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With Obama's presidency ascendant, there has been an outpouring of speculation as to if/when/how an initiative to reform the health care system will emerge. I turned into a hack promoting the purchase of Tom Daschle's book to encourage awareness of what may be coming down the pike. In today's Washington Post Davids S. Broder writes:

No one who knows the history of such efforts, from Harry Truman's administration through Bill Clinton's, needs to be reminded of the difficulties that inevitably confront any plan to overhaul one-seventh of the U.S. economy and bring high-quality medicine to millions of the uninsured.

But developments at both ends of Pennsylvania Avenue last week -- and across the country -- pointed up both the urgency of the problem and the prospects for seeing significant action.

When Barack Obama's transition team let out word that former Senate majority leader Tom Daschle would be his choice to run the Department of Health and Human Services and to quarterback his work on health reform, it signaled that Obama is serious about his campaign promise to make that issue a first-term priority.

Daschle would not leave a lucrative job at a law firm to twiddle his thumbs. Only with a clear understanding that the new president will put his own political capital at risk in this cause would the South Dakotan sign up for the job.

Daschle can be of great help to Obama in achieving the goal. He has made his own in-depth study of health-care issues and brings a genuine passion to the subject. And he knows the Senate, where past efforts have foundered.

There are positive signs within the Senate as well. Max Baucus of Montana, the chairman of the Finance Committee, one of the two main centers of Senate action, moved first by releasing a detailed outline of his preferred piece of legislation. Edward M. Kennedy of Massachusetts, the chairman of the other committee of jurisdiction -- Health, Education, Labor and Pensions -- quickly asserted his right to be at the center of action. He organized three task forces within his committee and reached out to Baucus to suggest that their staffs start exchanging ideas as well.

One issue that could have clouded House prospects was resolved when the Democratic caucus voted to make Henry Waxman of California chairman of the Energy and Commerce Committee, replacing John Dingell of Michigan. Both are skilled legislators; Waxman is closer to Speaker Nancy Pelosi.

A fast start is important because it takes untold hours to work through all the complex issues involved in comprehensive health care. When Bill Clinton delayed in getting Hillary Clinton's legislative proposal up to Capitol Hill until the end of 1993, his first year in office, he made it much easier for opponents to throw up roadblocks.

The architects of the Clintons' defeat were Newt Gingrich and Bob Dole, then the leaders of GOP forces in the House and Senate. Gingrich has now become an advocate for systemic change in the way health care is financed and delivered. His approach differs from Obama's, but it starts from the same premise: The current system is too wasteful and unproductive to be sustained.

And Dole, who in 1994 moved belatedly to opposing the Clinton effort as his own presidential ambitions rose, told me last week that today's circumstances make a repetition of those scorched-earth Republican tactics inappropriate. Instead, he is reminding Republicans of his own contributions to bipartisan successes -- the 1983 Social Security rescue and the passage of the Americans With Disabilities Act in 1990.

Dole and Daschle have both worked for the firm of Alston and Bird for the past few years, and it would not surprise me if Dole finds ways to be helpful to Daschle and Obama in the coming fight.

Some have argued that Obama will be forced to delay his promised effort at health-care reform, either because of the urgency of the economic problems facing the country or because there will be no money in the budget to pay for such an enterprise.

But every indication is that he will not wait. Indeed, he could well argue that the current plight of the Big Three automakers stems in part from the burden that Ford, General Motors and Chrysler are carrying for the failures of our employer-based health-care system. One of their basic competitive disadvantages stems from the fact that Japanese and other foreign carmakers are operating in countries where government and society as a whole -- not individual companies -- pay the costs of health care.

The Wall Street Journal has weighed in repeatedly:

One signal is yesterday's news that Barack Obama has selected Tom Daschle, the very liberal former Senate warhorse, to head the Health and Human Services Department. But an even clearer sign was last week's release by Montana Senator Max Baucus of a policy blueprint that closely resembles the one Mr. Obama campaigned on for 17 months. The plan is significant not only because its author is Chairman of the powerful Finance Committee, which oversees taxes and about half of all government spending. Mr. Baucus is also one of the more moderate, and cautious, senior Democrats.

If the Obama White House decides that reorganizing the 17.1% of the economy that the U.S. is likely to spend on health care in 2010 is a first-year priority, then Mr. Baucus's bill will be the place they start. Americans need to learn what they'd be paying for.

First, Democrats want the government to create a national insurance exchange, or marketplace, in which all comers could buy into a range of heavily regulated private policies at group rates. These private plans would then "compete" with a new public insurance option, i.e., a program managed by the government and modeled after Medicare. Lower-income earners would get subsidies to make coverage "affordable." Businesses that didn't cover their employees would pay a tax on some portion of their payroll.

