American Healthcare (Was "Need to rant...")

[jewelspike]

What's wrong with the state of healthcare these days? Are the people who are running healthcare idiots? Anyone who believes that hospitals could be run like a business are delusional. The hospitals would get in trouble if they turned down patients who are unable to pay.

Indeed, this happened here in Los Angeles recently, at the King Drew medical center. The hospitals are failing because they were not designed to take the slack of those who lack insurance.

One can argue that some parts of health care could be run like a capitalistic business, such as insurance. But the insurance companies are part of the problem in the first place, because they raised their rates! All that talk about cheaper, better, and faster medicine hasn't come to fruition at all!



Thanks. I need that.

[thundertail]

Don't get me started on that!

[aric]

jewelspike said:

What's wrong with the state of healthcare these days? Are the people who are running healthcare idiots? Anyone who believes that hospitals could be run like a business are delusional. The hospitals would get in trouble if they turned down patients who are unable to pay.

Indeed, this happened here in Los Angeles recently, at the King Drew medical center. The hospitals are failing because they were not designed to take the slack of those who lack insurance.

One can argue that some parts of health care could be run like a capitalistic business, such as insurance. But the insurance companies are part of the problem in the first place, because they raised their rates! All that talk about cheaper, better, and faster medicine hasn't come to fruition at all!



Thanks. I need that.

It's nice to live in a society where money is valued more than people, eh?

On a related note, here's some new numbers for the number of Americans who have no health insurance.

Linky

47 million Americans with no health care.

BTW jewelspike, you might want to modify the title of your thread to make it more descriptive. Adding something like "American Healthcare" in parentheses (if it'll fit) might be better.

- Aric

[jewelspike]

Thanks for the suggestion, Aric. I've changed the title.

[jewelspike]

I just watched Michael Moore's film "Sicko" last week. I recommend anyone who cares about this subject to watch the film too.

[aric]

Here's another point from this article.

According to that, US drug companies spend twice as much on marketing as they do on research. And guess where those costs of passed off? Looks like granny's gonna have to pay more out of her fixed income for medicine she needs to live in order to make up the cost. God bless the US! WAH HA HA HA!



- Aric

[jewelspike]

I once heard (so don't take this necessarily as fact) that the government pays for most research in medicine anyway. That's big business for you. Some industries work well as businesses, while others don't.

[aric]

jewelspike said:

I once heard (so don't take this necessarily as fact) that the government pays for most research in medicine anyway.

I thought so too. I think I had a link to an article that pointed to NIH statistics about the actual percentage, but it's on the old computer.

Anyway, this and this seem to indicate that while there are government funds for these things, it's not universal and it appears there is pharmaceutical research that appears to be solely in the hands of corporations.

Of course, the solution would be to remove these from them and put the research into the hands of universities and such.

- Aric

[jewelspike]

I bumped us this debate due to the recent discussion in the news about President Obama's proposed health care plan. (It's been everywhere -- my brother was visiting a math board and they were discussing this too!)

What really annoys me about the Republicans is that their party line comes directly from the insurance companies. They say that health care ought to be an issue between the doctor and the patient, not with the government intervening as a third party. But I counter, isn't the way it is now is that the insurance companies intervene as a third party? They have the power to give or deny health care at their whim!

Another complaint is that under Obama's plan, health care would be rationed and there would be long lines at the doctor's office. Once again, don't we have long lines and waiting lists for certain procedures now?

The only legitimate argument I've seen that isn't insurance company propaganda is that some pro-lifers don't want their tax dollars to pay for abortions. I don't happen to agree with them, but at least they have a valid point.

My own thoughts: I think that when someone has a serious disease the insurance companies would be better off if the patient dies, so that they can save money on the procedure. Thus, I don't believe that the insurance companies have the patient's best interests. At least the
government would want the patient to live so that he/she can pay taxes.

[aric]

Aug 3, 2009 0:46:55 GMT -5 jewelspike said:

What really annoys me about the Republicans is that their party line comes directly from the insurance companies. They say that health care ought to be an issue between the doctor and the patient, not with the government intervening as a third party. But I counter, isn't the way it is now is that the insurance companies intervene as a third party? They have the power to give or deny health care at their whim!

Exactly. Republicans have no problem with corporate bureaucrats meddling in life and death decisions that doctors and patients alone should be handling. But when it comes to a government run program it's suddenly "ZOMG TEH SOSHULISM!!!!"

Aug 3, 2009 0:46:55 GMT -5 jewelspike said:

Another complaint is that under Obama's plan, health care would be rationed and there would be long lines at the doctor's office. Once again, don't we have long lines and waiting lists for certain procedures now?

Yeah. Healthcare is never about handing out services willy-nilly. It's all about a sliding scale of need. Those who most urgently need medical attention will likely get it first. All healthcare programs have limited resources.

Aug 3, 2009 0:46:55 GMT -5 jewelspike said:

The only legitimate argument I've seen that isn't insurance company propaganda is that some pro-lifers don't want their tax dollars to pay for abortions. I don't happen to agree with them, but at least they have a valid point.

It's legitimate in the sense that people who are against abortion shouldn't pay for it, but it has nothing to do with the current debate. Here is the truth-o-meter from politifact. Government-subsidized abortions were never even considered. Republicans are just making stuff up to scare people. As they usually do.

