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Not perfect, but what legislation ever is? - Health Care Rx Panelists

Not perfect, but what legislation ever is?

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Unlike so many, I find myself being more impressed each time I delve into the new law. This is, ultimately, a piece of legislation that WILL achieve many stated and even unstated objectives:

1. It will extend the Medicare Part A trust fund for just long enough to allow BOTH sides to discuss meaningful reforms to make it truly sustainable.
2. It provides a real commitment to our nation's poor; and strengthens Medicaid at the same time. Here, too, there are opportunities for additional reforms, but this makes clear what our priorities are; and, importantly, demonstrates our national humanity and compassion for those less fortunate.
3. It dramatically reforms our understanding of and right to health insurance. We have never had a federal definition of health insurance and this begins that discussion in a meaningful way.
4. It is financially sustainable, as long as our elected officials do not undo the tax and revenue-generating items.

What do we need to wait for and hope for?
1. Tort reform and/or Malpractice reform. This should have been firmly part of this law, but will have to wait.
2. Sustainable Growth Rate legislative reform: This is universally recognized as necessary and putting it off, even for a few months, is a big disappointment.
3. Implementation of insurance regulation and insurance exchange regulation will be the first real tests of the success of the law.
4. Taking the Medicare savings and law changes as a first step; and not ignoring the very real legacy costs that we still have to address. AND working with the private (for-profit and not-for-profit) sector to develop a structure and process for improving the delivery of high-quality health care with consideration of cost.
5. Revisiting the notion of better patient education and not being scared off by hateful rhetoric. Discussions around end-of-life and compassionate care should not be politicized or used for pure political gain.

I remain very optimistic about this country and about seeing our elected officials, of both parties, come together around common goals and purposes. In the mean-time, I am proud of the many elected individuals (and their staffs) for having stood behind their promises and made this a reality.

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Positive effects, deep flaws - Health Care Rx Panelists

Positive effects, deep flaws

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The passage of the health insurance legislation has two overriding positive effects: it brings more clarity to the health insurance issue and it demonstrates the President's ability to govern.

The legislation also affirms that Americans should not face financial ruin from being unable to afford health insurance. It also makes good progress on prevention, on increasing the supply of health care professionals, on eliminating the flawed "doughnut hole" in the Medicare prescription drug system, and on beginning to address the long term care crisis. These are the good elements of this legislation.

As health insurance system restructuring, the legislation has deep flaws that must be addressed in subsequent legislation. We cannot guarantee coverage, prevent people from being subject to pre-existing condition exclusions, and prohibit insurers from canceling policies for those who become ill during the policy period without significantly increasing costs for all policyholders unless we cause healthy uninsured people to buy insurance, reduce what we pay health care providers, or levy more taxes on people to pay for increased subsidies.

The penalties for healthy people refusing to buy insurance are far too low and do not take effect for several years. Reducing payments to doctors and hospitals either drives them out of the system or causes them to drop Medicaid patients. Raising taxes on everyone to pay for these increased costs worsens our economic situation.

One situation illustrates my point: in the 8th Ward of Washington D.C., there is a severe shortage of specialists, including one urologist for a large population. Most people have health insurance or Medicaid. After this legislation passes, there will be even more people with insurance, but still a severe physician shortage. We have more work to do before our health care system is viable. Health insurance affordability does not produce health care access.

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Yeah, insurers are scapegoated. But tell me again why we have this industry? - Health Care Rx Panelists

Yeah, insurers are scapegoated. But tell me again why we have this industry?

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Insurers are a smaller part of the problem than Americans like to think. As far as I can tell, the whole supply side of the medical economy is happy for insurers to be the bad guy for defeating efforts that would increase the bargaining power of medical consumers. The Medicare buy-in and the public option would have passed both houses if insurers were the only political opponent. Patients are equally happy to blame insurers for our own refusal to acknowledge the need for reasonable constraints on medical service use.

Effective cost control requires painful measures that affect physicians, hospitals, pharmaceutical companies, device manufacturers -- not to mention patients. Most of these constituencies are more powerful, and probably contributes more to excess costs, than private insurers do.

Does this mean insurers are being treated unfairly?

Yes and no. Our collective desire to deny cost-control realities encourages a rather childish public debate. It's not insurers' fault that our society leaves poor people and sick people to the tender mercies of the insurance market. Regulating this industry--by itself--cannot address our most serious obstacles to universal coverage. Insurers are not the source, nor are they the potential solution to our worst cost control problems.

At the same time, the industry treats many people unfairly, and at times cruelly. Many of the industry's specific practices demand stringent regulation. More fundamentally, insurers face a special burden of proof because....well, there is no obvious reason for this industry to exist in its current form. Every other component in the medical economy creates tangible social value. Academic medical centers waste money, but they save many lives. Pharmaceutical companies like to overcharge, but they develop drugs that cure diseases and prolong life. I struggle to write a similar sentence about insurers, particularly those who compete through risk-selection in the small-group and individual markets.

I feel as if this debate has come full circle. More than two years ago, in my very first foray in the health insurance reform fight, I noted: "Increasingly, I and others scratch our heads to wonder: Why do we have this industry again?"


I don't believe private insurers are less ethical, as a whole, than soft drink manufacturers or manufacturers of plush carpet. I just can't explain what we are getting here....

Private insurers are too fragmented to promote needed efficiencies such as electronic medical records. A Chicago provider dealing with 20 payers is hardly swayed by the pay-for-performance standard of any one of them. In general, private payers are too fragmented to exert powerful market discipline on providers. The [history of Medicare Advantage] provides one of many embarrassments for those who assert the inherent superiority of the private sector.

