The Real Problem With the Public Health-Care Plan

As the Senate gets ready to debate its version of a health-care reform bill, including the potential for a back-from-the-dead public plan, it's important to realize exactly what the fight is all about.

The problem with a public plan isn't what it will do to insurance companies such as UnitedHealth Group (NYSE: UNH  ) and Aetna. Really, it won't do a whole heck of a lot, because the plan will serve fewer than 4 million of the 46 million uninsured Americans, at a cost higher than private insurers can offer.

No, the problem is in what the public plan might become.

Slippery slope
Earlier this month, the U.S. Preventive Services Task Force recommended that women get mammograms starting at age 50, instead of the previously recommended 40. The task force claims that the change was recommended to eliminate needless biopsies on women in their 40s, after mammograms show a potential for breast cancer that turns out to be nothing.

Critics think otherwise. They're worried that the recommendation was made to save money. Maybe so, but that's always a consideration with preventive care. I'd imagine that getting a professional dental cleaning once a month would prevent some cavities, but no one does that. The cost in time and money doesn't make it practical.

And besides, it's just a recommendation, right?

Maybe. Forty-year-old women still have the option to get a mammogram, but what if the government-sponsored public plan takes the recommendation from the government-sponsored task force as fact and begins paying only for mammograms for women 50 and older? Now that public option isn't looking like a very good option, if you're one of the many women who develop breast cancer in their 40s.

Just look east
You only have to look at the U.K.'s National Institute for Health and Clinical Excellence (NICE) to understand how complicated the potential for the trade-off of cost versus effectiveness can be.

Earlier this month, the agency in charge of running the country's single-payer system said it wouldn't cover Bayer and Onyx Pharmaceuticals' Nexavar for liver-cancer patients, because it costs too much -- $4,850 per month. The drugmakers even offered a buy-three-get-one-free deal, but NICE wouldn't bite.

Granted, the drug doesn't cure liver cancer, but it does extend patients' lives by at least three months. I've always wondered what a month of my life was worth; according to NICE, it's less than $5,000.

This isn't the first time NICE has rejected a cancer drug because of cost. The agency reiterated its rejection of GlaxoSmithKline's (NYSE: GSK  ) breast -cancer drug Tyverb last month for the same reason, even after a similar offer of free drugs.

Ultimately, NICE could still cover both drugs. The companies will just need to offer deep enough discounts, as Johnson & Johnson (NYSE: JNJ  ) and Pfizer (NYSE: PFE  ) have done with their cancer drugs.

Financial implications
Unlike some staunch opponents of the public option, I'm not convinced that a penny-pinching single-payer system is a guaranteed inevitability of establishing a public plan. The government hasn't exactly been a cheapskate about spending money on its citizens and corporate entities recently, after all.

On the other hand, the talk of comparative medicine -- figuring out which drugs work better than others -- is clearly targeted at lowering costs. Why use a high-priced brand-name drug when a cheap generic will do? Even pharmacy-benefit manager Medco Health Solutions (NYSE: MHS  ) is running these comparative trials, in testing sanofi-aventis and Bristol-Myers Squibb's (NYSE: BMY  ) Plavix against Eli Lilly's (NYSE: LLY  ) Effient. Plavix will go off patent soon, and Medco is hoping to prove that the generic, which would save its customers money, works just as well as the full-priced drug.

The bottom line is that investors in the health-care space will need to keep a cautious eye out. The passing of a public plan probably won't affect the companies you invest in all that much, but there's certainly the possibility that a public plan could change into something that could do a lot more damage.

Is a public option really as scary as its opponents make it out to be? Let us know in the comments below. 

Medco Health Solutions and UnitedHealth Group are Motley Fool Stock Advisor picks. Pfizer and UnitedHealth are Inside Value recommendations. Johnson & Johnson is an Income Investor pick. Try any of our Foolish newsletter services free for 30 days.

Fool contributor Brian Orelli, Ph.D., is due for a tooth cleaning, but he doesn't own shares of any company mentioned in this article. The Fool owns shares of UnitedHealth and has a disclosure policy.


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  • Report this Comment On November 30, 2009, at 1:11 PM, TMFKris wrote:

    Into the mix of the huge amount of information to consider is research looking at regional differences. The Dartmouth Institute for Health Policy & Clinical Practice, for instance, has documented regional differences in medical spending on seniors and notes that care is often better in low-cost areas.

    The center website: http://tdi.dartmouth.edu/centers/health-policy-research/

    PDF press release: http://dartmouthatlas.org/press/NEJM_Release_RWJF_022609.pdf

    Which govt agency could get it right? Would a public plan look at useful data or get sucked into testimony of survivors whose loved ones were denied care and politicians' pandering to rightfully nervous taxpayers?

    Kris (Motley Fool copyeditor)

  • Report this Comment On November 30, 2009, at 3:41 PM, northhill wrote:

    $5000 for 3 months more of life is a reasonable withdrawal from your savings account, but not a reasonable outlay for a government health plan. This would be different were the drug lifesaving or underpinning multiyear survival. As a physician, I see health care decisions - read rationing - perpetrated by insurance companies every day. They are in business to make a profit; patient care comes a distant second. They know within hours if someone has missed a premium but cannot even answer the phone for a doctor calling to beg for a process that "requires preapproval". The obvious fact is that health insurers hope the doctor will give up, that the patient will give up, in such frustrating attempts to gain payment approval. Far far better to have a system that offers more basic care to many many more people, individuals who have no care now, who overburden our ER's, whose unpaid bills cause ungodly cost shifting to those who are trying to make it out of pocket. Insurance companies need to make it clear what they cover and to spell out what they do not. They may simply be too expensive to continue to exist except to offer supplement coverage, for the services that basic insurance cannot reasonably, at taxpayer expense, afford to cover. Long standing drugs that cost no more to manufacture grow increasingly expensive, as drug companies buy them, rename them, heavily advertise them, and sell them at a 40-200% surcharge to prior cost. Bigger is better when cost savings are available to the consumer, not when the costs are rising for necessities that cost no more to produce. Can you imagine the hue and cry were milk, cornmeal, electricity and beer to increase 10-20%/year?

  • Report this Comment On November 30, 2009, at 3:56 PM, WordDog wrote:

    Like many commentators, Orelli seems not to have comprehended the recommendation's foundation. It is based on findings that regular mammograms for women under 40 do not appear to reduce mortality. That's counterintuitive enough that it just seems to bounce off people's brains, but nonetheless ... If there's no benefit, there's no point, even if the procedure is free. Plus, some proportion of mammograms lead to biopsies. No surgical procedure is without risk. (I know of someone who died after a routine tonsillectomy, and another who died after a nose job.) If you have something that provides no overall benefit to a particular group, generates some risk, and costs money, why push it on them?

  • Report this Comment On November 30, 2009, at 4:03 PM, Melaschasm wrote:

    The idea that the "public option" is only going to cover 4 million people is laughable. The current public options, Medicare and Medicaid, already cover far more than 4 million people. If we were talking about so few additional people on a government plan, the politicians would just expand the current Medicaid & Medicare programs to a few more people, and move on to other parts of the health insurance plan.

  • Report this Comment On November 30, 2009, at 4:16 PM, northhill wrote:

    Medicare is a government health insurance plan and it works. Medicaid is a hodgepodge of state plans, using a favorable match ratio with federal money. Some state Medicaid plans are reasonably effective but many, Florida's for instance, stink. Medicaid plans change dramatically year to year, depending on the amount of state monies available. You truly cannot mention Medicare and Medicaid in the same breath.

  • Report this Comment On November 30, 2009, at 4:44 PM, Bamafan68 wrote:

    Unfortunately, the end of life medical costs are one of the two elephants in the room that no one is really talking about. (The other is medical malpractice reform, but that's another can of worms). The bottom line is that at least a quarter of every health care dollar is spent in the last 3 months of a patient's life. Now, some of those dollars are spent on 16 year olds who have been in car wrecks or 8 year olds with some form of cancer, but a lot of that money is spent on the 81 year old with incurable cancer. As a society, we are going to have to come to grips with this issue. We cannot afford to provide health care for everyone while still providing gold plated end of life care to patients with terminal diagnoses.

    There's even a certain degree of black humor in the medical profession about end of life treatment. Q: why do funeral homes seal coffins? A: to keep the oncologists from giving ONE MORE round of chemo.

  • Report this Comment On November 30, 2009, at 5:14 PM, selves wrote:

    As a consumer of a publicly-funded health insurance plan (I'm a Canadian), I'd like to throw a few comments into the mix.

    First of all, no honest Canadian will say that our system is perfect. BUT, very few Canadians would be willing to scrap it in favour of the current American system. Yes, we have waiting lists, but by and large people that need treatment get it, on an honestly-applied triage basis. Having the provincial government administer the health plan is sometimes cumbersome, but you can bet that our politicians LISTEN when the public is unhappy, and they DO react. When was the last time you heard of a big multinational insurer doing that?

    We have the freedom to pick our G.P., and to use generic drugs if we wish. Some (but not all) alternative treatments/therapies are covered, and the cost for a family is quite reasonable. Part of the reason it is reasonable is that coverage is mandatory - there is no selection bias. So, yes, in part the healthy pay for the sick, but that is the way it was intended to work.

    What are the premiums? Here in British Columbia, a family pays about $75 per month or so. My provincial income taxes go in part towards making up the difference - my provincial tax rate is approximately 6% (total) and my federal tax rate is approximately 21% (based on an income of about $85,000) - I certainly don't feel that I am being taxed to death!

  • Report this Comment On November 30, 2009, at 5:27 PM, nottheSEC wrote:

    I with NORTHHILL in caps so he/she may see it. I think the new health care plan should be designed by physicians with some outside input much like hedge funds/ mutual funds are run by traders with some outside input. I personally worked in a hospital and later a doctors' for most of my adult life and I concur with the evaluation. Especially the following and as always AGAIN IMHO>

    "I see health care decisions - read rationing - perpetrated by insurance companies every day"

    IMHO and experience insurance companies like to say a treatment is not medically necessary Unless its done by a facility that routinely minimizes modalities. they hope you will give up.

