Yes, ALTERNATIVE - not, REPLACEMENT! He talks quite a lot about eliminating waste, particularly in Medicare & Medicaid. He doesn't talk about eliminating the programs themselves, I believe he wants to make them a more efficent part of the system:

"We also want to create an independent group of doctors and medical experts who are empowered to eliminate waste and inefficiency in Medicare on an annual basis -- a proposal that could save even more money and ensure long-term financial health for Medicare. Overall, our proposals will improve the quality of care for our seniors and save them thousands of dollars on prescription drugs, which is why the AARP has endorsed our reform efforts. ...

It's not going to reduce Medicare benefits. What it's going to do is to change how those benefits are delivered so that they're more efficient.

Let me give you a very specific example. You've heard that as a consequence of our efforts at reform, the pharmaceutical industry has already said they're willing to put $80 billion on the table. Now, why is that? Well, the reason is, is because there's probably even more waste than $80 billion, in terms of how the drug plan in Medicare is administered. We might be able to get $100 billion out or more, but the pharmaceutical industry voluntarily said, here's $80 billion.

You know what that means? That means that senior citizens who right now have a so-called doughnut hole in their plan where after spending a certain amount on prescription drugs suddenly they drop off a cliff and they've got to pocket the entire cost, suddenly half of that is filled. That's a hard commitment that we already have.

So that's a change in how we are delivering Medicare. But you know what, it turns out that it means out-of-pocket savings for seniors. That's why AARP has endorsed this."

And then since you'll be in an ER they can't deny care for lack of payment or insurance anyway, your costs will be written off. Mine, being a patient in the same hospital, will go up. My insurance will have to pay more, I will have to pay more, my taxes will go up to pay more for you, and you pay nothing....

sigh...

(not you specifically, just you in the general sense)

For my grandmother: "If you have health insurance, the reform we're proposing will provide you with more security and more stability. ... It will prevent insurance companies from dropping your coverage if you get too sick. ... It will limit the amount your insurance company can force you to pay for your medical costs out of your own pocket. ...

For my dad: "Now, if you don't have health insurance, or you're a small business looking to cover your employees, you'll be able to choose a quality, affordable health plan through a health insurance exchange -- a marketplace that promotes choice and competition."

For B_F: "Finally, no insurance company will be allowed to deny you coverage because of a preexisting medical condition."

That's IF he gets that passed, which is the only reason I'm supporting his efforts. Do I believe government control is the right way to go? NO NO NO NO NO. Do I believe we need more oversight in this industry to stop them from screwing Americans over? YES YES YES.

You quoted well, Becka. I concede the point.

I still don't believe that he can do what you quoted, especially if he insists on rushing it through. Haste makes waste and there's just too much to loose here.

True, but some of the millions of unisured make that calculation and say, you know what, I would rather roll the dice and not pay for insurance I am unlikely to use. The administration is saying no one can make that decision.

I was really highlighting what you said to point out why the current health care costs are skyrocketing and nothing in the reforms being proposed will stop that. Without the consumer having a stake in the cost, the costs will only continue to rise.

We will insure more people for lower costs. We will lower the world's temperture. We will increase spending. We will not raise taxes. There, I just made promises too. Anyone want to wager on whether they can be kept.

Come on Becka, need to look past the spin, and I mean that for all politicians, not just Obama. He is making promises he can't hope to keep and may not even want to keep.

“You come in and you’ve got a bad sore throat, or your child has a bad sore throat or has repeated sore throats,” President Obama explained at Wednesday’s press conference. “The doctor may look at the reimbursement system and say to himself, ‘You know what? I make a lot more money if I take this kid’s tonsils out.’”

I think this speaks volumes of what Mr. Obama thinks of health care and the medical profession.

I'm sure he just calibrated his words incorrectly

Thank you. I respect your skepticism.

"Now, the truth is that unless you have a what's called a single-payer system in which everybody is automatically covered, then you're probably not going to reach every single individual, because there's always going to be somebody out there who thinks they're indestructible and doesn't want to get health care, doesn't bother getting health care, and then unfortunately when they get hit by a bus end up in the emergency room and the rest of us have to pay for it."



I'm not sure I understand what stakes you think are missing?

My boss and I were talking the other day about this specific issue, Straw. He basically considers Doctors "predatory", just like us big bad lenders. Predatory Doctors. I want an Early TIL and GFE from my doctor.

Under current House proposal this is false. All will be required to obtain coverage or pay a penalty greater than cost of coverage.



The economic stakes that the patient should have in treatment costs. None of us have that today and current proposal will not change that. Without patient having economic costs for treatment (not small deductible and nothing more), then health costs will continue to rise.

Think about what this is going to cost. I will quote this from another thread. Becca, do you think it is cheaper to just buy insurance or use the government one:

http://emac.blogs.foxbusiness.com/2009/06/23/health-care-myths/

OK here are average tax rates. Lets compare France (who has socialized medicine to the US: http://en.wikipedia.org/wiki/File:Income_Taxes_By_Country.svg

Please review the graph. Now both countries have certain services provided by the government. France obviously has more than the US does, but it is not so significantly different (other than health care) that we can't do a simple analysis.

