Beth's Health Care Reform Blog

Post by **stilltrucking** » September 1st, 2009, 6:22 pm

We don't need no stinking terrorists to poison us. We doing a pretty good job of doing it to ourselves.

The E. coli victims are among millions -- one in four Americans -- sickened by food-borne illnesses each year. As waves of recalls have caused the public to lose confidence in the safety of food, lawmakers are scrambling to respond. In July, the House approved legislation that would give the Food and Drug Administration broad new powers and place new responsibilities on food producers. The bill would speed up the ability of health officials to track down the source of an outbreak and give the government the power to mandate a recall, rather than rely on food producers to voluntarily pull tainted products from the shelves.
washingtonpost.com

We need more legislation written by lobbyists for the food industry.

Post by **roxybeast** » September 2nd, 2009, 6:14 am

Some days everybody has something to say ... except Grandma, who got killed by the death panel's laser ray yesterday

,

How Can President Obama Regain His Political Footing?
http://www.washingtonpost.com/wp-dyn/co ... 03158.html

Taking the Kennedy Way ... President Obama can still secure major health-care legislation this year if he learns from his mistakes in recent months and spends more time reminding Americans why they were once eager for fundamental change. http://www.washingtonpost.com/wp-dyn/co ... 02254.html

Ted Kennedy and Health Care
http://www.huffingtonpost.com/stephen-g ... 73422.html

Has Obama's Handling of the Bank Bailout Undermined Health Care Reform? By Arianna Huffington http://www.huffingtonpost.com/arianna-h ... 73341.html

Health Bill Would Cut Drug Spending for Many on Medicare, Budget Office Says
http://www.nytimes.com/2009/08/31/healt ... 1drug.html

Study: CBO May Be Missing Potential Savings From Efforts To Prevent Diabetes, Heart Disease http://www.huffingtonpost.com/2009/09/0 ... 73495.html

Baucus: Health Care Reform Will Happen This Year With Or Without GOP http://www.huffingtonpost.com/2009/08/3 ... 73366.html

Senate GOPers: We'll Block Health Care Under Reconciliation http://thehill.com/homenews/senate/5689 ... hcare-plan

One Of The Three GOP Senators Considering Bipartisan Health Bill Blasts Dem. Plan http://www.huffingtonpost.com/2009/08/2 ... 71922.html

Joe Barton: Republicans Will Repeal Health Care Reform If If It Passes http://washingtonindependent.com/57198/ ... -it-passes

The Gang of Six Appears to be Dead -- But How Many of Them Know It? http://voices.washingtonpost.com/ezra-k ... to_be.html

Rep. Pete Olson Booed For Suggesting Baby Would Die Under Public Option (VIDEO) http://www.huffingtonpost.com/2009/08/3 ... 72786.html

Apparently, You CAN Fool All of the People All of the Time http://www.huffingtonpost.com/brian-ros ... 72136.html

Dole Advises Obama to Be More Than ‘Cheerleader’ on Health Care http://prescriptions.blogs.nytimes.com/ ... alth-care/

Prevention Battles For Survival In Health Reform Legislation http://www.huffingtonpost.com/2009/09/0 ... 71535.html

Some Anti-Reform Doctors Using Scare Tactics On Patients http://www.huffingtonpost.com/2009/09/0 ... 71453.html

RNC Targets Seniors With New Ad (VIDEO) http://www.huffingtonpost.com/2009/09/0 ... 73899.html

Huckabee Doubles Down On Controversial Kennedy Comments http://www.huffingtonpost.com/2009/08/3 ... 72908.html

Fighting Health Care Overhaul, and Proud of It Senator Jim DeMint, the South Carolina Republican who predicted that President Obama’s effort to overhaul the health care system would become his “Waterloo,” is doing his best to make that happen.
http://www.nytimes.com/2009/08/31/us/po ... emint.html

White House Not Pleased With Two Republican Senators http://prescriptions.blogs.nytimes.com/ ... -grassley/

The Corporate "Alliance" For Health Care Reform: III. The Hospital Industry http://www.huffingtonpost.com/john-geym ... 73924.html

More blogs from NY Times on health care reform:
http://prescriptions.blogs.nytimes.com/

Obama, Public Differ on Diagnosis
http://www.huffingtonpost.com/jim-jaffe ... 72213.html

Health Insurance Reformers Continue Coming Out in Massive Numbers Saturday http://www.huffingtonpost.com/jeremy-bi ... 72717.html

Et Tu, Lefty? Allies Critical Of President
Waffling on Health Care Riles His Loyal Pundits http://www.washingtonpost.com/wp-dyn/co ... 02518.html

White House Defends Obama’s Energy Level on Health Care http://prescriptions.blogs.nytimes.com/ ... alth-care/

Obama's Looming Health Care Disaster: Looking for Love in All the Wrong Places http://www.huffingtonpost.com/les-leopo ... 73435.html

Don't Let The Crazy People Win This One
http://www.huffingtonpost.com/erica-jon ... 72337.html

For Team Obama, A Refresher on Jack Johnson and "The Great White Hope" http://www.huffingtonpost.com/dave-ziri ... 72542.html

Obama Organizing Advisers Rap Health Care Push
http://www.huffingtonpost.com/ari-melbe ... 73080.html

Let's Pass Ted Kennedy's Health Plan
http://www.huffingtonpost.com/roger-hic ... 72340.html

Here's the thing to remember about tort reform ... doctors are subject legally to adhere to the reasonable standards of care in their community, that's a good thing, established by looking at the way most doctors in the community would handle the same health care situation. While there are breakthroughs in medicine, they do not happen that often or radically change the nature of practice in any particular field. So the reality is that these standards of reasonable care have already been established by the doctors in the community and locked into place by legal precedents - this is true in every type of medicine. These standards are not going away, nor are they going backwards, nor do they need to be repealed. They are in place to protect patients. YOU. The insurance companies and doctors are aware of them and adhere to them. It's the standards which result in the higher costs, the insurance companies and doctors are not going to start NOT adhering to them just because of a cap on attorneys fees or patient recoveries. They would be idiots if they did that. Thus, tort reform, which btw already passed, only injures people whose lives have already been devastated by serious medical neglect and those who seek to help them. The courts have already imposed standards which make it incredibly more difficult to bring a medical malpractice case than almost any other type of tort claim and the judges have a lot of authority & discretion to throw out frivolous suits right now. If you want true reform on this issue, look at coming to agreement on a new set of agreed community medical standards, rather than just blindly yelling "cap the fees, cap the awards!" and buying into the hype.

And read this ... Would Tort Reform Lower Costs? http://prescriptions.blogs.nytimes.com/ ... are-costs/

Gibbs Slams Key GOP Health Care Negotiator: He's Walked Away From Table http://www.huffingtonpost.com/2009/08/3 ... 72988.html

ECONOMIC VIEW - A Public Option Isn’t a Curse, or a Cure
http://www.nytimes.com/2009/08/16/busin ... 6view.html

Drug Industry Newsletter Assesses Senator Dodd on Health Care http://prescriptions.blogs.nytimes.com/ ... alth-care/

1 in 7 Californians Have Medical Debt, Study Finds http://prescriptions.blogs.nytimes.com/ ... ical-debt/

Health-Care Reform, One Stop at a Time
Obama Supporters Organize Bus Tour, Campaign-Style Events Across U.S.http://www.washingtonpost.com/wp-dyn/co ... 02654.html

What kind of health care coverage does the nation's top health insurance lobbyist have? Her trade group refuses to say. Mother Jones … http://www.motherjones.com/politics/200 ... gnis-copay

Change, Not a Restoration: The Death of Conservatism and Rebirth of Reform
John R. Bohrer
Historian of 1960s American politics

The tide is about to turn in the debate over health care reform. The lies and the screaming that captured the discussion in August have a lot of Republicans thinking they've got the Democrats right where they want 'em.

They are wrong. And they are wrong because their castle is built upon a pile of sand... a pile of crazy, crazy sand.

Sam Tanenhaus talked about it earlier today on Morning Joe. Discussing his new book, The Death of Conservatism, Tanenhaus warned that today's Republican Party is more about radicalism than conservatism. He recalled how in the 1950s, William F. Buckley, Jr., began pushing the lunatics and extremists out of the conservative movement in order to legitimize and strengthen their argument. This preparation allowed them to pounce when the time was ripe in the late 1960s.

This is why supporters of health care reform are about to experience a second wind. Because while the mobs, the conspiracy theorists and the lie-pushers look like they're winning the debate for the Republicans, they are actually setting them up for a big fall.

For the discussion will inevitably move past what the protesters think the dreaded 'Obamacare' will do (Kill grandma!!!), to ask A) why they feel this way and B) what's their alternative?

The crazy-crazies can only answer the first question. A lot of ink has been spilled debunking the lies; not as much attention has been focused on explaining why some so easily believe them. Confronted with explaining how any sane person could believe 'President Obama's bureaucrat army will kill grandma,' they'll spin into whatever tizzy best suits them, be it Kenya, Communism, black nationalism, Nazism -- who knows what. Their explanations are way, way out of the American mainstream, and frankly, creepy.

So that leaves the response of the reality-based Republican community (a rapidly shrinking field). These people have enjoyed the hysterics of the last month, happy to see Obama and the Democrats sweat. At the same time, they seem somewhat embarrassed by the most heinous lies and would love to fast-forward fourteen months to when they can reap the benefits and regain power. For the time being, they will explain their opposition to health care reform as based on bigger deficit projections or excessive harm to the insurance industry.

Though no matter what they say, it will miss the mark. David Brooks points to Obama losing support among independents, supposedly frightened of debt tied to his health care reform. What Brooks does not acknowledge is that they're not so much opposed to reform as they are confused as to what it will do. It's hard not to be confused with so many lies being so carelessly tossed around... But once the din dies down, and the conversation moves on to the why and the what behind the opposition, Republicans are in for a rude awakening.

Because people want change -- not a restoration.

Change, Not a Restoration: The Death of Conservatism and Rebirth of Reform
John R. Bohrer
Historian of 1960s American politics

And here the Republican Party is utterly unprepared. Their alternatives are lousy because their party has spent no significant time honing and improving their failed ideas from when they were recently in power. Nor, as Tanenhaus suggested, have they pushed the lunatics and extremists away from the debate; if anything, they've pushed them to the front.

In so many ways, you have the case of an opposition party that is not yet ready to be an opposition party. The smash-it-up approach may have worked for August, but it has done nothing to improve the Republicans' capability to offer cohesive, plausible alternatives.

At least ones that are not a return to the policies of George W. Bush and Dick Cheney.

Source: http://www.huffingtonpost.com/john-bohr ... 74309.html

Four our daily slap, I love this cartoon: http://www.whatnowtoons.com/images/wn_218_color.jpg

Post by **roxybeast** » September 11th, 2009, 4:09 pm

"I am not the first President to take up this cause,
but I am determined to be the last."
President Barack Obama, September 8, 2009

Here is a link to watch the full speech by the President to the joint session of Congress on health care last Tuesday night (Sept. 8, 2009):

VIDEO OF SPEECH: http://www.hulu.com/watch/94638/preside ... s-p1-so-i0

Here is a Transcript of the the President's entire speech to Congress:

REMARKS BY THE PRESIDENT
TO A JOINT SESSION OF CONGRESS
ON HEALTH CARE

U.S. Capitol
Washington, D.C.

8:16 P.M. EDT

THE PRESIDENT: Madam Speaker, Vice President Biden, members of Congress, and the American people:

When I spoke here last winter, this nation was facing the worst economic crisis since the Great Depression. We were losing an average of 700,000 jobs per month. Credit was frozen. And our financial system was on the verge of collapse.

As any American who is still looking for work or a way to pay their bills will tell you, we are by no means out of the woods. A full and vibrant recovery is still many months away. And I will not let up until those Americans who seek jobs can find them -- (applause) -- until those businesses that seek capital and credit can thrive; until all responsible homeowners can stay in their homes. That is our ultimate goal. But thanks to the bold and decisive action we've taken since January, I can stand here with confidence and say that we have pulled this economy back from the brink. (Applause.)

I want to thank the members of this body for your efforts and your support in these last several months, and especially those who've taken the difficult votes that have put us on a path to recovery. I also want to thank the American people for their patience and resolve during this trying time for our nation.

But we did not come here just to clean up crises. We came here to build a future. (Applause.) So tonight, I return to speak to all of you about an issue that is central to that future -- and that is the issue of health care.