Private insurers do have two advantages: They are more nimble than government is. More important, they can take the political heat for saying "no" when patients want some desirable but unjustified service, drug, or therapy. This is hard for government to do, and "no" should sometimes be said even when this is painful.

But maybe we have this backwards. It seems to me that even when insurers are justified in saying no... profit-making firms lack the legitimacy to deny anyone a desperately wanted treatment that provides some plausible benefit. Denying important treatments is an inherently political question. A transparent process, by financially disinterested parties, is required to secure public legitimacy.

If this is so, private insurers themselves have a strong stake in government assuming a larger role in scrutinizing costly therapies. And they have a strong stake in some larger regulatory structure to constrain the more predatory aspects of current market practice.

Two years later, these questions continue to puzzle me. I'm uncomfortable demonizing insurers when the ground rules of the individual and small-group market make the industry's excesses and cruelties almost inevitable. Like Jonathan Cohn, I do blame insurers for not openly acknowledging this fact. I also blame the industry for wielding its political muscle to oppose needed reforms.

I expect health reform to pass, which will curb the worst industry practices. Insurers should hope so. Because I stand by my final prediction of that piece:


Ironically, then, insurers themselves have a stake in the success of the Democrats' proposed health reforms. If health reform dies -- particularly if private insurers have their fingerprints on the murder weapon -- millions more Americans will stop scratching their heads and will support a single-payer plan.

2 Comments

perhaps what Mr Pollack needs is a dose of reality. Maybe a spending a few weeks away from the ivory tower would improve Mr Pollack's grip on reality.

There is much to agree with in the above essay, but Mr Pollack engages in a rhetorical slight of hand that is simply beneath someone of his academic credentials. He asks a question that he can't answer. This is a trick anyone can perform. Watch how it works: I struggle to find an answer to a basic question: why do we have underarm deodorant? I can see the social value of plain old soap, but what societal good does the stuff Mitchum sells offer?

See how easy that is? If Mr Pollack doesn't know what good the insurance companies provide he's simply ignorant of the lives most Americans live. Not all of us are noted, and no doubt tenured, professors. Some of us work hard to amass a small asset pool. For many of us that small nest egg is what we rely on for current comfort and future plans.

Insurance PROTECTS that small asset pool. Buying a health care insurance policy is a clever way of avoiding the need to part with a house or a savings account to obtain treatment for a dread diseases.

Again, were the good professor part of the work a day world, instead of living in his isolated convent, he might understand that insurance companies sell peace of mind to millions.

Sure, its easy to blame the insurers for not reforming the industry. But isn't that a bit like blaming GM for the bad roads in my city? Certainly the struts on my car would last longer if GM spent some of its enormous profits on paving the local streets!

I am by no means defending the insurance companies, I have to deal with many of their heinous practices every day. But without some type of transparency in how much things cost, there will never be reform. We also need electronic medical records so other doctors and hospitals know what has been done before and not repeat the same treatments that didn't work or the same tests that were performed by another doctor just hours ago.

When a doctor treats you for something, you have no idea if what he/she is doing is covered under your insurance. And neither does the doctor! What if you went into Sears to buy a new refrigerator and there were no prices on any of them. You pick the refrigerator you want and Sears slaps it on your credit card that you sign the receipt for, but still don't know the price. You go home, your refrigerator arrives and 3 weeks later, you get your credit card statement in the mail and find out the refrigerator cost $3000! Would anyone in their right mind buy a refrigerator this way? I hope not, but this is exactly how the healthcare system works. If you go in a hospital, you sign all this paperwork that you will be responsible for anything insurance doesn't pay and you have no clue how much that might be.

The only time I have seen anything remotely reasonable from heathcare is on maternity, and its done mostly to make sure the doctor gets paid. When a pregnant woman's condition is confirmed by the doctor, they set up a separate appointment with the insurance person from the doctor's office. They will actually break down all the costs, what your insurance will pay and how much its going to cost you. They will allow you to make payments up to delivery time.

We are all to blame for this crazy system, not just the insurance companies.

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Let's get it done - Health Care Rx Panelists

Let's get it done

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"America prevailed because we chose to move forward as one nation, as one people," President Obama explained in his State of the Union address as he reflected on history.

He later said that Americans today perceive that Washington seems unable or unwilling to solve the middle class's problems.

Too right, Mr. President. Based on the latest polls, the American people want Democrats and Republicans to get to "yes" on jobs and the economy.

Don't give up. Don't quit, Congress.

Jobs are certainly the No. 1 focus, the President said. But we know that more businesses are dropping health insurance, and small businesses -- the engine of job growth in this country -- more often than not simply cannot afford to cover health care in today's insurance market.

The President wants to fix problems that hamper the nation's economic growth. One of the key constraints on growth is health care costs. The Congressional Budget Office said today that spending on Medicare and Meciaid are the "single greatest threat" to the nation's budget stability. Last year, higher unemployment drove up Medicaid spending by 9 percent. Outlays on Medicare grew by 10 percent. Both of these growth rates exceeded those seen in the past decade.

Our health care cost and access challenges must be dealt with, not next year, but now.

The President said, "Here's what I ask Congress: don't walk away from reform now that we are so close. Let us find a way to come together for the American people. Let's get it done."

Please, just do so. The dots directly connect between health care costs, jobs and the economy today, and for the health of the national budget in the long run.