Aug 3, 2009 0:46:55 GMT -5 jewelspike said:

My own thoughts: I think that when someone has a serious disease the insurance companies would be better off if the patient dies, so that they can save money on the procedure. Thus, I don't believe that the insurance companies have the patient's best interests. At least the government would want the patient to live so that he/she can pay taxes.

Here is an interesting interview by Bill Moyers where he interviews Wendell Potter, who was the former vice president of CIGNA, a private health insurer. Beware, though. The interview is forty minutes long. Here are some quotes from the transcript. I think everyone will find it quite illuminating.

WENDELL POTTER: Well, I was beginning to question what I was doing as the industry shifted from selling primarily managed care plans, to what they refer to as consumer-driven plans. And they're really plans that have very high deductibles, meaning that they're shifting a lot of the cost off health care from employers and insurers, insurance companies, to individuals. And a lot of people can't even afford to make their co-payments when they go get care, as a result of this.

WENDELL POTTER: I picked up the local newspaper and I saw that a health care expedition was being held a few miles up the road, in Wise, Virginia. And I was intrigued.... I didn't know what to expect. I just assumed that it would be, you know, like a health-- booths set up and people just getting their blood pressure checked and things like that.

But what I saw were doctors who were set up to provide care in animal stalls. Or they'd erected tents, to care for people. I mean, there was no privacy. In some cases-- and I've got some pictures of people being treated on gurneys, on rain-soaked pavement.

And I saw people lined up, standing in line or sitting in these long, long lines, waiting to get care. People drove from South Carolina and Georgia and Kentucky, Tennessee-- all over the region, because they knew that this was being done. A lot of them heard about it from word of mouth.

As an aside, this looks very much like what you see in a Third World country in those commercials appealing for donations to the unfortunately impoverished and neglected...

BILL MOYERS: People are going to say, "How can Wendell Potter sit here and say he was just finding out that there were a lot of Americans who didn't have adequate insurance and needed health care? He'd been in the industry for over 15 years."

WENDELL POTTER: And that was my problem. I had been in the industry and I'd risen up in the ranks. And I had a great job. And I had a terrific office in a high-rise building in Philadelphia. I was insulated. I didn't really see what was going on. I saw the data. I knew that 47 million people were uninsured, but I didn't put faces with that number.

Just a few weeks later though, I was back in Philadelphia and I would often fly on a corporate aircraft to go to meetings.

And I just thought that was a great way to travel. It is a great way to travel. You're sitting in a luxurious corporate jet, leather seats, very spacious. And I was served my lunch by a flight attendant who brought my lunch on a gold-rimmed plate. And she handed me gold-plated silverware to eat it with. And then I remembered the people that I had seen in Wise County. Undoubtedly, they had no idea that this went on, at the corporate levels of health insurance companies.

BILL MOYERS: But you had, all these years, seen premiums rising. People purged from the rolls, people who couldn't afford the health care that Cigna and other companies were offering. This is the first time you came face to face with it?

WENDELL POTTER: Yeah, it was. You know, certainly, I knew people, and I talked to people who were uninsured. But when you're in the executive offices, when you're getting prepared for a call with an analyst, in the financial medium, what you think about are the numbers. You don't think about individual people. You think about the numbers, and whether or not you're going to meet Wall Street's expectations. That's what you think about, at that level. And it helps to think that way. That's why you-- that enables you to stay there, if you don't really think that you're talking about and dealing with real human beings.

BILL MOYERS: Your own resume says, and I'm quoting. "With the chief medical officer and his staff, Potter developed rapid response mechanisms for handling media inquiries pertaining to complaints." Direct quote. "This was highly successful in keeping most such inquiries from becoming news stories, at a time when managed care horror stories abounded." I mean, you knew there were horror stories out there.

WENDELL POTTER: I did. I did.

BILL MOYERS: You put these techniques to work, representing Cigna doing the Nataline Sarkisyan case, right?

WENDELL POTTER: That's right.

BILL MOYERS: And that was a public relations nightmare, you called it. Right?

WENDELL POTTER: It was. It was just the most difficult. We call them high profile cases, when you have a case like that — a family or a patient goes to the news media and complains about having some coverage denied that a doctor had recommended. In this case, Nataline Sarkisyan's doctors at UCLA had recommended that she have a liver transplant. But when the coverage request was reviewed at Cigna, the decision was made to deny it.

It was around that time, also, that the family had gone to the media, had sought out help from the California Nurses Association and some others to really bring pressure to bear on Cigna. And they were very successful in getting a lot of media attention, and nothing like I had ever seen before.

It's amazing that Sarah "I can see Russia from my House" Palin talks about government Death Panels when private healthcare companies already have them.

BILL MOYERS: You were also involved in the campaign by the industry to discredit Michael Moore and his film "Sicko" in 2007. In that film Moore went to several countries around the world, and reported that their health care system was better than our health care system, in particular, Canada and England.

.....

So what did you think when you saw that film?

WENDELL POTTER: I thought that he hit the nail on the head with his movie. But the industry, from the moment that the industry learned that Michael Moore was taking on the health care industry, it was really concerned.

BILL MOYERS: What were they afraid of?

WENDELL POTTER: They were afraid that people would believe Michael Moore.

BILL MOYERS: We obtained a copy of the game plan that was adopted by the industry's trade association, AHIP. And it spells out the industry strategies in gold letters. It says, "Highlight horror stories of government-run systems." What was that about?

