About Last Night…

Do you think the election of Scott Brown to the U.S. Senate sent a message to President Obama and the Democrats or do you think he was elected because Martha Coakley ran a bumbling campaign?

Personally, I think it was a combination of the two. I think the health care initiative has people worried and angry. I think that the “change” people voted for in 2008 was to get our country back on track, NOT make it more socialistic.

If you’re a Democrat, I don’t think all is lost. I do think it’s time to put the brakes on health care reform by scrapping the current plan and going back to the drawing board, and THIS TIME have open meetings with no backroom deals. However, if Democrats continue to try to push this bill through as-is, they will have a tough time getting re-elected in November.

Thoughts? Please, lets act like real adults here…

40 thoughts on “About Last Night…”

  1. JLP) I agree with that. I consider myself an independent (but did vote for Obama), but I dislike how this Health Care reform bill is being rammed in. Don’t get me wrong, I think we need some sort of reform — but I think the democrats got this one wrong and need to go back to the drawing board (as you say) and come up with a true bi-partisan package.

    I think we have a big imbalance between quality of care, and cost of care. In the US, we pay the most for healthcare out of all countries in the world, yet our quality is ranked somewhere around 20th. We need some sort of reform that either:

    1) lowers cost
    2) increases quality
    3) or both

    I’d like to sidestep the entire debate on whether healthcare is a right/privilege — and just concentrate on the financial part.

    Something is really wrong if it is cheaper for me to purchase prescription medications from CanadaDrugs.com that it is for me to purchase through my own insurance companies’ prescription mail order business. And these aren’t medications manufactured in some Chinese plant, these are medications manufactured in the US and never leave our borders.

  2. If they go back to the drawing board, we can expect the whole thing to die, as it has in the past.

    Unlike BG, I think the entire debate should START with whether healthcare (and health insurance) is a right. Specifically, what does the country “owe” every citizen? And answer specific questions like:
    “If a child is born with Downs Syndrome, who should pick up the tab for the next 20, 30, 40 years?”
    “Is it fair to place the burden on the parent?”
    “Should all 80-yearolds be entitled to hip replacement surgery?”

    I see a huge sense of entitlement, and most politicians (D&R) don’t have the guts to say – “I’m sorry, you will have to suffer (or even die). We will not pay for that treatment.”

    I think the loss is about more than healthcare. Some people have realized that credit card regulation, taxing bank bonuses, regulating executive salaries, etc. amount to big government inetrference and in the long run will hurt everyone.

    Government functions best when there is no monopoly on power and they are fored to compromise or gridlock.

  3. BG, you say that “our quality is ranked somewhere around 20th.” Tell me:
    1. If you had a heart attack, which country you would prefer to have it treated in?
    2. If you had colon cancer, which country would you rather have it treated in?
    3. Which country would you rather have a premature baby in?

  4. Quality of care measures are affected by the fact that Americans are obese leading to higher infant mortality and an increase in health problems that shorten life.

    Obesity is not caused by our health care system, it’s caused by our lifestyles. Increasing the number of doctors visits will not decrease the average weight of this country, and thusly reduce health problems.

    I agree with Mark, however, that we need to start the debate over whether free health care is a right.

    Personally, I do not believe it is. Nothing tangible can be a right. If it were, wouldn’t housing then be a right? Or food? Of course, all of those are required for a person to live.

  5. Brown’s win is a balance of the two. Coakley dropped the ball on her campaign. I believe this to be because she just assumed that the D next to her name would win her the election. It also didn’t help that she referred to is as Kennedy’s Senate seat and not a Massachusetts’ senate seat (going with the implication that it belong to the family and not the state). When she finally realized that she was not the favored candidate she rolled out attack ads.

    Scott Brown had ads running since Thanksgiving, and then pulled them for the Christmas and New Years holidays, before putting them back. I am not aware of any Coakley ads prior to New Years. Incidentally that is also when the polls started showing Scott with the lead.

    AS far as Healthcare, Massachusetts has been the testing ground of Universal Insurance, and its cost estimates, no matter how inflated, are always orders of magnitude low – look at our budget problems. I have a job that provides insurance that meets the “minimum medical coverage” as required by Massachusetts. The state plan is about $400 per month (2 people, age 28 making a combined total of more than $40k) if you work, but free if you don’t. If you don’t have coverage, it was a $500 fine last year. I prepare taxes and had many clients opt for this rather than pay for the state sponsored plans.

