We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
Our Recent Essays Behind the Front Page
Tuesday, March 10. 2009
George Bernard Shaw warned “Beware of false knowledge; it is more dangerous than ignorance.” The major overhaul of American health care pursued by President Obama and his supporters is based on many false premises and is excessive and likely to do more harm than good. Tuning up and improvements already always dynamically occurs. Instead, ObamaCare is aimed at dramatically changing one-sixth of the US economy in ways that are untested or tested and found wanting, primarily involving huge increases in government direction of health care.
The details of ObamaCare are largely being left to Congress, the same body that stuffs the federal budget with earmarks, waste, and other programs that are not requested. ObamaCare is premised on claims for drastic changes in health care and major increases in government programs being necessary. Those claims are largely specious.
Below the fold, the top ten specious premises for ObamaCare are discussed:
1. Comparing US Health Care To Other Developed Countries
(More could be added, such as that government restraints on prescription drug prices will not impede incentives for innovations, but they are so transparently false that the list below dwells on other ObamaCare premises more misleading.)
1. Comparing US Health Care To Other Developed Countries: Those pushing for government-run health care are fond of comparing the US unfavorably to other developed countries with heavier government-run or directed systems. Actually, the US is more successful on comparative costs, efficiency of resource use, and outcome.
Typical of misleading statistics, a US advocate of government-run health care touts a report from the Organization for Economic Cooperation and Development (OECD), comprised of the 30 most developed economies, favoring universal coverage as exists in most of the other OECD countries. The OECD report is actually titled a “working paper” by the three researchers. The encyclopedia defines a “working paper” as “a document created as a basis for discussion rather than as an authoritative text.” This OECD “working paper’s” statistics are misleading.
More accurately, a January 2009 analysis of the data gathered from the OECD points at life expectancy as the single best measure of outcomes. Excluding deaths by injury, to focus on health related outcome, “the US does the best of all the OECD countries” having the longest life expectancy.
Even the OECD “working paper” has to admit that the US’ higher infant mortality rate is misleading: “Even if there were uniform reporting standards of infant mortality across countries, a second limitation to using it as an indicator for health outcomes is the potential effect of certain interventions on the likelihood of a live birth. It is conceivable that additional health care provided in the second or third trimester causes a pregnancy that would almost assuredly be a stillborn to become a pregnancy with an improved chance of a live birth but also an above-average likelihood of dying within the first year. These interventions increase health care expenditures and result in the birth of more low-weight- and very low-weight babies, with significantly greater health problems.” The “working paper” does not address the moral issues or that most such babies go on to productive lives: “43% of children had survived without any impairment. Minor impairment was diagnosed in 39% and major impairment in 18% of assessed children.”
This OECD analysis also corrects per capita health spending to use price parity (comparative purchasing power) instead of oscillating currency exchange rates. The decline of the dollar compared to the Euro in the past decade did not increase the US’ comparative costs per person by 55%. In fact, other OECD countries’ health spending is understated by 56%, and “the US is no longer the highest [spending] country. France and Norway exceed the US in real health care consumption.” Still, other OECD countries’ spending on health care is lower than in the US.
The OECD analysis accounts for this, “because many health care systems use price controls to some extent….that systematically understate the economic cost of the health care system. The first is the hidden cost of nonprice rationing, while the second is the hidden cost of informal, black market co-payments.” Long waits, reduced access to advanced drugs and treatments, shifting development costs on to US consumers, traveling abroad for care, untracked side payments to providers are among the hidden costs.
The “working paper” admits that high US tort rewards drive up US health care costs via defensive medicine. “[P]rofessional liability reforms do indeed reduce the practice of defensive medicine.” Defensive medicine increases US health care costs by about 10%. Lawyers lead all groups in political contributions. In 2000, 86% of contributions from tort lawyers went to Democrats, one periodical calling them the “Cash Bar” for Democrats.”