WENDELL POTTER: The industry has always tried to make Americans think that government-run systems are the worst thing that could possibly happen to them, that if you even consider that, you're heading down on the slippery slope towards socialism. So they have used scare tactics for years and years and years, to keep that from happening. If there were a broader program like our Medicare program, it could potentially reduce the profits of these big companies. So that is their biggest concern.

BILL MOYERS: And there was a political strategy. "Position Sicko as a threat to Democrats' larger agenda." What does that mean?

WENDELL POTTER: That means that part of the effort to discredit this film was to use lobbyists and their own staff to go onto Capitol Hill and say, "Look, you don't want to believe this movie. You don't want to talk about it. You don't want to endorse it. And if you do, we can make things tough for you."

BILL MOYERS: How?

WENDELL POTTER: By running ads, commercials in your home district when you're running for reelection, not contributing to your campaigns again, or contributing to your competitor.

BILL MOYERS: This is fascinating. You know, "Build awareness among centrist Democratic policy organizations--"

WENDELL POTTER: Right.

BILL MOYERS: "--including the Democratic Leadership Council."

WENDELL POTTER: Absolutely.

BILL MOYERS: Then it says, "Message to Democratic insiders. Embracing Moore is one-way ticket back to minority party status."

WENDELL POTTER: Yeah.

BILL MOYERS: Now, that's exactly what they did, didn't they? They--

WENDELL POTTER: Absolutely.

BILL MOYERS: --radicalized Moore, so that his message was discredited because the messenger was seen to be radical.

WENDELL POTTER: Absolutely. In memos that would go back within the industry — he was never, by the way, mentioned by name in any memos, because we didn't want to inadvertently write something that would wind up in his hands. So the memos would usually-- the subject line would be-- the emails would be, "Hollywood." And as we would do the media training, we would always have someone refer to him as Hollywood entertainer or Hollywood moviemaker Michael Moore.

BILL MOYERS: Why?

WENDELL POTTER: Well, just to-- Hollywood, I think people think that's entertainment, that's movie-making. That's not real documentary. They don't want you to think that it was a documentary that had some truth. They would want you to see this as just some fantasy that a Hollywood filmmaker had come up with. That's part of the strategy.

BILL MOYERS: So you would actually hear politicians mouth the talking points that had been circulated by the industry to discredit Michael Moore.

WENDELL POTTER: Absolutely.

BILL MOYERS: You'd hear ordinary people talking that. And politicians as well, right?

WENDELL POTTER: Absolutely.

BILL MOYERS: So your plan worked.

WENDELL POTTER: It worked beautifully.

BILL MOYERS: The film was blunted, right?

WENDELL POTTER: The film was blunted. It--

BILL MOYERS: Was it true? Did you think it contained a great truth?

WENDELL POTTER: Absolutely did.

BILL MOYERS: What was it?

WENDELL POTTER: That we shouldn't fear government involvement in our health care system. That there is an appropriate role for government, and it's been proven in the countries that were in that movie.

You know, we have more people who are uninsured in this country than the entire population of Canada. And that if you include the people who are underinsured, more people than in the United Kingdom. We have huge numbers of people who are also just a lay-off away from joining the ranks of the uninsured, or being purged by their insurance company, and winding up there.

And another thing is that the advocates of reform or the opponents of reform are those who are saying that we need to be careful about what we do here, because we don't want the government to take away your choice of a health plan. It's more likely that your employer and your insurer is going to switch you from a plan that you're in now to one that you don't want. You might be in the plan you like now.

But chances are, pretty soon, you're going to be enrolled in one of these high deductible plans in which you're going to find that much more of the cost is being shifted to you than you ever imagined.

BILL MOYERS: I have a memo, from Frank Luntz. I have a memo written by Frank Luntz. He's the Republican strategist who we discovered, in the spring, has written the script for opponents of health care reform. "First," he says, "you have to pretend to support it. Then use phrases like, "government takeover," "delayed care is denied care," "consequences of rationing," "bureaucrats, not doctors prescribing medicine." That was a memo, by Frank Luntz, to the opponents of health care reform in this debate. Now watch this clip.

REP. JOHN BOEHNER: The forthcoming plan from Democratic leaders will make health care more expensive, limit treatments, ration care, and put bureaucrats in charge of medical decisions rather than patients and doctors.

SEN. MITCH MCCONNELL: Americans need to realize that when someone says "government option," what could really occur is a government takeover that soon could lead to government bureaucrats denying and delaying care, and telling Americans what kind of care they can have.

SEN. JON KYL: Washington run healthcare would diminish access to quality care, leading to denials, shortages and long delays for treatment.

REP. JOE WILSON: How will a government run health plan not lead to the same rationing of care that we have seen in other countries?

REP. TOM PRICE: We don't want to put the government, we don't want to put bureaucrats between a doctor and a patient.

BILL MOYERS: Why do politicians puppet messages like that?

WENDELL POTTER: Well, they are ideologically aligned with the industry. They want to believe that the free market system can and should work in this country, like it does in other industries. So they don't understand from an insider's perspective like I have, what that actually means, and the consequences of that to Americans.

They parrot those comments, without really realizing what the real situation is.

I was watching MSNBC one afternoon. And I saw Congressman Zach Wamp from Tennessee. He's just down the road from where I grew up, in Chattanooga. And he was talking-- he was asked a question about health care reform. I think it was just a day or two after the president's first-- health care reform summit. And he was one of the ones Republicans put on the tube.

And he was saying that, you know, the health care problem is not necessarily as bad as we think. That of the uninsured people, half of them are that way because they want to "go naked."