I am not the first President to take up this cause, but I am determined to be the last. (Applause.) It has now been nearly a century since Theodore Roosevelt first called for health care reform. And ever since, nearly every President and Congress, whether Democrat or Republican, has attempted to meet this challenge in some way. A bill for comprehensive health reform was first introduced by John Dingell Sr. in 1943. Sixty-five years later, his son continues to introduce that same bill at the beginning of each session. (Applause.)

Our collective failure to meet this challenge -- year after year, decade after decade -- has led us to the breaking point. Everyone understands the extraordinary hardships that are placed on the uninsured, who live every day just one accident or illness away from bankruptcy. These are not primarily people on welfare. These are middle-class Americans. Some can't get insurance on the job. Others are self-employed, and can't afford it, since buying insurance on your own costs you three times as much as the coverage you get from your employer. Many other Americans who are willing and able to pay are still denied insurance due to previous illnesses or conditions that insurance companies decide are too risky or too expensive to cover.

We are the only democracy -- the only advanced democracy on Earth -- the only wealthy nation -- that allows such hardship for millions of its people. There are now more than 30 million American citizens who cannot get coverage. In just a two-year period, one in every three Americans goes without health care coverage at some point. And every day, 14,000 Americans lose their coverage. In other words, it can happen to anyone.

But the problem that plagues the health care system is not just a problem for the uninsured. Those who do have insurance have never had less security and stability than they do today. More and more Americans worry that if you move, lose your job, or change your job, you'll lose your health insurance too. More and more Americans pay their premiums, only to discover that their insurance company has dropped their coverage when they get sick, or won't pay the full cost of care. It happens every day.

One man from Illinois lost his coverage in the middle of chemotherapy because his insurer found that he hadn't reported gallstones that he didn't even know about. They delayed his treatment, and he died because of it. Another woman from Texas was about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne. By the time she had her insurance reinstated, her breast cancer had more than doubled in size. That is heart-breaking, it is wrong, and no one should be treated that way in the United States of America. (Applause.)

Then there's the problem of rising cost. We spend one and a half times more per person on health care than any other country, but we aren't any healthier for it. This is one of the reasons that insurance premiums have gone up three times faster than wages. It's why so many employers -- especially small businesses -- are forcing their employees to pay more for insurance, or are dropping their coverage entirely. It's why so many aspiring entrepreneurs cannot afford to open a business in the first place, and why American businesses that compete internationally -- like our automakers -- are at a huge disadvantage. And it's why those of us with health insurance are also paying a hidden and growing tax for those without it -- about $1,000 per year that pays for somebody else's emergency room and charitable care.

Finally, our health care system is placing an unsustainable burden on taxpayers. When health care costs grow at the rate they have, it puts greater pressure on programs like Medicare and Medicaid. If we do nothing to slow these skyrocketing costs, we will eventually be spending more on Medicare and Medicaid than every other government program combined. Put simply, our health care problem is our deficit problem. Nothing else even comes close. Nothing else. (Applause.)

Now, these are the facts. Nobody disputes them. We know we must reform this system. The question is how.

There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada's -- (applause) -- where we would severely restrict the private insurance market and have the government provide coverage for everybody. On the right, there are those who argue that we should end employer-based systems and leave individuals to buy health insurance on their own.

I've said -- I have to say that there are arguments to be made for both these approaches. But either one would represent a radical shift that would disrupt the health care most people currently have. Since health care represents one-sixth of our economy, I believe it makes more sense to build on what works and fix what doesn't, rather than try to build an entirely new system from scratch. (Applause.) And that is precisely what those of you in Congress have tried to do over the past several months.

During that time, we've seen Washington at its best and at its worst.

We've seen many in this chamber work tirelessly for the better part of this year to offer thoughtful ideas about how to achieve reform. Of the five committees asked to develop bills, four have completed their work, and the Senate Finance Committee announced today that it will move forward next week. That has never happened before. Our overall efforts have been supported by an unprecedented coalition of doctors and nurses; hospitals, seniors' groups, and even drug companies -- many of whom opposed reform in the past. And there is agreement in this chamber on about 80 percent of what needs to be done, putting us closer to the goal of reform than we have ever been.

But what we've also seen in these last months is the same partisan spectacle that only hardens the disdain many Americans have towards their own government. Instead of honest debate, we've seen scare tactics. Some have dug into unyielding ideological camps that offer no hope of compromise. Too many have used this as an opportunity to score short-term political points, even if it robs the country of our opportunity to solve a long-term challenge. And out of this blizzard of charges and counter-charges, confusion has reigned.

Well, the time for bickering is over. The time for games has passed. (Applause.) Now is the season for action. Now is when we must bring the best ideas of both parties together, and show the American people that we can still do what we were sent here to do. Now is the time to deliver on health care. Now is the time to deliver on health care.

The plan I'm announcing tonight would meet three basic goals. It will provide more security and stability to those who have health insurance. It will provide insurance for those who don't. And it will slow the growth of health care costs for our families, our businesses, and our government. (Applause.) It's a plan that asks everyone to take responsibility for meeting this challenge -- not just government, not just insurance companies, but everybody including employers and individuals. And it's a plan that incorporates ideas from senators and congressmen, from Democrats and Republicans -- and yes, from some of my opponents in both the primary and general election.

Here are the details that every American needs to know about this plan. First, if you are among the hundreds of millions of Americans who already have health insurance through your job, or Medicare, or Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. (Applause.) Let me repeat this: Nothing in our plan requires you to change what you have.

What this plan will do is make the insurance you have work better for you. Under this plan, it will be against the law for insurance companies to deny you coverage because of a preexisting condition. (Applause.) As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it the most. (Applause.) They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or in a lifetime. (Applause.) We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick. (Applause.) And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies -- (applause) -- because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives. (Applause.)

Now, that's what Americans who have health insurance can expect from this plan -- more security and more stability.

Now, if you're one of the tens of millions of Americans who don't currently have health insurance, the second part of this plan will finally offer you quality, affordable choices. (Applause.) If you lose your job or you change your job, you'll be able to get coverage. If you strike out on your own and start a small business, you'll be able to get coverage. We'll do this by creating a new insurance exchange -- a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices. Insurance companies will have an incentive to participate in this exchange because it lets them compete for millions of new customers. As one big group, these customers will have greater leverage to bargain with the insurance companies for better prices and quality coverage. This is how large companies and government employees get affordable insurance. It's how everyone in this Congress gets affordable insurance. And it's time to give every American the same opportunity that we give ourselves. (Applause.)

Now, for those individuals and small businesses who still can't afford the lower-priced insurance available in the exchange, we'll provide tax credits, the size of which will be based on your need. And all insurance companies that want access to this new marketplace will have to abide by the consumer protections I already mentioned. This exchange will take effect in four years, which will give us time to do it right. In the meantime, for those Americans who can't get insurance today because they have preexisting medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill. (Applause.) This was a good idea when Senator John McCain proposed it in the campaign, it's a good idea now, and we should all embrace it. (Applause.)

Now, even if we provide these affordable options, there may be those -- especially the young and the healthy -- who still want to take the risk and go without coverage. There may still be companies that refuse to do right by their workers by giving them coverage. The problem is, such irresponsible behavior costs all the rest of us money. If there are affordable options and people still don't sign up for health insurance, it means we pay for these people's expensive emergency room visits. If some businesses don't provide workers health care, it forces the rest of us to pick up the tab when their workers get sick, and gives those businesses an unfair advantage over their competitors. And unless everybody does their part, many of the insurance reforms we seek -- especially requiring insurance companies to cover preexisting conditions -- just can't be achieved.

And that's why under my plan, individuals will be required to carry basic health insurance -- just as most states require you to carry auto insurance. (Applause.) Likewise -- likewise, businesses will be required to either offer their workers health care, or chip in to help cover the cost of their workers. There will be a hardship waiver for those individuals who still can't afford coverage, and 95 percent of all small businesses, because of their size and narrow profit margin, would be exempt from these requirements. (Applause.) But we can't have large businesses and individuals who can afford coverage game the system by avoiding responsibility to themselves or their employees. Improving our health care system only works if everybody does their part.

And while there remain some significant details to be ironed out, I believe -- (laughter) -- I believe a broad consensus exists for the aspects of the plan I just outlined: consumer protections for those with insurance, an exchange that allows individuals and small businesses to purchase affordable coverage, and a requirement that people who can afford insurance get insurance.

And I have no doubt that these reforms would greatly benefit Americans from all walks of life, as well as the economy as a whole. Still, given all the misinformation that's been spread over the past few months, I realize -- (applause) -- I realize that many Americans have grown nervous about reform. So tonight I want to address some of the key controversies that are still out there.

Some of people's concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim made not just by radio and cable talk show hosts, but by prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Now, such a charge would be laughable if it weren't so cynical and irresponsible. It is a lie, plain and simple. (Applause.)

There are also those who claim that our reform efforts would insure illegal immigrants. This, too, is false. The reforms -- the reforms I'm proposing would not apply to those who are here illegally.

AUDIENCE MEMBER: You lie! (Boos.)

THE PRESIDENT: It's not true. And one more misunderstanding I want to clear up -- under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place. (Applause.)

Now, my health care proposal has also been attacked by some who oppose reform as a "government takeover" of the entire health care system. As proof, critics point to a provision in our plan that allows the uninsured and small businesses to choose a publicly sponsored insurance option, administered by the government just like Medicaid or Medicare. (Applause.)

So let me set the record straight here. My guiding principle is, and always has been, that consumers do better when there is choice and competition. That's how the market works. (Applause.) Unfortunately, in 34 states, 75 percent of the insurance market is controlled by five or fewer companies. In Alabama, almost 90 percent is controlled by just one company. And without competition, the price of insurance goes up and quality goes down. And it makes it easier for insurance companies to treat their customers badly -- by cherry-picking the healthiest individuals and trying to drop the sickest, by overcharging small businesses who have no leverage, and by jacking up rates.

Insurance executives don't do this because they're bad people; they do it because it's profitable. As one former insurance executive testified before Congress, insurance companies are not only encouraged to find reasons to drop the seriously ill, they are rewarded for it. All of this is in service of meeting what this former executive called "Wall Street's relentless profit expectations."

Now, I have no interest in putting insurance companies out of business. They provide a legitimate service, and employ a lot of our friends and neighbors. I just want to hold them accountable. (Applause.) And the insurance reforms that I've already mentioned would do just that. But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. (Applause.) Now, let me be clear. Let me be clear. It would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5 percent of Americans would sign up.

Despite all this, the insurance companies and their allies don't like this idea. They argue that these private companies can't fairly compete with the government. And they'd be right if taxpayers were subsidizing this public insurance option. But they won't be. I've insisted that like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums it collects. But by avoiding some of the overhead that gets eaten up at private companies by profits and excessive administrative costs and executive salaries, it could provide a good deal for consumers, and would also keep pressure on private insurers to keep their policies affordable and treat their customers better, the same way public colleges and universities provide additional choice and competition to students without in any way inhibiting a vibrant system of private colleges and universities. (Applause.)

Now, it is -- it's worth noting that a strong majority of Americans still favor a public insurance option of the sort I've proposed tonight. But its impact shouldn't be exaggerated -- by the left or the right or the media. It is only one part of my plan, and shouldn't be used as a handy excuse for the usual Washington ideological battles. To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage available for those without it. (Applause.) The public option -- the public option is only a means to that end -- and we should remain open to other ideas that accomplish our ultimate goal. And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have. (Applause.)

For example -- for example, some have suggested that the public option go into effect only in those markets where insurance companies are not providing affordable policies. Others have proposed a co-op or another non-profit entity to administer the plan. These are all constructive ideas worth exploring. But I will not back down on the basic principle that if Americans can't find affordable coverage, we will provide you with a choice. (Applause.) And I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need. (Applause.)

Finally, let me discuss an issue that is a great concern to me, to members of this chamber, and to the public -- and that's how we pay for this plan.

And here's what you need to know. First, I will not sign a plan that adds one dime to our deficits -- either now or in the future. (Applause.) I will not sign it if it adds one dime to the deficit, now or in the future, period. And to prove that I'm serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don't materialize. (Applause.) Now, part of the reason I faced a trillion-dollar deficit when I walked in the door of the White House is because too many initiatives over the last decade were not paid for -- from the Iraq war to tax breaks for the wealthy. (Applause.) I will not make that same mistake with health care.

Second, we've estimated that most of this plan can be paid for by finding savings within the existing health care system, a system that is currently full of waste and abuse. Right now, too much of the hard-earned savings and tax dollars we spend on health care don't make us any healthier. That's not my judgment -- it's the judgment of medical professionals across this country. And this is also true when it comes to Medicare and Medicaid.