In 2008 the percentage was 95%. ObamaCare proposals do not include tort reforms. Another health care result: malpractice premiums are two to three times higher for gynecologists delivering babies, leading many to cease, and the resulting medical care is lessened.
Finally, the OECD analysis measures the personnel inputs to health care, finding “it is clear that the US health care system is not a particularly high user of health care resources….the US resource use is 6th of 12, slightly below the mean.” The higher pay for doctors and nurses in the US “creates a large bias towards inaccurately portraying the US system as inefficient in producing health with health care resources,” and further ignores the US attracting its own and the best providers from other countries to benefit US health care.
2. US Health Care Spending Is More Than We Can Afford: As it has become more evidenced that the US does not compare unfavorably, the push for heavier government involvement has shifted toward saying we can’t afford the current and future costs. The affordability claim is exaggerated. We can afford more than previously, have chosen to, and benefited.
Our ability has greatly increased to pay for and enjoy a higher standard of living, allowing a shift in priorities. From 1901 to 2003, the percentage of personal expenditures on the necessities of food, clothing and housing declined by half from 79.8% to 50.1%, while the quality and amount has increased. Home ownership increased from 19.1% to 67%. Other personal discretionary spending was able to increase from 20.2% to 49.9%, including all the modern conveniences and pleasures. Voluntary sharing of the bounty has also increased as the percent given to charities has doubled. Personal spending for health care increased from about 2% to almost 5%. Although some may be pressed to spend on health care, the overwhelming majority can and do.
The US’s per person Gross Domestic Product (GDP) is 5.4 times larger in 2008 than 1929 and disposable personal income 6.7 times larger, in inflation adjusted dollars, according to the US Commerce Department’s Bureau of Economic Analysis. The share of GDP spent on personal consumption has decreased from 74.7% to 70.5% during that time. Defense spending went from 9/10ths of a percent of GDP in 1929 to over 40% during World War II, in the teens during the 1950”s declining to about 6.6% by the end of the Cold War, further dropping to 3.8% prior to 9/11/2001 and rising to 5.2% in 2008. Nondefense federal and state and local spending has near doubled from 8.2% in 1929 to 12.7% of GDP in 1966’ Great Society expansion to an even larger 15.1% in 2008 and climbing rapidly under the Obama administration.
The Share of GDP spent on health care, per the US Department of Health and Human Services, has nearly tripled from 5.2% in 1960 to 16.2% of GDP in 2007. The primary cost driver is new technologies. The government share of that has almost doubled to 46.2% from 24.7%. By 2018, it is projected to rise to 20.3%.
This primarily reflects the increased spending by government on added coverage for more, and the vast improvements enjoyed by all from new drugs, technologies and treatments delivering significantly better prevention, relief and cures. The main competitor for this spending is the further large expansion of other social programs favored by liberals. Inflation-adjusted government spending has increased by a multiple of 58 times since 1929, by over 5-fold since 1946, and is sharply escalating now.
3. Reform Overhaul Will Yield Major Savings: Price Waterhouse analyzed the primary cost drivers in health care. Leading the pack are new technologies, public demand for broader coverage and access, and defensive medicine. ObamaCare is not proposing restraints on lawsuits, tort lawyers being a major constituency. Health care consumers’ demands for fast access to the latest and best is not contradicted.
The Lewin Group is the leading consultants to government and private groups on health plan costs. Lewin says the two closest Congressional proposals to Obama’s stated design, from Senator Baucus and from Senators Wyden and Bennett, would increase National Health Expenditures, while dramatically increasing employer costs. It is reported that Senator Baucus is expected to be the “architect” of the emerging detailed plan, and the Wyden-Bennett proposal enjoys major support, the Obama administration saying it will hand off detailing to Congress.
Senator Baucus, reported to be the main “architect” of the emerging detailed ObamaCare, is already pressuring the Congressional Budget Office to be “creative,” otherwise known as cooking the books.
