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I'd like you to keep this quote in mind as you read. "You don't want to take them from nothing to a Cadillac."

Markos writes about Rewarding good behavior. I'm going to talk about condemning bad behavior.

Look, I don't like to be the bearer of bad news, and I consider all our Democratic candidates imperfect angels, but this doesn't mean we just roll over and play dead.

So you're wondering what I'm talking about?

I'm talking about this article in the New York Times.

You're also wondering who's "them"?

Them is us. Them is the American people.  You and I are them, to the political class. We need to be dealt with.  We need to be placated. If the truth be told, they want us to shut up and sit down. They plan on throwing us crumbs. They plan on offering many of us high deductible junk insurance which we know is insurance in name only.

Here's what Professor Guber who is advising several Democratic presidential candidates had to say. I appreciate his brutally frank words. I also think he's delivering a message. I suggest you read the entire article so you can place him in proper context.

I'll give you my interpretation. Since the politicians don't want  to take them (that's you and me), from nothing to a Cadillac, let's just throw them some junk insurance. We'll call it insurance and we can all say, problem solved. Yes, I know I've become quite cynical.

Health Plan Used by U.S. Is Debated as a Model

In order to make insurance affordable to a greater number of the 47 million who currently have none, experts say, the coverage might have to be much more limited than even the most basic federal employees option, and be designed to protect mainly against catastrophically high doctor or hospital bills.

"You don’t want to take them from nothing to a Cadillac," said Professor Gruber, who noted that affordability was a vital component of the Massachusetts plan, which he helped develop. The lowest-priced options in that state are as much as one-third cheaper than what is currently available through the federal employees’ program, he said.

So who is Jonathan Guber? He's an MIT professor advising various Democratic presidential candidates on ways to tweak the Federal Health Benefits Program and make it available to Americans who can afford it.

Jonathan Guber is also the man who helped Mitt Romney craft Mandated coverage in Massachusetts

"What Hillary proposed is in many ways the Massachusetts plan gone national, and I think that's great," said MIT economics professor Jonathan Gruber, an early adviser to Romney on the healthcare reform law who has consulted with all the major Democratic presidential candidates. "We are the shot fired around the world again - there's a whole new movement in healthcare started by what we did here. And rather than claiming credit for it, Romney's running away from it."

Once again, I don't want you to believe me so I'll turn to the experts at PNHP. This is what PNHP had to say on Romneycare and Massachusetts "reform". Forcing Mandating people to buy high deductible junk insurance is simply throwing money at the insurance industry and does nothing to address the healthcare catastrophe in the United States.

Americans need more than affordable insurance; they need affordable health care. California Gov. Arnold Schwarzenegger plans to copy the Massachusetts reform in shrinking the numbers of uninsured people by forcing them to buy stripped down, bare-bones policies.

With premiums for family coverage now averaging $10,000 a year, the only way that states can make premiums affordable is to strip down the plans, which then forces policyholders to pay out of pocket when they get sick. High deductibles, co-payments and benefit reductions are destroying the financial protection that insurance should provide.

Half of U.S. bankruptcies are a result, in part, of medical illness or medical bills. Three-quarters of Americans who are forced into medical bankruptcy had health insurance at the onset of the illness that bankrupted them. Worse, suffering and death can occur when patients cannot afford the care that their private insurance does not cover.

The big winners in the Schwarzenegger and Massachusetts health plans are private health insurance firms. The new insurance mandates will hand them billions in wasteful administrative fees that do not occur in government insurance programs such as Medicare. Private insurers will continue their cream-skimming, enrolling primarily the low cost, healthy workforce and their families, while leaving the costs of the unprofitable sick and elderly to the taxpayers.

Affordibility is the operative concept.

Now, I want to tell you what's really going on here. It's courtesy of George Lakoff, and it's called Surrender-in-Advance.  Maybe this notion of surrender in advance could characterize the bizarre behavior that many of us find so abhorent about our current crop of Democratic leaders.

Perhaps refusing to surrender-in-advance is what we find so mesmerizing about Chris Dodd's recent display of spine.

I recommend you read Lakoff's analysis of the American healthcare catastrophe, it's among the best I've seen and hopefully the message will be widely disseminated.


The Logic of the Health Care Debate

Neoliberal thinking can lead to a dangerous trap. We call it the Surrender-in-Advance Trap. With an exaggerated emphasis on system-based solutions, neoliberal thought may lead one to surrender in advance the moral view that drives an initiative in the first place. Those who pragmatically focus on appeasing what they assume will be unavoidable political opposition to their proposals also run the risk of moral surrender. For instance, assuming strong, possibly insurmountable, conservative resistance to government-based health care solutions, they will embrace profit-maximizing insurance solutions because they believe that 1) political opposition can be muted; and 2) the "free" market, properly regulated, can serve moral purposes, such as providing health care for all Americans. Proponents of these neoliberal solutions often overlook the fact that the very source of the health care crisis is the structure of insurance: the less care they authorize the more profit they make, and profits come first and are maximized.

. . .There is an additional danger. As a strategy, surrender-in-advance puts advocates in the weak position of starting negotiations by going half way or more toward what the other sides want. No one would think of taking that approach when bargaining in the marketplace.

Returning for a moment of the futility of maintaining our for-profit healthcare system. I'd like you to know how well UnitedHealth is doing. Wall Street is happy.

UnitedHealth Posts 15% Profit Increase and Raises Its Full-Year Forecast

The UnitedHealth Group reported a 15 percent rise in profit on Thursday and said it would buy back more of its stock, but it said it had given up some health insurance customers to stay profitable rather than go too low on prices.

UnitedHealth’s total enrollment was up from a year ago to almost 71 million people under a range of health and drug plans. But the number of people served by United Healthcare, which manages health coverage for self-insured employers and is one of UnitedHealth’s most important segments, declined by 80,000.

The president and chief executive, Stephen J. Hemsley, said that was partly by design. He said the company had held firm on pricing in the commercial benefits market "even at the cost of membership growth."

