What's going on with the healthcare bill being voted on tomorrow (3/21)?

[theunc31]

Why can't we live in a world where reason and logic win out...

http://online.wsj.com/article/SB10001424052970204251404574342170072865070.html

Saw this guy on Stossel a few weeks back. He had some interesting points.

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[willow18]

Why can't we live in a world where reason and logic win out...

http://online.wsj.com/article/SB10001424052970204251404574342170072865070.html

Well, I'm in a writing mood, so lets see how much reason and logic there is in Mr. Mackey's proposal:

 Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs). The combination of high-deductible health insurance and HSAs is one solution that could solve many of our health-care problems. For example, Whole Foods Market pays 100% of the premiums for all our team members who work 30 hours or more per week (about 89% of all team members) for our high-deductible health-insurance plan. We also provide up to $1,800 per year in additional health-care dollars through deposits into employees' Personal Wellness Accounts to spend as they choose on their own health and wellness.

Money not spent in one year rolls over to the next and grows over time. Our team members therefore spend their own health-care dollars until the annual deductible is covered (about $2,500) and the insurance plan kicks in. This creates incentives to spend the first $2,500 more carefully. Our plan's costs are much lower than typical health insurance, while providing a very high degree of worker satisfaction.

While this will save some money by forcing patients to ask for generics, and challenge docs about some recommendations, the real driver of the skyrocketing costs are not the nickel and dime things like strept-throat visits and so forth, but the long hospitalizations, expensive and un-indicated procedures like the majority of $100,000 prostatectomies, etc that shoot past the $2500. So really? The doc says you need a cath or some crazy ass nuking of your prostate that costs $50k and you think people will quibble about the $2500 deductible?

The real power is in the physician's pen. And until you correct the incentives (money, lawsuits, etc) that guide that pen, nothing substantive will change.

Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits. Now employer health insurance benefits are fully tax deductible, but individual health insurance is not. This is unfair.

Sure, whatever.

Repeal all state laws which prevent insurance companies from competing across state lines. We should all have the legal right to purchase health insurance from any insurance company in any state and we should be able use that insurance wherever we live. Health insurance should be portable.

All the people up in arms about the Feds usurping state rights should be all over this one eh? If competition doesn't work within each state, why will it work nationwide? Oh, because you'll get a couple of huge conglomerates that will consolidate and control the market and make things cheaper a la Walmart or Google? Right. Hmm, actually not too bad an idea, maybe we'll have single payer after all, but with Blue Cross being the payer.

Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.

I agree that politicians should not be meddling in medicine. But the idea that ‘customers' can decide what to have covered and what not to cover is preposterous. So what's it gonna be, when you apply for insurance you'll click through a list of all the diseases we know of to select what you'd like to cover? – "Oh, how about Glioblastoma, Mr Smith, we have a wonderful GBM package, it covers everything up to Avastin, including two debulking procedures and 10 days and 10 nights in the neurosurg ICU of the hospital in the next town; transportation is, of course, included. Would you like to add that to your policy?"

Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. These costs are passed back to us through much higher prices for health care.

All for that.

Make costs transparent so that consumers understand what health-care treatments cost. How many people know the total cost of their last doctor's visit and how that total breaks down? What other goods or services do we buy without knowing how much they will cost us?

All for it.

 Enact Medicare reform. We need to face up to the actuarial fact that Medicare is heading towards bankruptcy and enact reforms that create greater patient empowerment, choice and responsibility.

Very ambiguous. What kinda reform do you have in mind, Mr. WholeFoods?

 Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren't covered by Medicare, Medicaid or the State Children's Health Insurance Program.

Oh cool, why don't we abolish social security and all other social programs and make them into government run charities? Hmm, lets see, this year we're gonna have to let 3.4 million elderly people starve to death because Americans were pretty stingy with their checkboxing in April. Oh, and all you kids out in Montana, sorry, no schools for you, not enough donations came in. Silliness.

Many promoters of health-care reform believe that people have an intrinsic ethical right to health care—to equal access to doctors, medicines and hospitals. While all of us empathize with those who are sick, how can we say that all people have more of an intrinsic right to health care than they have to food or shelter?

Health care is a service that we all need, but just like food and shelter it is best provided through voluntary and mutually beneficial market exchanges. A careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter. That's because there isn't any. This "right" has never existed in America

The constitution doesn't say we have a right to urinate and poop, but we all do it, every day. Not everything we do needs to be spelled out in the constitution. And as a country we are allowed to believe and hold values that are different and that aren't spelled out in a 230 year old document. And just because something "never existed in America" doesn't mean it can't exist in the future.