4. Increased Evidence-Based Medicine And Health Information Technology Will Significantly Improve Care and Reduce Costs: ObamaCare proposes major increases in the use of evidence-based medicine. There is a strong case for increased analyses of the effectiveness of alternative treatments to have more evidence-based (also called performance-based or comparative-effectiveness) medicine. The above Price Waterhouse report cites a study that estimates as much as 30% of health care spending is excessive due to overuse, misuse and waste. It cites another study that defensive medicine increases health care spending by 10%. However, if major benefits are to emerge, they will be very expensive to find, seriously troubling and possibly dangerous to administer, and a long time coming. We should move very carefully and not faddishly rush pell-mell into this sphere.
At the American Legislative Exchange Council of about 2000 legislative members in all 50 states and 80 in Congress, a lengthy analysis raises many caveats about evidence-based medicine. Not only will it not guard against frivolous lawsuits, laudable sounding evidence-based medicine is scientifically and statistically ill-defined and ill-definable when it comes to actual clinical practice and individual variations in needs and efficacies. Also, the “integrity of medical decisionmaking” is not protected, leading to “cookbook” medicine. Further, for a variety of largely irremovable reasons, “[i]n fact, ‘evidence-based’ research results can strongly contradict each other.” Lastly, there is very little such “gold standard” analyses available due their huge cost and time consumption.
In a February 2009 New York Times article by a leading specialist, who supports increased evidence-based medicine, she “began searching for clinical trials on pay-for-performance plans” finding “most disturbingly, very few high quality studies on efficacy. Looking for a few good studies, it turned out, was like searching for a needle in a massive haystack of social experimentation.”
Further, with good reason, there is considerable expectation that such evidence-based medicine, with all its weaknesses, is intended or will inevitably lead to rationing that may be as harmful to many’s health as it is beneficial to costs.
President Obama chose his Chief of Staff’s brother, Dr. Zeke Emanuel, to be counselor on health care costs and coverage to Obama’s budget director. In his former position at the National Institutes of Health, Dr. Emanuel told the Bloomberg interviewer he “focused on the ethics of conducting research and clinical trials as well as allocating medical resources – de facto rationing, he said.”
Dr. Robert Wachter, professor and Associate Chair of the UCSF’s Department of Medicine, Chief of Hospital Medicine at UCSF Medical Center, widely published peer reviewed author on quality, safety and health policy, wonders if “we are mature enough to make use of comparative effectiveness research?” He says, “I worry that we’re not.” He is critical of our excessive spending. But, his wide experience tells him, there’s “cautionary tales” from Britain’s efforts (typically in governmentese, acronymed NICE -- National Institute for Health and Clinical Excellence).
To me, NICE’s experience shows that rationing based on cost-effectiveness can be done, but we can count on it being about ten times harder in the United States (with our fragmented healthcare system, our sensationalist media, our hypertrophied legal system, and our tradition of individual benefit trumping the Good of the Commons) than it has been in the UK.
Dr. Wachter concludes with sheer hope, “But let’s not be naïve about it – one person’s ‘cost-ineffective’ procedure may be a provider’s mortgage payment, a manufacturer’s stock-levitator, and a patient’s last hope for survival.”
Without repeating the litanies of individual stories of critical health care denied in Britain, or elsewhere, by rationing, one need only recall Americans’ retreat from the far more lenient restrictions in our HMOs to be skeptical of the prospects for or outcomes from increased restrictions.
A close companion of evidence-based medicine is health information technology (HIT) to collect and carry individual’s records and tell providers the practices recommended or imposed. The promise is to reduce medical errors and costs. That promise seems remote.
The Obama ‘stimulus” bill included $20 billion to develop a national HIT system, with tens of billions more to be invested. In Britain, with a small fraction of our health care providers and facilities in a far less diverse health care system than ours, they’ve already spent over $18 billion, and it doesn’t work. It would not be unrealistic to expect US costs to well exceed $100 billion to reach a possible prototype.