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Dysfunctional Congress:
The President said, "Here's what I ask Congress: don't walk away from reform now that we are so close. Let us find a way to come together for the American people. Let's get it done."
I agree. Like many I have been appalled and shamed by many of the recent actions by our national Congress members, particularly on health care issues. I believe we need to provide health care for all our citizens. Presently, any legislation providing that seems to be in danger. Meanwhile, the US still ranks 31st among nations in life expectancy, although those over 65 and on Medicare live longer than the average in industrialized countries. Uninsured hospitalized children are still 60 percent more likely to die than insured hospitalized children. Uninsured, poor citizens are still dying for lack of health care.
The mandate that hospitals must admit and treat the severely ill uninsured is not health care; it is more like end-of-life care, simply unacceptable from both a moral and societal view. Real health care for these 30 million people should result in decreasing society costs. “An ounce of prevention is worth a pound of cure.”
The present senate bill costs about $90 billion per year, about 4% of the 2008 US total yearly expenditure of $2.3 trillion for health care (http://www.cms.hhs.gov). The whole game is to redistribute that other 96% so there is a net decrease in overall cost. It’s not rocket science. If that is too difficult, let’s streamline the bill and try a 2%-98% split. If that does not work, we should: vote against all incumbents in the next elections, refuse to contribute money to any political party or cause, and boycott any corporation that contributes to political parties.

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The lesson from Massachusetts - Health Care Rx Panelists

The lesson from Massachusetts

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Tuesday night's historic Senate election in Massachusetts delivered a resounding message to President Obama and Congress relative to health-care reform: slow down, drop the sweetheart deals and get back to publicly pursuing positive reform that all Americans want and need.

Assuming Congress and the President do the right thing and step back to reevaluate their health-care reform agenda, many proposals will likely be offered in the coming days and months. We at the Center for Health Transformation have consistently offered a practical, cost-efficient and consumer focused approach to reform. Any new plan must include civil justice reform, elimination of fraud in the Medicare and Medicaid systems, greater development of health information technology and much more that the Center details on its Web site.

Scott Brown and the people of Massachusetts fired a shot heard around the American political world on Tuesday. We can only hope that President Obama, Majority Leader Reid, Speaker Pelosi and others were listening. Sen. Jim Webb (D-Va.) certainly did, as he indicated that it is likely time to reevaluate the health-care reform agenda and possibly move in another direction. Any attempt to force through legislation in its current form serves as a detriment to the American people.

The American people need real reform that leads to lower cost and better care, not higher taxes and compromised delivery.

66 Comments

My State of California needs the same kind of message that Brown gave Massachusetts. Liberals will blame the current governor for the State's troubles but they forget that a liberal Democrat governor was just as ineffecual as the Terminator is. It's the legislator which is owned lock, stock and barrel by unions and particularly public employee unions at the head of which is the teachers' union. They are draining the public treasury with health care and pension plans and in the case of teachers with lifetime jobs that make the dismissal of incompetents impossible. Unless the taxpayers throw the Democrats out of ofice the unions' legalized stealing will continue.

Pretty much any republican's take on results from pretty much anywhere -

* If we won, it's time to gloat. We're number one, the opposition is toast. Rush Limbaugh and Sister Sarah, break out the party hats!

* If we lost, it was an aberration. The public was misinformed. The opposition lied to you. Rush Limbaugh and Sister Sarah, time to crank up the spin machine!

Let's see, Newt and the Republicans assert Massachusetts spoke for the nation but when Obama won and the Democrats scored a supermajority, that wasn't the nation speaking for the, uh, nation? It just won't be that easy right wingers--Democrats are still in control until you manage to replace them by way of the ballot and Barack Obama is still President. So pardon us if we snicker at your silly assertions that Brown somehow speaks for the entire nation. That's a whole lot of hooey.

NEW: Health Care Mandates are Constitutional? Not Even Close


“The claim that the Founding Fathers would have thought the Constitution allows Congress to impose health care mandates is little short of absurd."
--Rob Natelson, Professor of Constitutional Law, Legal History, and Advanced Constitutional Law


http://www.tenthamendmentcenter.com/2010/01/25/health-care-mandates-are-constitutional-not-even-close/


A word of warning to the republicans and conservatives. We live in a political era where things can turn on a dime. In January of 2005, Karl Rove was levitating and boasting of a permanent republican majority. By the end of 2005, his President and his party was in the crapper. Same here with Obama. He and his party got overconfident, even arrogant. In early 2008, he was on top of the world. Noe he and the democrats are in the crapper.

But take heart folks. The GOP is in the crapper too. And the Tea Party is in a delusional bliss that will not last long either. They didn't win this either. It was a victory for the center. Any leader or party who grasps that will be the one to come out on top. My prediction is that the GOP will overinterpret this as a move to the right. And a year from now they will be even deeper in the crapper if they do.

This was a victory for the center, not for the right or the left. If the GOP tries to move the country to the Tea Party right, in 2012, they will get buried. Forever.

Newt is a fat pig, and a womanizing one as well.

Isn't it curious that none of these big name republicans were on hand to campaign for Scott Brown before his election. Only after he pulled off this historic victory do big names from the past like Gingrich, Armey, Romney and the present GOP leadership step up to take full credit for a victory that was not won by republicans. It was won by independents and by default, disgruntled liberals and democrats who did not show up at all.

And don't some of you find it at least a bit odd that none of the big names in the Tea Party movement--Sarah Palin, Michelle Bachmann, Dick Armey, Jim Demint--made any public appearances in support of Brown? Only after he was elected did they crawl out like termites out of rotten wood to claim a victory they did nothing to earn.

And what did Brown win on? He didn't win on the GOP bread-and-butter issues. He didn't win by calling Obama all sorts of names and accusing him of being a communist or a socialist. Indeed, if one listens closely, it is hard to distinguish Scott Brown from the Barack Obama who won in 2008. He ran on changing business-as-usual in Washington and a whole range of populist issues having to do with making Washington more responsive to main street rather than Wall Street.