Even in countries like Canada and the U.K., there is no intrinsic right to health care. Rather, citizens in these countries are told by government bureaucrats what health-care treatments they are eligible to receive and when they can receive them. All countries with socialized medicine ration health care by forcing their citizens to wait in lines to receive scarce treatments.

Uhhm, last I checked those countries are full-fledged democracies. If the citizens didn't like their politicians who apparently force some sort draconian health care measures on them, they could've voted them out. And yes, of course if you give everyone access to a limited supply you need to ‘ration' whatever it is you're giving people access to.

Although Canada has a population smaller than California, 830,000 Canadians are currently waiting to be admitted to a hospital or to get treatment, according to a report last month in Investor's Business Daily. In England, the waiting list is 1.8 million.

I have no idea where those numbers come from or what they mean. I'm sure there are hundreds of thousands of patients in the US with scheduled appointments for procedures, etc for the next few months, i.e. they're on "waiting lists". Having said that, that does not point to a flaw in the concept of govt run health care, just in how They happen to run it. In Canada there's little incentive to work more, and in England there's simply a shortage of specialists. Still, I think it's morally fair to have a rich person wait 3 months for a hip replacement so the poor person can get their cancer removed and not go bankrupt.

Rather than increase government spending and control, we need to address the root causes of poor health. This begins with the realization that every American adult is responsible for his or her own health….blah blah blah prevention blah blah blah

All for it.

Recent scientific and medical evidence shows that a diet consisting of foods that are plant-based, nutrient dense and low-fat will help prevent and often reverse most degenerative diseases that kill us and are expensive to treat. We should be able to live largely disease-free lives until we are well into our 90s and even past 100 years of age.

Not so sure about the living into the 90's with no problems, but it'll help.

 

[theunc31]

Well, I'm in a writing mood, so lets see how much reason and logic there is in Mr. Mackey's proposal:



While this will save some money by forcing patients to ask for generics, and challenge docs about some recommendations, the real driver of the skyrocketing costs are not the nickel and dime things like strept-throat visits and so forth, but the long hospitalizations, expensive and un-indicated procedures like the majority of $100,000 prostatectomies, etc that shoot past the $2500. So really? The doc says you need a cath or some crazy ass nuking of your prostate that costs $50k and you think people will quibble about the $2500 deductible?

The real power is in the physician’s pen. And until you correct the incentives (money, lawsuits, etc) that guide that pen, nothing substantive will change.




Sure, whatever.



All the people up in arms about the Feds usurping state rights should be all over this one eh? If competition doesn’t work within each state, why will it work nationwide? Oh, because you’ll get a couple of huge conglomerates that will consolidate and control the market and make things cheaper a la Walmart or Google? Right. Hmm, actually not too bad an idea, maybe we’ll have single payer after all, but with Blue Cross being the payer.


I agree that politicians should not be meddling in medicine. But the idea that ‘customers’ can decide what to have covered and what not to cover is preposterous. So what’s it gonna be, when you apply for insurance you’ll click through a list of all the diseases we know of to select what you’d like to cover? – “Oh, how about Glioblastoma, Mr Smith, we have a wonderful GBM package, it covers everything up to Avastin, including two debulking procedures and 10 days and 10 nights in the neurosurg ICU of the hospital in the next town; transportation is, of course, included. Would you like to add that to your policy?”




All for that.




All for it.



Very ambiguous. What kinda reform do you have in mind, Mr. WholeFoods?



Oh cool, why don’t we abolish social security and all other social programs and make them into government run charities? Hmm, lets see, this year we’re gonna have to let 3.4 million elderly people starve to death because Americans were pretty stingy with their checkboxing in April. Oh, and all you kids out in Montana, sorry, no schools for you, not enough donations came in. Silliness.



The constitution doesn’t say we have a right to urinate and poop, but we all do it, every day. Not everything we do needs to be spelled out in the constitution. And as a country we are allowed to believe and hold values that are different and that aren’t spelled out in a 230 year old document. And just because something “never existed in America” doesn’t mean it can’t exist in the future.



Uhhm, last I checked those countries are full-fledged democracies. If the citizens didn’t like their politicians who apparently force some sort draconian health care measures on them, they could’ve voted them out. And yes, of course if you give everyone access to a limited supply you need to ‘ration’ whatever it is you’re giving people access to.



I have no idea where those numbers come from or what they mean. I’m sure there are hundreds of thousands of patients in the US with scheduled appointments for procedures, etc for the next few months, i.e. they’re on “waiting lists”. Having said that, that does not point to a flaw in the concept of govt run health care, just in how They happen to run it. In Canada there’s little incentive to work more, and in England there’s simply a shortage of specialists. Still, I think it’s morally fair to have a rich person wait 3 months for a hip replacement so the poor person can get their cancer removed and not go bankrupt.