UnitedHealth said its medical care ratio, or the percentage of each dollar of premiums it pays out for health care, was 79.5 percent for the quarter, down 1.6 percentage points from a year earlier.

Let me remind you again about the medical care ratio. This is the amount of money the insurer spends on paying for our healthcare.

Every dollar they spend on your care or mine, goes against the bottom line.  So it's a very good day for wall Street when the medical loss ration declines.

You and I are losses to the bottom line. You and I are the enemy of profit.

This system cannot be fixed by maintaining the status quo.
This is the dirty secret the politicians know but dare not say.

The only solution to our national catastrophe is single-payer healthcare and they know it.

Why do they always surrender-in-advance?

Originally posted to nyceve on Sat Oct 20, 2007 at 05:45 AM PDT.

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Comment Preferences

  •  Hmmm. (25+ / 0-)

    UnitedHealth skims off 21.5% of all incoming premium dollars into the pockets of investors and CEO's. Medicare spends something less than 2% of all incoming "premiums" (i.e. Medicare taxes) on overhead and 98% on actual medical care.
    Hmmm. Which to choose, which to choose....

    •  Ralphdog, are you shocked? (11+ / 0-)

      This is the system functioning perfectly in the United states.

      And sadly, this is what the Dems plan on maintaining.

      •  I wish I were still shocked (5+ / 0-)

        In what may be his most famous dictum, Keynes said: "When the capital development of a country becomes the byproduct of the activities of a casino, the job is likely to be ill-done."  We've been living in a casino economy for years, and health care is just one piece of that larger puzzle.

        People have been propagandized for the past 25-30 years into believing that markets are all-seeing, all-knowing, all-powerful, and the best cure for halitosis.  They've almost lost the ability to see things another way.  The New Deal consensus that I vaguely recall from my youth largely appears to have gone the way of the rotary phone.

        It is interesting to note that, in the S-Chip debate, people seem to be willing to see things a different way.  I guess that the idea of kids being denied health care is too blatant for them to ignore.  There's still a vein of compassion that one can find if one drills through the Friedmanish BS that pollutes the popular discourse.

        As to the Dem candidates, HRC and, to a lesser extent, Obama have too much invested in the status quo to really shake things up.  The fact that Edwards has clearly lost whatever insider status he once held is his greatest strength.  He has very little invested in the status quo, so he would be the most likely to openly confront a system that badly needs to be confronted.

        Some men see things as they are and ask why. I see things that never were and ask why not?

        by RFK Lives on Sat Oct 20, 2007 at 07:31:01 AM PDT

        [ Parent ]

        •  RFK, you sound a bit weary? (1+ / 0-)
          Recommended by:
          means are the ends

          Maybe exasperated is a better word.

          I don't know exactly why I detect a bit less fight in you today than usual. Am I correct or just projecting?

          A bit of outrage fatigue, perhaps.  It happens to all of us.

          •  Mustering outrage is becoming more difficult... (0+ / 0-)

            Looking at my profession, I see an AG nominee who parses words about what types of torture should be legal.  Admittedly, it's an improvement over the former AG who found the Geneva Conventions to be "quaint."  It's still pretty repulsive if one thinks about it.

            We see outrageous actions every day.  We can't muster outrage for all of them.

            Some men see things as they are and ask why. I see things that never were and ask why not?

            by RFK Lives on Sat Oct 20, 2007 at 07:07:40 PM PDT

            [ Parent ]

      •  It sounds good to me! (5+ / 0-)

        Giving the people a choice of private/employer insurance or a Medicare-type plan that's affordable or free. Hmmm...decisions, decisions...

        I'm not aware of any country that has switched from "nothing to a Cadillac" - or private insurance to single payer WITHOUT a transitional process. Giving us a choice will lead to single payer - which John Edwards supports. WooHoo!
        Hillary does not support single payer. Not sure about Obama - but he doesn't have a UHC plan.

        •  Health Insurance Is Not Healthcare (9+ / 0-)

          We need to keep the focus on the need for universal healthcare and take the insurance vampires out of the equation.

          There would be plenty of money to fund our national healthcare needs if we spend our healthcare dollars on healthcare instead of profit driven paper pushing predatory premium collectors.

          Medicare D is a peek at how our need for healthcare is subverted by a parasitical "free market." Being forced to aid and abet big pharma by federal mandate is a burden and horror for those it purports to help. This massive failure feeds the notion that the federal government fails at aiding healthcare shortfalls and therefore should be looked at with suspicion by the electorate for a remedy to our healthcare crisis.

          •  Well - we can keep screaming about UHC (2+ / 0-)
            Recommended by:
            nyceve, dewey of the desert

            and futilely voting our Kucinich consciences - while Congress critters continue taking bribe money from the In$urance and Pharma industries - or go another route.
            Obviously the corporate media promotes Corporate Democrats "approved" by their corporate sponsors - the Insurance and Pharma industries - while dissing Edwards who has made careers defeating those industries and rejecting their bribe money.

          •  I agree. . . (0+ / 0-)

            Health insurance is not healthcare.  I have to incur $5,200 each year before my insurance kicks in for anything.  That is not healthcare.

            Other than the obvious protecting everything I have worked my entire life for, the only up side to having my insurance is that it provides the opportunity to receive billing for services at the insurance rate rather than the full rate that is charged to the uninsured (which happens to be 3-4 times as much as the insurance companies pay).

            I use my insurance as little as possible.  I just cannot afford to use it and only pray nothing bad or big happens.

            "Our lives begin to end the day we become silent about things that matter." ~ Martin Luther King, Jr.

            by givmeliberty on Sat Oct 20, 2007 at 11:26:45 AM PDT

            [ Parent ]

  •  Lets start by requiring by law (12+ / 0-)

    that US and THEM get exactly the same health insurance.