    The most disturbing thought is: the House can accept the Senate bill as is and there will be no vote. The bill can then be amended, which may be easier to do than to pass a reconciled bill. The only positive to this will be the potential loss of many re-election campaigns.

  6. #2) I think you are arguing the anti ‘socialistic’ view points. But think of the other ‘socialistic’ programs in the US: mail service, flood insurance, fire/police, Medicare, and the list goes on and on. If 100% of the population where required to be covered (and pay into) some form of insurance, then yes, everyone should be ‘entitled’ to, at least, basic care.

    #3 Dave) If I had a heart attack, and insurance, then I’d be better served in the US. If I didn’t have insurance, then I’d be much, much better off in Canada, or any other ‘modern country, specifically France (with has the best cost/quality ratio). Same goes for the other 2 questions. If I was uber-rich, then I’d go see the best doctor on the planet regardless of country.

    Have you not seen the prices that hospitals and doctors charge people without insurance? It is easily 2x to 10x more that what an insurance company+patient would pay for the exact same treatments.

    A specific example from my records: A doctor billed $167.00 for something. My insurance company paid $26.46 and I paid $6.62 for a total of $33.08 (about 1/5th what a person without insurance would have paid). Every single entry in my records is similar covering tens of thousands of dollars over the past few years.

    The system would be better off if the only ‘reforms’ passed were simply to require doctors to charge one amount, whether you have insurance or not. Of course, different doctors could charge different amounts (competition), but not different amounts whether you have insurance or not (similar to cash -vs- credit).

  7. It’s interesting that the Republicans want to fight against health care becoming more “socialistic” but they are opposed to cuts in Medicare and controlling the price for drugs. They want the government to subsidize the pharmaceutical company profits. Both parties are so abjectly incompetent on this issue, it is unreal.

  8. Retired,

    Nowhere have I given the impression that I support everything the Republicans are doing.

    I had read somewhere several years ago that American pharmaceutical companies sell drugs for less to foreign countries because the foreign countries refuse to pay market price. Guess what, that means the US customers must pay more in order to make up the difference. If this is true, then I say we make other countries pay market price for drugs if they want them. Surely, this would bring down prices in the US.

    As far as Medicare is concerned…that is pure politics and I hate it.

  9. #8 JLP) But, market-price, is exactly defined by what the market is willing to pay. If foreigners are not willing to be ripped off by US drug companies — then those drug companies must lower the prices (and obviously they did) — because that is what the market will bear.

    The problem in the US, is that these costs are mostly out of US consumers control. The prices are already set in stone in people’s insurance policies, etc. As for me, I order certain medications via Canada, because I can still get 1/3rd off the ‘insurance adjusted’ price that way.

    Why can’t Medicare do the same? Why is it that Medicare must pay the crazy high prices? The answer is the pharmaceutical lobbies pushed legislation requiring Medicare to only purchase drugs inside the US (protectionism) — on the notion that somehow only US-made drugs sold in the US are somehow safer than US-made drugs intended to be sold overseas.

  10. That’s fine, JLP. It just find the Republican rant against socialism rather laughable. It is a party that subsidizes the defense industry, the oil industry, the drug industry. Defense spending is incredible and yet we need MORE of it. Lots more.

    For a party that is against socialism, they sure do like it a lot.

    As far as foreign drug prices are concerned, other countries negotiate drug prices. The drug companies sell to them because to not sell to them is to turn away money.

    You can’t make other countries pay what we pay because they will not pay it and they do not have a government that insists on subsidizing the pharmaceutical industry.

    We pay more in the U.S. because the govt, led by the Republicans, refuse to allow Medicare and other govt programs to put the hammer down on drug prices which they could easily do as other countries do. That’s because it would hurt the stock prices for drug companies which is a big no-no for a party that worships at the feet of the stock market.

  11. IF the other countries desired our drugs, they’d pay market prices. My guess is that drug companies don’t say no because they know they can make up for it here in the U.S.A.

  12. To answer JLP’s original question, I think it is a little of both. This is almost the exact situation as in 2006 when the Dems took Congress back. The people were angry with Bush so they voted out the next best thing. The people are angry with the shady Dems and their version of change (which really didn’t change anything at all – hello 2 wars, a semi-illegal jail that still exists, and unemployment).

    Neither party excites me, I am a libertarian which basically says I want the smallest gov’t possible so while I agree with SOME of what Retiredat40 Said, I also agree with a lot of what the others are saying about Health care.

