I think Republicans are succeeding at scaring people over health care again.

[Eraserhead]

I'd like to know what the Republicans are pushing for healthcare reform?

The party of no is fresh out of ideas.

They are pushing for more competition and transparency, and have some good ideas about it, but can't get their arms around how to deal with the uninsured, and if you don't deal with that, along with the skyrocketing cost of all these new medical technologies, you just aren't in the game, but nibbling around the edges. It is pathetic really.

They need to sell the accurate fact that nationalized medicine will squash medical innovation. The uninsured are a small segment of the population. Why should we destroy the healthcare of the vast majority of Americans to cover 10-15 million Americans?

Well, I don't agree with the first part of your post to begin with but don't you find the fact that millions are uninsured a little, err, morally disturbing?

[??????????]

I'd like to know what the Republicans are pushing for healthcare reform?

The party of no is fresh out of ideas.

They are pushing for more competition and transparency, and have some good ideas about it, but can't get their arms around how to deal with the uninsured, and if you don't deal with that, along with the skyrocketing cost of all these new medical technologies, you just aren't in the game, but nibbling around the edges. It is pathetic really.

They need to sell the accurate fact that nationalized medicine will squash medical innovation. The uninsured are a small segment of the population. Why should we destroy the healthcare of the vast majority of Americans to cover 10-15 million Americans?

Well, I don't agree with the first part of your post to begin with but don't you find the fact that millions are uninsured a little, err, morally disturbing?

Insurance =/= medical treatment. Insurance should exist for only catastrophic circumstances. The way that health insurance exists now is the major reason why we are having the problems we're having now.

[Eraserhead]

I'd like to know what the Republicans are pushing for healthcare reform?

The party of no is fresh out of ideas.

They are pushing for more competition and transparency, and have some good ideas about it, but can't get their arms around how to deal with the uninsured, and if you don't deal with that, along with the skyrocketing cost of all these new medical technologies, you just aren't in the game, but nibbling around the edges. It is pathetic really.

They need to sell the accurate fact that nationalized medicine will squash medical innovation. The uninsured are a small segment of the population. Why should we destroy the healthcare of the vast majority of Americans to cover 10-15 million Americans?

Well, I don't agree with the first part of your post to begin with but don't you find the fact that millions are uninsured a little, err, morally disturbing?

Insurance =/= medical treatment.

Haha, I can assure you that for many it means exactly that.

[??????????]

I'd like to know what the Republicans are pushing for healthcare reform?

The party of no is fresh out of ideas.

They are pushing for more competition and transparency, and have some good ideas about it, but can't get their arms around how to deal with the uninsured, and if you don't deal with that, along with the skyrocketing cost of all these new medical technologies, you just aren't in the game, but nibbling around the edges. It is pathetic really.

They need to sell the accurate fact that nationalized medicine will squash medical innovation. The uninsured are a small segment of the population. Why should we destroy the healthcare of the vast majority of Americans to cover 10-15 million Americans?

Well, I don't agree with the first part of your post to begin with but don't you find the fact that millions are uninsured a little, err, morally disturbing?

Insurance =/= medical treatment.

Haha, I can assure you that for many it means exactly that.

No ER can turn you down.

[Eraserhead]

I'd like to know what the Republicans are pushing for healthcare reform?

The party of no is fresh out of ideas.

They are pushing for more competition and transparency, and have some good ideas about it, but can't get their arms around how to deal with the uninsured, and if you don't deal with that, along with the skyrocketing cost of all these new medical technologies, you just aren't in the game, but nibbling around the edges. It is pathetic really.

They need to sell the accurate fact that nationalized medicine will squash medical innovation. The uninsured are a small segment of the population. Why should we destroy the healthcare of the vast majority of Americans to cover 10-15 million Americans?

Well, I don't agree with the first part of your post to begin with but don't you find the fact that millions are uninsured a little, err, morally disturbing?

Insurance =/= medical treatment.

Haha, I can assure you that for many it means exactly that.

No ER can turn you down.

Medical treatment should really extend beyond an emergency room.

[??????????]

I agree but don't you think that medical insurance should really only be for disastrous situations?

[Eraserhead]

I agree but don't you think that medical insurance should really only be for disastrous situations?