He sure as hell didn't run on Rush Limbaugh or Glenn Beck style rhetoric. I challenge any of you Tea Party bugs out there to refute what I have said.


It never ceases to astonish me how the media tries to interpret this as a great victory for the Tea Party. Doesn't anyone find it at least a bit odd that not one of the big name Tea Party supporters--Sarah Palin, Michelle Bachmann, Dick Armey or Jim Demint--made public appearances in support of Brown before the election, but were all over the boob tube after he won trying to take credit for his win.

The GOP demonstarted in the first decade of this century that it is incapable of governing. Why ANYONE would listen to someone like Newt Gingrich is puzzling to say the least.

Newt, I have to ask you.... When you were in Congress during the Reagan administration, were you willing to change and make reforms that were not in line with your Contract with America in order to compromise with those who were against your policies? I wonder, as a young inexperienced politician and president if Obama feels the same as you did back them.

As a Mass resident, lets put some basic facts down:

-Mass has more independents than Dems & Repubs combined. Brown energized the independents.
-The independents were concerned, not by the HC bill itself, but the process. Brown was not elected to kill the bill, but to help it. He said so during his acceptance speech.
-If Brown does not work with Dems in the next 2 years, he will be voted out just as quickly as he was voted in.
-Martha Coakley ran a terrible campaign. She took a vacation just after the primary and never went out to meet voters. Brown did. He criss-crossed the state. The towna that voted for him had a 60% turnout, the obes that voted for Coakley had a 40%.

The only national referendum this was to get politicians to work together. That is it. Nothing else.

Your short piece was right on the money Newt. Well said.

All these insults aimed at Newt, they certainly tell me how serious Democrats are about bipartisanship
----------------------------------------

Please explain to me how serious the Republicans are about bi-partisanship? Last I checked the senate still has 59 Dems, and 41 Repubs. I guess the Repubs will not have to explain why they filibuster just about every piece of legislation (112 times in 2009).

so, Newt, how IS the wife??

Mass. said "We have our own health care, scr€w the rest of the country."

That is America isn't it? "I have mine, scr€w you. Praise the Lord."

82% of Christian America thinks that the Bible says: "God helps those that help themselves." That ladies and gentlemen is an American Christian value. The phrase came from Ben Franklin not the Bible.

The people of MA no more spoke for the u.s. than you do salamander-man. The people of MA just did not want anyone f_ucking with their UNIVERSAL HEALTH-CARE. What the people of MA ACTUALLY said was: "gimme that it's MINE". They did not want someone in the senate who would bring about changes to the state's current health-care system because that might mean that MA changes to its system could go bye-bye and be replaced with something considerably less than what they now have.

All that the people of MA said in Tuesday's election was that they are a bunch of greedy b_astards.

Mr. Gingrich is doing it again - some call it reframing, some call it spin - but if it is completely divorced from the facts, isn't that more like lying?

Howard Dean reported the day after the Mass. election on the overnight polls in which voters who stayed home and didn't vote expressed their need for more health care - not less, preferably in the form of the public option.

Other polls showed those who did vote to be angry about the economy and the loss of jobs - not health care which came in at about 2%. Yet Republicans are using this occasion to preach the same sermon - which is essentially lying to us about what the true meaning of the Mass election was in service of their own cause.

"We at the Center for Health Transformation" ok Newt, so you're doing lobbying for a special interest, I get it. I'm sure they pay you well. But don't try to pretend you're out to do other than guard profits from blood money, because at least some of us know better.

It'd be better for everyone if Newt crawled under a rock until he came up with some ideas that didn't involve screwing the public some more.

Boscobobb,
23% percent of the country voted for Obama in '08. By your definition apathy wins every election. Fact is, the turnout for the Mass election was considered very high especially considering the weather conditions that day.

The numbers from the CBO and accepted by Harry Reed state that the rates for people who don't get insurance through their employer would rise 10-12% under the senate plan. Does this sound to you like something that would encourage innovators to go out on their own? And look, when Bob Herbert in the NY Times writes that there is a ticking time bomb for the middle class in these "reform" bills, we should be nervous. Unless of course if you belong to a union. By the way, how does something that encourages you to belong to a union encourage innovation or start up?

Most of the country has intuitively understood the con here. This is an entitlement program with very little reform for the middle class. And the former director of the CBO, writing in the WSJ, said that the bill contained every budget trick in the book.

Yet more fact-free Newt opinions.

Apathy won in Massachusetts, not Mr. Brown.

Newt, there are over 5 million eligible Massachusetts voters. 23% voted for Mr. Brown. 77% of Mass. residents did NOT vote for Brown.

I live in California, where the medical loss rate on health insurance for small technology startups like ours is about 75-80%, which means the insurance firm steals 20-25% of the top of every premium dollar, leaving about 60-70 cents for actual medical care.

By comparison, malpractice cost is about 1-2%.

Why do you. Mr. Gingrich, keep ignoring the theft implicit in insurance model? They add no value, so why should they take margin? Don't you realize the private insurance business practices are strangling American innovation and entrepreneurship? The auto industry is obvious victim, but medical devices innovators like my firm have same problem.

Prospective recruits are fearful to leave a big company to join a startup and invent the next generation of new technology. The small company can't match medical benefits because we have fewer than 25 employees. We seek PhDs, who are generally older, with families and are more likely to have pre-existing conditions. Literally US health insurance is a ball and chain imprisoning US innovation.

Looking closely at the numerous posts slamming Newt, it seems many of them were written by the same person using different accounts.


With a name like "Newt Gingrich" it's GOT to be Good !

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All these insults aimed at Newt, they certainly tell me how serious Democrats are about bipartisanship.

Sure, indulge your hatred and let the country do down the drain. At least you will have the satisfaction of bashing Republicans. And that is worth it, right?