    In the end, I always have to ask myself what has the gov’t been good/efficient at running? Social Security? Medicaid? FRE/FNM?

    GREAT (GROWNUP!) discussion thus far

  13. I almost think insurance is the problem and not the solution. There should not be various pricing structures based on whether or not you have insurance.

  14. Evan, for the most part we have great discussions here. Every once in a while someone comes along and gets offended by the discussion (or by me…lol) and leaves for good. Oh well…

  15. So you think that drug companies are just selling to other countries out of charity and concern for the availability of drugs in those countries? So they sell at a loss and make up for it by charging the U.S. more? Yeah, right.

    Other countries are paying market price. If they weren’t, the drug companies wouldn’t sell to them. By definition, a market price is the price arrived at with negotiation between a buyer and a seller. They buy at a price that the drug makers are willing to sell at.

    We are paying above market price because of the govt mandated subsidy. It is illegal for Medicare to negotiate drug prices. Prices are higher because Medicare agrees to pay sky high prices mandated by the pharmaceutical industry.

    The government, being a gigantic buyer of meds, should have some say in what it is willing to pay. If the government paid less, insurance companies would want the same deal and drug prices would come down and so would pharmaceutical profits and drug company stock prices. That’s where the trouble starts.

  16. #11 JLP said:

    “My guess is that drug companies don’t say no because they know they can make up for it here in the U.S.A.”

    Bingo! You got it right. We in the US are subsidizing the rest of the world’s “cheap-socialized” health-care, and yet deny the same for our own citizens.

    You think that other countries should pay what we pay for prescriptions, yet the best place is a ‘meet-in-the-middle’ approach where they pay more, and we pay less. This would help fix the imbalance in the cost/quality ratios I was talking about earlier.

  17. Agreeing with JLP and BG,

    “So you think that drug companies are just selling to other countries out of charity and concern for the availability of drugs in those countries? So they sell at a loss and make up for it by charging the U.S. more? Yeah, right.”

    Once the pill is developed and passed the FDA to make the 2nd pill is often pennies. Its like software – all the expenses are built into the R&D. So if they can make their moeny here charging X why wouldn’t the drug companies make extra selling for Y elsewhere.

  18. I don’t think FREE health care is a right, but
    if AFFORDABLE health care isn’t available, then
    something is seriously wrong.

  19. Most drug companies are public. Look up their cost structures, their gross profit, and net profit margins. We rant and rave about them making “all this money” then we want them in our portfolios for that very reason. Everyone ranting against drug companies forget that it takes 20 years of research and development to bring something to market. That’s thousands of salaries, millions in income taxes from those workers and the sales taxes they spend.

    It isn’t as simple as “drug companies make too much money.”

  20. At the minimum, health care reform should prevent insurance companies from denying coverage for pre-existing conditions and allowing them to increase premiums or cancel coverage when you get sick. After that, the whole bill should be reworked. How about opening Medicare to everyone, with people under 65 paying higher premiums?

  21. “…if Democrats continue to try to push this bill through as-is, they will have a tough time getting re-elected in November”

    I think you got it backwards; don’t you think that, should health care reform fail, it is more likely that a great majority of the people that so enthusiastically voted for Obama would be very dejected with those inept Democrats they put in office?

    Don’t you think that many Democrats know darn well that “scrapping the current plan and going back to the drawing board” is a Republican code for “kill health reform, bury it and forget about it?” (How many Republicans clamored for health care reform after Bill Clinton’s overhaul attempt failed in 1994?)
    With all due respect I think your advice for Democrats to “put the brakes on health reform” sounds pretty condescending. That’s nothing more than republican talking points.

    I voted for Democrats and Obama and the Democrats in 2008 hoping they would pass health care reform. It is imperfect in its current form but still better than nothing. The Democrats better be sure that if they don’t pass health reform, in both 2010 and 2012 I, for one, will vote straight ticket Republican. So there you have it Democrats, take your pick now…

  22. John (#20) wrote:

    “At the minimum, health care reform should prevent insurance companies from denying coverage for pre-existing conditions…”

    Isn’t that kind of like trying to buy car insurance on a car that you’ve already wrecked and expecting the insurance company to cover the tab?

  23. #6 BG

    If you had a heart attack and no insurance, you would receive the same care in the US as you would if you had insurance; the difference would be the bill.