There are advantages to a fully developed, interactive HIT. However, most medical providers will not reap rewards anywhere commensurate with the very high costs, requiring either far more government spending or imposed costs on providers driving up their expenses and charges. A few tightly controlled institutions, like Mayo and Kaiser, have expended great resources in developing highly customized HIT for themselves, but their utility or applicability to others is very limited. One of the key disadvantages of a national HIT is the increased ease with which rationing practice regimens can be imposed upon individual health care.
5. Present Administrative Costs And Insurer Profits Are Too High: The above Price Waterhouse analysis finds 86% of premiums being paid out for claims and an additional 5% for consumer services like prevention, wellness, care coordination, education, and information systems. Government compliance and reporting requirements cost another 6%. That leaves 3% for profits and reserves needed to generate added investments. Indeed, in 2008, Fortune Magazine’s compilation of industry profitability had health care insurance and managed care well behind some commonly assumed to have low profits such as railroads (12.4%). Discretionary entertainment (12.4%) is more profitable than necessary health insurance.
6. US Consumer Dissatisfaction Requires Drastic Health Care Changes: There are numerous polls with many Americans expressing dissatisfaction with the US health care system, usually asking general questions like “would you like to see major improvements.” However, more careful polling reveals quite the opposite in reality. For example, Gallup’s annual polls are summarized by Gallup thusly:
These ratings have been fairly stable in the seven years in which Gallup's Healthcare survey has been conducted. Similarly, votes on drastic overhauls have consistently lost. There is no public mandate for drastic health care changes.
7. Health Care Costs Are So High They Are A Major Cause Of Personal Bankruptcy: President Obama publicly claimed last week that “The cost of health care now causes a bankruptcy in America every thirty seconds." ABC News Director of Polling examined that claim and found it “simply unsupportable.” Examination of the basis for Obama’s claim and of other studies found the numbers vastly overstated.
The suspect Harvard research professor from whom Obama drew his claim cofounded an advocacy group to push for government-run, single-payer health care. Another professor with concerns for the impact of high medical costs on the uninsured says, “It stinks to be uninsured. I don’t want to be quoted saying anything else. But there are correct studies, and incorrect studies. For academics, the validity of the research methods matters.” It should for Presidents as well.
8. The Number Of Uninsured Is So Large That Drastic Health Care Changes Are Necessary: That about 16% in the US are uninsured is repeated as cause for universal coverage schemes to cover them that at the same time grossly changes the health care system and costs affecting the other 84%. Even if the other 84% were not negatively affected, the uninsured count is actually an overblown statistic.
The definition of uninsured includes all those lacking coverage any time in a year. Those lacking coverage for more than a year is 11%. The long term uninsured is primarily among working-age adults with low education.
The Kaiser Foundation offers a recent analysis of the uninsured. 19% can afford coverage but don’t purchase it. 25% are eligible for current programs but don’t enroll. That leaves 56% for whom affordability is considered too difficult, needing assistance. About 5 million, over 10%, of the uninsured are illegal immigrants, who tend to have low educations. About 19% of those needing assistance are illegal immigrants.
In short, less than half of those bemoaned as uninsured are legal residents in need of additional financial help. 16% becomes less than 8%. The negative impact of low-skilled illegal immigrants is most directly felt among low-skilled Americans, as a National Bureau of Economic Research analysis shows, low-wage competitors illegally in the US adding to low-wage/low-educated citizens’ difficulty in affording insurance.
Two related issues need addressing in updating the uninsured statistic. The large expansion of the federal SCHIP program just enacted will expand government coverage to more people and at higher incomes. Analysis shows that while reducing the number of uninsured, as many as 50% of those newly enrolled will be substituting previously affordable private insurance for low to no cost government coverage. Their taxpayer cost is larger than the entire present SCHIP program’s.