In fact, I want to speak directly to seniors for a moment, because Medicare is another issue that's been subjected to demagoguery and distortion during the course of this debate.

More than four decades ago, this nation stood up for the principle that after a lifetime of hard work, our seniors should not be left to struggle with a pile of medical bills in their later years. That's how Medicare was born. And it remains a sacred trust that must be passed down from one generation to the next. (Applause.) And that is why not a dollar of the Medicare trust fund will be used to pay for this plan. (Applause.)

The only thing this plan would eliminate is the hundreds of billions of dollars in waste and fraud, as well as unwarranted subsidies in Medicare that go to insurance companies -- subsidies that do everything to pad their profits but don't improve the care of seniors. And we will also create an independent commission of doctors and medical experts charged with identifying more waste in the years ahead. (Applause.)

Now, these steps will ensure that you -- America's seniors -- get the benefits you've been promised. They will ensure that Medicare is there for future generations. And we can use some of the savings to fill the gap in coverage that forces too many seniors to pay thousands of dollars a year out of their own pockets for prescription drugs. (Applause.) That's what this plan will do for you. So don't pay attention to those scary stories about how your benefits will be cut, especially since some of the same folks who are spreading these tall tales have fought against Medicare in the past and just this year supported a budget that would essentially have turned Medicare into a privatized voucher program. That will not happen on my watch. I will protect Medicare. (Applause.)

Now, because Medicare is such a big part of the health care system, making the program more efficient can help usher in changes in the way we deliver health care that can reduce costs for everybody. We have long known that some places -- like the Intermountain Healthcare in Utah or the Geisinger Health System in rural Pennsylvania -- offer high-quality care at costs below average. So the commission can help encourage the adoption of these common-sense best practices by doctors and medical professionals throughout the system -- everything from reducing hospital infection rates to encouraging better coordination between teams of doctors.

Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan. (Applause.) Now, much of the rest would be paid for with revenues from the very same drug and insurance companies that stand to benefit from tens of millions of new customers. And this reform will charge insurance companies a fee for their most expensive policies, which will encourage them to provide greater value for the money -- an idea which has the support of Democratic and Republican experts. And according to these same experts, this modest change could help hold down the cost of health care for all of us in the long run.

Now, finally, many in this chamber -- particularly on the Republican side of the aisle -- have long insisted that reforming our medical malpractice laws can help bring down the cost of health care. (Applause.) Now -- there you go. There you go. Now, I don't believe malpractice reform is a silver bullet, but I've talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. (Applause.) So I'm proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine. (Applause.) I know that the Bush administration considered authorizing demonstration projects in individual states to test these ideas. I think it's a good idea, and I'm directing my Secretary of Health and Human Services to move forward on this initiative today. (Applause.)

Now, add it all up, and the plan I'm proposing will cost around $900 billion over 10 years -- less than we have spent on the Iraq and Afghanistan wars, and less than the tax cuts for the wealthiest few Americans that Congress passed at the beginning of the previous administration. (Applause.) Now, most of these costs will be paid for with money already being spent -- but spent badly -- in the existing health care system. The plan will not add to our deficit. The middle class will realize greater security, not higher taxes. And if we are able to slow the growth of health care costs by just one-tenth of 1 percent each year -- one-tenth of 1 percent -- it will actually reduce the deficit by $4 trillion over the long term.

Now, this is the plan I'm proposing. It's a plan that incorporates ideas from many of the people in this room tonight -- Democrats and Republicans. And I will continue to seek common ground in the weeks ahead. If you come to me with a serious set of proposals, I will be there to listen. My door is always open.

But know this: I will not waste time with those who have made the calculation that it's better politics to kill this plan than to improve it. (Applause.) I won't stand by while the special interests use the same old tactics to keep things exactly the way they are. If you misrepresent what's in this plan, we will call you out. (Applause.) And I will not -- and I will not accept the status quo as a solution. Not this time. Not now.

Everyone in this room knows what will happen if we do nothing. Our deficit will grow. More families will go bankrupt. More businesses will close. More Americans will lose their coverage when they are sick and need it the most. And more will die as a result. We know these things to be true.

That is why we cannot fail. Because there are too many Americans counting on us to succeed -- the ones who suffer silently, and the ones who shared their stories with us at town halls, in e-mails, and in letters.

I received one of those letters a few days ago. It was from our beloved friend and colleague, Ted Kennedy. He had written it back in May, shortly after he was told that his illness was terminal. He asked that it be delivered upon his death.

In it, he spoke about what a happy time his last months were, thanks to the love and support of family and friends, his wife, Vicki, his amazing children, who are all here tonight. And he expressed confidence that this would be the year that health care reform -- "that great unfinished business of our society," he called it -- would finally pass. He repeated the truth that health care is decisive for our future prosperity, but he also reminded me that "it concerns more than material things." "What we face," he wrote, "is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country."

I've thought about that phrase quite a bit in recent days -- the character of our country. One of the unique and wonderful things about America has always been our self-reliance, our rugged individualism, our fierce defense of freedom and our healthy skepticism of government. And figuring out the appropriate size and role of government has always been a source of rigorous and, yes, sometimes angry debate. That's our history.

For some of Ted Kennedy's critics, his brand of liberalism represented an affront to American liberty. In their minds, his passion for universal health care was nothing more than a passion for big government.

But those of us who knew Teddy and worked with him here -- people of both parties -- know that what drove him was something more. His friend Orrin Hatch -- he knows that. They worked together to provide children with health insurance. His friend John McCain knows that. They worked together on a Patient's Bill of Rights. His friend Chuck Grassley knows that. They worked together to provide health care to children with disabilities.

On issues like these, Ted Kennedy's passion was born not of some rigid ideology, but of his own experience. It was the experience of having two children stricken with cancer. He never forgot the sheer terror and helplessness that any parent feels when a child is badly sick. And he was able to imagine what it must be like for those without insurance, what it would be like to have to say to a wife or a child or an aging parent, there is something that could make you better, but I just can't afford it.

That large-heartedness -- that concern and regard for the plight of others -- is not a partisan feeling. It's not a Republican or a Democratic feeling. It, too, is part of the American character -- our ability to stand in other people's shoes; a recognition that we are all in this together, and when fortune turns against one of us, others are there to lend a helping hand; a belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgment that sometimes government has to step in to help deliver on that promise.

This has always been the history of our progress. In 1935, when over half of our seniors could not support themselves and millions had seen their savings wiped away, there were those who argued that Social Security would lead to socialism, but the men and women of Congress stood fast, and we are all the better for it. In 1965, when some argued that Medicare represented a government takeover of health care, members of Congress -- Democrats and Republicans -- did not back down. They joined together so that all of us could enter our golden years with some basic peace of mind.

You see, our predecessors understood that government could not, and should not, solve every problem. They understood that there are instances when the gains in security from government action are not worth the added constraints on our freedom. But they also understood that the danger of too much government is matched by the perils of too little; that without the leavening hand of wise policy, markets can crash, monopolies can stifle competition, the vulnerable can be exploited. And they knew that when any government measure, no matter how carefully crafted or beneficial, is subject to scorn; when any efforts to help people in need are attacked as un-American; when facts and reason are thrown overboard and only timidity passes for wisdom, and we can no longer even engage in a civil conversation with each other over the things that truly matter -- that at that point we don't merely lose our capacity to solve big challenges. We lose something essential about ourselves.

That was true then. It remains true today. I understand how difficult this health care debate has been. I know that many in this country are deeply skeptical that government is looking out for them. I understand that the politically safe move would be to kick the can further down the road -- to defer reform one more year, or one more election, or one more term.

But that is not what the moment calls for. That's not what we came here to do. We did not come to fear the future. We came here to shape it. I still believe we can act even when it's hard. (Applause.) I still believe -- I still believe that we can act when it's hard. I still believe we can replace acrimony with civility, and gridlock with progress. I still believe we can do great things, and that here and now we will meet history's test.

Because that's who we are. That is our calling. That is our character. Thank you, God bless you, and may God bless the United States of America. (Applause.)

END 9:03 P.M. EDT

Source: White House Press Office ... http://www.whitehouse.gov/the_press_off ... alth-Care/

Here's a nice survery from the N.Y. Times of the media reaction to the speech from lots of different media columnists in different newspapers:

What He Said, What They Heard
By ERIC ETHERIDGE
Reactions to President Obama’s speech last night.
September 10, 2009, 11:44 AM

Harold Pollack in the New Republic:

President Obama closed in bravura fashion, evoking the memory of Senator Edward Kennedy, and the Senator’s lifelong passion for universal coverage. This was more than a tug on the heartstrings. President Obama unmistakably reminded America that conservatives called Social Security socialism in 1935. Conservatives called Medicare socialism in 1965. They are calling health reform socialism today. This was the opposite of triangulation. President Obama placed himself firmly in the camp of Franklin Roosevelt, Lyndon Johnson in providing a leavening hand of wise policy to intervene when markets crash or when individuals need help.

In his final months, Senator Kennedy noted that the character of our country is at stake. Is our heart large enough to embrace people who need help? President Obama closed by saying: “We did not come to fear the future. We came here to shape it.” He added: “I still believe we can act even when it’s hard.”

He has staked his presidency on this final point. That’s exactly what I wanted to hear.

William Kristol in the Washington Post:

So President Obama invited himself into our living rooms tonight…why? Not to address questions of war and peace — even though we are fighting two wars overseas, and even though an avowed enemy and terror sponsor is rushing towards nuclear weapons. Not to address the economy — even though unemployment continues to rise, the deficit is at an all-time high, and we face a truly worrisome debt burden in the years ahead. And not to rally the nation in the face of some other crisis.

But isn’t health care a crisis? No.

Indeed, the president acknowledged it isn’t: “But we did not come here just to clean up crises. We came to build a future. So tonight, I return to speak to all of you about an issue that is central to that future — and that is the issue of health care.” In other words, health care — unlike, say, the financial system a few months ago — is not in a state of crisis.

So there is no health care crisis. There are a host of normal public policy issues dealing with health care that can be dealt with through the normal political process.

But that doesn’t suit Obama. He’s decided a big victory on health care is key to his political success. He’s decided we all have to acquiesce in a massive overhaul of our health care system because…he’s decided he wants it.

Tina Brown at the Daily Beast:

Obama’s great asset has always been an ability to maintain his air of authority without being baritone about it. He can be boring, but he is never ridiculous or pompous. When he called timeout on the bickering and the games, the Republicans sitting sullenly on their hands were reduced on TV to foolish members of the class who had been throwing ink bombs all summer at the math teacher. They looked all the more surly after Obama had wrung a double thumbs-up from John McCain for adopting a McCain campaign measure—offering Americans who can’t get insurance because of pre-existing conditions low-cost coverage to protect them against financial ruin if they get seriously ill.

No, he wasn’t convincing about the cost of all this, and he lost me when he got into that damn insurance exchange, but he had an ace up his sleeve with Ted Kennedy’s posthumous letter. His riff about what the dying senator had called the “character of our country” was inspired, reminiscent of his original career-making “not a liberal America and a conservative America” hit at the 2004 Democratic convention. There was something about the writerly way Obama relished the phrase “the character of our country” that made it his own, not Ted’s, and conjured up an America that was flinty but big-hearted, self-sufficient but also neighborly. It communicated, at the eleventh hour, the missing soul in the partisan debate.

Tucker Carlson at the Daily Beast:

This didn’t look anything like the Barack Obama I remember from the campaign. Obama the candidate seemed almost unaware of his opponents. At his best, which was most of the time, he rose above them completely, utterly unwounded by the attacks.

He also seemed like an adult. Obama was forever reminding audiences of the hard choices America needed to make, choices that had been sugarcoated when they weren’t ignored completely by politicians too fearful to tell the whole truth. Once elected, Obama promised, that would change.

Never has a president been warped by Washington quicker. At times tonight, Obama sounded like an embattled second-termer with a 35 percent approval rating. What percentage of his speech was spent lashing out at his enemies, real and imagined? Radio and cable-television pundits, George W. Bush, former Congresses, unnamed ghouls employing “scare tactics,” whose “only agenda is to stop reform at any cost”—they’re all against him, Obama said. And they’re lying.

This isn’t how confident leaders speak. These are the complaints of a man on his way to bitterness. So soon?

Michael Kazin at Politico:

Put all the policy details and misinformation aside for a minute. Obama’s masterful speech was as clear a statement of a progressive — that is, LaFollette/TR/Woodrow Wilson/Jane Addams progressive — viewpoint as any national figure has made in a very long time.