Obama is not himsself a hater - he is a conciliater. But unfortunately he has a lot of baggage to carry in the form of hateful Democrats.

WRONG!

where do you get these nonsense ideas from?

first of all, Brown was (presumably) elected to represent ONLY massachusetts voters -- NOT the national republican party.

newt, did you flunk your high school civics class and did you buy your PhD off some website?

the last time i checked each state has two senators and they are supposed to do the work of the senate NOT represent a political party, ideology, or be "anti" anything; they should intend to make lives better for their own constituents. Let's hope Mr. Brown knows what his constitutional responsibilities are before he heads for d.c.

Why would anyone care what that fat old Gingrich thinks,Gawd the guy is sooo out of touch with real Americans,Hey mr. newt Mass does NOT speak for All Americans please get a grip on reality.What did newt ever do for those Americans without affordable healthcare? NOTHING!!!

In 1994 after the republican takeover of Congress, I emailed Speaker Gingrich this message: there is a family here in S W VA. that has been on welfare since its beginng. If you and your fellow republicans get them off, I'll vote republican the rest of my days as will my family. GUESS WHAT NEWT? these folks are still on welfare. The only things that change in Washington is one bunch of thieves replaces another. TERM LIMITS will fix it. Obama won because Americans were tired of the lying republicans who have never done anything for working families since Lincoln was assinated, & never will. What the dems need to do is return to the populism of our fathers & take care of working men & women who made this nation. The Tories & republicans did not & will not. They along with Bill Clinton deported jobs without replacing them with other jobs. HOW ABOUT A WPA or CCC. Put folks to work.Republicans will cut the rich folks taxes & hope it tricles down. Let's let some trickle up.

I wonder if Mr. Gingrich's definition of health care reform includes serving his wife with divorce papers as she comes out of cancer surgery. Which wife was that, anyway, Newt? By the way, if you want real health care reform, why didn't you do something when you held the office you disgraced?

Let's see....according to the former Speaker of the House, Massachusetts has spoken for America. This is great news!! Since Massachusetts has had long had same-sex marriage, I guess it has spoken on that for America too. Will Newt lead his GOP into the promised land of LBGT equality nationwide?

For 4 decades the people of Massachusetts voted for Health care and a Democrat. Not once in those years did Newt say, "the people of Massachusetts spoke for America". Another brilliant insight by Newt...

Wrong. Conservatives have stood in the way of health care reform for seven decades. This magnification of Massachusetts is simply another ruse to preserve the poor health status of average American citizens. Frangible are superficially reasonable analyses of the behaviors of masses of persons. Perhaps what many have said is true--Coakley simply appeared to be to arrogant for words.

"The American people need real reform that leads to lower cost and better care, not higher taxes and compromised delivery."

And the republicans have stood in the way of this goal for 30 years. They have stood against any health care reform and insurance reform, and have only worked to reduce taxes on the wealthy. Why should we trust republicans to bring to America what they have prevented for 30 years? Do you think America is stupid?

What happened in MA is local politics. They have health insurance. They could care less what happens with health reform on Capital Hill. To take this local election and blow it up to be what it is not is, well, very like Gingrich, to ignore the results of Obama's own election but hype a 3rd rate politicians like Brown, who has already shown his morality by denigrating his daughters in front of a national audience. What a guy you got there... He'll be out in 2010 for sure.

Doing nothing on health care is not an option and should not be considered any kind of victory for the GOP - it could come back to bite in a big way because they now have skin in the game. I continue to be amused by a GOP that continues to arrogantly tell the world that they fave the ONLY answers after a ruinous 8 years when they were in charge. If the policies they espouse had any merit, then we should have been in deep clover (instead of the stuff we're in) by now, wince we had 8+ years of full-throated application of these nonsensical policies which boil down to "give all the money to the rich, and hope for the best" and "kill all dark-skinned people we don't agree with"

Coakley was actually a typical Republican. She prosecuted persons who were likely innocent as a means to obtain public office. Scum is scum, whether it poses as a "reforming" Speaker of the House or a "crusading" prosecutor.

Shut the uck up, you fat unfaithful cheating on your wife hypocrite fool - you don't speak for me.

Dear areyousaying,

If you and fellow Democrats do not understand that the country has been and remains "center right", you will get nowhere. If Obama does not understand that the majority do not want bigger government and spending, he will lose massively in 2010.

The Beck types and some teabaggers are a fringe of the right just as are the moveon folks & crazy pink grandmas to the left.

This contemptible parasite's sole skill is finding a community of idiots and bleeding them for their last nickels.


The sausage that the Congress was producing had little appeal to the majority of voters. Scott Brown's election from a indigo state did send a message from the country and Democrats in Congress will not ignore it because they like their jobs.

Whether they can craft a more palatable recipe is entirely in their hands.

Massachusetts, which already has state funded heath benefits for all its residents, has no dog in the health care fight.

They spoke for themselves accordingly.

Let's not make local politics more national than then should be.


Liberals are still at their favorite sport-
insulting the opposition.

Posted by: mhr614

Are you saying you conservatives don't do the same al la, Beck, Limbaugh and the entire RNC cast and crew of Fox News who do it for ratings, fame, power and a fast buck?

Are you saying they are not "...stooping to scatology and insultos (sic) whenever a "liberals" (sic) voices fact-based opinion in print...." even though Limbaugh and his parrots with their limited vocabulary know no other word to describe Obama other than "narcissistic"

Another new, "brighter" whiter Republican (obviously without a spell or grammar checker) calling the proverbial kettle black.