The last cog is the "individual mandate." This requirement that everyone buy coverage has grabbed most media scrutiny of the Baucus plan, because Mr. Obama opposed it during the campaign. But the many moving parts don't work together unless the young and healthy foot the bill for care of the older and sicker -- one reason Hillary Clinton kept nagging Mr. Obama about the individual mandate during the primaries.

Strap yourselves in, little dudes, it's gonna be a wild ride.
 

enjoydrywax

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I wonder what this clown will do about dwindling physician reimbursement--I hope he realizes that the only way to motivate physicians is through financial reward.
 

wasteoftime

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I will be very upset if I have to pay the same amount as a heavy smoker, fat ***** 10 cheeseburger a day eater, non exercising, poor life decision making burden to society under any plan that is enacted. People who take responsibility for their own health should be rewarded, not punished.
 
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kami333

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I will be very upset if I have to pay the same amount as a heavy smoker, fat ***** 10 cheeseburger a day eater, non exercising, poor life decision making burden to society under any plan that is enacted. People who take responsibility for their own health should be rewarded, not punished.

And you don't already???
 

Law2Doc

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I wonder what this clown will do about dwindling physician reimbursement--I hope he realizes that the only way to motivate physicians is through financial reward.

ROFL -- no one has ever suggested that physician motivation is a current healthcare problem.
 

cbrons

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I wonder what this clown will do about dwindling physician reimbursement--I hope he realizes that the only way to motivate physicians is through financial reward.

I will be very upset if I have to pay the same amount as a heavy smoker, fat ***** 10 cheeseburger a day eater, non exercising, poor life decision making burden to society under any plan that is enacted. People who take responsibility for their own health should be rewarded, not punished.


man this is gunna be interesting. I'm not gunna get upset though, I'm just gunna sit back and laugh at the whole process and see what happens. I read the WSJ q am so we'll see how badly everything gets destroyed... and if it doesn't get worse then ill be happy I'd had nothing to laugh at. Worst comes to worst, i can take my American medical degree to some country with an emerging economy who knows what a real free market system is supposed to look like.
 

wasteoftime

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And you don't already???


Free market insurance companies charge smokers and other unhealthy high risk individuals higher premiums at present. If our taxes are increased to pay for a government system, people who actually care about their bodies should receive some sort of tax break.
 

Emmet2301

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Free market insurance companies charge smokers and other unhealthy high risk individuals higher premiums at present. If our taxes are increased to pay for a government system, people who actually care about their bodies should receive some sort of tax break.

I guess theoretically it could be true, but how do you know if they are trying to be healthy? Someone could be overweight and trying to reduce their weight. Also, won't a lotta people be upset if the government tried to enforce this. Just because you are unhealthy it's seen as "bad" by the government and you don't get a tax break?
 

cbrons

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Vast majority of people who come to our pharmacy, who are on state-aid ($0 medications that cost hundreds of dollars) are overweight, have overweight kids on expensive ADHD drugs, and smoke. $0 copay? I mean, it cant be at least 50 cents or a $1.00??????? FREE?????

Illinois is run by *****s.
 

bobsagat

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Thanks for posting these. Important for us to keep an eye on what's going to happen.

For my money, no policy change is going to be successful unless the behavior of the average American also changes. We are the unhealthiest people in the developed world.

Step 1: outlaw motorized scooters for the overweight.
 

gustavo32

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Wasn't the educated young adults the ones that voted for him?
Here we have it,if lucky enough for 8 years.Just going to ask for loan forgiveness,that is a posibility.
 

sixpence

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this would benefit public hospitals with financial crises from seeing too many uninsured patients right?
btw, i haven't been following, but whats the physician salary supposed to look like if obama's plan does go through?
 

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this would benefit public hospitals with financial crises from seeing too many uninsured patients right?
btw, i haven't been following, but whats the physician salary supposed to look like if obama's plan does go through?
The same or slightly lower for a long time. Contrary to popular SDN belief Obama isn't a scythe-carrying Socialist and neither is his health plan.
 
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Decicco

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I'm still hoping that Obama will be too busy with the economy to start redistributing money from doctors to the insurance companies.
 

Decicco

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How did you reach this conclusion?

Which conclusion?
First, I think that Obama will not have enough political capital to spend on healthcare if the economy does not drastically improve. Since election day, stocks have went down 16%, and I just don't see anything in the pipeline that will make this situation much better. There is some talk that Obama will put off his tax increases (esp. the capital gains increase) until later, which would be a step in the right direction.

Second, physicians do not have much political power. If health care "reform" does happen, the dollars will go to the politically powerful: insurance companies, government bureaucrats, lawyers, etc.
 

