The current cost for covering 45 million Medicare enrollees (including patients' portion) is estimated to be $484 billion in 2009. Since enrollees pay a 20% co-pay for most services, the total government-payout will be 80% of that total, or $387 billion for 2009. (This is consistent with the Treasury Department's $390 billion figure for Medicare-- http://www.kff.org/medicare/upload/7305-04... --for fiscal year 2008 in Table 9.) This total includes Parts A, B, C, & D.

If 45 million uninsured Americans were instantly given Medicare-type insurance, with 80% government funding, it would cost taxpayers no more than $387 billion, since the new patients would be younger and healthier. But $387 billion is a gross overestimation of the predicted cost, given the much smaller costs of covering healthier, under-65 year-old patients (as opposed to Medicare's sicker, predominantly over-65 patients).

Therefore even if the government were to pay the 80% share for a Medicare-type program, the costs would be nowhere near the $300 billion to $1,200 billion estimated by the government, which are based exclusively on the extensive subsidization of private insurance company premiums. The amount would be further reduced if there were extra premiums paid by those who voluntarily buy in.

According to the above estimates, it would be 3 to 6 times more expensive to taxpayers to enroll the uninsured in private insurance plans than it would be to extend Medicare to cover them, even if taxpayers paid entirely for this public option. Not only would the proposed amendment be a lot cheaper, it could be implemented immediately.

Because literally, in terms of voting records, Democrats and Republicans are almost two separate species. Following are graphs of the 2008 environmental records of the WA state legislature. Scores are voting records rated from 0-100% by the League of Conservation Voters.




House Dems: N = 66
AVG = 89.7
STDEV = 11.2
Range = 50-100

House Repubs = 38
AVG = 28.7
STDEV = 18.3
Range = 0 - 73

Numbers total more than 98 because six legislators did not serve a full term and were replaced.
Outliers defined as over 40% for Repubs (7) and under 40% for Dems (none).

Similar results for the Senate



Senate Dems: N = 32
AVG = 87.5
STDEV = 14.5
Range = 34-100

Senate Repubs = 17
AVG = 22.5
STDEV = 11.1
Range = 7-45
The one Dem outlier (under 40%) caucuses with Repubs. There are three Repub outliers (over 40%) representing purplish King County suburban areas.

I analyzed national ratings on issues important to retirees in 2005 similarly (no graphs)

House Dems: N = 201
AVG = 94.6
STDEV = 8.0
Minimum = 58

House Repubs = 222
AVG = 5.5
STDEV = 6.2
Maximum = 33

Senate Dems: N = 43
AVG = 93.3
STDEV = 10.5
Minimum = 52

Senate Repubs = 57
AVG = 8.0
STDEV = 11.5
Maximum = 69 (Jeffords)
Next after Jeffords - 35


And how many conservative Dems and liberal Repubs are there really? Counting as a conservative D someone with less than 85% rating and as a liberal R someone with more than 15%-- 7 liberal Repubs and 5 conservative Dems

Senate ConservaDems: N = 5
AVG = 71.6
STDEV = 13.0

Senate liberal Repubs = 7
AVG = 34.4 (minus Jeffords = 28.3)
STDEV = 16.5 (minus Jeffords = 6.5)

House ConservaDems: N = 19
AVG = 75.8
STDEV = 8.8

House liberal Repubs = 16
AVG = 22.2
STDEV = 4.6

So even the gap between the most liberal Repubs and the most conservative Dems is a chasm. The fly in the ointment is, of course, that when it comes to serving people rather than corporations or the military-industrial complex, the good stuff never gets out of committee. The Repubs, joined by a significant block (and even sometimes a slight majority) of Dems, block it. We are seeing this played out in health care, financial regulation and war appropriations right now. Still, much legislation, however timid, that does get out helps real people, or at least mitigates harm to same. And that is why I'm still a partisan Dem, despite of the health care and other fuckups.

At least according to the cheerleaders for the Pelosi health care bill. You are all right of course, in insisting that there are some things in this bill that are worth having. I just don't get the insistence that these things absolutely have to be tied to the forced purchase of a garbage product from private insurance thieves. It is exactly like insisting that expensive perfume MUST be dumped into a pile of used kitty litter instead of being kept in its own bottle. Or that you absolutely have to eat a poison ivy salad just because it's dressed with expensive balsamic vinegar.

Why not try to save only what's worth saving instead? I've read the numbered highlights that Pelosi put out, and have the following suggestions. (I've noticed that neither Pelosi nor any of the people hyping this press release have said a single thing about mandates, nor about the public option being more expensive and available to only 10%. I’m sure they are hoping that no one notices.)

Put all the useful parts of Medicare reform into one separate bill.
Include with 6-8 the Dicks/Inslee bill (Cantwell in the Senate) changing reimbursement to end the penalty against states which provide better results with less money now.



1. BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE — Reduces the donut hole by $500 and institutes a 50% discount on brand-name drugs, effective January 1, 2010.

Throw the above on the burn pile and start over. This is an area where incrementalism is witless. Pass one piece of legislation abolishing the entire donut hole starting now. And negotiate bulk prices with pharmaceutical companies while you are at it.

2. IMMEDIATE HELP FOR THE UNINSURED UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH-RISK POOL) — Creates a temporary insurance program until the Exchange is available for individuals who have been uninsured for several months or have been denied a policy because of pre-existing conditions.

Burn pile. A useless overpriced abortion, given that it would probably be like what high risk pools at the state level are now. Just let high risk people into Medicare early like we do with disabled people. Put the subsidy money into Medicare to take care of the extra expense.

Private insurance consumer reform bill. Another separate bill with 3, 4, 5 and 10



9. IMMEDIATE SUNSHINE ON PRICE GOUGING—Discourages excessive price increases by insurance companies through review and disclosure of insurance rate increases.

Burn pile-- useless tripe, not unlike Conyers' sternly worded letters to Rove et al chastising them for refusing to answer subpoenas. If we have to work through private insurance, just cut the crap and regulate what they can charge and what they must cover like every other civilized country with privately insured universal care does.

12. HELP FOR EARLY RETIREES—Creates a $10 billon fund to finance a temporary reinsurance program to help offset the costs of expensive health claims for employers that provide health benefits for retirees age 55-64.

Burn pile. Useless to retirees with no access to such benefits. Put the $10 billion into Medicare, and allow retirees in this age group to join, as Senator Rockefeller has already proposed. Direct benefits to retirees should trump benefits to employers.

Each of the following could be separate bills.

11. CREATES NEW, VOLUNTARY, PUBLIC LONG-TERM CARE INSURANCE PROGRAM—Creates a long-term care insurance program to be financed by voluntary payroll deductions to provide benefits to adults who become functionally disabled.

13. COMMUNITY HEALTH CENTERS—Increases funding for Community Health Centers to allow for a doubling of the number of patients seen by the centers over the next 5 years.

14. INCREASING NUMBER OF PRIMARY CARE DOCTORS — Provides new investment in training programs to increase the number of primary care doctors, nurses, and public health professionals.

That is because huge amounts of everyone's otherwise discretionary income will be diverted from buying real products to subsidize a totally unproductive part of the economy. The sociopaths who are really running the country don't even bother talking in terms of recession/recovery anymore. They are talking about a "reset." The language they like to use to refer to the future is "the new normal," which means far fewer jobs in general, more productivity for lower wages, greatly reduced consumer spending over the long term (because they don't intend to hire people if they can help it), increasing business in the BRIC (Brazil, Russia, India, China), and in general looking to accelerate the cheap labor race to the bottom. http://www.businessweek.com/globalbiz/cont...

What I will be required to pay will wipe out most of my discretionary income, and there are millions in the same situation. I know because I've used the Kaiser Family Foundation to calculate $450/month that still leaves me with 30% of medical expenses to pay.

We are talking 8-12% of income for premiums alone, not even counting co-pays and deductibles. This is an unmitigated disaster for an economy consisting of 70% consumer spending. The subsidies reducing the cost for those lower on the income scale will come from money that could have gone to the productive economy of rebuilding our infrastructure or creating new green collar jobs. And that is assuming that the subsidies don't get cut--the legislation says that they will if national deficit targets are not met.

Congress and the president seem almost to be from another planet when they talk about "affordable choices." To them it seems to mean that if income minus food minus rent/mortage/utilities minus transportation minus health insurance costs equals a number slightly greater than zero--VIOLA! Affordability! I'm not going to be homeless or starve, and may even be able to pay medical bills. I just won't be buying much else.

What this means for the economy at large is that more of the businesses dealing in non-essentials like bookstores, restaurants, etc. that I patronize are more likely to close. I have had to become more frugal during retirement, and that means we eat out once or twice a month, as opposed to once or twice a week when I was working. I'm letting magazine subscriptions run out and buying fewer books. Political donations have been cut in half. Already two restaurants where we used to eat have gone down. Elliott Bay Books will be moving from Pioneer Square, and is in serious financial trouble. This is a store that was founded during a major recession in 1973.

Wnen I start getting nailed for $450/month, plus the $60 for DH's Medicare Part B, a lot of things are going to end. Buying any books or magazines at all. Eating out. No online clothing shopping, just St. Vinnies and the like. Get rid of the CREDO cell phone. I might be able to spare $5 a year for DU, but no political contributions. No donations to Dem party organizations or candidates other than my volunteer time, not out of spite against Blue Dogs, but just because the money won't be there. Since DH is handy at electronics and programming, we'll probably stay connected to cyberspace, but if something craps out it will get repaired with stuff on hand or other people's cast-offs or we do without.