    "individuals who have no care now, who overburden our ER's, whose unpaid bills cause ungodly cost shifting to those who are trying to make it out of pocket"

    Go to any poor neighborhood and you will see the emergency room flooded with baby's fevers and the complications of untreated disease usually asthma in children and in the middle aged and elderly untreated acid reflux confused for cardiac problems and of course more gravely diabetes and hypertension.

    "Long standing drugs that cost no more to manufacture grow increasingly expensive, as drug companies buy them, rename them, heavily advertise them, and sell them at a 40-200% surcharge to prior cost".

    Extremely common despite curtailing of incentives to doctors and outcries.

    "Some state Medicaid plans are reasonably effective but many.. Florida's for instance, stink.You truly cannot mention Medicare and Medicaid in the same breath."

    Medicare works everywhere but I would reccommend a Medigap cause 20 % of big money is big money.Medicaid in Florida does stink and in NYC its great. My sister in Florida is a special needs adult under my mother's care covered by medicaid , my mother has Medicare. Both used to live in NYC. in NYC under Medicaid there was/is a choice of 60-70% of all doctors in NYC half in good neighboorhoods. In Floiida its hard to find a medicaid provider but Medicare is accepted everywhere.

  • Report this Comment On November 30, 2009, at 5:41 PM, bbell46356 wrote:

    The real problems with all of the health care proposals and the current system as well are that they take the consumer out of the picture.

    A women should be able to weight the risks and costs with her doctor and decide if she wants the procedure.

    A mammogram is not an emergency procedure. It is not a scarce commodity. No one shops for one now because under most plans you can't, most providers won't even discuss the cost, especially if you have insurance and most consumers don't care what it costs because they don't pay enough.

    As bad as your choices are now, the more Uncle Sam gets involved, the less choice you will have. You won'teven be able to pay for that extra month of life out of your own pocket.

    If you don't want that mammogram, you won't have a choice either. One reason insurance costs so much now is because benefits are mandated by politicians influenced by interest groups that want more coverage, not less.

    There is no way costs will go down with more government. The current proposals does away with less expensive high deductible plans - plans where you have some control over spending and taxes cosmetic medical procedures - one of the only areas in health care where the market has forced costs lower.

    Melaschasm is right - this debate is not about poor uninsured people, it's about trading your personal liberty for a government nanny that will dictate not only what you can and can't do but if you are worth living or not.

  • Report this Comment On November 30, 2009, at 5:46 PM, abacadabra wrote:

    The only thing "scary" about the public option is the fear that Orelli and his ilk seek to inject into the debate.

    The suggestion that results-based medicine is based primarily on cost considerations is poppycock. We here in the US already spend an outlandish sum on medical care relative to the rest of the developed world, so of course cost reductions are absolutely on the table. We cannot continue on the present course. But basing medical decisions on RESULTS, on BEST PRACTICES, seems logical and prudent, does it not?

    And I, for one, would place more trust in a national "best practices" board, working with physicians, hospitals, and health-care professionals to determine those "best practices" than I would in a bunch of profit-centered insurance companies and their shills.

    I want affordable, high-quality health care for all in the US. Yes, we can afford it. Have we the will?

    And really, if we really wanted to cut costs, why not go to single-payer, ASAP? It works (see Medicare; see most developed nations). No death panels. No horror stories, honestly.

  • Report this Comment On November 30, 2009, at 6:24 PM, zumamike wrote:

    This is not the REAL answer. There are several, and I see little discussion of what I think is the main one - extortionate billing charges by the hospitals in the first place, which are 4 ,5 and 6 times their cost. The insurance companies get a hefty discount from those charges, up to 70%, but the hospitals still make a tone. Work it out! There is also the habit hospitals have of padding bills, and perpetrating outright fraud, of which I have clear evidence. They took an outside lab bill of $7000 (for which we were billed) multiplied it by 7, and added into my daughters $265,000 hospital bill. When I caught them at this, they reduced their total bill to $17,000 to keep us quiet. Was it sheer coincidence that the hospital's Director of Pathology was also an officer of the outside lab?

    Another hospital in the same group was fined $6.2 million by the Feds for defrauding Medicare after a whistle blower blew the whistle. No firings of the people involved, no jail terms for the perps. People like this are common thieves trading on people's misery. They should execute them like they do in China.

  • Report this Comment On November 30, 2009, at 6:29 PM, familydoc66 wrote:

    I've never experienced so many contrary views as in the health care debate. In the past, I thought government programs were more nefarious than health insurance programs. Through the years I have come to believe that the insurance companies are without doubt act much less in the interest of patients than government ever did. Medicare is an exmple of a reasonable program that is underfunded. One set of rules that everyone more or less understands.Overhead is manageable. I would opt for an expansion of medicare by gradually reducing the eligibility age for all americans. Each of us would have the choice to join and pay the medicare premiums (which should be lower than private insuers because the medicare overhead is lower). We would have the choice to be covered by private insurance, Medicare or none at all. Those needing hospital care must have cash or sign up for Medicare.

    The younger subscribers need less health care than the older subscibers and would help fund the program. The other funding now in place is the medicare payroll tax which is regressive since it is a flat percentage of gross earnings. A graduated tax schedule would be my recommendation. I

    Every employer should be responsible for providing health care for employees and their families either through the private sector or the Medicare plan. Some businesses may need some tax consideration for doing so.

    Government can support the preium of those whose incomes are below certain levels as they do with medicaid. I would like to see medicaid phased out by medicare in this way because medicaid is such a second class program and the coverage varies so widely..

    One complication of all the current proposals is that most employed Americans have had very minimal out of pocket expenses for medical care. Premiums of $500 per month person or $1200 per month for a family as tossed about are totally unrealistic even though employers pay these premiums routinely.

    Paying a penalty for not having health insurance reflects the midset of congress-truly sad.

    my two centavos.

  • Report this Comment On November 30, 2009, at 6:37 PM, tkell31 wrote:

    I think the real problem with health care is that americans are so unhealthy and pretty greedy. Obeseity, smoking, drugs, alcohol...eliminate the people who dont care about their own health from the program. Then tack on the ones committing insurance fraud or just looking for a disability so they dont have to work and the problem would be solved. Require an hour of exercise a day and health problems would drop by 50%.

  • Report this Comment On November 30, 2009, at 6:45 PM, snoswell wrote:

    Here in Australia we have a universal federal govt run Medicare system that is paid for by a 1.5% tax on personal income (if you earn over about $30k a year). You still can get private cover if you like, in fact you get an extra 1% tax if you don't have private cover and earn over $73k for individuals and $146k for families. Private cover cost anywhere from maybe $50-$400 a month. Generally the cost of medical services is way cheaper than in the US (drugs, visiting a doctor, hospital procedures etc) - someone is grossly over charging somewhere. ($1AUD=$USD0.915)

  • Report this Comment On November 30, 2009, at 7:03 PM, lwwjrmd wrote:

    Back to the original question--mammograms for women aged 40 to 50. Who appointed the members of the commission, what are their qualifications, what are their conflicts of interest and are they experts in the field of mammography (obviously they should all be mammogram radiologists or oncologists)? Whenever 7 out of 10 doctors (or any collection of learned people) make a statement we need to ask ourselves--what about the other 3 (what do they know that the first 7 don't) and are all 10 doctors qualified in that field?

  • Report this Comment On November 30, 2009, at 9:01 PM, KeitaiOtaku wrote:

    Here's one thought not mentioned.

    If health companies are no longer allowed to reject people due to chronic illness or any illness, for that matter (I had a friend get rejected due to misinformed information about her being depressed) I wonder if they can hold their bottom lines?

    Meaning, if an insurance company cannot reject people who are sick, will they just reject everyone for a while?

    If the system breaks down completely, as it well could, the public option will need to be there to pick up the slack. The public option is there, in my opinion, to make sure the legislation actually works... I feel the legislation will fail if more and more people go without coverage, because the insurance companies have a rebellion against adding new people to their plans, and there is no other option for those people.

    I feel the insurance companies cannot threaten the entire country by no longer providing new insurance policies, with a public option. Because they will simply lose customers, the public option becomes the meat of the issue. It is the threat (intentional or not) to the insurance companies to get their act together and to stop gouging the public.

  • Report this Comment On November 30, 2009, at 9:01 PM, KeitaiOtaku wrote:

    Here's one thought not mentioned.

    If health companies are no longer allowed to reject people due to chronic illness or any illness, for that matter (I had a friend get rejected due to misinformed information about her being depressed) I wonder if they can hold their bottom lines?

    Meaning, if an insurance company cannot reject people who are sick, will they just reject everyone for a while?

    If the system breaks down completely, as it well could, the public option will need to be there to pick up the slack. The public option is there, in my opinion, to make sure the legislation actually works... I feel the legislation will fail if more and more people go without coverage, because the insurance companies have a rebellion against adding new people to their plans, and there is no other option for those people.

    I feel the insurance companies cannot threaten the entire country by no longer providing new insurance policies, with a public option. Because they will simply lose customers, the public option becomes the meat of the issue. It is the threat (intentional or not) to the insurance companies to get their act together and to stop gouging the public.

  • Report this Comment On November 30, 2009, at 9:12 PM, lts2lrn wrote:

    I have been a reluctant heavy user of the health care system for the last 5 years. One thing that the insurance companies excel in is denial of coverage and treatment. I used to be a big opponent of government run anything, but it is unlikely it could be much worse.

    And as far as all the "let the consumer choose" talk, most of the college graduates I know cannot decipher the legalese and obfuscation of a standard policy. Nor do they want to spend their time that way.

