That is clear."

    Actually, it's pretty clear that people, real people (with real problems rather than people being paid to make a stand) really do want the government running their healthcare system.

    It's like this: somewhere between 35million and 46 million people have no health insurance. The little healthcare they get is government provided via the emergency room or through medicaid for children.

    Another big chunk of people are on Medicare. For the most part, they're pretty happy with it.

    There's another big chunk of people, like me, who get their healthcare from the VA. That's also government provided healthcare.

    I can't imagine wanting a private insurer to take over the VA healthcare system. I doubt the seniors want privatization of Medicare, either. Thanks, but no thanks.

  • Report this Comment On August 28, 2009, at 2:27 PM, theHedgehog wrote:

    jcb1948 says: "Conservatives and insurance companies don't object to competition but to the trojan horse."

    Balderdash. The insurance companies have manipulated their markets so that they are now effectively bureaucracies. Within a bureaucratic society, there is no competition. And, since the barriers to competition and startups are so high, there will be no competition.

    Bureaucracies control is not the purview of private industry. Private companies are meant to compete. They are allowed to exist for the primary function of providing a service at *competitive* prices. Once it becomes impossible for that to happen, then the onus is on the government to step in and take control of such an industry that cannot and will not be competitive.

    The goal of a health care system is to provide health care, and NOT to provide a captive audience for private enterprise. If industry hadn't forgotten that basic fact, we wouldn't be where we are today: considering nationalization of healthcare.

  • Report this Comment On August 28, 2009, at 2:39 PM, bbestes wrote:

    I don't want the healthcare industry running my healthcare, and I don't want the government running my government... Yeow! What are we gonna do?

  • Report this Comment On August 28, 2009, at 2:54 PM, mpabraham wrote:

    While I DO support health care reform efforts, I suggest Mr. waxman and his colleagues first LOOK INTERNALLY before criticizing the private sector for their excessive spending. ALL federal, state and local agencies should be looking at THEIR excessive spending on salaries junkets, health care, retirement programs, retirement spiking etc. There was a time when government employee compensation always trailed the private sector. Generally speaking, this is no longer the case, and the situation is worsening in the current recession.

  • Report this Comment On August 28, 2009, at 2:55 PM, theHedgehog wrote:

    mpabraham,

    With all due respect, sir, please do not change the subject. This thread's subject is healthcare.

  • Report this Comment On August 28, 2009, at 3:07 PM, mpabraham wrote:

    Mr. Orelli's table showing 'low' net income's of several large insurance companies is somewhat misleading. The net profits shown surely depict what remains AFTER potentially excessive expenses are deducted. If such expenses were brought under control, net profits would rise.

    From personal experience and from experiences I've read about, most if not all insurers focus on denying claims. I suspect in many cases bonuses are based on how much an employee might save the company by successfully denying claims.

    Anyone out there that can refute or support my suspicions?

  • Report this Comment On August 28, 2009, at 3:10 PM, kkconway wrote:

    BIg Brother, Nanny Sam and the All Seeing Eye of Government have us under their spells. Take your Soma* like a good little boy or girl and keep watching your TV, at least until Fearless Leader declares that it has to go off to save on carbon offsets. Get it? ... "off sets" is what Obama wants with your TV -- set off unless you power it with pedal power like a gerbil or something. Paleolithic Power!

    *cf A. Huxley's Brave New World and don't forget "1984" by Geo. Orwell !!

  • Report this Comment On August 28, 2009, at 3:10 PM, elsiejay wrote:

    Wow!!! a lot of words, most of them thoughtful.

    It makes sense to have socialized military, Interstate Highway System, Ventrans Admistration (a program that is truely socialized medicine, the Feds own the hospitals, pay the Drs, etc..... I am willing to bet that few vets want it all demolished and turned over to the insurance co's.) Post Office (yes I know about UPS.. but it would cost more than 28 cents to mail a post card) The National Parks... Money (there was a time when banks issued their own money!!) Air Safety and more. Most of us have recieved our education thanks to taxpayer support. What they all have in common is that these programs are of absolute national interest. They all matter to all of us. To say that in this age of medical technology that the health of all of our citizens is not of national concern is absured. I am willing to have my taxes raised a great deal if I can be assured that none of my fellow Americans suffer for lack of health care. I believe that those who would deny health care to the less fortunate are mean and selfish. Maybe even cruel. I have no idea what the answer is, but this system sucks and I am afraid that it is being run by mean and selfish people.

  • Report this Comment On August 28, 2009, at 3:16 PM, mizzensheet wrote:

    My eyes are sore reading all the real concers of all the post on this listing! I think that which ever way thing turn, that it may be a very good time to not have large numbers of shares in the varieous insurance co.

  • Report this Comment On August 28, 2009, at 3:33 PM, theHedgehog wrote:

    mpabraham says: "I suspect in many cases bonuses are based on how much an employee might save the company by successfully denying claims.

    Anyone out there that can refute or support my suspicions? "

    Not directly, no. But, my ex has worked in non-health related insurance claims for several decades. Her job is to enforce the contract, not to see that either her employer or her claimant comes out ahead in any one claim. Think about that for a moment, then look at your insurance policy. It is what is the lawyers say it is, and probably not what you understand it to be.

    People on both sides of this issue must understand that a health insurance policy is not a health care policy. What we, the people, need is a health care system - not a diverse collection of doctors, hospitals, and insurance policies. Such a health care system can never occur given what we have. Nationalization is the only way.

  • Report this Comment On August 28, 2009, at 3:39 PM, GeneLander wrote:

    Excellent discussion on this thread. Unfortunately, I don't have time to read all the comments; however, I would like to add a couple of comments of my own.

    I disagree fundamentally with the premise of Brian Orelli that the "profit" margins of healthcare insurers is the relevant metric. Healthcare should not be a "business". Call me a socialist or whatever you like but I firmly believe that healthcare is an essential component of our society that is just too important to be governed by profit-driven business interests. Why don't we contract out military services to wage our wars? Answer: its too important to be left to business interests. And lets not ignore the fact that the market-driven approach has not been able to control costs for decades and never will as long as we refuse to legislate pricing regulations as every other Westernized society has done. Another important long-range goal for healthcare reform is to free up American business from the burden of healthcare and make America more competitive with other economies.

    I also appreciate the comment by the person of Scottish origin who pointed out that the peace of mind of universal coverage was priceless. Government regulated/insured healthcare may or may not be as efficient as profit-driven healthcare but it would certainly be more equitable.

  • Report this Comment On August 28, 2009, at 3:39 PM, Littleducky wrote:

    We have guardianship of a child that was once on Medicaid and now on our insurance, which is expensive. Medicaid was better: more comprehensive, easier to use, and wider (though not complete) choice of providers. I know we pay for this through taxes, so it was in no way "free" but it was quick, comprehensive, and easy to use.

  • Report this Comment On August 28, 2009, at 4:13 PM, bugsy98 wrote:

    Perhaps Brian Orelli would better serve fox news than the Motley Fool... his inflamed rhetorick ..."withch hunt"seems more a political statement not a financial one...and one I personaly disagree with!

  • Report this Comment On August 28, 2009, at 4:27 PM, oldguy1950 wrote:

    I would like to add some facts to the discussion. As an executive in a small, private, not-for-profit mission-based health insurance company, I can speak from knowledge on this subject. Here are some relevant facts:

    1. Our cut of the premium dollar is less than 10% and goes to cover our expenses. So, the 18% implied in this article is not typical of the competitive landscape in our neck of the woods. Medicare is less efficient than we are and they have higher administrative costs and provide fewer services to patients. And, yes, our administrative costs do include salaries, benefits, small bonuses for performing efficiently, and a number of member services, including a staff of nurses and doctors who call people up and remind them to take their meds and keep themselves out of the hospital. We also review claims for fraud. Oh, yes, there is fraud on the part of some friendly neighborhood practitioners.

    2. Contrary to popular opinion, we are not about making a profit. We are about trying to provide the most value at the lowest cost. This is difficult in a marketplace that has allowed provider unit costs and conversion rates to increase at double digit percentages annually while the CPI has been in the 2% to 4% range. If you want to understand rising healthcare costs, you have to look at what is driving the cost up for hospitals, clinics, labs, specialists, and pharmaceuticals. It is not insurance companies who have consistently improved their operational efficiencies and added services while trying to control abusive medical excesses. While there are some "for profit" companies that have abused their market dominance, there are many, many, "not for profit" insurance companies with a mission of funding the highest quality healthcare at the lowest cost to the consumer and who also pay special attention to the needs of the destitute and vulnerable among us.

    3. Political Fact: This government has already gained control of the banks and the other large financials by panicking us into a "too big to fail" hysteria. It has gained control of the large manufacturers with capital funding arms (GE, GM, for example) Health insurance is the last sector of finanicals not fully controlled by this government. Do you see a pattern here??? This is simply the last big government money grab--after which the government will have complete control of the so-called private sector financial markets. Make no mistake about it. This is about control of the money--not about reforming healthcare. As you can see from the acrimonious anti-health insurance posts on this thread, insurance companies are easily demonized and they are being attacked because a. Most of the money to fund healthcare goes through them b. They are few in number relative to the real agents driving the price of healthcare--lawyers, specialists, pharmacies, labs, clinics, hospitals, and people who take out of the system but don't pay into it. c. Insurance companies are not neither powerful enough nor popular enough to defend themselves. d. People in this debate are too lazy or stupid to break away from the TV set long enough to find out where the reall cost drivers for healthcare are. I recommend that you google the article by Dr. Gawande (a surgeon) about a county in Texase with high healthcare costs. You won't find insurance companies mentioned as a cost driver.

    4. You will recognize true healthcare reform when you see: 1. Tort reform to eliminate the waste and harm of "defensive medicine" 2. Pay for health value as a function of people getting healthy and staying healthy instead of paying for number of procedures performed. 3. A complete overhaul of Medicare to eliminate the perverse incentives caused by dictating lower unit costs while ignoring health outcomes. Doctors either get out of that game or figure out how to do more procedures--necessary or not, high quality or not.

    But don't let anyone confuse you with the facts. To quote one of our great contemporary leaders in the House of Repressors, "We won the election. We wrote the bill." So, just give them all of your money (and it is still your money) and then (when it is no longer your money) trust them to solve all of your problems! The term "useful idiots" was coined to describe people who don't understand the facts and blindly support charismatic slick talking demagogues until all of their freedoms are gone. Now you can go back to your sitcoms. Maybe they will make a disaster flick out of this some day and we can watch that if it is not censored. I wonder if we would be entertained.

