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It's a talking point you hear regularly from President Obama--in order to fix the larger economy, healthcare costs have to be brought under control. That's not just rhetoric, there's plenty of empirical evidence to back up the claim, including two brand new studies.

The first, conducted by the non-profit Rand Corp links the rapid growth in U.S. health care costs to job losses and lower output. Commenting on the study at BusinessWeek's Money & Politics blog, Cathy Arnst says

The Rand researchers examined the economic performance of 38 industries from 1987 through 2005, in an attempt to assess the economic impact of "excess" growth in health care costs on U.S. industries. Excess growth is defined as the increase in health care costs that exceeds the overall growth of the nation’s GDP—a yearly occurrence in the U.S. The team compared changes in employment, economic output and the value added to the GDP product for industries that provide health benefits to most workers to those where few workers have job-based health insurance.

After adjusting for other factors, industries that provide insurance had significantly less employment growth than industries where health benefits were not common. Industries with a larger percentage of workers receiving employer-sponsored health insurance also showed lower growth in their contribution to the GDP....

The rate of growth in U.S. health care costs has outpaced the growth rate in the gross domestic product (GDP) for many years. In 1940, the share of GDP accounted for by health care spending was just 4.5%. By 1990, it had reached 12.2%, and 16% in 2005, when health care spending totaled nearly $2 trillion, or $6,697 per person, far more than any other nation. This year health care spending is on track to equal 18% of GDP.

That's largely the reason why so many American businesses are supporting reform.

Wal-Mart, on the other hand, recently came out in support of a mandate on employers to provide health insurance, and the temp firm Kelly Services, which employs thousands, followed with a similar statement.

Less noted has been the diversity of opinion among small and medium-size businesses. Many agree with the Chamber that a public insurance option would undermine the private insurance market and that requiring companies to provide coverage would impair job growth. Others say the current system is so broken that they are assessing whether to support the reform plans.

The wait-and-see approach that many businesses are taking -- alternately skeptical and hopeful -- is a further sign that the alliances that previously scuttled health-care reform may be scrambled this time around, not just in the health-care industry but also in the business world at large. President Obama and congressional Democrats face formidable obstacles to their reform efforts, but one factor in their favor is businesspeople who may not be as inclined as they were in the past to bring grass-roots pressure against reform.

Another new study, conducted by the progressive Center for American Progress looks at the potential costs for American families if the system isn't reformed.

Health care costs are expected to grow 71 percent over the next decade, which will in turn drive premium increases for health insurance. Unless we take serious steps now to reform our health care system—in particular to reduce the rate of growth in health care costs—health insurance coverage will slip out of reach for even more individuals than the 52 million Americans who today are uninsured.

This analysis shows that without health reform, average family premiums will grow to more than $22,000 by 2019, up from $13,100 today. In some states with higher-than-average premiums, family premiums will exceed $25,000 in 10 years. Of course, a family’s total health care costs will be even higher once co-payments and other out-of-pocket expenses are calculated into the total.

The costs of not fixing this now are extreme, and have the potential to bankrupt not only individual Americans, but the country. It will continue to hamper job growth, which will in turn lead to more people unable to get insurance, which in turn will increase the premium costs for those "lucky" enough to have insurance. This is not an acceptable future.

But don't forget the short term costs of not getting this done, because this can't be repeated enough. Three weeks of delay means:

Originally posted to Daily Kos on Sat Jul 25, 2009 at 09:02 AM PDT.

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Comment Preferences

  •  The Republican 10-Point Plan for Health Care (14+ / 0-)

    The RAND study is #7 on the list below.

    Here is the Republican 10-Point Plan for Health Care:

    1. 50 Million Uninsured in America
    1. Another 25 Million Underinsured
    1. Employer-Based Coverage Plummets Below 60%
    1. Employer Health Costs to Jump by 9% in 2010
    1. One in Five Americans Forced to Postpone Care
    1. 62% of U.S. Bankruptcies Involve Medical Bills
    1. Current Health Care Costs Already Fueling Job Losses
    1. 94% of Health Insurance Markets in U.S Now "Highly Concentrated"
    1. Dramatic Decline in Emergency Room Capacity
    1. Perpetuating Red State Health Care Failure

    Details and data on each here.

  •  All the discussion that there is no reduction... (2+ / 0-)
    Recommended by:
    lcrp, fedupcitizen

    of healthcare expenditures in the current proposals are not relevant...all we need to do is slow the growth to inflation or lower...and we will be fine...

    Obama - Change I still believe in

    by dvogel001 on Sat Jul 25, 2009 at 09:05:46 AM PDT

    •  Fine? Compared to what? (3+ / 0-)
      Recommended by:
      stitchmd, bigchin, snaglepuss

      If you mean compared to what we have now, what we have now is absolutely craptastic: multiples of what other first-world nations spend, and almost 50 million uninsured.

      I want what every other advanced country has. I want it to cost me what it costs them, and I want it to cover the things they get covered. Bloated, wasteful BigMed costs certainly are relevant if I have that expectation.

      And why should I have that expectation?

      •  I should say "shouldn't" have that expectation . (0+ / 0-)
      •  It will only cost what it does... (0+ / 0-)

        in other SP countries if we ration care and make people wait for "elective procedures"

        Obama - Change I still believe in

        by dvogel001 on Sat Jul 25, 2009 at 10:21:31 AM PDT

        [ Parent ]

        •  and? (0+ / 0-)

          we're already rationing it on the ability to pay.

          You think that's fine? Moral? Ethical?

          Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

          by stitchmd on Sat Jul 25, 2009 at 10:28:06 AM PDT

          [ Parent ]

          •  When did I say I was not in favor... (0+ / 0-)

            of only point is that we will never spend as little as SP countries because we will not ration like they do...

            Please do not project your opinion of lack of morality on me...

            Obama - Change I still believe in

            by dvogel001 on Sat Jul 25, 2009 at 10:48:18 AM PDT

            [ Parent ]

            •  I'm not projecting, I'm asking, (0+ / 0-)

              and you evaded the question.

              We already do ration and we still have the most expensive system in the world without the outcomes benefits to show for it.

              I'm asking you if you think that's ethical. If you can't answer the question, that's not my fault or my projection.

              Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

              by stitchmd on Sat Jul 25, 2009 at 12:58:06 PM PDT

              [ Parent ]

              •  We already do ration based on the availibility... (0+ / 0-)

                to pay...and that will not change under a public option in the US as it does not change in many countries in Europe where those who are able to pay can opt out of the public option or get supplemental insurance...

                Obama - Change I still believe in

                by dvogel001 on Sat Jul 25, 2009 at 09:23:32 PM PDT

                [ Parent ]

                •  which makes Europe different from Canada (0+ / 0-)

                  and it's what I've been saying for weeks, even months, to the single payer group around these parts.

                  It's not unreasonable to allow people to buy supplemental insurance if they can pay for it, and allow those people to purchase whatever healthcare services they decide they want. That does, however, allow them to know the true costs of those services and not depend upon the society to pay for them.

                  It's still a question of whether it is just or not.

                  Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

                  by stitchmd on Sun Jul 26, 2009 at 03:40:25 AM PDT

                  [ Parent ]

                  •  We cannot win this debate... (0+ / 0-)

                    by selling shared sacrifice...we will lose if that is what you are selling...the majority who have health insurance coverage will not sacrifice care for thier family in order to give healthcare to the uninsured...

                    Obama - Change I still believe in

                    by dvogel001 on Sun Jul 26, 2009 at 07:49:02 AM PDT

                    [ Parent ]

                    •  then, frankly, we are all screwed (0+ / 0-)

                      but "the greatest country on Earth" specializes in extreme selfishness in the name of "individual freedom."

                      And so we have the situation we have with health care, with the destruction of the environment, with the credit crunch, because we want it all, we want it now, and we don't want to pay for it. And we deserve it because we're exceptional. That's what Reagan told us, right? That's the mantra we've lived on for too long.

                      And once some of the countries of Europe bought into that, instead of their usual idea of social good and shared sacrifice, they got screwed, too - Iceland and Ireland are the most extreme example.

                      But I guess it's okay as long as you've got yours, right? If you had to truly pay the costs for all of what you've talked about getting for your family, would you feel the same way?

                      Come on down to the clinic where I work some time and talk about the idea that 'shared sacrifice' ain't gonna work. Make sure you're wearing body armor, though.

                      Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

                      by stitchmd on Sun Jul 26, 2009 at 09:28:56 AM PDT

                      [ Parent ]

                      •  If you want real reform... (0+ / 0-)

                        it will have to be sold by getting efficiencies by not duplication of services...not by telling people hey there is this great chemotherapy...but you are not worth the cost to save your life so we will give you the inferior one...

                        Obama - Change I still believe in

                        by dvogel001 on Sun Jul 26, 2009 at 10:18:00 AM PDT

                        [ Parent ]

    •  no, it's not fine (1+ / 0-)
      Recommended by:

      everyone wants to blame all the costs on insurance companies, and gd knows I'm not defending them, but there are enormous other costs that have to be addressed and cut back.

      There are folks whose jobs involve selling things to docs - drugs, medical devices, services, etc. They often make more than the docs themselves. Know cardiac stents? The stent reps make more, on average, than the cardiologist - and cardiologists make $300K per year, or more (some do make less, but they are not the ones who put in the stents.)

      I was looking for jobs for internal medicine, and a google search for such came up with a sales job where the starting salary was about $140K - and there were bonuses, too; total compensation was expected to be well above $200K. The average salary for an internist in my area is under $150K.

      I could give you loads of other examples.

      Not to mention docs who over order tests because of subtle kickbacks like cross referrals, and other incentives, well described in Atul Gawande's New Yorker article.

      "Healthcare" has become big business above and beyond the insurance companies. Lots of people want a piece of that pie, and are going to do whatever it takes to protect that piece if they already have it.

      "Stakeholders," indeed.  

      Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

      by stitchmd on Sat Jul 25, 2009 at 10:27:12 AM PDT

      [ Parent ]

      •  Agree to disagree... (0+ / 0-)

        we need new technology and innovation in healthcare...