    Most commentators miss the tremendous amount of time required to shephed claims through the insurance labyrinth. It is a real waste of human potential in our country.

    The other cliche that is trotted out is how private enterprise can compete so well. So why not show that by running a public option out of business. Get creative, start prioritizing the patient.

  • Report this Comment On November 30, 2009, at 9:52 PM, tkell31 wrote:

    Please. Its a fact america has the unhealthiest people in the world which is crazy because we have one of the highest standards of living in the world. You think other countries have fat slobs riding around in go carts because they are too fat to walk? Think again. We've created diseases just to explain people's mental issues. Jesus, walk into an elementary school and look at all the porkers walking around. Theres our future diabetics, heart and circulatory problems and all the other myriad problems that come with being morbidly obese it's crazy. Require people to exercise and the health care problem will disappear. Maybe an exaggeration, but the problem will get cut in half. And if you are fat, reading this and getting mad I dont give a crap, go lose some weight and you will feel better. Depressed? Go exercise for an hour, its a scientific fact it naturally releases chemicles that make people feel happy. Let the doctors treat people with problems they cant do anything about.

    Oh, and how about we cut out all the ridiculous law suits in this country? I mean the number of people abusing the system for money is out of control. Increase the penalty for doctors, lawyers and patients who set up clinics just to bill the insurance companies (and if you dont think it happens, wake up you're in la la land). Believe me in NY, Philly, LA its big business. If insurance fraud was a business it would be the second largest business in the US behind only Exxon.

    What a shock, our healthcare system mirrors the US, fat, bloated and corrupt.

  • Report this Comment On November 30, 2009, at 10:06 PM, XTDNMAN wrote:

    The unstated premise of the original argument is that the new medication would somehow be available to most of us now, without having to pay the lion's share of the exorbitantly high price. Not so for most of us.

    As "snoswell" points out, we're being hosed here in the US now, and many of us who have lived outside the USA, with chronic medical conditions to pay for both here and there, realize just how badly we're being handled.

    The larger issue for the economy as a whole is that we are presently running a welfare state for the poor (Medicare) that is running the middle class into bankruptcy. Not surprisingly however, the wealthy benefit in the current system to a significant degree because we can deduct our health care costs one way or another, and we own the health care provision systems that overcharge so much. We've taken over what was a relatively local public health care system run by localities with the local doctors and we have privatized it at a very great profit with monopolistic impunity.

    Corporations that hire some of the disadvantaged do also provide health care, but at a subsistence level, and in exchange for work at poverty level wages.

    Some of the people most at odds with the idea are the wealthiest of us all. Surely this is because they feel responsible for the benefit of their employees, and not because they want to maintain a fearful and subservient work force afraid to lose their jobs and medical benefits.

    And even some of the so-called "wealthy" are afraid to strike out on their own because there is no health insurance for those of us with preexisting conditions....

    Unfortunately I doubt if either side of the aisle will give much consideration to solving this to the benefit of the country, as both have far too much to gain in status quo.

  • Report this Comment On November 30, 2009, at 10:38 PM, ItsInscosstupid wrote:

    This is not a complex problem to solve. EVERYWHERE else in the Western world does not accept a system that is not managed by patients,doctors and healthcare workers. Patients, Doctors and Healthcare workers everywhere else do not complain about the costs or quality of service anymore than we do in the US. I know because I grew up in the UK and live here. No-one goes to bed worrying about their Healthcare elsewhere in the world. The reason its so expensive here is because its a cartel here in the US and the Healthcare companies do the rationing. No-one seems to notice that one. Its the Healthcare companies - stupid. In the other countries politicians don't want tabloid or cable news stories about Healthcare so they do something about it because it makes them accountable at the polling booth. A Public Option will 'dramatically' reduce the cost of Healthcare as we will keep healthcare inflation in check through the ballot box. Politicians don't get elected by raising taxes in the US - a great incentive. Why is the Private system so good at keeping costs down again? Oh its not. Please don't call the other systems socialist. I know socialism and all the other countries systems are not. Look it up.

  • Report this Comment On November 30, 2009, at 11:39 PM, ET69 wrote:

    Nice to see so many thoughtful comments like Northhill's but as a doctor I think the issue is a little more political. When all is said and done the problem is we have a health care system based on capitalist profit.That is an oxymoron.We can't have a rational health care system based on private business profits.Sorry ,but in this case the the doctor recommends the nationalisation of the insurance companies, drug companies and hospitals and yes the AMA.

  • Report this Comment On December 01, 2009, at 12:57 AM, WyattJunker wrote:

    Oh, but a public option WILL have a VERY DEVASTATING effect on private insurers!

    As a private small business, such as I am, with 110 employees, the moment this is passed (after the front load in the taxes for 3 years before the actual benefit: can you say 'theft'?), I would rather pay the cheaper penalty and let my employees go into the public plan option. Many small businesses will do the same. Why wouldn't they? As this occurs, private insurers will have to mitigate this migration trend not by lowering costs, but by raising them to offset the migration away. There is just no way they will be able to compete against the tax-funded monopoly that is government.

    Why would I as a business owner incur more costs than necessary? Answer: I won't. Which is why I will switch my employees over to Obamacare. And, hey, they voted for him anyway, by and large. You asked for it, you get it.

    As this occurs all over, and it will, you can say goodbye to most private insurance, except the ones who service Congress, of course.

  • Report this Comment On December 01, 2009, at 12:59 AM, ozzfan1317 wrote:

    I agree with the doctor Insurance companies already ration care and let people die I dont think it could get much worse.

  • Report this Comment On December 01, 2009, at 12:59 AM, ozzfan1317 wrote:

    I agree with the doctor Insurance companies already ration care and let people die I dont think it could get much worse.

  • Report this Comment On December 01, 2009, at 1:00 AM, WyattJunker wrote:

    God forbid, hospitals like Kaiser should make a profit(as low as they are). Rather, they should go in the red every year to show how kind they are, doing the Lord's work!

    HAHAHA

  • Report this Comment On December 01, 2009, at 1:02 AM, WyattJunker wrote:

    People die no matter what, now with private insurers or with nationalized Obamacare. But trust me, once we have to sit in our DMV emergency rooms, you can bet the dying will be like nothing you've ever seen!

  • Report this Comment On December 01, 2009, at 1:57 AM, drericrasmussen wrote:

    Mr. Orelli tries a "hail Mary pass" in his attempt to make his spurious example of a public health care decision into an "investment concern." As if your employer doesn't make that call in negotiating a plan? He claims that the design of the public option may have a major impact on our portfolios. In fact, he's simply opposed to any government involvement in health care. Not rabidly opposed. Just opposed.

    I am pleased to see so many investors rejecting Mr. Orelli's canard. Every year my wife scans her employer's loop of providers to see which of her's has be dropped in the new contract. Years ago she lost the woman who did her mammograms because of the failure of her employer and the MD to agree to terms. That's business. But if a government makes a decisions that's.....tyranny? You still have to option of getting the mammogram, or expensive drug, on your own hook if you really want. My wife did and she did get it from her out-of-loop doctor.

    End of life decisions aren't going to vanish. By how much do we wish to drain our children's inheritance? Frankly, when I sense the time is right I think I'll just give all a hug, exit the igloo and go for a walk in the snow.

  • Report this Comment On December 01, 2009, at 3:01 AM, jaketen2001 wrote:

    Ditto Northill.

    The government can establish a baseline for treatment and insure everyone. If you are wealthy and want to pay $5,000 to live another 30 days, great.

  • Report this Comment On December 01, 2009, at 7:28 AM, gsgreen wrote:

    There is no doubt that we need a better way to deliver health care in this country. While huge sums of money do flow into the "health care" system that we have, a distressingly large percentage of those funds is absorbed well before the actual delivery of care to the individual by administration and documentation. Adding another layer of administration only adds to the percentage of funds syphoned off before providing care to the individual.

    That being said, the current bills being promogulated in Washington are not nearly as wonderful as our elected representatives would have us believe. The proof of that statement? One of the first things Congress does in this bill is to exempt themselves from the provisions of the bill. 'Nuff said.

  • Report this Comment On December 01, 2009, at 9:14 AM, money4eds wrote:

    Name one government program that really works. If this is about covering everyone then mandate everyone to play. If you are trying to lower cost then start with tort reform. After that you are into rationing.

    You will ration:

    Care, we simply cant spend that much on end of life

    Doctors, negotiated rates, every medicare doctor in my parents county will no longer accept medicare, they now must travel or pay their own way.

    Drugs, the US underwrites the development cost of many drugs, we the profit drops so will the selection of drugs.

    The fix:

    Mandatory insurance, spreads the risk

    Tort reform, it will lower medical malpractice cost

    Buy health insurance accross state lines, more competition

    Pay the patient not the provider, that will bring the patient into the cost choices

    Eliminate pre existing conditions

    Start to reward healthy habits

    Start to really raise the cost for unhealthy habits

  • Report this Comment On December 01, 2009, at 10:00 AM, jcwmd wrote:

    I couldn't agree more with the sentiment that $5,000 per month for 3 months out of your own bank account is reasonable. NICE did not make the liver cancer drugs illegal - it just said their federal government was not going to pay for it. These drugs don't cure the liver cancer. So that would mean in addition to the $5,000 per month for the liver drugs - their government would have been paying for the other treatments that I'm sure go along with a progressive deadly liver cancer - for an additional 3 months. At some point, this country's citizens are going to realize - we can't have our cake and eat it too - we can't complain about entitlements, debt and deficits - and then insist that every single drug, treatment and test is justified all the time.

  • Report this Comment On December 01, 2009, at 10:22 AM, Bamafan68 wrote:

    I find it interesting that so many people are pushing Medicare as a great system. A lot of physicians limit the amount of Medicare that they will see due to its byzantine coding rules, draconian penalties for miscoding, and low reimbursement rates. (Before any of you say "Just code better", check out Medicare coding guidelines sometimes. They're almost like trying to figure out the tax code.) A sudden influx of people into Medicare, especially if the government cuts reimbursement by $500 billion as proposed, is going to leave a whole lot of people who can't find doctors.