    When a government violates the unalienable rights of the people, it loses its legitimacy.

    by Rayk on Sat Oct 20, 2007 at 06:02:29 AM PDT

    •  Rayk, yes indeed . . . (7+ / 0-)

      The American political system only responds to a crisis.

      Since they are not in a crisis, they will not respond until and unless they are forced to endure exactly the same healthcare gauntlet as us.

      •  Let's GIVE THEM a crisis. (7+ / 0-)

        300 million Americans cannot be controlled by a few thousand thugs and a dictator of the American DEMAND (not just ask for) their freedom.

        We CAN say no to torture, secret prisons, suspension of  habeas corpus and the destruction of our unalienable rights. Lets do it.

        When a government violates the unalienable rights of the people, it loses its legitimacy.

        by Rayk on Sat Oct 20, 2007 at 06:11:42 AM PDT

        [ Parent ]

        •  Yes, but the thugs have all the money. (8+ / 0-)

          The Congresscritters care a lot more about Big Pharma and the large insurers than they do about me and my family. I am very pessimistic. We need serious healthcare reform, and we are likely to get junk insurance and mandales. We con't even get rid of those awful "medicare advantage" plans that are costing taxpayers 10% MORE than conventional medicare.

          •  Yes, but WE THE PEOPLE (4+ / 0-)

            won't be bought off. These guys literally want our Iraq. They want to be able to make us disappear if we oppose them, or expose their crimes, or exercise our rights.

            Are we Americans? Or just cowards?

            When a government violates the unalienable rights of the people, it loses its legitimacy.

            by Rayk on Sat Oct 20, 2007 at 06:37:11 AM PDT

            [ Parent ]

          •  Unfortunately, Blue Jersey Mom is correct (6+ / 0-)

            The only way a single payer plan comes to reality is a top down break down of the political system. With three health care lobbyists per congress critter and very few lobbyists advocating single payer and moreover, not holding fund raisers for the various critters PACs and Campaign funds, the end result is some more of the same but worse.

            As health Insurance increases, I see a "Donut Hole" of coverage coming at around age 55-65 when people either won't be able to get or afford health insurance premiums in the segment of their lives that they need it more than ever.

            It could get to the point where people take low paying jobs to qualify for public assistance when the math of a higher paying job less health care premiums or no insurance wipes out the difference between the higher paying job and a lower paying job.

            As a anecdotal example; a friend had private health insurance and needed a heart bypass. His monthly premiums shot up to $3000 a month. He couldn't go with out it because that would require paying retail for health care and his home equity was high enough that his house would have been at risk should he file bankruptcy.

            I'm pricing out preventative screenings for cancer now and it looks like my out of pocket is $5,000. I have it, but don't think I won't feel it and God help me if they find something. I have a shitty health care company. But then again  pick your poison. They all go to the same conferences. They all look at the money being made by competitors. So to lock in their profits they throw money with abandon at Washington.

            New candidates who get elected are quickly and efficiently co-opted by the system or they are just back-benched.

            The solution then is either Hunter's ( which I like the best) - dissolve the House of Representatives or turn it into a game show- or wait until the amount of Americans negatively effected by health care costs, Rs and D's, reach critical mass where 200-300 seats can change hands in a single election regardless of party by the single issue. Then it would probably have to happen again for any movement.

            As much as any presidential candidate says they are for some sort of reform, it's simply consultant written lip service as they have to have congressional support. Lets face reality- the R's took congress to a level of corruption probably never seen and now the D's want some of that.

            More D's and better D's only works if it's a complete rout where they have the power to elect the Speaker and set some new rules.

            Then and only then will a single payer plan become close to reality. Withe gerrymandering that has gone on: That is way beyond my dirt nap time.

            There is one thing that we can depend on though. Greed know no boundaries. High paid executives like to keep score with their competitors. That's one of the reason CEO pay has gone through the roof. There will be a time when Health Insurance is so high as it pays claims by say 60 cents on the dollar , a Health Insurance Executive will pocket a few billion and that's when mass outrage meets action. That could push it along faster.

            Activists who have the time should have ready statistics on publicaly held executive compensation. Then add it up. When it hits billions, then that MAY hurry things along.

            Support The Troops
            Let them see IMPEACH

            by Dburn on Sat Oct 20, 2007 at 07:18:21 AM PDT

            [ Parent ]

            •  The greed mongers (4+ / 0-)

              have a need to get our very last dollars before we reach retirement.

              Once they have drained our assets from student loans, predatory mortgages and lending, college for the kids, taxes on the middle class and wars with no end the bloodsuckers must pry our last $$$ from our still warm hands by holding our very lives hostage by essentially saying pay or die.

              •  Agreed (0+ / 0-)

                I have made a promise to myself just to do without rather than pay a dime of interest to consumer loan sharks financial institutions. My mortgage is different. It's a tax write off they I need and I couldn't rent for a cheap as I'm paying for my house/condo.

                But as I look at my utility bills, insurance of all kinds and all other day to day living expenses, I'm just not sure that anyone will ever be able to put their feet up and say they are done with working unless they are a lucky member of the 1% or did without for most of their adult lives or work for the Govt and retire after 20-30 years with full health benefits paid by us.

                It used to be a good argument that Govt paid less then the private sector but that argument grows weaker with time once you add the benefits up they still have and we've lost.

                No  one is going to take their health insurance away because that would require a congressional vote. I haven't seen them vote against themselves on raises, so I see no reason why they would put themselves and career govt employees in the same dessert , absent of real benefits,  that we're in.

                Taxation without Representation. We did something about that awhile ago if my recall of history is correct.

                Support The Troops
                Let them see IMPEACH

                by Dburn on Sat Oct 20, 2007 at 12:44:27 PM PDT

                [ Parent ]

    •  NO (6+ / 0-)

      Not health insurance. Health care. The only thing ensured by health insurance is the profit for the insurance companies.

      Why do we need a for-profit middleman to get between us and our doctors, nurses, and pharmacists?