He kept returning to the same tropes he used so effectively during the ‘08 campaign: take care of yourself so you can take care of your neighbor, government has to serve all the people not the special interests, the only ideology we have is a kind of communitarian Americanism (some political philosophers, like Michael Sandel, call it republicanism). FDR and LBJ were both effective liberals, but they needed to attack their enemies to make their points. Obama can do that, but he clearly would rather be reasoning together. Will that work? I don’t know, but it calls on impulses that many religious groups cherish and, if independents take him at his word, could lift him out of the doldrums and help him get more than a health care bill enacted.

Rod Dreher at Crunchy Con:

I clapped when the president said that he would make it illegal for insurance companies to punish people with pre-existing conditions. Terrific! I like too his statement about making the plan pay for itself, but I’m skeptical about that one. We’ll see. Overall, my gut feeling is that it was a very good speech, and that the president helped himself a lot tonight - especially with his close. . . .

Julie and I were talking over the weekend about friends who are struggling to pay for health care between jobs, and how we’d be pleased to pay higher taxes if it would make it easier for families like them to sleep at night knowing that they don’t have to worry about their children’s health coverage. There’s a tremendous moral aspect to this debate, and Obama did well to speak to that tonight. This part of his speech challenged me as a Christian, and it will color my thinking as I try to figure out what the right thing to do on health care is.

Jonathan Cohn in the New Republic:

The critical passage came at the end, after Obama was done laying out all of the problems with American health care and after he was done explaining, or trying to explain, how his health care plan would solve those problems. That’s when he turned a bit more pensive and wistful–you could see this was the part of the speech he liked best–and started sounding a bit more like a preacher than a lawyer.

He invoked the spirit of Ted Kennedy, reminding people of Kennedy’s determination to help the disadvantaged and marginalized. He conjured up the examples of Medicare and Social Security, noting the tough battles waged on behalf of each. And then he made his argument . . .

It’s a careful statement, deferential to critics in the way Obama typically it is. But it’s also a pretty clear defense of government–at a time when defending government is pretty controversial.

We saw that in August, when town hall meetings dredged up some pretty primal feelings. The protesters showing up at these events weren’t simply angry about health reform. They were angry about every government program since the New Deal. Most Americans don’t see things quite that way; Medicare and Social Security remain incredibly popular. But government remains unpopular in the abstract, as it has been at least since the time of Ronald Reagan.

With these final passages, I think, Obama was trying to shift that mindset–to remind people that government is already a part of our lives, and a force for good, in ways that are entirely consistent with basic notions of citizenship and shared responsibility.

To be sure, none of this will affect the outcome of the health care reform debate. But if Obama can convince Americans that govenrment works–an effort that will require action, yes, but also some words–it might shape debates in the future.

Yuval Levin at National Review:

Obama concluded with a painfully inappropriate abuse of the memory of the late Sen. Ted Kennedy-calling by name on several Republican friends of Kennedy’s, as if to shame them into voting for a bill they do not support because failing to do so would be a failure of friendship. Is this how a president behaves? Using the memory of the recently deceased as a club with which to pound upon the man’s friends?

Stepping back, it is striking how partisan this speech was — both in its offense and its defense. There’s nothing necessarily wrong with that, of course. But it’s telling. It suggests the White House and the Democratic leaders have decided that the Democrats must go it alone, and therefore needed a pep talk to give them the courage to push against public unease and Republican opposition. This speech may well serve them on that front. But it is hard to imagine that it will persuade independent voters who are worried about the plan, and that kind of persuasion is what moderate Democrats needed.

Ta Nehisi Coates at the Atlantic:

I think what you saw yesterday was very predictable. Again, big media sets up this narrative of the “Make or break” speech. Again, Obama shoots the lights out. Again, Obama says something innocuous, “no illegal immigrants will be covered.” Again, a Republican overplays his hand. The temptation is to say that Obama planned for August to happen, that he baited his adversaries, the way Deion Sanders used to bait quarterbacks. Probably not. Still, the catch-up speed is incredible. . . .

I keep meeting lefties who tell me Obama’s “too soft” with these guys, and I keep looking at them like they’re crazy. I am going to go out on a limb and say that there is something deeper at work here, something beyond the policy fights. I think a lot of us don’t just want Obama to be effective, we want him to exact some measure of revenge. It’s smart to understand the difference between the two, and moreover, how the desire for one can undermine the other. A section of conservatives love Sarah Palin because she drives liberals crazy. That she drives a lot of other people crazy too, and hence undermines herself, is beside the point.

Let’s not make that mistake. Besides. If it’s blood on the walls you want, the GOP is doing fine by itself.

Alex Knepper at New Majority:

Did the President of the United States really just convene a joint session of Congress to announce that the time for bickering is over, that the healthcare issue is very, very important, that we need to take Real Action, that tort reform is (maybe) on the table (once Kathleen Sebelius looks into it), and that an individual mandate (hello, Mitt Romney!) is a must? Was that the big speech? Am I missing something?

Sadly, I don’t think so. That was amateur hour, plain and simple. Presidents just don’t use their ability to address a joint session of Congress simply to make a political stump speech — it’s utterly unprecedented. And let’s be very clear: a stump speech is exactly what that was. That he needed to do that, of course, is confirmation of the position of weakness he finds himself in. He was doing what he always has done when he finds himself in a tough spot: he made a speech. The mission last night was to keep healthcare from becoming, well, his Waterloo. . . .

Citizens and commentators should send Obama a clear message tomorrow: go back to your office and come up with something substantive or stop wasting our time.

Atul Gawande in the New Yorker:

Before President Obama’s speech on health care, I wrote out a list of what I thought we needed him to do.

1. Make clear the stakes.
2. Make clear what we get under his reform.
3. Understand our fears.
4. Convey strength in the face of them.
5. Speak to our core beliefs as a nation.

I thought he did this and did it amply. . . .

And yet I remain concerned that he may not have done enough.

The stone faces of his conservative enemies made clear the limits of what words could do. I was struck that for nearly the entirety of his speech, he spoke facing not the camera or the Democrats but the Republican throng. This has become a test of who we will trust. Are we going to trust the Republicans, with their predictions of dark disasters that will result from going along with a President they do not believe should be allowed even to speak to our schoolchildren? Or are we going to trust this still new and untested President enough to give his changes a chance?

Obama has continued to defend policies that would push us, for the first time in history, in the direction of encouraging doctors to make more rational, better coördinated, less costly clinical decisions. This includes experiments with changing the way doctors are paid, a clinician board to identify inappropriate care, and a “fee” (i.e., tax) on extremely high-cost insurance premiums. I was also made hopeful by his willingness to break with Democrats and admit that the medical malpractice system is itself broken and, although not the cause of our cost crisis, a wasteful contributor.

But this is just a start. Our current health-care system presents seemingly insurmountable difficulties. It is too big, too complex, too entrenched, bloated, Byzantine, and slowly bursting. What may be most challenging about reforming it is that it cannot be fixed in one fell swoop of radical surgery. The repair is going to be a process, not a one-time event. The proposals Obama offers, and that Congress is slowly chewing over, would provide a dramatic increase in security for the average American. But they will only begin the journey toward transforming our system to provide safer, better, less wasteful care. We do not yet know with conviction all the steps that will rein in costs while keeping care safe. So, even if these initial reforms pass, we have to be prepared to come back every year or two to take another few hard and fiercely battled steps forward.

In this way, successful reform will have to be more like a series of operations, with x-rays and tests in between to show how we’re doing. Embarking on the effort will be among the most severe challenges we take on as country. Outside the settings of war and economic collapse, we’ve never sustained any policy effort of this scope and duration. It is perfectly possible that our next push will be defeated, or used as an opportunity to dismantle the progress we’ve already made. But I can see no other choice. We can only forge ahead.

Source: http://opinionator.blogs.nytimes.com/20 ... hey-heard/

Post by **roxybeast** » September 11th, 2009, 4:12 pm

The Public Option

Here's a nice video from Robert Reich explaining the public option and what it means to you. Simple & direct. Pass it on to your friends! ... http://www.youtube.com/watch?v=dBi8A_HutII

The Final Sprint for Health Care Has Now Begun
By Robert Reich, former US Labor Secretary & Professor at UC Berkeley

The real political race for health care has just begun. The significance of the President's speech to Washington insiders was its signal about where the White House is placing its bets and its support. More on this in a moment. First, let's be clear about who's racing and why. Think of the speech as the starting gate of a two-month sprint between two competitors -- and they're not Democrats and Republicans.

On one side are America's biggest private insurers and Big Pharma. They're drooling over the prospect of tens of millions more Americans buying insurance and drugs because the pending legislation will require them to, or require employers to cover them. The pending expansion of Medicaid will also be a bonanza. Amerigroup Corp., UnitedHealth Group Inc. and other companies that administer Medicaid are looking at 10 million more customers. Healthcare Inc.'s Medicaid enrollment is expected to jump by 43 percent, according to its CEO. WellPoint Inc., the largest U.S. insurer, is also looking at big gains.

But the big insurers hate the idea of a public option because it will squeeze their profits. A true public option will force private insurers to compete in markets where there's now very little competition, and also have the bargaining power to force drug companies to offer lower prices. Big Pharma also wants to prevent Medicare and Medicaid from having the power to negotiate lower prices, for the same reason. Private insurers and Big Pharma would rather fudge the question of where the savings will come from or how all this will be paid for. They certainly don't want to pay for wider coverage with a surtax on the rich, because, hey, their executives and shareholders are mainly rich.

On the other side lies the Democratic base (organized labor, grassroots progressives, leading activists) whose main goal is to make health care more affordable for a hundred million American families who are now paying through the nose (higher and higher co-payments, deductibles, and premiums, not to mention wages that are depressed because of employer-provided health insurance), and affordable to the tens of millions who can't get it now. To this end, the Dem base wants a public option and wants Medicare and Medicaid to have negotiating power. That's because every dollar that's squeezed out of the private insurers and Big Pharma is a dollar saved by average Americans on their health care -- or a dollar saved by taxpayers who otherwise end up footing the bills for Medicare and Medicaid. There's simply no more direct way to control costs. And the Dem base isn't at all reluctant to put the burden of paying for wider coverage on the wealthy.

Private insurers and Big Pharma are being represented in this race by Max Baucus and his Senate Finance Committee. Senate Finance is on the verge of reporting out a bill that requires that just about every American have health insurance and just about every business provide it (or else pay a fee). But the bill will not include a public option. Nor will it change current law to allow Medicare to negotiate low drug prices. Nor will it include a surtax on the wealthy. The Committee's only real nod to cost containment is a small tax on expensive insurance policies, which doesn't worry the private insurers because its cost is so easily passed on to the beneficiaries. The Democratic base is being represented by Nancy Pelosi and House Dems, who have reported out a bill that includes a public option, want Medicare and Medicaid to have negotiating power, and will pay for universal coverage with a surcharge on the rich. The Senate's Health, Education, Labor, and Pension Committee, formerly chaired by Ted Kennedy, also represents the Democratic base, and reported a strong bill that parallels the House.

Where's the White House? For months now, it's been straddling the fence -- reassuring the Dem base that the President is with them (he did it as recently as Monday with a rousing speech to organized labor), while at the same time nodding and winking in the direction of the private insurers and Big Pharma. Last spring the White House agreed to Big Pharma's demand that Medicare not be permitted to negotiate low drug prices in return for Pharma's agreement to support the health care bill emerging from the Senate Finance Committee. Since then it has quietly told private insurers that it will work with Senate Finance to find less potent alternatives to the public option, such as Kent Conrad's "cooperatives" or Olympia Snowe's "trigger" mechanism, in return for the private insurers' support of the compromise. And it has told the private insurers and Big Pharma that it will not support a surtax on the wealthy.

Obama's Wednesday night speech reassured the Democratic base that the President is deeply committed to getting universal coverage. But the speech also made clear that the White House has decided to side with the Senate Finance Committee and against the Democratic base on the details. The President was careful to note that a public option is only a means to an end and he remained open to other ideas (read: Conrad's cooperatives or Snowe's trigger). The speech included nothing about Medicare bargaining leverage, thereby letting the drug deal stand. The President clearly sided with Senate Finance on the funding mechanism of a tax or fee on high-end insurance rather than a surtax on the wealthy. And his promise to limit the costs of universal coverage to $900 billion put the President directly in league with the Senate Finance Committee rather than than the House, whose bill is projected to cost more than $1 trillion.