  • Report this Comment On December 01, 2009, at 10:47 AM, sspickens wrote:

    What seems to be missing from the debate is honest discussion of the real world issues - starting with the proper role of insurance.

    Somewhere in the neighborhood of $3500 per year per person is the cost that everyone does or should incurr in primary and preventive care. Since this is a predictable cost for every person, primary/preventive care at this level is not an appropriate place for insurance. Insurance is a tool to spread the risk of unpredictable bad things happening to a few people. So let's honestly discuss whether primary preventive care is something that should be available to all citizens and who should pay for it and how the money should be collected.

    At the other end of the healthcare spectrum is catastrophic care. This is most definitely an appropriate realm for insurance. And again, let's have an honest discussion about what levels of catastrophic care should be available at what cost to which people and who should pay for it.

    In between is chronic disease management - where the vast majority (75%?) of healthcare dollars are spent. Insurance may be an appropriate tool to address paying for this care but it's a specialized situation that requires specialized risk pools etc.

    The healthcare debate gets muddled when we assume all healthcare needs are equally well addressed by the same solutions. This approach causes distortions in the system and political mayhem by promoting statements that are so obviously illogical that there is a strong tendency to throw out the reform baby with the bathwater.

    Covering more citizens with more services will NOT cost less. It will cost more. Cutting reimbursement to providers will NOT squeeze out waste. It WILL drive providers from the market and create less access to care. Not allowing all 600 US health plans to compete in every market to allow more options at lower cost is completely illogical. Pretending that wasteful defensive medicine in the absence of tort reform doesn't exist is ridiculous. Pretending that we can somehow not ration care (by market price or government fiat) giving everyone all the care they might want and not have to pay for it is economic silliness and demeans us as a nation.

    Let's stop the nonsense, the pretense, the silliness, and debate the real issues and options for the real world.

  • Report this Comment On December 01, 2009, at 12:29 PM, woodheater wrote:

    I believe a public option is needed, but the way the discussion has been going, it looks like the public will need more assurance of its feasability. Therefore, instead of an Olympia Snow "trigger" option as a bottom line political solution, I suggest a ten year trial, with careful evaluation of essential criteria (ie. bending the cost curve downward) provided regularly along the way and a sunset provision at the end. After ten years the new debate would be on more solid ground.

  • Report this Comment On December 01, 2009, at 1:03 PM, jkomsky wrote:

    "takes the recommendation from the government-sponsored task force as fact and begins paying only for mammograms for women 50 and older? Now that public option isn't looking like a very good option, if you're one of the many women who develop breast cancer in their 40s."

    And yet with the public option, more women in their 40s who do develop breast cancer (which has relatively high survival rates compared to other cancers) will be able to afford treatment for their cancer. Without the public option, not only will these women still not be able to get mammograms, but they also wouldn't be able to get treatment because they don't have insurance.

    The public option may not be the optimal solution, but it seems to me that it will help more people afford health care, and that is a step in the right direction.

  • Report this Comment On December 01, 2009, at 1:32 PM, Keal7 wrote:

    This is really enlightening and like complaining that a bear could kill you when walking through a jungle also filled with lions and tigers. Author totally omits to mention that private insurance companies already do this!!! Refuse to cover specific treatment according to their own decisions and sometimes arbitrarily. And you dont even get to vote on them!!!

    Cool. Let's refuse to set up a public alternative because it could practice statistics based recommendations and continue to suffer private insurance company doing the same. And of course since private companies would go out of business if they do not apply any rational ceiling in deciding what to cover, What if said treatment regiment costs 100K a month for instance? There is no limitless spending on health care either in government or private sector but the government can probably absorb bigger limits per individual

  • Report this Comment On December 01, 2009, at 9:55 PM, jm7700229 wrote:

    Does anyone actually believe that an insurance company could make an arbitrary decision and have it slide unnoticed past the plaintiff's bar? How absurd.

    I'm all for a public option -- with one caveat:that it must always -- ALWAYS -- follow the same rules under which the private sector lives. No subsidies, no political interference, sink or swim on its own merits.

    The only thing wrong with this idea is that it would require the investment of a few more billions of dollars of taxpayer money, just to prove that there never has been and never will be a government enterprise (I use the term loosely) that can compete on a level playing field with private enterprise.

    Of course, as we all know, the Congress could never let the playing field be level. You don't buy votes with efficiency, you buy them with money. So the public option would be getting subsidies before the ink dried on the promise.

  • Report this Comment On December 02, 2009, at 8:57 AM, nokingforme wrote:

    I often wonder how so many of us fail to grasp the history of this great country and what seperates us from the rest of the world.Immigrants from every corner of the globe come to america for the freedom to succeed and the freedom to control that which is most desirable- ones own destiny.I do not depend on the government for the food on my table,the clothes on my back or the shelter over my head. I do not intend to rely on the government for my healthcare either. I have been on this earth for 55 years.self sufficient and proud of it.. There will always be a need for compassion and charity for those, who through no fault of their own, are unable to attain the basic neccessities of life.For those in true need I am willing to give up some freedom and income to meet those needs. The great problem with governmernt intervention is that compassion and charity is replaced with entitlement and the heavy hand of forced compliance-much like the monarchs and dictators of europe and asia - maybe this is why they willingly accept government intrusion into every facet of their lives. We did not become the greatest nation on earth by limiting liberty and forcing citizens to become wards of the state. Lets don;t start now.

  • Report this Comment On December 02, 2009, at 11:37 PM, lucas1985 wrote:

    @lwwjrmd,

    "Back to the original question--mammograms for women aged 40 to 50. Who appointed the members of the commission, what are their qualifications, what are their conflicts of interest and are they experts in the field of mammography (obviously they should all be mammogram radiologists or oncologists)? Whenever 7 out of 10 doctors (or any collection of learned people) make a statement we need to ask ourselves--what about the other 3 (what do they know that the first 7 don't) and are all 10 doctors qualified in that field?"

    Learn by yourself: http://www.annals.org/content/151/10/716.full

  • Report this Comment On December 03, 2009, at 8:28 PM, interdependent wrote:

    Pharmaceutical companies and their profit margins are not "health care". If you are concerned about getting good health care, get your head out of your 'profit potential' and just say no to drugs.

    The most expensive health care in the world does not lead to a life of good health. Likewise the business of health care and the pills we take to fix our problems can get in the way of thinking clearly about how to really live well.

  • Report this Comment On December 04, 2009, at 8:28 AM, holyyikes wrote:

    I am paying for my own healthcare right now. I am only worried about how to pay for it when I am really sick and can't work to make enough to keep it. Like public school option is there for my children, should I can no longer afford to give them the private education they are getting, I want to have the peace of mind of a public option, be it much inferior than the private ones.

    BTW, I don't think public schools affect private ones. If anything, they make private ones compatitive. Add; it is so sad to see that since my time, public schools have deteriorate so much because of the cut of fundings. When has this nation become so selfish and short sighted that we forgot that we simply cannot all be self sufficient all the time?

  • Report this Comment On December 04, 2009, at 12:53 PM, randallengle wrote:

    Come on Town-Hallers!! As the physician reported, the insurance companies are already making such decisions. The most important part of the article was the quote

    "Ultimately, NICE could still cover both drugs. The companies will just need to offer deep enough discounts, as Johnson & Johnson (NYSE: JNJ) and Pfizer (NYSE: PFE) have done with their cancer drugs"

    That, in fact, is what a public option can do. Get the citizens a better price.

  • Report this Comment On December 04, 2009, at 1:11 PM, Krantzman wrote:

    Set aside the politics. Why isn't anyone focusing on the costs. Using the CBO numbers, the cost for Uncle Sam's plan is about $250/ month to cover someone who doesn't have it now. Not bad, except, that number only counts 6 years over coverage, but 10 years of premiums. The real cost is $750/ month or so. We can all buy coverage for less than $750/ month if you are reasonably healthy. And we don't even know what the plan will look like. What if it has a $2,000 deductible? Is that worth it?

    Your premiums will go up, when Uncle Sam says we need this program to cover someone else. So your costs will be $1,000/month so someone elses' can be free. Why?

    And insurance companies are hard to deal with and make a lot of mistakes, but they always work to fix them. Free market demands it. Government doesn't demand excellence. But they are the ones that afford Doctors a nice living. The Insurance companies don't cure Cancer they pay for it. Doctors make lots of billing mistakes too, but they don't get the "demon" treatment Insurnace companies do. But if the problem is the costs are not because the insurance companies make more money, it is because Doctors and hospitals charge for their service. Can't fix that, unless you want to pay Doctors with Chickens and a buschel of corn, or we can just not pay them. Who wants that? A doctor from Bombay Medical School is who!

  • Report this Comment On December 04, 2009, at 1:14 PM, smivic wrote:

    Talk of how single-payer systems don't cover expensive drugs is really a red-herring. Our monopolistic, anti-humane system operates in the same way just to increase their profits, while their CEOs receive tens of thousands of dollars per hour just to deny our coverage. They put profiteers between us and doctors. Somehow administrators seem to be a more humane approach than this.

    The real problem is the costs of modern health care and ours fools rush to make so much of it for-profit.

    We now have the best medical care that few can hope to afford. 60% of all personal bankruptcies are due to medical costs and 70% of those folks have health "insurance".

  • Report this Comment On December 04, 2009, at 1:24 PM, CopyCat3000 wrote:

    I would hope that no one here hopes the U.S. Government will be able to administer a 2000 page health care bill correctly. I'd bet most of our Congresspersons don't even understand the impact of the current bill. Forget about the Canadian system. It won't work here, we're far, far larger than Canada. We need to back up and fix the system we have one step at a time addressing the many serious wrongs with our system now.