        Obama - Change I still believe in

        by dvogel001 on Sat Jul 25, 2009 at 10:50:13 AM PDT

        [ Parent ]

        •  toward what end? (0+ / 0-)

          seriously. We have loads of technology for those who can afford it and loads more people who can't access basic care. Again, is that ethical? Just?

          And I don't know how familiar you are with how such 'technology' gets approved, but the approval for medical devices, for example, is far, far less stringent than that for drugs. All a medical device has to prove to be approved is that it doesn't hurt. It doesn't have to prove effectiveness, it doesn't have to prove that it's better than the alternative.

          And so people wind up with multiple stents in a single coronary artery, at $30K per, and there's not a single study out there that proves that that's more effective than medical therapy. Certainly nothing proves it's more effective than bypass surgery.

          Here's another thing about technology - it's great to not have to do exploratory surgery on patients when you can do an imaging study like a CT scan to look for what the trouble may be. CT scans were first used outside of just research in the late 70s, and came into widespread use in the 80s, with MRI becoming big in the 90s. Now, if you're a young woman on birth control pills coming into the ED with chest pain and/or shortness of breath, you have just bought yourself a trip through the spiral CT scanner to see if you have a pulmonary embolism or not.

          Thing is, radiation doses are cumulative. The body does not significantly recover from many doses of radiation, and radiation damage gets worse over time. We're starting to see the effects of that on people who have had multiple scans involving radiation therapy. And this has taken many forms, including increased cancer rates in some people.

          And we have Gardasil, a great success in term of prevention of HPV, but we have way too many women who can't even get regular Pap smears. And the epidemiology is very clear that the vast, vast majority of women who develop cervical cancer in this country are women who have gone more than 5 years without having a Pap smear. And Gardasil has not been shown to decrease the rate of cervical cancer, it's deceptive ads notwithstanding.

          We have to decide: do we want technology, or do we want basic care. Do we want CT scanners on every corner, or do we want to be able to reach people like those in the diary for basic dental care and essential screening services.

          Don't tell me we can do it all. We can't. We've been living on the big credit card for too freaking long now. We've got to get over this idea, perhaps born out of a sense of American exceptionalism, that we can have it all and we can have it now, and it won't cost anything.

          Because it does. Everything has a cost.

          Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

          by stitchmd on Sat Jul 25, 2009 at 12:56:31 PM PDT

          [ Parent ]

          •  I understand your concern... (0+ / 0-)

            My father who had bypass 20 years ago has been kept alive by stents and it has reduced his chance of a heart attack and death by having multiple angioplastis and stents...

            When my dad had his bypass 20 years ago...he almost died due to complications...nothing that serious has ever happened to him from angioplasti procedure...

            The whole area of having minimally invasive surgery which is more technology challenging but less recovery time and less stressful on the body is an area that is very promising on more technology leading to better outcomes and less cost procedures...

            So I say we can have it all and it is not all about doing save money...

            My dw who has stage 2 breast cancer has an innovative treatment that is more expensive but more effective from Memorial Sloan is taking the same medications but giving them in a more concentrated fashion (every 2 weeks instead of 3 with a imune booster drug that cost $2500 per dose).  But the cancer treatment is more effective and less taxing on the patient......

            That is clearly worth it in my opinion...MSK decided on this treatment regardless of cost...but based on effectiveness..but a doctor visiting from Canada said that this treatment was not available in "poorer countries"...

            So in the end....I am not against expanding medical availability to all but I am against rationing care in the greatest country on earth.../peace...

            Obama - Change I still believe in

            by dvogel001 on Sat Jul 25, 2009 at 09:21:01 PM PDT

            [ Parent ]

            •  okay, (0+ / 0-)

              but as for these treatments, (and I can tell you I've seen plenty of really awful outcomes after experimental treatments, hate to say it) would you be all for it if you had to bear the true costs?

              You have insurance which covers those costs, but your premiums alone, whether paid by you or by your employer or both, do not cover the entire costs of that treatment, and probably wouldn't even if you added up what you've paid thus far for the insurance. So you are, in effect, relying upon the "kindness of strangers" to at least partially pay for those very expensive treatments. Do they not get a say in how their money is spent?

              That's the issue we must deal with as we take on the issue of healthcare costs as a society. We cannot pay for everything, regardless of what you might think. We simply can't. And so we have to determine what the best use of the society's funds is for the society at large, and that means that some individuals are going to get left out. There's no avoiding that unless we want healthcare to account for 40% or 50% or GDP as opposed to the 16%+ we have right now.

              You've even admitted we ration care on the basis of the ability to pay. That is not likely to be accepted under a society-wide plan; in fact, it's exactly that which is being rebelled against by the society and is pressing the calls, the screams, for reform. It has the potential to really get people into the streets, although that does seem to take a hell of a lot in this country these days.

              Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

              by stitchmd on Sun Jul 26, 2009 at 03:48:17 AM PDT

              [ Parent ]

              •  I am not talking about experimental... (0+ / 0-)

                treatments...experimental treatments for the most part are not covered by any insurance unless you are in a clinical trial...

                These are all approved treatments...for all non-experimental treatments...we should provide the best procedure, process, medicine that is available regardless of cost that provides the best outcome and the least overall risk to the patient...

                If you are trying to sell that we should all sacrifice our medical care so all can get will lose that battle...

                It has to be sold like POTUS Obama said...nothing will change if you are happy with your healthcare...the only thing that will change is that if you do not currently have access to healthcare due to some will under this plan...

                There are always people who have catastrophic medical costs...those costs must be shared across the population equally...selling that we cannot have our cake and eat it the wrong way to go...

                We have to sell it that places like MSK are much more efficient at delivering cancer care because of coordination of all procedures through a central process that makes sure only one test is given instead of 5 different doctors ordering 5 different tests...but nobody should say to a doctor at MSK...hey I know that treatment is proven more effective for curing that cancer...but you should use the less expensive one anyway...

                Obama - Change I still believe in

                by dvogel001 on Sun Jul 26, 2009 at 07:46:30 AM PDT

                [ Parent ]

                •  you cannot provide anything regardless of cost (0+ / 0-)

                  aren't you an accountant? I would think that you would certainly understand costs.

                  There is no free lunch. There is no free healthcare.

                  Are you willing to pay the taxes or the insurance premiums necessary to guarantee that everyone can have everything that is the best procedure regardless of cost? Please, really, answer that and please don't dodge it the way you did the question about morality.

                  There are hard decisions to be made. If you're not willing to "give up" what you've got to make them, fine. You're right, that's going to be what decides this deal, whether it lives or dies itself.

                  But, and I mean this truly honestly, I hope you never find yourself in a position where you lose your insurance or don't have access to a plan that will provide coverage, because from what you've described about your own family's history, you'd very likely be uninsurable at any cost under our current system.

                  And then, seriously, will you be able to pay for "the best treatment?" Because I assure you, you would then find out the truth about the costs.

                  Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

                  by stitchmd on Sun Jul 26, 2009 at 09:34:47 AM PDT

                  [ Parent ]

                  •  Yes I am... (0+ / 0-)

                    and sometimes the best treatment is less cost than the 2nd best treatment.  Take minimally invasive surgery vs conventional surgery...the surgery may be more expensive but since the recovery time is cut down by 75% the total cost is lower...

                    Yes, we should pick the most effective treatments for diseases and procedures regardless of cost...if we do will all work out in the end...

                    As for my insurance situation...I am fortunate to live in NJ that has regulations in place that forbids denial based on pre-existing conditions and mandates community rating for the cost is spread to the entire population as it should be...

                    Keep on trying to sell this as those with good coverage have to give up their good healthcare...and you will get nothing...I am for reform and insuring those without coverage...but not at the expense of my healthcare...and that is the majority of opinion in this country...

                    As POTUS Obama put it in his press conference...many people are wary...they do not necessarily like the current situation but it is better than the devil I don't know...and the devil you are describing is even worse...

                    Obama - Change I still believe in

                    by dvogel001 on Sun Jul 26, 2009 at 10:15:07 AM PDT

                    [ Parent ]

                  •  You are right... (0+ / 0-)

                    healthcare is not free...and we should be willing to pay for the best healthcare available in the world...we are America...the best country in the world...

                    Obama - Change I still believe in

                    by dvogel001 on Sun Jul 26, 2009 at 10:16:05 AM PDT

                    [ Parent ]

                    •  We aren't getting the best healthcare now (0+ / 0-)

                      if you measure it by outcomes data, life expectancy, etc. That is very clear even if as you keep trying to push the idea that this is the "best country in the world." But whatever. And you still dodged the question of whether you would be willing to shoulder the true costs of that kind of care.

                      But hey, the risks are spread evenly in your community, as you say it should be - but you are unwilling to say that you would give up one iota of what you think you deserve.

                      Pardon me for sounding like I'm attacking you personally. It isn't personal, I've heard way, way, way too many people make exactly the argument you're making. I want what I want, and damned the expense, because we are the "best country in the world." But damned if I'll really pay for it.

                      And that is why we can't achieve real reform in this country. And why so many people remain uninsured. Even in your home state of New Jersey. Even in mine which has similar restrictions.

                      There is no such this as "efficiencies." People have been saying for years, for example, that they are going to cut the cost of government by getting rid of "waste" and "bureaucracy" and "abuse." How well has that worked, eh?

                      What you are proposing for healthcare is the same thing. But you'd need to provide more specifics of what can be cut, what can be provided in terms of efficiencies, before it means anything more than a bunch of hot air.

                      Frankly, look at yourself in the mirror and ask yourself if you really want reform. Be honest with yourself. Really.

                      From everything you've said, and as you've pointed out, your view is pretty common, if it means that you'd lose even one iota of what you've got, you couldn't frankly give a damn if other people are uninsured. Unless it could be proven to you that it raises your costs (and that data is out there.)

                      And so it is with the majority of the citizens of the "best country in the world...."