Multiply this by a few tens of millions for a picture of the "new normal" after insurance "reform." Still enthusiastic?

The traditional historians’ joke about the Holy Roman Empire is that it was neither holy, nor Roman, nor an empire. Once upon a time, the original framers of the public option proposal envisioned a plan that would be open to anybody, and very likely have more than 100 million enrolled—a really big and cheap risk pool which would drive prices down. All current legislative versions of the public option, unfortunately, are neither public nor options given that 95% of the public will not be allowed to take advantage of them. Our Democratic representatives have figured out by now that their base likes it whenever they act tough advocating a public option. Few of those people understand that the public option will most likely never be there for them. When they find out, I predict very serious political blowback.


Why are so many on the side of health care reform are more interested in the idea of a public option than the actual facts about the proposed real legislation? Probably because it is an automatic reflex response against the Republicans and insurance companies who don't like the idea, but please consider that they are taking this approach because it enables them to win no matter what happens. This is already becoming a close replay of 1993, when Clinton's bill, written in secret by big insurance companies at Jackson Hole, was attacked by Republicans and small insurers. Of course the big insurers didn't defend her and the legislation they had written—they preferred no reform at all, and the Clinton legislation was just a Plan B fallback in case it was forced on them. That is exactly what is going on in the current debate.

Of course the public likes the public option idea. After all, this is the same public that overwhelmingly wants government involvement in health care one way or another, whether a comprehensive single payer plan or just taking care of all the people who don't now have access to health care in some unspecified way.

But the facts on the ground are this. The public is going to absolutely hate any of the bills being considered if they are actually enacted. For one thing, we have two election cycles to go through before anyone sees anything at all happen in 2013, during which the victims of a jobless recovery are going to see health care in this country go further and further down the drain. Yes, I know that forbidding discrimination on the grounds of pre-existing conditions comes into effect immediately, but that has no practical significance as long as insurers are allowed to charge whatever they want for such policies.

Also, what people will experience instead is being forced under penalty of financial sanctions to spend 8-12% of their incomes to buy private insurance which at the basic level will only cover 70% of medical expenses. (Mandated private insurance in other countries using that approach is not only far cheaper, but also has minimal or no co-pays or deductibles.) They will still have insurance companies choosing their doctors and denying claims at will. Expenses will still be going up from an extremely high baseline, despite limits on the allowable percent increase per year. Those worried about deficit spending will be asking "We've gotten ourselves another trillion into national debt for THIS?"

Older people are going to hate the mandated age discrimination. Younger people are going to hate having to pay anything when most aren't going to see any benefits.

How to get around this while our legislators insist on incremental reform? Very simple—just make the Medicare program that exists right now open to anyone. If there is concern about a big rush to the door, open the door in increments, starting with early retirees over 55 and the unemployed of any age. No set-up time necessary, since Medicare is a working system right now. The result will be a visible and good-sized minority who will counter any insurance company lies about reform with a really big fact on the ground. If anyone is thinking "Don't let the perfect be the enemy of the good," let me just say this about that. In this case it's the existent that is the enemy of the non-existent.

Still, there will be problems even with an incremental approach that starts to pay off for people immediately. Clearly, those who volunteer to enroll in Medicare with be sicker, driving up costs without a commensurate input of funds. The cheapest and most efficient solution of all is still single payer Improved Medicare for All. If you are going to force everyone to pay into a health care system, why not the HR 676 system for $125/month instead of insurance “exchanges” for $400-$2000/month? The latter will wipe out large swathes of middle class discretionary income in return for nothing at all, not a good thing in an economy 70% dependent on consumer spending.

Most people would answer this by saying that they want to choose their doctor and make decisions about the kind of treatment they get. If you ask them if they enjoy trying to figure out which of dozens of insurance plans are both within budget and likely to actually reimburse them in the event of illness, you get a very different response. And of course with insurance provided by employers, there is often no choice offered at all other than turning it down. The very existence of thousands of private health insurers often eliminates the choice of practitioner entirely—you choose from their preferred provider pool or pay through the nose to go out of network. Even if you are lucky enough to develop an ongoing relationship with a doctor, it can be cancelled any time if your employer drops your plan, or even if the plan stays the same but the preferred provider list changes.

It is almost a general systems principle that eliminating or strictly limiting choices at the level of infrastructure is exactly what permits the largest variety of choices at the level of superstructure. It wouldn’t be possible at all to have the huge variety of electrical appliances we have today if manufacturers were allowed to make plugs any size and shape they felt like making them. I have yet to meet anyone who has felt oppressed by having only the choices of 110V or 220V for line voltage. Yet the congressional architects of current health care reform seem to think that offering a choice of insurance plans is far more important than choice of practitioner or treatment, yet it is those choices which are the very choices that private insurance limits or forbids entirely.