With due respect to Mr. Gingrich, I find it extraordinarily ironic that he would cast Massachusetts as the voice of all American voters. This is a traditionally liberal state with heavy concentrations of minority voters. Will Mr. Gingrich concede that Massachusetts voters delivered a "resounding message" when they adopted universal health coverage requirements a couple of years ago? Will he further concede that there was a "resounding message" intended in the election of a Republican who is pro-choice and pro-gun control?

I suspect not. Anyone who thinks that the voters of a particular state or region speak for the Union as a whole is, and always has been, badly mistaken.

Liberals are still at their favorite sport-
insulting the opposition. Why liberals, who pride themselves on their superior intelligence and education, insist on stooping to scatology and insults whenever a conservative voices fact-based opinion in print, is something I have never understood. The comments liberals have posted here are typical. Now that they no longer have Air America to listen to, I would have hoped that liberals would study US history and learn about rational argument.

Just who America needs to hear from on this event. One of the last two of three former republican Speaker of the House who had to resign in disgrace.

Newt should keep his conservative ideas down South with the good old boys. They live in a world of discrimination, racism, cheap labor, this is a change we don't need.

Mr. Gingrich eschewing "sweetheart deals": Now, there is a twist.

Newt Gingrich speaking about what's good for America, don't insult my intelligence. I hope he runs for President with the rest of the GOP HOPEFULS.

Why is this guy writing here again. He was run out of Congress for his corruption. He has no credibility left.

As for Massachusetts, look at the Republican's campaign. Just like all the other Republicans before him - at least over the last 40 years - his platform was one of lies and distortions. What is so galling is the American voters are gullible to buy it. He offered no solutions to the problems his party's 30 years of failed fiscal policy have caused. Nothing, nada, nyet, zip, not one hint of a solution.

To Republicans healthcare reform has become protectionism for insurance company profits. Wouldn't it be nice to have your doctor deciding how to treat you instead of an accountant in New York City? That is what the GOP is offering, and a 7-11% annual increase in premiums the insurance companies already promised to impose just because Americans talked about reform. Conservatives cost too much to have around.

The people of MASS speak for their state and only their state.

In two years they'll toss this yutz out on his ear.

What MASS does point out is how sadly unfocused Democrats are: no coherent message, no state by state strategy, no focused national posiiton and no leadership.

How unfortunate that so little brain power is invested in so many comments. No wonder the nation find the Post and it's moronic readership so hopelessly disconected from the base of American voters.

Sorry Newtie, Massachusetts nor the Republican party speak for me.

Well... I not really "sorry."

Didn't Newt go out and find a religion to wear on his sleeve?

Cancer survival rates are far better in the United States than elsewhere, for all common cancers.

Infant survival rates in the U.S. match that of Europe; we consider it a live birth from the moment he or she is born; in Europe, they do not consider it as a live birth if it dies within a day, or up to a month, depending on the country.

In Canada, I'd likely be dead of colon cancer by now. Here, most receive colonoscopies in time to detect early. In Canada, only about 20 or 25% receive them. The survival rate there is accordingly high.

Roughly 85% of medical advancements - drugs, diagnostics - originate here in the United States.

From Scott Atlas, M.D., professor of radiology and chief of neuroradiology at Stanford University Medical School:

"Nine out of ten middle-aged American women (89 percent) have had a mammogram, compared to fewer than three-fourths of Canadians (72 percent)

Nearly all American women (96 percent) have had a Pap smear, compared to fewer than 90 percent of Canadians.

More than half of American men (54 percent) have had a prostate specific antigen (PSA) test, compared to fewer than one in six Canadians (16 percent).


"Americans have better access to treatment for chronic diseases than patients in other developed countries. Some 56 percent of Americans who could benefit from statin drugs, which reduce cholesterol and protect against heart disease, are taking them. By comparison, of those patients who could benefit from these drugs, only 36 percent of the Dutch, 29 percent of the Swiss, 26 percent of Germans, 23 percent of Britons, and 17 percent of Italians receive them."

Do we spend more on health care? Absolutely. Reason? We get more! Even a socialist could understand that, but only if they work at it.

You sir, are the basest of hypocrites. You have no credibility. Go to your local community college and acquire training for a new profession. Just please, go away.

swva

Did Massachusetts speak for America on Gay Marriage too?

Are you saying, Newt, you want to drop the "sweetheart deals" your new, brighter, whiter GOP now has with big insurance companies?

"eliminating fraud" isn't going to get it done, especially when medicare's administrative cost ratios are lower than most private insurers

actually were some good things in the now dead bill, but Obama lost me when he gave the unions a special exemption on the cadillac tax

"eliminating fraud" isn't going to get it done, especially when medicare's administrative cost ratios are lower than most private insurers

actually were some good things in the now dead bill, but Obama lost me when he gave the unions a special exemption on the cadillac tax

The lesson from MA is that MA has its own state-run exchanges, its own mandate, and its own best-in-the-nation rate of coverage. And there's no movement to end that regime.

Wait, did that cut against your thesis? While you think about that, try not to let your *own* neighbors die.

I am from Massachusetts. I am soooo tired of the national press and politicians like Newt making more of this election than they should. We Massachusetts Democrats and Martha Coakley ran a stinky campaign. But Ted Kennedy won every time because he had great constituency service and he brought home the bacon. He did not have to campaign during an election because he campaigned all the time. He was a tough act to follow, especially in a year in which a number of Democratic state officials are under indictment (one most recently for drunk driving and leaving the scene of an accidenct). Reading more into this election, as many have been doing, is simply dangerous. If the Democrats in Congress don't pass health care reform and start wimping out on other issues (Ben Bernake needs to be confirmed), many of us who vote Democrat all the time will become independents too. The Democrats need to get some courage and stop acting like a bunch of babies.