    Thank you.

  • Report this Comment On August 28, 2009, at 4:50 PM, mtracy9 wrote:

    The Medicare program operates with just 3% overhead, compared to 15% to 25% overhead at a typical HMO.

    Provincial single-payer plans in Canada have an overhead of about 1%.

  • Report this Comment On August 28, 2009, at 4:59 PM, oldguy1950 wrote:

    Oh, Mr. Hedgehog, a little fact check on who is paying for emergency room care for the uninsured and underinsured. You seem to think it is government provided. It is not. It may be government mandated but they don't pay a nickel. The cost of uncompensated emergency room care is shifted by hospital financial departments to the rates charged by those who pay--which is not medicare because they set their rates and dictate them to providers. So, who is it? Well, you will never guess, so I will tell you: It is private commercial corporations who buy insurance from private insurance companies who then have to pay rates to the hospitals that include 1. uncompensated care, including emergency care and 2. the money hospitals lose on serving the medicare community.

    This is called "cost shifting." The cost of mandated free care is shifted to the wealth producing private sector--which you would like to destroy--so, after you destroy the evil private sector, who will produce the wealth???

    So, contrary to your apparent illusion, the government doesn't actually produce wealth and give it to people in need. Government can only dictate the redistibution of wealth or provide very inefficient programs for doing it. Let's be brutally honest for a change: redistribution means taking from the productive and giving to the unproductive. Even in this activity, the private sector is more efficient, so the regulatory mechanism that mandates redistributing wealth to the ER from the private sector without letting the politicians get their hands on it, is actually less destructive of wealth than sending it to DC and getting a fraction back to the poor people who need it--after the politicians siphon off a boatload to buy votes, consolidate power, and fund pet programs. Follow the money. I mean, REALLY, follow the money. Where the money goes explains almost everything. Money=Power. So, you, apparently trust the government with all the power and the private sector with none. History doesn't support your faith. Remember, as our founding fathers understood, the citizens lose a lot less blood taking down a corrupt private company than a corrupt government. You should be most worried about an alliance between government and the mega-companies like GE, GM, Goldman-Sachs, the Fed Banking System, etc. You should be supporting a healthy balance of small and medium sized businesses competing in a marketplace that encourages efficiency, innovation, and quality rather than the consolidation of power in the hands of a few.

  • Report this Comment On August 28, 2009, at 5:00 PM, theHedgehog wrote:

    oldguy1950 says: "1. Our cut of the premium dollar is less than 10% and goes to cover our expenses.

    Now, there's a null statement if I ever saw one.

  • Report this Comment On August 28, 2009, at 5:08 PM, theHedgehog wrote:

    oldguy1950 says:"So, contrary to your apparent illusion, the government doesn't actually produce wealth and give it to people in need."

    I don't think for a moment that anyone believes that the government produces wealth. Government provides services. As to where the money comes from to pay for ER care for the indigent, it makes no real difference. If it comes from the government, then it's a tax. If it comes from the private sector after passing through too many hands, then it's still effectively a tax. Personally, I'd much rather see tax money called what it is - a tax - and go to the government to provide those services that it is mandated to do.

    Irrespective of your petty arguments, though, the fact remains that somewhere between 35 million and 46 million people - American citizens - have no health insurance because they either don't qualify or can't afford it.

    Yes, I know that you free-trade guys have all kinds of excuses and reasons why those people don't have adequate health care, but none of those are worth a fig.

    Here's an interesting idea for you. Google "cage people" and watch the movie. It's about 10-15 minutes long, and shows what happened in Hong Kong - that bastion of free trade. That's really what happens in an environment of "free trade", and it's inexcusable.

    We need for every citizen of this country to have access to adequate health care. As I stated above, it appears that the only way to democratize (make available to all) health care is to socialize the health care system. There is simply no reason that some should do without so that others can make a higher profit.

  • Report this Comment On August 28, 2009, at 5:15 PM, ryanhodge wrote:

    OK enough with the tort reform stuff. The cost of defensive medicine and malpractice awards has been debunked by all reputable studies examining the issue. Caps are in place in numerous states. The number of malpractice suits is down across the board. The median value of the verdicts and settlements is down across the board.

    What is running up the cost of health care is the CPT coding methodology. Dr's are looking for every procedure code they can come up with to bill. Dr's dont run people through a thousand tests to practice defensive medicine. They do it to bill more to the insurance company. Even the sitcoms such as scrubs get this one right.

  • Report this Comment On August 28, 2009, at 5:23 PM, jm7700229 wrote:

    There is very little honesty being shown by the proponents of national health care. That's unfortunate, because I would like to support it, but I won't support a lie. Let's start with the famous 46 million uninsured (Or 45 or 47). About 20 million of them are either professionals over the $100k line, like doctors and lawyers, who can but don't want to pay for insurance, or people at the other end who are eligible for Medicare but don't bother because they just go to the emergency room anyway for free. This is based on government figures. Another 12 or 13 million are illegal residents and won't be eligible for the national program, but will, instead, continue to receive free treatment just as they do now. That leaves something around 4% of our population who are caught in the middle. We need to deal with them, but we don't need to screw up the health care of 85% of Americans in order to do it.

    Here's another: the major factors in health care delivery are doctors, hospitals, pharmacies, health insurers, lawyers and government. Of these entities, which is the only one that is actually working to contain the cost of health care (hint: it's not the government).

    Here's another: the two major reasons we "need" health care reform are that it's too expensive and not there are too many people left out. As noted above, few people are left out except by choice, and the plans being debated will increase cost by 10 to 15% according to the CBO.

    Here's another: the figure being bandied about as the cost of health care is a trillion dollars a year. Medical malpractice litigation costs $200 billion, or 20% of that and is growing at a faster rate than the overall cost of health care. Developing a no-fault type of compensation system for patients would save enough money to provide insurance for every resident, legal or not. Why isn't that on the table? Could it be that the president and many congressfolk are lawyers? Or that the trial lawyers lobby, which spends several times what the insurance lobbies spend, are a solid Democratic base?

    And the "government option" for health insurance? I don't have any problem with that, as long as the government has to meet the same legal and financial standards as the insurance industry. But if that were the case, the "government option" would go bust in months. So congress would have to tweak it to make it competitive, sucking money from the rest of the economy to finance more government inefficiency.

    To fix the present system, costs need to be addressed first. Why do we spend so much on health care? A big part of the answer is, to the user, it's free or cheap. Insurance companies cannot restrict what doctors order: the lawyers won't let them. Doctors and hospitals can't restrict themselves to reasonable measures: the lawyers won't let them. And why should they anyway, when the insurance company and not their patients are paying the bills? So the answer is, we spend this much on health care because we want to.

    Then we need to correct the anti-trust legislation that prevents insurance companies from working together to design a form of "assigned risk" for health plans as is done for auto liability and fire insurance. Until all insurance companies will take people with pre-existing conditions, none can afford to do so.

    Only then do we need to design a system that coerces people to insure themselves based on their ability to pay.

    And we need to fix the medical litigation lottery. End that and the need for defensive medicine, and I think we would find that our health care costs are not out of line with the rest of the modern world.

  • Report this Comment On August 28, 2009, at 5:32 PM, oldguy1950 wrote:

    mtracy9. Could you please support your numbers with a more complete analysis and some sources? It is unbelievable that the bloated government bureaucracies you use as examples employ fewer bureaucrats than private companies doing the same thing. I will give you an actual recent auditable benchmarking study refuting your medicare numbers. Then you can give me a link to your sources. I don't think you will find that your numbers are apples-to-apples comparisons. Check out a more complete and up to date analysis of medicare administrative costs vs. private health plans in the following report:

    http://www.bcbs.com/issues/uninsured/Sherlock-Report-FINAL.p...

    This report makes clear that, when you adjust for the fact that Medicare performs only a fraction of the services performed by private plans the administrative cost efficiency actually favors the private marketplace.

    Add to that the fact that Medicare has the regulatory power to make private plans do a lot of work for them--adding to the cost of private plans and taking that part of the administrative burden away from Medicare. You may just find that they are including work that the private sector is actually doing for them in their denominator. For example, my company handles the claims payment for tens of thousands of Medicare members who subscribe to our Medicare Advantage plan. Medicare just has to take a file from us. We handle all of the claims adjudication, fraud detection, customer service calls, and medical management services. If the government has to do all of that, who will they shift their administrative costs to, then? They won't be able to take credit for someone else doing their heavy lifting and those costs will come home to roost in the government program.

  • Report this Comment On August 28, 2009, at 6:05 PM, jm7700229 wrote:

    There is very little honesty being shown by the proponents of national health care. That's unfortunate, because I would like to support it, but I won't support a lie. Let's start with the famous 46 million uninsured (Or 45 or 47). About 20 million of them are either professionals over the $100k line, like doctors and lawyers, who can but don't want to pay for insurance, or people at the other end who are eligible for Medicare but don't bother because they just go to the emergency room anyway for free. This is based on government figures. Another 12 or 13 million are illegal residents and won't be eligible for the national program, but will, instead, continue to receive free treatment just as they do now. That leaves something around 4% of our population who are caught in the middle. We need to deal with them, but we don't need to screw up the health care of 85% of Americans in order to do it.

    Here's another: the major factors in health care delivery are doctors, hospitals, pharmacies, health insurers, lawyers and government. Of these entities, which is the only one that is actually working to contain the cost of health care (hint: it's not the government).

    Here's another: the two major reasons we "need" health care reform are that it's too expensive and not there are too many people left out. As noted above, few people are left out except by choice, and the plans being debated will increase cost by 10 to 15% according to the CBO.

    Here's another: the figure being bandied about as the cost of health care is a trillion dollars a year. Medical malpractice litigation costs $200 billion, or 20% of that and is growing at a faster rate than the overall cost of health care. Developing a no-fault type of compensation system for patients would save enough money to provide insurance for every resident, legal or not. Why isn't that on the table? Could it be that the president and many congressfolk are lawyers? Or that the trial lawyers lobby, which spends several times what the insurance lobbies spend, are a solid Democratic base?

    And the "government option" for health insurance? I don't have any problem with that, as long as the government has to meet the same legal and financial standards as the insurance industry. But if that were the case, the "government option" would go bust in months. So congress would have to tweak it to make it competitive, sucking money from the rest of the economy to finance more government inefficiency.