Good, useful choices: Lots of different electrical appliances: Your doctor, hospital and treatments

Bad, dysfunctional choices: Making outlets and plugs whatever size you want: Which hard to understand insurance plan you want to risk enrolling in

In addition to the systemic structural reasons for eliminating choice in health insurance plans, there is an ethical reason to do so as well. It makes me furious whenever anybody says that people ought to “be able to choose the plan that is best for their families.” This is one of the most morally and ethically vile things that anyone could ever say, because what they are really saying is that some people deserve good health care, and other people are relatively worthless sorts who do not. Families with more money are better than families with less money, who just ought to adjust to the greater odds that they may die or be bankrupted.

All current legislation describing an insurance "exchange" proposes having four different levels, each of which costs more and covers more. That includes the "public option" proposals as well. Every other developed country in the world, whether they achieve universal coverage with tightly regulated private insurance, outright government ownership of the health care system or the publicly funded privately delivered single payer system, provides a single standard of coverage for everyone with no exceptions. Co-pays and deductibles are far cheaper, if they exist at all. No age discrimination is allowed, in contrast to the proposed reforms which actually write such discrimination into law.

It’s certainly true that all these countries have multi-tiered health care in practice simply because the affluent buy extra bells and whistles for themselves over and above what the government either guarantees or provides to the general population. That is morally acceptable, because only after everyone’s basic health care needs have been met in a reasonably comprehensive way should "choice" should come into play in the area of health care. It's like Bill Gates being able to have an expensive sprinkler and fire alarm system that most people could never afford. That doesn’t matter as long as everyone gets the same fire engines in the event of fire. Why have our legislators written bills underpinned by the assumption that people with more money should have access to the health care equivalent of modern hook and ladder trucks and the rest of us should get something more like the horse-drawn wagons of a century ago? Only the cheapest plan would be eligible for subsidies.

According to the online calculator provided by the Kaiser Fountation(1), someone over 60 with a family income in the area of $40,000 be forced to pay $410-$450/month to get only 70% of expenses taken care of with the Basic Plan under HR 3200 (the best of the proposed reform packages). That includes both the allowable age discrimination and the offsetting subsidy. Under the single payer bill HR 676, individuals would all pay $125/adult/month regardless of age, and businesses would have a payroll tax of 8-10% above a certain (negotiable) threshold. (Note that businesses that self-insure generally are paying significantly more than that now). With the $325 savings per month, even someone at this modest income level could afford a choice of many self-financed gold-plated health care extras.

Conservatives, and Obama himself, say that raising taxes to pay for universal health care is unacceptable. Just how dim-witted does someone have to be in order to prefer a $450/month "premium" to a $125/month "tax"? There are probably a few sociopaths around who would cheerfully pay someone to saw off their dominant hand if the other half of the deal was that someone they hated got both hands sawn off, but how many of them could there actually be?

Why not force private health insurance into the business model now used by private life insurance? If you work, you must pay Social Security tax, and if you die before your dependents reach majority, they get Social Security survivors’ benefits. Despite this mandated government support of orphans with a single benefit level by all workers, a large variety of private life insurance plans are available because some parents want more income for their kids than Social Security provides. And buying such insurance takes not so much as one thin dime from the kids whose parents can’t afford that option.

Hey, Congress!!! I don’t want to “shop” for health insurance in any kind of “market”! I want to pay a tax to support a trust fund which pays for care when and if I need it, just like I pay my property tax to support the fire department. In the event of fire, they send a truck out. Just the truck and people with the training required to put out the fire. No more or no less than what I would need in that circumstance. No personal responsibility questionnaires to prove that I’ve taught my kids not to play with matches, that I have my wiring up to code, that I don’t store oily rags in the basement and am truly eligible for and deserving of assistance. And especially no tripling of my property tax just for using the service. There is not one single logical reason why a heart attack should not be treated (and paid for) like putting out a house fire. The cheapest and most efficient way to pay for health care is to pay for it like we pay for any other public good, like schools, roads, libraries, fire and police protection, or any other part of our society’s infrastructure.

(1)http://healthreform.kff.org/SubsidyCalcula...

Resources

http://www.healthcareforallwa.org /
http://www.pnhp.org /
http://www.1payer.net
http://www.healthcare-now.org
http://www.unitedforsinglepayer.org

--than the actual facts about it? Probably this is an automatic reflex response against the Repubs and insurance companies who don't like the idea, but please consider that they are taking this approach because it enables them to win no matter what happens. This is already a close replay of 1993, when Clinton's bill, written in secret by big insurance companies at Jackson Hole, was attacked by Republicans and small insurers. Of course the big insurers didn't defend her and the legislation they had written--they preferred no reform at all, and the Clinton legislation was just a fallback in case it was forced on them. This is exactly what is going on here.

