White House Concedes on Illegal Immigrant Benefit Ban

Larry – Obama saying illegals will not be covered of course is not a lie. He plans on amnesty for ALL illegals. That of course, would make them LEGAL. What is most important, is that your Messiah has plans to deny coverage to people like me (who pays into every system possible so people like him can abuse the system) so he can get illegals to vote for him and his democratic fiends (NOT friends, you will notice there is no R in it). I have had enough of his: transparency, no earmarks, no increase of taxes for anyone making less than $250K, etc. He is a compulsive liar, and I am SOOO glad somebody had the b*lls to call him on it. Too bad you and your kind can’t see the toilet for all the sh*t he’s spewing all around.
My opinion
Madalyn

He plans on amnesty for ALL illegals. That of course, would make them LEGAL

Were that true, it would mean that he has the same “plans” that President George W Bush supported.

LW/HB

Obama does not write bills. Obama does not read Bills. Obama knows nothing about health care or anything else; he depends on other people to tell him what to say and what to sign. When he speaks without knowing what he is saying he deserves to be criticized. He is only the President – he is not a king and he is surely not God. America is a nation where we do not put a crown or a halo on a Human Being – and that’s the way we will remain.

Mike, If Obama doesn’t get health care passed, then I’ll concede that you were right (#9).

But my personal opinion is that he’s playing you guys like a violin.

– LW/HB

The fundamental problem that Obama has right now is that he, along with the DNC led congress) has lost credibility on this entire issue. For starters…isn’t this the same president that DID want that earlier version of the bill we’ve been clawing over the past month passed in 2 weeks time before they took a break? That, with GOP members complaining they were completely locked out of the debate and that the various versions of the bills had BIG problems. But, the “debate was over”, and people in opposition were just obstructionist. THEN, when it became obvious that there was enough push back that he wasn’t going to get that bill rammed through congress, the whitehouse, and the president, started issuing not so subtle statements..that the time for debate was over. That the president didn’t not want to hear from the people who “caused the problem in the first place” and that the opposition to the bill,was disingenuous, “myths”, lies, by republicans and organized “mobs”, etc. when even his own CBO office and honest fact checking you care to look at …says the president has not been factually accurate about some of these larger issues (including cost, guarantees about what you can keep, and whether there was specific language in the proposed bills that specifically prohibited the use of Fed money for abortions, or for treating illegals) that the opposition has brought to light. Debate?? What debate. Neither Obama nor the DNC had any interest in debate over this bill. They wanted to ram it through before anyone could actually look at it (sort of like…oh…the “stimulus” bill).

To further complicate, or erode, the presidents credibility on this issue would be the fact that while he’s saying one thing about what his policy is, etc., his own party is out there undermining him at every turn in the media. Obama says…that he’s not seeking to destroy private insurance or to get rid of it, or to push for a single payer, gov run system. And there’s DNC leadership and others…specifically saying the opposite…YES>..they wan’t to take down the private system and this is just a first step to single payer, gov run medicare/aide for everyone. To even further complicate his position on this..Obama himself has earlier been recorded/quoted saying that ultimately that is what HE wants or thinks would be best as well. (although he now denies it as a “myth”….a quick trip to youtube contradicts him using his “own” words.)

Anthony Weiner (NY representative), left Joe Scarb. (MSNBC) speechless when he finally just came out and admitted that that this was in fact their goal….to get rid of private insurance. Joe tried to bring up the point that his own party and the president are telling everyone that this is a myth…and here he is…basically admitting that it’s NOT a myth. Weiner responded appropriately that this is a difference he and others have with the president, but Wenier and his buds are the ones WRITING this bill!! Obama can say whatever he wants.. ….but it’s still gonna be a bill from congress that ends up on his desk with the choice that he can either sign in, or send it back. He cant’ just rewrite it to conform with his views. And given the amount of disarray between his stated (if not changing) position and his own party who controls everything….one has to wonder just how much control Obama and the whitehouse have over this issue. At the very least, I’d say it doesn’t boost my confidence in how much “leadership” is going on when one hand doesn’t know what the other is doing/saying and there is no unity of message even within their own party on such a sweeping issue as restructuring our entire healthcare system in the midst of a financial meltdown and economic crisis.

The “smart-power” white house got their ass handed to them over this issue by stubbornly refusing to listen, and to attempt instead to ram this bill through without debate. They got busted on that then tried to pretend they actually wanted a debate..accusing the “GOP sponsored “mobs” of blocking debate on an issue they didnt’ want to have debate on in the first place! Then they tried to frame any opposition to their bill as mythical, irrational, etc., etc., while behind the scenes they were removing some of the “mythical” language that didn’t exist. Even more than that, having Pelosi and the leadership directly OPPOSE and blockvote down such changes to fix the language to more clearly say (and close any loopholes) what they claim, Obama included, the bill is actually for!! (example: trying several times to put specfic language in all the various versions of this bill to close the loophole that would allow illegals in this country to access the same system)

Without acknowledging that such an unintended loophole “does” exist in the bills various revisions, Obama insists that it’s not true that illegals would have access to the system. That’s what he says. And yet, any attempts to actually introduce specific language in that bill that says that (ie., what Obama claims he wants) have been blocked. The current revisions of the bill do not specifically say that illegals “are” covered….but there is loophole in the wording that could allow it (despite Obama’s insisting that its not what he wants)…that was pointed out and requests were made to close it up. Obama may not intend for the bill to do that…but the nuts in congress DO want it that way, and they were the ones who are writing the bill and opposing efforts from both RNC and moderate democrats to shore up those things so they can get something passed. Obama wants “competition”, and yet when they try to introduce provisions to open up the private insurance industry “nationally” so they can compete in larger pools, (which is what they want to do with their Fed program), they say no. Obama says this is going to be zero net sum….that it’s going to pay for itself. That’s what he wants. There is no one…no one…I know of with any credibility at all on this issue who would say that’s true, or even possible. And yet, Obama continues to say that people who suggest otherwise…are propagating myths.