    To fix the present system, costs need to be addressed first. Why do we spend so much on health care? A big part of the answer is, to the user, it's free or cheap. Insurance companies cannot restrict what doctors order: the lawyers won't let them. Doctors and hospitals can't restrict themselves to reasonable measures: the lawyers won't let them. And why should they anyway, when the insurance company and not their patients are paying the bills? So the answer is, we spend this much on health care because we want to.

    Then we need to correct the anti-trust legislation that prevents insurance companies from working together to design a form of "assigned risk" for health plans as is done for auto liability and fire insurance. Until all insurance companies will take people with pre-existing conditions, none can afford to do so.

    Only then do we need to design a system that coerces people to insure themselves based on their ability to pay.

    And we need to fix the medical litigation lottery. End that and the need for defensive medicine, and I think we would find that our health care costs are not out of line with the rest of the modern world.

  • Report this Comment On August 28, 2009, at 6:18 PM, oldguy1950 wrote:

    Hedgehog, I understand your point and agree that, a tax is a tax. In principle, I agree that it is more honest to treat it like a tax instead of hiding it in a cost shift that has been forced on the private sector by an unfunded mandate--which is what free ER care for the uninsured is. I am not arguing against free ER care. My only point is that even in that "government provided service" the mechanism of redistribution is more efficient in the private sector than in the public sector. Which brings us to our main area of disagreement which is the presumption that it is the role of government to ensure that everyone has what they need or want. I see the role of government as defense, security, and regulating a level playing field. When they get in the business of wealth redistribution--even for basic necessities--in a big way (more than just a safety net), the incentives get all messed up. Corruption takes over the system because the referees are now the players. Just look around and see who is rounding up votes and who is getting the government funding. Then ask yourself why meaningful tort reform is flat out off the table in the proposed bill, even though it would be the one single biggest improvement in the cost--regardless of who the payer is. Oh, Howard Dean just answered that--it is because the trial lawyers are big democratic supporters and we can't make them angry--even though they are such a big part of the perverse incentives in healthcare.

    So, we can agree to disagree about the role of government. I happen to trust private business and private charity to handle services. Maybe because I devote my life and substance to both of those hallmark institutions of a truly free people. I believe, as did Adams, Jefferson, Washington, and Franklin, that a free people can only exist if they have the virtues of honesty, generosity, individual social responsibility, and courage. Those who trust government and the coercion of charity are on a different planet--one that leans toward totalitarianism. That is what I am afraid we are becoming--and selling ourselves out to. I think that "cage people" is a red herring for the U.S. economy. The structural changes that are occurring in Hong Kong are much more gradual here in America because we haven't had an economy based on cheap labor for the better part of a century. We have an economy based on cheap energy. But, we are stupidly undermining that platform before we have developed a suitable replacement. It is not healthcare but Cap and Trade that is our royal road to creating a generation of cage people here--when our productivity plunges because the price of energy goes sky high and we can't keep people employed. Again, follow the money. Who is buying up Cap and Trade exchanges? They will be the new HK-like power brokers. They will be the people on the Yachts and in the Skyscrapers and our factory workers will be our cage people with the proposed schemes to drive out carbon as an energy source before we have a suitable cheap replacement. Oh, it's Al Gore--the Green Profit, er, Prophet, himself. In government policy today, always follow the money and you will be able to sort out the politics.

  • Report this Comment On August 28, 2009, at 6:26 PM, nopolitics1 wrote:

    My suggestion is that Motley Fool should stay out of the political arena and focus on your core. There is enough confusion and time wasted by others being obsessed with political issues. We don't subscribe to Motley Fool for your political analysis.

  • Report this Comment On August 28, 2009, at 6:40 PM, oldguy1950 wrote:

    And you think politics and money are different? That might be true only if government stays out of the financial sector--other than its constitutional role of setting the value of money, which it doesn't do.

  • Report this Comment On August 28, 2009, at 7:02 PM, Bianca209 wrote:

    SmallWords Indeed,

    Despite todays choice for a username, I am not wed to the idea of Single Payer. I think it is the surest and most cost effective way to extend coverage to the 50 million or so uninsured as well as improving coverage to the millions more who are underinsured with low lifetime caps, high copays and deductibles.

    It would be nice if opponents of universal health care would look at other countries (all Capitalist) and see how they have been able to provide high quality coverage at less cost instead of shouting out platitudes about big brother, inefficient government and the like. As for considering the the details of what such a program would like like, I have devoted considerable to doing just that but would an opponent of reform such as yourself even be willing to listen? Try it out

    Human Rights and the Insecurity of Health Care in the US

    If we are going to a successful democratic society, we have to have a well-educated and healthy citizenry.

    --Thomas Jefferson

    Of all of the forms of inequality, injustice in health is the most shocking and the most inhumane.

    -- Martin Luther King, Jr

    The United States shares the distinction along with South Africa of being one of the few industrialized nations that fails to provide universal health care coverage. According to the U.S. Census Bureau, there were 46.6 million uninsured people in 2005 or about 15.9% of the population, an increase of 1.2 million from 2004 (See Table 5 below). These figures compare to 39.8 million uninsured in 2000 and 26.6 million or 12.6% in 1980.

    Table 4.1

    Health Insurance Coverage: Us Population 2004

    Total Population Under 65

    Source of Coverage Percent Number Covered/

    Uncovered

    Percent Number Covered/

    Uncovered

    Employer 54% 157.2 million 61% 155.6 million

    Uninsured 15.7% 45.8 million 17.8% 45.4 million

    Medicaid 12.9% 37.6 million 13.4% 34.2 million

    Medicare 12% 34.9 million

    Individual 5% 14.6 million 5.4% 13.8 million

    Other Public 2.% 6.1 million 2.3% 5.9 million

    Source: Kaiser Family Health Foundation and US Census Bureau

    Of these 45.8 million uninsured, about 80% are from working families that have at least one full-time worker. Another 13% have at least one part-time worker in the family According to Families USA, the total of uninsureds in any one year is much larger when the number of people who were uninsured at some point throughout the year are included. For example, in the years 2003-2004, one out of every three people under age 65 was uninsured at some point.

    Nor does the number of uninsured tell the whole story as an increasing number of Americans are underinsured, i.e., the cost of their premiums, co-pays and deductibles is so high that they either opt out of coverage or are reluctant to use it. A Kaiser Foundation comparison of costs for employer-based health insurance from 1988 to 2004 found that health plan premiums are outpacing both the inflation rate and increases in workers’ salaries. In 2005, premiums for family coverage increased 9.2%, the first year of single rather than double digit increases since 2000. While lower than in previous years, the 9.2% increase exceeds the overall inflation rate by nearly six percentage points and the increase in workers’ earnings by over six percentage points.

    In addition to higher co-pays and deductibles, health insurers have increased the number of restrictive practices—loopholes and exclusions—that minimize their payment responsibility. In 2004, about 6.8 million insured Americans spent more than one-third of their income on health care while another 51 million insured Americans spent more than one-tenth. In a new twist, health insurers have been retroactively dumping patients who run up high medical bill. Seeking to explain why employment in the health insurance industry has grown even while less people are insured, NY Times columnist Paul Krugman quips:

    Now we know at least part of the answer: they're working harder than ever at identifying people who really need medical care, and ensuring that they don't get it. In the past, they mainly concentrated on screening out applicants likely to get sick. Now, it seems, they're also devoting a lot of effort to finding pretexts for revoking insurance after they've already granted it. They typically do this by claiming that they weren't notified about some pre-existing condition, even if the insured wasn't aware of that condition when he or she bought the policy.

    Meanwhile, employers are responding to rising healthcare premiums by cost-shifting, self-insuring or refusing to continue coverage. Since the year 2000, the percentage of population under 65 that is covered by an employer-based health plan has dropped by five percent to 61%. And former editor of JAMA, George Lundberg, notes that some 50 million workers are now covered under employer sponsored ERISA plans that are exempt from state regulation over such items as benefits, coverage levels, and quality standards and less than 30% as of 1995 have traditional fee for service insurance.

    High medical expenses are responsible for about one half of the over 1.6 million personal bankruptcies filed in U.S. courts each year. Over three-fourths who filed for bankruptcy due to illness had health insurance when they first became ill and the majority had jobs, owned homes and had some college education. With the recent tightening of the bankruptcy laws, Americans with serious illnesses face the prospect of being indebted for life and/or losing all of their assets as a result of a medical catastrophe.

    If access to health care is so bad and more and more people are unable to afford it, why haven’t we done anything about it? It is not because the US public doesn’t favor universal health care. A number of polls have indicated broad public support. A 2003 ABC/Washington Post poll found that Americans supported single payer health care over the existing employer based healthcare by a 2 to 1 margin. However, support fell to 40% when universal health care was linked with lack of choice of doctors and with waiting lines for non-emergency procedures. A Pew Research Center survey from 2005 found that 65% of the respondents agreed that the US government should guarantee health insurance for all citizens even if it means raising taxes.

    Despite growing public support, we have yet to see Congress pass any meaningful health care legislation. A simple explanation is that in the absence of a broad educated constituency in favor of universal health care, opponents such as the American Medical Association up until 1970s and a coalition of employers, hospitals, and insurers thereafter have consistently out maneuvered and out lobbied supporters. The powerful healthcare lobby has been able to divert popular support for improved healthcare coverage into ineffective and confusing legislation such as the 2003 Medicare prescription changes. In the absence of a strong coalition in support of universal health care, opponents have waged campaigns through the media using a combination of anti-government rhetoric and scare tactics about loss of choice and queuing up for surgery.

    Among the arguments opponents have used are that universal health care would offer less choice for health care providers, create a huge government bureaucracy, be too expensive, drastically reduce quality, result in long waits for necessary care, and put a damper on innovation. Because those who currently stand to benefit from our ineffective and chaotic health care system –insurance companies, pharmaceutical companies, for profit health care providers--have been so successful at defeating legislative attempts to develop universal health care, let’s examine these claims individually using some cross-country comparisons. Bear in mind that the purpose of reviewing the medical delivery systems of other countries is not to suggest that the U.S. should adopt any one country’s health care system without applying it to our unique circumstances, but rather that the available models from other developed economies amply demonstrate that it is possible to extend high quality care to all while paying the same or less than we currently do.