  • Report this Comment On December 04, 2009, at 1:34 PM, starfish36 wrote:

    The "real problem" with public health care is that the American people, who abandoned any national service obligation (not just the draft) decades ago, have been raised to nourish greed and worship money and markets -- that is, their own money and material objects. Whatever their income, they don't want to shoulder the burden for others who are less fortunate. They cite the poor state of care at some VA hospitals not for the proposition that our soldiers obviously deserve better but as a reason to leave 45 por 50 million more people on the street without health insurance. Lacking historical perspective, they pretend that the highest marginal federal income tax rates (38% or, when you arrive in the land of the rich, 35%) are quite high, when the maximum rates under Truman Eisenhower and Johnson (when we at least tried to pay our bills) were 91%-92%, and under Kennedy, and Nixon were 77% or 73%. Unfortuately, many are more interested in filling their wallets to the tune of millions of dollars in annual compensation, as though it were deserved, while letting the poor accept their fate as though it were unavoidable and not especically inmportant in any event. After all, doing seomthing would increase the burdens on the wealthy and lead to some sort of "socialism," a word that most Americans barely understand.

  • Report this Comment On December 04, 2009, at 1:35 PM, Catsslady wrote:

    I'm all for having somebody compare drugs to see which works best, and I'm all for having cost in the equasion, as long as the somebody doesn't have the right to use force. That's why the government should act as referee, and the referee should never never be a player in the game he or she referees.

    I'm also in favor of somebody promoting care that isn't from big pharma. There are double blind peer reviewed tests that say ginger is at least as good as the best prescription drug for arthritis. Raisins and gin is better. But nobody makes money promoting them. And drug companies do keep track of which doctors prescribe what - and reward the ones who prescribe most - and I think that should be illegal. Which illustrates the importance of government as referee.

    And we do need a way to get established cures better known. It took decades to get penicillin in common use after it's uses were recognized. And I much doubt the situation is getting better.

    I've got a degree in statistics, and I do not, repeat NOT, agree that our medical system is inferior to those with longer life expectancy. Take out deaths due to car wrecks and similar items, ours compares rather well. Our death rate from cancer is decidedly better than any government managed system.

  • Report this Comment On December 04, 2009, at 1:40 PM, sigmull wrote:

    Medicare pts cannot get a specialty app't in Florida now.. Mayo Cl and other top places limit or dont take medicare pts now. Gov't health plan will definitely limit access. How can dems cut 400 B from medicare payments to "pay" for new coverage. Are you nuts to believe this. If politicians were covered by the same plan, then OK ---but they will continue to get their Cadillac medical premium coverage. Lets just give the medical (medicaid) coverage to the 10-20 million uninsured and leave the rest of us alone. It would be cheaper and fair.

  • Report this Comment On December 04, 2009, at 2:08 PM, grooverking wrote:

    Try to keep in mind the underlying concept of insurance. By pooling our money (premiums) together, we can make the cost of healthcare (accidents, death, business liability, whatever) predictable and manageable. Whoever is the 'trustee' of our pooled money is supposed to pay the costs of whoever is part of the pool. The trustee earns a salary, plus incentives to provide better service and negotiate lower costs from the suppliers. But it's inherently communistic,and that can't be avoided. Any attempt to earn a profit from this venture results in cheating the participants.

    Let's return our means of paying for healthcare to it's original design: a "mutual" company that refunds excess premiums to the members.

    Know of any?

  • Report this Comment On December 04, 2009, at 2:12 PM, Sidroe101 wrote:

    As a military guy I know the meaning of "govt run healthcare" which is why I put myself on my wife's health insurance plan. Came in handy when I had to have a tumor removed, ...from my brain. I got to pick a guy at Methodist in Houston (BTW some of th best Physicians in the world are there) and not one like the Army guy that resected my fractured elbow and nicked my Ulnar nerve in the process.

    Don't get me wrong, Army docs are good at trauma and other types of medicine but for some things I want the choice. I did have to fight the insurance company to pick my doc, but they relented, ever try fighting a govt entity?

    Things to keep in mind:

    Medicare, Social Security, the nation's roads, bridges and critical infrastructure and two drawn out wars are being run by your congressman, your healthcare is next.

    Insurance companies aren't charities, they're a hedge against medical catastrophies in your life, for a realtively small monthly premium, don't knock them.

    Doctors make a very good living from those same insurance companies, again don't knock 'em.

    Ditto for drug companies...what's your life worth??

    The gentleman from BC, paying 26% in taxes may not be alot if your healthcare is covered, imagine where it would be if you had a large standing Army like the US, And providing over 40% of all world aid, among other things?

    Americans want free healthcare while still engaging in unhealthy behavior, I have close relatives in that category. For the proponents of the single payer system, thanks for paying their doctor's bills, especially the smoker, the diabetic with the sweet tooth, and the two alcoholics.....sounds just like Europe doesn't it?

  • Report this Comment On December 04, 2009, at 2:37 PM, Alabare wrote:

    I agree that Medicare is a government-run health care plan that works well -- but at whose expense? Its gov-imposed DRG reimbusement system pays hospitals about 45% of the charges. Result? Massive cost-shifting to the public.

    Sure, let's have Medicare for everybody. Great idea! But if we do that, upon whom will the cost-shfting fall?

  • Report this Comment On December 04, 2009, at 2:40 PM, raystom wrote:

    IF we end up with a public health plan, I predict we will see two results: (1) many rules and regulations, in typical government fashion and (2) a surge of enrollments for folks in poor health, which eventually will cause high costs and even higher premium rates. You can't insure a lot of sick people without incurring big time costs.

  • Report this Comment On December 04, 2009, at 3:21 PM, turnkeyusaa wrote:

    I'm an American health care exile living a large part of the year abroad in Riga, Latvia. I can't live in the US with my new Latvian wife without health insurance, which is completely unaffordable in the US for the self-employed. Full coverage (25 GBP deductible with no co-pays) expat health insurance costs $2550/year; for just in-patient coverage with a travel option which includes visits to the USA of up to 90 days, it costs $1813 with the same deductible. In the US such a policy doesn't even exist.

    I have a doctor friend in London making a fortune (15000 GBP/month), while in France he was un or under-employed as a doctor (and got an American MBA from Duke as a result). Why? The French government sees to it that medical schools churn out an enormous supply of doctors who compete with each other and hold down costs. In France Hippocrates meets Adam Smith; the govt sets the reimbursement rate and patients choose their clinic or doctor at more or less that price, whether or not they have insurance. I paid 60 euros for a visit with a great orthopedist in Paris who in NY would have cost 4-5 times as much for a less attentive shorter assembly-line style visit. In provincial Albi, near Toulouse, the waiting period for a triple bypass is 8 days. How do I know? A patient's wife told me.

    My mother needed treatment for a dislocated shoulder while visiting me in Lecco, Italy in 1996. No forms, no credit cards, caring personable doctors and never a mention of money. Health care in Italy is a fundamental human right, even for foreign tourists.

    When a Swiss friend visiting Hawaii about the same time had an emergency, the first question was about a credit card or insurance (he had insurance).

    In Utah, First Aid at Alta wouldn't even look at my friend's injured daughter without a $500 deposit and a credit card. This is barbarism, plain and simple.

    Three years ago an American friend of mine living in Tallinn had an asthma attack requiring an ambulance, 6 days in the hospital and major treatment. The bill for a foreign resident contributing to Estonia's social security system: 65 euros. Estonia's GDP per capita at the time: $14000, less than 1/3 the US.

    In the US we have the worst of both worlds, collectivism with central planning by insurance company accountants and and capitalism with no free market, but a rigged cartelized market without anti trust rules being applied to non-competitive regional markets.

    It is an obscenity that a relatively poor country such as Estonia has a better health care system than the USA. Estonia and Poland are now medical tourism destinations for lots more than plastic surgery, while all medical tourism from the US is outbound. What does that tell you?

    If a healthy, in shape, mortgage-free expat foreign investor skier and cyclist like me is terrified of the USA's predatory health care system, imagine how an average working American should feel when he first submits a 5 or 6 figure claim to his insurance company. Most Americans who are satisfied with their private insurance haven't yet made a big claim.

    I want a public system to use predatory pricing to compete with private insurance and raise the supply of doctors to lower costs: Hippocrates must get to know Adam Smith. A new national health plan should include government financing the medical education of tens of thousands of students who sign up to work at a fixed salary for the government health service where the patients most need them to work. So we'll raise the supply of doctors who are debt-free and more motivated to treat patients and do research, instead of feeling they have to make tons of money to pay off debt. I prefer to be treated by doctors motivated altruistically by service, not their next Mercedes. That's the way medical care, which is a fundamental human right, should be. Economic illiterates like John Mackey should read Kenneth Arrow's Nobel prize winning paper of 1963 which proved that medical markets are inherently prone to failure due to assymetry of information. Or are they too cynical to

    bother? If you haven't read it, I'd be happy to send it to you, as I believe your mind is open to change when exposed to heretofore unfamiliar data and ideas.

    If you want to know how to run a health care system, travel. France, Central and Northern Italy, Holland, Estonia, Canada, Finland....take your pick. Abstract free market fundamentalism can't compete with empirical data and personal experience--come and need treatment where I've lived or needed it, and you'll see. If you disagree, please present me with a coherent argument why I shouldn't have the same government paid health insurance you have and which my mother has through Medicare. If you're against a public option for me, to be consistent you should present a bill to abolish Medicare.

    As an MBA member of the investor class, I am no socialist; but I know from personal experience that single payer works because I've lived in and benefitted from it.

    Lester Golden

  • Report this Comment On December 04, 2009, at 3:43 PM, jgknerklfv wrote:

    Face it:

    1- Our current private heath care is going down in flames and needs fixing.

    * It is effectively an oligopoly of a few brand names, no competition

    * Companies are going out of business because of the cost of health care and retirement. Crazy!