Another related issue is that some of the uninsured can afford coverage but are rejected for coverage or are priced out due to health conditions. The National Conference of State Legislatures offers useful information about these high risk, high care cost uninsureds. Over 200,000 are enrolled in state high risk pools, but there aren’t good numbers on how many more there are, which is surely much higher. The association of health insurers reports that about 11% of those applying for individual private insurance – by which there are about 25 million covered -- are rejected. About 11% of those offered policies is at above-standard premium rates. The insurers propose to cap surcharges at 50%. That may help some. For others, the 35 state high risk pools are frequently underfunded and have limited benefits. Some will be helped by the SCHIP expansion, but much more funding for high risk pools is needed. I guesstimate the annual cost at $12 billion (Double the average individual premium/cost of health care to $500/month and multiply by 2 million people.) Imposing this cost on private health plans through guaranteed enrollment will price others out of affordable coverage. It will also attract those who delay coverage until needing it, which imposes their costs on others and prices more out of coverage. Properly funding high risk pools will limit this coverage to those who more genuinely need it and not have the extra costs created by guaranteed enrollment for private plans.
9. More Preventive Care Will Better Serve Consumers And Save Costs: The February 2008 New England Journal of Medicine contains a review of 599 peer-reviewed articles between 2000-2005. The conclusion: “Studies have concluded that preventing illness can in some cases save money [and health] but in other cases can add to health care costs….[and] also sidesteps the question of whether such measures are generally more promising and efficient than the treatment of existing conditions.” The effectiveness of wellness programs is difficult to measure but are less costly than extensive additional testing of the population for rarely occurring illnesses. More early diagnosis uncovers some treatable illnesses but leads to more avoidable interventions, side effects, discomfort, and overuse of resources. Further, extended life health care costs are estimated to cost more, particularly for the aged.
Ironically, but consistent with a one-size-fits-all approach to health care, the Obama administration is eliminating subsidies to Medicare Advantage plans from private providers. Medicare Advantage plans offer additional benefits, care management and coordination. About 20% of Medicare enrollees have chosen Medicare Advantage plans, 57% of whom have incomes between $10-$30 thousand, 35% more of whom are minorities, and poorly provided rural area residents enrollment has increased over four-fold. A third as many Medicare Advantage members report delaying care due to costs as among traditional Medicare members. Aside from added benefits, Medicare Advantage members have lower out-of-pocket costs. The Congressional Budget Office estimates a savings of $157 billion over the next 10 years by eliminating this subsidy. Given the imminent financial collapse of Medicare, this economizing may be necessary, but given some of the other spending in Obama’s budget that may be seen as lower priority this subsidy may not be seen as high a priority to save from. Interestingly, AARP generally supports ObamaCare but its members benefit from and AARP profits from selling Medicare Advantage plans, so AARP is not in favor of this trimming.
10. Health Care Consumers Are Being Served By Drastic Health Care Changes: News reports of Obama administration health care parleys say that consumers are at the table. In fact, there are various interest groups each protecting the interests and costs of their members, usually at odds with each other. The interest groups’ before and behind curtain maneuvering is intense and complex, and much of what they’re telling the public misleading of intent or outcomes. Not nefarious in a free country, but each is angling to profit and enlarge from a bigger pie of spending. The only reliable measure of consumer preference is in general polling which, as shown above (point 6), has consumers not dissatisfied with their present arrangements.
ObamaCare's pseudo assumptions
As Bruce Kesler over at Maggie's Farm points out, ObamaCare is aimed at dramatically changing one-sixth of the US economy in ways that are untested or tested and found wanting, primarily involving huge increases in government direction of health care: The details of ObamaCare are largely being left to Congress, the same body that stuffs the federal budget with earmarks, waste, and other programs that are not requested. ObamaCare is premised on claims for drastic changes in health care and major increases in government programs being necessary. Those claims are largely specious.According to Bruce, the top ten specious premises for ObamaCare are:1. Comparing US Health Care To Other Developed Countries 2. US Health Care Spending Is More Than We Can Afford 3. Reform Overhaul Will...
Tracked: Mar 11, 10:43
Obama's health plans are based on false information
At Maggie's Farm, Bruce Kesler presents a detailed examination of the top ten reasons given why we need nationalized healthcare NOW. Those reasons are... Comparing US Health Care To Other Developed Countries US Health Care Spending Is More Than We...