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See, all of your people don't realize is that Obama is a SMART guy. Thats the reason i voted for him. He knows what he is doing. He knows the pros and cons of every plan that he will make and he will try to balance them out.
 

wasteoftime

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I guess theoretically it could be true, but how do you know if they are trying to be healthy? Someone could be overweight and trying to reduce their weight. Also, won't a lotta people be upset if the government tried to enforce this. Just because you are unhealthy it's seen as "bad" by the government and you don't get a tax break?


easily. An ounce of preventing yourself from becoming fat is worth a pound of fat you burn off on the treadmill. All the naysayers who say its glandular or big bones (the big bones you are eating that meat off of), can go read a recent study about the amish who possess an obesity gene, but work very hard and are in great physical condition. My gym scans your id card every time you go in. Blood tests will show if you have nicotine in your system. Won't a lotta people be upset if they are extremely healthy and they have to pay for some idiot fat arse's quadruple bypass? It's either they pay more taxes, or there should be a $10 federal tax put on top of every mcdonalds cheeseburger like there is with cigarettes.
 

JeetKuneDo

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easily. An ounce of preventing yourself from becoming fat is worth a pound of fat you burn off on the treadmill. All the naysayers who say its glandular or big bones (the big bones you are eating that meat off of), can go read a recent study about the amish who possess an obesity gene, but work very hard and are in great physical condition. My gym scans your id card every time you go in. Blood tests will show if you have nicotine in your system. Won't a lotta people be upset if they are extremely healthy and they have to pay for some idiot fat arse's quadruple bypass? It's either they pay more taxes, or there should be a $10 federal tax put on top of every mcdonalds cheeseburger like there is with cigarettes.

I see where you're going with the tax breaks for people trying to be healthy and preventing becoming obese, smokers, etc. Although it would be really cool to have, I don't really see it happening though. Some factors like obesity could be caused by your socioeconomical status. Buying a cheeseburger and fries at mcdonalds is cheaper and less time consuming than going to the supermarket and cooking your own food if you do not have a car and need to work many long hours to barely support a family.
 

Decicco

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By mindlessly regurgitating anything that presents Obama negatively.

:rolleyes: It sounds like someone has been watching too much of this. My reasons for why doctors will get a raw deal in Obama's healthcare plan is in my previous post. The Clinton healthcare team has a huge presence in Obama's cabinet, and I don't think that many (informed) people would claim that Hillarycare would have been good for physicians. Doctors were not even consulted during the Clintons' formation of their health care policy. But, do you know who was at the table? The politically powerful: drug companies, insurance agencies, and "academics" who fancied themselves as the new powerful bureaucrats of government-run healthcare.
 
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Gut Shot

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:rolleyes: It sounds like someone has been watching too much of this. My reasons for why doctors will get a raw deal in Obama's healthcare plan is in my previous post. The Clinton healthcare team has a huge presence in Obama's cabinet, and I don't think that many (informed) people would claim that Hillarycare would have been good for physicians. Doctors were not even consulted during the Clintons' formation of their health care policy. But, do you know who was at the table? The politically powerful: drug companies, insurance agencies, and "academics" who fancied themselves as the new powerful bureaucrats of government-run healthcare.

This is all fine and good, except that we know the reforms that are being proposed by Obama, Baucus, and Daschle, and they don't look anything like the 1993-94 debacle. I was hoping for some discussion of what's actually about to hit the table, instead you're giving me six degrees from Hillarycare.
 

wasteoftime

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Some factors like obesity could be caused by your socioeconomical status.

Again, socioeconomical status is a result of prior decisions you made in your life, good or bad. This is america, the 21st century, not the 1300's. Too many people in this day and age prefer to blame someone else for their problems rather than take responsibility for their own lot in life. Poor gpa and low mcat and can't get into med school is someone elses fault, right? Well, maybe some urm with worse statistics who takes your spot, maybe :p
 

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Yeah I definitely, I hope that there will be some sort of physician rights' presence in the any meeting concerning policy. There must be greater compensation from medicaid and medicare. But ultimately I think that we are chasing our tails when discussing this, we have to agree that Obama is a smart guy (you don't beat Hillary Clinton and the rap that comes from "running while black" without being smart) and more than other nameless, ignorant presidents, is willingly to listen to all sides of the story.

We must also remember that there something fundamentally wrong with the most powerful, prosperous nation in the history world losing (according to the IOM) an estimated 18000 lives of year due to directly to their lack of access to health-care. That is human capital equivalent to six 9/11 tragedies. Our infant mortality rate is in the lower third amongst industrialized nations, so something must change. Health-care is NOT just a right for the rich or more fortunate among us.