      Talk about who's insured and who isn't blurs the argument. Always remember that insurance companies are in business to make money, and when they pay your doctor, they lose.

      Al Qeada is a faith-based initiative.

      by drewfromct on Sat Oct 20, 2007 at 06:33:25 AM PDT

      [ Parent ]

      •  How much profit can insurance companies rake in (3+ / 0-)
        Recommended by:
        nyceve, means are the ends, MizC

        before there is rebellion in the streets?

        They are still testing our limits and it won't stop until WE stop them.

        It is the equivalent of the soda can that gets thinner every year until it just won't hold in the product anymore. The company doesn't care if you have to mop up after that ruptured soda can because you already paid them for it.

        What has been happening in the corporate world for decades is that if they can shave off even a tiny amount of the cost of the product, they do it until it harms the bottom line, i.e. the consumer stops buying.

  •  Where is the (11+ / 0-)

    "Recommend Again" button?

    You don't need a weathervane to know which way the wind blows.

    by jhop7 on Sat Oct 20, 2007 at 06:08:59 AM PDT

  •  The arrogance! The gall! (6+ / 0-)

    Please, which Democratic candidates is this neo-Dickensian jerk Guber advising?
    We really need to know.

    I could have been a soldier... I had got part of it learned; I knew more about retreating than the man that invented retreating. --Mark Twain

    by NogodsnomastersMary on Sat Oct 20, 2007 at 06:24:36 AM PDT

  •  I have Medicare and I am uninsurable (14+ / 0-)

    without it. I have many pre-exsisting conditions and would not be able to buy insurance. I am a risk. As is, I owe Hospitals, and Doctors money that I will never get paid off. Yet I have to suffer with the threats of collection agencys and phone calls day in and day out. And I am not the only one. Medicare pays 80% of what they feel should be charged. I have to pay the rest. I wish I could trade places with a Congress person for a Month. Then they might get it!

    "Though the Mills of the Gods grind slowly,Yet they grind exceeding small."

    by Owllwoman on Sat Oct 20, 2007 at 06:29:51 AM PDT

    •  Owllwoman, I'm glad you mentioned Medicare (12+ / 0-)

      yesterday in NYC, I attended and open meeting of the local coverage determination Medicare committee.


      It was quite an experience and I'm trying to think how I can write about it.

      Basically a ton of pharma, medical equipment and assorted healthcare parasites were there. They go to see what coverage changes Medicare is contemplating.

      As Medicare goes usually so go the for-profits.  So if Medicare won't cover a drug, procedure, what have you, then you can bet the for-profits won't either.

      At the end of the meeting one of the local medicare officials spoke and essentially said, that Medicare is going to face a huge crisis in 2008 in the area of the NPI database. NPI stands for National Practicioner Identifcation. I think this is a fairly new way for doctors, hospitals to get paid. Basically she was saying fasten your seat belts.

      I left rather puzzled about her prediction.  But I started to think and here's what's beginning to develop in my brain.

      I think the heavily politicized CMS/ Medicare is planning to in essense Swiftboat itself. Medicare will face some sort of payment meltdown in 2008 which will turn the medical community and perhaps the American people against any sort of single-payer healthcare. This may be what this Medicare executive was predicting.

      Now she may not understand why this is going to happen, but we do. If during this election cycle Medicare faces some withering structural challenges, it could really sour the American people on the role of the government in healthcare reform.

      Anyone who reads this comment and can shed some light on my hypothesis, please weigh in. Because if there is a grain of truth to my fears then we need to get to the bottom of this ASAP.

      •  I can assume that Bush is cutting the amt. of (3+ / 0-)
        Recommended by:
        nyceve, drewfromct, blue jersey mom

        funds paid again. He did it last yr. and is probably going to do it again. If a Doc charges 60 dollars for an appt.Medicare will pay 30 dollars of that. That means the Patient will pay the other 30 dollar. They cut the amt. Medicare pays last year. We used to pay 10dollars a visit. Now it is 14.50 for each visit. I also imagine they will cut the amt. of Aids such as WC, Canes, Walkers, etc. Bush has really put a dent in people on Medicares quality of life.

        "Though the Mills of the Gods grind slowly,Yet they grind exceeding small."

        by Owllwoman on Sat Oct 20, 2007 at 06:57:37 AM PDT

        [ Parent ]

      •  Your instincts are spot on Eve (2+ / 0-)
        Recommended by:
        nyceve, MizC

        this smacks of a preemptive strike.

        This is war and they are going to carpet bomb us before we have a chance to even let the American people understand that they have a choice about how we fund and utilize healthcare in this country.

        The medical community must be kept in mortal fear of socialized medicine. It has worked for decades but they are beginning to see that they have been had.

        Time to get them back on the reservation before they get uppity.

      •  re: the NPI meeting. (2+ / 0-)
        Recommended by:
        nyceve, MizC

        Eve, I don't know if this is helpful but Medicare has just announced that it will not cover certain "preventable events" during a hospitalization such as pressure ulcers, blood stream catheter infections, and urinary tract infections starting in Jan 2008. There will be tremendous pressure on hospitals to struggle to stay open. No reimbursement-no way to pay staff and therefore closure.
        Staff can still try like hell but sometimes the outcomes are unfavorable. That is just too bad. NO exceptions.
        I'm just guessing here but I think this is just part of the scheme to make Medicare "for profit medicine" too.

        What do we want? Universal health care! When do we want it? Now!

        by cagernant on Sat Oct 20, 2007 at 08:42:57 AM PDT

        [ Parent ]

        •  Yes, this is all true, cagernant . . . (1+ / 0-)
          Recommended by:

          Meidcare won't pay for hospital acquired infections ( or some version of this). But the systemic failures this Medicare official predicted have something to do with the NPI payment system, becuase this is where she said the breakdown will occur.

          As I said, i was initially perplexed, but I'm stsrting to think this is a planned failure designed to turn off the American people to any form of single-payer or an expanded role for Medicare.