    Countering the Myths

    Universal health care would result in less choice of medical providers

    Opponents of universal health care, especially of the single-payer option, have painted a picture of a government bureaucracy that will strip patients of their choice of health care providers. Ironically, this argument is made while millions of Americans slip into the ranks of the under- or uninsured with little or no choice of providers. Millions more are forced to transfer because their new cheaper health care plan does not include their regular physician or they may be covered by HMO or PPO plans that require a gatekeeper physician who must approve a referral to a specialist. Others are denied medical care by a healthcare itnnsurance bureaucrat who may lack a medical background. It is also ironic because the model most often proposed for the U.S., a Canadian style single-payer system, has complete choice of physicians and far less bureaucracy. Patients fill out a short form to obtain the coverage and then present their medical cards to their doctors. Administrative costs are drastically reduced because hospitals and physicians do not have to contend with hundreds of continually changing billing procedures or worry about what particular plan will pay for what particular treatments while patients are spared the hassle of being sought out by bill collectors while trying to get well.

    Universal health care would create a huge government bureaucracy

    This argument ignores the simplified administration that would be possible with single payer and the fact that there are already at least three current government bureaucracies (Medicare, Medicaid and Veteran’s hospitals) each of which must separately negotiate prices with thousands of insurance companies, providers and suppliers. Single payer would simplify work for physicians, direct more dollars to patient care instead of to administrative costs and could, if properly set up, facilitate cost containment through regional budgets and negotiated fees for services, drugs and equipment. Health care providers—doctors and hospitals would continue to provide direct service while the government would pay the bills as it currently does with Medicare.

    Universal health care would be too expensive

    Actually, the opposite is true—for the same reason that we have not implemented universal health care, we have also not passed legislation that would effectively control its spiraling costs. While methods vary among countries that provide universal health care, all of them have adopted laws and regulations that control health care costs. Among the range of methods used to hold down costs are: lowering administrative costs through single-payer systems (Canada), negotiating fee schedules for medical procedures (Germany, Canada, France, Australia, Japan), adopting hospital budgets (Australia, Great Britian, Canada, France), regulating drug prices (Australia, Canada, France, Germany, Italy, Japan) and co-payments (Japan, France).

    The United States spends more of its GNP on health care than any of the countries that make up the Organization for Economic Cooperation and Development (OECD). A 2005 OECD report shows a long-term upward trend in the amount of spending on health care for the thirty countries in the OECD. The report attributes part of this increase in spending to aging populations and advances in health technology. However, the average for the OECD countries is 8.8% of GNP while the United States at 15% spends the highest percentage of its GNP on health care.

    Universal health care would result in a lower quality of care

    The health care industry and many politicians attribute the higher spending to increased quality, and no doubt, most of the American public believes the US does have the best system in the world. While there is little doubt that the U.S. does have some excellent centers of medical care, international data about healthcare in other developed countries contradicts this myth for our system as a whole. A study released on September 20, 2006 by the nonprofit Commonwealth Fund’s Commission on a High Performance Health System found that of 24 highly industrialized countries, the U.S. ranked last in infant mortality and had the lowest life expectancy for people surviving past the age of 60. The study gave each country a score for 37 indicators of health outcomes including quality, efficiency, equity and access. The U.S averaged 66 out of a possible 100, a failing grade.

    Similar data from countries from the Organization of Economic Cooperation and Development (OECD), show that only four of the 30 OECD countries have infant mortality rates greater than the US, and of these four countries, only Turkey is not a recent entry into the ranks of the OECD (the others are the Slovak Republic, Mexico and Hungary.) For life expectancy at birth, only seven of the 30 OECD countries have a lower life expectancy rate than the US, and once again, these are recent and far less-developed entrants into the ranks of the OECD including four ex-Soviet satellite states as well as Turkey, Korea and Mexico. A World Health Organization study that subtracts the number of years spent in poor health from life expectancy found the US ranked 29th among all the world’s nations, and when considering the totality of healthcare (including access and cost distribution), the US global ranking was 37th.

    A 2005 international survey by the Commonwealth Fund interviewed nearly 7,000 adults from the United States, Australia, Canada, Germany, Great Britain and New Zealand about their health care experiences between March and June of 2005. Not only did the Americans report paying far more for out-of-pocket expenses, but they reported the greatest number of medical errors with 34% reporting they had been given the wrong medication or dosage, incorrect test results or a mistake in their treatment or care. According to the Commonwealth International Health Survey:

    One-third of U.S. patients with health problems reported experiencing medical mistakes, medication errors, or inaccurate or delayed lab results—the highest rate of any of the six nations surveyed. While sicker patients in all countries reported safety risks, poor care coordination, and inadequate chronic care treatment, with no country deemed best or worst overall, the United States stood out for high error rates, inefficient coordination of care, and high out-of-pocket costs resulting in forgone care.

    Moreover, in the deregulatory environment that has flourished since the 1980’s, government agencies such as the Food & Drug Administration (FDA) have been weakened and politicized. In a survey of FDA scientists conducted by the Union of Concerned Scientists, over one-third of the respondents said that the agency was not adequately protecting the public health. Fifteen percent claimed they had been asked to keep information out of documents or change their conclusions for nonscientific reasons.

    Universal health care would result in lengthy waits for medical procedures

    Joseph White of the Brookings Institute, in his comparative study of six countries healthcare systems, concedes that some countries, notably Great Britain and Canada, have had some problems with waiting for non-emergency procedures while others, such as Germany and France, have not. In Britain’s National Health Services (NHS), the government both delivers services and pays the bills, a model that has never been seriously considered for the U.S. This and other critical differences—more restraint on the part of British physicians in the use of both drugs and surgery and the low level of spending for health care (3.4% of GDP) make Great Britain an inappropriate model for comparison. With respect to Canada, which has a very similar medical system and has often been proposed as a model, White points to a study by the U.S. General Accounting Office (GAO) that shows that waits in Canada have “been greatly exaggerated by those with an interest in doing so.” They have primarily been the result of short-term conditions and the Ministries of Health in the provinces have been responsive to addressing their causes. For example, a waiting list in Ontario province for open-heart surgery was found to be the result of physicians changing their ideas about the appropriateness of surgery for elderly patients. In terms of outcomes for treatments, a study by the GAO showed that there was no statistical difference in survival rates for three cancers for U.S. and Canadian patients—Canadian survival rates were substantially similar or better.

    What about those hoards of Canadians crossing the border to get care in the U.S.? White points out that U.S. hospitals that border large Canadian population centers may contain as many as 1% of Canadian patients. Many are there for cosmetic surgery which is not covered by Canadian health insurance while others are referrals from provincial health service funds where distance to a major health care center and excess US capacity are the main reasons for medical care. White also notes that no-one is counting the large number of Americans who use Canadian or Mexican medical services or the hundreds of thousands who buy drugs from Canada. Then there is the relatively new and thriving medical tourism industry that finds thousands of Americans seeking less expensive medical and dental services in such countries as Thailand, India, Hungary and Costa Rica.

    Universal health care would dampen innovation

    Pharmaceutical companies are ardent opponents of any attempts to control prices and often oppose universal health care because they fear, not without justification, that it would lead to more public regulation of drug prices. They argue that such regulation would dampen their profits and stifle innovation. Several alternative studies have pointed out that pharmaceutical companies spend far greater amounts on administration and advertising than they do on research and development. According to one such study by Families USA, drug companies spend about 2 and one-half times as much on marketing, advertising and administration as they do on research. Moreover, as physician and former editor of the New England Journal of Medicine, Marcia Angell points out, most of the research on new drugs is performed by universities and the government with drug companies taking over mainly at the clinical trials stage. The research budget for the U.S. government funded National Institute of Health (NIH) alone was 28.4 billion for 2006 and many of the NIH’s discoveries are turned over to pharmaceutical companies with little in the way of compensation for the tax dollars spent. Additionally, Angell notes that many of the drugs that receive new patents are “me-too” drugs that have minor changes in their chemical composition. According to the industry lobbyist, the Pharmaceutical Research & Manufacturers of America, drug manufacturers spent approximately 34 billion on research in the year 2004 , yet in a review of the years 1989 to 2000, the National Institute for Healthcare Management found that only 15% of 1035 FDA approved drugs were high-priority innovative medicines while 65% were either identical, combined with another drug or drugs, or differed in dosage or route of administration. Under the Hatch-Waxman Act of 1984, pharmaceutical companies can extend a drug’s patent life by three years for such minor modifications, adding to pharmaceutical profits by providing protection against competition from generic drugs. The Hatch-Waxman Act and subsequent legislation increased the initial patent life from about eight years to fourteen years. The Hatch-Waxman Act followed the Bayh-Dole Act of 1980 that allowed universities and small businesses to patent discoveries from NIH research. The result of such favorable legislation has been spiraling profits for pharmaceutical companies. Since 1986, pharmaceutical companies in the Fortune 500 have made approximately two to three times the profit of other Fortune 500 companies. In 2005, the rate of return on assets was 15.7% as compared to a median of 5.7% for all firms.

    The pharmaceutical industry claims that other countries are “free riders” whose ability to maintain lower prices stems from US drug companies’ phenomenal innovation. After examining audited financial reports of large drug companies in the UK and Canadian, a 2004 study in the American Journal of Bioethics, found that drug research in Canada and the UK was paid for by domestic sales, with profits to spare. Moreover, negotiating lower drug prices in Europe has not led to the abandonment of research: research is steadily increasing with some countries having a more rapid increase than the U.S. The authors concluded that prices can be lowered without jeopardizing basic research for new drugs.

    The Notion of Health as a Human Right

    Establishing universal health care coverage based on the notion of health care as a human right is advocated in several human rights treaties. Some salient examples:

    From the Universal Declaration of Human Rights:

    Article 25

    Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

    From the International Covenant on Economic, Social and Cultural Rights:

    Article 12

    1. The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

    2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for:

    (a) The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child;

    (b) The improvement of all aspects of environmental and industrial hygiene;

    (c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases;

    (d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness.

    From the International Covenant on Civil and Political Rights:

    Article 7

    No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment. In particular, no one shall be subjected without his free consent to medical or scientific experimentation.