The only reason these questions have even come to light of day is because of the “oppositions” voices…..who wanted this hashed out, questions answered, to understand things better, to take more time, to be heard, etc. Again, I remind that they tried to have this version of the bill rammed through congress and put on Obama’s desk to sign without “any’ of this debate. Now, Obama seems to be saying…he’ll listen to you, only if you are interested in coming up with ideas on how to implement “his” ideas/goals better. I say that’s not really asking for debate now is it? A debate he never wanted to have in the first place. Damned if you do or don’t? I think not. The white house and DNC leadership stepped in a hornets nest on this one, then tried to ignore the opposition to it and ram it through anyway. That having failed, they then tried to blame the repercussions, anger, etc. of that on others (including their own constituents). They aren’t going to get a bill until they are honest about what they are trying to do, and hashing out a debate on THOSE issues. They (Pelosi and Reid led congress) want a single payer, gov only healthcare (to take health insurance out of private sector). That is their “stated” goal. Obama says, this is NOT what he wants…Biden is less than clear about the point of whether or not the whitehouse is seeking to maintain a public option..or whether they would give that up. In any case, it’s up to HIM to “lead” and get Pelosi Reid on the same page—not blame and chastise the critics and opponents of this bill for pointing those things out.

@Patvann: You NAILED IT!

I do agree in part with ole Larry. Obama doesn’t seem to mind at all how angry we get about beiing insulted and called liars, racists, unAmerican and evil. He’s such an asshole that he wants us to be upset.

The problem with Obama’s scheme is that the Independents who voted for him are tending to agree with us so the tactics that Larry is admiring appear to be backfiring.

@Dc said: “Obama seems to be saying…he’ll listen to you, only if you are interested in coming up with ideas on how to implement “his” ideas/goals better.”

You noticed that too hunh?

I am responding to Larry.

At the beginning of the health care discussion, Obama articulated two main objectives: (1) to bend the cost curve downward – that is, to reduce the cost of medical services generally and to reduce the rate of cost increases that we have experienced for quite some time, and (2) to make the same quality of medical services available to all Americans regardless of income status. Those are both laudable goals. However, the decision to delegate the entire formulation of the legislation to Nancy Pelosi and company morphed the objectives from what Obama had articulated into a complete government takeover of the healthcare system. (Although I believe that was consistent with Obama’s hidden agenda.) More importantly, both of the original objectives were completely abandoned as Pelosi, with the help of over a thousand lobbyists created a structure of indigestible complexity which delegates rule making authority to at least fifty boards and commissions. These bills are full of references to other sections, cross-references to the tax code, and internal cross-references that are nearly impossible to follow. (I am an attorney with more than forty years of experience reading statutes.)

When scored by the CBO, the legislation will result in at least a trillion dollars in deficits over the next four years and will cover only about a third of the presently uninsured. The legislation expressly discourages innovation in medical technology, and intrudes deeply into the traditional doctor-patient relationship. No longer will your doctor be permitted to try unapproved approaches to treatment even though medical science has proven time and again that people respond differently to the same treatments and that some treatments that are effective in some individuals are ineffective in others.

The legislation is largely patterned after the universal medical care legislation in the states of Massachusetts, Maine and Washington. All three of these programs have failed miserably to achieve the objectives of controlling costs and providing universal care. In fact, all three are responding to impending bankruptcy by reducing coverage, eliminating participants, and rationing treatments. Unlike the Federal government, states do not have the power to print money, and hence they are constrained by budgetary experience.

In my opinion, the costs of medical care are driven by two main engines: (1) the ever increasing sophistication and effectiveness of medical technology. Complex diagnostics, sophisticated pharmaceuticals, elegant surgical techniques, and ongoing medical research all deliver greater curative and treatment success, but they cost money. (2) an increasing population that demands and gets these modern treatments. And there is another element consisting of coverage mandates imposed by both Federal and state governments on insurance policies and government sponsored programs like Medicare and Medicaid. These mandates, the fruit of successful lobbying by providers of quasi-medical devices and procedures run up medical costs in ways that are difficult to track, but are very significant.

Not one of the bills floating around the House or in the Senate address either of these cost factors. Obama pontificates that his plan, whatever it is, will bend the expense curve and will provide savings in medical expenses. However, that rhetoric, however often repeated, can’t possibly do the job, for more people will be receiving more treatments whether one of the pending bills passes or not. There is nothing in the bills that reduces the costs of these treatments except the prospect of denial to people not considered disserving.

Moreover, the plans offer nothing to increase the supply of medical personnel or medical facilities. Hospital construction is hugely expensive due to all sorts of Federal and state mandates that have found their way into the applicable building codes. Medical school remains hugely expensive and there is nothing that facilitates the expansion of existing schools or adds additional schools to the mix or reduces the educational costs. Already we cannot produce an adequate supply of nurses and we import them from India, the Philippines and elsewhere. (Nursing school is also very expensive.) Defensive medicine adds unknown quantities to the mix but tort reform is off limits.