                      Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

                      by stitchmd on Sun Jul 26, 2009 at 12:54:53 PM PDT

                      [ Parent ]

                      •  As someone who unfortunately... (0+ / 0-)

                        has had to consume way too much healthcare for me and my family I can tell you the incredible waste of the system that has nothing to do with choosing inferior care to save money or forcing people to wait months for "elective surgery"

                        Examples are:  

                        1. Keeping patients in the hospital for extra days until their drains stop draining rather than sending them home when they are ready and having a nurse practitioner visit you for 3 visits to make sure your drains are clearing.  When I had surgery they had to keep me in the hospital when I was feeling fine for 5 extra days until the drains stopped draining.  Even then they took one drain out too soon which caused me to have to be re-admitted into the hospital for another 5 days with complications.  Why did they rush trying to take that drain out...because I was over the allotted time in the hospital on a negotiated fee for that procedure.  So if they did what they did for my wife and just train me and or give me some nursing support at home, I could have saved money, been more comfortable and there would have been no pressure to take out the drains early.  Total cost of the procedure/hospitalization $250K total additional cost $50K.

                        There are numerous examples that could have cut down my considerable medical expenses while improving quality and not having to choose an inferior procedure due to cost considerations...

                        Obama - Change I still believe in

                        by dvogel001 on Sun Jul 26, 2009 at 04:40:20 PM PDT

                        [ Parent ]

                        •  when I was in residency (0+ / 0-)

                          and later, we had good access to home health care, and we'd send people home all the time with the kind of care that you are talking about. Then some people came in to cash in on it, and then started bragging about how much money they made on it, and all of a sudden the coverage was cut back dramatically or eliminated.

                          The whole issue of readmission to the hospital has to do with an inadequate system for outpatient care and lack of communication between inpatient and outpatient doctors, which has only gotten worse with the rise of the hospitalist movement (I'm not opposed to this, btw, but it requires good communication) and turning over most post-operative care to mid-levels, the frontpage diary on PAs notwithstanding. Until we address that problem, we're going to have problems with hospital readmission rates.

                          System is FUBAR.

                          Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

                          by stitchmd on Sun Jul 26, 2009 at 04:46:51 PM PDT

                          [ Parent ]

                          •  And we come full circle... (0+ / 0-)

                            in my wife's case it is all coordinated and they are all part of the treatment plan from there is no waste, fraud and abuse...they planned 3 visits, we needed 3 visits, insurance approved 3 visits...and that is the way it should be...

                            Obama - Change I still believe in

                            by dvogel001 on Sun Jul 26, 2009 at 05:19:10 PM PDT

                            [ Parent ]

                    •  and I'll ask you one more time (0+ / 0-)

                      if you had to pay that $2500 dollar cost of your wife's medication (I'm assuming it's GCSF or something similar) every 2 weeks, would you? Would you if your insurance didn't cover it? Would you do it if the full cost of the more standard therapy was completely covered by your insurance, but this program is not? And do you know what the 'marginal' benefit of this is, anyhow?

                      Would you be willing to pay that cost?

                      Once again, I ask you not to dodge. You haven't answered directly any question I've asked yet.

                      Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

                      by stitchmd on Sun Jul 26, 2009 at 12:59:33 PM PDT

                      [ Parent ]

                      •  Yes...If the doctor's said it was... (0+ / 0-)

                        the best case (which they did) for preventing recurrence of cancer...I would pay every penny...

                        My wife is 44 years have basically 1 chance to get rid of the cancer (80% survival rate in stage II)  after that if it recurs it is a 20% survival rate...that means you should throw the kitchen sink at it in the first round because you basically only get one realist shot of killing the cancer...

                        In the scheme of her life $20,000 is a small price to pay...(8 x $2500)...

                        But I also believe that just because I am willing to pay for it others should not have to forgo the best and most effective treatment...

                        Obama - Change I still believe in

                        by dvogel001 on Sun Jul 26, 2009 at 02:50:43 PM PDT

                        [ Parent ]

                        •  here's the thing about it, though (0+ / 0-)

                          I've been in practice long enough to have seen a myriad of treatments for breast cancer come and go. I truly wish the best for your wife and I hope she beats it. Pre-menopausal breast CA is a beast, but many people do well - 80% as you say.

                          But the thing that has been shown over the past few years is that more is not always better. When I was in training and coming out of it (and I almost went into an oncology fellowhip) the big deal was to do fully ablative chemotherapy and then do a bone marrow or stem cell transplant. What was found was that the toxicity and risks (especially of the transplant not engrafting or not fully, I saw cases related to that which were truly ugly) were not outweighed by higher disease free survival rates and that overall survival was not better.

                          Yes, I'd give it a full guns gonzo blast, too. I'm the same age, and I have kids.

                          And I appreciate that you recognize and would be willing to pay the cost. It's not an option even open to most people.

                          Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

                          by stitchmd on Sun Jul 26, 2009 at 03:12:07 PM PDT

                          [ Parent ]

                    •  and just for your interest (0+ / 0-)

                      here's a link to the abstract first discussing intensive breast chemotherapy treatment. There was a non statistically significant trend toward increase in disease free survival; the toxicity of the treatment was much higher independent of the immunosuppressive effects. It's a far from settled deal that this improves the outcomes, sorry to say. And yes, this is the kind of study that would deserve close scrutiny if there were to be evaluations of what might be covered.

                      Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

                      by stitchmd on Sun Jul 26, 2009 at 01:05:41 PM PDT

                      [ Parent ]

          •  My parents have basically been kept... (0+ / 0-)

            alive on stents for the past 15 years and have made it to their 50th anniversary seen 4 grandchildren born and their oldest grandchild bat mitzvahed...yes that is worth the cost of stents...

            And I am well aware of the FDA process for approving medical devices...I have many clients over the years with companies that manufacture such devices...

            Obama - Change I still believe in

            by dvogel001 on Sun Jul 26, 2009 at 10:27:05 AM PDT

            [ Parent ]

          •  But I guess keeping someone alive... (0+ / 0-)

            and active for 15 years is not worth the would have been cheaper to let them both me selfish...

            Obama - Change I still believe in

            by dvogel001 on Sun Jul 26, 2009 at 10:28:22 AM PDT

            [ Parent ]

            •  that is not my point (0+ / 0-)

              and btw, my mother had stents in the early days and underwent cardiac bypass surgery in 2002 at the age of 75. I'm not saying let anyone die.

              And I can remember, back in the day, when I was a med student and a well-known nonagenarian patient was admitted with chest pain. The attending cardiologist was quite the hotshot (he was one of the first really aggressive invasive cardiologist, I wouldn't be surprised if the term "cath jockey" was coined to describe him as I've been told previously) but was very unwilling to take that particular patient to the lab (this was in the days before stents) because the doc was very concerned about the risk of coronary rupture or dissection. But the patient began to have an acute infarct overnight and the doc came in, wound up taking the patient to the lab for angioplasty, and he did just fine.

              But the question is whether multiple drug eluting stents are better than bare metal stents alone. Or, frankly, in many cases whether cardiac procedures are at all more beneficial than medical therapy. The costs are exponentially higher. And I've reviewed the data. The outcome data is not statistically significantly better for the DES than the BMS. But the cost is much higher. Not to mention the potential for complications of having to be on long term anti-platelet agents. The cardiologists who are frankly unable to look at the bigger picture, i.e., the whole patient, routinely refuse to allow patients to come off of those drugs even when needed for life saving surgery, and frequently surgeons won't operate if patients are on those drugs. I've seen it multiple times. Talk about your hidden costs.

              We need comparative effectiveness research. We need to look at outcomes data. We need, frankly, to look at the number needed to treat and the cost per number to treat to prevent certain outcomes. It shouldn't have to be a hard and fast number. I'm not saying every 80 year old should not receive dialysis. I am saying, however, if that 80 year old is demented, contracted, and living in a nursing home, and comes to the hospital in renal failure, that patient should not receive dialysis. Even if she's your mother. Or mine. There is a thing called medical futility and we, as physicians, and as patients, need to recognize that there are times when treatments serve no true useful purpose, and we also need to recognize that sometimes the costs outweigh the benefits. Again, if we had to bear the true costs, we would make those decisions readily, on an individual basis as well as a societal one.

              Of course, there needs to be flexibility, as in the case of the 95 year old with coronary disease.

              And here's one other thing, and it's something we physicians often forget: everything we do has some cost to the patient, even if it's drawing blood which incurs some kind of pain. Some patients are more willing to bear that than others. But we are often not honest with patients about what kind of burden they will bear with the treatments we suggest.

              It is not always appropriate to offer the newest, most fancy, most 'advanced' treatment, when an old treatment will work as well or frankly almost as well.

              Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

              by stitchmd on Sun Jul 26, 2009 at 01:27:39 PM PDT

              [ Parent ]

              •  We mostly agree... (0+ / 0-)

                except who should think it should be some central planner like in Canada...I think it should be the doctor along with the patient...

                But we mostly agree on that it should be the most effective treatment with the least amount of side effects and risk...I just believe that should be regardless of think cost should come into the picture..

                The other thing I vehemently disagree with is looking at procedures only based on should also be based on the overall comfort and benefit to the patient...

                So if there are 2 procedures one being bypass that has a 4 month recovery and one being angioplasti which has a 2 week recovery and they are equally effective...then the less invasive procedure should be used...

                Obama - Change I still believe in

                by dvogel001 on Sun Jul 26, 2009 at 02:32:29 PM PDT

                [ Parent ]

                •  but in the latter case (0+ / 0-)

                  there are clear guidelines about who should be referred for cardiac surgery. There are far less clear guidelines about who should get stents, and there are no guidelines about who should get multiple drug eluting stents, and the outcomes data does not show a benefit of multiple DES over BMS. And many patients will have a similar outcome with medical therapy alone.

                  What I am saying is not that there should be a central decision maker, but we need guidelines, evidence based guidelines, that allow us to make proper decisions for the individual patient. I would not have wanted my active 75 year old mom to not have had surgery based on some arbitrary decision maker, anymore than you would. The problem with evidence based medicine, as I've always said and have always taught the residents, is that studies are done on populations in aggregate, but that the patient in the bed is an individual. You can't determine their particular outcome, just discuss the risks.

                  But we don't have enough data out there to even begin to counsel patients appropriately. That's what we need.