    This is by no means a complete list of all of the treaties that cover health care as a human right, and it is significant to note that per the 2003 preliminary study conducted by UN Special Rapporteur on Health, Paul Hunt of New Zealand, 60 countries now contain provisions in their constitutions that include the right to health care. Of course, the quality of health care varies greatly by country with many less developed countries lacking the resources to provide even basic health care while most developed countries cover all or close to 100% of their citizens. The language used in these treaties does not dictate how we should provide healthcare to our population. What it does suggest is that if it is within our means, and clearly it is, we should try to design a system that enables everyone to have affordable good quality coverage.

    What are the components of a quality affordable health care system?

    Comprehensive

    It should cover all medically necessary services, including inpatient and outpatient care, long-term care, dental services, prescription drugs, mental health, and medical supplies.

    Portable Coverage

    The coverage should be portable so that individuals changing jobs or locations can continue coverage.

    Full Choice of Providers

    While the government should serve as the bill payer as it does with Medicare, the provision of services can continue to be a mix of public and private.

    Geared toward preventive services

    Preventive services are sometimes thought to include routine measures such as PAP smears, vaccinations, and maternal health exams. The definition should be broadened to include research on the occupational, industrial and nutritional causes of disease with a concurrent strengthening of regulatory agencies charged with safeguarding the public such as the Food and Drug Administration (FDA), the Department of Labor (DOL) and the Environmental Protection Agency (EPA). Examples that cry out for a more systemic approach are the alarming increases in autism, asthma, and ADHD among children.

    Adequately funded public health service

    Public Health plays a key role in monitoring for diseases, looking at patterns of disease across the nation and helping to stop the spread of epidemics. Adequate funding of public health services is a key preventive measure.

    Provide for the placement and /or retraining of employees employed in medical and insurance company billing

    In the event that a single payer system causes job loss due to the decrease in medical claims processing, job placement and/or retraining of employees should be offered.

    Control costs through such measures as:

    • Reduce administrative costs by implementing single payer.

    • Regulate the cost of drugs by negotiating prices and reducing the amount of time before drugs can be sold as generics.

    • Institute quality controls that show a correlation between treatments, laboratory tests and medical outcomes.

    • Provide adequate funding for research on preventive medicine. E.g., autism, asthma

    • Stricter pollution controls.

    • Re-regulate EPA, FDA, DOL that monitor various aspects of health.

    • Adopt regional hospital budgets, fee schedules, and negotiate with equipment suppliers.

    • Control corporate lobbying.

    Further Study

    Angell, M.D., Marcia. The Truth About Drug Companies: How They Deceive Us and What To Do About It. New York, NY: Random House, 2004.

    Armstrong, Pat and Hugh with Claudia Fegan. Universal Healthcare: What the United States Can Learn from the Canadian Experience. , NY: The New Press, 1998.

    Bartlett, Donald L. and James B. Steele. Critical Condition: How Health Care in America Became Big Business—and Bad Medicine. New York, NY: Doubleday, 2004.*

    Drake, Donald and Marian Uhlman. Making Medicine: Making Money. Kansas City: Andrews and McMeel, 1993.

    Fein, Rashi and Julius B. Richmond. The Health Care Mess: How We Got Into It and What It Will Take To Get Out. Cambridge, MA: Harvard University Press, 2005.

    Garrett, Laurie. Betrayal of Trust: The Collapse of Global Public Health. New York, NY: Hyperion, 2000.

    Kessler, M.D., Jeanne. Bitter Medicine: Greed and Chaos in American Health Care. New York, NY: Birch Lane Press Book, 1994.

    Lindorff, Dave. Marketplace Medicine: The Rise of the For-Profit Hospital Chains. New York, NY: Bantam Books, 1992.

    Starr, Paul. The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry. Self-published Pulitzer prize winner, 1982.

    White, Joseph. Competing Solutions: American Health Care Proposals and International Experience. Washington D.C.: The Brookings Institute, 1995.

    http://familiesusa.org Families USA website.

    http://www.pnhp.org/ Physicians for a National Health Program.

    http://www.righttohealthcare.org Website advocating for health care as a human right.

  • Report this Comment On August 28, 2009, at 7:06 PM, theHedgehog wrote:

    Another post from a paid source.

  • Report this Comment On August 28, 2009, at 8:04 PM, vazu wrote:

    Reform Talk is Cheap == Supply exceeds Demand !

    Article states $0.82 of health insurance dollar goes to medical costs, The breakdown of the Health Care Dollar is roughlty 70% = hospital labor ( unionized).

    So, labor is the largest factor---but the Dems or Teddy K have NEVER advocated wage freeze, reductions or controls for nurses, technicians, support services, or administrators' CEO-style salsries,etc.. Doctors & big phama are a much , much smaller slice the pie.but the usual 'Boogey men" in the spurious "debate".. This is nothing about gov 'caring' for you but rather' gov 'controlling' you. In the same way, hospital CEOs really have no sincere interest in your care rather its only their 'market share' & ability to impress the hospital board that they are worth ttheir mega salaries. So, many more 'boogey men' & overpaid + overweight nurses out there. Ever notice that the 1st qualificationto be a Director of Nursing is a "beef-a-roni" behind ? Reflecting they are overpaid.

  • Report this Comment On August 28, 2009, at 8:34 PM, wa7bux wrote:

    Although I have not read all the posts, I am encouraged to see valid points made by both sides. I find drdave44's comments especially cogent although I am not in complete agreement. Health care reform is obviously a complex issue, and we can all be glad that the debate is ongoing well past the congressional recess. Although I do not pretend to have all if any of the answers, I would add the following points some more important than others and some which are largely overlooked in the current debate. There is probably something here to offend everyone.

    I am inclined to go fairly easy on the drug companies without exonerating them completely. We forget the vast improvement they have made in the quality of our lives. Think Viagra and antidepressants for starters.

    To attract bright people to the medical profession, they must have some reasonable prospect of compensation well above the average. I don't want a doc who finished in the bottom half of his or her college class. Potential physicians are not blind to the current debate, and few if any are saints.

    Although there are admittedly up front costs and privacy concerns, the provision for electronic medical records will be well worth the investment for both improved patient care and efficiency which will rather quickly amortize that investment.

    There is plenty of blame to go around. No component of the system is perfect and without need of modification. As documented in a recent New Yorker article, over utilization by physicians is a major problem. Tort reform will definitely help in this area but is not a panacea.

    There is no question that some and perhaps many high level insurance executives are over compensated. Not for profit insurance companies will not necessarily solve this problem. I have no hard data, but I suspect that many of those execs are very highly compensated as well.

    Call it something other than profit and transform it into executive pay. I may be paranoid, but I'm not naive.

    Upper level management of hospitals also takes a big cut. The most highly compensated CEO of a for profit hospital system earned in excess or $13M last year.

    Home infusion companies and durable medical equipment businesses are as a group extremely profitable. You have seen the ads to the effect that if you are covered by Medicare we will see that you are qualified for an electric "trike" or a chair that will help you stand up from sitting. Here's how that can work: if your doctor won't prescribe it, we will find you one who will. This sort of thing happens frequently with medications too. If you want medication for your child's attention deficit disorder, you can shop doctors until you find one who will make the diagnosis and write the prescription.

    Although the system cannot be perfected, it can be vastly improved, and, if done properly, the changes will result in improved care for all and more than enough cost saving to provide for the currently uninsured. Some government intervention will be required. Too much will, in my judgment, be a disaster. BTW the VA should not be a model to emulate.

  • Report this Comment On August 28, 2009, at 9:00 PM, tomalling wrote:

    I can't add much to the above, except to note that if you can't figure out why a "public option" is bad, bad, bad, you have no business running a financial newsletter.

  • Report this Comment On August 28, 2009, at 9:06 PM, theHedgehog wrote:

    wa7bux says: "BTW the VA should not be a model to emulate."

    Why not? The VA keeps a lot of people alive and in good health who would otherwise rapidly decline. There are literally millions of Americans would love to get the level of healthcare that our veterans (of which I am one) enjoy.

  • Report this Comment On August 29, 2009, at 1:47 AM, Cearmind wrote:

    If government healthcare is most likely to be, as many seem to believe, there is nothing to worry. People will not fall for it and it will die quickly, as medicare, USPS,etc.

    Costs are increasing because of increase in demand and reduced supply. The only way to reduce cost is making available very well qualified and experienced doctors from all over the world to come to our country to practice. Presently American Medical Association makes it next to impossible for such a senior doctor to practice in the USA by imposing humiliating conditions. That is the reason even insurance companies are permitting patients with coronary problems to go Singapore/India etc. with a companion and all expenses paid trip for treatment and still make a profit. It costs a knee replacement in our country about $50000 whereas it costs about $3000 in India! At the cost of full denture made in the USA, one can travel to India and back with one week stay and get a denture made there!

    Another major reason for foreign doctors not willing to practice here is the tort problem. Claims against doctors for malpractice should not be settled in court where jurors and judges decide on medical evidence which they can hardly understand. They should be decided by arbitration tribunals totally based on available records. If a cap is fixed on compensations, a lot of tort cases will not even be filed!

    Very high cost of medicines and health accessories and equipment will drastically come down if hospitals will not have to use the most costly medicines/equipment only to avoid accusation that they are stingy with health care. Discoveries of life saving drugs should not be restricted by patents, but should be awarded royalties over a much longer period than available for patents to cover costs. Let's not talk about the superiority of our pharmaceutical companies in research. Most of the basic research is farmed out to developing nations through their subsidiaries or is being carried out in our country by foreign research scholars!

    Finally, all with everything else, we should accept that available healthcare will always be proportionate to the money you pay for it. Denigrating proposed government health service at a lower cost and at the same time expecting medical service 'equal to that is available to President and Senators for all Americans' at that cost is laughable.

    Just like credit cards, insurance also encourages a false sense of unnecessary wants and irresponsible behaviour.

    Why not prohibit malpractice suits for treatments not involving hospitalization and freely allow very well experienced foreign doctors to practice without any hindrance and humiliation? Competition among such general practitioners, labs, etc. coupled with generic medicines will very greatly reduce healthcare expenses.

  • Report this Comment On August 29, 2009, at 9:14 AM, micarterpa wrote:

    It's difficult for me to read Fool opinions before they become noise to my eyes. Like TV business shows, your guests and commentators are rich people in large East Coast cities trying to sell me something. I haven't any idea what their lives are like. They most certainly know nothing about my blue collar retired life. In my long years the only people who put themselves between me and my doctor were private insurance companies. The free government medical care I received from the US Air Force was as good as that anywhere. After oral surgery the USAF dentist came to the barracks at night to see how I was doing. You won't find that kind of care from a private HMO.