          This is what is very frightening, if I'm correct.

          There are no coincidences. This will be a beautifully  well timed failure.

      •  Here is one change re NPI (2+ / 0-)
        Recommended by:
        nyceve, MizC

        Though this page is from a health plan  it explains the changes that takes effect

        CMS has announced they will not impose penalties until May 23, 2008 for providers or health plans who are acting in good faith to replace legacy ID numbers with NPI.

        It is suppose to, uh,

        Simplify the administration of the health care system and encourage the electronic transmission of health care information.

        but doesn't seem to make it easy. (CMS) and NHIC have not yet issued final rules. However, solo incorporated physician practices must, on the new CMS 1500 (08 -05) enter their 'individual' NPI number in box 33 (a) and their legacy Medicare provider number in box 33 (b). The corporation NPI does not need to be  reported on the new CMS 1500 to Medicare at this time.

        Also, "solo incorporated" physicians should check with all other insurance carriers to whom they submit claims for CMS 1500 form completion instructions as their rules may differ from Medicare.

        We know that lack of clear instructions is a huge and costly problem for solo doctors

      •  I can guess about the manufactured "crisis" (2+ / 0-)
        Recommended by:
        nyceve, MizC

        Under the old provider number system a provider had an identifier for each insurance and some insurers like Medicare required a provider to have a separate number for each office or venue of care outside of a hospital. I know some doctors have as many as 15 different provider numbers. Many private insurers just used the Employer Identifying Number (EIN) to pay claims and issued a 1099 to that corporation at the end of each year. I know of some doctors who have a different corporation for every one of their offices, 2 or 3 in some instances.

        The problem with this system is you can't easily identify provider fraud. Under this system what's to stop a psychiatrist from "seeing" 40 patients a day or a primary care physician from seeing 120 patients a day? You would have to get all the insurers together comparing notes to figure this out. Plus, there was no way to find out if doctors were billing patient visits to their RN's or PA's or other physician extenders under their name.

        The NPI system was to make it easier to id fraud as it is supposed to issue 1 number to each provider and that provider is supposed to be able to use it on every insurance claim to every insurer. That number is supposed to follow that provider where ever they go to render care whether it is in 15 different places within 1 city or in 3 different states.

        The "crisis" isn't going to be in issuing the numbers so much as handling the onslot providers thinking they need a different number for every office and dealing with duplicate issues. I guarantee you that CMS hasn't budgeted enough resources to make this changeover efficiently or effectively.

        eve, you make a good guess here. It would be typical of the Bush Administration to manufacture a problem when one shouldn't occur to score political points.

        If a nation expects to be ignorant and free, in a state of civilization, it expects what never has and never will be. Thomas Jefferson

        by JDWolverton on Sat Oct 20, 2007 at 09:16:59 AM PDT

        [ Parent ]

        •  JD, you're a wealth of information . . . (1+ / 0-)
          Recommended by:

          Thanks so much.

          Again, I'm going to do some research and see what I come up with and your explanation of the NPI system helps.

          But if as this Medicare executive predicted there will be some signficant NPI related breakdown in 2008, it will definitely score political points, but even more grotesque, it will also be used to derail any contemplated new role for expanded Medicare, or a larger role for the government.

          A sort of Katrina for Medicare. The Grover Norquists  of the world will say it's proof again, that the government is inferior to the private sector.

    •  We do qualify for (1+ / 0-)
      Recommended by:

      Medi-gap insurance that pays deductibles and that 20% copay. Pre-existing conditions  don't change that or affect the cost. Mine is <$100/month. The prices vary by area and level of coverage but comparisons are easy (unlike Medicare D) because a certain level has the same benefits whoever you buy it from. Medi-gap was a good plan.</p>

      There are funny rules if you have been without it though, don't know if eligibility is the same if you have been without any supplemental coverage for a while.

      That 20% could be an incredible burden if you see specialists or get hospitalized or need special testing

  •  If there was no health care system at all (12+ / 0-)

    in the U.S. and people were given a chance to choose one,  how many people would choose the one we have now?

    No one but insurance executives.

    No matter how big the insurance industry is, we have the right as a country to choose another path.

    We chose to replace slavery with free labor. We can make a choice to replace pseudo-insurance with real universal health care.  The insurance companies will object, and we will just have to beat them like cheap rugs.

    Those who counsel that "the country isn't ready" for single payer health care are standing in the way of real reform and should step aside and let the real fighters do the job.

    Bush repealed Godwin's Law with a Signing Statement.

    by Mad Kossack on Sat Oct 20, 2007 at 06:39:21 AM PDT

  •  Everytime (5+ / 0-)

    a "murder by spreadhsheet" diary appears I get so angry I want to put my fist through the computer screen.  Our system is more than just broken, it's sadistic and inhumane. Profit-driven health insurance is just plain evil.  

    We need single-payer health care and we needed it yesterday.  

    Build bridges not fences.

    by sable on Sat Oct 20, 2007 at 06:41:43 AM PDT

  •  Wonder if this will be a topic... (5+ / 0-) the "values voters" conference?  My guess: no.

    In TX-32, track the voting record of Pete Sessions at SessionsWatch.

    by CoolOnion on Sat Oct 20, 2007 at 06:48:22 AM PDT

  •  Surrender in Advance (8+ / 0-)

    is essentially the tactic of "centrist" Democrats across the board for the last generation.

    How do you get your face on FOX or CNN? Be a "reasonable" or "serious" Democrat. What is a "serious" Democrat?  One who has surrendered-in-advance to the Republican frame on any particular issue.

    Why is there no impeachment? Because Pelosi et al chose surrender-in-advance as the outcome of an impeachment inquiry. Thus, no need for the actual procedure.

    Why did so many Democrats choose to vote for the AUMF in October 2002?  Because they chose the surrender-in-advance option so that the mean old Republicans wouldn't say bad things about them on the campaign trail. (See how well that turned out?)