                  I don't disagree with you, mostly, on what you say about the issues of comfort. When the spouse blew a disk and had neurologic problems related, I knew that if there was a good response to the physical therapy, it would save several weeks of being off work and laid up in recovery - and would still have required PT at the back end. So we saved the costs of surgery, not only monetarily but also in terms of time and pain of surgery. However, had there not been some improvement, let me tell you I would have been on the phone to my friend the neurosurgeon pronto.

                  But too many people think the first thing is to cut, and the idea of watchful waiting is not acceptable. A few years back, my mom, again, had problems with her knee. She'd had problems with her knee for a long time, but it got worse over a several week period. My parents called their regular doc who suggested she see a particular orthopedist, who was supposed to be the best in the area. But it was going to take several weeks to get in to see him, and my dad found that to be unacceptable, so he got her in with another doc, who also had a good reputation. Unfortunately my mom had a bad outcome. Would it have been better had she been to the original doc? Maybe. But this wasn't an acute, life threatening problem and waiting a couple of weeks might have led to a better outcome, of course, it might not have either.

                  I tend to be a therapeutic minimalist, and I like to deal with specialists who are very conservative and don't do things unless they are indicated. And I have attracted patients who have a similar mindset. People who want treatment now, right now, don't tend to stick around in my practice, but there are plenty of people in Baltimore who will accomodate them. Too many, probably.

                  Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

                  by stitchmd on Sun Jul 26, 2009 at 03:24:11 PM PDT

                  [ Parent ]

                  •  Believe me... (0+ / 0-)

                    as someone who has been through 3 major by all means it should be a last resort...and that is why when my condition started...the last person I spoke to was a surgeon...

                    Obama - Change I still believe in

                    by dvogel001 on Sun Jul 26, 2009 at 05:14:48 PM PDT

                    [ Parent ]

  •  Thank you! I'll keep fighting to make (7+ / 0-)

    Congress stay in instead of going off on their fucking vacation.

    I'm on Twitter. I'm also a part of the FDL team on health reform.

    by slinkerwink on Sat Jul 25, 2009 at 09:05:52 AM PDT

  •  How to get the "media" to talk about (10+ / 0-)

    the results of these studies, rather than continuing to focus on the "doomed" scenario or the "angry strife" scenario or--of course--the "government boogie man" scenario?  Can't figure this out.  It's great for us here on Dkos to read about this, but what about those Blue Dems' constituents, for example.  Any ideas?

    Sometimes I wonder whether the world is being run by smart people who are putting us on or by imbeciles who really mean it. --Mark Twain

    by SottoVoce on Sat Jul 25, 2009 at 09:07:09 AM PDT

    •  Call the BBB and CofC in their districts. (5+ / 0-)
      Recommended by:
      askew, lcrp, phonegery, moosely2006, JC from IA

      Talk about how many of their members have had to drop health care.

      Geez, even Walmart has come around in Arkansas and Mike Ross doesn't get it?

      Give every American a fair chance at the race of life - A. Lincoln and B. Obama

      by captainlaser on Sat Jul 25, 2009 at 09:13:36 AM PDT

      [ Parent ]

      •  There's a deeper issue that needs to be solved (5+ / 0-)

        to have coverage of anything that actually matters reach the airwaves.

        The corporate-controlled media is using their outlets to craft their message - and that does not include progressive issues...ever.

        Until the media ownership laws are changed, this is what we will see.

        Write the President and let him know that until we liberate the media - we're going to be fighting every battle in the dark.

        We need two lists: those we will work to elect and those we will defeat. If you're not progressive, you're not a Democrat.

        by moosely2006 on Sat Jul 25, 2009 at 09:26:55 AM PDT

        [ Parent ]

      •  Not out of the kindness of their hearts (1+ / 0-)
        Recommended by:

        People need to realize there are still Machiavellian reasons for opting to change their positions on employer-mandated health care with a public option.

        In Walmart's case, they calculated it would seriously hurt total cost to operate of their next rival, Target.

        We're going to have to model this all the way through, because we want a national health care plan with a public options, but not to the benefit of oligopolic businesses.

    •  It's going to cost you $9000/yr to do nothing (5+ / 0-)

      without health reform, average family premiums will grow to more than $22,000 by 2019, up from $13,100 today.

      While republicans are saying reform will mortgage our grandchildren's future, That reform will cost too much money. Democrats should be using these real numbers to paint the picture. A family of four pays about $12000/yr for heathcare premiums, if we do nothing in 2019 that same family is going to be paying $22,000.
      It's going to cost you $9000/yr to do nothing.

      Can you afford an insurance premium tax of $9000/yr?
      I can't.

      It should be a no brainer.
      Use some real numbers that stick in a person's head.

      They need to take this out of the "do-good" frame and put in the "save you money" frame.

      Of course, I don't what the projected cost of public option premiums will be in 2019. Maybe they will be $25,000 with all the goodies Baucus and Blue Dogs are holding out for.

      Today's problems are yesterday's solutions. Don Beck

      by Sherri in TX on Sat Jul 25, 2009 at 09:52:19 AM PDT

      [ Parent ]

    •  Take away their health care (0+ / 0-)

      Seriously, it was cynical of Mark Halperin, but he was right to say that health care would fail, or at least have serious problems, because the media people all had health care and didn't understand the problems.

      I think Obama's emphasis on insurance reform is the right way to appeal to those people who do have insurance to explain what reform would do for them.  And I think that taking most of the profit our and offering a public option will ultimately price the for-profit insurers only to high-end care, which is as it should be.

      If we get reform started now, it can be improved after the 2010 and 2012 electuions.  If it fails now for whatever reason, then we are looking at another 10 years most likely.

      That's a lot opf deaths and disabilities.

      Democracy needs accountability. Investigate and prosecute the Torture Thirteen.

      by Mimikatz on Sat Jul 25, 2009 at 10:03:39 AM PDT

      [ Parent ]

      •  Take away the Congressman's Health Care (0+ / 0-)

        Better yet, during August:

        It's only a short delay, so, it shouldn't matter, Mr. Representative, that you and your family won't mind being without health care for the the month of August.

        So it's only a few of you that need some time to think this through?

        Well 40 million people have had lots of time to think through being uninsured..

        So how about if we have a proportionately uninsured Congress that looks and feels like all of us...

        To make things fair, we can split it 50% / 50% Republican and Democrat and 50% of Mr Lieber-whatever he is.

        Guarantee you that they'll be running back to DC to get things fixed FAST!

  •  N Cavuto discussion re: health care=Soylent Green (2+ / 0-)
    Recommended by:
    captainlaser, PorkBelly

    There was a panel and a guest do not know his name happened upon talking about US denying healthcare and choices and essentially people will die like in the movie Soylent Green...proceeded to show a clip where there is an elderly man on a gurney and i think he is dead and being rolled into a one of those mortuary refigerators.

    I'm just in actual shock and I hope that someone captured this b.s. on tape.

    It is better to remain silent and be thought a fool, than to open your mouth and remove all doubt . -- George Eliot

    by fedupcitizen on Sat Jul 25, 2009 at 09:08:01 AM PDT

  •  Insurance companies vs. manufacturers (5+ / 0-)

    That's the choice Congress has.
    Unfortunately, insurance companies have more money for lobbying and more direct interest in the bill.

    "I'm not opposed to all wars; I'm opposed to dumb wars." -- Obama in 2002

    by Frank Palmer on Sat Jul 25, 2009 at 09:08:34 AM PDT

  •  It really comes down to this: (10+ / 0-)

    every reasonable forecast shows that unless we change course, health care costs will swamp the economy, because they are consistently growing faster than GDP.

    The US today spends 16% (and climbing) of its GDP on health, around twice the average of other rich economies, and yet a sixth of the population lacks medical coverage. Most Americans receive health insurance through their employer. The government picks up the bill for the poor and elderly. But an estimated 47m people fall through the cracks – a number that is rising as premiums soar.

    The number of uninsured is large and continues to increase in recent years as a consequence of declining employment in manufacturing industries that typically provide health insurance benefits, the creation of new jobs in service industries that typically do not, and employer health insurance cutbacks in the face of rising premiums and a weakened labor movement.

    The present course leads off a cliff. The status quo will, in the coming decades, bankrupt us. We must get this done this year.

    Now are the days we've been working for.

    by StrangeAnimals on Sat Jul 25, 2009 at 09:08:51 AM PDT

    •  The problem is that, like a truck screaming ... (12+ / 0-)

      ...down a steep grade qt 80 mph, the most likely health insurance reform is one of putting on the brakes instead of doing what needs to be done, steering into the runaway truck ramp, and then starting up under a whole new plan. The weakness of the most likely reform to be enacted this year may buy some help for some people for some time. The best face we can put on that is that it may buy time until we get a real reform, and it may reduce those final three figures in mcjoan's commentary. But it won't eliminate them.

      Some people would be better off not reading diaries they comment on, since they already have all the answers.

      by Meteor Blades on Sat Jul 25, 2009 at 09:38:57 AM PDT

      [ Parent ]

      •  So, since the legislators are goiing on vacation (5+ / 0-)

        to buy more time for the lobbyists to help them keep their corrupt ways...

        ...shouldn't we up the stakes?  The stake that scares this vampire is single payer. Let's put it back on the table and talk, in depth, not about how we CAN'T FUCKING DO IT, but instead on how it will actually solve the health care problems.

        Bottom line in case you haven't noticed - is that the health care industry has watered down the public option to the point that it's not reform at all.

        So, let's up the stakes. Advocate for single payer.

        We need two lists: those we will work to elect and those we will defeat. If you're not progressive, you're not a Democrat.

        by moosely2006 on Sat Jul 25, 2009 at 09:43:36 AM PDT

        [ Parent ]

        •  It has no chance. But I agree that it ... (4+ / 0-)

          ...should still be discussed. What a miracle it would be if there were two weeks in which the mainstream media narrative was fixed on an objective examination of the health care systems of all the other developed countries in the world - examining each of them in detail, without the usual: everybody stands in line for medical care in Japan, England, Canada, Germany, France, et al., and America has the best health care system in the world malarkey.