Weblog: Public Secrets
Tracked: Mar 11, 12:17
Preparing for the "Healthcare Reform in the United States" Debate: Addendum
If you have not yet seen Bruce Kesler's guest post at Maggie's Farm discussing Healthcare Reform, please do so. Here is a small taste: Top Ten Reasons For ObamaCare Are Based On False Information George Bernard Shaw warned “Beware of...
Tracked: Mar 11, 20:59
Do the facts matter at all?
A wave of a fine cigar to all of the sites that linked with Bruce Kesler's excellent and well-researched post on ObamaCare here. Light one up for the cause of freedom and choice in medical treatment, with our thanks. We do want
Weblog: Maggie's Farm
Tracked: Mar 12, 10:10
Virginia, Severance & Section 1501
A major question is, what are the effects of the Virginia federal district court ruling that the individual mandate within ObamaCare (officially titled PPACA) is unconstitutional? For now, and even if the Virginia ruling is eventually sustained by the US
Weblog: Maggie's Farm
Tracked: Dec 13, 19:44
Display comments as (Linear | Threaded)
Alas, lawmakers in most countries are (like most people) prone to hear mostly the loudest voices about matters of which they are themselves not highly educated, and news media are even more likely to fail to do a great deal of research of matters beyond supplied press releases.
Tyhe results can be disastrous. One example is NYCity's proposed effort to have people limit themselves (with government "assistance") to 1500mg of salt per day, pushed by Mayor Bloomberg at the behest of his medical advisor. Even with my limited education, I can read the table[s] from other government sources, which clearly show that 1500mg/day is the minimum requirement for adults, not a maximum, but salt (sodium) is a "bad" thing so feel-good proposals outweigh science.
It would be nice if facts or some kind or cost/benefit analysis were actually in play as these periodic power grabs are initiated by the jokers in DC. Remember the Great Society? They actually ran ads to propagandize their good intentions. Urban Renewal, Public Housing, Medicare, The War on Poverty, expanding welfare, etc., etc. How many trillions down the drain? The president, we are told over and over, is very smart. History and economics are not his strong points.
Yes, facts are not especially relevant to this debate, which is political and, I agree, a power grab. But facts will always get you in the end...just like death.
11. All medical specialties are not equal (though they'd like you to think they are). Some 15-20% are of indisputable benefit (trauma care, for instance). Another 15-20% are of such dubious value that studies show not just your pocket book but your health suffer on average (illnesses with vague presenting symptoms, for example). The other 60-70%... if they were to simply disappear, neither our economy nor health would suffer on average.
12. Not all patients are the same. Kaiser, for example, segments its members into 6 groupings of roughly similar size. Three are deemed profitable, including one group that makes close to no demand on services. The other three are unprofitable, including two groups that make extreme demands more related to their ignorance or neediness than to greater health issues. How do you justify charging all for the unhelpful behaviors of some?
13. By and large, medicine wants health-care bureaucracy as a remedy against innovation. The great majority of services could be provided by personnel a rung or three down the training/cost ladder without compromising public health--indeed improving it by making treatment more available but less costly. But then the RNs and specialist docs would have to give up some of their lucrative gatekeeper role. Sure, most health centess have "bench to bedside" programs but with little to show for it, and almost no one is devoting creative thought to how to make care more readily available and less costly.
14. Demand-side solutions (rationing, e.g.) always make a problem worse in the long run.
Too many words, not one hottie picture. WTF?
I say on healthcare something similar to Will Ruggers
If you're healthy, enjoy life, if you're sick and get sicker you're probably going to die
Nice job, Mr. Kesler. In the last week, I've read two long magazine articles about this and your post is what summed it up and made sense. Thanks!
I detect Hillary's fine Italian hand in this mess. Bill and Hillary couldn't get this monstrosity passed during Bill's presidency, so they think the Rock Star can push it through. And if it gets passed, we'll all suffer. What a depressing month. And it isn't even over.
