Obama Care

Thats why I choose a female Dr. ..... cough , cough ... LOL !

I was seeing a female doctor for a "check up". She asks me, "Do you mind having a female doctor examine you?" I told her that if I minded strange women handling my family jewels, I wouldn't be seeing a doctor. :FIREdevil

I was seeing a female doctor for a "check up". She asks me, "Do you mind having a female doctor examine you?" I told her that if minded strange women handling my family jewels, I wouldn't be seeing a doctor. :FIREdevil

Haha, nice.

I was seeing a female doctor for a "check up". She asks me, "Do you mind having a female doctor examine you?" I told her that if minded strange women handling my family jewels, I wouldn't be seeing a doctor. :FIREdevil Ha , I know your Dr. Says she cannot wait to grab , I mean see you again .

And so it begins:
NYT: Drug firms raise prices ahead of reform - The New York Times- msnbc.com (http://www.msnbc.msn.com/id/33959759/ns/health-the_new_york_times/)

"Even as drug makers promise to support Washington’s health care overhaul by shaving $8 billion a year off the nation’s drug costs after the legislation takes effect, the industry has been raising its prices at the fastest rate in years.

In the last year, the industry has raised the wholesale prices of brand-name prescription drugs by about 9 percent, according to industry analysts. That will add more than $10 billion to the nation’s drug bill, which is on track to exceed $300 billion this year. By at least one analysis, it is the highest annual rate of inflation for drug prices since 1992.

The drug trend is distinctly at odds with the direction of the Consumer Price Index, which has fallen by 1.3 percent in the last year."

12th - I read the article you referenced. It seems to cite the same concerns I (and others) have previously discussed here (and in the other 50 pages of health care discussion) without really saying anything other than "We'll see".

Saden - Other than the pledge from health care actors to find ways to lower costs and the issues you have cited concerning doctors, what other cost cutting methods are in teh bill? You cite the generic pooling that is to occur, that's fine but ignores that the increased pooling also creates increased costs. With HC costs rising steadily w/in the current framework, what systemic changes to the insurance based system are being proposed? I am aware of none. Rather, the public option included in the bill appears to be nothing more than a gov. run HMO which will be even further divorced from market forces than the current system. (See Schneed's various discussions as to how little market accountability currently exists in the healthcare system).

I have read the various summaries you have provided. I do not see where the "downward pressure" on costs is coming from. Mandatory pooling will not cure the cost inflating ills created by the anti-market influences of the current voluntary pooling system.

Your assumption is that we're already at 100% capacity utilization of our health-care system and those 47 million new patients will utilize the capacity all at once. I don't believe this to be the case across the country. Furthermore you aught to be familiar with H. Res 903 (http://rules.house.gov/SpecialRules_details.aspx?NewsID=4498), which allocated 100 million dollar annual grant to organizations/institutions to develop medical schools in areas experiencing medical professionals shortage, was passed along with the Healthcare Bill (note that all your boys voted against it (http://clerk.house.gov/evs/2009/roll882.xml)).

If there will be no increase in demand for health care services, then why was this bill needed? Isn't the presumption that demand for HC outstripped its supply so we needed to artificially mandate supply?

My assumption is that we are already experiencing a shortage of medical providers that will be excerbated as fewer doctors enter the system (again, per your own earlier citation - and a couple of my own: http://www.nytimes.com/2009/04/27/health/policy/27care.html?_r=2&em; http://www.reuters.com/article/reutersEdge/idUSTRE56M14E20090723). At the same time, the same system is expected to provide care to more individuals. Based on these two events: generally, an increase in the demand for services and, generally, no increase in the supply of providers, I assert that physicians will charge more for there services in conjunction with the law of supply and demand (Supply and demand - Wikipedia, the free encyclopedia (http://en.wikipedia.org/wiki/Supply_and_demand) - which, by the way, incorporates your "Law of Demand", but see my discussion below).

Will the additional incentives assist in creating appropriate supply? Perhaps. That is one I just don't know the stats for and would be very suspect of anyone claiming that they did as it is simply speculative. Further, to be clear, I believe the physician shortage to be only one basis for the increased premiums (and thus decreased care) we should all expect w/in the next 4-8 years.