Of course the public likes the public option idea. This is the same public that overwhelmingly wants government involvement in health care one way or another, whether a comprehensive single payer plan or just taking care of all the people who don't have access to health care in some other way.

Buthe facts on the ground are this. The public is going to absolutely hate any of the bills being considered if they are enacted. For one thing, we have two election cycles to go through before anyone sees anything at all happen in 2013, during which the victims of a jobless recovery are going to see health care in this country go further and further down the drain. Yes, I know that forbidding discrimination on the grounds of pre-existing conditions comes into effect immediately, but that has no practical significance as long as insurers are allowed to charge whatever they want for such policies.

For another thing, the public option is sort of like the Holy Roman Empire. It's neither public nor an option if 95% of the public is not allowed to take advantage of it. Our Dem representatives have figured out by now that their base likes it whenever they act tough advocating a public option. Few of those people understand that the public option will most likely never be for them. When they find out, I predict big political trouble.

And for another, what people will experience instead is being forced to spend 10-12% of their incomes to buy private insurance which at the basic level will only cover 70% of medical expenses. They will still have insurance companies choosing their doctors and denying claims at will. Those worried about deficit spending will be asking "We've gotten another trillino into national debt for THIS?"

Older people are going to hate the mandated age discrimination. Younger people are going to hate having to pay anything when most aren't going to see any benefits.

How to get around this while being stuck with incremental reform? Very simple--just make the Medicare program that exists right now open to anyone. If there is concern about a big rush to the door, open the door in increments, starting with early retirees over 65 and the unemployed of any age. No set-up time necessary. The result will be a visible and good-sized minority who will counter any Republican lies about reform with a really big fact on the ground.


Edit--oops! over 55!

Hard to tell at this point. If they ramp up the assholism, that may counter their advantage in attacking a health care bill with no visible benefits for anyone until 2013.

http://seattletimes.nwsource.com/html/opin...

Recall that with solid Democratic and Republican backing, the 2002 Iraq resolution was far more "bipartisan" than any health-care bill will ever be. Yet, Democrats turned right around and used the Iraq war to criticize Republicans — and because the conflict was so wildly unpopular, Americans in 2006 and 2008 were willing to overlook the contradiction and vote for the only major party echoing any semblance of an antiwar message.

The lesson, then, is simple: If Democrats hypocritical Iraq criticism only worked because the war was such a disaster, then the GOP's inevitable health-care attacks — however hypocritical — can be thwarted only by making health-care reform the opposite of Iraq (i.e., a major success). For Democrats, in other words, good health-care policy is great politics, and bad policy is the worst politics.

Whether passed by one congressional vote or 50, real reform that improves the system (i.e., a bill with a public option, tough insurance regulation and universal coverage) will transform the Democratic Party into an election-winning force forever known as "the generous protector of middle-class interests," as GOP strategist William Kristol admits.

Conversely, even if passed unanimously, bad legislation that makes the system worse (i.e., a bill empowering insurance companies, preventing a public option and leaving millions uncovered) will make GOP criticism of Democrats extremely effective.

Drawn by Roberta Gregory. See more of her stuff at http://www.robertagregory.com/index.html . She's fine with spreading it far and wide, and I mention her website every time I do.

Backstory: A CIGNA employee gave the finger -- literally -- to a woman whose daughter died after the insurance giant refused to cover her liver transplant.

http://www.huffingtonpost.com/2009/10/08/c...

--Opening Medicare to Retirees Over 55

WHEREAS people between the ages of 55 and 64 are being particularly hard hit by layoffs, involuntary early retirement and subsequent age discrimination when looking for new employment; and

WHEREAS Democrats will be campaigning for state and national public offices in 2010 and 2012; and

WHEREAS should a health care bill pass with no visible benefits for anyone until 2013, Democratic PCOs will be charged with the task of explaining through two election cycles why our health care system is still a major disaster for the unemployed and uninsured with continually escalating costs and decreasing benefits; and

WHEREAS Senator Jay Rockefeller (D-WV) has proposed an amendment to the Senate HELP bill to open Medicare to early retirees over age 55(1); and

WHEREAS a large and visible cohort of people undeniably benefiting from health care reform initiated by Democrats will benefit not only those people but also the political prospects of the Democratic Party; and

WHEREAS adoption of this amendment should once and for all spike the Republican lie that Democratic health care proposals will harm Medicare; and

WHEREAS an increase in the number of people benefiting from Medicare (a program which is so popular that even older demonstrators against health care reform are insisting that reformers should not mess with it) will create a demand for its further expansion;

THEREFORE BE IT RESOLVED that the 11th Legislative District Democrats ask that President Obama endorse and Senators Murray and Cantwell cosponsor and publicly advocate the Rockefeller amendment to expand Medicare to early retirees.