I suspect that some watered down bill will pass Congress and will be signed in a triumphal flourish by Obama. I am doubtful whether his efforts to ram a comprehensive monster down the collective American throat has any chance now that these fundamental defects have been exposed for all to see.

Note the absence of name calling, personal insult or the like.

@Disturber (#17):

>>At the beginning of the health care discussion, Obama articulated two main objectives: (1) to bend the cost curve downward – that is, to reduce the cost of medical services generally and to reduce the rate of cost increases that we have experienced for quite some time, and (2) to make the same quality of medical services available to all Americans regardless of income status.<<

The biggest reason all of us have a stake in health care reform is that all of us — you and I and everyone — are a single illness or injury away from personal bankruptcy. I’m a physician and can afford to buy the “best” insurance; yet I can’t find a policy which will assure me that I won’t bankrupt my family, should I get cancer (the most likely form of catastrophic illness). Up until this summer, I was paying more than $22,000 per year for two health insurance policies (Blue Cross and AMA Catastrophic), until the AMA policy put a limit of $15,000 per year on oral prescription drugs. The newest cancer drugs cost between $5,000 and $12,000 PER MONTH. Since the AMA policy wasn’t doing what I needed it for, anymore, I dropped it and am saving about half of my former premiums. But this still leaves me one cancer (or automobile accident or bicycling accident or neurological or organ disease) away from personal bankruptcy. My insurance (for my wife and I) costs nearly $12,000 per year for $8,000 annual deductible. I’m 62 years old, but am perfectly healthy and athletic, as is my wife, who is younger than I:

http://www.ocregister.com/photos/weisenthal-water-laurin-2539328-swim-swimming/pid2539329

Now, if I have to pay nearly $1,000 per month for utterly inadequate insurance, and was paying nearly $2,000 per month for barely adequate insurance, that is no longer available, just imagine buying health insurance for your 85 year old parents. Absent Medicare, we’d all be bankrupt and, absent health care reform, we are all facing bankruptcy. The number one cause of personal bankruptcy in this country are health care expenses in middle class people like most of us, who own their own homes and who have private insurance. This is not the case in France, Germany, Sweden, Norway, Australia, the UK, or Canada (the last two of which have decidedly undesirable systems, which are, however, much beloved by their citizens).

To top it off, one of my kids, recently graduated from college, is an otherwise healthy NCAA Division I championship level varsity athlete with a history of two sports injuries. She applied for private insurance months before her college group insurance ran out and was just last week denied coverage, because of the pre-existing conditions (which have resolved and are unlikely to recur). So now I’ve got a first degree family member who is without insurance coverage. Were there to be an injury or illness tomorrow, we’d be stuck with Medi-Cal (Medicaid), and I’m someone who thinks that health insurance is the number one priority for any person or family and I can afford to help my kid pay for it. We are, right now, appealing and otherwise scrambling to obtain coverage, but, as of now, we are one of the 45,000,000 uninsured.

>>Those are both laudable goals. However, the decision to delegate the entire formulation of the legislation to Nancy Pelosi and company morphed the objectives from what Obama had articulated into a complete government takeover of the healthcare system. (Although I believe that was consistent with Obama’s hidden agenda.) More importantly, both of the original objectives were completely abandoned as Pelosi, with the help of over a thousand lobbyists created a structure of indigestible complexity which delegates rule making authority to at least fifty boards and commissions. These bills are full of references to other sections, cross-references to the tax code, and internal cross-references that are nearly impossible to follow. (I am an attorney with more than forty years of experience reading statutes.)<<

The Obama administration saw what happened to the Clinton bill and, I think, have played this beautifully. Let’s look at health care reform as a business plan. You need to start out with some form of a draft plan. Then circulate it and let people take pot shots at it. Yes, I agree, the strategy was to ram something through both chambers of congress and sign it into law before before anyone could really figure out what was in the bills. This was a political strategy to get something passed. It failed, and I’m personally glad it failed. I’m glad for the Tea Parties (including yesterday’s) and I’m even glad for the “You lie” (literal) shout out, because all will result in a better final bill (although the loss of end of life counseling is not only regrettable; I’d call it a tragedy — as I explained elsewhere). But, even if the House bill had passed without modification, I would have considered it to be a vast improvement over what we have now.

I should note that even the AMA (in which I am not a member, but which is a traditionally conservative organization) has endorsed Obama’s health care reform effort. This is the organization representing the nation’s doctors, who certainly understand the strengths and deficiencies of the current system and who would certainly not support a “government takeover” of health care or a government intrusion into doctor-patient relationships (see below).

>>When scored by the CBO, the legislation will result in at least a trillion dollars in deficits over the next four years and will cover only about a third of the presently uninsured. The legislation expressly discourages innovation in medical technology, and intrudes deeply into the traditional doctor-patient relationship. No longer will your doctor be permitted to try unapproved approaches to treatment even though medical science has proven time and again that people respond differently to the same treatments and that some treatments that are effective in some individuals are ineffective in others.<<

I have big news for you. Blue Cross doesn’t “permit” unapproved treatments. Aetna doesn’t “permit” “unapproved” treatments. United Healthcare doesn’t “permit” unapproved treatments. Nor does Kaiser. Or Humana. Or whomever you care to cite. You know who does “permit” (and pay for) many “unapproved” treatments not “permitted” by the private health insurance carriers? Medicare. I live and breathe in this world, every day. I’ve spent an enormous amount of time writing medical necessity letters, going with patients to Small Claims court (16 separate times, at my own expense and on my own time — won every single case, by the way, counselor), talking to medical reviewers by phone, and talking to medical review panels in person. There is vastly more “rationing” of health care that goes on in the world of private insurance than in Medicare.