          Some people would be better off not reading diaries they comment on, since they already have all the answers.

          by Meteor Blades on Sat Jul 25, 2009 at 09:47:37 AM PDT

          [ Parent ]

    •  We Live in Interesting Times (2+ / 0-)
      Recommended by:
      phonegery, StrangeAnimals

      (posted this in an earlier comment thread)

      This issue is bigger than the "now." Yes, I think of the matrix everyday. The vast majority is still so plugged in. They won't see. Many living today will never see the truth. All of us here believe (I think rightly) that we have shed the plugs.

      We will have to work towards our ends over the long haul. We are just one small part of the history of making that happen. I am 55 years old. There were times I never thought I'd see the day when so many women were in the work place, when our schools were no longer segregated, and when a black man was elected President. Could I have ever dreamed something called the internet would show its potential for taking down a repressive regime? That the internet would be the force that could unplug so many all at once?

      My lifetime is a nano second of history and of all the events that make that history. My job is to move that history just one more inch toward the goalpost.

      We are up against strong forces, and we always will be. I want single payer, but it isn't going to happen this time around. I hope it will happen in my lifetime, and, in the meantime, I will work to unplug as many as I can.

      We are impatient, and we should be, because it is the impatient who move those inches.

      There is only one thing to do right now in regards to health care reform.

      We must make sure there is a public option that is non-profit, that has great potential, and that will eventually (if not now) be open to all. It has to be designed to work, not to fail, regardless of how many or how few are covered at the get go. To do this, we must create a firewall in the house with a block of votes that will accept nothing less.

      Nothing else is acceptable because anything else moves us back an inch instead of forward.

      They don't win until we give up.

      by irmaly on Sat Jul 25, 2009 at 10:21:17 AM PDT

      [ Parent ]

  •  Rand Article link broken? (1+ / 0-)
    Recommended by:

    When I click in the first link, I get a SYSTEM COKKIE ERROR.  Help?

  •  The real story is small business. Finally! (11+ / 0-)

    I'm pleased to see the President place competitiveness in the discussion of health care.  

    My landscaper has two crews.  Eight guys.  His business brings him a few hundred thousand a year in business.  He had one of his crew get sick and his health care insurer cancelled his health insurance for the company.  They offered to reinstate it for an increase in $35,000 in premium.

    He could not afford it and had to drop health care for his workers.  He hated to do it, but it was that or go out of business.

    How many more stories can you find where small business people are put out of business by health care companies?

    Give every American a fair chance at the race of life - A. Lincoln and B. Obama

    by captainlaser on Sat Jul 25, 2009 at 09:12:01 AM PDT

  •  And the Chamber's point is? (7+ / 0-)

    Many agree with the Chamber that a public insurance option would undermine the private insurance market ...

    How about doing nothing and undermining the nation's economy, my savings account, and most people's future? God, I hate most Chambers; they ruin our little towns with their "growth at any cost" mentality, and they'll do the same here.  

    stay together / learn the flowers / go light - Gary Snyder

    by Mother Mags on Sat Jul 25, 2009 at 09:14:45 AM PDT

  •  Face it we have corrupt government, won't fix it. (6+ / 0-)

    We just elected a progressive president with Democratic Congressional majority but they will not pass health care reform even though it is killing the nation's economy and citizens.

    On top of that we have a major recession that increases support for reforming health care.

    But Congress will not pass it. Obama will not even address the real reform needed as we see from his most recent empty, platitude filled speech.

    At the same time we have the industrial groups who profit from the current system bribing Congressmen to the tune of $150M per year.

    They use the money effectively ($2M to Senator Baucus) and are able to block health care reform.

    Corruption, "super majority" non-Constitutional rules, the US does not have a functioning government that can deal effectively with the nation's problems.

    •  Absolutely agree and on top of that our president (1+ / 0-)
      Recommended by:

      Holds a press conference to push his health care bill, babbles incoherently for over an hour and at the end plays the race card. WTF is that.
      So far in six months he has done nothing other than give our money away to the big corporations, and partisan special interest groups, bulshi t  the people who elected him and  we are getting HOSED again!  Is this the twilight zone or what, maybe the outerlimits, Alice in wonderland.  Surely, there must be a grand plan right, and we are just not smart enough to follow his tactical maneuvers?

  •  missed opportunity (4+ / 0-)
    Recommended by:
    lcrp, moosely2006, oxfdblue, JC from IA

    GM and Chrysler went bk in large measure because of health benefits for present and past employees.  For years they stinted on product to compete with foreign competitors that didn't have those costs.  Obama should be parading this out whenever he discusses health reform.

  •  "The Tyranny of Dead Ideas" (3+ / 0-)

    Matt Miller's new book discusses the paradoxical situation wherein Detroit executives uniformly opposed government-provided health care even as their own companies were driven toward bankruptcy by ever-increasing health care costs.

    Even the auto workers' unions opposed government health, apparently because they wanted to look like heroes to their members by negotiating health care benefits as another perq of union membership.

    One wonders what they'd do if they had it to do over.

    What is valued is practiced. What is not valued is not practiced. -- Plato

    by RobLewis on Sat Jul 25, 2009 at 09:21:09 AM PDT

  •  Sadly, a mere pittance (2+ / 0-)
    Recommended by:
    bigchin, moosely2006

    compared to the money to be made by skimming the industry of profiting on your neighbor's poor health.

    There's money to be made, dammit!  

  •  What are citizens to do? (4+ / 0-)
    Recommended by:
    irmaly, bluesteel, bigchin, phonegery

    The only major party that even pretends to give a shit about its constituents can't fund $100B/yr for health care, but it will fund trillions in war, bailouts to the wealthiest institutions in the world for poorly thought through speculation, and attempts to solve a major economic crisis by printing money.

    But we can't afford 1/20th of the budget for the 1/6th of the nation that has no health insurance.


    Citizens have no access while wealth non-citizen institutions have disproportionate access. Hell, they fucking write the laws congress passes. This can not continue. They are eating the nation and its economy alive. They seek to kill the goose and roast it tonight, for otherwise they might have to share its golden eggs.

    This nation has devolved into a corporate/government tyranny.

  •  Unfortunately, nothing gets "fixed" in the House (3+ / 0-)
    Recommended by:
    wsexson, bigchin, moosely2006

    or Senate plans.

    On this one criteria alone, both plans should be sent to the rubbish bin and talks started all over from scratch.

    Reform?  What bullshit.

    The cost of services will be exactly the same a day after that bill goes into effect than the day before.  Premiums may go down a bit, but neither bill addresses ongoing upward spiral of health care costs.

    "Those are my principles, and if you don't like them... well, I have others." - G. Marx

    by Skeptical Bastard on Sat Jul 25, 2009 at 09:24:42 AM PDT

  •  There is anothee thing that rarely gets (6+ / 0-)

    mentioned in arguments for a single payer health plan - Missed opportunities for personal and career growth.

    How many people stayed with a job they hated because they needed health care coverage for their families?

    How many people didn't try to open their own business because individual health care is too expensive?

    How many older workers stayed on at work, waiting until age 65 when they can get Medicare coverage?  How many younger workers missed an opportunity to move up because older workers couldn't afford to leave?  

    There would be more opportunities, less stress (a contributing factor in heart and chronic diseases) and certainly less paperwork (! to be hoped) with a public option, much less with single payer.

    It's ironic that a country which idolizes the "pull up by your bootstraps" and the "American Dream" myths.  Yet we have a health system that militates against these 2 profoundly American ideals.

    The land was ours before we were the land's...Robert Frost, The Gift Outright

    by HylasBrook on Sat Jul 25, 2009 at 09:25:32 AM PDT

    •  You're under the mistaken assumption that... (6+ / 0-)

      The wealthy and business leaders of this country want a more open economy for individual entrepreneurs. They talk that talk, but when it comes to legislation and regulation they use their influence to limit competition and even seek monopoly power.

      The United States is not anything approaching an open market with transparent standards. For a market like that is too dangerous for a large business with every market advantage to risk. Better to subjugate your peasants by limiting access to basic necessities and creating a baroque maze of arbitrary and capricious rules that bind them to a system designed to hold them in place like suspects in handcuffs.

      We have passed the point of no return. The republic is lost to a corporate dictatorship both political parties enabled.

      •  the GOP talks about small business (3+ / 0-)
        Recommended by:
        maynard, moosely2006, HylasBrook

        but, like everything else they talk about, is complete when Bush would talk about saving "family farms" by eliminating the estate tax, as if they gave a shit about family farms. As if eliminating the estate tax would just happen to give a bazillion dollars to the already absurdly wealthy heirs of the mega-rich, but really it's to relieve the "family farms".

        I'm not sure we're beyond hope, at least relative to, say the Reagan years, or the Robber Baron era, but if the Dems can't pass this health care reform, that'd pretty much prove that the non-super rich are utterly powerless to change their affairs by way of their votes.

      •  Call me paranoid, but I don't doubt that Wal-Mart (1+ / 0-)
        Recommended by:

        support for employee-paid insurance probably includes the feeling that such a mandate puts some of their remaining rural competition out of business.

      •  So, Maynard (1+ / 0-)
        Recommended by:

        I think to summarize your point.

        The US has become one big corporate run sweatshop.

        We need two lists: those we will work to elect and those we will defeat. If you're not progressive, you're not a Democrat.

        by moosely2006 on Sat Jul 25, 2009 at 10:02:22 AM PDT

        [ Parent ]

  •  The House Should Start Counting The Votes (1+ / 0-)
    Recommended by:
    JC from IA

    Majority leader Pelosi should have Rep Clyburn whip the votes.  If they need a certain amount of the blue dogs to come on board they could start on the more moderate of the blue dogs, and go to them and put the pressure on them or could offer them more money out of the DCCC pot.  There are blue dogs who are more like elephants that will never vote for this bill and will side with the repugs.  Pelosi has to know who these reps are.  It is useless to deal with them.  Some blue dogs are honest and want to do the right thing for their constituency, but doing the right thing would be voting for health care reoform.  Theses blue dogs need a nudge on realizing that.  It amazes me that we have democrats who have be nudged to do the right thing.  I know one thing, we democrats will be watching closely on who votes yes and who votes no.  There will be consequences.