REP. ZACH WAMP: Half the people that are uninsured today choose to remain uninsured. Half of them don't have any choice but half of them choose to, what's called, go naked, and just take the chance of getting sick. They end up in the emergency room costing you and me a whole lot more money.

WENDELL POTTER: He used the word naked. It's an industry term for those who, presumably, choose not to buy insurance, because they don't want to. They don't want to pay the premiums. So he was saying that half... Well, first of all, it's nothing like that. It was an absolutely ridiculous comment. But it's an example of a member of Congress buying what the insurance industry is peddling.

BILL MOYERS: Back in 1993, the Republican propagandist, William Kristol, urged his party to block any health care proposal, in order to prevent the Democrats from being seen as the quote, "generous protector of the middle class." But today, you've got some Democrats who are going along with the industry.

Max Baucus, the senator from Montana, for example, the most important figure right now in this health care legislation that's being written in the Senate. He's resisted including a public insurance option in the reform bill, right?

As an aside, Baucus is currently the weaselly turd sabotaging the public option in the current healthcare reform bill.

Potter goes on to talk about lobbying:

BILL MOYERS: Why is the industry so powerful on both sides of the aisle?

WENDELL POTTER: Well, money and relationships, ideology. The relationships-- an insurance company can hire and does hire many different lobbying firms. And they hire firms that are predominantly Republican and predominantly Democrat. And they do this because they know they need to reach influential members of Congress like Max Baucus. So there are people who used to work for Max Baucus who are in lobbying firms or on the staff of companies like Cigna or the association itself.

BILL MOYERS: Yeah, I just read the other day, in THE WASHINGTON POST, that Max Baucus's staff met with a group of lobbyists. Two of them had been Baucus's former chiefs of staff.

WENDELL POTTER: Right.

BILL MOYERS: I mean, they left the government. They go to work for the industry. Now they're back with an insider status. They get an access, right?

WENDELL POTTER: Oh, they do, they do. And these lobbyists' ability to raise money for these folks also is very important as well.

Lobbyists, many of the big lobbyists contributed a lot of money themselves. One of the lobbyists for one of the big health insurance company is Heather Podesta, the Podesta Group, and she's married to Tony Podesta, who's a brother of John Podesta.

BILL MOYERS: Who used to be the White House chief of staff.

WENDELL POTTER: Right. Right. And they're Democrats. And my executives wanted to meet with — and when I say my, the people I used to work for--

BILL MOYERS: At Cigna.

WENDELL POTTER: Yeah, wanted to meet with Hillary Clinton, when she was still in the Senate and still a candidate for president. Well, that's hard to do. That's hard to pull off, but she did. That just shows you that you can, through the relationships that are formed and that the insurance industry pays for, by hiring these lobbyists, you can your foot in the door. You can get your messages across to these people, in ways that the average American couldn't possibly.

BILL MOYERS: So it's money that can buy access to have their arguments heard, right?

WENDELL POTTER: That's right.

BILL MOYERS: When ordinary citizens cannot be heard.

WENDELL POTTER: Absolutely right. It's the way the American system has evolved, the political system. But it does offend me, that the vested special interests, who are so profitable and so powerful, are able to influence public policy in the way that they have, and the way that they've done over the years. And the insurance industry has been one of the most successful, in beating back any kinds of legislation that would hinder or affect the profitability of the companies.

Now Potter goes on to talk about the merits of private and public health insurance and compares them:

BILL MOYERS: Why is public insurance, a public option, so fiercely opposed by the industry?

WENDELL POTTER: The industry doesn't want to have any competitor. In fact, over the course of the last few years, has been shrinking the number of competitors through a lot of acquisitions and mergers. So first of all, they don't want any more competition period. They certainly don't want it from a government plan that might be operating more efficiently than they are, that they operate. The Medicare program that we have here is a government-run program that has administrative expenses that are like three percent or so.

BILL MOYERS: Compared to the industry's--

WENDELL POTTER: They spend about 20 cents of every premium dollar on overhead, which is administrative expense or profit. So they don't want to compete against a more efficient competitor.

CONSERVATIVE: "WHAAA!!!! Big Government is MORE EFFICIENT than Big Business!!!" *head kerplodes*

Now he shows just how these market capitalists think:

BILL MOYERS: You told Congress that the industry has hijacked our health care system and turned it into a giant ATM for Wall Street. You said, "I saw how they confuse their customers and dump the sick, all so they can satisfy their Wall Street investors." How do they satisfy their Wall Street investors?

WENDELL POTTER: Well, there's a measure of profitability that investors look to, and it's called a medical loss ratio. And it's unique to the health insurance industry. And by medical loss ratio, I mean that it's a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry's been dominated by, or become dominated by for-profit insurance companies. Back in the early '90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they'll punish them. Investors will start leaving in droves.

I've seen a company stock price fall 20 percent in a single day, when it did not meet Wall Street's expectations with this medical loss ratio.

For example, if one company's medical loss ratio was 77.9 percent, for example, in one quarter, and the next quarter, it was 78.2 percent. It seems like a small movement. But investors will think that's ridiculous. And it's horrible.

BILL MOYERS: That they're spending more money for medical claims.

WENDELL POTTER: Yeah.

BILL MOYERS: And less money on profits?

WENDELL POTTER: Exactly. And they think that this company has not done a good job of managing medical expenses. It has not denied enough claims. It has not kicked enough people off the rolls. And that's what-- that is what happens, what these companies do, to make sure that they satisfy Wall Street's expectations with the medical loss ratio.