    * The balance of power is non-existent: they can deny you whenever: They pay, they process claims, their doctors decide if you die. See sicko for extreme cases.

    * We must factor out ambulance chaser lawyers who suck up the money and cost us all.

    * My copay has shot up from $5 to $30 in 8 years. My coverage has dropped. I don't feel safe.

    * If I loose my job, I loose my health.

    * If I have a preexisting condition I loose coverage.

    * People forget all the working poors with no coverage. We the people? Yeah right... The only freedom left in the US is the freedom of corporations to make a profit with rules loosely set by lobbies.

    2- Socialized health care has some goods, some bads, and mostly a lot of disinformed bad press in the US.

    * Fact: French socialized heath care saved my mother's life. She lived an extra 10 years with cancer and cutting edge care at ZERO cost. Continued working and be a productive member of society till she died. In the US she would have died years ago from lack of decent treatment.

    * Fact: Europe is mostly on socialized heath care and it works. Many different systems, not all good, not all bad, not all expensive for society. Of all, the british one is the most messed up/flawed. I have a friend who died of cancer in England and could've been saved anywhere else in the world, late diagnostics.

    3- If we start from scratch we can make a good system. But it has to not yield to compromises. Here's what I identify as priorities:

    * Private and public must compete. A public offer might not be needed but will shake-up the HMOs.

    * Strict rules on eligibility for all: An insurance must insure ALL legal US residents, no restrictions like preconditions, working or anything, no extra premiums. Unregulated pricing or extra services however. Maybe even make these independant of companiesyou work for.

    * A special pool must be set aside and contributed to by all, to pay for extreme/expensive/rare conditions, to allow small insurance players to grow. Access to the pool is decided case by case by independant governement appointed doctors, and decisions must be public to detect fraud.

    * Expensive/elective work approval must be allowed/decided by independant organisation, not the insurance company, unless it is really deemed useless/cosmetic work.

    * Insurance companies should not be allowed to ask volume discounts to doctors. Docs just inflate the price to account for the discount, and then just charge walk-ins incredible amounts. It's anticompetitive and works agianst the consumer. Inaceptable. Price fixing should be done by the governement or better, left to the docs, with customary caps set by the governement using price surveys, and not capitol hill policies.

    One last note: Insurance is not about being selfish. It's about society caring for all. We expect most to be in good health, but if one's health falters then all of us contribute for that one occurence to help that person. It's about 10,000 people pitching $1 when a person needs it. I'd rather see that than have my tax dollars burnt in one shot with a $1M missile exploding in a desert.

  • Report this Comment On December 04, 2009, at 4:11 PM, yoyoWordUp wrote:

    The real objection is very simple: The government is huge, getting huger, and running ever-increasing deficits to fund itself. There is no debate on this fact.

    And when we add healthcare to to list of things that it runs, we'll have yet-another-money-loser on our hands and we'll all pay dearly for it. Taxes will increase, and deficit spending will spur ever-greater inflation and erode our savings. We'll all get poorer, and quality of healthcare will not increase. It's a losing proposition.

    Leave healthcare in the private sector where it will be managed it like a real business.

  • Report this Comment On December 04, 2009, at 4:34 PM, prhutson wrote:

    An excellent discussion...

    I am in favor of the public option for reasons of both fairness and efficiency stated by several above. As an academic pharmacist, my practice area is in cancer treatment and palliative/end of life care. My family has benefited from very good medical care (surgery and radiation for my son's cancer treatment. Money well spent, since the prognosis for him is not perfect, but argues for a normal life span. On the contrary, there is no cure for metastatic lung cancer, but for more $50,000 we can give you a couple of extra months, typically with poor quality of life at that. We do have better cancer survivorship in the US than other countries, but except for a very few cancer types, we cannot cure patients with metastatic or recurrent disease. Increasingly, we can extend their survival, but at a substantial cost. Similar prognoses apply to patients with severe heart failure and obstructive lung disease from smoking and other lifestyle choices.

    We as a nation are, I think, morally obliged to provide care to the ill. However, we should not provide futile care, and we need to decide as a nation what we can afford to treat. We cannot be driven by unique experiences, but what is the best treatment we can afford for all patients. And yes, this will for many patients mean that we will spend the money on improving their quality of remaining life, rather than spending tens of thousands of dollars to extend their life by 2 months, and THEN spending money on improving their quality of life.

    I agree that we need to pay for the majority of medical tuition for MDs and advance practice RNs and RPhs that participate in the public option practices.

    The VA is a great system, with the best electronic health record system in the country, and would be my recommendation for the basis of the public option. My concern about 'the public option' is that it is open-ended. We don't know what 'a qualified health care plan' would entail or cost. If it modeled the VA, that would be a good start.

    Don't want the VA-based public option? Give people a tax credit for the cost of minimal health insurance purchased elsewhere, but we must allow insurers to compete across state lines. For example, studies have shown the Kaiser plan to have equivalent results with the UK NHS, but with higher patient satisfaction. It is quite conceivable that Kaiser or other insurers would be more attractive to consumers than a government program with similar premiums, but any contracts on drug costs would have to be equitable. Allow competition to drive innovation and efficiency. People with more income could choose to buy an additional medical policy that gives them access to fancier hospital settings, and perhaps a shorter wait time for procedures. Or that additional policy would grant you access to as many courses of futile chemotherapy as you like.

    The key is that we as a nation need to decide how much money we have to spend on our health care (how much we want to be taxed), and then decide what health care that amount of money will be spent on. I trust a panel of experts (Institute of Medicine) and lay people to make that decision (with input from public forums) far more than I do my or your legislators.

  • Report this Comment On December 04, 2009, at 5:11 PM, tnale wrote:

    I am a dentist, once a month cleanings will do nothing to prevent tooth decay, eliminating sugar from your diet will. Once a month cleanings might do wonders for gum disease if an ultrasonic cleaning is done as it will flush out the harmful bacteria from the gum pocket and cleanse the root of the toxins that the bacteria have laid down, however, research has shown that in most cases it takes 3 months for those toxins to build up to harmful levels, therefore, 3 month cleanings for perio patients.

    Would national health care decide that 1 or 2 times a year cleanings be enough for most of the population and therefore to balance the insurance costs that would be the benefit.

    England's National Dental Plan pays more to extract teeth then fix them, as dentures over the long run are a less expensive benefit and the projection is an $8 to $10 Billion dollar deficit in their Nation Health Plan budget next year.

    Germany has had a national health plan for over 100 years. There is an 8% payroll tax to pay for it and they are estimated to be $12 Billion short!

    Don't believe the lies that this will pay for itself in savings from fraud. If there is that much fraud wiy are they not going after it now? How come 10 years of taxes will be needed to provide 6 years of benefits? Does not sound like balanced budget is coming in the 11th year.

  • Report this Comment On December 04, 2009, at 6:12 PM, kencoatsystems wrote:

    I am a republican and a capitalist through and through....However....

    I think[because of uncontrolled greed] it is enevitable that we go to a single payer system. After all, fire fighting and law enforcement used to not be government affiliated or ran by municipalities. If you didn't have the money to hire a gunslinger or security of your own--you were faced with protecting your self with any means possible, which lead to an unruly society. It had to be taken over by a system that works better than any system we or any other goverment has ever had...even though it's not perfect.

    Once upon a time in America,

    Banks/Insurance companies[for the most part] were motivated to have fire fighting capabilities to protect 'their' assets - IF they had your loan or were insured by them. However; if you WERE NOT -they had no motivation to save YOUR asset. That is how/why whole towns were burnt to the ground. Your burning barn, that noone else had an intrest in, -didn't care -----until it spread to their house.

    See the similairities?

    The medical industry will end up being a 2 or 3 tiered system just like security and fire prevention. We are in the 1st phases of it..it's happening right now.

    The health care industry is steeped in fradulent and gross overbilling. In many cases it gotten to be a 'lets just see how much can we actually get' situation with the insurance companies collecting premiums that are astronomical....and 'seeing how much they can get away with NOT paying'.

    That hurts everyone. WE are paying for it whether you know it or not. People who say leave the system alone, they like it like it is...don't understand they are getting robbed and are oblivous to it

    [which is what the insurance companies love]

    If we don't have the public option the insurance companies will morph into another being that continues to do the same thing that they have always done...just in a different fashion.

  • Report this Comment On December 04, 2009, at 7:47 PM, lcarliner1 wrote:

    The major problem is the reprobate nature of the private health insurance industry. As far as I am concerned, they have demonstrated ethics comparable to that of the degraded nature of the former ENRON energy futures trader. Senator Chuck Grassley is so concerned about the private health insurance industry being crowded out that he opposed the extension of the SCHIP program, and now any public option in insurance reform!

    Back in 1972 one company, that is headquartered in Chuck Grassley's home state of Iowa, would not "touch me with a ten-foot colonoscope" because of my mild to moderate ulcerative colitis, but would sell me life insurance at grossly inflated rates. At the same time that company would issue health insurance to my late wife even though no life insurance company would underwrite her because of her polycystic kidney condition, but would sell her health insurance, with her kidney condition excluded, of course. One year later, at the urging of the then family financial advisor, the policy was going to be replaced. The company agent, frustrated over his failed attempt to dissuade me from switching, told me of an article that appeared in one of its company publications in which the underwriters were chortling over "how cute and clever" they were in that they would issue health insurance to a skydiver, but not life insurance! That company, American Republic Insurance Company, located in Des Moine, Iowa, is an excellent poster child for why a robust public option, at the very least, is needed!

  • Report this Comment On December 04, 2009, at 7:56 PM, 3Cwheels wrote:

    One simple question. If the Health care before the senate so good, why aren't the legislators voting for HR 615, HR 615 requires the senators & representatives to drop their current plan, and accept the plan they're voting on to replace their taxpayer supported plan now available to themselves and family

  • Report this Comment On December 04, 2009, at 10:35 PM, Wh1sp wrote:

    The initial part of this article was rather silly. Of course there's a cost benefit analysis behind the recommendation. Leave it at that and don't make it a target for a straw man setup. TMF can do better.