  •  Health Laffer Curve? (0+ / 0-)

    The Laffer Curve (the theory of Reaganomics whereby lower taxes were said to increase revenue by stimulating growth and increasing the tax base) was shown to be bullshit in practice. Is that why I never read that a healthier workforce will generate revenue sufficient to pay for insurance reform--because the two ideas are similar?

    Of course I may have missed it. It sounds like a job for Nate Silver.

  •  Huge momentum at the end of August (3+ / 0-)

    Starts with a lot of work to get the ball rolling now.

    •  And that ball (3+ / 0-)

      needs to be single payer.

      You know, the Republicans take simple points and trumpet them over and over.

      Single Payer is a simple point. It's easy to understand - just make everyone eligible for medicare if they CHOOSE.

      And there's not way to water it down.

      I mean what's with this Baucus crap? Taking boatloads of money from health industry lobbyists, without shame or cover - and then turning out NOTHING.

      He's a fucking tool.

      Single payer. It's simple. It's understandable. It's time.

      Single Payer. Single Payer. Single Payer.  

      Medicare for all.

      We need two lists: those we will work to elect and those we will defeat. If you're not progressive, you're not a Democrat.

      by moosely2006 on Sat Jul 25, 2009 at 10:05:24 AM PDT

      [ Parent ]

  •  but will it cost less? (4+ / 0-)

    I work at a non-profit located in Florida. Last November we laid off 10% of our staff as a preventative measure against lower donations. We were also told that we'd now have to pay for more of our health insurance. Oh, and no raises for 2009, and probably 2010. I'm sure this is a familiar story across America.

    Luckily for us we had a board member step up and anonymously donate an amount that would cover health care costs through September of this year. So in a month, the squeeze will be on at work. Worse thing is suddenly having to come up with another $100 a month isn't so bad when you're an executive level employee, but if you're entry-level, that's possibly 10% of your take home, or more.

    So I want to know exactly this plan will help non-profits like ours. Anyone?

  •  The $22,000 may be too low (2+ / 0-)
    Recommended by:
    phonegery, moosely2006

    For us to get to $22,000 in 2019 requires a dramatic slowing in the current rate of health insurance cost growth - because that's only a 5% annual increase. If there are any of you seeing only a 5% annual increase, please raise your hands.

    Of course, they're probably appreciating that even the health insurance companies can't charge more than we earn.

    (I also think $13,100 is not today's median, but rather a 2008 number. In the world of compounding, this makes a difference.)

    If you instead use 8%, the 2019 number is around $32,000.

    If you instead use 10%, the 2019 number is $41,000.

    Our policy, over the last 5 years, has had an annual increase ranging from 9% to 19%.

    Fry, don't be a hero! It's not covered by our health plan!

    by elfling on Sat Jul 25, 2009 at 09:33:18 AM PDT

    •  Question (0+ / 0-)

      Is it true that one or more of the bills currently out there determines that no individual can be out of pocket more than $5,000 in any given year (counting premiums, co-pays, health care costs, etc.)?

      If that's the case, how will that work? If the average cost of premiums a year is $12,000 or so, how does this $5,000 out-of-pocket cap work?

      They don't win until we give up.

      by irmaly on Sat Jul 25, 2009 at 10:28:20 AM PDT

      [ Parent ]

      •  The cap means (0+ / 0-)

        That after you pay for your insurance, you can't be asked to pay more than (say) $5000 per individual in co-pays, co-insurance, blah blah blah.

        For example, most insurance goes something like this:

        $2000 deductible - before this is hit, you are responsible for all costs. Or all costs in certain categories, like the ER.

        THEN, above the deductible, there's a split. It could be 90%/10%, where the insurance pays 90% of all the next band of costs. It could also be 60%/40%. Imagine a $100k hospital bill. Yes you have insurance.... but you are so screwed, man, on the hook for a bit more than $40,000.

        Some policies have an out of pocket maximum. So if it's $10,000, you pay your deductible, $2,000, then $8,000 of the next $80,0000 in bills, and then after that the insurance picks up everything... until you hit your lifetime cap. Your lifetime cap could be as low as $1 million or as high as $10 million. A $1m cap is fairly easy to hit. After THAT cap, the insurance pays 0% and you're SOL.

        Fry, don't be a hero! It's not covered by our health plan!

        by elfling on Sat Jul 25, 2009 at 06:45:03 PM PDT

        [ Parent ]

  •  Medicare for All (5+ / 0-)

    Yes, it is "socialized medicine".  Get over it.  Congress has it.  Greedmongering profiteers in the health insurance industry hate it because it will end their corrupt careers and close the gold mine.
     Single payer is the way to reduce costs--buying in volume works to do just that.  Big Pharma sells drugs to the Canadian government at 25% of what they charge Americans because of this.  And the U.S. government heavily subsidizes drug company research and development of new drugs (Corporate Welfare) to add insult to injury.  Get smart--that's "socialized medicine" and price gouging.
     Do you deserve the best care anywhere, the same that the president and Congress receive at your expense?  I do!  If you do too, then let them know you will accept nothing less!

  •  We're reforming insurance, not care. n/t (2+ / 0-)
    Recommended by:
    riverlover, bigchin

    How do you tell a predator from a protector? The predator will eat you sooner rather than later.

    by hannah on Sat Jul 25, 2009 at 09:38:14 AM PDT

  •  The only health care reform (3+ / 0-)
    Recommended by:
    bigchin, phonegery, moosely2006

    that would relieve business of these burdens would be government run single-payer.  No "reform" building on the current system" no matter how public optiony would eliminate these uncontrolled and uncontrollable costs that are spiraling businesses as well as their employees into a financial wall.

    "99% of the battles and skirmishes that we fought in Afghanistan were won by our side." ~ Marshall Akhromeyev

    by ActivistGuy on Sat Jul 25, 2009 at 09:40:06 AM PDT

  •  Except that, what Obama says and Congress does (2+ / 0-)
    Recommended by:
    bigchin, phonegery

    are two different things.

    Proposals on the table now don't do much of anything to cut health care costs.  That would require some actual structural reform measures.

    In a way, the current effort is the opposite of HillaryCare -- instead of swamping everybody with its reach, it underwhelms, and underwhelms in a way that increases risk to individuals and the economy as a whole.

    Frankly, it's criminal.  Employers who provide decent health care know would get behind reform that cuts their costs.  It's a big win for them.

    Employers that offer health benefits but can't currently afford to cover much of the costs would likely be interest as well.  They could become more competitive  in the job market if that benefit gap is narrowed.

    Employers that would like to offer health care but can't afford it at all might be interested as well.

    That's a lot of businesses up for grabs, and a lot of potential lobbying of their employees to get behind health care reform.

    And, in the end, the only way we can afford to cover everyone is to puncture the cost balloon. Simply laying a Medicare or Massachusetts style veneer on top of the current rotten edifice is a recipe for failure.

    Free speech? Yeah, I've heard of that. Have you?

    by dinotrac on Sat Jul 25, 2009 at 09:41:43 AM PDT

  •  The wallstreet repukes that stole trillions (1+ / 0-)
    Recommended by:

    timed it so healthcare would appear immpossible. All part of the american-hating, freedom-hating, liberty-hating repuke plan. Or do we get kicked of this "liberal blog" for suggesting such a thing.

    The world will never forget: the crimes and atrocities committed by the Bush administration!

    by Freedom Loving American on Sat Jul 25, 2009 at 09:43:57 AM PDT

    •  It's a little CT (0+ / 0-)

      but - these days, I'm not thinking that's so crazy anymore.

      Look where we are - look where the corporations are.

      We've been had.

      We need two lists: those we will work to elect and those we will defeat. If you're not progressive, you're not a Democrat.

      by moosely2006 on Sat Jul 25, 2009 at 10:09:34 AM PDT

      [ Parent ]

  •  This American Life on NPR today (4+ / 0-)

    is doing a segment on denied health care.

    I agree with TeacherKen's diary on the rec list.

    We should be mad as hell and not take it any more.

    No Senator or Congressman goes home in August without having people camping on their lawn.

    Let's hold triage health care clinics on the street in front of Congressmen's houses.

    Give every American a fair chance at the race of life - A. Lincoln and B. Obama

    by captainlaser on Sat Jul 25, 2009 at 09:47:19 AM PDT

    •  Let's up the ante (3+ / 0-)

      Don't give them complex "Public Option" bills to water down, obfuscate and fill with legal language to render them impotent.

      Single Payer. It's the "We're Mad as Hell" position in it's purest form.

      It's not new - it's been on the table for 60 years.

      It's effective - every other industrialized nation thrives with it.

      It's simple and easy to convey - Medicare for all.


      Keep it simple, just like the Republicans.  One point. Single Payer.

      Single Payer. Single Payer. Single Payer.

      We need two lists: those we will work to elect and those we will defeat. If you're not progressive, you're not a Democrat.

      by moosely2006 on Sat Jul 25, 2009 at 10:12:26 AM PDT

      [ Parent ]

    •  TeacherKen's diary (1+ / 0-)
      Recommended by:

      talks about a clinic offered by health care providers.  Your idea of doing the same thing very visibly is great.  People came from miles around, and they had too many to help.

      At the capitol, it would be on teevee.

      I'm new here; lurking since before '08 election. I'll try to find something pithy from William Wilburforce.

      by Regina in a Sears Kit House on Sat Jul 25, 2009 at 11:22:24 AM PDT

      [ Parent ]

  •  what costs will be cut? (1+ / 0-)
    Recommended by:

    I have posted on this before.

    I want universal health care.  I want all to be covered.  I want there to be doctor decisions on treatment.  I want everyone to have access.

    What each of those statements does not include is how to cut costs.  

    The majority of Americans are relatively pleased with what they have now.  What seems to be true is that they are wondering how our plan will cut their costs, reduce their premiums, reduce the hole in the middle of schedule D, reduce their co-pay.  You cannot cut costs without cutting out something that you are paying for now.