BILL MOYERS: And they do what to make sure that they keep diminishing the medical loss ratio?

WENDELL POTTER: Rescission is one thing. Denying claims is another. Being, you know, really careful as they review claims, particularly for things like liver transplants, to make sure, from their point of view, that it really is medically necessary and not experimental. That's one thing. And that was that issue in the Nataline Sarkisyan case.

But another way is to purge employer accounts, that-- if a small business has an employee, for example, who suddenly has have a lot of treatment, or is in an accident. And medical bills are piling up, and this employee is filing claims with the insurance company. That'll be noticed by the insurance company.

And when that business is up for renewal, and it typically is up, once a year, up for renewal, the underwriters will look at that. And they'll say, "We need to jack up the rates here, because the experience was," when I say experience, the claim experience, the number of claims filed was more than we anticipated. So we need to jack up the price. Jack up the premiums. Often they'll do this, knowing that the employer will have no alternative but to leave. And that happens all the time.

They'll resort to things like the rescissions that we saw earlier. Or dumping, actually dumping employer groups from the rolls. So the more of my premium that goes to my health claims, pays for my medical coverage, the less money the company makes.

BILL MOYERS: So, the more of my premium that goes to my health claims, pays for my medical coverage, the less money the company makes.

WENDELL POTTER: That's right. Exactly right.

BILL MOYERS: So they want to reverse that. They don't want my premium to go for my health care, right?

WENDELL POTTER: Exactly right. They--

BILL MOYERS: Where does it go?

WENDELL POTTER: Well, a big chunk of it goes into shareholders' pockets. It's returned to them as part of the investment to them. It goes into the exorbitant salaries that a lot of the executives make. It goes into paying sales, marketing, and underwriting expenses. So a lot of it goes to pay those kinds of administrative functions. Overhead.

Like private jets for executives who dine on fine china using gold-plated utensils...

WENDELL POTTER: Well, they were talking to Wall Street at that moment. They were saying that because-- I guess they might have to spend some additional dollars to be more vigilant, to make sure that they were not rescinding a policy inappropriately. It makes no sense. The only reason they would have said that is to cover themselves. And to send a signal to Wall Street that you know, we're going to continue business as usual here.

You know, I've been around a long time. And I have to say, I just don't get this. I just don't understand how the corporations can oppose a plan that gives the unhealthy people a chance to be covered. And they don't want to do it themselves.

Well, keep in mind, what they want to do is enhance their profits. Enhance shareholder value. That's number one. And the way that the business that they're in is health care, certainly. But their primary motivation is to reward their shareholders.

Most of the shareholders are large, institutional investors and hedge funds. Hedge fund managers are the ones who look at the stock. And investors for large organizations. It's not mom and pop investor.

BILL MOYERS: You know, there's an irony, because you hear the companies and their trade groups talking about how we don't want a public option that would put a bureaucrat between a patient and his doctor. But you've just described a situation in which a CEO is actually between a doctor and the patient,

WENDELL POTTER: It's true. And that same thing happened, in the Nataline Sarkisyan case. You had a corporate bureaucrat making a decision on coverage. So, they are trying to make you worry. And fear a government bureaucrat being between you and your doctor. What you have now is a corporate bureaucrat between you and your doctor.

BILL MOYERS: Whose motive is profit. Understandably, naturally, profit.

WENDELL POTTER: Right.

BILL MOYERS: But companies, any company is in business to make a profit, right?

WENDELL POTTER: Oh, absolutely.

BILL MOYERS: So how can you object? How can we object when an insurance company wants to increase its profits? That's a serious question. I mean, it sounds like a set-up but it's a serious question.

WENDELL POTTER: It's a very serious question. And I think that people who are strong advocates of our health care system remaining as it is, very much a free market health care system, fail to realize that we're really talking about human beings here. And it doesn't work as well as they would like it to. Yeah, there's nothing wrong. And I'm a capitalist as well. I think it's a wonderful thing that companies can make a profit. But when you do it in such a way that you are creating a situation in which these companies are adding to the number of people who are uninsured and creating a problem of the underinsured then that's when we have a problem with it, or at least I do.

BILL MOYERS: This is the key question for me. Can health reform that includes a public plan actually rid our system of the financial incentive on the part of the insurance industry to provide less for more?

WENDELL POTTER: It will help. It would help. Would it rid it? No, I don't think it would, because of the for-profit structure that is now dominant in this country. But the public plan would do a lot to keep them honest, because it would have to offer a standard benefit plan. It would have to operate more efficiently, as does the Medicare program. It would be structured, I'm certain on a level playing field, so that it wouldn't be unfair advantage to the private insurance companies. But because it could be administered more efficiently, then the private insurers, they would have to operate more efficiently. And that 20 cents in that medical loss ratio we talked about earlier might get narrower. And they don't want that.

BILL MOYERS: As this debate unfolds in the next month, into the fall, what should we be watching for? Tell us as an insider what to look for that is more than meets the eye?

WENDELL POTTER: Well, what happens is they will continue this charm offensive, until there's actual legislative language. And what that means, of course, is that right now, you're not really seeing the bills before the House and the Senate that will actually be voted on. When we see the actual legislation, when there's something before Congress, and it will happen, presumably, within the next few weeks, you'll start seeing a lot more criticism of it.