    Why is there not universal health care in this country? Well, when the last serious attempt at reform was tried in the '90s, the single payer option was surrendered-in-advance in an attempt to mollify the opponents. The supporters of Hillarycare said it was necessary because "the country isn't ready" for single payer. "We need to do this as a first step". Obviously, it didn't work.  

    Forcing people to buy junk insurance is not the solution.  

    Bush repealed Godwin's Law with a Signing Statement.

    by Mad Kossack on Sat Oct 20, 2007 at 06:57:58 AM PDT

    •  Exactly, Mad Kossack (8+ / 0-)

      But this is apparently what's in store for us.

      Forcing people to buy junk insurance is not the solution.


    •  But who (4+ / 0-)
      Recommended by:
      eugene, nyceve, Mad Kossack, MizC

      are the Dems really surrendering to? The Rethugs?  The "centrist" voters? No, I think it's a matter of the Dems in congress being just as beholden to the corporations and the Money Power as the Rethugs are.

      We're starting to wake up to the fact that our elected representatives play the same role between us and the corporate money power as the insurance companies do between us and our doctors.

      Al Qeada is a faith-based initiative.

      by drewfromct on Sat Oct 20, 2007 at 07:34:13 AM PDT

      [ Parent ]

      •  you got it (4+ / 0-)
        Recommended by:
        thejeff, nyceve, drewfromct, MizC

        The democrats' job is opposition management.

        I have come to the conclusion that the job of the Democratic party, as it presently exists, is to manage and contain opposition to the corporate money system within a framework that renders it ineffective while maintaining the illusion that they represent an alternative.

        Given that context, what we really have is one party, the Incumbent Party, that has two arms.  Furthermore, much of the outrage exhibited by Democrats as they go through the motions of being "outraged" by this or that is feigned for our benefit and amusement.  Granted, there are figures within the Democratic Party who are at least perceived by the leadership to represent real opposition.  These folks are marginalized and/or ostracized by the leadership.
        (Note Speaker Pelosi's rush to criticize Pete Stark's unvarnished truth-telling about Commander Guy Bush.)

        The Democratic Party has become sort of like the chain link fence of a Free Speech Zone in which we, as progressives,  are required to corral ourselves in order to be able to participate in electoral politics.

        Bush repealed Godwin's Law with a Signing Statement.

        by Mad Kossack on Sat Oct 20, 2007 at 08:06:06 AM PDT

        [ Parent ]

    •  The cynics believe that Pelosi et al (1+ / 0-)
      Recommended by:
      Mad Kossack

      have decided to be passive on all fronts to feed our anger in preparation for our next trip to the ballot box.

      I can't fathom any other reason for rolling over time and again when WE control congress.

      I cannot picture LBJ allowing his fellow democrats to get away with such disloyalty as we have seen from the Bush dogs.

  •  S.I.A. (4+ / 0-)
    Recommended by:
    eugene, nyceve, drewfromct, MizC

    Surrender in advance seems to be the growing mantra, whether in health care reform, the FISA mess, Iraq, Iran, and so on and on and on.  It does make you wonder.  What is truly disturbing is that the trend seems to be correlated with lobbyist money, now flowing the Dem's way because they are in control of the House and Senate.  

    Getting the American people to understand that tweaking the system is putting a bandaid on a severed artery is challenging.  The noise machine is going into overdrive.  

    A tyrant must put on the appearance of uncommon devotion to religion. - Aristotle

    by DWG on Sat Oct 20, 2007 at 07:18:37 AM PDT

  •  Surrender In Advance Is The Dems Current (4+ / 0-)
    Recommended by:
    eugene, nyceve, drewfromct, MizC

    strategy on every issue. Health care, Iraq, the Constitution, you name it they come at the issue with white flag waving.

    Why? Are they misguided, cowards or just bought and paid for by Big Bizness. As long as the corporations are willing to supply the big bucks and people are willing to vote for the lesser of two evils regardless of what they do, we have very little leverage to change their SOP.

    No courage = No $$$ for Dems

    by MO Blue on Sat Oct 20, 2007 at 07:18:59 AM PDT

  •  Cadillac? All us welfare queens want one! (6+ / 0-)

    Man! Talk about playing the bigot racist card, this takes the cake!

    We can't have real health-care in this country because those other folk would be getting more than what you already have (of course you'd be getting more than you already have too). And, well, we just can't have that! That would be unamerican!

    What the people that this type of rhetoric is targeting doesn't realize is that the guy spouting this crap thinks of them as....THEM! They don't care about what color you are. All they care about is the color of your money! If you have lots and lots of money then you are in the club, else it's back of the bus.

  •  There is No Practical Way to Represent the People (3+ / 0-)
    Recommended by:
    eugene, nyceve, pioneer111

    under the American system.

    It's designed and built to work this way.

    The fixed terms of office, the pay-per-byte communication environment, the 1st amendment rights protecting corporate communication system owners from the people and from society.

    There is no way to create a party that mainly represents the people under this system. It's not logistically possible.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Sat Oct 20, 2007 at 07:34:01 AM PDT

  •  Cheese eating surrender monkies? (3+ / 0-)
    Recommended by:
    nyceve, milkmit, dewey of the desert

    How about s**t eating surrender donkeys.

    Why vote republican lite when you can have the real thing?

    by usedmeat on Sat Oct 20, 2007 at 07:44:57 AM PDT

  •  Healthcare reform (2+ / 0-)
    Recommended by:
    nyceve, MizC

    Great diary,Eve. Thanks again.
     But the question again is as Micheal Moore poses in Sicko. Are we as a society going to be a me society or are we going to be a we society? Skyrocketing profits with a bottom line as the end all and be all is incompatible with meeting the health needs of our citizenry. As long as the role of  "health insurance" is to provide profit there will be gaps, inequities and the other problems that plague the system today.
     Noone in our  country should ever have to go to an ER for basic, primary care.