As for "my boys", let's get something straight - I don't believe any one was "my boy" in this past debate b/c no one exhibited real leadership and said "There are no sacred cows." Pharmaceuticals, Malpractice Lawyers and Insurance Companies have too much money to be ignored and were essentially untouched in this litigation. Only someone with political charisma and leadership could have pulled off real reform. No one - Republican or Democrat demonstrated this leadership.

There's also the expectation on your part of perfection from this bill which I think is ludicrous. You also seem to completely ignore the law of demand (http://en.wikipedia.org/wiki/Law_of_demand). Revamping the healthcare system is an incremental process and there's lots of good stuff in the bill and the kinks will get worked out. You can have a doom and gloom attitude but I don't think the substance of this bill warrants it.

1. I did not expect perfection. I expected reform. This bill is not reform, it is a mandatory expansion of the existing system. A system that was market challenged from its inception and has become more so in the last 20 years with the growth of HMO's, medical malpractice litigation, and the increased expectation of full coverage from employer based insurance. You cannot "incrementally" untie Gordian's Knot and this bill does not even begin to do so.

2. I do not see how my assertion that increasing the number of insureds will cause a rise in cost ignores the "Law of Demand", please enlighten me. I assert that demand will increase due to the mandatory expansion of insureds, because of increased demand, costs will rise. As costs rise, people will be forced to pay more for their current coverage or choose a lesser coverage. Where am I ignoring the Law of Demand and how?

As people are forced to purchase lesser coverages, will demand decrease and thus, again, force prices down? Possibly - However, I believe it is more likely that the "incremental legislative" approach will cause legislative changes to the minimal coverage provide by the Public Option ("There are too many under insureds, the Govt. needs to ensure a better base coverage"). As more services are legislatively mandated, demand is artificially inflated and costs again rise, etc., etc. As insurers are unable to create profitable pools because they must provide unprofitable coverages under the expanded "basic" services, fewer insurers will opt for that market and only the very wealthy will be able to afford the rich coverage provided to the vast majority of current insureds.

I have no love for the insurance industry. Frankly they're going to reap what the sawed. They need to compete with the government and if they can't then their business model is dated. Honestly, I can not muster the emotion required to feel sorry for them or care for their wellbeing, kinda like how I don't give a shit what happens to a child molesters in prison.

Neither do I. It is why I advocate reform, not expansion, of the current system. Insurers have a very simple business plan - collect as much as you can in premiums, pay out as little as possible in HC costs. Obviously, this plan is in direct conflict with the consumer purchasing insurance who would like the reverse to be true.

Unlike a standard arms length agreement, and due to pooling, however, the insurers have a distinct advantage inherent to the product being sold. We need them, they do not need any one of us. Hell, they don't really need any small group of us. Further, we need several of them so that no one of them can set the market.

On one hand, the Public Option addresses this inherent market flaw - individually, we no longer need them - "You cost too much, I will go to the Public Option". On the other hand, and at odds with this, however, the Public Option addresses the second need only if it ensures the insurers continued existence which it can only do by offering an inherently uncompetitive product. If it does not ensure the continued existence of insurance companies, the Public Option becomes the only option and the already flawed system becomes completely divorced from the market process. Once that occurs, a government entity, unconcerned with profitability, determines what services will be provided at what cost. You apparently trust such a system to be relatively cost efficient and sufficiently consumer friendly. I do not.

As for private companies competing with the govt., to me that is a ludicrous statement. In light of the surcharge and tax support, the Public Option is essentially given 50 yard head start in a 100 yard dash. What's your business? If your competitor receives an anually subsidy of 100M from the Govt. and you receive nothing, do you think your company could devise a plan that would compete with that? Or would it be driven into bankruptcy as, even at its most efficient, it can't generate 100M in cost cutting to remain competive?

Real reform would have attacked the market dichotomy presented by the current employer insurance based system, addressed the anti-market effects of pharmaceuticals R&D development/production costs, and the rising costs of malpractice (all the costs - litigation, premiums, excessive defensive medicine, etc.).