    In your example:
    “A doctor billed $167.00 for something. My insurance company paid $26.46 and I paid $6.62 for a total of $33.08”

    The doctor billed the insurance company $167.00 also. The insurance company refused to pay and settled with the doctor for the actual payment. This is an agreed upon settlement amount. This amount comes from the fact that if a contract for that amount was not in place, the insurance company would refuse to pay until the doctor took them to court and then end up settling for something in that ball park.

    Many doctors are willing to reduce billing amounts if you talk with them (or their staff) and are paying cash. The inflated prices come from having to make up losses due to lower insurance payouts.

    Possible solution for Doctor: Don’t accept insurance. Unfortunately that also tends to mean don’t accept patients since most if not all carry some form of insurance and wish to use it to reduce their costs.

    Here’s a general thought: I have automobile insurance. I don’t use it for minor repairs or preventative maintenance; it’s for major accidents. Isn’t automobile insurance sort of like medical insurance for vehicles? Why do we expect our medical to cover things that we pay entirely out of pocket for our cars? Maybe medical insurance should cover only catastrophic events, with all preventative medicine being out of pocket (yet if preventative medicine is used, a reduction in premium is provided). Just some thoughts.

  24. #22 JLP) the car analogy doesn’t work so well. My son had an illness that went mistreated and misdiagnosed for the first two years of his life. We’ve had insurance the entire time, never a lapse. Due to not catching it early (negligence of the doctors), his issue still requires twice-yearly ultrasounds, and has a possibility for him to develop renal failure in his 40s-50s. Other kids who have this condition and are treated at birth have no lasting effects.

    This condition would be considered a pre-existing condition, and no _new_ insurance company would insure him (at least for anything related to this) even though there was never a lapse in coverage. That is what the ‘pre-existing’ condition limitations are all about.

    #24) No, most doctors are _not_ willing to negotiate. Heck, most doctors have no idea what is being charged (since its different per insurance company anyway). My neighbor is considered an under-insured, cash only, person — and he has told me about doctors offices that absolutely refuse to negotiate on the inflated prices. In their case, they just go without (ie; quality of care in the US sucks, if you can’t afford to pay).

    I am on a High-Deductible plan — so it is only for major medical. I easily pay over $10k a year in medical out of pocket. Even if my insurance company didn’t pay a single penny for my claims, I would still be able to pay the bills. But I could never afford the prices that the doctors would charge if it wasn’t ‘insurance negotiated’.

    Someone having a heart attack (with insurance) would probably pay $20k (insurance+patient payments) to the doctors and hospitals. Someone without insurance would easily be billed over $100k for the exact same treatments by the exact same doctors.

  25. Another example from my records, a surgery my wife required:

    Billed: $15,630
    Insurance adjusted: $3,920

    Personally, I don’t see how anyone can afford to not have insurance — if only to just get a negotiated rate.

  26. BG,

    Yeah, you have a point. By pre-existing conditions, I was referring to people who mistreat their bodies for years, get heart disease and then want to hop on an insurance plan in order to get coverage.

  27. I keep having a thought about why health care bills poll so badly. I haven’t seen anything that breaks the opposition down. Some folks are against the bills because they go too far, some folks don’t think they don’t go far enough. There is wide agreement we have a real problem and we need to make a change.

    The sad truth is we no longer have a government of, by and for the people. We are governed by giant corporations. I’d rather have a government bureaucrat making decisions about my health care than a corporation “to big to fail”.

  28. #27) Glad you are seeing it my way. Now, if we take my example to the next step:

    If my son’s medical costs, in the future, will be considered an uncovered pre-existing condition, by a new insurance company — then the doctors are no longer obliged to only charge the ‘insurance negotiated’ rate, because there is technically no insurance / contracted rate.

    My medical bills could shoot up an order of magnitude (10x), even though I have insurance, and never had a lapse in coverage.

    This is why reform is needed.

  29. #29 JLP) I not so sure that having the government make medical decisions is really worse than what we have today: for profit insurance companies making the medical decisions…

    Something to think about.

  30. Politicians have an opportunity to actually listen to voters and go back to the drawing board on healthcare reform. People I talk to are worried about the size and expense of government. And they are tired of hearing about all the pork and special interest carve outs in the current bills. These same people would support a simple plan which:

    1) Levels the tax playing field. Let everyone deduct premiums or nobody – not a little bit of both.

    2) Cuts the links to employment. Insurance should be portable.

    3) Eliminates pre-existing condition exclusions.

    4) Allows purchases across state lines.