  • Report this Comment On August 29, 2009, at 11:01 AM, Nukeman100 wrote:

    For Obamacare to get passed 2 things must happen. There must be a bad guy and we the sheep must be convinced that we are doomed without Congress. This is just the first phase of the battle plan.

  • Report this Comment On August 29, 2009, at 11:40 AM, minowe wrote:

    I'm amazed to read so many comments in an INVESTMENT newsletter "Comments" section that seem to believe that PROFIT is evil. So many who believe that Enron & Bernie Madoff personify capitalism. So many who believe that Big Government, whose budget is limited only by the amount of cash they can force from the proletariat, will efficiently and fairly compete with private enterprises

    Yes, the current government healthcare programs, provided to all congressmen at taxpayer expense, ARE run by private companies. And NO, no one in Congress will subject himself or herself to the plan they have in store for us.

    We have no idea what Medicare's overhead is. NONE. And Medicare is near-broke. As is Social Security.

    Add to that the fact that most people with private health insurance are happy with their plans, and even many UNINSURED are happy with their health care, and you have to dig a little deeper for the reason that Big Government wants to take over 1/6 of the U.S. economy and completely re-make it. Yet virtually NO ONE in Big Government has spent the time or money to become a doctor (where he or she could benevolently provide for free all of his or her services, superior services, I'm sure, given their selfless dedication to the well-being of humankind). Yet they DO feel they know best how you should receive your health services.

    These are the same legislators who managed to bring down the U.S. financial system!! We thought THAT couldn't be done (or at least Barney Frank, Chris Dodd, and Maxine Waters said so). Do you really think they can't bring down the entire medical system??? Do you really want THIS Congress to insert one finger into YOUR medical care?? (I hope that last sentence brings to mind an ugly image.)

    Obama took Tort Reform off the table at the very inception of this debate. There will be no further mention of that subject. Is it really, as Obama said, because Tort Reform would harm patients injured by medical malpractice (probably like the unnecessary amputation of your feet!)? Or is it because the Plaintiff's Bar owns the Democrat party? I dunno, but it ISN'T because multi-million-dollar recoveries (or, more likely, settlements) don't add significant cost to our health care. How serious is this bunch about reducing our health care costs? Not.so.much.

    How serious is this bunch about taking ever-more control of your life? WAAAAAAY!! Used to be drip, drip, drip, a little at a time, but NO retreat. With this bunch, it's SPLASH!!! NOW!!! (Uhh, or else the economy will never recover.... Are ya scared enuf?)

  • Report this Comment On August 29, 2009, at 1:32 PM, johnnymiami wrote:

    The big private insurers are terrified of gov. health because once it gets in, the people never vote it out. Why is that?

    What does FedEx and UPS do for 43 cents?

    How about letting private enterprise run our military, how would that work out? Oh, we already know this one, I forgot about Dick Cheney and Haliburton.

  • Report this Comment On August 29, 2009, at 2:39 PM, etdiii wrote:

    It seems to me you miss an important point and that is the abuse of power illustrated by congressional members Waxman and Stupak. Their letter does not even deserve the dignity of being called a "thinly veiled threat". What is the matter with people in this country when such outrageous behavior by government officials is greeted with ennui.

  • Report this Comment On August 29, 2009, at 2:43 PM, minowe wrote:

    Well, johnnymiami, why not make it legal for UPS and FedEx to deliver first class mail and see what happens to the Post Office? The Post Office is unable to stay solvent without increasing postal rates at a rate much higher than inflation. Could UPS and FedEx do worse?

    Just about the only duty imposed upon the federal government by our Constitution is protection from the aggression of foreign entities. Still, where private enterprise is utilized (because of their superior abilities), they're usually successful. (Nothing against our military; they are AWESOME!)

    People don't vote out government health care because for the most part, people are healthy enough that they don't need "health care" at all. Healthy people don't even notice rationing or sub-par hospitals. Plus they think they aren't PAYING for their health care coverage. And they aren't, unless they pay taxes. When people DO need immediate and excellent health care, they come to the U.S.

    The availability of our excellent facilities relieves those other countries of the burden of investing in such miracles themselves. But what happens when government health care brings us down to their level? Who will care for those in real need then?

    Or do you think, "Who cares"?

    [That dirty rat, Bill Clinton, awarded no-bid contracts to Haliburton well before Dick Cheney was v.p. Did you write President Clinton letters of protest when he did that?]

  • Report this Comment On August 29, 2009, at 4:55 PM, oncoals wrote:

    Your analysis is weak in just looking at net profit. A thorough analysis would also look at advertising, lobbyists fees, overblown salaries, bonuses and options, etc. that those in favor of a public option maintain would not be costs in the medical care for those electing a public option.

    I believe that a public option would force out the private insurers just like the US Postal Service has forced out UPS and Fedex.

  • Report this Comment On August 29, 2009, at 5:14 PM, Skeedoodle wrote:

    The Government needs to stay out of Health care until they can run the Government at a profit and maybe not even then.

  • Report this Comment On August 30, 2009, at 5:57 PM, Gouda24 wrote:

    Among the principles President Obama stated are making health care available to everyone and reducing cost. There is much to like in those principles but they seem difficult to accomplish simultaneously and the way they will be accomplished isn’t fully clear. Saying it should be so is encouraging, but to simultaneously increase capacity and reduce cost is a goal where the means needs explanation.

    Capacity:

    The only way I see to make healthcare more widely available is to provide many more doctors and especially primary care doctors. A figure of as many as 45 million has been mentioned as lacking healthcare (by my rough calculation this would seem to imply producing 100,000 new GPs). The plain fact is that it is currently difficult to recruit primary care doctors and Medicare (and insurance programs) pay them poorly, and expose them to legal and administrative complications which make other work seem more attractive.

    Cost:

    To actually lower the cost of care (or at least reduce the rate of its growth) is a difficult problem itself. I suspect that the big expenses are the cost of administration and the cost of insuring doctors, for their legal liability to malpractice suits.

    If the approach is reducing cost by tort reform, the issue includes the tension between tort reform and impunity by the medical profession. How will a new system hold the doctors accountable for mistakes, without the sensational results the current adversary proceedings produce? I believe there does need to be some way to find out what went wrong if a patient is harmed and assess responsibility (and correct the process so it doesn’t keep happening).

    If the approach to reducing cost is to reduce administration, how will the cost be reduced if we will simply keep the insurance plans we currently have?

  • Report this Comment On August 30, 2009, at 9:08 PM, bullrider71 wrote:

    Tort reform, HMO reform, research reform.

    I will explain:

    What makes America different and American health care so expensive is the enormous cost of defensive medicine. No other country has to carry that burden. I am a doctor and I know how the system works. Trust me- it costs a lot each day. In my opinion tort reform is not addressed because most politicians are also lawyers and some even madey their fortunes suing doctors. But has a lawyer ever made one patient better? This is where the waste is clear and present.

    HMO reform is needed to reduce endless hours spent by doctors to deal with the insurance bureaucracy- we could be seeing patients instead! Also, before we earn anything we have to pay a large staff and often billing companies and other consultants to deal with the insurance companies. Regulation is needed here to reduce administrative burdens for medical offices - filing a form has not made anyone better either. If a public plan achieves that - fine, but don't try to manage the care even more than it is (mis-) managed presently.

    Research reform is needed as more and more research is coming out of the private sector. If this continues we will soon have "evidence" that only the most expensive medications work and become standard of care. Combined with the tort system this will force doctors to prescribe these expensive treatments or face the risk of financial ruin by way of a lawsuit.

    Finally, patients, doctors and politicians need to accept that we cannot do everything for everyone all the time. We physicians don't get paid more for what we do than in the past. In fact most of us get less and less. The cost go up because we now have technology and therapies that was not existent in the past. That is great but it will lead to higher and higher costs no matter how efficient we are. As a society we need to decide how to resolve this. And believe me this will not get resolved unless the physicians really come to the table and cooperate. And that won't ever happen unless there is meaningful tort reform.

  • Report this Comment On August 30, 2009, at 9:12 PM, PALH wrote:

    Oh, how my heart bleeds for the poor, beleaguered multimillionaire health insurance CEOs.

    The money funneling into health insurers comes from a captive market, companies and small businesses and their employees barely making it because they're paying huge premiums to these jerks.

    One effect of the economic collapse is that it has put a spotlight on just how deeply greed is ingrained into companies that have continued to make boatloads of money. Logic says that in a generalized collapse they should have suffered too, but they haven't. Captive markets.

  • Report this Comment On August 30, 2009, at 11:28 PM, m2gordon wrote:

    the Government should stay out of health care.

    Everything the government is involved is a looser

    We have the worlds best health care, why not keep it so

  • Report this Comment On August 31, 2009, at 12:07 AM, drlo wrote:

    It is curious that tort reform seems to have been left out of the debate completely. The impact of malpractice insurance to the costs of hospitals and medical practioners seems an obvious place to start.

  • Report this Comment On August 31, 2009, at 10:13 AM, FinancialBill wrote:

    I find it disturbing that the blog I posted around midnight which was, with the exception of an incomplete sentence and some punctuation errors due to my being overly tired, was none the less, well written and contained several interesting perspectives and issues not seen elsewhere and from the viewpoint of an economist and Certified Financial Planner yet this morning it no longer exists on your site. It contained no bad language or such, though it did call for the RECALL of many politicians. So, you must have a hidden agenda to keep this information from reaching others. Sorry to see that.

  • Report this Comment On August 31, 2009, at 1:14 PM, montepeterson wrote:

    The belief was expressed in the article that a public plan would not eat into the insurance company profits all that much. The author is perhaps unaware that the government currently pays (Medicare and Medicaid) only about 75% of what private insurers pay to providers. Private companies negotiate (as does the government in theory). But let's be fair...since the government already accounts for for around half the revenue of providers they simply say if you want to keep that half of your income you're going to accept this rate. So...if there is a public plan...and it uses Medicare reimbursements as the Waxman House bill suggests...private insurers will cease to exist as we know them today. Providers will begin to drop out of the public plan (out of economic necessity)thereby creating a two tier system...a new duplicative private health care and insurance system - like BUPA in Great Brittain.

  • Report this Comment On August 31, 2009, at 3:25 PM, theHedgehog wrote:

    montepeterson opines: "So...if there is a public plan...and it uses Medicare reimbursements as the Waxman House bill suggests...private insurers will cease to exist as we know them today."