The Dem leadership got the message. Yesterday, Senate majority leader Harry Reid said that while he favored a strong public option, he could be satisfied with establishment of nonprofit cooperatives. And Nancy Pelosi, who as recently as two weeks ago said the House would not support a bill that didn't include a public option, passed up a chance to say it was a nonnegotiable demand. When pressed, she said that as long as legislation makes quality health care more accessible and affordable, "we will go forward with that bill."

But, again, the race has just begun. Your input is still important -- in fact, more important now than before. The Senate Finance's bill will be reported out next week and voted on by the entire committee in the following week, then go to the floor of the Senate for a vote in mid October. The House bill will go to the floor at about the same time. Each side is now counting noses. Pelosi knows she won't have any Republicans with her, so will need to keep 40 Dems from bolting. If Reed can't get 60 votes by October 15, he'll add health care to a reconciliation bill, which will need only 51.

The more you can make your voices heard, the more likely it is that the race will be won by the public rather than the private interests.

Source: http://www.huffingtonpost.com/robert-re ... 83553.html

Post by **roxybeast** » September 11th, 2009, 4:22 pm

Wilson Shouts 'You Lie' After Wife Fakes Orgasm
by Andy Borowitz

Rep. Joe Wilson (R-SC) courted controversy again today as he reportedly shouted "You lie" during a sexual encounter in which his wife pretended to have an orgasm.

While details of Rep. Wilson's latest outburst are sketchy at best, congressional experts say that it is totally against the decorum of the House of Representatives to speak out during a spouse's faked orgasm.

But the South Carolina congressman got a vote of support from a fellow Republican lawmaker, Sen. John Ensign (R-NV), who told reporters, "It's so rare for a Republican politician to have sex with his own wife, we should applaud it when it happens."

In a related story, President Obama said that Rep. Wilson's outburst during his speech Wednesday night was "productive," adding, "Joe Wilson highlighted the need for mental health care."

Source: http://www.huffingtonpost.com/andy-boro ... 83843.html

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Post by **roxybeast** » September 11th, 2009, 5:16 pm

"A Moral Obligation - A Clear Responsibility"

EDITORIAL
"A Clear Responsibility"
N.Y. Times, 9/10/09

In the moving peroration of his speech to Congress Wednesday night, President Obama cast health care reform as a moral issue that reflects on the character of our country. He also made clear that there are some problems that are too big for individuals to solve on their own — and that guaranteeing that all Americans have access to health care is one of them.

“Our predecessors understood that government could not, and should not, solve every problem,” he said. “But they also understood that the danger of too much government is matched by the perils of too little.”

Any critic who still questions the need for health care reform or rails against a “government takeover” of health care should look at the latest Census Bureau estimates of the number of people without health insurance in this country — and the number who have avoided disaster precisely because of government help.

The overall number of the uninsured rose from 45.7 million in 2007 to 46.3 million in 2008. The fact that tens of millions of Americans may be one major illness away from bankruptcy is unacceptable. But there is also some heartening news: The increase was relatively small considering the depth of the economic crisis. That is only because government programs helped offset the decline of private insurance and employer-based coverage.

An aging population made more people eligible for Medicare, that much-maligned “single-payer” government program that provides coverage to almost all of the nation’s elderly, usually to their deep satisfaction. And deepening poverty rates made more people eligible for Medicaid, a joint federal-state program to cover the poor.

A strong push to enroll children in either Medicaid or S-chip, the state health insurance program for children from low-income families, has driven the number and rate of uninsured children to its lowest levels since 1987, the first year comparable data were collected. This is a stunning achievement — courtesy of your federal and state governments.

The most worrisome trend is that the number of adults under age 65 who lack insurance is high and rising, reaching 20 percent of that age group last year. The number of uninsured adults increased by 1.5 million in 2008. The toll in 2009 is likely to be worse as unemployment rates continue to rise, depriving workers of their group coverage, and more companies drop or shrink health benefits.

The health care reform plan that President Obama and many Democrats in Congress are calling for could do a lot to reduce Americans’ vulnerability and stem that tide. Likely reforms would require employers to provide health benefits to their workers or pay a fee to help cover them elsewhere, thus slowing the erosion of employer coverage. Reform would also expand Medicaid to cover more poor people, create exchanges where people without group coverage at work could buy affordable policies and receive subsidies based on their incomes and prohibit insurance companies from denying coverage or charging exorbitant rates based on medical conditions.

Critics of health care reform have done Americans two great disservices. They have obscured and denied the very real suffering of tens of millions of uninsured Americans and the very real danger that millions more could soon join them. And they have twisted and denied the goal of health care reform when they rail against a fictitious government takeover.

As Mr. Obama said in his speech, when facts, reason and civility are thrown overboard, he said, “we don’t merely lose our capacity to solve big challenges. We lose something essential about ourselves.”

Source: http://www.nytimes.com/2009/09/11/opinion/11fri1.html

Post by **roxybeast** » September 11th, 2009, 5:28 pm

So What Do Doctors Think? ... (well, at least some doctors):

Doctors Pauline Chen, M.D., and Allan Brett, M.D., discussing health care reform in the New York Times recently ...

Q. What about freedom of choice in health care? Isn’t that uniquely American?

A. There are three types of choice in health care.

The first is the choice of your preferred physician. In the most popular health plans, the choices are virtually unlimited; people can chose whom they want to see and where they want to go. But a single-payer system, for example, does not necessarily change that, since all the facilities and practices as we know them today are left in place. In fact, if you take away all the insurance restrictions we have today on whom you can see, your choice is increased.

A second type of choice is the freedom to choose a health care plan. We do want to choose our hospitals and doctors. But do we really look forward every November to choosing between one of five plans with permutations and combinations of physicians, providers in network and providers out of network? What people really want is a user-friendly system to get what they need.

Finally, the third kind of choice has to do with deciding on whatever tests and treatments you might want as a patient. But that element of choice has to be carefully handled no matter what kind of system we have because those choices affect cost. Over the last 10 to 20 years, the pendulum has swung toward patient autonomy — which is a good thing — but it has also swung to the point where doctors sometimes feel they must give patients whatever they want without thinking critically about the risks and benefits. That has led to a huge proportion of money being spent on care that is not only marginally beneficial but is also of no benefit at all. I think that if we had a way to eliminate that — which means using our clinical decision-making skills and saying no when appropriate — we would have more money to spend on care that does matter and that makes a difference.

No matter what system we ultimately decide upon, there will have to be mechanisms in place to insure that we spend money wisely.

Q. So is there anything that is uniquely “American” about our way of approaching health care?

A. Yes. We are unique almost worldwide in that we deny health care coverage to a proportion of our population.

I do not believe there are pivotally important distinctions between our “American values” and those of other Western European and North American countries, and certainly not the kind of distinctions that would prevent us from sorting out our health care system. I don’t think we are as unique as politicians make us out to be. Even if we were that unique, the important thing is to get health care right and not to harp on the uniqueness of the system we come up with.

Q. How would you envision a health care system that is imbued with “American values”?

A. In virtually every opinion poll conducted in recent years, a majority of Americans favor government guaranteed health insurance. While a single-payer system isn’t the only way for the government to guarantee coverage for all, I think one way to think of such a system is to consider it “Medicare for all.”

But such a system would have to be accompanied by a really hard look, led by medical experts and members of the community, at what works and what doesn’t, an assessment of how we can best budget our health care dollars to achieve the best possible health care outcomes. Such a system would take time and there would be hard choices, and not everyone would be happy. But we might come closer than we are to representing the interests of most Americans.

Source: http://www.nytimes.com/2009/09/10/health/10chen.html

Post by **roxybeast** » September 11th, 2009, 5:39 pm

Issue Spotlight: Abortion

Consider this article on the provisions regarding the facts & fictions of the status of abortion language in the current health care legislation:

The Next Health Reform Myth
by Ruth Marcus
Washington Post, Sept. 9, 2009

Item: "President Obama and top Democratic congressional leaders are pushing hard for health care bills that would result in federal government funding of abortion on demand!" warns the National Right to Life Committee.

Item: A television ad broadcast by the Family Research Council shows an older couple -- Harry and Louise on Medicare -- sitting at their kitchen table and worrying about how to afford a needed operation. "They won't pay for my surgery, but we're forced to pay for abortions," says the man.

Item: House Minority Leader John Boehner asserts that House Democrats' health bill "will result in federally mandated coverage of abortion on demand in virtually all of America's health plans," making it "illegal for health-care providers nationwide -- even Catholic and religious-based hospitals . . . -- to provide anything less than abortion on demand for anyone who seeks it."

You're going to be hearing more of the same. Don't believe it. These inflammatory statements do a disservice to a complex issue of public policy: how, in the context of health reform, to balance the deeply felt views of both sides in the abortion debate.

I am firmly in the camp of those who think the abortion decision should be left up to the woman. But I respect those who fervently believe that abortion is the taking of human life, so I am sensitive to concerns that their tax dollars not be used to pay for the procedure.

Actually, let's remember: Tax dollars already are used to pay for abortion. Even the Hyde amendment, which since 1976 has prohibited the use of federal Medicaid funds for abortions, makes an exception in cases of rape and incest and when the mother's life would be in danger. Americans who believe that abortion should not be permitted, even in such cases, are nonetheless required to pay, yes, tax dollars to underwrite these procedures.

On a more subtle level, the federal government offers tax credits to purchase health insurance and subsidies for people who have lost employer coverage -- without excluding plans that cover abortions. Again, tax dollars.

Still, the status quo is generally to keep federal money out of abortions. The health care given to members of the military doesn't include coverage for most elective abortions. Neither does the insurance offered to federal employees.

At the same time, most private insurance plans do offer abortion coverage. So the abortion question unavoidably arises in the context of health reform -- notwithstanding President Obama's understandable desire to "not get distracted by the abortion debate."

The controversy has two dimensions: First, if a public plan is created, should abortion be among the covered services? Second, even without a public plan, should the private insurance plans available on the exchanges be allowed or required to cover abortion -- even though government funds would go to subsidize some, but not all, of those obtaining insurance this way?

The only Senate measure produced so far is silent on the subject. In the House, an amendment offered by Rep. Lois Capps (D-Calif.) nicely threads these narrow-eyed needles.

With respect to private insurance, the Capps amendment makes clear that companies participating in the exchange cannot be required to include abortion coverage and that plans cannot -- contrary to Boehner's assertion -- discriminate against health providers that decline to provide abortions.

In addition, it requires that the exchanges include at least one plan without abortion coverage -- relieving abortion opponents from worrying that their premiums would be used to pay for abortions -- and one that offers coverage. Although private plans could include abortion coverage, they could not use federal funds for that purpose. Instead, plans that choose to include this coverage could set aside a portion of their private premiums that could then be used to pay for abortion services.

The most questionable, and politically vulnerable, aspect of the Capps amendment involves the public plan. It provides that abortion, if included among the covered services, can be financed only from a separate pool of purely private contributions -- as with the private plan. This is even more stringent than the Medicaid rules under which states can use their own money to pay for abortions.

It is hard to imagine how to craft a more sensitive approach -- other than telling women who purchase insurance through the exchanges entirely with their own money that they cannot obtain abortion coverage.

Then again, that would be perfectly fine with some of the critics. Others are happy to seize on any argument, however misleading, that might derail the larger enterprise.

Source: http://www.washingtonpost.com/wp-dyn/co ... 02960.html

Post by **roxybeast** » September 11th, 2009, 8:20 pm

Assessing President Obama's Health Care Speech and Ideas for Reform
by Bill Moyers

This week on the JOURNAL, public health expert Dr. Jim Yong Kim, who is also the incoming president of Dartmouth College, spoke with Bill Moyers about his vision of health and educational reforms for a better future. Dr. Kim commented on President Obama’s health care speech and the Republican response, and offered his suggestions for reforms that would benefit America’s dysfunctional medical system.

“As a speech, it was really stunning and masterful... But what was most interesting to me was the Republican response afterwards, and how many things that they seem to agree on... One, everyone should have health insurance. Two, we need to lower costs. Three, we need to maintain quality, [and four,] that the expenditures right now in health care, especially public expenditures, are unsustainable... There's no simple solution to this problem... For many, many years, we've been working under the fantasy that if we come up with new drugs and new treatments, we're done [and] the rest of the system will take care of itself... What we've learned about organizations is that it is very difficult to get a complex organization, a group of people, to work consistently toward a goal... What we need now is a whole new cadre of people who understand the science, who really are committed to patient care, but then also think about how to make those human systems work effectively.”