Care to hazard a guess what April's gonna be like? " April is the cruelest month, Breeding lilacs out of the dead land." Et cetera, et cetera.
I remember Hillary Clinton holding up her idea of a "health security card" as part of her attempt to convert our health care to a single payer (government run) system when I was a first year Optometry student. During those years, the rising cost of health care was a concern that played out in the media like a constant drum beat. Since those days, the marketplace seemed to find a "steady state" and we moved on to other concerns. Health Care costs as a destructive factor fell off the radar as our wealth increased concurrent with the increase in technology and costs. Certainly, health care is expensive here in the US, but it is the best in the world. The current system incentivises inovation and quality. Now, having forgotten the old panic we felt back then over healthcare induced financial meltdown, it seems like a strange dejavu to hear those old arguments surfacing again. The culprits of our current financial woes are well known. Health Care did not get us in this mess in any substantive way, and it doesn't threaten to make things worse in my estimation.
Given government's track record of fixing any private sector enterprise (is there a single shining example?) we should shun any attempt to nationalize our health care or the payment of it any more than we already have. The involvement government already enjoys in medicine via medicare and medicaid puts tremendous strain on the system. The weak attempt to gin up another crisis in the midst of the current bunch of crises (ie. the market meltdown, global warming) as an excuse for government to further conscript the current system out of our hands is deplorable. Our cowing to it is more than deplorable. It is inexcusable.
What we have to really get in our minds--really get it fixed, is this: there is no Obama there, there. What some of us knew before, because we have seen how the dems set up minority members to front for their issues--some of us knew last year that Obama was a speaker--not a leader. There is no there there!
But, just for fun to get an idea of how bad the institutions are coming apart take a look at this:
Anybody interested--qualifications not much.
Which reminds me. With regard to Hillary's little button she gave to the Russian:at first I thought that one of our people in the diplomatic core had set her up with a poor choice of words. But, after giving it some thought I realize that it was the Russian who was on top! Here's the reasoning: in most languages "re" means to do again, to do over, i.e. return, reconsider, etc. The verb "to charge" has several ways of being translated. I think the Russian was much quicker than MZ Hillary! God Help the little slavey in the state department who tried to choose the best Russian word for Hillary's big button theory!
#2 falls into precisely the same trap the feds, the AMA, pharmaceutical companies and all comprehensive health insurance companies want us to fall into.
The costs of health care goods and services - the vast majority of which is are commodities - have increased at multiple times the rate of inflation primarily for one reason: the proxy monopoly perpetuated by the so-called 'comprehensive' health insurance mechanism. Health care costs are no longer controlled by any recognizable economic mechanism.
The notion that we should be paying more for health care, and the laughable notion that we have 'benefited' ignores the practical reality and the facts. As health care costs have risen, quality of care has decreased overall.
The proper response to BHO's "argument" in #2 is simply to point out that pricing controls over health care are confounded by a broken, open-loop insurance system that propels increases in cost.
Turning such a broken system over to an even more broken federal government is insanity of the highest order.
We haven't had health insurance for about eight years. The companies where my husband has worked usually had so few employees that the cost of their health insurance was just too high - it was over $800/month at one. We have three kids ages 10, 8 and 4. Fortunately, we have generally been healthy. My husband lost his job due to downsizing about four years ago, and it took him a while to find another in his field. We almost lost the house, but didn't because he does freelance work on the side. He finally got a job, but at a lower salary. Even if his current company offered insurance - which they don't - we probably couldn't afford it, as it's a start-up and has very few employees.
Because he also does work on the side, we qualified at one time for an insurance for the self employed - which wasn't cheap. That was when we had our second child and found out that they treat pregnancy as an illness. We incurred quite a bit of debt for that, as they paid very little of the hospital bill (maybe 20%) and I had to have another C-section. Fortunately, our baby was healthy.