The Average GDP for the US is listed here: http://en.wikipedia.org/wiki/List_of_countries_by_GDP_(PPP)_per_capita

US = 46,859 we will round to 46
France = I used 36k. But the reason they are so much lower than we are is they are taxed so much (because of health care). Now, the difference in tax rates for an individual is the US = 28% vs France 52% for individuals (seems high but they are socialist).

So, what part of the income goes to tax? US = 12880, France 18720 for a difference of.... $5840. In a year I pay ~1200 in insurance payments. I spend ~40 on copays and have paid $500 once for an MRI and not needed major surgery. Of which case, if I did, there would be a deductible. The only way, that it would pay off to have France's health care program, is if I had major surgery annually?

So I ask. Which country has the higher cost health care program?

It sounds like you advocate a reduction of insurance services that would force people to pay more directly for the care they need. But how does that reduce the cost of care itself?

I advocate forcing people to pay more directly yes. Costs would come down because when people have to spend out of their own pocket, they will more carefully choose which doctors they see and for what purposes, like you did when you did not have insurance.


But rather than having some bureaucrat decide what care a person should get, the individual has control. If someone wants to spend more, they can choose to. If someone would rather spend that money somewhere else, that is there decision.

Just to throw this out there then (and I am not a supporter of Obamacare), but if we restructure to get people to pay more personally, that simply translate into paying for basic needed care... what encourages people to continue to seek out preventive care and checkups?

Without that, the costs could be far larger on the back end when they finally do go to the doctor because their pain is so great, and lo and behold they have late stage cancer of something or other... those costs could destroy peoples finances worse then, force hospitals into a further charity situation, and just overall be hurt the health of the nation and economy.

How do we as a socitey score on preventive care now? You can set up costs to be less for these for than for illness care, but unless we build in more individual responsibility into the equation, costs will continue to skyrocket. (Also need malpractice reform, which is never mentioned because of tort lobby donating heavily to democrats)

I'll support whatever healthcare the Presidnet and Congress come up with that has them on the same plan as me...until then, it is a joke

Except that not having insurance forced me to forego all of the basic preventive care that most everyone I think agrees is important for long-term health, and only seeking care in the event of an emergency. And when I did have a serious situation, I had to opt for the care & treatment I could afford, rather than the care & treatment that would best serve my conditon.

What I am saying is you would still have insurance, but you be responsible for a greater part of the cost than a $10 deductible. Now, if preventive care is something that concerns you, you could spend your money on that. If others would rather spend their money on lattes, they could choose to do that. Or would you rather tell the person that wants to spend their money on lattes that it is frivilous and they MUST forego that so they can contribute to a pool that allows others to get practically free preventive care, or whatever other procedure.

And when you have a serious situation, you could choose a doctor and facility with all the bells and whistles or you could choose a clinic, depending on how much would have to come out of your pocket for the differences. At least it would be your choice, rather than a bureaucrat.

straw, what you are describing sounds very much to me like the status quo. It seems to me that your argument against the reform proposal is based on the assumption that all of the people who are currently working and paying for their own insurance are going to be working and paying more for everyone else's insurance. That's not the intention of the plan as I understand it. The idea to make insurance more affordable is for all of the people currently NOT paying to start contributing to the pool, so that nobody is getting services for free. But I don't see anywhere that anyone loses freedom of choice in the matter.

Becka, lets just agree to disagree as I don't think you can see what the next logical step has to be.

Look at Europe, Canada, Mass. and Hawaii, all of whom have universal coverage. Europe and Canada have government reviewed care (care can only be obtained if deemed worth it, as determined by a formulary using patient's age, cost, expected outcome), Hawaii had to drop universal coverage due to sprialing costs and Mass. now has spiraling costs.

All come to the same point, rationing.

Explain how this will not happen under current plan.

This is going to sound nuts to some folks, but I think human medical insurance shouls work more like equine major medical/mortality insurance works. Just stay with me for a second here, OK? Now - when we *choose* to insure a high value animal we have options based on the desired insured amount and the "regular risk" the animal is exposed to (a mutli-000 performance critter vs a beloved backyard pleasure horse, for example). The insurance is only claimable for major procedures IF regular maintenance can be proven (those costs are out-of-pocket for the owner) and IF at least 2 vets agree the major procedure is required (if not an emergency situation). The owner pays a certain percentage of the cost out of pocket and the policy pays the rest. This mostly 'cash-and-carry' keeps vets competitive for basic procedures and routine care, and it keeps the major procedures located at conglomerate clinics with multiple in-house vets who can pool their resources for the cost of the big-time equipment. University clinics are still the go-to option for most owners in these situations.

Have I confused everybody yet? I think the point I'm trying to make is that scaling back WHAT insurance is used to cover and meeting those needs in cash would be a big first step in adding competitive restraint to medical costs. OK...I've rambled enough...sorry for the tangent. Just for the record, I think that what little I understand of the "Obamacare" proposal stinks. There's no way we (as a country) can afford it.

Another concern I have heard Becka is that if there is a "public option" some employers may drop coverage knowing there is another option for its employees to fall back on, adding more burden to the system.