All for it.



Not so sure about the living into the 90’s with no problems, but it’ll help.

You should probably read more about how his company runs things rather than just his NY times article. I don't agree with everything he does, but a lot of it is reasonable.

Having said that, it seems like you want nationalized healthcare and are very close-minded towards anything short of that. You're certainly entitled to your opinion, but I, along with many others on this forum, respectfully disagree.

 

[EctopicFetus]

I think the argument on the constitutionality of this bill lies in the fact that the FEDERAL government is mandating you buy an intangible good. Federal regulation over state commerce, through the interstate commerce act, has been limited recently by the conservative supreme court. In the example of auto insurance, the STATES have the right to mandate the purchase of auto insurance within their own borders through the 10th amendment.

http://www.cnn.com/2010/POLITICS/03/22/health.care.lawsuit/index.html?hpt=T1

cCollum said the lawsuit would challenge the bill's provision requiring people to purchase health insurance, along with provisions that will force state government to spend more on health care services.

"This is a tax or a penalty on just living, and that's unconstitutional," he said of the mandate to purchase health coverage. "There's no provision in the Constitution of the United States giving Congress the power to do that."

McCollum also said that portions of the bill would force states to spend money they don't have, which he called a violation of the 10th Amendment to the Constitution.

So they are suing that 1) they are forcing the states to spend money and 2) forcing people to buy insurance

 

[EctopicFetus]

With life comes experience, experience changes your view on things.

Medical student views are different from residents are different from attendings. While there is no consensus among any of these groups I think you start with very liberal and move to moderate/conservative with time in the health care world.

Few doctors like this bill and thats just a fact per the poll that was released by JAMA.

 

[GeneralVeers]

With life comes experience, experience changes your view on things.

Medical student views are different from residents are different from attendings. While there is no consensus among any of these groups I think you start with very liberal and move to moderate/conservative with time in the health care world.

Few doctors like this bill and thats just a fact per the poll that was released by JAMA.

This matches my experience as well. Most of my med school colleagues were very Liberal and thought that the role of the government was to help all poor people.

By Residency that had dropped to less than 50%.

Now as an attending, I don't know a single private practice physician (in any speciality) who is for Obama, the healthcare plan, or any other Marxist ideology.

 

[docB]

This matches my experience as well. Most of my med school colleagues were very Liberal and thought that the role of the government was to help all poor people.

By Residency that had dropped to less than 50%.

Now as an attending, I don't know a single private practice physician (in any speciality) who is for Obama, the healthcare plan, or any other Marxist ideology.

I knew several in academics who were very leftist. And I know a few in private practice, but even they are scared of this bill.

 

[Curious Biff]

There are multiple discussions ongoing in the Sociopolitical Forum. Come join in there.

Biff

 

[EctopicFetus]

I knew several in academics who were very leftist. And I know a few in private practice, but even they are scared of this bill.

Whats interesting is that academics is basically communism. I thought of staying in academics but realized at my place I would always be at the will of the chairman and in my case that wasnt something I wanted.

I would rather be at the mercy of the government than the government, the university and the chairman.

 

[willow18]

This matches my experience as well. Most of my med school colleagues were very Liberal and thought that the role of the government was to help all poor people.

By Residency that had dropped to less than 50%.

Now as an attending, I don't know a single private practice physician (in any speciality) who is for Obama, the healthcare plan, or any other Marxist ideology.

I see the role of government is to implement the will of the people who elect (majority) that government. I am no weeping heart and I hate leeches just like you, but the fact remains (and EMTALA, social security, medicare, etc is your evidence) that we're 'too soft' in this country and don't like to let people die on the streets. So once you accept that fact, it's a question of how best to solve that dying in the streets problem.

I, too, am afraid of this insurance reform because it does not address the underlying issues that make our healthcare so much more expensive than anywhere else. What it does do, however, is finally acknowledge the fact that this country are full of softies just like those poor socialists in Europe instead of all of us hiding under the "well no one dies on the streets because of EMTALA" tent.

 

[GeneralVeers]

I see the role of government is to implement the will of the people who elect (majority) that government. I am no weeping heart and I hate leeches just like you, but the fact remains (and EMTALA, social security, medicare, etc is your evidence) that we're 'too soft' in this country and don't like to let people die on the streets. So once you accept that fact, it's a question of how best to solve that dying in the streets problem.

I, too, am afraid of this insurance reform because it does not address the underlying issues that make our healthcare so much more expensive than anywhere else. What it does do, however, is finally acknowledge the fact that this country are full of softies just like those poor socialists in Europe instead of all of us hiding under the "well no one dies on the streets because of EMTALA" tent.