    What do we want? Universal health care! When do we want it? Now!

    by cagernant on Sat Oct 20, 2007 at 08:13:04 AM PDT

    •  The folks with all the money (1+ / 0-)
      Recommended by:

      have yet to see a downside to the lack of health care for people who DON'T have money. However, there IS a downside, even for those who are not personally touched by the problem: Besides the possible eventual rebellion of those locked out of the health care system (more and more of us all the time), there will be a breakdown in the economy as too many people are affected by medical problems that take them out of the workforce, bankrupt them, etc.

      Edwards/Obama 2008

      by MizC on Sat Oct 20, 2007 at 10:30:45 AM PDT

      [ Parent ]

  •  nyceve (5+ / 0-)

    wow, you did a smashing job on this.  I read through the NY Times article and I was struck by how much it's a "oh no, this isn't socialized medicine!" bit.  

    They touch around the edges of the issue - 5% of federal employees can't afford the federal health care - but they never address the elephant in the room.  How do we cut 30% out of our health care cost?

    If we could get 20-30% off the 250 Million insurance policies (the profit margin) we could afford to cover the other 50 million and have some spare change.  

    Lakehoff's work is just phenomenal. He really looks at the underlying "frame" and addresses it instead of arguing the "talking points."  If you're arguing the talking points you've already lost.

    "Strength and wisdom are not opposing values" - Bill Clinton.

    by RAST on Sat Oct 20, 2007 at 08:27:31 AM PDT

  •  Yeah, we spend a greater percentage of GDP (3+ / 0-)
    Recommended by:
    nyceve, dewey of the desert, MizC

    on health care than any other nation, I think. Costs are too high, and that's the problem. These health care plans aren't getting anything fixed.

    Why can't I have both Edwards and Obama?

    by bhagamu on Sat Oct 20, 2007 at 08:41:16 AM PDT

  •  Yes, nyceve, (3+ / 0-)
    Recommended by:
    nyceve, splashy, MizC

    Them is us. Them is the American people.  You and I are them, to the political class. We need to be dealt with.  We need to be placated.

    Them is definitely us.
    Pacification, that's the line they'll take whether they will admit it or not.
    It was by way of pacification that Catherine the Great subdued the serfs.
    It was by way of pacification that the Hungarians were ground under heel in 1956.
    And certainly, by way of pacification, the countryside of Vietnam was turned into an uninhabitable hell by American fear and militarism.
    I wonder what they've got in mind?
    After all, they've already surrounded the bureaucrats with barricades.  When you go into any medical facility, you have to speak through a small window.  Any accident?  Of course not.
    The fear of the great "them" is everywhere.  And damn well it should be.  Because "them's" getting madder with every instance of suffering, every unjust death.  
    Let them fortify and fortify.  When the American people really get fed up, no locks of any sort will keep them from what they need.  It is only a matter of time before courage and rage replace resignation on the part of the great "them."
    Stability be damned.
    I demand justice.

    •  No accident (1+ / 0-)
      Recommended by:

      When you go into any medical facility, you have to speak through a small window.  Any accident?  Of course not.

      I have been to an emergency room a couple of times in the past few years because of sick relatives. I have seen nurses ignoring or responding with extreme slowness to people who are obviously sufferning.

      What makes me the most nuts, is watching so-called "triage nurses" telling people to get in line and fill out their paperwork before they can be seen. It makes me want to scream "What part of TRIAGE don't you understand!"

      Edwards/Obama 2008

      by MizC on Sat Oct 20, 2007 at 10:37:13 AM PDT

      [ Parent ]

  •  asdf (3+ / 0-)
    Recommended by:
    nyceve, dewey of the desert, MizC

    But a market-based solution is much more palatable politically than a government-run program, he said. Any government-run program proposed by a Democratic presidential candidate might be quickly tarred by conservatives as "socialized medicine."

    Politically more palatable to whom?
    More palatable to the rich, that's who.
    It demonstrates in clear black and white just who the government represents and works for.
    The market-oriented solution favors markets, maintains markets, and is corporate welfare.
    The people?  Since when are they important.
    Make your choice-- are we a nation of citizens or a nation of dollars?

  •  That line is telling... (3+ / 0-)
    Recommended by:
    nyceve, Keone Michaels, MizC

    You don't want to take them from nothing to a Cadillac.

    Really, why not? The line should be  we want to take American citizens from nothing to a Cadillac, not "them" as if Americans are nasty peasants. Yes, we wouldn't want to give them too much, they won't appreciate it seems to be the thinking. Somehow the them are less deserving Americans, the lesser.

    Time for the peasants to storm the Bastille, I say.

  •  I never realized how easy it was to snooker (3+ / 0-)
    Recommended by:
    nyceve, Dave925, MizC

    the whole country.  Even the brain surgeons in America are no brain surgeons as a examination of the collusion between the AMA for example, and the American Drug Interests.  Collusion is the correct word.

    The illusion that we are all on a level playing field ("anyone can be president in the USA") and the memes that originate from this false mindset is enough for some.  It is all pretty much bullshit that even the dullest of us should recognize and reject.  Face it, you or I are not going to be invited to the next barbecue down at Crawford.

    Nancy and Harry might tho!

  •  "You and I are the enemy of profit." (4+ / 0-)
    Recommended by:
    tmo, nyceve, Dave925, MizC

    This is something that is understood in just about every nation other than the US, and that's why there is a significant socialist or social-democratic tradition in every nation other in the world.  Here in the US we believe that if the choice is between ourselves and profit, we must sacrifice ourselves on the altar of Mammon, die like a dog in the street to advance someone else's bottom line, and everything else is eeeeevil communism.