  • Report this Comment On December 04, 2009, at 11:32 PM, TwoGeezer wrote:

    The real fallacy with much of the opposition to a government insurance program is the idea that since the government won't be perfect, we better leave it up to business. However, the facts are that business gets practically nothing but profit-taking right. What kind of idiot would leave water purification up to business? Or protecting the environment? Or the military, police, or fire departments? Corporations screw up everything they touch.

    Since we are practically at the bottom of the world barrell in industrialized national health, pretty much anything we do will be a step in the right direction, as long as that thing removes profit from healthcare.

  • Report this Comment On December 05, 2009, at 2:06 AM, ehudmos wrote:

    Commercial insurers demonstrate everyday that they are not as efficient as the government in providing health care. Whenever they take a 'Straight Title 19" patient into a (commercial) "HMO Title 19" they demand and get the cost of care of T-19 + about 12%. They provide essentially the same level of service for a 12% surcharge paid by the taxpayer.

    What are they going to do when the comparison with the "public option' proves they have to charge us all 12% more? I bet even some Republican lawmakers will attempt to emerge from the pocket of their insurance company benefactor to demand efficiency and savings.

  • Report this Comment On December 05, 2009, at 6:15 AM, JRS4 wrote:

    A lot of people mention the greedy insurance companies as a reason to favor a public option. One of the reasons taht insurance companies get away with "murder" is that most don't have competition, or little competition within a State. Is the reason because of trying to dispense Medicaid? If you extend true competition then healthcare costs are sure to come down. Now introduce tort reform except for surgeries and you've got a real chance to bring down costs. Finally tackle a portion of pre-existing conditions by allowing employees to be able to transport their insurance policy between employers. This sounds difficult to accomplish but could be done by the government mandating that insurers, that employer uses, has to accept the pre-existing condition but the employee would have to pay something for the pre-existing condition. Finally extend Medicare to the jobless, but they would have a certain amount to use every year for regular care (at least they would have an incentive to not abuse the system). For catastrophic care then that would be decided by Medicare. As you know free insurance is always abused. So you can see that it benefits you not to be unemployed, and if you're not employable then you can receive some help. But do not ruin some of the health care, that we have right now, for the rest of us. This should give us a chance to control costs and a chance to keep, improve and minimize the cost of our existing health care plans.

  • Report this Comment On December 05, 2009, at 8:53 AM, JRS4 wrote:

    I just got this e-mail from Congressman Ron Paul.

    "Dear Friend,

    It is a myth that big business is a friend of freedom.

    Exposing the ways big business has worked to undermine liberty and explaining how the anti-market policies enrich large corporate interests at the expense of average Americans is a vital task for the freedom movement.

    In Tim's Carney's book, Obamanomics: How Barack Obama Is Bankrupting You and Enriching His Wall Street Friends, Corporate Lobbyists, and Union Bosses, Tim looks past the Left's anti-business rhetoric to expose how big business benefited from the stimulus bill, and how the current administration is funneling taxpayer money to failed Wall Street firms.

    Perhaps the most useful section of the book is the chapters detailing how the insurance and pharmaceutical industries are lending their clout to the push for nationalized health care.

    Despite the sound bites from the pro-ObamaCare politicians and their cheerleaders in the media about the evil insurance companies, the insurers are actually on Obama's side in promoting a giant expansion of the government's role in health care.

    And why not? A major plank of the health care plan is to force every American to have health insurance—in other words, to make every American a customer of the insurance industry.

    Every libertarian and free-market conservative who still believes that large corporations are trusted allies in the battle for economic liberty needs to read Obamanomics, as does every well-meaning liberal who believes that expansions of the welfare-regulatory state are done to benefit the common people.

    Sincerely,

    Congressman Ron Paul"

  • Report this Comment On December 05, 2009, at 2:51 PM, sedgefish wrote:

    the fact is that we have allocation of medical resouces right now, only the insurance companies do it, by denying coverage for pre existing conditions, denying policies to those with detailed medical histories, and denying coverage for expensive drugs. since costs are not going to be reduced without allocation of resources, the government is likely to be a fairer siystem albeit not without problems along the way which will have to give us the experience to build on.

  • Report this Comment On December 05, 2009, at 4:42 PM, camerapro wrote:

    America spends more than double what most other industrialized nations spend on medical coverage and the government's answer is to spend even more money?

  • Report this Comment On December 05, 2009, at 5:18 PM, MrsCathyGF wrote:

    So, why do we spend billions of tax dollars funding medical research at NIH, and a host of public and private universities ? All that money goes into drug development for the greater good. If the gov't starts denying drugs, not only will it deny us care, it will decimate the medical research AND DRUG DEVELOPMENT industry, which, by the way, fuels drug development all over THE GLOBE. As it stands now, Congress and millions of Federal workers enjoy the FEHBP, a consumer-driven, market-based, world's largest group healthcare plan,where they can choose from 100s of private plans, with many options to choose from. They are trying to stick the american people with a hugely subpar, rationed, restrictive plan, opposite of what they have enjoyed for about 50 years. They are ALL ABOUT keeping us down, and in control, make no mistake.

  • Report this Comment On December 05, 2009, at 7:20 PM, tomfool00 wrote:

    I am amazed at the shock, I tell you, shock, voiced at the idea of government involvement in the medical care marketplace. Certainly the insurance companies now would never think of denying any care based on cost. And they would never mandate less expensive procedures rather than the one prescribed as effective by my own physician. Oh wait, that already happens on a regular basis. So explain to me again how a public option means the end of Western civilization as we know it?!

    What I DO agree with is that we should have access to the same choices offered members of congress - for the same pricing. If that's deemed too expensive for us, then they also should become part of the public marketplace so beloved by some.

  • Report this Comment On December 05, 2009, at 11:50 PM, mfscheer wrote:

    As a physician, I have to respond to the article and to some of the postings. The basic point of the article is that a public health option will evolve into something more and that is absolutely correct. It makes some points about the rationing of care and that will also be correct. Some of the postings talk about current "successful" government programs and the fact that private health insurers are in it for the profit and one even mistakenly indicates that the new goverment task force recommendations indicate that women under the age of 40 should not get mammograms when they either meant age 50 or don't know what the recommendations are. These recommendations are important for two reasons; they are suspicious because they essentially refute the same task force's recommendation from 2002 using the same data and they are government sponsored. It is very easy to see how a "public health option" could adopt these recommendations as guidelines and then refuse to cover the service in order to save money. This would be a rationing of preventive care and thus far I have found only one entity that agrees with the task force recommendations and this is headed by a women MD, MBA in southern CA who has made some outrageous claims as fact.

    I have no problem with health insurance reform but would prefer that the reform come from the medical field and not politicians. Now I will tell you why the public option is a bad idea for America. Despite how some feel about Medicare, it is currently successful to a point but it will be bankrupt in the near future and that is not successful. Medicaid on the other hand is an abject failure and I fear that a public option would mirror Medicaid. Remember the main point of the article is what the public option will become. I disagree with the comment that only 4 million of the 46 million uninsured would end up on this plan, I think it will be much higher, but it will soon evolve into a plan that covers 100-150 million patients because it will be either the cheapest option for individuals and corporations will choose not to pay for health care with the understanding that their employees can acquire coverage under the public option and the fines assessed will cost less to the corporation than insurance premiums. This is when the real problem will occur because the public health plan will fail unless there is a huge tax increase or there is huge rationing of health care both preventive and treatment. Additionally and I want everyone reading this to remember, there is no legal recourse for patients who are either denied care or receive suboptimal care from a public option. You will not be able to sue the federal government! when they deny coverage for cancer treatment or intensive care or for refusing to cover a mammogram for a woman in her 40's who develops cancer. There have been numerous class action suits against insurers for denying coverage with massive verdicts but this is not possible with a public option. This is one of the many reasons that the current health care reform legislation will be a complete failure and needs to be redone from square one. The main goals of reform are to cut costs and to insure those uninsured. Unfortunately, as currently written, it will do neither. Costs will rise exorbitantly AND although there may be less uninsured, there will be 100-150 million who are underinsured just as those currently covered by Medicaid are underinsured.

  • Report this Comment On December 06, 2009, at 9:40 AM, exeter17 wrote:

    Granted, the drug doesn't cure liver cancer, but it does extend patients' lives by at least three months. I've always wondered what a month of my life was worth; according to NICE, it's less than $5,000.

    ________

    Then you should pay that out of pocket. I don't like killing people off but that $5,000 a month would feed and clothe a lot of babies that could grow up and cure cancer. They could end up being a drain on society but thats a risk you take either way.

  • Report this Comment On December 06, 2009, at 4:11 PM, foolishfoolhead1 wrote:

    A lot of people are concerned about a public option denying to cover things, mammograms for women under 50, for example. What they don't realize is that there will still be private insurers that cover those things. Even if the public option is cheaper, people can still get the coverage they want by going to private insurers.

    The only way there will be a "government takeover" is if the public option provides the same quality of healthcare. If it doesn't offer the same quality, people will go to private insurers. But if it can offer quality healthcare at a lower cost, what are you complaining about?

  • Report this Comment On December 06, 2009, at 8:55 PM, flip4mac wrote:

    It is interesting that as a physician I worry more that a government pubic health plan, will not limit care, and do no UR or cost evaluations. And I do want to make one comment about what Medicaid , at least in California does right. I also want to make a few comments about the most important Public health plan Medicare, and what needs to be done to save it.

    In the Wall Street Journals front-page story of June 24th 2005 it noted that some states are going after the estates of Medicaid recipients to recoup their costs. While the Medicaid program is for the cash poor and destitute , with housing inflation from prior years, the irony is that many of these people die wealthy. It seems only fair the estate pay back if able, some if not all. California, were housing values are high, seems to be the leader, recouping tens of millions of dollars yearly. Maybe in this light, the federal government needs to rethink the Medicare entitlement.