    So, where's the problem? Sure, some people will have to look for jobs, but in the main, those same service jobs will be available, just for the government instead of an insurance company.

    Net/net, the big thing that happens is that a middle-man loses his plush income and not a lot else. Or are you bemoaning the fact that the government will continue to force actual health costs down?

    Hedge

  • Report this Comment On August 31, 2009, at 8:55 PM, newth3 wrote:

    Perhaps insurance costs could be more reasonable if there were tort reform. Not only does that drive up malpractice premiums, but encourages doctors to order tests that may not be necessary just to protect themselves.

  • Report this Comment On August 31, 2009, at 9:36 PM, bmialone wrote:

    "Efficiencies" invariably ends up meaning loss of privacy, which then leads to a lack of control over our own information and choices.

    Third-party outsourcing by medical providers And insurance companies is a major reason for the current inefficient system. Keeping all of our records close to home, in our providers' offices, handled only by their employees in their offices is actually much more efficient in the end. Very little should have to be shared and moved between our providers and the entity that pays them.

    The insurance companies have created so much bureaucratic paperwork and so many games intended to avoid payments, demanding more and more from medical providers, they are behind the explosion in "paperwork" costs.

    Physicians owning clinics, labs, and hospitals also creates a profit motive that ends up raising costs. Research shows that where physicians own the expensive technology used, patients get overly-aggressive care and testing.

    Medicare worked just fine until the federal government started starving it. Patients had full provider choice and the paperwork was streamlined and minimal. The meltdown we are witnessing is the same as all of our other government programs set up by us to benefit us, the people; antigovernment administrations, especially the last one, intentionally placed antigovernment, private sector cronies in place as directors. Once there, funds were also cut by a Republican controlled Congress (not that the Democrats are blameless, just not as much as the Republican party). Our federal agencies, and our state agencies dependent on federal dollars, have been Starved!

    The same thing happened to Medicaid first, even though Medicaid actually cost us a tiny percent of of the nation's overall budget.

    I worked as a medical social worker and both programs were vastly easier, faster, and more efficient to deal with than were patients' private insurance companies. No one from the government told us what our patients could and could not have because requests were submitted by us, the professionals working with patients. Patients had vastly more healthcare privacy with Medicare and Medicaid than they did with their private insurance companies.

    People, profit isn't always the best tool or value for achieving all things. Treating profit as a God to the detriment of our nation and hundreds of thousands of lives is immoral-it is nothing to be proud of, and it does not make our nation great.

    Anyone who believes he or she is not already paying much more than necessary for the current system needs to look more closely at how our system is working and what it is costing. Those of us with insurance are paying more every year for our own care, and we are also paying for all of those people who do not have insurance at all! Those of us with money to spend on healthcare pay more for it because the cost of caring for all of those who are not covered are passed on to us by insurance companies and medical providers!

    We are already spending the money, only we are spending much more money for much less value in return! If we pushed both the Republicans and the Democrats, forcing them to cut the money-teet from these mega, international corporations lobbying against our national interests, we would end up spending less! We as individuals would spend less and our nation would spend less!

    An added benefit is it would be more affordable for new business start-ups and even to bring jobs back from overseas if healthcare wasn't such a huge burden to private sector businesses.

    We have many other nations' systems to look at, pick and choose from, to create our own. Ours does not have to look exactly like another country's, but we are fortunate that other countries have been providing universal healthcare for so long that we do not have to start from square one in thinking up a design. We also have Medicare and Medicaid as models, because like I said, until they were starved, they worked great. We can use existing models and tweak them to create one that works best for our culture.

    Right now, Obama is being pushed back from his original, smart goal, by Both the Republican and Democrats so that he will not be able to push through a truly effective, clean-up-the-system plan. If we do not stop believing we still have "the best" of everything compared to the rest of world and join together in a loud, collective voice to support his efforts, we will all lose, those with money and those without.

    As previous generations had labor, financial, utility, and civil rights reform moments in their histories, all of which arose because of the abuses of those profiting at the time, Universal Healthcare is our big reform moment. I hope we rise to the example of past generations and don't blow it. Not only will it be shameful, but it will ensure the United States continues down the current path toward a faded, second rate nation that can't compete economically or morally.

  • Report this Comment On August 31, 2009, at 10:02 PM, bmialone wrote:

    It is a myth that lawsuits against medical providers is at "epidemic" proportions. It is repeated so often, though, that most people believe it. Please, do real research and read the reports published by those who do not have a profit motive or political agenda beyond consumer protection.

    If most people believe it, however, then most people will stand by as those who stand to profit manage to pass so-called "reform" that really further inhibits consumers' rights to protect ourselves (as we saw happen with the credit card industry shooting down all consumer protection regulations and passing an unjustified bill preventing most of those preyed upon by the same lenders to declare bankruptcy. It was the same sort of misinformation, not supported by research and real numbers).

    Who benefits from these erroneous beliefs? Follow the money.

    Who sells insurance to hysterical medical providers feeling vulnerable to lawsuits at every turn? Who is causing a further escalation in unnecessary, overly-aggressive testing by using any hint of "pre-existing condition" to avoid paying for medical care and to dump customers?

    There is no doubt that medical providers themselves are contributing to the high cost and this mess, but insurance companies whip up the hysteria and in turn sell more insurance (and that is true for more kinds of insurance than just medical), then drive the cost up further with unethical policies, forcing people into unneeded tests in order to show they have no pre-existing condition when they are purchasing new insurance policies. We've also lost all of our medical privacy for the most part, too.

    I just had first-hand experience with that second one. My 20-something daughter, with no history of medical problems, was told she had to have multiple brain scans and a neck scan, totaling $700 in co-payments for the tests and physicians' visits, merely because she had tension headaches during her last semester of college while working a heavy load.

    Because she needed to purchase a private plan after losing her college plan, she was told she had to take any of the tests doctors wrote they thought might be warranted or if she did get sick later, any insurance company she went with would look at her record and claim she had not followed physician recommendations, and refuse to pay for treatment.

    In other words, she had to prove she doesn't have a brain tumor or something even though there was no reason to think she does, or we would pay her insurance for nothing if it turned out she really needed it in the future.

    Oh, and by the way, the physician who wrote in her chart that these scans were warranted is an owner of the facility her physician sent her to. Which leads me to wonder how my physician and hers decides which labs and diagnostic centers to send us to. I know mine has ownership and financial arrangements with some he's sent me to.

    See the problems, people? Profit motive has distorted our entire medical care system.

  • Report this Comment On August 31, 2009, at 10:11 PM, bmialone wrote:

    One last point about aggressive testing in response to insurance company policies, not only are people forced into unnecessary treatments and tests in order to protect themselves just in case they do get sick later, but this new despicable tactic also effectively removes our right to refuse treatments and decide for ourselves what is best for us, because if an insurance company can find in our records where a provider made a suggestion, even a provider that is wrong because he or she is shoving us through in 15 minute appointments, and we decided the suggestion was not the best course of action for us, it will be used to deny our coverage and dump us later.

    Doctor patient confidentiality, and the right to determine one's own healthcare are effectively gone.

  • Report this Comment On August 31, 2009, at 11:20 PM, TuDoc2 wrote:

    As a physician, tort reform is a must. Yes some physicians pay $50,000-400,000 per year for liability insurance. But defensive medicine has to be practiced and the cost is more than half a million dollars per year, in some cases several millions a year per physician. Multiply that by 800,000 plus physicians and you will see what saving there is in the system.. In my private practice clinic every physician has been sued for frivolous reasons and the trial lawyers on both sides benefit even with settlements out of court. When in court there is no room for cognitive medicine just hard cold facts ie. tests and imaging, thus the need for ordering testing. What a waste of resources, and outrageous expense. For you non medical folks, for medical students to practicing physicians mortality and morbidity conferences are held and chart reviews are made on complications within the hospital and surgical suites. Errors occur and these are reported and systems set up to try to reduce them. Improvements occur but it is a slow process. Health courts should be set up to compensate for errors and injuries. Physician can be censured, fined, privileges suspended or have their licenses revoked. These methods already exist within hospitals and state boards, but a non tort system would be open to more people than now sue, and their needs could be met at a much lower cost to society. Also counter suits, for fear by competitors that bring up poor practice patterns by their peers, could be eliminated by outside non biased third party reviewers. For Obama to take Tort Reform off the Table from the beginning is an insult to the American people's need for cost cutting in the health system. For those of you who think the AMA is representative of physicians only 17% of physicians belong to the AMA. Most of us think it has been ineffective in convincing the government (lawyers), that it is in the best interest of even the lawyers to reform health care the right way.For as bad as the health insurance industry has behaved. As a physician I can talk to their physician reviewers and try to convince them to reconsider payment or treatment options, if the government is controlling health care the bureaucrats, won't give me the time of day, and our patients will suffer.

  • Report this Comment On September 01, 2009, at 1:27 AM, IRS706 wrote:

    I looked at the Value Line for Humana & Wellpoint. They average a payout for benefits of 82.75%. I belong to a not-for-profit insurance plan. It pays out over 94% on benefits to its 415,000 members worldwide. My family plan costs my former employer and myself $8,101/year and there is no pre-existing condition nor can my coverage be canceled. It even covers my 37 year old disabled child. From 2001 through 2009 the total cost to me (25%) and my former employer (75%) went up at 2.79%/year compounded (for the years 2006, 2007 & 2008, there was no increase in premiums). Were its cost to match Humana/Wellpoint, my former employer and I would be out $1,000/year more.

    While I could switch to a Blue Cross plan, I choose to stay with my current plan. Of course, the plan's benefits and its cost is negotiated by the federal government on my and my ex-employer behalf.

    Something to keep in mind when making cracks about government and health care. With a large enough pool of members, the federal government can be a pretty tough bargainer, which may be why the for-profits do not like the idea.

  • Report this Comment On September 01, 2009, at 1:07 PM, theHedgehog wrote:

    The one thing that stands out when you read these posts is that no-one, whether it's doctor or patient, likes the system we currently have.

    Think about that for a moment - no-one likes it. So how come there are so many people who want to keep things the way they are? Makes no sense.

    Hedge

  • Report this Comment On September 01, 2009, at 8:04 PM, softwareplayer wrote:

    You can tell a lot about a society not by what they debate - but by what they don't debate. To debate the merits of the government's ability to insure private U.S. citizens, in a manner that is competitive with existing private or publicly owned companies, is to accept the premise. Namely, that governments have the necessary expertise and competence to engage in such activities.