Virtually every country in the advanced world gets better healthcare outcomes than the US at considerably lower costs, and they all have one thing in common - socialized medicine. Is it possible we could learn something from them?

"America hates ugly". "Screaming Idiots." "Evil people live and talk forever." You folks are nuts.

Gingrich does NOT speak for me nor for millions of Americans. As a long-time registered Independent, I have found that neither party is perfect, no matter how they try or what they say.

It is up to us, as individuals, to research the backgrounds, the policies and voting records of all candidates. We have gotten lazy and too many rely on people like Gingrich when making decisions.

Newt is continuing proof that good people die too young and evil people seem to live and talk forever.

This country is politically hamstrung and nothing substantitive will ever get done. Its a joke.

Meanwhile millions more wont be covered and thousands more will die as a result of not having healthcare.

U must be so proud Newt.

Civil justice reform? Just another fancy word for Tort reform? You could never ever give me enough civil justice for the health care system that destroyed 2 of my family members and subjected us all to years of hellish care.

Gingrich was never concerned about the little guy, why start now?

Newt you know for sure that your party will never take on health care because you all believe that anyone who doesn't have any is just a lazy bum. Your party has no mercy on anyone except yourselves. Your permanent Republican majority, which you worked so hard to bring about, never happened either because you were too ambitious and refused to accept anything close to being bipartisan.

Your own immoral behavior as a husband also gave us a window into just who you really are. Now that you are no longer king of the House, you've toned down your boastful sureness. Perhaps you should try being a patriotic American and start dealing with your fellow Americans as equals. I know that is something you cannot stomach, thinking of yourself as an equal to anybody.

Republicanism never used to be the way it is today, but the era of Atwater, Gingrich and Rove turned your party into an evil entity who will stop at nothing to smear the most decent of humans just to gain all of the spoils. None of you really have one bit of concern for this country or its citizens. Your point of view and those like you is all about power and riches for you and yours, only.

Just like the chickenhawks Cheney and Bush who sent everyone's sons and daughters to their battle deaths, but not themselves or their own children, you view uninsured people as not your worry.

Mr.Brown of Massachusetts has a long way to go in proving just how good a citizen he is in working for his fellow citizens and not his political party. If he is just another Newt Gringrich or John Boehnner, seeking only fame and fortune, than he won't last long. We citizens are calling you out, calling out the screaming idiots bought and paid for by big Health Insurance, calling out the racists and hypocrits who claim to be Christians but their actions follow the devil. You're one of those.

Newt you disgusting cherub! Thank god America hates ugly.

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Health-care honeymoon - Health Care Rx Panelists

Health-care honeymoon

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A bill will likely get signed that puts in place health information exchanges for consumers to gain more access to choice, as well as penalties to employers for not playing along. There will be no mechanism to really control cost nor hold insurance companies accountable.

While none of the bills will actually kick in until 2013--it won't matter. Costs will continue to rise since none of the bills truly bends the cost curve. People who really need coverage will end up with inadequate coverage and will ultimately cost the system more in the next five to 10 years. There will remain millions of people still without coverage.

During the honeymoon, insurance carriers will drain the system in advance of impending losses to soften the blow. In the interim, we will continue to pay more for less and there will be no mechanism to hold insurance companies accountable. Our deficit will continue to increase since we have underestimated the costs truly required to re-vamp the system.

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Reflecting on 2009 - Health Care Rx Panelists

Reflecting on 2009

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Looking back over the past year of health-care legislation, I would make the following observations:
• The Obama Administration made remarkable progress on health information technology, prevention and wellness and health-care quality in the February 2009, stimulus legislation.
• Although the House and Senate health-care reform bills were not bipartisan and some of the compromises were not particularly good ones, I am pleased that the Senate discarded the public option, the logic for which was never compelling.
• Relative to what the bills attempted to accomplish, the goal of enabling universal health insurance would be achieved. However, there are some structural flaws in the design of the insurance systems that, if not corrected, will put our country at serious financial risk.
• Structural health-care payment and delivery reform could avoid a financial crisis, but it is not clear that any level of government has the political will to tackle these issues, and they were addressed in these bills. Raising taxes to fund health insurance will cripple the economy, and cutting Medicare payments in our existing flawed system will simply drive doctors and other providers out of the system, which will create shortages. At this stage, it is unclear how we will create universal insurance that is affordable and financially sustainable.
• I commend Senators Harkin and Dodd and their colleagues for some excellent work on prevention and wellness. I also believe that the foundation has been laid for supporting more community health centers, a vital tool for health care delivery. Nevertheless, the good pieces of the legislation are relatively under-developed nuggets, not full-blown health care transformation solutions.

Politically, this legislation went as far as Congress could probably go, but much remains to be done.

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Older middle-class Americans locked out of reform - Health Care Rx Panelists

Older middle-class Americans locked out of reform

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The most damaging concession in the Senate legislation has received relatively little discussion in the last few days: as the bill now stands, many Americans in their late 50s and early 60s who don't have employer-based coverage will find comprehensive insurance unaffordable.

Under the Senate bill, insurers cannot discriminate against customers who suffer from pre-existing conditions. They cannot charge women more than they charge men.
But they can demand that older Americans who are shopping in the Insurance Exchanges pay premiums that are triple what a younger customer would be expected to shell out. (The House bill only let insurers double premiums.)

Commentators such as Ruth Marcus have suggested that this makes sense: "Older people cost more money to insure than younger Americans--and more than three times as much. Is it fair to require younger people to shoulder all the extra cost?"

In theory, this might sound reasonable. But, in practice, red-lining older citizens so that younger Americans don't share in their risk just won't work. Marcus and others who support "age rating" should take a hard look at the numbers. The fact is that if this provision stands, a large share of people in this older cohort won't be able to afford good coverage.