And the special interests will be attacking this or that. The AMA will be upset about something. The pharmaceutical industry will be upset about something. The insurance industry will not like this or that. It's, you know, a lot of money is made in this country off sick people. And then you'll start seeing a lot more of the behind-the-scenes attacks on this legislation, in an attempt to kill it. The status quo is what would work best for these industries.

BILL MOYERS: In other words, if the industry is able to kill reform, or the Democrats and the Republicans can't agree on a proposal, that's what the industry really wants.

Which is happening right now...

WENDELL POTTER: Exactly. And it happened in '93 and '94. And just about every time there has been significant legislation before Congress, the industry has been able to kill it. Yeah, the status quo works for them. They don't like to have any regulation forced on them or laws forced on them. They don't want to have any competition from the federal government, or any additional regulation from the federal government. They say they will accept it. But the behavior is that they will not-- you know, they'll not do anything after say this plan fails.

Say nothing happens. They're saying now what they did in '93, '94. "We think preexisting conditions is a bad thing," for example. Let's watch and see if they really take the initiative to do anything constructive. I bet you won't see it. They didn't then.

BILL MOYERS: Well, on the basis of the past performance, and on the basis of your own experience in the industry, can we believe them when they say they will do these things voluntarily?

WENDELL POTTER: I don't think you can. I think that they will implement things that make them more efficient. And that enhance shareholder value. And if what they do contributes to that, maybe so. But now, they do say, they are in favor of an individual mandate. They want us all to be insured.

BILL MOYERS: For the government to require every one of us to have some policy.

WENDELL POTTER: Exactly. And that sounds great. It is an important thing that everyone be enrolled in some kind of a benefit plan. They don't want a public plan. They want all the uninsured to have to be enrolled in a private insurance plan. They want-- they see those 50 million people as potentially 50 million new customers. So they're in favor of that. They see this as a way to essentially lock them into the system, and ensure their profitability in the future. The strategy is as it was in 1993 and '94, to conduct this charm offensive on the surface. But behind the scenes, to use front groups and third-party advocates and ideological allies. And those on Capitol Hill who are aligned with them, philosophically, to do the dirty work. To demean and scare people about a government-run plan, try to make people not even remember that Medicare, their Medicare program, is a government-run plan that has operated a lot more efficiently.

And also, the people who are enrolled in our Medicare plan like it better. The satisfaction ratings are higher in our Medicare program, a government-run program, than in private insurance. But they don't want you to remember that or to know that, and they want to scare you into thinking that through the anecdotes they tell you, that any government-run system, particularly those in Canada, and UK, and France that the people are very unhappy.

And that these people will have to wait in long lines to get care, or wait a long time to get care. I'd like to take them down to Wise County. I'd like the president to come down to Wise County, and see some real lines of Americans, standing in line to get their care.

So, this is American health care, ladies and gentlemen. It's unbelievable that there are people out there who would defend this or buy into the fear-mongering of the Right so easily. I guess Americans haven't learned from the Iraq War debacle. What was the old saying? "Fool me once, shame on you; Fool me twice, shame on me." Shame on you, America. Shame!

Of course, I'm just using the lead-up to the Iraq War as a specific example. Americans as a whole - including Democrats - have been drinking from the Right-wing Reaganite Kool-Aid for decades, now.

- Aric

[jewelspike]

Thanks for reminding me about the Moyers-Potter interview. I think I've watched it before. I'm surprised that other big businesses are going along with the insurance companies as well, since I'd think that the other businesses wouldn't want to pay either and would be happy for the government to pay for health care. Oh, never mind!

[aric]

Here's an interesting article from Business Week

It's a big article, but here are some interesting excerpts.

Terence's treatment was expensive. The bills for his seven years of medical care totaled $618,616, almost two-thirds of which was for his final 24 months. Still, no one can say for sure if the treatments helped extend his life.

Health-care costs represent 17% of today's U.S. gross domestic product. Medicare devotes about a quarter of its budget to care in the last year of life, according to the policy journal Health Affairs. Yet as I fought to buy my husband more time, it didn't matter to me that the hospital charged more than 12 times what Medicare then reimbursed for a chest scan. It also didn't matter that UnitedHealthcare (UNH) reimbursed the hospital for 80% of the $3,232 price of a scan, while a few months later our new insurer, Empire BlueCross & BlueShield, paid 24% for the same test. And I didn't have time to be thankful that the insurers negotiated the rates with the hospital so neither my employers nor I actually paid the difference between the sticker and discounted prices.


Looking at that stack of documents, it is easy to see why 31% of the money spent on health care went to paperwork and administration

The documents revealed an economic system in which the sellers don't set the prices and the buyers don't know what they are. Prices bear little relation to demand or how well goods and services work. "No other nation would allow a health system to be run the way we do it. It's completely insane," said Uwe E. Reinhardt, a political economy professor at Princeton University who has advised Congress, the Veteran's Administration, and other federal agencies on health-care economics.

Some drugs Terence took probably did him no good. At least one helped fewer than 10% of patients. Today, pharmaceutical companies and government agencies are trying to sort out the economics of developing drugs that will help only a small subset of patients. These drugs are very expensive. Should every patient have the right to them?

Terence and I answered yes. Each drug potentially added life. Yet that, too, led me to a question I still can't answer. When is it time to quit? Congress dodged the question last year as it tried to craft a health-care bill. The mere hint of limiting the ability to choose care created a whirlwind of accusations of "death panels."