Medical review for medical necessity is much more transparent and patient favorable in government-sponsored health care than in privately-sponsored health care. It’s not even close. Private insurance companies can get away with things which would never be permitted in the public sector, where, for example, in Medicare there are 5 levels of review and where patients can call their congressman, many of whom have a medical doctor on their staff to assist constituents with Medicare coverage issues. Medicare has unsurpassed choice in physician and hospitals, the most liberal (in a good way) coverage policies, lowest overall cost (taxes plus insurance premiums plus out of pocket costs), unsurpassed treatment outcomes, the highest level of patient satisfaction, and the lowest personal bankruptcies (see above).

>>The legislation is largely patterned after the universal medical care legislation in the states of Massachusetts, Maine and Washington. All three of these programs have failed miserably to achieve the objectives of controlling costs and providing universal care. In fact, all three are responding to impending bankruptcy by reducing coverage, eliminating participants, and rationing treatments. Unlike the Federal government, states do not have the power to print money, and hence they are constrained by budgetary experience.<<

The best model is the Massachusetts plan.

http://blogs.wsj.com/health/2008/06/03/sign-of-success-for-massachusetts-health-insurance-mandate/

http://www.online-health-insurance.com/articles/health-news-6-9-08.php

It hasn't been a panacea, but it's clearly been an improvement. And it's early on in the process. The biggest problem for all health care systems, including those in Massachusetts, France, and the USA (as currently existing) is runaway cost. Let's go on to address that.

In my opinion, the costs of medical care are driven by two main engines: (1) the ever increasing sophistication and effectiveness of medical technology. Complex diagnostics, sophisticated pharmaceuticals, elegant surgical techniques, and ongoing medical research all deliver greater curative and treatment success, but they cost money. (2) an increasing population that demands and gets these modern treatments. And there is another element consisting of coverage mandates imposed by both Federal and state governments on insurance policies and government sponsored programs like Medicare and Medicaid. These mandates, the fruit of successful lobbying by providers of quasi-medical devices and procedures run up medical costs in ways that are difficult to track, but are very significant.

As to number 1, I am in partial agreement. But another important component is the profit margins currently built into the private health care system, with regard to both physicians’ income, overutilization driven by profit-seeking by physicians who make the diagnostic and treatment decisions, and profit margins in the insurance companies.

With regard to the first part of number 2 (increasing demand for the latest and “best”), I again agree. With regard to mandating coverage for new devices and treatments in Medicare, you are arguing against yourself. Here’s what you wrote earlier:

The legislation expressly discourages innovation in medical technology, and intrudes deeply into the traditional doctor-patient relationship.

As I wrote above, organized medicine and academic medicine wouldn’t be supporting this legislation, if it really did these things. And private insurance does much more “rationing” of innovative treatments and diagnostics than does Medicare. Yet, despite the fact that Medicare pays for more new and innovative treatment than does privately-funded health care, the total costs of care are lower for Medicare than for privately-funded health care. Medicare controls costs, while providing access to more providers, services, and hospitals, and delivering greater patient satisfaction. What a deal.

>>Not one of the bills floating around the House or in the Senate address either of these cost factors. Obama pontificates that his plan, whatever it is, will bend the expense curve and will provide savings in medical expenses. However, that rhetoric, however often repeated, can’t possibly do the job, for more people will be receiving more treatments whether one of the pending bills passes or not. There is nothing in the bills that reduces the costs of these treatments except the prospect of denial to people not considered disserving.<

<

You are complaining that the bill is already more than a thousand pages long. I view it as a first step to a French style system. I think that this is the clear objective. I've explained this elsewhere. No country yet has a good answer to the problem of exploding health care costs, but it's very clear that the first step is to move away from the system we have now toward a French/European/Australian type of system. The current system we have is a catastrophe. Insurance premiums are rising at 30% per year. The only reason Medicare and other public health care plans are so much in the red is that they can't raise taxes as easily as private insurance can raise their premiums. But, in the end, we must pay for health care. Insurance premiums are as great a drain on our economy and prosperity as are taxes (which are comparatively low in the USA, despite all the gnashing of teeth among conservatives).

http://www.forbes.com/global/2006/0522/032a.html

Moreover, the plans offer nothing to increase the supply of medical personnel or medical facilities. Hospital construction is hugely expensive due to all sorts of Federal and state mandates that have found their way into the applicable building codes. Medical school remains hugely expensive and there is nothing that facilitates the expansion of existing schools or adds additional schools to the mix or reduces the educational costs. Already we cannot produce an adequate supply of nurses and we import them from India, the Philippines and elsewhere. (Nursing school is also very expensive.) Defensive medicine adds unknown quantities to the mix but tort reform is off limits.