Copies of this resolution shall be sent to the King County Democrats Central Committee, the Washington State Democrats Central Committee, President Obama, Senator Harry Reid, Senators Murray and Cantwell, and State Senator Karen Keiser.

Submitted to the 11th Legislative District Democrats for consideration at the meeting of October 20, 2009.

Disposition:
Date:

_______________________________________________________________________
REFERENCES
(1)Rockefeller Amendment #C26 to Title I, Subtitle G (Role of Public Programs) to America's Healthy Future Act, p. 260. This amendment would add the option for early retirees between ages 55 and 64 to buy into Medicare using language consistent with the concepts included in the Medicare Early Access Act (S. 960).

This is one of the most morally and ethically vile things that anyone could ever say, because what it really means is that some people deserve good health care, and other people are disposable human garbage who do not. Families with more money are better than families with less money, who just ought to take the Repukes' advice and die quickly.

What is this horseshit about an "exchange" including four different levels, each of which costs more and covers more? That includes the so-called "public option" provisions. Every other goddam developed country in the world, whether they use the Bismarck model, the Beveridge model or the Douglas model requires a single standard of coverage for everyone, no exceptions. No age discrimination, or any other kind.

Still, all these countries have multi-tiered health care in practice simply because the affluent buy extra bells and whistles for themselves. That is actually fine by me, because that is the ONLY time when "choice" should come into play in the area of health care. It's like Bill Gates being able to have an expensive sprinkler and fire alarm system that I could never afford. I could care less as long as we both get the same fire engine in the event of fire. Our over-privileged representatives, including Obama, seem to think it's just fine that some should have access to modern hook and ladder trucks and the rest of us get the horse-drawn wagons of a century ago.

According to the calculator, I'd be forced to pay $450/monhth to get only 70% of my expenses taken care of with the Basic Plan. (That includes both the age discrimination and the offsetting subsidy I'd get.) Under HR 676, individuals would all pay $125/adult/month, and businesses would have a payroll tax of 8-10% above a certain (negotiable) threshold. Note that businesses that self-insure generally are paying more than that now. With the $325 extra a month, even someone on a modest retirement income like me could afford self-financed gold-plated health care extras if I wanted them.

How fucking sociopathic and stupid are our fellow citizens anyway? Would they really prefer a $450/month "premium" to a $125/month "tax"? I know that there are probably teabagger assholes out there who would cheerfully pay someone to saw off their dominant hand if the other half of the deal was that someone they hated got both hands sawn off, but how many of them could there actually be?

Are current health care reform proposals modeled after any of them?


The four basic methods of paying for health care are as follows.

The Bismarck model
 Created in 1880s by Otto von Bismarck in Germany
 Based on private, tightly regulated, insurance funds
 Mostly through employers
 Government pays for enrollment of the unemployed
 Germany, Switzerland, the Netherlands, France and Japan

The Beveridge model
 Britain’s National Health Service created by William Beveridge in the 1940s
 Government owns and operates the entire health care system
 General taxes pay all costs. No bills to patients
 Some private care, privately paid for – about 3% of total health care costs
 Great Britain, Italy, Spain, Scandinavia, Hong Kong

The Douglas model
 Tommy Douglas, Premier of Saskatchewan, got this program established in 1947 and 1961
 Tax-funded government payments for health care
 Nearly all doctors and some hospitals are private
 Canada, Taiwan, South Korea

You’re On Your Own, Baby! (YOYO)
 Third World model
 The vast majority of care paid for out-of-pocket (OOP)
 If you have money you get health care; if you don’t have money you don’t
 Rural regions of Africa, India, South Asia, China, South America

All other developed countries around the world focus on making one of the first three models provide the majority of health care. One of the reasons that our current non-system is such a mess is that we have all four systems in operation at the same time instead of focusing on just one. Our current employer-based insurance resembles the Bismarck model, except without the strong regulation of private insurance. We have the Beveridge model for the military, the VA and Indian health services. We have the Douglas model for people over 65 with Medicare. And then there are the large numbers of people staying in animal shelters on state fairgrounds to get free care offered by organizations that mostly operate in Third World countries, not to mention the 45,000 a year who die because they can’t pay for the care that would have saved them.

Currently, there are several versions of health care reform being considered by Congress originated by Democrats. (All Republican proposals are essentially YOYO, even though to a person they would insist on adding another trillion to the national debt to obliterate any foreign power that killed 45,000 Americans a year.) The Beveridge model is out except for those already served by it—no American progressive health care activists have ever proposed anything remotely resembling it.