Post by **roxybeast** » September 12th, 2009, 7:36 pm

Parsing Mr. Wilson’s Apology
By Gail Collins, New York Times
Published: September 11, 2009

Let’s take a moment to rejoice in our country’s infinite capacity to surprise.

I’d have been willing to bet that we had a national consensus on the undesirability of a congressman yelling out “You lie!” during an address by the president of the United States. But no. It turns out there are quite a few people who think this is a good idea.

Joe Wilson, who will be forever known as the “You lie!” congressman, unless he does something even weirder in the future, has a lot of fans this weekend at the Taxpayer March on Washington. This is an anti-Obama demonstration organized by FreedomWorks, the group that helped bring us the summer town hall meeting protests.

Those were, of course, the events where we learned that we did not actually have a national consensus on the inadvisability of bringing loaded weapons to places where the president is speaking.

Among the co-sponsors of the march are the Tea Party Patriots, who helped bring us those anti-tax rallies last spring, during which we learned that there are some patriots who love the country so much that they would like to see their state secede from the union.

And now they also love Joe Wilson. “People need to stop being afraid and not bite their tongues,” one of the marchers told the newspaper The Hill. Actually, fear of self-expression does not seem to be that big of a problem with this group, but Wilson undoubtedly appreciated all the supporters who honored him by yelling “Liar!” as often as possible.

The tea party movement activists range from geeky Ron Paulists who obsess about the money supply to conspiracy theorists who believe that Barack Obama is a noncitizen brought here by people who hate this country and had the foresight to plant a birth notice in a Hawaiian newspaper 48 years ago, just in case they ever needed it.

The one thing that unites them seems to be a sense of inchoate rage. Although mentioning it makes them really, really mad.

Perhaps that’s why they like Joe Wilson. (His actual name is Addison Graves Wilson Sr. Where do the Republicans find all these faux Joes?) After his outburst, he explained that he had been so furious when the president said illegal immigrants would not be covered by the health care reform bill that he “let my emotions get the best of me.”

This does not seem like a great excuse. Wouldn’t you rather admit it was a plan than say you had so little self-control that hearing the president make a frequently stated claim about a much-debated bill caused you to create a spectacle on national TV? Obviously, this is not a guy you want to let in the room if Hugo Chávez ever comes to town.

Perhaps Wilson is just given to mood swings. He seemed somewhere between mild-mannered and zombielike in a follow-up video, in which he stared into the camera and promised not to be muzzled if people would send him contributions. “Health care is a matter of life and death for so many,” he intoned. “I choose life with health insurance reform.”

Not all that catchy, but who knows what works these days?

The Republicans are pointing out that Democrats made unfriendly noises during George W. Bush’s 2005 State of the Union address. This is true, although the difference between that and “You lie!” is about the same as the difference between calling an opponent wrong and accusing him of “hatred of America,” as Wilson did in a TV debate with a congressman opposed to the Iraq war.

After a certain amount of arm-twisting by Republican leaders, Wilson did apologize for his behavior. Now we are going to move on to arguing about the apology.

The Democrats are demanding that Wilson apologize all over again, on the floor of the House, or face the wrath of their official disapproval. Meanwhile, just to make sure nobody else ever goes off the rails like this again, the Senate Finance Committee is changing its version of the health care bill from one that does not provide benefits to illegal immigrants to one that absolutely, positively, for sure does not provide benefits to illegal immigrants.

Over at the Taxpayers March, people wanted the Republicans to apologize for asking Wilson to apologize. They seemed to be taking a cue from Rush Limbaugh, who said he was “ecstatic” when Wilson yelled at the president, since he himself had been shrieking “liar” at his TV throughout the speech.

Tea Party Patriots, do you really want your members of Congress doing something just because Rush Limbaugh does it? The next thing you know, they’ll be abusing prescription drugs and comparing the Abu Ghraib tortures to a fraternity initiation.

Interestingly, very few of Wilson’s defenders have noted that in the British Parliament, members shout insults all the time. They are probably loath to unfavorably compare Congress with a legislative body that supports inhumane and murderous practices like national health care.

Source: http://www.nytimes.com/2009/09/12/opini ... llins.html

Post by **roxybeast** » September 12th, 2009, 8:14 pm

Improving the Delivery of American Health Care

Great interview by Bill Moyers with Dr. Jim Yong Kim, who has an amazing health care resume with truly outstanding credentials & experience, on the need to focus resources and human systems expertise to vastly improve the DELIVERY of health care in this country ...

Watch it here: http://www.pbs.org/moyers/journal/09112009/watch2.html

Transcript:

Bill Moyers' Journal,
PBS, September 11, 2009

BILL MOYERS: If anyone understands the big challenges when it comes to healthcare systems, not just a domestic but a worldwide scale, it's the man you are about to meet.

Dr. Jim Yong Kim is a physician and anthropologist who has combined the skills of both to become one of the most acclaimed visionaries in the field of global health. "The world's troubles are your troubles," that's what he urged the recent graduating class of young doctors always to remember. That imperative has been the inspiration for his own work.

As co-founder of the humanitarian group, Partners in Health, and a senior official with the World Health Organization, Jim Yong Kim has been a crusader against infectious diseases and an advocate for the poor among the forsaken of the world in cities and villages in Haiti and Peru to Rwanda and Siberia. "U.S. News and World Report" said he is one of America's 25 best leaders. "Time Magazine" named him one of the 100 most influential people in the world. The Chair of three, that's right, three departments at Harvard University, Dr. Kim was a MacArthur Foundation genius whose efforts helped to treat 3 million new HIV/AIDS patients in developing countries.

By the way, he was also the quarterback for his high school football team in Muscatine, Iowa. So why at 50 years of age is this world renowned scholar and physician leaving all that behind for the hills of Western New Hampshire? Just a few days from now he will be formally inaugurated as the 17th President of Dartmouth College.

Welcome to the JOURNAL.

BILL MOYERS: Welcome to the Journal.

DR. JIM YONG KIM: Thank you very much Bill.

BILL MOYERS: I am indeed curious. You have spent the last 25 years of your life working with the sickest and the poorest people in the world. And here you are, now about to sit in the corner office of a wealthy, elite school with fewer than 6000 undergraduate students. What in the world did you tell the search committee?

DR. JIM YONG KIM: Well, it was entirely unexpected. I was minding my own business, working with colleagues who were interested in global health. But also colleagues in Harvard Business School and the engineering department at MIT, to try to figure out how to make health care programs in developing countries work more effectively. Dartmouth came out of the blue and said, "Would you look at this job?"

You know I work with Paul Farmer, who was chronicled in the book "Mountains Beyond Mountains," and he's one of my heroes and my closest friend in the world-

BILL MOYERS: Great public health--

DR. JIM YONG KIM: Great public health advocate, made a lot of personal sacrifices in his life. They call him the modern day Albert Schweitzer. But he is a person who works tirelessly for the health of poor people. And I have been very touched by the extent to which young people are motivated and moved by his life story. So I think that there's always a sense in young people that they want to do something great. I think there's a danger. A lot of young people don't think they can make a difference.

That's really what I am at Dartmouth to do. I'm there to tell the young people, "Look, a few committed souls can change the world." The famous Margaret Mead line, you know, that, never doubt the capacity of a small group of committed souls to change the world. In fact, that's the only thing that ever has. So I am there to give them that message. And you know I'm not sure. I'm not sure if that will work in my role as college president, but I'm going to give it a shot.

BILL MOYERS: But you know, you're coming with not the most popular message right now, because you know, when you told those young doctors graduating from medical school last May, "The world's troubles are your troubles." And that's the last thing many young people and old people in America want to hear right now, because we've got so many of our own troubles right here at home.

DR. JIM YONG KIM: Right. Well, I don't think that I would exclude our troubles. For example, one of the projects that I started just before leaving Harvard was a project looking at the health care of Native Americans in New Mexico. So there are a lot of problems right here. You know, in my own view, the life expectancy of Native Americans in the United States is one of the really great moral crises that we face.

BILL MOYERS: How so?

DR. JIM YONG KIM: Well, the life expectancy is often very much lower than life expectancy in some of the developing countries that I work in, in the 40s and 50s in some communities. So the world's troubles are right here as well.

And I was just tantalized by the notion of reaching back into the undergraduate curriculum. And trying to think hard about what would it take to train a group of young people, who would leave the college energized, inspired, and really thinking that there's no problem that they couldn't tackle.

DR. JIM YONG KIM: And I think that this is a good time to get them thinking about, look, you know, there's global warming. There's the crisis in the health care system in the United States. There's global health problems. There's a lot of huge problems out there. What do you need to do to prepare yourself for a meaningful life, tackling those kinds of problems? That's the question I'm going to ask them every day, as college president.

BILL MOYERS: Why are we talking about the American health care system as a crisis? What's wrong with our health care system?

DR. JIM YONG KIM: My own particular take on it is that I think for many, many years, we've been working under the fantasy that if we come up with new drugs and new treatments, we're done.

The rest of the system will take care of itself. In my view, the rocket science in health and health care is how we deliver it. And unfortunately, there's not a single medical school that I know of that actually teaches the delivery of health care as one of the essential sciences

In other words, what we've learned about organizations is that it is very difficult to get a complex organization, a group of people, to work consistently toward a goal. In the business world, if you don't do it well, the market gets rid of you. You go out of business. But many hospitals executing very poorly persist for a very, very long time. So my own view of it is that we have to rethink fundamentally the kind of research we do and the kind of people we educate, so that they'll think about the complexity of delivery as a topic that we can take on and study and learn about as a science.

BILL MOYERS: What do you mean, complexity of delivery?

DR. JIM YONG KIM: Well, just think about a single patient. So a patient comes into the hospital. There's a judgment made the minute that patient walks into the emergency room about how sick that person is. And then there are relays of information from the triage nurse to the physician, from the physician to the other physician, who comes on the shift.

From them to the ward team, that takes over that patient. There's so many just transfers of information. You know, we haven't looked at that transfer of information the way that, for example, Southwest Airlines has. Apparently they do it better than any other company in the world.

BILL MOYERS: Computers?

DR. JIM YONG KIM: No, they have taken seriously the human science of how you transfer simple information from one person to the next. And in medical school, and in the hospitals that I've worked in, we've done it ad hoc. Sometimes we do it well. Sometimes we don't do it well. But what we know is that transfer of information is critical. Now to me, again, that's the rocket science. That's the human rocket science of how you make health care systems work well

What we need now is a whole new cadre of people who understand the science, who really are committed to patient care. But then also think about how to make those human systems work effectively. We've been calling it, aspirationally, the science of health care delivery. And we do it at Dartmouth.

30 years ago, one of our great faculty members, Jack Wennberg, started asking a pretty simple question. Why is there variation, for example, in the number of children who get their tonsils taken out, between one county in Vermont versus another? 'Cause one of his children was in school at one place. Another of his children were in the school in another place.

And in one place, almost everyone had their tonsils out. And in another place, almost no one did. And of course, he found that there happened to be a doctor there who liked to take tonsils out and benefited from it. And he kept asking this question, you know, outcome variation. He called it the evaluative clinical sciences. And I think that's really the forerunner to what we're talking about in terms of the science of--

BILL MOYERS: Fancy--

DR. JIM YONG KIM: --health care delivery.

BILL MOYERS: That's a fancy name. What does it mean to the layman?

DR. JIM YONG KIM: It means how do you evaluate clinical outcomes? How do you understand variation in doctors' practices, for example? And ultimately, how do you fix the problems? So the group at Dartmouth Institute does all of that. We look at variation. You know, why is a Medicare reimbursement rate, you know, almost a third in the Mayo Clinic area, as opposed to Miami?

It's around 6,000 and around 15,000, huge differentials. And they simply ask that question. That's the Dartmouth Atlas, that looks at variation in health care expenditures from one place to the other. And we keep asking the question. "Why does this happen? Why does this happen?"

And we continue to do that research. And then we find places that are spending a lot of money and not getting the outcomes that they want. Folks in the Dartmouth Institute have developed techniques that borrow from industry, that borrow from, for example, the Toyota production system models, Six Sigma, these great management tools, and try to bring them to the hospital.

So not only do we study the problem and try to understand why there's variation and why there's poor outcomes in one place, but we also work very hard in the kinds of interventions that will change the tide. I think that's the science of health care delivery. And that's what we're going to really grow at Dartmouth College.

BILL MOYERS: Why have we been so resistant to doing this? It sounds so sensible.

DR. JIM YONG KIM: Well, I've noticed over the years that when it comes to our most cherished social goals, not only do we tolerate poor execution, sometimes we celebrate poor execution. Sometimes it's part of the culture. You know, these folks are trying to solve this terrible problem. They can't keep their books straight.