I’ve discussed the first of the above, before. In my med school class at the University of Michigan (1975) we had, I believe, 215-220 graduates (I’ll have to count up the faces on the class photo). Today, there are only 170 students admitted in each class. It’s the same way all over the country. In the late 70s, organized medicine feared a “glut” of physicians and lobbied hard for cut backs. Today, we have an aging population (mea culpa) and a physician shortage. This does need to be addressed (I’d advocate dramatically easing restrictions on immigration of foreign medical graduates), but it’s not at all clear that increasing physicians, under the present system, would do anything other than increase overall costs (see my next post, in which I give an example). It’s going to be difficult to do everything needed in a single, initial bill. We didn’t get into this problem overnight, and we won’t get out of it overnight.

Let’s talk tort reform. I presume that you agree we can’t limit actual damages (costs of medical care, loss of earnings, etc.). This leaves pain and suffering. What’s the lowest cap on pain and suffering which is reasonable? Thirty years ago, California instituted a $250,000 cap (adjusted for inflation, that would be much more today). Texas recently instituted the same $250,000 cap. I’d argue that it would be wrong to go below this. If you have one good kidney and one bad kidney and a surgeon takes out the wrong one and you have to go on hemodialysis, then how much should you be compensated for pain and suffering, beyond merely paying your expenses? I’d probably want (and feel I deserved) 10 million. Anything less than $250,000 would be heartlessly inhuman, in my opinion.

What was the effect of this pioneering tort reform in California? I gave a link for this elsewhere (don’t want to go looking for it now), but there is no evidence at all that this reduced “defensive” medicine, or reduced overall costs. There’s no evidence that this happened in Texas, either. Doctors don’t like to get sued, period. Costs of actual damages are plenty high enough to encourage defensive medicine. Savings on malpractice premiums were not passed along to patients and payers, either in California or Texas.

I suspect that some watered down bill will pass Congress and will be signed in a triumphal flourish by Obama. I am doubtful whether his efforts to ram a comprehensive monster down the collective American throat has any chance now that these fundamental defects have been exposed for all to see.

I agree. And the GOP is doing everything possible to shoot itself in the foot by making it abundantly clear that Obama is passing health care reform despite every weapon the GOP can employ against it. Barry Goldwater opposed Medicare, along with the rest of the GOP. The GOP had some absolutely half-baked, ineffective plan they called “Eldercare.” Today, their only ideas are to allow health insurance to be sold across state lines, Health Savings Accounts, and malpractice reform (been there, done that, in CA and TX without demonstrable benefit). So Obama will get all the credit and the American people will be very happy to see that the number one cause of personal bankruptcy has been rendered a much less threatening problem.

Note the absence of name calling, personal insult or the like.

Duly noted, and much appreciated. It’s a pleasure discussing these issues with you.

– Larry Weisenthal/Huntington Beach, CA

Let me give you just one of 1,000 examples of why health care will never conform to the rules of market economics, anymore than national defense or police protection would ever conform. And why you could build 1,000 more medical schools, to increase the supply of doctors (and ostensibly create more “competition”), and health care costs would only go up, and not down.

Prostate cancer 101:

Prostate cancer is extremely prevalent among older men. If we live long enough, almost all of us (men) will have it, but, fortunately, few of us will die from it. Today, there is a true epidemic of prostate cancer over-treatment, related to the PSA test, being enthusiastically pushed on all men over 50, with a current movement to push this on all men over the age of 40. I’m a medical oncologist (age 62), and I refuse to have a PSA test and so does my Uncle (my Dad’s brother), a retired urologist who performed many prostatectomies himself.

You have to perform 48 radical prostatectomies to prevent one death from prostate cancer. Radical prostatectomy is a very morbid and expensive procedure, with a long recovery time, and it frequently produces urinary incontinence and, less commonly, very big time erectile dysfunction. The most common alternative (brachytherapy — an expensive form of radiation therapy) produces (and I quote from a large, important study published in the New England Journal of Medicine) “long-lasting urinary irritation, bowel and sexual symptoms, and transient problems with vitality or hormonal function.” But if I had an elevated PSA, I’d probably be freaked out not to have SOMETHING done. So it’s very easy to “sell” expensive prostate cancer treatment to people who are poorly-served by such treatment. The statistics are that you have to screen more than 1,400 men with PSAs and provide morbid treatment to 48 men to prevent one prostate cancer death. You get lots of false positives, meaning men who undergo prostate biopsies (sometimes multiple), for ultimately no good purpose, which produces unnecessary morbidity. This is why me and my Uncle have opted out of PSA screening. There’s an epidemic of radical prostatectomies going on, increasing numbers of which using very expensive Da Vinci robotic machines, which must be paid for; prompting more screening and more prostatectomies.

I should add that the 1 in 48 “save” rate for prostate cancer treatment are data which came out of a single “positive” study. Other studies have failed to show any benefit whatsoever. So the 1 in 48 statistic is putting prostate cancer treatment in the most favorable light possible.

Very sophisticated people, have gotten trapped in the prostate cancer screening web. e.g. http://www.usrf.org/news/010815-celebrities_CaP.html

Would all of these people have died from prostate cancer, absent screening? Certainly not. Would ANY of them have died? Possibly not, although I don’t have the details of their pathology and clinical stage; so I can’t know this, but, again, only 1 in 48 (at best) men treated for prostate cancer have their lives extended because of the treatment. And at a huge cost to the health care system and at considerable morbidity to the patients.

Now, they probably don’t do this sort of thing in the UK (though they certainly do in France, which has the world’s best health care system, which is one reason why the French, along with everyone else, are having problems containing costs, although they are still much more successful at this than are we hapless Americans). So, this is only one of a great many situations where “rationing” care is actually a good thing for health care consumers (and taxpayers).