The bills from Regence BlueCross BlueShield of Oregon show the operation was relatively inexpensive, just over $25,000, about 4% of the eventual total charged to keep Terence alive. Our share was $209.87. I never looked at or thought about the total cost, or the $14,084 that our insurance—in reality, my employer—paid. We never had to consider who was actually shouldering the bills.

When it came to the insurance companies, the sticker price meant little since they had negotiated their own deals with the hospital. Neither the hospital nor the insurance companies would elaborate. The entire medical bill for seven years, in fact, was steeply discounted. The $618,616 was lowered to $254,176 when the insurers paid their share and imposed their discounts. The portion of the charges that were not covered for the most part vaporized. Terence and I were responsible for and paid $9,468—less than 4%.

Empire BlueCross paid $6,566.40. We paid nothing. So who did the paying? The health insurance system depends on healthy people bearing the cost for sick ones like Terence. For all its incredible treatment benefits, the system is untenable. Should you have had a voice in Terence's final days? Would I make the same decision with my money for your loved ones? These are things I think about now but can't answer.

The whole article is chilling. Here is what I believe to be an incisive estimation of private healthcare by a gentleman from another message board:

I've often said that you can't apply a market paradigm to health care, since the marketplace is about choice but nobody really goes to the hospital out of choice. This, on the other hand, shows me a situation I had not really suspected but should have given the above supposition. When a so-called market is not tied to the realities of supply and demand as other markets are, there literally is no limit as to how high prices can go and no requirement for any rational system to determine pricing mechanisms at all.

And to further punctuate the sheer stupidity of America's private healthcare, here is a list of the world's countries ordered by life expectancy:

Linky

America is Number 38, by the way... Just behind Cuba... So much for the greatest healthcare system in the world.

- Aric

EDIT - Just got something to add:

Health.com

62% of all bankruptcies in the US are in some way due to medical bills. Most of those are middle class families going down the tube.

Interesting excerpt:

“That was actually the predominant problem in patients in our study—78% of them had health insurance, but many of them were bankrupted anyway because there were gaps in their coverage like co-payments and deductibles and uncovered services,” says Dr. Woolhandler. “Other people had private insurance but got so sick that they lost their job and lost their insurance.”

[aric]

Rather than making more edits to my previous post, I thought I should just make a new post and bump the thread up a bit.

Soooooo, HCR just got passed and here is a brief outline of what it does:

Reuters

WITHIN THE FIRST YEAR OF ENACTMENT

*Insurance companies will be barred from dropping people from coverage when they get sick. Lifetime coverage limits will be eliminated and annual limits are to be restricted.

*Insurers will be barred from excluding children for coverage because of pre-existing conditions.

*Young adults will be able to stay on their parents' health plans until the age of 26. Many health plans currently drop dependents from coverage when they turn 19 or finish college.

*Uninsured adults with a pre-existing conditions will be able to obtain health coverage through a new program that will expire once new insurance exchanges begin operating in 2014.

*A temporary reinsurance program is created to help companies maintain health coverage for early retirees between the ages of 55 and 64. This also expires in 2014.

*Medicare drug beneficiaries who fall into the "doughnut hole" coverage gap will get a $250 rebate. The bill eventually closes that gap which currently begins after $2,700 is spent on drugs. Coverage starts again after $6,154 is spent.

*A tax credit becomes available for some small businesses to help provide coverage for workers.

*A 10 percent tax on indoor tanning services that use ultraviolet lamps goes into effect on July 1.

WHAT HAPPENS IN 2011

*Medicare provides 10 percent bonus payments to primary care physicians and general surgeons.

*Medicare beneficiaries will be able to get a free annual wellness visit and personalized prevention plan service. New health plans will be required to cover preventive services with little or no cost to patients.

*A new program under the Medicaid plan for the poor goes into effect in October that allows states to offer home and community based care for the disabled that might otherwise require institutional care.

*Payments to insurers offering Medicare Advantage services are frozen at 2010 levels. These payments are to be gradually reduced to bring them more in line with traditional Medicare.

*Employers are required to disclose the value of health benefits on employees' W-2 tax forms.

*An annual fee is imposed on pharmaceutical companies according to market share. The fee does not apply to companies with sales of $5 million or less.

WHAT HAPPENS IN 2012

*Physician payment reforms are implemented in Medicare to enhance primary care services and encourage doctors to form "accountable care organizations" to improve quality and efficiency of care.

*An incentive program is established in Medicare for acute care hospitals to improve quality outcomes.

*The Centers for Medicare and Medicaid Services, which oversees the government programs, begin tracking hospital readmission rates and puts in place financial incentives to reduce preventable readmissions.

WHAT HAPPENS IN 2013

*A national pilot program is established for Medicare on payment bundling to encourage doctors, hospitals and other care providers to better coordinate patient care.

*The threshold for claiming medical expenses on itemized tax returns is raised to 10 percent from 7.5 percent of income. The threshold remains at 7.5 percent for the elderly through 2016.

*The Medicare payroll tax is raised to 2.35 percent from 1.45 percent for individuals earning more than $200,000 and married couples with incomes over $250,000. The tax is imposed on some investment income for that income group.

*A 2.9 percent excise tax in imposed on the sale of medical devices. Anything generally purchased at the retail level by the public is excluded from the tax.

WHAT HAPPENS IN 2014

*State health insurance exchanges for small businesses and individuals open.

*Most people will be required to obtain health insurance coverage or pay a fine if they don't. Healthcare tax credits become available to help people with incomes up to 400 percent of poverty purchase coverage on the exchange.