    5) Mandates only catastrophic coverage above $10,000. Only about 5% of the population spends over $10,000. Free people to cover the first $10,000 any way they choose.

    6) Requires healthcare providers to post and charge one rate for all customers. Ever try to pay cash for a procedure? I find it to be at least twice the insurance reimbursement rate.

    7) Contains no pork, special interest provisions, or targeted taxes.

    I think that such a bill would receive broad support from both parties.

  31. Regarding foreign drug costs, my understanding is that US pharmaceutical companies charge less abroad because if they didn’t, their IP would simply be violated. Foreign countries are willing to pay production costs for the drugs they buy, but not the R&D costs for all the drugs that don’t make it to market, but those costs still have to be covered.

    Regarding pre-existing conditions, insurance exists to cover unexpected costs. Pre-existing conditions are not unexpected, so why would anyone bet against you having them? It would amount to insurance companies definitely paying some large amount of money in exchange for a very small amount of money, and that’s a losing proposition. The reason insurance is profitable is because most people who buy it don’t need it, so the revenue far outstrips the expenses. Mandate coverage for pre-existing condition, and the profit disappears, and thus, so does the insurance company.

  32. @34, well by extension I guess the next time someone here is buying an Audi, Toyota, etc, we should demand that the price excludes the R&D on all the models that didn’t make it to the showroom floor!

    For being a nation filled w/brilliant people, our country can be pretty stupid in how we allow people to take advantage of us.

  33. @29: I’d rather have a bureaucrat that I can vote out make some decisions about my health care than a private, for-profit corporation that has no accountability (most people that have health insurance can not choose to go to a different company if they don’t like the service; we get one choice and that’s it). One of the campaign ads used here talked about how health reform would take away our freedom to choose our doctor, our hospital, and our procedures. It always made me laugh because we don’t have that freedom now. We choose our doctor based off of a list that the health insurance co. puts together, same with the hospital. For many procedures, the insurance company decides whether or not they’ll allow it. I don’t see any freedom there.

    Back to the point of the post, Brown had support because Coakley didn’t put any effort into the race and only attached rather than provided examples of what she would do better. Plus, she wasn’t that likable of a person, and even if we want to think that merit or some other factor plays the majority roll in who people vote for, more often than not its likability.

    Health reform had little to do with it since we have a health care system that covers most of the state’s population, and the majority of the MA population supports it. This article provides some back up: http://www.boston.com/news/politics/politicalintelligence/2010/01/setting_the_rec.html

  34. #34 Jason) So, what do you propose when someone gets a life-long illness, like diabetes? Insurance companies cover them for the rest of the year, and then they are dropped, because it is no longer ‘profitable’?

    Everyone should watch this Obama’s speech (specifically starting at 6:55):


    If it is unprofitable for capitalism/business to do something, then that is exactly the thing that government is for.

  35. BG: Who on Earth buys insurance that doesn’t include extended-care in case of debilitating injury or illness? I’d think that was basic.

    It’s requiring insurance companies to pay for extended-care for people who needed it *before they bought their policies* that I object to. Perhaps I should be allowed to buy homeowner’s insurance after my house burns down and retroactively require the insurer to build me a new house? That would be a great deal for me! Not so much for the insurance company or it’s other customers.

  36. #38 Jason) I am not arguing that insurance companies should be forced to cover pre-existing conditions before a policy is purchased. I’m arguing that insurance companies should be forced to cover illnesses if there has never been a lapse in insurance (either the old insurance company or the new one — I really don’t care).

    I’ve never argued that an insurance company provide any type of coverage for pre-existing conditions when the customer has lived their entire life uninsured — not sure why you think I’ve been saying that.

    Here is an example: Jan 1st get an insurance policy (after undergoing insurance companies health exams, etc). November of same year, diagnosed with having diabetes. Dec 31, the one year policy is up, and the insurance company refuses to renew. Go to new insurance company, and they refuse to cover diabetes because it is a ‘pre-existing’ condition — they will however under-insure you by inflating your rates, and exclude anything related to diabetes for 18 months. After 18-months, they drop you, rinse repeat.

    Never a lapse in coverage, yet never really covered.

  37. Health insurance in this country is not insurance. It is more of a club. You pay your dues and you get access to all of the club benefits.

    Real insurance is not socialism. Insurance is a fee you pay to get access to a large pool of money in the event of a catastrophe. Examples being a hurricane, fire or flood.

    When this country seperates the two, we will be on our way to real reform.

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