Single payer (HR 676/HR1200/S703, the Douglas model) has been pushed “off the table.” Howard Dean (Democracy for America) and radio host Thom Hartmann have proposed an incremental implementation of this model, opening Medicare to voluntary enrollment by anyone, though only Senator Rockefeller has written actual legislation with a more restricted version of the proposal, opening voluntary enrollment in Medicare to early retirees between the ages of 55 and 64.(1) This particular type of incremental proposal is the only kind which will benefit anyone at all before 2013. (Actual current proposals will leave Democrats two full election cycles to explain to the public why their health care situations are continuing to go straight to hell.)

That leaves the Bismarck regulated private insurance model. Would any of the current national legislative proposals(2)(the Senate HELP bill, the Senate Finance committee bill, or the House combined bill HR 3200) result in a true Bismarck model system? Or could they at least be the start of an incremental approach to such a system?

The answer to the first question is clearly no. Countries like France, the Netherlands and Germany spend around $3000 per capita in US dollars compared to our $6000 per capita expenditure(3), and current proposals recommend spending up to a trillion dollars more over a ten-year period. They also recommend mandating the payment of an outrageous 10-12% of income for private insurance premiums alone, which would only cover 70% of actual health care costs to individuals and require co-pays as well. That these premiums would be subsidized for some means only that our national debt would be increased to line the pockets of insurance company CEOs instead of to create green jobs or rebuild our infrastructure.

The French pay 8% of their income for health care, which takes care of everything, with no deductibles and minimal co-pays. The Netherlands, which taxes employers to pay 50% of health care costs, requires mandated private insurance for the remainder costing 100 euros/month (~$140) per adult, with no co-pays or deductibles. Everyone gets the same standard of care regardless of age or employment status, in contrast to the four tier system proposed by our Congress, which is based on the principle that some people deserve good health care and other people whose lives are worth less do not. In addition, age discrimination is written in to all current legislation, with charging older people from two to five times as much as standard premiums allowed. (This is not to say that affluent people in countries using the Bismarck, Douglas or Beveridge health care models don’t buy a lot of extras for themselves—they do. But it’s on their own dime, and costs for good standard comprehensive care for everyone are low enough that they have plenty of extra dimes to use for that if they so choose.)

The costs to individuals in these Bismarck systems are very similar to what single payer systems proposed here would charge. HR 676 estimates $125/month/adult, and the Washington State single payer model originally proposed $75/month, more recently up to $100/month.(4) These approximate cost levels should serve as a basic standard to determine whether any health care reform proposal is acceptable. Clearly current proposals are not.

But could they become acceptable eventually if enacted? The answer could be yes if Congress ever develops the will to impose cost controls on insurance companies. France, Germany, the Netherlands, et al. impose cost controls which regulate what doctors, hospitals, pharmaceutical companies and insurers can charge for their services. Currently, Congress refuses to do that, and without a considerable amount of public pressure they are not going to change. And if Congress ever had the political will to really regulate insurance companies, it would also have the will to put single payer back on the table. Enacting current legislation as is and hoping for good behavior from insurance companies is nothing but a recipe for an ongoing disaster.

Thanks to Dr. Sherry Weinberg, Vice-President of Health Care for All—WA, for her description of the four basic models for health care financing. They were derived from the book The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care by T. R. Reid


Notes
(1)Rockefeller Amendment #C26 to Title I, Subtitle G (Role of Public Programs) to America’s Healthy Future Act, p.260
(2)http://www.kff.org/healthreform/upload/hea...
(3)http://www.infoplease.com/ipa/A0934556.htm...
(4)http://www.healthcareforallwa.org/health-s... /

If nothing passes, the Dems can correctly blame Republican obstructionism. The only incremental approach acceptable to me is allowing voluntary enrollment in Medicare, which could be implemented right away. This ought to be a slam dunk, given that Medicare is so popular that even elderly teabaggers don't want reformers messing with it.

www.michaelmunk.com
Is There Any Way Out for Obama?
By Leonard Rodberg , Chair, Urban Studies Department, Queens College/CUNY
VIA David Delk <davidafd {at} msn.com>

Progressives worry that, if Obama’s health reform plan (hereafter called the “Plan”) fails to pass, a latter-day right-wing Gingrich movement will take over the Congress in 2010 and the White House in 2012. What I have not heard, but what I am increasingly coming to believe, is that, if the Plan passes in any of its current forms, things will go just as badly for him! Why is that?