They really don't know what they're getting. They don't measure anything. But they're on the right side, so that's okay. I think we're in a different time.

BILL MOYERS: So what can we learn, for our own health care purposes, from the partnerships you've spent the last 25 years creating around the world?

DR. JIM YONG KIM: One of the things that we've learned is that community health workers, which are really members of the community who help people go through very difficult treatment regimens, this can work anywhere. We've done it first in Haiti. Then we did it in Peru. And then in Africa. But most remarkably, we've also implemented that program in Boston, and are now thinking of implementing it on the Navajo reservation in New Mexico.

BILL MOYERS: And in essence, it means what? Describe it to me briefly.

DR. JIM YONG KIM: It means that for people who are, say, taking HIV medications that are very difficult, that they have to take every day, that they have to really be careful about, with nutrition, et cetera, that having someone who just visits every day, just to make sure that you're taking your medicines and you're doing okay, that has a huge payoff down the line in terms of overall outcomes, overall health outcomes.

You know, we found a group of patients living with HIV in Boston, who are really falling through the cracks. And we implemented almost an identical program in Roxbury. And we've had really astounding results. The cost of their care has gone down. And of course, they're back and they're working, and they're productive members of society. And they're not landing in the emergency room, when their disease gets out of control. So we think that that's one of the lessons. But there are many more that I think can be directly applied to health care in the United States.

BILL MOYERS: Does President Obama get it? Did you watch his speech?

DR. JIM YONG KIM: I did.

BILL MOYERS: What do you think about it?

DR. JIM YONG KIM: Well I thought as a speech, it was really stunning and masterful. He's a wonderful speaker. But what was most interesting to me was the Republican response afterwards. And how many things that they seem to agree on. What do they agree on? One, everyone should have health insurance.

Two we need to lower cost. Three, we need to maintain quality, that the expenditures that right now, in health care, especially public expenditures are unsustainable.

But my view of this goes back to what I said earlier. There's no simple solution to this problem. I think we have to take very seriously that health care delivery is rocket science. And we've got to bring the best and the brightest to work on this problem.

And the only way to do that is to get more people thinking every day about it. Right now, the physicians who are running these hospitals have never been trained. Most of them have never been trained in system thinking, in strategy, in management.

And the places where there are leaders. Intermountain Healthcare, which President Obama mentioned, is run by a visionary leader named Brent James, who was a biostatistician and has been an expert on studying outcomes for a very long time. So when you bring that kind of expertise to the running of a hospital system, it gets better.

BILL MOYERS: One of the big disappointments to a lot of people is that the White House seems to have made a deal, reportedly has made a deal with the drug industry, not to use the power of the government to negotiate lower drug prices, or through Medicare and Medicaid. Now I know you know something about negotiating for lower drug prices, when you were at the World Health Organization, right?

DR. JIM YONG KIM: Right.

BILL MOYERS: Tell me about that.

DR. JIM YONG KIM: It's a very complicated business. If you look at three diseases, the three major killers, HIV, tuberculosis and malaria, the only disease for which we have really good drugs is HIV. And it's very simple, because there's a market in the United States and Europe.

So what we know is that market incentives to drive drug delivery are critical. We have to maintain them somehow, because if you don't have market incentives, there are almost no malaria or tuberculosis patients, we have almost no new drugs. So somehow, we have to maintain the market incentives, for the pharmaceutical industry to keep working.

Now having said that, I've worked a lot with the drug companies to say, "Okay, so make as much money as you can on the HIV drugs in the first world. We will work with you to protect those markets and protect your intellectual property. On the other hand, in those areas where you make no money anyway, work with us to make those drugs available." And they've done that for HIV drugs, in a way that's really quite astounding.

So somehow-- you know, this is a complicated issue. We've got to make sure that the incentive for the drug companies to make new drugs is still there. But at the same time, be reasonable about making sure that people have access to them.

BILL MOYERS: Yeah, there was a strain of TB, if I--

DR. JIM YONG KIM: Right.

BILL MOYERS: --understand the story, that could be cured by a drug, but the drug was so expensive that poor people couldn't afford it in the developing world. And what did you do about that?

DR. JIM YONG KIM: What happened was, we looked at the cost of these drugs and the drugs for a complete cure for a patient living in a developing world. When we started, was about $25,000. But what we later learned was that the only reason they were so expensive is because they were only sold in first-world countries.

So what we did was we got everyone who was interested in purchasing these drugs. We went to Doctors without Borders. We went to other health organizations and said, "Can you help us get the Indian and Chinese drug industry to start making these drugs?" And they did it. Now, the real key was at Eli Lilly and Company, that was making two of the drugs, they came on board and said, "You know what? We're going to help you with this program. We don't make any money off these drugs, they're off patent a long time ago. We're going to actually help you find manufacturers in those countries that can make these drugs at a lower cost."

So I think it's one of the greatest acts of corporate philanthropy I've ever seen, Eli Lilly and Company stepping in on two drugs that they don't make any money off anymore, helping us to craft the overall response to drug-resistant tuberculosis. We're not there yet. If there were a market for tuberculosis drugs, then I think we'd have lots of new drugs. But because there's not one in the developed world, we're still struggling.

So those of us who have been really working, you know, on a day-to-day level to try to provide those drugs, we've learned a couple of things. One, intellectual property is important-- but the drug companies, if you keep working with them, they'll see that there is a great philanthropic and humanitarian achievements that they can claim for themselves, by helping to make them accessible. Now we're not there yet. But you know, the Gates Foundation, for example, is working very hard to fill the holes that the market is not filling. You know, we're all-- got our fingers crossed, hoping that Bill and Melinda Gates will be successful in getting us these new drugs and vaccines.

BILL MOYERS: But when you see health fairs where people so poor in this country go because they can't afford to have a toxic tooth pulled, how do you justify spending that much effort and that much money in Africa and Haiti and South America and other places, when we have such desperate need in this country? And that's a question--

DR. JIM YONG KIM: Right.

BILL MOYERS: --I get a lot.

DR. JIM YONG KIM: If you look at what we're doing in those developing countries-- so for example, all of the efforts that we're making in some of the poorest countries, what we're doing is we're taking annual expenditures on health care from two or three dollars up to maybe 15, 20, or 30 dollars.

Where as in the United States, it's well over $7000 per person per year. So they're two very different problems. Both of them break my heart. So in a country where we're spending, on average, $7000 per person per year, we should be able to find a way to provide health care for everyone. And I think, we can do that. And I think we can do that fairly quickly, if we put our minds to it. The problems with health in the developing world, for example, drug-resistant tuberculosis. The majority of the cases of drug-resistant tuberculosis are among the foreign-born. So it is not a smart idea to think that those kind of diseases are over there, and we're immune from them. We're not, in fact. And you know, with H1N1 and the other pandemic flues, we are-- that has shown us more than anything else-- I was at the World Health Organization and involved in the very later stages of the response to the SARS epidemic. Boy, you know, there's no question that in terms of infectious diseases and other health problems, we are one planet.

BILL MOYERS: You are trained as an anthropologist too, as well as in medicine. What do you think the eye of an anthropologist sees, that a physician on his or her own might not see?

DR. JIM YONG KIM: Well, I think that in medicine, what we're trained to do is to look for patterns, to build order out of great complexity, out of very subtle signs and symptoms, and then have a plan where you can act. Anthropologists are a little bit different, we don't often act on what we do. So I'm sort of in the middle now. I do the ethnography, to try to get a sense of what the culture is.

You know, if you want to know what anthropologists do, one of my great professors, Sally Falk Moore once said, it's very simple. You walk into a room and you say, "Who are these people and what do they want?" So if you're constantly asking that question, over time, you build up a sense of how a particular social system works. That's always what we've done. Paul Farmer's also an anthropologist, we've done this together for many, many years.

What is it that we need to do to actually change policy around HIV treatment or drug resistant TB treatment? And that anthropological piece of it, linked to a physician's approach to solving a problem and putting a solution on the table, taking people through difficult times-- That's been a very good combination for me.

BILL MOYERS: Friends of mine and viewers who are anonymous will write me or say to me, you know, "Moyers, don't bring us any more bad news. We don't want to see any more starving children in Rwanda, sick children in the Congo or dying children in Haiti. If Bill Gates can't save them, there's nothing we can do." What keeps you from getting depressed?

DR. JIM YONG KIM: Well, again, I-- for 25 years, in working with Partners in Health, we've really seen some tremendous changes. I mean, in the central plateau of Haiti, Haiti suffers from so many problems, including deforestation, poor health care, poverty, all these different kinds of problems, but in our one little area, not only have we built a health care system that now sees almost two million patients a year, but the trees have come back.

We just sort of did this almost quixotic little project where we kept planting trees. And the area around our clinic looks almost like the rainforest that it once was. So, in going to those really difficult situations, first of all, it does something to me, make-- you know, it brings out a kind of humility that I don't feel unless I go and see the most excruciating thing in the face of the earth, which to me is a mother who can't feed her child.

So having the experience of seeing those things, I think it does something to me as a person, to my soul. But then in seeing the possibilities, the programs that can turn things around, that's the most inspiring thing that I've ever seen.

BILL MOYERS: Where does this passion come from in you? I mean, if an anthropologist walked in here and said, "Who is that person, where he's from?" What's the answer?

DR. JIM YONG KIM: Well, I've been very fortunate. You know, my father came by himself, across the North Korean border when he was seventeen. And hasn't seen his brothers or sisters or parents since then. And he died some time ago, but never saw any of his relatives. My mother was a refugee, in war-torn Korea. And was plucked, because she was a good student, to come to Scarritt College in Tennessee. So there have been so many accidents of luck that have gotten me to this position.

BILL MOYERS: Where did you all come to from--

DR. JIM YONG KIM: So we first came to Dallas, Texas, where my father-- my father had been a well-established dentist in Korea, but then had to do dental school all over again, because they didn't recognize Korean degrees. So Dallas, Texas, Southern Methodist University-- excuse me, Baylor University -- he did his dental degree--

BILL MOYERS: --There's a big difference, one's Methodist, one's Baptist.

DR. JIM YONG KIM: I know. I know. (LAUGHTER) That's right. I couldn't get that wrong. So he got his dental degree from Baylor dental school, and then we moved to a small town in Iowa, and grew up in Iowa. And even though, you know, we lived a very-- a sheltered kind of existence, I always kind of knew from my mother, who, again, lived through war and then did her master's with Reinhold Niebuhr and Paul Tillich and these folks at Union Theological Seminary.

BILL MOYERS: Two great theologians of the twentieth century.

DR. JIM YONG KIM: Absolutely. It was one of the most exciting intellectual environments in the country at that time, in the 1950s. So we always had the sense from my mother that we should do something great, that there are great things to be done in the world.

BILL MOYERS: What does she say to you? What does she do with you?

DR. JIM YONG KIM: Well, she would read to us the speeches of Martin Luther King in 1968. She would-- she even gave me, at one point, I remember reading Booker T. Washington when I was in grade school. So I had the exposure to a lot of great thinkers.

So she kept trying to convince us that, you know, we had a responsibility in the world. Now my father was a dentist, one of the most practical people on the face of the earth. When I came back from my first semester at Brown University, he picked me up at the airport and we were driving home. And I said to him, I said, "Dad, I think I'm going to study philosophy." So he slowly pulls his car over to the side of the road, looked back at me and says, "Look. When you finish your residency, you can do anything you want."

It was clear. If I was going to make it in this country as an Asian-American, he said, "You're going to need a skill. You can do anything with that. You know, whatever you do after you have that skill is okay. But I can't go to my grave," he basically said, "without knowing that you have some way of supporting yourself, if everything else falls through."

BILL MOYERS: Were you the only Asian family in that little town?

DR. JIM YONG KIM: We were.

BILL MOYERS: What was that experience like?

DR. JIM YONG KIM: Well, we were comfortable, economically. But if you go to a mall, just up the road, where they don't know who you are, of course, back in those days Kung Fu was the big exposure to Asian culture. So you know, everyone would come up to us and either be fearful or mocking. So racism was there. But you know, I've come to understand that the racism that we felt was more like sort of indignant, it was it was embarrassing. It wasn't the kind of racism that, in fact, that impacted, for example, African-Americans in the south in the '30s and '40s. It was different. I think I developed a sensitivity for people who are marginalized and outcast. But I don't have any illusions about me being an oppressed person. I-- you know, my father was a dentist. My mother was a philosopher. We loved Iowa Hawkeye football, so we had a great time there.