Lately, we have utilized the Health Department for immunizations and any illness that we might become concerned about. Don't get me wrong - I'm thankful for having the option of going to the Health Department. However, we never get to see a doctor, but always a nurse practitioner. I suppose that's fine for really bad colds and yearly exams. However, I don't think it's an improvement if everyone has Health-Department-like quality of care. You can't make appointments too far in advance, and you run the risk of all the appointments being taken when you do call. we've had to wait a long, long time in the waiting room.
I have learned something through all of this, though. When we first became parents, we took our daughter to the doctor for every little sniffle or cough. We had insurance. The co-pay for an office visit was $15, I believe. Cheap. (We didn't think about the premiums.) However, many times we went to the doctor and he didn't have to give any medicine, and she would have gotten better without going to the doctor at all. Fortunately, I'm a smarter and more confident parent now, but I cringe at the times I look back and see that I wasted our time and the doctor's time as well. This drives up the cost of health care and insurance premiums. That's part of the problem. We want our children to get better now - we expect it, in fact. We think taking them to the doctor will do the trick. I believe a lot of people do this.
The misuse of doctor's offices by people who have low or no co-pays. The misuse of emergency rooms by people who have ER coverage. People who use these services and have no insurance. Undocumented workers with fake SS numbers. This drives the cost of health care - and health coverage - up for everyone.
We have looked at different insurance policies and figured that even if every member of my family visited the doctor once a month for a year, it would still be cheaper than health insurance to pay out of pocket - so what's the point? There are policies just for "catastrophic" illnesses - and at some point I would like to get that for us.
Do I want nationalized health care? No way! The government messes up everything it tries to get involved in. There is already all kinds of Medicaid/Medicare fraud - can you imagine the amount of cheating that will go on once the government has control of all health care and they start pouring money we don't have into it? And don't try to hand me that line Obama does about how you'll be able to keep your current health coverage - that will last about a week, probably.
As a critical care RN I find BHO idea of healthcare very disturbing. As one who see's first hand treatment that would be per the goverment "cost ineffective" is actually a patients last chance at life. By following this reasoning my years spent as a paramedic prior to becoming a nurse, care for the multi-system major trauma patient would be considered cost ineffective. Since this person depending on the distance from a major trauma center would require at minimum one ambulance ride and multiple specialties to a bean counter in goverment it looks like a waste of money. One see's everyday patients that at the scene looked like they would not make it survive and be discharged. Yes, there is a cost but when you start putting a fixed price on a human life you head down the slope of euthenasia as practiced in the Netherlands, where if you have a adverse outcome during surgery they do not treat it unless you have expressed in writing that you wish adverse effects aka. "risks" of the surgery treated and even than that does not guarantee they will. In looking for cost savings will the american public allow the 911 to be abandoned? It is a service that operates at a loss. Yes it saves lives but if we are looking for cost effective as BHO states, it is not. Will we again allow the funeral industry to use the hearse as a ambulance and go back to the "you call, we haul" with little or no treatment or care rendered?
In order to truly reform healthcare and make it affordable we need to include tort reform. BHO will never allow this to happen since the ambulance chaser lawyers were a major donating part of his election funding. By enacting tort reform one could eliminate a large portion of CYA medicine practiced today. I see this everyday in the ICU, where tests and procedures are done to CYA the physician because if its not done some lawyer will sue everyone who has taken care of the patient stating that the caregivers were negligiant by not ordering this certain test.
Yes, I agree healthcare needs to be reformed but, let the free market do it without interference from the goverment and lawyers.
Barry Soetoro is a left-wing lawyer with virtually no experience in anything, yet like many "academics", he is filled with ideas on how to "improve" the nation.
Question: What percentage of Americans do not have health insurance? I believe it's around 15%. Who makes up that 15% and why?
Many people in that group are illegal aliens. Many others are Americans who have left one job and got another but the new company's insurance hasn't kicked in yet. Still others are people who choose to make more money instead of having health insurance.
Bottom line: Surely there are better ways to offer (not force) people to get health insurance. Centralized government control, which is favored by Barry is the worst solution.