The general reason is that the Plan is a DOG. It is a terrible, complex plan that will accomplish almost nothing. Relatively few people will benefit from it, while everyone who has to use health care will continue to experience the mess that is, and will continue to be, the American health care system. And, because of the new requirements built into the Plan, health care finance will become even more complex and confusing.

More specifically:

1. The large majority of people, who receive their insurance from their employer, will see no benefit whatsoever from the Plan. Most will, in fact, find their premiums rising as new requirements imposed by the Plan (e.g., the elimination of lifetime limits) raise the cost of insurance. And, of course, to their undoubted surprise, most of them will not have access to the public option, even if there is one.

2. Most provisions of the Plan will not become effective until 2013. This gives four years for Republicans to criticize the Plan, including (1) its use of cuts in Medicare reimbursements and Medicare Advantage premiums as principal sources of funding, (2) its lack of any real or believable mechanism for containing costs, and (3) its bureaucratic complexity.

3. The taxes on high-cost insurance plans, the other principal source of funding, will cause those who now have good insurance (called, pejoratively, “Cadillac” plans) to find these plans heavily taxed and their employers given a strong incentive to cut back on their benefits. Instead of reducing underinsurance, this part of the Plan will increase it! (And the rest of the plan does little about underinsurance at all.)

4. During the four years of waiting for the Plan to take effect, costs will continue to rise. By the time the Plan takes effect, costs are likely to be at least 25% greater than now. Even more people will find insurance and health care unaffordable. People will ask “What was health reform about?” The disillusionment will be great.

5. The complexity of the plan, including (1) federal rules regarding what kinds of employer-based insurance plans are “qualified,” (2) new income tax forms that will be needed to implement the individual mandate, and (3) the process of determining income eligibility for everyone, will all lend themselves to criticism and even ridicule.

Is there a way out? Not, in my view, as long as Obama sticks with this worthless and unworkable Plan. Only if we were to adopt a much simpler plan that would benefit everyone — a Medicare for All plan — would he be seen as actually addressing the problem and really offering a workable solution. Short of that, he, and all of us, are in real trouble.

http://www.huffingtonpost.com/michael-moor...

Here are 13 problems with the current health care bills (partial list):

1. No cost controls on insurance companies. The coming sharp increases in premiums, deductibles, co-pays, co-insurance, etc. will quickly outpace any projected protections from caps on out-of-pocket costs.

2. Insurance companies will continue to be able to use marketing techniques to cherry-pick healthier, less costly enrollees.

3. No restrictions on insurance denials of care that insurers don't want to pay for. In case you missed it, the California Nurses Association/National Nurses Organizing Committee uncovered data on the California Department of Managed Care website recently that found six of the biggest California insurers rejected, on annual average, more than one-fifth of all claims every year since 2002.

4. No challenge to insurance company monopolies, especially in the top 94 metropolitan areas, where one or two companies dominate, severely limiting choice and competition.

5. A massive government bailout for the insurance industry through the combination of the individual mandate requiring everyone not covered to buy insurance, public subsidies which go for buying insurance, no regulation on what insurers can charge, and no restrictions on their ability to decide what claims to pay.

6. No controls on drug prices. The White House deal with Big Pharma, which won bipartisan approval in the Senate Finance Committee, opposes the use of government leverage to negotiate real cost controls on inflated drug prices.

7. No single standard of care. Our multi-tiered system remains with access to care still determined by ability to pay.

8. Tax on comprehensive insurance plans. That will encourage employers to reduce benefits, shift more costs to employees, promote proliferation of bare-bones, high-deductible plans, and lead to more self-rationing of care and medical bankruptcies.

9. Not universal. Some people will remain uncovered, including those exempted, and undocumented workers, denying them treatment, exposing everyone to communicable diseases and inflating health care costs.

10. No definition of covered benefits.

11. No protection for our public safety net. Public hospitals and clinics will continue to be under-funded and a dumping ground for those the private system doesn't want. Public monies going to hospitals serving low-income communities will be shifted to subsidies for private insurance.

12. Long delay in implementation. Many reforms don't go into effect until 2013.

13. Nothing changes in basic structure



Read more at: http://www.huffingtonpost.com/michael-moor...

That is because huge amounts of everyone's otherwise discretionary income will be diverted to totally useless intermediaries. We are talking 12% of income for premiums alone, not even counting co-pays and deductibles. This is an unmitigated disaster for an economy consisting of 70% consumer spending. The subsidies reducing the cost for those lower on the income scale will come from money that could have gone to rebuilding our infrastructure or creating new green collar jobs.

Certainly mandated private insurance might conceivably in theory be like that of the Netherlands, which has 100 euro/adult/month payments with NO copays, NO deductibles, AGE or any other kind of discrimination allowed. That, however, would depend on Congress mustering the political will to severely regulate insurance companies. But if we had that, then single payer would never have been off the table.