    There has been little or no discussion of this.  Cutting drug company salaries and profits, cutting out insurance companies' profits, reducing redundant services (too many heart centers in each town), reducing unnecessary testing (?), and such have all been mentioned, but there is no definitive plan to cut costs (witness Elmendorf).

    Until that is clear, the population will think we are going to reduce services and no amount of pushing on congress will change their minds.

    Send your college kid a little love

    by graybeard on Sat Jul 25, 2009 at 09:57:29 AM PDT

    •  Cut out "insurance" (1+ / 0-)
      Recommended by:

      Obama now says: "health insurance reform"

      and what we will get is somewhere between none and zero, because insurance is the problem.

      The UK's national Health System, as I remember it: E&O warning: It's not current as I don't live in the UK now.

      Paid for by National Insurance Contributions.
      Covers all residents, cradle to grave, for about the same percentage of GDP as Medicare.
      Has no claims, payments and any of the insurance paperwork.
      GPs are paid a capitation rate, a fixed amount for patient on their "list".
      Specialists (Hospital Doctors), nurses and admin staff, are paid by the NHS (they are all employees of the NHS) on a pay scale.
      Drugs are charged a fixed fee per prescription. OAPs (Senior Citizens) do not have to pay a fee.
      The terminal, are not hooked up in ICUs.
      There is a focus on Prevention, Child en & health, not sickness.
      If you don't like the NHS you have to option to pay from private treatment.
      Longevity and Infant mortality, the best measure of a Health System, are better than the US.

  •  mcjoan, (1+ / 0-)
    Recommended by:

    I came across this July'09 poll by Kaiser (not sure if this has been looked at and posted on by you or other FPs): Key Findings: Kaiser Health Tracking Poll—July 2009 which has some interesting findings on the public plan option (some 59% support it, but the support is down from 67% in their earlier poll) giving indications as to how Dems/Obama should message on it to keep the support level for it high in public opinion.

  •  Where was The Rand Corp. all these years? (0+ / 0-)

    All these years with no health care for all Americans, and where was The Rand Corp. on this issue?  Last time I looked, the Rand Corp. was funded in great part by taxpayers, so one would expect that they be non-profit.  I wonder if all their employees get health care.  I would guess that they do.

     The Rand Corp. (spoofed by Dr. Strangelove as The Bland Corp.) never seemed to be interested in health care until now.  I guess they're finally realizing that corporations can't continue to pay the exorbitant cost of health insurance and still compete with corporations whose governments cover all citizens.  Also, some countries actually control and regulate health costs, but in the U.S. we have something like economic anarchy where there are no rules or regulations on making money, and in the recent past, the ones we might have, haven't really been enforced.

    Couldn't all those brilliant people who work for the Rand Corp. figure out that there's always a demand for health care and that invisible hands and the laws of supply and demand don't apply to issues of life and death?  Also, people can and will be forced to pay exorbitant amounts of money for things they can't live without, unless of course, someone with an ounce of commen sense does something about it.  It certainly took them a long time to figure out the obvious.

    So it must be that the Rand Corp. is concerned about health care affecting how much money a corporation can make and how this affects  investors and the future economic security of the entire United States of America.  They never seemed to be interested in health care when the forgotten people without it suffered and died in silence.  Well, we'll take their support if they're willing to give it.  After all, it's barbaric to brag that you're the richest nation on the planet when so many of your people are suffering and dying because the people who are supposed to care really don't.    

    •  Rand is frequently cited for this study of copays (0+ / 0-)

      The study compared how people used health care in circumstances where it was free, a small co-pay, an a large co-pay. What they found is that higher co pays caused people to use less care, but they went without both needed and unneeded care.

      Fry, don't be a hero! It's not covered by our health plan!

      by elfling on Sat Jul 25, 2009 at 10:22:31 AM PDT

      [ Parent ]

      •  Health care should have been done long ago (0+ / 0-)

        because it's the moral, humane, decent, and right thing to do.  It's very disappointing that it's always and only about money for many people, especially the people who make these decisions.

      •  Higher co-pays leading to less care seems obvious (0+ / 0-)

        Health care should be done because without it, people suffer and die.  It's really very simple.  Even a child can figure that out, sometimes even better than lots of adults.

  •  Single-payer IS economic stimulus (2+ / 0-)
    Recommended by:
    phonegery, moosely2006

    and the "public option" churning its way through Congress is an obscene give-away to the private insurers,  See Bill Moyers last night...

    Here's a diary I wrote many months ago: Single - Payer Is Economic Stimulus: NNOC, CNA

    "History is a tragedy, not a melodrama." - I.F.Stone

    by bigchin on Sat Jul 25, 2009 at 10:10:50 AM PDT

  •  Filed for chapter 7 on medical bills (5+ / 0-)

    should be going to court within the next week
    Medicare part A didnt cover an emergency appendectomy or a hospital visit for a possible heart attack.
    court date next month from a lawyer who doesnt know that you cannot squeeze blood out of a turnip.
    disabled with no garnishable income and no property that leins can be placed on yet a lawyers insistance on bringing it to court forced me to file

    •  Congratulations (1+ / 0-)
      Recommended by:

      You're the poster child for what the health care industry has done to this country.

      Bless you and I'll pray for you.

      We need two lists: those we will work to elect and those we will defeat. If you're not progressive, you're not a Democrat.

      by moosely2006 on Sat Jul 25, 2009 at 10:14:33 AM PDT

      [ Parent ]

    •  Binding contract (2+ / 0-)
      Recommended by:
      bigchin, Bluerall

      In an emergency, your imminent death, you signed a contract.

      Why is this contract binding? Contracts signed under duress (and I'd believe your immanent death is a good definition of duress), are not binding.

      What does you lawyer say to this?

      •  Actually I didnt sign anything (0+ / 0-)

        contract being more verbal, still the hospital split the bill 9 ways to sunday
        Was trying to pay them off 1 or 2 at a time
        the er docs billing demanded 150 a month
        tried to explain that having 9 bills while being disabled there was no way to pay that amount
        they demanded it and said if i didnt pay that amount i would have to pay court costs and attorney fees
        2 years ago the attorney met me at court,he was informed I was disabled with no property, again the attorny tried to get me to agree to the added costs at 50 dollars a month that I could afford, I refused to accept the added costs, I will not be blackmailed into higher costs because of an outrageous demand by the billing dept. was told to expect a court date in 6 months, 2 years later i get a court date

        •  oh my bankruptcy attorney said (0+ / 0-)

          my situation is commonly called uncollectable and she couldnt believe the other lawyer was persisting in going to court

          •  Noncollectable? (0+ / 0-)

            When you agreed to pay you ratified the verbal contract.
            If you have refused to pay, and insisted the contract was formed under duress, and not enforceable, and that the treatment was a gift because of your financial status, you'd have had a better chance of escaping the collection activity.

            Starting to pay is a mistake. You are ratifying (agreeing) there was treatment was given for a consideration (money), and not as a gift.

            Now you are where you are...I surprised that the bankruptcy trustee has not jumped all over the plaintiff.

            •  you misunderstand (0+ / 0-)

              several things

              Uncollectable as in no way to enforce payment
              because my disability is not garnishable and I have no proprty to seize/put leins on

              I didnt start payment on that particular bill

              •  Did you start payment on any bill? (1+ / 0-)
                Recommended by:

                Then you ratified the contract(s).

                I understood uncollectable, no means to pay.

                The other thing is that you got bills from many vendors, and contracted with the one (the hospital). I've always questioned how these forms of contract are enforceable.

                Because you and I cannot enter into contract which is not discussed between principals, not agreed, and no discussion of price, terms & conditions.

                That would be a clear definition of "no meeting of the minds" and hence not a contract. If the doctor went ahead without those items, then again, it looks like a gift.

                An interesting defense would be a demand: "both show me the contract, and prove it's a valid contract".

                •  See the thing is (0+ / 0-)

                  one contract with the hospital
                  and not with all the individual contractors
                  ie ER docs
                  nursing staff
                  etc etc
                  I provided proof of medicare part A to the hospital
                  it paid part of the billing
                  the remaining unpaid billing got seperated and the billing started
                  I have been recieving bills left and right with no documentation many times double and tripled billed
                  I paid off 1 bill of 300ish and was halfway thru 1 bill of 900ish
                  it took a viewing of my credit report to find that I owe close to 8000 with many of the bills being reported twice and the doubles bill being reported at a small varience
                  No way can I afford that with all my other debts/responsibilities

        •  Can you apply for Financial Aid? (0+ / 0-)

          Some hospitals have a group, not in Billing, that receives appeals for financial aid.  A friend who is a young widow, had many bills after her husband's death from glioblastoma.  She successfully applied for financial aid and had substantial reductions in her remaining bills.

          I also have learned, once one hospital system agrees that financial aid is ok, other providers fall in line afterward.

          I know more work when you are sick.  Hope you can get help with this.

          I'm new here; lurking since before '08 election. I'll try to find something pithy from William Wilburforce.

          by Regina in a Sears Kit House on Sat Jul 25, 2009 at 11:26:41 AM PDT

          [ Parent ]

          •  nope (0+ / 0-)

            even tho im disabled I make too much to qaulify
            go figure
            Right above the cutoff for aid
            Eli Lilly the pharma giant here in Indiana has a grant for the poor but you gotta make well below the poverty line to qaulify and Im just above it
            Many aid programs are like that
            alot fall in the cracks

  •  The Cost Conundrum (1+ / 0-)
    Recommended by:

    Here's a New Yorker Article by Atul Gawande I found interesting, although many here have probably read it already:

    The Cost Conundrum

    It looks at the various factors behind why one town has extremely high health costs, while a similar town does not. Worth a read. (Also see his response to some criticism about the article.)

    •  We need both single payer and single employer. (0+ / 0-)

      There is no limit to greed.

      The doctors and the method of payment (payment for procedures) are at fault.

      Manufacturing discovered long ago that piecework (greed) and quality are incompatible.

      That the heath care need systemic reform, and not just reform health care insurance.