  •  "I" was insured "I" was denied care (2+ / 0-)
    Recommended by:
    nyceve, MizC

    I Forbid You To Have Good Health - - Arnold/Bush

    "I was a Teacher I have Insurance I was Denied Care"
    "I made very good money I have insurance I was Denied Care"
    "I have been insured as long as I can remember my son was Denied Care"
    "I paid into insurance companies but I was Denied Care"
    "I am a Nurse I was Denied Care"
    "The Healthcare Solution: California OneCare" - - excellent video

    California State Assembly passed this bill - Arnold vetoed it

    Information is shock resistance - arm yourself

    by pollwatch on Sat Oct 20, 2007 at 10:21:20 AM PDT

  •  Remember that Hillary and Edwards (3+ / 0-)
    Recommended by:
    tmo, nyceve, MizC

    plan has a public option, unlike the one here in Mass. That is very important in competing with private, and potentially moving to single payer, if the people want it.

    •  Such a mixed system has already (0+ / 0-)

      failed in the Netherlands.

      The Dutch abandoned their old mixed public/private system in 2006.

      Premiums varied widely for people with the same income and they wanted to get rid of the dependency upon employment.

      Das Krankenversicherungsgesetz beendet die Situation, dass Menschen mit vergleichbarem Einkommen deutlich voneinander abweichende Beiträge zahlen und dass die Versicherung von der Beschäftigungssituation abhängt.

      Competitive pressures were causing great problems.

      Die Versicherer werden in einen stärkeren Wettbewerb miteinander treten, um für ihre Versicherten bei den Leistungsanbietern das günstigste Preis-Leistungs-Verhältnis herauszuholen. Die Leistungsanbieter müssen ihrerseits leistungsorientierter arbeiten, erhalten aber auch mehr Möglichkeiten, genau die Leistungen anzubieten, die die Bürger brauchen und wünschen.

      •  And yet a mixed system works in France (0+ / 0-)

        And yet, from what I've read, such a mixed system is working in France. It's the details and the circumstances that will determine success, not the type of plan in abstract; we can't just throw out a certain system because a variant of it didn't work somewhere else.

        A word after a word after a word is power. -- Margaret Atwood

        by tmo on Sat Oct 20, 2007 at 11:55:36 AM PDT

        [ Parent ]

        •  British imperialism (0+ / 0-)

          worked well for 100 years.

          Our medical health insurance worked well from the 1930s into the 1970s. It started to fall apart in the 1980s. Another Republican greedfest administration later and the system is hoping to survive on the contributions of healthy young black men in Detroit and young people who can barely pay their rent and college loans elsewhere.

          Blue Cross once was the equivalent of the government plan proposed. By the 1970s BC was coming under pressure. Ask Kos how his Blue Cross coverage in California is working out. California often leads the nation.

        •  The Wikipedia article (0+ / 0-)

          is written in German. The German system is coming under pressure.

          I'm studying Spanish exclusively now, so I don't know what happened concerning the German doctors' strike about a year ago.

  •  Not "the only way" (0+ / 0-)

    With premiums for family coverage now averaging $10,000 a year, the only way that states can make premiums affordable is to strip down the plans, which then forces policyholders to pay out of pocket when they get sick. High deductibles, co-payments and benefit reductions are destroying the financial protection that insurance should provide.

    Hospital billing could be simplified. Medicare pays by diagnosis code. One number instead of hundreds or thousands of charge items.

    We also need patent reform to remove exclusivity. Only Edwards has mentioned this.

    All medical technology should be subject to compulsory licenses like all music has been for almost 100 years.

    The radio patents were pooled by Federal mandate. The transistor and color TV technology were forced to be licensed.

  •  I paid $57 a month (0+ / 0-)

    for COBRA coverage from a large computer company in 1987.

    The cost of that coverage adjusted for inflation [~doubled to $114 a month] should serve as a benchmark which America's health care industry could be brought in line with.

    All the patents in effect at that time have expired.

    That 1987 care offered CAT and MRI scans, bypasses, stents, and reasonable length hospital stays.

  •  I found a notice at my local library (0+ / 0-)

    last week informing me that the Prescription Drug Plan is instituting a lot of changes for Medicare and Medicaid:
    September 2007:  If you receive a GRAY letter from CMS,
    you no longer automatically qualify for Low Income Subsidy.

    October 2007:  If you receive an ORANGE letter from CMS,you will continue automatically qualify for LIS with a different co-payment level.

    Oct.-Nov. 07, if you receive a Blue letter from CMS, you have been re-assigned to another plan, either because the premium amount is higher than Medicare will pay for you, or the plan is terminating.

    If you receive a YELLOW letter from CMS, you have been auto enrolled in a Prescription Drug Plan.

    I haven't received anything yet.  But, it appears to me that some plans are terminating because they are not allowed to gouge the consumer as much as they would like.

    Also, attached to this Medicare announces premium deductibles for 2008.  Now, the Social Security COLA came out this week and it is 2.3 for 08, which is ridiculous with food and energy costs skyrocketing.  But, according to our beloved leaders, food and energy are not counted in the COLA, although they are the two most important costs in any individual's budget.  However, the premiums are going up 3.1%.  So, the elderly are getting poorer and poorer, but we still are not as bad off as you guys under 65.
    With global warming, my kids won't even be able to send me off an ice floe.

    The ignorance of one voter in a democracy impairs the security of all - JFK- 5/18/63-Vanderbilt Univ.

    by oibme on Sat Oct 20, 2007 at 11:56:03 AM PDT

  •  Blue Cross premiums under the Federal plan (0+ / 0-)

    Mel Martinez and George Voinovich are living in another world. All they have to do is look at their own federal health insurance. Here is a couple of examples for 2008;

    1. Blue Cross standard, for one person, the total premium will be $449/month and federal employees and retirees will pay $135/month.
    1. Blue Cross family, for two and up, the total premium will be $1,028/month and the cost to feds and retirees will be $314/month.

    In most instances, the employee/retiree is paying about 32%.

  •  Thank you, Eve, for everything (1+ / 0-)
    Recommended by:

    for everything you do to wake this country up.
    And thank you Evan, for posting the Rockrdige video in this thread.

    I've lost TU status or would add Rockridge Institute to your tags.

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