– Larry Weisenthal/Huntington Beach

Larry, thank you for your thoughtful responses. As a fellow Michigan grad (’64) with a son who is presently a senior (probably hung over from celebrating the win over ND), and a father (’35), I am particularly interested in your observations. I disagree with some of what you say, but unfortunately I have a huge project that must be completed and hence have to work today. I will respond in more detail later.

I know people that are like President Obama. I’m sure everyone here does. They will tell you how things should work, and then blame you when it does not go right. You never see a written proposal by them. They can’t do that. Doing that would tie them to their ideas and they would no longer be able to blame anyone else.
You will never, ever see a written proposal from Obama on anything. Doing so would take away his one major weapon…blame.

@openid.aol.com/runnswim: As Larry grudgingly admits the socialist models for health care he cites all have problems with runaway costs. They also ration care and treat the hapless souls with no other option like dirt.

Larry goes on to praise the Massachusetts Model. Here’s the reality:

http://www.realclearpolitics.com/articles/2009/09/05/obamacare_increases_costs_wait_times_98176.html

Massachusetts’ Obama-like Reforms Increase Health Costs, Wait Times
By Michael Cannon
If you are curious about how President Barack Obama’s health plan would affect your health care, look no farther than Massachusetts. In 2006, the Bay State enacted a slate of reforms that almost perfectly mirror the plan of Obama and congressional Democrats.

Those reforms reveal that the Obama plan would mean higher health insurance premiums for millions, would reduce choice by eliminating both low-cost and comprehensive health plans, would encourage insurers to avoid the sick and would reduce the quality of care.

Massachusetts reduced its uninsured population by two-thirds — yet the cost would be considered staggering, had state officials not done such a good job of hiding it. Finally, Massachusetts shows where “ObamaCare” would ultimately lead: Officials are already laying the groundwork for government rationing.

The most sweeping provision in the Massachusetts reforms — and the legislation before Congress — is an “individual mandate” that makes health insurance compulsory. Massachusetts shows that such a mandate would oust millions from their low-cost health plans and force them to pay higher premiums.

The necessity of specifying what satisfies the mandate gives politicians enormous power to dictate the content of every American’s health plan — a power that health care providers inevitably capture and use to increase the required level of insurance.

In the three years since Massachusetts enacted its individual mandate, providers successfully lobbied to require 16 specific types of coverage under the mandate: prescription drugs, preventive care, diabetes self-management, drug-abuse treatment, early intervention for autism, hospice care, hormone replacement therapy, non-in-vitro fertility services, orthotics, prosthetics, telemedicine, testicular cancer, lay midwives, nurses, nurse practitioners and pediatric specialists.

The Massachusetts Legislature is considering more than 70 additional requirements.

Those requirements can increase premiums by 14 percent or more. Officials further increased premiums by imposing new limits on cost-sharing.

“The effect,” writes the Boston Globe, “has been to provide more comprehensive insurance than in most other states but also to raise costs.” Premiums are growing 21 to 46 percent faster than the national average, in part because Massachusetts’ individual mandate has effectively outlawed affordable health plans.

Massachusetts long ago adopted another feature of the Obama plan: price controls that prohibit insurers from varying premiums based on a purchaser’s health status. Those price controls further increase premiums for the young and healthy.

They also eliminate comprehensive health plans. Obama adviser David Cutler found that in Harvard University’s price-controlled health insurance exchange, “adverse selection” or the attraction of the sickest patients caused premiums for the most comprehensive plan to rise until insurers eventually canceled it. Those price controls also encourage insurers to avoid the sick. And who can blame them, considering that the government is forcing them to sell a $50,000 policy for just $10,000?

One way insurers can avoid the $50,000 patients is to drop benefits those customers find attractive. Shelby Rogers is a 12-year-old girl with spinal muscular atrophy, whose parents chose an Aetna plan through the price-controlled health insurance exchange for federal workers. Last year, Aetna announced it would drop coverage for Shelby’s 12-hour-a-day nurse, who, among other things, helps Shelby avoid bedsores by turning her over at night. An Aetna spokesman explained the reason was to avoid offering a benefit that causes the sickest patients to flock to the plan.

Over time, as mandates eliminate low-cost options and price controls eliminate comprehensive options, both the Massachusetts and Obama reforms will march consumers into a narrow range of health plans.

As goes choice, so goes quality. Statistics on waiting times for specialist care in Massachusetts read like a dispatch from Canada. In 2004, Boston already had the longest waits among metropolitan areas. By 2009, waits had generally shortened in other metro areas (average wait: less than three weeks) but lengthened in Boston (average wait: seven weeks), according to the Merritt Hawkins survey.

Voters who believe the Massachusetts law reduced the quality of care outnumber those who believe it helped by nearly 3-to-1 (29 percent to 10 percent).

Massachusetts has reduced the share of its population that lacks coverage from an estimated 8.3 percent in 2006 to an estimated 2.6 percent by June 2008. Former Gov. Mitt Romney, a Republican who signed the Massachusetts reforms into law, boasts that “no other state has made as much progress in covering their uninsured.”

Yet that achievement carries an exorbitant price tag: at least $2.1 billion this year, according to the Massachusetts Taxpayers Foundation, a figure that doesn’t even include the cost of the additional coverage discussed above. Since Massachusetts has covered just 432,000 previously uninsured residents, the cost of covering a previously uninsured family of four — at least $20,000 — is well above the average cost of an employer-sponsored family policy (about $13,000).