Ultimately we did not choose this profession for the money (though pragmatically it is nice). We would have been business people or many of things that don't require the tremendous commitment it takes to learn and practice the science and art of medicine. Don't bash people for making health-care accessible to everyone, helping our common man is not only a bastion of what composes the very best of physicians, but also the very best of humankind.
 

kami333

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Free market insurance companies charge smokers and other unhealthy high risk individuals higher premiums at present.

Only if you have individual health insurance. If you are covered under a group policy, they aren't allowed to.

And since the majority of Americans still get health insurance under group policies through their employer, most Americans are already paying for smokers and other unhealthy coworkers. They, like you, just don't realize it.
 

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Here's an interesting perspective...People get free or inexpensive healthcare thru the government via medicare or state health insurance plans (like AHCSSS in AZ or MediCal in Cali). The doctors who accept these plans discount their UCR fee substantially to the fee that these government run plans pay and cannot balance bill.

However, these same people can qualify for food stamps usually. Does the grocery store discount the cost of the food that these people buy on food stamps? NO.

Why is that?
 

cbrons

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Universal healthcare is a terrible idea. Pay for your own stuff. And no, I don't care about your health problems or that you had a rough time growing up. Thats tough ****. We all have problems. You solve yours and I'll solve mine.
 

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Yeah I definitely, I hope that there will be some sort of physician rights' presence in the any meeting concerning policy. There must be greater compensation from medicaid and medicare. But ultimately I think that we are chasing our tails when discussing this, we have to agree that Obama is a smart guy (you don't beat Hillary Clinton and the rap that comes from "running while black" without being smart) and more than other nameless, ignorant presidents, is willingly to listen to all sides of the story.

We must also remember that there something fundamentally wrong with the most powerful, prosperous nation in the history world losing (according to the IOM) an estimated 18000 lives of year due to directly to their lack of access to health-care. That is human capital equivalent to six 9/11 tragedies. Our infant mortality rate is in the lower third amongst industrialized nations, so something must change. Health-care is NOT just a right for the rich or more fortunate among us.

Ultimately we did not choose this profession for the money (though pragmatically it is nice). We would have been business people or many of things that don't require the tremendous commitment it takes to learn and practice the science and art of medicine. Don't bash people for making health-care accessible to everyone, helping our common man is not only a bastion of what composes the very best of physicians, but also the very best of humankind.
Part of our claim to fame for the heightened mortality risk is that we have the capabilities to help children born early. There are many preemies born each year. Some of them we can save (and we do it well) whereas others we can't. Because of this, the increase in pre-term births, the mortality rises.
 

jarmen

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Health-care is NOT just a right for the rich or more fortunate among us.


your right, healthcare isnt a RIGHT for anyone, people have to pay for healthcare just like people have to pay for anything else they need to live... like food and shelter. where are all the advocates for handing out free houses? we are the richest country in the world arent we? everyone should have a house, and have food, we should just pay for it all.

what made this country what it is was free market. and free market at times is a b*tch... but in my opinion a wonderful way to live. you get what you earn... not what your neighbor earns but u need.

and btw for all those "holy-er than thou-- i dont care for the money as long as we help everyone"... realize that the reason why healthcare isnt accessible to all is because its a limited resource just like everything else. therefore even under universal healthcare systems SOMEONE gets shafted (although not as visibly). for example an older relative of mine living in such a state (which will remain nameless) needed a knee replacement. however, since she was retired and no "social benefit" was at stake by her not receiving this procedure she was told shed have to wait 8 months... without being able to walk or exercise... probably reducing the short years left of her life... irregardless of whether she worked hard her whole life and she earned the wealth necessary to care for herself, her wealth was busy being used by those who "needed it".

and all those arguing that physicians wont have to flip (a disproportional part of) the bill in universal healthcare just look at europe or any other socialized healthcare system which provides universal care... remember, as doctors we represent a very small proportion of the population... and being the ones who provide the care, our wonderful peers wont have any problem leaving us with the bill when they are faced with the choice... and because were applying a socialist system into a democratic country the majority's (non physician) will rules.

this of course is not to say that the current healthcare system is a much better scenario.... but at least its still free (relatively). call me old fashion but freedom to me is a beautiful thing.
 

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Wasn't the educated young adults the ones that voted for him?
Here we have it,if lucky enough for 8 years.Just going to ask for loan forgiveness,that is a posibility.

I wouldn't call too many of our young adults "educated", I think many of the so called "educated young adults" voted for Obama because he is a great speaker and has sugar-coated plans, what they don't release is that their nice lives at college are going to get hit hard when mommy and daddy can't pay for their tuition anymore because their taxes just went up. Last time I checked when you work hard you were suppose to be rewarded, not be punished with higher taxes.
 

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Please, tell my musicalmedicine, what are some of Obama's "sugar coated plans"?
 
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