No, not really. Obviously we disagree on that.

[King]

Let's agree on a compromise.

Free dental for all and call it a day?

[Eraserhead]

Let's agree on a compromise.

Free dental for all and call it a day?

Do I get to pick what color my new toothbrush will be?

[King]

Let's agree on a compromise.

Free dental for all and call it a day?

Do I get to what color my new toothbrush will be?

No, but you do get choice of flavor for the free floss you won't use.

Of course, I'm kidding as this is plan is lunacy and will only lead to the rationing of the free Colgate and Crest samplers just like in Canada.

[Mechaman]

Let's agree on a compromise.

Free dental for all and call it a day?

And make it easier for dentists to force their evil torturous procedures on people?
These people live to cause pain!

[anvi]

There are several problems with the process of health care reform this time, along with one considerable problem with real long-term reform.

The first problem is the conduct of the White House.  These guys are so scared to repeat the Clinton mistake of ramming their own plan through that they take a totally hands-off approach to the writing of the legislation.  They declare a few preferences and lobby for public approval and declare deadlines, but they don't set legislative parameters of their own.  The president doesn't need to present them a ready-made plan and say "stick with me or die," but he does need to set more specific parameters than have been set so far.  If this really is the president's number one domestic agenda item, he has to have more of a hand in the crafting of the legislation he wants to sign.  Congress is kicking the president's butt all over the place, and the White House, outside of begging and pleading with Congresspeople and reducing the president to the role of a mere public cheerleader, is letting it happen.  Don't get me wrong, it's good the president is out there lobbying for public support, so long as the people who want the plan turn on the heat with their own Congressional representatives.  But a president, if they want legislation, has to have a baseline for what it will include and push it with his party members, whose own success is tied to his.

The second problem is the complete lack of party discipline in the Democratic camp.  The party made their Faustian pact in 2006 by retaking majorities in both houses by supporting lots of southern conservative Democrats and Blue Dogs, and now they are paying the price of the bargain.  When Republicans held a one or two vote majority in the Senate and a slim lead in the House, they exerted incredible party discipline and, while it did backfire now and then, made them look like they held absolute power.  The Democrats, with a massive majority in the House and a virtual super-majority in the Senate, act like they have no power over their own caucuses.  You don't let your own party members give the president a full moon in public over his number one domestic policy initiative, you find ways to make the bridge creek under their feet or pledge support for them on other things as long as they come along on this one.  This is a failure of the leadership, and it sets a lousy precedent for the party's effectiveness as a whole.  The Democratic party has the discipline of a parade of cats, and the display is pathetic.

Finally, while some version of the current legislation will probably bring premiums down over time by bringing more people under coverage, which is a good thing to be sure, none of this this addresses cost inflation.  One of the major reasons that other industrialized countries are able to manage their health care systems as efficiently as they do is because the governments are empowered to negotiate prices with the suppliers, the hospitals and pharmas.  If we cannot find a way to control costs on the suppliers' end, either the way everyone else does it or in our own novel way, we will continue to be plagued by the massive costs of this problem, both through inefficient private insurers or through increased government expenditures.  But, it looks like the United States will have to go actually broke, not just hang on the verge of financial ruin, before we learn that lesson.

'Tis enough to give me the blues...

[anvi]

The point, anyway, of my long-winded post is that, if health care reform does not pass, the Democrats have only themselves to blame.  They control the White House and Congress, which means they have the biggest mandate in government then they've had in decades.  They have a considerably popular president.  They have outspent their opposition about 3-1 in tv ads supporting the plan, which has majorities of people polled supporting the basic contours of the bill they want.  If Democrats can't pass a decent plan, it won't be because Republicans said "boo!", it will be because Democrats couldn't find a way to walk in a straight line.

[Sam Spade]

I know what to expect but I am curious as to the details.

What are you expecting?

An attempt to centralize the health insurance process (i.e. coverage) and individual decision-making, probably through the back-door.  I'm sure this can result in us having universal coverage of some sort, though.

A dramatic increase in costs, which will probably be severely understated unless care is rationed to a great extent.

Torie is quite right on the rationing point - it is inevitable.  The point I would make is that there are different kinds of rationing available.  States mentions one not-so-obvious type immediately - rationing of health-care availability to persons. 