    But first lets talk money. Is Medicare broke?

    The present value of the Social Security shortfall is about $5 trillion -- roughly equal to today's national debt . Thats a lot of money, but now lets look at Medicare.

    The present value of the Medicare shortfall is about $30 trillion." Actually several years ago it was estimated to be 37 trillion and that was before the Medicare Part D drug benefit. That’s the conclusion of work by Jagadeesh Gokhale, a senior fellow at the Cato Institute and former economic advisor to the Cleveland Federal Reserve, and Kent Smetters, an economist at Pennsylvania University’s Wharton School of Business. See WSJ article Oct 15, 2004

    So what can be done ?

    The primary issues facing the escalating costs of Medicare is that program has insulated the patients from the costs of the care, and a significant portion of the program is spent on futile treatments in the last few months of life.. With the Schivo case, it is painfully clear that politicians are unable to limit care , no matter how futile, or what the prognosis of the patient is.

    I propose that every Medicare patient would have an account. The money that the individual paid in to Medicare, would be subtracted from the money the Government spends via Medicare, to care for that individual. When the individual dies, some percentage of any negative balances ( and essentially all would be negative) would become a lean on the person's estate. It the person had no estate , the balance would be written off.

    As a teenage working in my Uncle’s Auto Parts store, a man ran into the shop yelling for a fire extinguisher as his motorcycle was on fire. As my brother handed him the extinguisher from the wall, my Uncle inform the man he would need to pay the $20 to refill the canister. The man ran outside, and a few minutes later came back. He never used the extinguisher, noting that as he looked at the heap on fire, he realized it wasn’t worth $20 and he just let it burn. As my uncle put back the fire extinguisher, he softly said in my direction, “ If its not worth it to him, its not worth it to me. “ It was a lesson I vividly remember .

    25 yrs later as a physician I was caring for an elderly man who had a severe stroke. He was unable to swallow safely, His wife gave me permission to place a G tube for feeding , with the promise that the feeding could be stopped , if his condition did not improve. After 3 months she called me , and we agreed as promised that the “ forced feedings “ would be stopped, as his condition was unchanged. I agreed to change him to oral feedings as tolerated, with the expectation that he would be unable to maintain his nutritional status and would not survive more than a few weeks. As I wrote the order at the rest home the nurse asked me if I knew why now the wife wanted to stop the feedings. I informed her “ she realizes he is not improving and his quality of life is very low “. She informed me that while that was true, he had finished his 100 days of Medicare coverage, and now she was paying for his feedings and some of his care. As I sat there thinking about what she said, I felt OK with the issue. The wife now needed to make a decision because she was financially being affected . She had to confront the reality of her husbands condition , the benefits vs. the costs of continuing his care, , and her decision was appropriate. It was a repeat of the first lesson; it just wasn’t worth the costs to continue keeping her husband alive in his present state. .

    We need to place back the responsibility of the cost effectiveness of care back to the patient and their families . I can think of no program that would do this better than to have private accounts with many possible types of variations with the patient knowing their estate was at risk. .

    Nothing else in the Medicare program need change. Immediately patients would be evaluating the costs of their care, asking more definitive questions, stopping duplication of services, and asking for a cost benefit analysis. Instead of patients reading the Internet for what can be done, they would be reading articles on cost effective care. . Medicare fraud would almost immediately stop, as patients would be monitoring costs closely. As an interesting aside, the Government. would have a vested interest in trying to get all Americans out of poverty, and into homes, so that everyone would have a valuable estate.

    We need to realize that it’s unfair for someone making pizzas for minimal wage to pay the medical bills for someone, so that their children can inherit a million dollar estate intact.

    Ultimately we need to come to the realization, that if its not worth it to the patient , its not worth it to anyone.

  • Report this Comment On December 06, 2009, at 11:21 PM, plopg wrote:

    Sooner or later, there will be a company offering service sending a plane load of sick people to be treated in China or any other third world countries. Since it would be cheaper as WalMart did. Why can't they apply the same cost/benefit as any other service/product. I took the same template of greed that cause upheaval in the US financial system. Anyone is for God's insurance?

  • Report this Comment On December 07, 2009, at 9:57 AM, frabis wrote:

    To those who oppose a public option, much less a single-payer government plan, I've never understood why the whole area of health care should be seen as a necessarily profit-driven area in the first place. Is law enforcement? Is firefighting? In fact, what about one of the largest costs to me, public education? I live in an area with one of the highest property tax rates in the country and much of this goes to the local school district. I have never had kids and have no intention of having any - yet I pay the same taxes as my neighbor with the identical house who's got four kids in the public school system. Do I have the option of opting out? Nope. It's not inherently fair but it's the way we've designed our society. In this country, free public education - for all its many deficiencies - is something we take for granted. It's considered a societal good from which we all ultimately benefit and in whose cost we all share. Why should we not think of health care in the same way?

  • Report this Comment On December 07, 2009, at 10:15 AM, hellbound1 wrote:

    The real problem with public health care in the future or now with medicaid is there is no accountability. No tort reform such as you can not sue for emergent medical or surgical care and you still have the expensive and unnecessary tests being ordered. You can not have 12 children if you don't have the means for paying for them. These patients show up to the ER rather than a family doctor just because they can... and we the tax payers pay for it... then to expand that to cover 46 million more people??? Not to mention STD tests which can be done at the health department for free (they have the medications there already paid for) but show up to the ER and a $600 visit later we the tax payers front the bill. No one is keeping this in check. Bring your child to the ER for a check up or sore throat without a fever on a weekday when the doctor's office has "sick visit hours" once again no accountability. That's not counting the ambulance rides many of these patients take for non-emergent care. $750 for the ride and $500 to $1000 for the ER visit. No prenatal care, show up to the ER, get your ultra sound, just say you have abdominal pain or bleeding. Don't take a pregnancy test from the dollar store, take an ambulance.

    There needs to be a line drawn in the sand other than blame the doctors who are threatened to be sued and have their malpractice sky rocket. Or end up in the national practioner data base a few too many times and be un-employable. Where is the President on this issue??? He goes to the Cleveland Clinic, he should have gone to East Cleveland instead to see what happens in the Urban hospitals and the atrocities we pay for... No home work will create more deficit, more over crowding, and less quality care.

  • Report this Comment On December 07, 2009, at 4:19 PM, rweiler1023 wrote:

    People need to understand that Orelli doesn't much care if people get the medical treatment they need as long as the system maximizes profits for health care companies. The current US system from that point of view is nearly perfect. An effective public plan would reduce profits, so Orelli is against it.

  • Report this Comment On December 13, 2009, at 2:08 PM, Trustearner wrote:

    Obviously what seems important to one fool is different from what seems important to another. This to anyone else out there who thinks the following are important:

    1. The problems with health care in the U. S. are not just philosophical or axiomatic. They are problems of real people whose problems are absorbed into the "systems" of governance and economics, whether any of us like it or not. For example, when a homeless person goes into an emergency room of a hospital with an infected ingrown toe nail, he or she cannot be turned away for reasons of both raw humanity and laws growing out of raw humanity. And, although that could be handled by a GP in an office, it could if untreated result in further complications and even death in some cases. So highly skilled emergency personnel handle it, and the cost is "absorbed" by way of increasing the costs to patients throughout the hospital whe CAN pay.

    2. One of the things any wise and practical public health plan SHOULD do is prevent gouging the sick. That is, it does not seem right to me, at least, that because someone is injured or ill that he or she should be pauperized in order for those who treat him to become millionairs. Somewhere there is bound to be a reasonable limit to just how grandly can live any one man or woman who has a veritable unlimited license to live grandly as a result of a take-it-or-leave-it approach to billing that is tantamount to, "Your money or your life."

    (And, hey, I've got doctors I know and love as friends and family, so don't think I'm saying doctors who study and work more than the average person does do not deserve to live better than many on account of that. I'm talking reasonably.)

    3. Standing on its own feet the RISK of some patients gaming the system by, say, showing up at their doctor's office every day, that, too, would be unreasonable. NO health care system that solves problems whould be set up in such a way as to be GAMED or GOUGED by anyone, not a doctor, not a hospital, and not a patient.

    4. How hard is it, for crying out loud, to justify saying, "Mrs. Citizen, if you want a breast exam every six months, you can pay for it yourself. But, we will pay for them after you are fifty, OR, if there are grounds to qualify you as being high-risk (as, for example, if several of her female relatives have developed breast cancer).

    Exceptions for reasonable cause should not be hard to justify. But the point here is that any hypochondriac who can afford it can go to ten doctors a day (if they will see him or her) so long as he/she self-pays.

    5. Debate is GOOD! Putting limits on things that most reasonable people would comprehend and agree with is GOOD! Making exceptions on some limits for people who have special needs is GOOD!

    So, my question is, "Why do we have to hear so much extremism and talk of slippery slopes, when intelligent, reasonable rules can be made by intelligent, reasonable people.

    Do we say that no person should be allowed to lie down on a sidewalk if he has a heart attack, or gets struck down by a speeding automobile because that opens up a slippery slope that could lead to EVERYBODY lying down on the sidewalk? I know. I know. That's absurd, isn't it. But isn't it alse sort of absurd to suppose that an intelligent, reasonable, properly-informed public and doctors and hospitals and insurance companies and

    POLITICAL PARTY EXTREMISTS cannot stop accusing one another of causing the sky to fall, and deal with issues and sub-issues (such as the vital need for dealing with real problems in a realistic way) instead of

    one's trying to shout down the other, or obstruct any progress toward any solution to anything?

    Jimminy Christmas, folks! Doesn't it ever occur to some of us that we have these wonderful brains to COPE with problems, rather than try to prevent one another from doing so as if we all had good sense?

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