As a society we've made everything too comfortable, and it's virtually impossible to "die in the streets". As a result we've removed much of the risk that entails personal decisions and every day living. You want to smoke crack, be an alcoholic or not take your psych meds? That's okay, there'll be an ER and free government food, housing, and medical insurance to pick up the slack and save you from yourself.

I think we should make a minimum effort to protect people from some risk, but we should allow people to fail, and those who do not wish to work, or do not want to help themselves should be allowed to die.

 

[deleted109597]

Still, I think it’s morally fair to have a rich person wait 3 months for a hip replacement so the poor person can get their cancer removed and not go bankrupt.

If ever there was a straw man.
1. Not only rich people have bad hips
2. Who are you to say that chemotherapy improves quality of life more than hip replacement? How many devastatingly futile procedures do we do in this country every day? How many more ICU beds would be available if we just up and let the gomers die, instead of letting them catch their third bout of VAP-septicemia?

 

[willow18]

As a society we've made everything too comfortable, and it's virtually impossible to "die in the streets". As a result we've removed much of the risk that entails personal decisions and every day living. You want to smoke crack, be an alcoholic or not take your psych meds? That's okay, there'll be an ER and free government food, housing, and medical insurance to pick up the slack and save you from yourself.

I think we should make a minimum effort to protect people from some risk, but we should allow people to fail, and those who do not wish to work, or do not want to help themselves should be allowed to die.

I agree with you re the crack addict/alcoholic, etc. Society doesn't, however, and that dictates legislation. Also, something like 50-60% of the uninsured are full-time workers. I know life isn't "fair" and I don't think everyone should have an 'equal' life, but just saying that not all people who suffer and can be helped brought it onto themselves.

If ever there was a straw man.
1. Not only rich people have bad hips
2. Who are you to say that chemotherapy improves quality of life more than hip replacement? How many devastatingly futile procedures do we do in this country every day? How many more ICU beds would be available if we just up and let the gomers die, instead of letting them catch their third bout of VAP-septicemia?

1. That was an example to make a point about society having priorities.
2. I agree re quality of life; in my Utopia QALY would guide treatment decisions; still, you can't improve someones quality of life if they're dead (okay, i guess death can improve someones quality of 'life' but you get my point, I hope). And I very much agree re the useless procedures and gomers. But tell that to Sarah Palin.

 

[Jeff698]

Now as an attending, I don't know a single private practice physician (in any speciality) who is for Obama, the healthcare plan, or any other Marxist ideology.

I'm a private practice EP who would have voted for this bill. I'd prefer it to be different and, if I were King, would have done it differently. Having said that, I think it, while not even close to perfect, will be an improvement. And yes, I know it will raise my taxes.

I obviously reject the notion that this is Marxism. We obviously disagree.

So.. now you do know (internet-know, you know?) a single private practice physician who is both for Obama (I voted for him) and for this bill. FWIW, I know several. I'll bet you do, too. Most probably just got bored of the endless conversation and don't tell you anymore.

Take care,
Jeff

 

[GeneralVeers]

I'm a private practice EP who would have voted for this bill. I'd prefer it to be different and, if I were King, would have done it differently. Having said that, I think it, while not even close to perfect, will be an improvement. And yes, I know it will raise my taxes.

I obviously reject the notion that this is Marxism. We obviously disagree.

I'm just amazed that so many people have confidence in the government to control huge portions of the economy and our lives. Has the government displayed such competence in the past?

As a larger issue I can't understand why so many Americans are nonchalant about the role of government in general. This country was founded with a Constitution that was clearly different from anything in history and strictly defined the role of Federal government. Why are we so quick to throw this away out of political convenience?

Marxism is a philosophy comprised of a number of tenets, one of them being that the proletariat (the poor) should seize the assets of the wealthy and redistribute that wealth in order to promote social justice and equality.

This health care bill fits that precisely. Assets are confiscated by the government through payroll taxes, capital gains taxes, and the individual mandate in order to provide a free tangible good (healthcare) for the poor so that we promote equality and "justice" in healthcare. To further this goal the Feds have essentially made the insurance companies wards of the state in order to better distribute healthcare more equally.

This is frightening stuff and a harbinger of things to come. BTW did anyone notice the Federal takeover of education as well? Perhaps more insidious than the more blatant takeover of health insurance.

 

[pinipig523]

This is frightening stuff and a harbinger of things to come. BTW did anyone notice the Federal takeover of education as well? Perhaps more insidious than the more blatant takeover of health insurance.

I agree re Marxism and this bill.

Also, what about the education bill? I know that it can no longer be 10% of your discretionary income per month x 20 years, anything beyond that is forgiven. However, it starts for those who take out their first federal loan after 2014.