But in any type of system that is "government-centered", I expect them to focus one particularly effective (if not the most-effective) type of rationing - namely care in the last year of a person's life.  In other words, the elderly and the terminally ill (or thought to be terminally ill). 

In other words, basically, if the tables say that you are unlikely to survive past one year with X cancer, you don't get chemo.  This type of rationing probably will eliminate a certain amount of "exotic" treatments as well for other types of diseases that may not be terminal within one year.  Now, this doesn't mean that you wouldn't be able to get it (either in the US if privately allowed or elsewhere), so long as you can pay, but generally it would be out of most people's grasp.

Anyway, this has been and what I continue to expect will occur.  Myself, I would prefer what States is proposing to this, but that is not what I expect to happen, since most people don't see this occuring (or maybe want it to occur - your choice).

Oh, and yes, there are ways to pick off around the edges in terms of costs.  But that will not fix anything, even in the short-term, unless we can get another major private debt expansion, a possibility I consider close to nil.

[Stampever]

While the Republicans have done their job as the counter-force on the legislation, I think the mere scope and discontinuity between the Democrats in Congress have had a greater hand in "scaring" people.  There is no reason for a 1000+ piece of legislation.  Congress needs to step back, toss out the crap they've currently worked up, and begin a series of smaller bills to target key areas of the health issue.  That would gain a bipartisan level of support, it will be easier for everyone to digest, and it would have less of a shock to the industry.

[Nym90]

I'd like to know what the Republicans are pushing for healthcare reform?

The party of no is fresh out of ideas.

They are pushing for more competition and transparency, and have some good ideas about it, but can't get their arms around how to deal with the uninsured, and if you don't deal with that, along with the skyrocketing cost of all these new medical technologies, you just aren't in the game, but nibbling around the edges. It is pathetic really.

They need to sell the accurate fact that nationalized medicine will squash medical innovation. The uninsured are a small segment of the population. Why should we destroy the healthcare of the vast majority of Americans to cover 10-15 million Americans?

Well, I don't agree with the first part of your post to begin with but don't you find the fact that millions are uninsured a little, err, morally disturbing?

Insurance =/= medical treatment. Insurance should exist for only catastrophic circumstances. The way that health insurance exists now is the major reason why we are having the problems we're having now.

A major reason why costs are so high is because people who are uninsured are not going in for preventative measures and other more basic procedures, and this is then leading to larger problems down the road that are more costly. This also increases the likelihood they will then not pay the larger bill later and thus drives up the cost for everyone else.

Another large contributor is people making unhealthy lifestyle choices, but obviously trying to legislate "good behavior" is (for good reason) taboo, though I think we should incentivize healthier choices as much as possible. Otherwise we simply have to accept expensive health care as being one of the consequences of our actions.

[Nym90]

We all know what the end game of this, don't we, which is absolutely necessary. The word I am thinking of starts with an "r."  The trick is how to effect "r" politically, which is damn tough. Do you get my drift?

Yes, reform is always difficult, as the deck is stacked strongly in favor of the status quo.

No the "r" word is "rationing."  Write it down.

Well, we have rationing in the current system, too.....just from a different source.

[Torie]

We all know what the end game of this, don't we, which is absolutely necessary. The word I am thinking of starts with an "r."  The trick is how to effect "r" politically, which is damn tough. Do you get my drift?

Yes, reform is always difficult, as the deck is stacked strongly in favor of the status quo.

No the "r" word is "rationing."  Write it down.

Well, we have rationing in the current system, too.....just from a different source.

Well it isn't working very well. My dad was diagnosed with a cancer at 84 that after a week of research I knew was 100% fatal, and after surgery and all the rest, it cost the state 150K in 1991 dollars.  He was a medicare. That is insane. The only rationing really is efficacy, or certain therapies that are not covered, like the one's I am on to make an old body feel young again. That is just not enough. Sure the uninsured are rationed to qualifying for the emergency room (also insane), but they are what - 20% of the population?  Something will change, and soon, because the current system is collapsing without more rational rationing, and the issue now is how to get there, without freaking out the public - which is why politicians don't talk about it. They are scared sh**tless.