*Health plans no longer can exclude people from coverage due to pre-existing conditions.

*Employers with 50 or more workers who do not offer coverage face a fine of $2,000 for each employee if any worker receives subsidized insurance on the exchange. The first 30 employees aren't counted for the fine.

*Health insurance companies begin paying a fee based on their market share.

WHAT HAPPENS IN 2015

*Medicare creates a physician payment program aimed at rewarding quality of care rather than volume of services.

WHAT HAPPENS IN 2018

*An excise tax on high cost employer-provided plans is imposed. The first $27,500 of a family plan and $10,200 for individual coverage is exempt from the tax. Higher levels are set for plans covering retirees and people in high risk professions.

Hardly the apocalyptic nation-ending stuff the Republicans and their Tea Party cadres make it out to be.

And after all of the bitter wrangling, there are more Americans who support the bill than those who oppose it.

I'll write here what I've written elsewhere: The bill isn't perfect, but it's good. I would have liked to see a public option (i.e. Medicare Part E - "E" for "Everyone"), but that can be added at anytime in the future.

And here's an interesting take on the passage of HCR from David Frum

Conservatives and Republicans today suffered their most crushing legislative defeat since the 1960s.

It’s hard to exaggerate the magnitude of the disaster. Conservatives may cheer themselves that they’ll compensate for today’s expected vote with a big win in the November 2010 elections. But:

(1) It’s a good bet that conservatives are over-optimistic about November – by then the economy will have improved and the immediate goodies in the healthcare bill will be reaching key voting blocs.

(2) So what? Legislative majorities come and go. This healthcare bill is forever. A win in November is very poor compensation for this debacle now.

So far, I think a lot of conservatives will agree with me. Now comes the hard lesson:

A huge part of the blame for today’s disaster attaches to conservatives and Republicans ourselves.

At the beginning of this process we made a strategic decision: unlike, say, Democrats in 2001 when President Bush proposed his first tax cut, we would make no deal with the administration. No negotiations, no compromise, nothing. We were going for all the marbles. This would be Obama’s Waterloo – just as healthcare was Clinton’s in 1994.

Only, the hardliners overlooked a few key facts: Obama was elected with 53% of the vote, not Clinton’s 42%. The liberal block within the Democratic congressional caucus is bigger and stronger than it was in 1993-94. And of course the Democrats also remember their history, and also remember the consequences of their 1994 failure.

This time, when we went for all the marbles, we ended with none.

Could a deal have been reached? Who knows? But we do know that the gap between this plan and traditional Republican ideas is not very big. The Obama plan has a broad family resemblance to Mitt Romney’s Massachusetts plan. It builds on ideas developed at the Heritage Foundation in the early 1990s that formed the basis for Republican counter-proposals to Clintoncare in 1993-1994.

Barack Obama badly wanted Republican votes for his plan. Could we have leveraged his desire to align the plan more closely with conservative views? To finance it without redistributive taxes on productive enterprise – without weighing so heavily on small business – without expanding Medicaid? Too late now. They are all the law.

No illusions please: This bill will not be repealed. Even if Republicans scored a 1994 style landslide in November, how many votes could we muster to re-open the “doughnut hole” and charge seniors more for prescription drugs? How many votes to re-allow insurers to rescind policies when they discover a pre-existing condition? How many votes to banish 25 year olds from their parents’ insurance coverage? And even if the votes were there – would President Obama sign such a repeal?

We followed the most radical voices in the party and the movement, and they led us to abject and irreversible defeat.

There were leaders who knew better, who would have liked to deal. But they were trapped. Conservative talkers on Fox and talk radio had whipped the Republican voting base into such a frenzy that deal-making was rendered impossible. How do you negotiate with somebody who wants to murder your grandmother? Or – more exactly – with somebody whom your voters have been persuaded to believe wants to murder their grandmother?

I’ve been on a soapbox for months now about the harm that our overheated talk is doing to us. Yes it mobilizes supporters – but by mobilizing them with hysterical accusations and pseudo-information, overheated talk has made it impossible for representatives to represent and elected leaders to lead. The real leaders are on TV and radio, and they have very different imperatives from people in government. Talk radio thrives on confrontation and recrimination. When Rush Limbaugh said that he wanted President Obama to fail, he was intelligently explaining his own interests. What he omitted to say – but what is equally true – is that he also wants Republicans to fail. If Republicans succeed – if they govern successfully in office and negotiate attractive compromises out of office – Rush’s listeners get less angry. And if they are less angry, they listen to the radio less, and hear fewer ads for Sleepnumber beds.

So today’s defeat for free-market economics and Republican values is a huge win for the conservative entertainment industry. Their listeners and viewers will now be even more enraged, even more frustrated, even more disappointed in everybody except the responsibility-free talkers on television and radio. For them, it’s mission accomplished. For the cause they purport to represent, it’s Waterloo all right: ours.

Of course, I think he overestimates Democratic chances in 2010. The thing smells a bit like the kind of self-pity Democrats experienced in 2004. But it's nice to see a Republican who isn't utterly insane.

- Aric

[Nycki]

Public or private health care will still be corrupt, big government/big corporations I see little difference, hopefully the opposing parties will keep each other from doing any thing to crazy.

[thundertail]

I guess the only thing anybody can do is to pay the health insurance...
And by all means... Never... EVER... get sick or injured!
(It will cost THEM too much money to treat you, so they won't!)