  •  Small businesses helped by health care reform (0+ / 0-)

    Even the Democrats are talking about there being an "8% penalty" on small businesses that don't provide health care.  But, in the House bill, this amount applies only to "small" businesses with a payroll of over $400,000.  Real small businesses with payrolls of under $250,000 actually get help providing health insurance.  And, this should NOT be described as a penalty.  Rather, these large "small" businesses will be required to provide 72.5% of the cost of health care coverage for their employees.  If they cannot or choose not to do that, the government will arrange for that coverage at a cost to the business of some percentage of payroll.  To call this a penalty instead of a reasonable cost of doing business is self defeating.  As health care costs rise, the government is allowing businesses a way out that will cost less than the cost of providing health care in many instances.  

  •  Psh. (1+ / 0-)
    Recommended by:

    You and your "facts". I want to hear more about Michael Steele's great aunts hip.

    Some say we need a third party. I wish we had a second party. -- Jim Hightower

    by joe m on Sat Jul 25, 2009 at 10:21:50 AM PDT

  •  win/win (0+ / 0-)

    of course, it is still the economy stupid and its and american's recovery. those of us supporting president obama understand this. we know those government run programs such as medicare (until good ol' gwb catered to the health care industry in 2003 along with big pharma) and the VA provide excellent service for our tax dollars.

    the supposedly blue dog "conservative" democrats blocking this reform know which side their bread is buttered and by whom - the health care industry and the huge profits they are garnering at the expense of their policy holders.

    where were these guys when the tax cut to the wealthy was passed frivolously spending the budget surplus left to them by the clinton administration; or the war without end costing this country in blood and dollars and the obscene wealth transfer to those like halliburton, blackwater; or the ponzi scheme known as investment banking?

    the conservatives managed to bankrupt this government so, by default, there will be no government. "rollerball" and "1984" have arrived to our reality.

    the conservatives managed to

  •  It is obvious... (0+ / 0-)

    that there will be healthcare insurance reform this year.  The only question is whether it will be meaningful or not.  Regrading that: Obama & Co. have  done little publicly to make the case that a single payer system elininating the insurance industry all together will dramatically lower costs while maintaining present services and extending it to the thousands who do not have coverage.


    Now, there's a word.

    Why do we say "coverage" as if we are covered like a blanket.  Anyone who has   extensively dealt with our insurance system knows that its all about the money, baby!  They want to keep it!  You ain't gonna get covered!


    What the heck is that word all about.  Only in America can some pinhead accountant come up with a word like that to help deny that other word, "coverage", to millions of people who need care.

    Only late in the game is BO telling people what economic catastrophe lies ahead if we continue with the present system.  I say "Bravo!"  he and his minions (like you) need to amplify this message: the next economic recession will occur in a few years ALL because of the insuranbce industry.

    If you want to win the hearts and mindless minds of corporate America, you must show them the financial benefit.  

    SHOW THEM THE MONEY!!! And they may follow us to the promised land of a government run healthcare system where everyone, yues, even you my little dweeb, will be covered!

    •  It is also obvious (1+ / 0-)
      Recommended by:

      The "health care insurance reform" will not change they problem.

      Insurance and payment for procedures is the problem. It may be that Greed and the Collective culture will make a solution fail.

      There are three enemies:

      1. For profit insurance
      1. for profit hospitals
      1. Payment for procedures - doctors as businessmen.

      At best "health insurance reform" tackles one third of the cost, leaving the other two thirds undone.

  •  U.S. healthcare (0+ / 0-)

    system has failed. For what we spend and get in return for it is an outrage. Yet the conservatives are scaring people by lying about universal healthcare and it's working like it always does. They use buzzwords and slogans that go unquestioned. Between the medical industry, the conservatives and the MSM it is an uphill battle to get anything done.

  •  Pure Human Joy & Hope (0+ / 0-)

    in spite of all the 'horrors in health care'.

    I thought I would share this video because I feel it captures the purest of human hope and joy.

    Simply Fun and you will smile - when finished wathcing let's get back to work

    Demographics do not equal destiny.

    by dr fatman on Sat Jul 25, 2009 at 11:00:30 AM PDT

  •  One of the oppressive effects (1+ / 0-)
    Recommended by:
    Regina in a Sears Kit House

    of our current (non) system, is restriction on mobility of labor, for fear of losing healthcare.  All these small business entrepreneurial, innovative folks that are gonna get their asses taxed?  There is a huge population of potential entrepreneurs stuck in feudal serfdom because, even if they wanted to start a small business, can't, because they'd have no affordable access to healthcare.
    This sux, time for real change.  What head of household would abandon healthcare for their kids to start a business?  

    Those who hear not the music-think the dancers mad

    by Eiron on Sat Jul 25, 2009 at 11:02:42 AM PDT

  •  Wal-Mart tell employees to ask doc for samples (1+ / 0-)
    Recommended by:

    Wal-Mart made the news twice this week. They're doing a bit of rationing (of course, Republicans don't believe that rationing exists today).

    First, on July 20:

    Walmart Axes Half the Drug Brands Covered in Employee Health Benefit Plan

    Previously, Walmart’s health benefits covered about 260 brand name drugs — from Abilify to Zyprexa – according to a Walmart "Quick Reference Preferred Brand List" from January 2009. The July 20, 2009, list contains only about 128 preferred brands.

    The move has huge consequences for workers’ health — Walmart is the U.S.’s largest employer with about 1.1 million employees (or "associates," as the company calls them). Roughly 700,000 associates are covered by the health plan, a Walmart spokesperson said.

    In talking with my drug benefit provider, I was told that most insurance companies use the same formulary (that list of approved drugs). So it will be interesting to see if this spreads beyond Wal-Mart.

    From the notice to employees:


    Effective July 20, 2009, the Preferred and Non-Preferred Brand Name Drug programs will be eliminated and will be replaced with a singe [sic] Brand Name Drug Plan. All of the drugs covered under the Non-Preferred Brand Name Drug Program will be eliminated (except Specialty Drugs).

       Important changes to your Pharmacy benefits include: ... A single Brand Name Drug benefit with a cost to you of $30 or 20 percent, whichever is greater. (Any Brand prescription drug not on the Brand Name Drug List will not be covered.)

       We are committed to helping you save money and live a better life.

    You can download Wal-Mart's notice to employees here.

    Wal-Mart then sent out a list of questions to ask your doctor. Some of them could be helpful. But there's this:

    Walmart Wants Workers to Ask Docs for Generics, Samples Instead of Branded Drugs

    Walmart is asking its associates to suggest to their doctors "less costly" forms of treatment in a scripted list of questions that sometimes appears to be more in the interest of Walmart’s finance department than that of the patient.

    Samples, of course, cost Walmart nothing. But as drug companies only ever provide docs with samples of branded drugs, patients who receive samples will only get a taste of something that may no longer be on the menu.

    Side note: Those who believe President Obama’s healthcare reform plan is a communist plot to destroy our freedom to choose the luxurious healthcare plan offered by our employers may want to examine Walmart’s healthcare reforms closely. Where Walmart goes, eveyone else follows sooner or later.

    So true. My company sent out notice that they will no longer cover a brand name drug of a generic equivalent is available. They are also increasing the co-pay for generics so it is a few dollars more than what you pay for a 90 day supply at Wal-Mart or Target or the other retailers offering similar pricing. I'm sure it's so we no longer go through our insurance.

  •  I'm one of the 53,507 bankruptcies (0+ / 0-)

    My bills go back to 2007 but I saw the bankruptcy lawyer last week and things get put in motion next week. Yay for debt repudiation, darned shame about wasting eighteen months of my life being sick that didn't have to be.

    "Not dead ... yet. Still have ... things to do." -Liet Kynes

    by Stranded Wind on Sat Jul 25, 2009 at 11:28:19 AM PDT

  •  What makes one a Bluedog Democrat? (0+ / 0-)

    The willingness to take money from special interest and then let that money sway your vote away from serving the people?

    While the Healthcare Industry is threatening the Bluedogs that they will support Republicans against them in the next election....WE should inform them not to worry about it, since they will be knocked out in a primary if they continue to block reform/single payer.

    Hopefully, with Healthcare Reform passed, the greed-based healthcare industry will become less politically potent, and they won't be able to effect the Bluedogs in their districts.

    National Socialism is to Socialism, as counter clockwise is to clockwise

    by Carbon on Sat Jul 25, 2009 at 11:35:14 AM PDT

  •  None of them really care about the economy (0+ / 0-)

    Protecting their positions as adjuncts to the owning class, that top 1% who own half of all non-home capital assets, is really their priority.

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

    by Cassiodorus on Sat Jul 25, 2009 at 11:39:09 AM PDT

  •  more douche-baggery from Grassley (0+ / 0-)

    Trying to gut the public plan for some bipartisan sauce.

  •  Nice facts but you forget that this is not reform (1+ / 0-)
    Recommended by:

    Throwing more money into unreformed institutions was not a reform of the banking and financial sector.  

    Throwing money at health insurance is no reform of the health care sector.  Continuing the employer-based model, continuing the model in which getting sick means losing everything -- and that is what HR 3200 promises -- is not reform.  

    We need health care guaranteed -- not another d@#$%d insurance policy with premiums and out of pocket expenses and individual and business mandates.  

    The fundamental model is wrong: "insurance" is not what we should want or think about.  Rights and guarantees of those rights are the appropriate model.  A right to buy insurance is one thing.  A mandate forcing us to buy is another, and removes my rights rather than enforcing them.  

    HR 3200 is fake reform.

    Whatever your hand finds to do, do it with all your might. Ecclesiastes 9:10

    by not2plato on Sat Jul 25, 2009 at 11:47:33 AM PDT

  • (0+ / 0-)
  •  March on Washington (1+ / 0-)
    Recommended by:

    Many years ago I recall millions of Americans marching on Washington for women's rights.  "Hey hey, ho ho, George Bush has got to go" was the chant of the day.  Why aren't we doing this today?  Why isn't a march being organized for around Labor Day if there is no bill by then?  What's happened?  This issue is at least as important and affects men as well as women.

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