No one, not the President, not the Democrats, not the Republicans offered real HC reform with long term sustainability. Rather, the Dems & Obama protected the sacred cows and simply expanded the current system, costs be damned, and the Republicans adopted an opposition stance that simply said "No - Do Nothing". As I said earlier, each side has guilt and this act represents a massive fail for the people of America. We were ill-served.

Real leadership was needed. None was demonstrated.

This bill is very flawed, there's no doubt that. And I imagine once it comes out of conference the public option will be watered down a little more, but probably more budget friendly in terms of cost. I think Harry Reid is requesting two sets of scores from CBO and the Senate will more than likely move towards the one that has the more favorable score. That's just my speculation.

At this point, unfortunately, I think it's becoming more and more about winning, getting Obama a legislative victory, and less about health care. I think it's solid first step though. But they will have to address the cost containment portion again down the road I suspect, as well as the number of uninsured that will ultimately go into the exchange option.

I think that happened sometime over the summer when Obama essentially guarranteed the passage of a health care bill with the public option. He has consistently talked about cost containment and, initially, I was encouraged by his assertion that sustainability was important. My initial hope was snuffed when he touted the empty pledge from HC actors that they would cut costs as a real step towards sustainability. Quite frankly, other than "tax the wealthy, everybody must buy insurance", I have not seen any real steps towards cost containment from Obama or anyone else.

I think that happened sometime over the summer when Obama essentially guarranteed the passage of a health care bill with the public option. He has consistently talked about cost containment and, initially, I was encouraged by his assertion that sustainability was important. My initial hope was snuffed when he touted the empty pledge from HC actors that they would cut costs as a real step towards sustainability. Quite frankly, other than "tax the wealthy, everybody must buy insurance", I have not seen any real steps towards cost containment from Obama or anyone else.

I think they're "betting" on cost containment happening as opposed to actually producing hardcore numbers to prove it. I mean numbers have been produced, obviously, but from what I've seen certain variables have to fall into place almost perfectly over a period of time for costs to be driven down. In fact, premiums are still likely to rise either way.

A robust public option or a single payer system, which is simply too expensive and cumbersome to implement, in my opinion, was the best shot. Pros and cons to both, but it looks like they are getting further and further away from either as this drags out.

More than likely, if this bill passes, the cost issue will be revisted down the road. Maybe under Obama's presidency, maybe not.

If there will be no increase in demand for health care services, then why was this bill needed? Isn't the presumption that demand for HC outstripped its supply so we needed to artificially mandate supply?

My assumption is that we are already experiencing a shortage of medical providers that will be excerbated as fewer doctors enter the system (again, per your own earlier citation - and a couple of my own: http://www.nytimes.com/2009/04/27/health/policy/27care.html?_r=2&em; http://www.reuters.com/article/reutersEdge/idUSTRE56M14E20090723). At the same time, the same system is expected to provide care to more individuals. Based on these two events: generally, an increase in the demand for services and, generally, no increase in the supply of providers, I assert that physicians will charge more for there services in conjunction with the law of supply and demand (Supply and demand - Wikipedia, the free encyclopedia (http://en.wikipedia.org/wiki/Supply_and_demand) - which, by the way, incorporates your "Law of Demand", but see my discussion below).

Will the additional incentives assist in creating appropriate supply? Perhaps. That is one I just don't know the stats for and would be very suspect of anyone claiming that they did as it is simply speculative. Further, to be clear, I believe the physician shortage to be only one basis for the increased premiums (and thus decreased care) we should all expect w/in the next 4-8 years.

As for "my boys", let's get something straight - I don't believe any one was "my boy" in this past debate b/c no one exhibited real leadership and said "There are no sacred cows." Pharmaceuticals, Malpractice Lawyers and Insurance Companies have too much money to be ignored and were essentially untouched in this litigation. Only someone with political charisma and leadership could have pulled off real reform. No one - Republican or Democrat demonstrated this leadership.