Households in the 55-64 age group report median joint income of just $55,400. Half earn less. Only 25 percent enjoy joint income over $100,000. In other words, fully one-quarter earn somewhere between $55,400 and $100,000 --too much for a couple to qualify for more than a tiny subsidy, too little to able to afford pricey insurance. (When it comes to subsidies, the cut-off point for a family of two is $58,280.)

Middle-aged Americans need full, comprehensive coverage. Yet under the Senate plan, which offers four levels of insurance, many older middle-class households will be forced to pick the short blanket. The legislation offers four tiers, ranging from platinum plans that cover 90 percent of the cost of "essential care" to bronze plans that pick up 60 percent of medical bills, leaving 40 percent for the patient to pay out of pocket. Premiums for bronze plans will be significantly lower.

A 30-year old might feel comfortable with a bronze plan. After all, he doesn't plan to use the insurance very often. But most 60-somethings need to go to doctors regularly to control chronic diseases and address the many problems that come with age. And if they are middle-class, they probably cannot afford to shell out 40 percent of the charge every time they visit a specialist.

Granted, their out-of-pocket payments would be capped at $11,900, but for a household earning just $59,000 before taxes, $11,900 represents more than 20 percent of their after-tax income. Even for a couple earning $75,000, $11,900 is a hefty sum. No doubt, many would simply put off going to the doctor.

Just how much would a couple have to scrape together to buy a platinum plan? The Office of Personnel Management, which now oversees the Federal Employees Plan, will be contracting with private insurers. They have not done a good job of holding down premiums for government employees-- from 2001 to 2008, average premiums climb by 62.3 percent.

Judging by what federal employees pay now, it appears that under the Senate bill a top-of-the line platinum policy would cost a younger couple at least $10,000--probably closer to $12,000 in today's group market. (I'm taking these numbers from states where insurance is more expensive because insurers are required to cover people suffering from pre-existing conditions, just as they will be under reform.)

That means that even if an insurer charged the older couple only twice as much, the premiums could run as high as $20,000-$24,000 annually.

If it seems impossible that a 60-year-old couple earning $59,000 a year would be expected to pay that much, consider this: In Massachusetts, where insurers are only allowed to double (not triple) premiums based on age, an older couple in Boston faces premiums that run as high as $24,000 a year.

The Senate bill does offer some hope. If a state's insurance regulations do not let insurers gouge older customers, insurers must "comply with the State's more protective age rating requirements." And in fact, some states do shield older citizens. As Howard Dean pointed out over the weekend on Meet the Press, in Vermont, insurers can charge 60-somethings only 20 percent more--not 300 percent more.

But where you happen to live should not determine whether or not you have access to good care. That is not what I thought we meant by "universal coverage."

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Can't be everything to everyone - Health Care Rx Panelists

Can't be everything to everyone

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Former Secretary of Health and Human Services Donna Shalala, now president of the University of Miami, has often told me that for major legislation to pass there must be consensus on the problem and the solution. In health care, most people agree on the problems: the U.S. health care system is too expensive, leaves too many Americans uncovered and fails to achieve its potential in quality.

As for the solution, a consensus remains elusive. For liberals, reform entails a public option, a Medicare and Medicaid expansion and government subsidies for low-income Americans. For conservatives, the solution calls for the development of an individual insurance market with purchasing across state lines, medical malpractice reform and the expansion of health savings accounts. Some liberals may have believed that a Democratic caucus with 60 members would thwart the need for consensus. However, centrist Senators, who represented votes 55 to 60, quickly ended those notions.

In any negotiation, the power lies with the coveted undecided. Without the counter-balance of major conservative ideas to court Republican votes, it is no surprise that many liberal ideals have been stricken from the bill. While this compromise has produced a bill that leaves both liberals and conservatives wanting, no single bill would ever have done everything for everyone. Health-care reform will be a continuous process of learning and adaptation with many opportunities in the future. Given the lack of consensus, for a bill to exist, compromise was necessary.

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Medicare's fundamental flaws - Health Care Rx Panelists

Medicare's fundamental flaws

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I am strongly opposed to adding any more participants to the Medicare system until we correct its fundamental flaws and make it financially solvent for the long term. There is no question that adults who are between 55 and 64 years old, and who are either retired from businesses that have no retiree medical coverage, or who are employed by companies that do not have medical coverage have a high likelihood or being either uninsured or underinsured.

This is especially true in states like Connecticut, which allow insurance companies to adjust individual and group rates based on age, with the older insurance participant paying more. Lawmakers need to do something for this population.

But rather than opening up Medicare to these participants, we should simply require insurance companies to cover them, eliminate pre-existing condition provisions, and create more competition through national exchanges that do not allow for as steep a premium increase as a result of age. Provide subsidies as needed.

Medicare is flawed because its costs are out of control since it pays for activity, not results, and makes no attempt to monitor excessive use of drugs, doctor's visits, hospital readmissions, or diagnostic tests. In those instances in which more care produces worse outcomes, Medicare has done nothing to control costs, and has no infrastructure to do so.

Moreover, Medicare coverage and payment decisions are highly politicized and controls on questionable medical processes and activities are unlikely to withstand the power of special interest groups. Good changes, like the addition of diagnostic tests that will help determine the value of a new cancer drug, are under-reimbursed because of the long lead time on changes.

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About this Archive

This page is a archive of recent entries in the Health costs category.

Employer health plans is the previous category.

Health costs is the next category.

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About this Archive

This page is a archive of recent entries in the Health costs category.

Health Care Reform is the previous category.

Individual mandate is the next category.

Find recent content on the main index or look in the archives to find all content.