[Person Man]

We all know what the end game of this, don't we, which is absolutely necessary. The word I am thinking of starts with an "r."  The trick is how to effect "r" politically, which is damn tough. Do you get my drift?

Yes, reform is always difficult, as the deck is stacked strongly in favor of the status quo.

No the "r" word is "rationing."  Write it down.

Well, we have rationing in the current system, too.....just from a different source.

Well it isn't working very well. My dad was diagnosed with a cancer at 84 that after a week of research I knew was 100% fatal, and after surgery and all the rest, it cost the state 150K in 1991 dollars.  He was a medicare. That is insane. The only rationing really is efficacy, or certain therapies that are not covered, like the one's I am on to make an old body feel young again. That is just not enough. Sure the uninsured are rationed to qualifying for the emergency room (also insane), but they are what - 20% of the population?  Something will change, and soon, because the current system is collapsing without more rational rationing, and the issue now is how to get there, without freaking out the public - which is why politicians don't talk about it. They are scared sh**tless.

Yeah. There is simply no way around rationing, really.

[King]

Preventive care helps.  Although, not for cancer.

[Sam Spade]

I've read about 100 pages of the Senate and House version now.  I was originally going to read them straight on through, with each one separate, but the House version is so vague in so many areas that I had to go and read the Senate version to compare so I could make heads or tails of the damn thing in certain places.  Both plans are surprisingly similar.

My impression on what I've read so far:  Both bills are essentially a disaster waiting to happen in terms of health care quality and health care costs. 

On the costs side, the language of the legislation (since taxes and expenditures are generally undefined) is all I have to go on generally, but I can put 2+2 together and come up with the massive funding needed.  In fact, it may actually be worse than I expected. 

In terms of employment, there are some weirdly perverse disincentives going on for the both the employer (e.g. don't hire full-time workers) and the employee (eg don't ever switch jobs) that I find fascinating and which, btw, were probably never thought out before writing.

As for the health care quality itself, that will require oodles of time (and I have to read about 1500 more pages), but as basics become familiar with 1) what a "qualified plan" is and 2) the fact that it would have to cover "essential medical benefits" as defined by the Medical Advisory Council (or MAC) under the Secretary of Health and Human Services.  The House bill also implies such standards may be "set in statute", which means health care lobbyists have someone else to go after - the Senate bill does not. 3) Become familiar with the term "cost-sharing" - it is essentially a fancy term for rationing the essential medical benefits within qualified plans, as would be defined by the MAC.

Oh, and Torie, both the House and Senate bills explicitly forbid "qualified plans" from charging more for "health status" (i.e. risky behaviors) and forbid said plans from imposing any pre-existing condition exclusions.  To connect, that is but one of an (almost unimaginable) number of provisions that I have read in the first 100 pages that I can translate (without numbers) into meaning "this bill will cost a ton of money" (because the expansion of government subsidies for private health insurance goes into upper middle-class households) and "private/employer costs to insure themselves or their employees respectively will skyrocket".  A similar type of system has been instituted in New Jersey and New York and, needless to say, it caused premiums in both states to skyrocket ridiculously.

I'll do the rest over the next couple of days and see if I can describe how the thing works in plain English.  By that time, we may have another piece of legislation to throw on the health care pyre for examination.

[Mechaman]

Oh my gawd! Our Universal Health Care Plan is unpopular with people! The GOP must be up to their scaremongering fearmongering tricks! Quick! Somebody call the anybody who disagrees with liberals on this issue are rich hateful bigots Squad!

[Eraserhead]

Has the GOP earned your trust?

[Mechaman]

Has the GOP earned your trust?

No. Just commenting on the usual "our opponents are resorting to extreme scare tactics to win" kind of argument. Why is it that whenever people start disagreeing with Democrats lately it's due to some "far right wing plot" and not just people getting cold feet about ideas?
Don't worry, I was making these kind of observations whenever Bush was president too (with Republicans almost unamiously defending everything he did and blaming everything on some evil liberal plot).

[opebo]

They need to sell the accurate fact that nationalized medicine will squash medical innovation. The uninsured are a small segment of the population. Why should we destroy the healthcare of the vast majority of Americans to cover 10-15 million Americans?

Dude, you don't have health care - you'd be fired and kicked off your insurance in a matter of months if you got really sick.