1. I did not expect perfection. I expected reform. This bill is not reform, it is a mandatory expansion of the existing system. A system that was market challenged from its inception and has become more so in the last 20 years with the growth of HMO's, medical malpractice litigation, and the increased expectation of full coverage from employer based insurance. You cannot "incrementally" untie Gordian's Knot and this bill does not even begin to do so.

2. I do not see how my assertion that increasing the number of insureds will cause a rise in cost ignores the "Law of Demand", please enlighten me. I assert that demand will increase due to the mandatory expansion of insureds, because of increased demand, costs will rise. As costs rise, people will be forced to pay more for their current coverage or choose a lesser coverage. Where am I ignoring the Law of Demand and how?

As people are forced to purchase lesser coverages, will demand decrease and thus, again, force prices down? Possibly - However, I believe it is more likely that the "incremental legislative" approach will cause legislative changes to the minimal coverage provide by the Public Option ("There are too many under insureds, the Govt. needs to ensure a better base coverage"). As more services are legislatively mandated, demand is artificially inflated and costs again rise, etc., etc. As insurers are unable to create profitable pools because they must provide unprofitable coverages under the expanded "basic" services, fewer insurers will opt for that market and only the very wealthy will be able to afford the rich coverage provided to the vast majority of current insureds.



Neither do I. It is why I advocate reform, not expansion, of the current system. Insurers have a very simple business plan - collect as much as you can in premiums, pay out as little as possible in HC costs. Obviously, this plan is in direct conflict with the consumer purchasing insurance who would like the reverse to be true.

Unlike a standard arms length agreement, and due to pooling, however, the insurers have a distinct advantage inherent to the product being sold. We need them, they do not need any one of us. Hell, they don't really need any small group of us. Further, we need several of them so that no one of them can set the market.

On one hand, the Public Option addresses this inherent market flaw - individually, we no longer need them - "You cost too much, I will go to the Public Option". On the other hand, and at odds with this, however, the Public Option addresses the second need only if it ensures the insurers continued existence which it can only do by offering an inherently uncompetitive product. If it does not ensure the continued existence of insurance companies, the Public Option becomes the only option and the already flawed system becomes completely divorced from the market process. Once that occurs, a government entity, unconcerned with profitability, determines what services will be provided at what cost. You apparently trust such a system to be relatively cost efficient and sufficiently consumer friendly. I do not.

As for private companies competing with the govt., to me that is a ludicrous statement. In light of the surcharge and tax support, the Public Option is essentially given 50 yard head start in a 100 yard dash. What's your business? If your competitor receives an anually subsidy of 100M from the Govt. and you receive nothing, do you think your company could devise a plan that would compete with that? Or would it be driven into bankruptcy as, even at its most efficient, it can't generate 100M in cost cutting to remain competive?

Real reform would have attacked the market dichotomy presented by the current employer insurance based system, addressed the anti-market effects of pharmaceuticals R&D development/production costs, and the rising costs of malpractice (all the costs - litigation, premiums, excessive defensive medicine, etc.).

No one, not the President, not the Democrats, not the Republicans offered real HC reform with long term sustainability. Rather, the Dems & Obama protected the sacred cows and simply expanded the current system, costs be damned, and the Republicans adopted an opposition stance that simply said "No - Do Nothing". As I said earlier, each side has guilt and this act represents a massive fail for the people of America. We were ill-served.

Real leadership was needed. None was demonstrated.

Your analysis is pretty exhaustive, if not exhausting:)

I just wanted point out, if it hasn't been already, that the public option will initially be funded with $2 billion government money to cover initial costs and claims. This is expected to be paid back over a ten year period. Then the operation becomes a self-sustaining entity paid for with premiums by those who want coverage just like any other insurance company. So in that regard, there's no unfair advantage.

Your analysis is pretty exhaustive, if not exhausting:)

I just wanted point out, if it hasn't been already, that the public option will initially be funded with $2 billion government money to cover initial costs and claims. This is expected to be paid back over a ten year period. Then the operation becomes a self-sustaining entity paid for with premiums by those who want coverage just like any other insurance company. So in that regard, there's no unfair advantage.

You bought that? :laughing2

You bought that? :laughing2

hook, line, and sinker.