    The evidence is infinite that any government program ALWAYS costs more than it was originally expected, and it never competes effectively with the private sector due to the absence of the profit motive. If you want to curb excess salaries of CEOs (and for that matter boat loads of $500K/year sales guys, several of whom are my neighbors), then get employers and government completely out of the health care insuring and regulating business.

    The reason we don't have GEICO, or Progressive, or Allstate like alternatives (as we do in the automotive insurance market) is because we don't have 300 million people shopping every day and making a price vs. value decision that affects them personally.

    Get that right. And in a very short time, all of the "evils" being debated today will vanish. Washed away with the failed companies who would no longer be able to compete with such excesses in their business model. People will vote with their feet and their wallets. For the first time in our lives, health care costs would reverse their upward trend - and you would get exactly what you are willing to pay for. No more and no less.

    And for you poor lost souls who want to insist "health care is a right" - ask yourself whether you can survive without food, shelter, clothing, a job, and transportation BEFORE your precious, ridiculous, politically correct football of health insurance. The government should be paying for all of these things FIRST - which are infinitely more important on a daily basis - before any notion of equivalent health insurance for everyone. Are you willing to get real and admit that? And now pay for all of it? We'd have to nuke China and confiscate all their assets just to cover the first year cost. Who would we nuke and rob for the next year?

    I didn't need the same health insurance when I was 27 as I do when I'm 47. Three hundred million citizens, acting in their own self interest, will produce more brainpower, and more common sense, than every single government polititician and bureaucrat added together since the founding of this nation. And in making the judgment about how to spend their money in a competitive market, they will dwarf the relatively thimble sized knowledge of those who spend other people's money.

  • Report this Comment On September 02, 2009, at 9:31 PM, JLGST wrote:

    One of the more ridiculous arguments that is used repeatedly is "I do not want the governemnt between me and my doctor". It is obvious that these people have never had to fight with their insurance company to get approval for treatment their child's Doctor says is needed. I am strongly behind the need for a public option to our healthcare. Why shouldn't every American have the option to have the same insurance as the emebers of congress? I am not pleased with the excessive compensation that is given to CEO's and upper executives of insurance companies or other companies for that matter. The excessive compensation reduces returns for the shareholders. These excessive salaries are paid prior to getting to "net" profit in the chart you present in the article.

  • Report this Comment On September 03, 2009, at 7:03 AM, WheatBerry wrote:

    Hang them out to dry! I get angry every time I deal with our health insurance provider. They are supposed to pay 80% of the bill after our family deductible. What really happens is that we get billed for 20% of bill and they tell the health care providers how much of the 80% they are going to pay. So much for working to reduce costs for me!

    And don't even start on an 'Evil Government Plan' which would ration health care. Private insurance already does that by determining what they will pay for and how much.

    I think the proper business structure for a public health insurance option would be a cooperative. This would take the program out of direct government control (Yea!). Cooperatives also, by nature, are very conservative, and best of all, any profits flow to the people who use their services.

  • Report this Comment On September 03, 2009, at 7:12 PM, theHedgehog wrote:

    softwareplayer fantasized: "Three hundred million citizens, acting in their own self interest, will produce more brainpower, and more common sense, than every single government polititician and bureaucrat added together since the founding of this nation. And in making the judgment about how to spend their money in a competitive market, they will dwarf the relatively thimble sized knowledge of those who spend other people's money."

    This, in particular is worth addressing. First of all, it's a fantasy that 300 million people can make a more informed/better decision than one person who is trained to make that same decision. We saw that in software design, and we know it's true in other parts of life, as well.

    There's also the idea that the medical industry is competitive or can be made to be so. There are a number of reasons for lack of competition. One of those reasons is that there is simply no reason to have a competitive price. People must have healthcare. It's not a matter of "would like to have healthcare. Because of genetic drift, pollution, and personal and industrial accidents Americans simply MUST have access to healthcare. Given the fact that doctors have a captive audience, and the doctor to patient ratio is so low, there is little reason to constrain costs. Sure, we can expand the medical provider pool by shipping patients of to Indochina, but I'm not so sure that's really something we want to get into as a national policy.

    Another issue that keeps medical costs high and moves them higher is the problem of "barrier to entry". IOW, it costs an awful lot of money to become a doctor. It takes a level of personal motivation that most of us simply don't have, regardless of the potential reward. And, it takes a fair amount of intelligence to even qualify as the proverbial worst doctor in his/her graduating class. So, the average person is not going to become a doctor, and those that do have a reasonable expectation of making a lot of money.

    To reiterate the above, there is no "competitive market" available to us, so the idea of free trade saving us borders on lunatic raving.

    There is also the issue of medical malpractice tort. There are plenty of posts about this obvious issue, so I won't bother to belabor the point.

    The, of course, we need to consider the cost of medical hardware such as CT and MRI machines. These machines weren't designed in someone's garage after they got home from working on your Buick. In most cases, it takes PHD level effort to come up with the ideas that the engineers turn into hardware. So, it's only reasonable that they are expensive.

    Finally, for now, it the costs of emergency and surgical care. Unless you're an oddball, you want the most competent team you can get when you start leaking bodily fluids. You're also going to want your bodywork(sic) to be done in a sterile environment. A surgical team of 3-6 isn't going to come cheap.

    So, as we can see, the idea that the free market is going to reduce costs is just wrong-headed when it comes to the medical industry. Of course, you could always fly to Indochina or Central America and hope for the best.

  • Report this Comment On September 04, 2009, at 6:32 PM, kdros wrote:

    Much of the opposition to reform efforts would be silenced if the masses had to pay for health care and/or insurance out of their own pockets. The fact that a majority of these voices get care at little or no direct cost makes them defensive of the status quo.

    Drop the hidden compensation of employer provided health insurance. Bring that "income" out into the open and make people actually pay for the health coverage they get. Put these folks into the same arena that small business founders live with. Shop around and see what coverage really costs. These loud opposition voices will change.

    Require that the medical bill be covered by the patient first with reimbursement to the patient by the insurer. The loud opposition voices will suddenly be screaming about high medical costs.

    Have no policy cover more than 80% of costs and set the minimum deductible at $10,000 per year. Force everyone to take some responsibility for their health. If you smoke and are obese then perhaps this cost factor will lead you to change your ways. This would keep the insurance costs for everyone else at the minimum.

    As has been stated elsewhere, there is no competition at play when the mass of voices have a free ride and are unaware of the true costs. In a free market captialist system, you've got to pay for what you get to make it work. Nobody worries about cost when things are free.

  • Report this Comment On September 06, 2009, at 11:39 PM, tex41 wrote:

    Wonderful discussion of many different views. I would like to broaden the topic, which likely has been touched upon by one or more post with a reference to a short vidio about our form of government. It is a factual and non partisian lesson about the basic forms and how ours differs. Without a clear view of who we are, it is hard to structure any argument for or against single payer, universial, free trade or any term you pick for this issue. I think it will help frame the issue going forward.

    Thank you all for your time and thoughts. Too me the Fool is precisely where government and money discussion make the most sense.

  • Report this Comment On September 06, 2009, at 11:49 PM, tex41 wrote:

    sorry click here for video

    http://www.wimp.com/thegovernment/ or

    go to www.wimp.com

    Title of video The American Government

    Pardon lack of knowing how to get a click on ref.!

  • Report this Comment On September 08, 2009, at 12:43 PM, theHedgehog wrote:

    kdros you have some good ideas, but no matter how many times Kudlow repeats his mantra - America is not a "free market capitalist system".

  • Report this Comment On September 14, 2009, at 11:52 AM, dereksas wrote:

    (Late response after just reading the article)

    It's not a question of whether or not there are many people who would rather pay more for their existing insurance than go to a public option. Most people get their insurance from their employers, many (most) of whom will drop everything in order to be cost competitive with other companies. In the resulting massive shakeup, some insurance companies will grow, others will fall apart. Initially, the cheapest (public) option will garner a disproportionate share of the coverage pie...at least until most people figure out that the Government simply cannot do anything efficiently and within acceptible levels of service quality. They never have in the past. Why should I believe that they can in a comprehesive and complex area such as health care? It would be a rocky ride for insruance company investors to say the least...

    --Derek

  • Report this Comment On October 01, 2009, at 6:00 PM, jimerickson100 wrote:

    Much of the gist of the article and comments seems to be that 1) the health insurers cannot control most costs since they are in effect simply middlemen, 2) the government is a lousy competitor (just look at the PO - oh horror - and other gov't programs), and 3) save us from another government program, either because it will put the insurers out of business (by its inefficient competition?) or that it will cost taxpayers money.

    First off, I believe the study by the World Health Organization totally debunks nos. 2 & 3. The U. S. provides the most expensive health care of any country in the world, and the quality of its health care is worse than that in all other economically mature countries. That quality is, in fact, worse than that in many developing countries. Most (if not all) of those competing health care systems are government-run (by the way, please don't counter the impartial WHO report with self-interested reports from such organizations as the American Enterprise Institute, which is funded by very politically motivated donors). The only sensible conclusions are that our current system is defective; that government-run systems are better run, more efficient, and less expensive; and that a government-run system would beat the pants off of the "private" competition - unless, of course, you think that our government is more incompetent than those of France or the U.K.

    Second, our system is indeed complicated, with insured, insurers, providers, and the government all tangled up in a terrible knot. I suffered a ruptured Achilles tendon early this year. Although I received excellent care and am almost fully recovered, the paperwork morass that I had to navigate was unbelievable. It cost me untold hours of my time, of my insurer's time, and of the provider's time. There is HUGE room for improvement, and although you may find narrow arguments to exonerate the insurer, as a system ours is a bust!! Reform is necessary and long overdue.

  • Report this Comment On March 13, 2010, at 3:32 PM, 1sweet1 wrote:

    I don't know about hung out to dry, but they need to take their lumps. They've had state monopolies and special deals for too many years to count.

    To reiterate:1) It's not a federal takeover but a federal payment system

    2) profit margins are after huge salaries (and don't forget bonuses) are paid so that is not an effective measure

    3) insurance companies will now have to compete-in this capitalist democracy-what a novel idea.

    Bring it on, and maybe we can avoid health care costs gobbling less of the GDP. After we get out of this recession/depression, then we can work on reducing the debt, as Clinton did.

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