Had state officials not done their level best to hide those costs — the individual mandate pushed 60 percent of the cost off-budget, while expanding eligibility for Medicaid pushed another 20 percent onto the federal budget — no one would be hailing Massachusetts as a model.

As it is, Massachusetts has fooled some prominent watchdogs. The Boston Globe editorializes that the cost to the state taxpayer is “about $88 million a year,” when the actual cost to state taxpayers is 19 times that amount, and the total cost is 24 times that amount.

The New York Times editorial page’s account of the law’s cost was only off by a factor of three.

Nevertheless, those costs are appearing in higher taxes and health insurance premiums. State officials have raised taxes on tobacco, hospitals, insurers and employers, as well as eliminated coverage for many legal immigrants just to scrape up their 20 percent share of the cost. They are also showing the nation where ObamaCare would ultimately lead: government-imposed rationing.

To cope with the cost of its reforms, Massachusetts created a legislative commission that has recommended moving the entire market to a single, Canadian-style payment system that would encourage doctors and hospitals to ration care.

The Legislature also plans to leverage its power under the individual mandate to require “evidence-based purchasing strategies,” which is another way of saying government bureaucrats may soon be deciding who gets medical care and who does not.

When former Alaska Gov. Sarah Palin whipped people into a frenzy over “death panels,” she was warning not only against a proposal for end-of-life counseling but plans that would make it easier for Medicare to use its existing power to try to ration care to the elderly and disabled.

Massachusetts shows that Obama’s individual mandate would expand federal power by enabling it to ration care to patients under age 65.

Though initially popular, enthusiasm for the Massachusetts reforms may be on the wane. A recent poll found that more Massachusetts voters say the law has made health insurance less affordable (27 percent) than believe it has made coverage more affordable (21 percent). Voters who believe the reforms have been a failure outnumber those who believe the reforms have been a success by 37 percent to 26 percent.

I am glad to see that Larry has moved on to his other talking points after giving up on the issue of defending Obama for uttering LIES in his speech to a joint session.

Anyone who believes a LIAR will somehow do a better job of creating a government health care system which succeeds where all others have failed really must be sipping the Kool Aid!

As Larry grudgingly admits the socialist models for health care he cites all have problems with runaway costs. They also ration care and treat the hapless souls with no other option like dirt.

That quote above and the scaremongering in the Real Clear Politics editorial about rationing and death panels are total BS. I’ve discussed these issues and I’ve discussed the issue of Obama “lying,” and I have neither the interest nor the time to go running around and around on them. Mike “wins” his debates through a dogged determination to be the last man standing. Fine.

The Massachusetts plan was centered around expanding coverage. It has succeeded at this level. The problem has been the cost. But cost overruns have been the worst in the world in the US private health care system. Can you imagine governments raising taxes at 30% per year, the way that private insurance has done in this country? That’s the reason why the citizens of Massachusetts (and everywhere else) are finding their healthcare to be less affordable. And can you imagine the US government getting away with rationing care through the use of closed, opaque panels of businessmen and the doctors they employ? A huge virtue of government-administered insurance programs is their transparency, which just doesn’t exist in the private insurance sector.

Mike loves cutting and pasting lengthy passages from highly partisan op-eds.

I won’t do that, but here are some links, providing a more nuanced perspective, for those interested in more in depth reading:

https://www.tnr.com/blog/the-plank/massachusettss-health-care-success-story

http://www.prospect.org/cs/articles?article=a_limited_health_care_success_in_massachussetts_

http://blogs.wsj.com/health/2008/06/03/sign-of-success-for-massachusetts-health-insurance-mandate/

http://www.online-health-insurance.com/articles/health-news-6-9-08.php

– Larry Weisenthal/Huntington Beach, CA

@Aye: You keep running the same tired old graph. Why do you refuse to show the graph which really matters: The graph which compares the rise in Medicare costs with the rise in private-sector costs? Medicare delivers a product which is superior in every way, for a lower cost. Total costs are (1) taxes + (2) insurance premiums + (3) out of pocket patient costs. The sum of these three is lower for Medicare insurance than it is for private insurance (adjusted by age/disease, etc.) The only reason Medicare shows those huge deficits is because private insurance raises its premiums by 30% per year, while Medicare can’t raise taxes at will.

Thank goodness for Medicare. Without it, the country would be much worse off, paying for senior citizen care through private insurance policies which would probably cost in the neighborhood of $40,000 per year, or more, per beneficiary.

And graft and fraud are as bad or worse with private insurance as with Medicare. The graft and fraud comes from providers billing for services they didn’t provide or actually recruiting patients to get procedures and other services they don’t need. The only difference is that the government is transparent, while the private health insurance companies are opaque.

– Larry Weisenthal/Huntington Beach, CA

From Larry’s comment: “Aye: You keep running the same tired old graph. “ Has anyone else noticed that Larry completely dismisses nearly ALL of the points so many of us have been making these past months? It’s the same “my way or the highway” style of bipartisanship we have been getting from the Liar in Chief, Obama.

Sorry Larry, but in this Republic, being in a temporary minority in the legislative and shut out of the Executive, does not make us wrong. And in this case, it’s exactly the opposite of wrong.

Unless you can show me concrete proof that a singlepayer system is successful in meeting the needs of ALL it’s citizens without rationing or decrease in survivability from major disease and at a stable, predictable cost, then you have no basis of fact upon which to rest your opinions.

@Mike:

I’m not dismissing your points.

I only make these points.

1. “Death panels” is scaremongering
2. “Rationing” is scaremongering
3. The concepts that private health insurance provides superior service, “rations” less, or provides superior cost control are demonstrably false.
4. “Single payer” is a straw man. No one is proposing this as a serious plan for consideration. It will never get passed into law, no matter what the secret wishes of Barney Frank (or even Barack Obama). What we are headed for is a French-style system, with a basic level of care provided for everyone, with individual options for supplemental (or replacement) private insurance. This will take many years to achieve, but the presently discussed plans are a concrete beginning, and these plans are supported by the (conservative) American Medical Association, representing a large segment of America’s doctors.

And (how’s this for a statistic) 59% of the nation’s doctors would favor a single payer, “Medicare for all” system. The people in this country who know the health care system best agree that the current system is a disaster. I happen to be one of them.

http://www.prospect.org/cs/articles?article=the_doctors_revolt

– Larry Weisenthal/Huntington Beach, CA

Love the pic of O’Liar, but I think the nose is a bit short considering all the lies he’s told. I know I have lied in my lifetime, but I can guarantee that O’Liar has uttered more lies in the last 9 months than I have in my almost 70 years on earth. What does that say for the people who profess to love him, honor him, and obey him? Looks like they were made a fool of.
My opinion
Madalyn

@DC:

Larry, I think it’s you who is missing the point/difference between negotiating with a private company over your coverage/care or a given cost on the basis of their profit verses your health, and having those cost and other determinations set by government at given level based on balancing your care/coverage or cost of a given procedure with the rest of the nation and its cost/benefit to society ratio.

In the first place, that’s not the way it works with single payer government insurance (Medicare). I’ve explained this extensively in the past. It’s a totally transparent process, with input allowed by everyone, and coverage decisions are based on medical efficacy (not cost effectiveness) and Medicare is much more flexible with providing coverage than is private insurance, and the appeals process with Medicare is much more patient friendly, with the patient’s ultimate trump card being his congressman.

You are talking about some theoretical future possibility — a British “NICE” style system, which does ration on the basis of cost-effectiveness. This could, in theory, be done by Medicare at any time, but it won’t, because Medicare is transparent public and the hue and cry would be something awful. And the British system is unique and in no way a model for US health care. British physicians work for the government. British hospitals are owned by the government. This is not the way it works in France and other European countries, which are better and closer models for where the US is headed.

Let’s say, however, that at some point in the future, health care expenses are so great that cost effectiveness does come into play in payment decisions. Firstly, it would be an utterly transparent process, and wouldn’t be non-medical bureaucratic bean counters behind closed doors. Secondly, anyone troubled by such things could just buy private supplemental insurance. Thirdly, it’s very likely that the private companies will do this sort of thing in the future themselves. In fact, they are already doing it now, to some extent. They are more lenient with approving inexpensive drugs and procedures than they are at approving expensive drugs and procedures. A great many plans mandate the use of older drugs, which are less effective, in some cases, than newer, more expensive drugs. Medicare is often much better at paying for the newer drugs. Certainly if you get cancer, you’d have an easier time, in general, getting approval for the form of chemotherapy your oncologist wanted to prescribe than would private insurance, in cases of “off label” indications, which is about half the chemotherapy prescribed in this country.

The point is that the rationing thing is theoretical scaremongering.

With regard to malpractice reform, another beautiful theory ruined by an ugly fact. Of course OB-GYNS have huge malpractice costs. And they aren’t going to come down very much. No one is proposing a cap to actual damages — medical care plus lost earnings. The only thing talked about being capped are pain and suffering awards. This tort reform has been a reality in California for 30 years and hasn’t brought down health care costs. It’s worth doing; but it won’t make a dent in the health care budget; i.e. it won’t “bend the curve.”

I really don’t like you taking what I said about “mutilating” patients and twisting it. I NEVER referred to Cesarian sections as “mutilation.” I was referring to radical prostatectomies and I stand by my words, in this case.

And, for your information, there is less red tape and aggravation in dealing with Medicare than with Blue Cross, Aetna, et al. This is one of the reasons a substantial majority of American physicians are in favor of a single payer, government administered system (link/reference above, #40).

Furthermore, nobody is going to go to medschool and put in the time and money to do what it takes to become the massive amount of doctors, etc., we are going to need without MAKING MONEY.

Not correct: There are huge numbers of highly qualified would be med students who would jump at the chance to work for a measly $150K per year, as opposed to the $300K per year which adds to health care costs today.

– Larry Weisenthal/Huntington Beach, CA

Yes of course….in “Obama’s economy” (I can all it that? Since Bush’s war was declared after 9/11 (ie…on his watch..despite all the missteps before) ANY job that pays ANY money is worthwhile!!!

in fact…if you have any job…at all, that pays anything….you are lucky!@

Sure, I guess some people who might have been business majors, or art majors…might just sign up for 10 years of school (with no scholarship…not less), just so they can make the same money somebody else did with just an under grad degree.

Yep….the smarting of america. Is that “smart-power’? Or smart=power”?

Lastly…”anyone” who believes the gov is “transparent” …has Lost their damn mind. Particularly THIS admin…who’s had to hire “czars” to bypass the congressional vetting process…cause they dont’ like to pay taxes….they just like …”free shit”.