BILL MOYERS: I gave the commencement at Dartmouth a few years ago, and I discovered that roughly 80 percent of the students there participate in varsity, club or interactive-- intramural sports. So my only advice I would give you is: don't go without a Frisbee.

DR. JIM YONG KIM: Well, I have to tell you, Bill, I've already played with the women's volleyball team-- I played volleyball in college-- I've already been out throwing the football around with the football team, and that's one of the really great perks of this job, these fantastic young people who are both athletes and students. I happen to believe that athletics is a really important part of one's educational experience. So that's really the fun part of a job.

BILL MOYERS: Doctor Jim Yong Kim, thank you for being with me on the Journal, and good luck at Dartmouth.

DR. JIM YONG KIM: Thank you, Bill.

BILL MOYERS: That's it for the Journal. Don't forget to log onto our Web site at pbs.org. Click on "Bill Moyers Journal" and you can learn more about Dr. Jim Yong Kim and his pioneering work in education and global health. You'll also be able to observe the human cost of war as seen through the eyes of some of the world's finest photojournalists. That's all at pbs.org. I'm Bill Moyers. See you next time.

Source: http://www.pbs.org/moyers/journal/09112009/watch2.html

Post by **roxybeast** » September 12th, 2009, 8:27 pm

Bill Maher Rant on Health Care
September 11, 2009

Bill Maher -- This is our last best chance for health care reform that will be the envy of several African nations.

Conservatives go to town hall meetings and yell at the Congress members, Democrats yell at the TV.

70% of America is not crazy, but who would know? Get off the couch, get out of the snuggies, put down the Blackberry and take to the streets.

WATCH: http://tinyurl.com/ocsemj

TRANSCRIPT:

And speaking of that 70% -- let's call them the sentient majority -- when are we going to actually show up in all this? Tomorrow Glenn Beck's army of zombie retirees are marching on Washington in protest of, well, everything. It's the Million Moron March, although they won't get a million of course, because many will be confused and drive to Washington state -- but they will make news. Because people who take to the streets always do. They're at the town hall screaming at the congressman, we're on the couch screaming at the TV. Especially in this age of electronics and Snuggies, it's a statement to just leave the house. But leave the house we must, because this is our last best shot for a long time to get the sort of serious health care reform that would make the United States the envy of several African nations.

Source: http://www.huffingtonpost.com/bill-mahe ... 84151.html

Post by **roxybeast** » September 14th, 2009, 8:24 pm

Over 70% of America's Doctors Support Reform with a Public Option

Majority Of Doctors Back Public Option: New England Journal Of Medicine Study
Huffington Post, Sept. 14, 2009

A new study finds that a majority of physicians support the creation of a public health care option.

A Robert Wood Johnson Foundation (RWJF) study published in Monday's New England Journal of Medicine shows that 63 percent of physicians support a health reform proposal that includes both a public option and traditional private insurance. If the additional 10 percent of doctors who support an entirely public health system are included, then approximately three out of four physicians nationwide support inclusion of a public option. Only 27 percent support a private-only reform that would provide subsidies for low-income individuals to purchase private insurance.

Surveying a nationally representative sample of 2,130 physicians across America, researchers Salomeh Keyhani, M.D., M.P.H., and Alex Federman, M.D., M.P.H., from Mount Sinai School of Medicine in New York City queried physicians about a range of options for expanding health insurance coverage.

"There should be no confusion about where doctors stand in the debate over expanding health insurance coverage: they want reform," said Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation. "This survey reveals important information about the perspective of physicians on issues central to the health reform debate. Policy makers should listen to their doctors."

"We found that no matter how you sliced the data, physicians demonstrated majority support for a public health insurance option, regardless of their type of practice or where they live," said Keyhani.

Among those physicians who identified themselves as members of the American Medical Association, 62.2 percent favored both the public and private options. The AMA has opposed a public option, saying that it "threatens to restrict patient choice by driving out private insurers."

A majority of physicians surveyed (58 percent) also supported expanding Medicare eligibility to those between the ages of 55 and 64.

"These results give voice to individual physicians in the national discussion about health reform," said Federman. "Most often we hear the opinions of special interest groups rather than doctors themselves, but we know that Americans want to hear the opinions of doctors like those who treat them. This study lets us hear the unfiltered views of physicians on key elements of health reform and should be useful for lawmakers."

Source: http://www.huffingtonpost.com/2009/09/1 ... 86352.html

Post by **roxybeast** » September 15th, 2009, 11:37 pm

YOUR CHOICE: FAKE INSURANCE OR REAL REFORM

Want real health care reform?
Support H.R. 3200 which includes a public option.

Want to end up with fake insurance with no coverage when you need it most?
Support any of the other plans, including the Baucus compromise.

Consider the testimony of former Cigna Insurance VP Wendell Potter b4 Congress today:

WATCH VIDEO OF TESIMONY:
http://www.youtube.com/watch?v=GBFKkXDSKWw

TRANSCRIPT OF HIS TESTIMONY:

Testimony of Wendell Potter
Former VP of Cigna Insurance
before the House Democratic Steering and Policy Committee,
Tuesday, September 15, 2009

Thank you Madam Speaker for the opportunity to address the House Steering and Policy Committee. Madam Speaker and Members of the Committee, my name is Wendell Potter, and I am humbled to be here today to testify about the need for meaningful and comprehensive reform and about the efforts of an industry I worked in for many years to shape reform in ways that will benefit it at the expense of taxpayers and policyholders.

In the weeks since my June 24 testimony before the U.S. Senate Committee on Commerce, Science and Transportation, I have expressed hope at every opportunity that this indeed might be the year Congress will enact legislation to reform our health care system in ways that will truly benefit Americans for generations to come.

But I have also expressed concern that if Congress goes along with the so-called "solutions" the insurance industry says it is bringing to the table and acquiesces to the demands it is making of lawmakers, and if it fails to create a public insurance option to compete with private insurers, the bill it sends to the president might as well be called the Insurance Industry Profit Protection and Enhancement Act.

H.R. 3200, America's Affordable Health Choices Act of 2009, encompasses a comprehensive set of reforms that address the critical need for expanded coverage, lower health care costs, and greater choice and quality. Other legislative proposals, including the "Baucus Framework" being considered by the Senate Finance Committee's "Bipartisan Six," would benefit health insurance companies far more than average Americans.

The practices of the insurance industry over the past several years have contributed directly to the growing number of Americans who are uninsured and the even more rapidly growing number of people who are underinsured.

H.R. 3200 would go a long way toward making many of the standard practices of the industry illegal while providing much-needed assistance to low and moderate income Americans who cannot afford the overpriced premiums being charged by the cartel of large for-profit insurance companies that now dominate the industry.

H.R. 3200 would provide premium and cost-sharing assistance through the Health Insurance Exchange it would create. It would require the Secretary of Health and Human Services to establish a defined package of "essential health services" that all plans, public or private, would have to cover.

It also would prohibit insurance companies from denying coverage or basing premiums on pre-existing conditions, gender or occupation. It would eliminate deductibles or co-pays for preventive care as well as the lifetime limits currently common in health insurance policies. The bill also would set an annual cap on out-of-pocket expenses that is more reasonable than in other proposals.

As important if not more important than those market reforms, H.R. 3200 would also create a public insurance option to compete with private insurers. Contrary to the misinformation being disseminated by the health insurance industry and its allies, the public insurance option would not have a competitive advantage over private plans. It would have to meet the same benefit requirements and comply with the same insurance market reforms as private plans.

As I told Members of the Senate Committee on Commerce, Science and Transportation, insurance companies routinely dump policyholders who are less profitable or who get sick as part of their never-ending quest to meet Wall Street's relentless profit expectations.

While the reforms proposed in various bills before Congress would seemingly restrict insurance companies' ability to put investors' needs over those of consumers, Members must realize that provisions of some proposals, including the Baucus Framework, would actually drive millions more Americans, including many who currently have access to comprehensive coverage, into the ranks of the underinsured.

An estimated 25 million Americans are now underinsured for two principle reasons. First, the high-deductible plans many of them have been forced into by their employers require them to pay more out of their own pockets for medical care, whether they can afford it or note. Second, more and more Americans have fallen victim to deceptive marketing practices and bought what essentially is fake insurance.

The insurance industry is insistent on being able to retain what it calls "benefit design flexibility." Those three words seem innocuous and reasonable, but if legislation that reaches the president grants insurers the flexibility they claim they must have, and requires all of us to buy coverage from them, millions more of us will have little alternative but to buy policies that appear to be affordable but which will be prove to be anything but affordable if we become seriously ill or injured.

The big insurers have spent millions of dollars acquiring companies that specialize in what they call "limited-benefit" plans. Not only are the benefits extremely limited, the underwriting criteria established by the insurers essentially guarantee big profits.

H.R. 3200 would ban the worst of these policies. Other proposals, by providing financial incentives for employers to offer barebones plans with lousy benefits and high deductibles, would actually encourage them.

Unlike H.R. 3200, those proposals would not require employers to provide good benefits or even to meet minimum benefit standards. They also would permit employers to saddle their workers with the entire amount of the premiums in addition to the high out-of-pocket expenses, escalating the already rapid shift of the financial burden of health care from insurers and employers to working men and women.

The Baucus plan also would allow insurers to charge older people and families up to 7.5 times as much and younger people, impose big fines on families that don't buy their lousy insurance, and would weaken state regulation of insurers.

As a consequence, these proposals would do little to increase affordable coverage for those currently insured, or stop the rise in medical bankruptcy. They would, however, ensure that a huge new stream of revenue--much of it from taxpayers who would finance the needed subsidies for people too poor to buy coverage on their own--would flow--"gush" might be a more appropriate word--to insurance companies. And much of that new revenue would ultimately go right into the pockets of the Wall Street investors who own them.

Over the past several weeks, I have repeatedly told audiences around the country that the public option should not just be an "option" to be bargained away at the behest of insurance companies who are pouring money into Congress to defeat substantial and essential reforms. A public option must be created to provide true choice to consumers or reform will fail to truly fix the root of the severe problems that have been caused in large part by the greedy demands of Wall Street.

By creating a strong public option and restricting the insurance industry's ability to enrich executives and investors at the expense of taxpayers and consumers, H.R. 3200 will truly benefit average Americans.

The Baucus plan, on the other hand, would create a government-subsidized monopoly for the purchase of bare-bones, high-deductible policies that would truly benefit Big Insurance. In other words, insurers would win; your constituents would lose.

It's hard to imagine how insurance companies could write legislation that would benefit them more.

Over the coming weeks, I implore each Member of Congress to put the interests of ordinary, extraordinary Americans--the people who hired you with their votes--above those of private health insurers and others who view reform as a way to make more money.

Thank you for considering my views.

Source: http://www.huffingtonpost.com/2009/09/1 ... 87733.html

Dr. Dean's whipcount* has the House at 200 in favor of a public option (221 needed for passage), and only 6 flat out against it. He has the Senate at 45 in favor (50 needed) and 16 still undecided. 14 of those 16 are Democrats. So this is still quite doable. It is not a forgone conclusion that it won't pass, like some in the media love to preach.
* http://www.standwithdrdean.com/where_congress_stands

Post by **roxybeast** » September 16th, 2009, 12:50 am

Let's Address the Legitimate Concerns

A friend of mine on Facebook sent me this article and asked me what I thought ... so here's the article by Campaign for Liberty which I will post, despite my disagreements with some of it, because I do think it's one of the best written opposition pieces that I've seen & poses some questions and concerns with current proposals that legitimately do need to be addressed. And then I'll provide my commentary below.

Say No to the Individual Health Insurance Mandate!
By David McKalip, M.D.
Campaign for Liberty, 09/15/09

Americans are being misled by President Obama and the Republican Party in the health care debate. That is right, the Republican Party. Both are ready to foist a huge joke on the Democratic party, truly left-wing Obama Supporters and the American people. They plan to walk arm and arm together to a signing ceremony this year to finally turnover all health care financing to large insurance companies. The insurance companies will then follow "cost control" protocols (rationing) created by the government. I have written about this final plan since last spring and in July on Campaign for Liberty. For the President, there is no turning back. For the Republicans it is a defining moment for their party -- will they go along with Obama or stand up for liberty? You will need to tell them on which side to stand by contacting them immediately.

Mr. Obama has been keeping this secret until his 9/9/09 speech when he finally admitted that it will be everyone’s "shared responsibility" to buy health insurance. It was here where he finally threw the public option under the bus as planned all along while deflecting blame from himself and assigning it to "blue dog" and Senate Democrats. His base should be furious. Of course, the tea party activists -- a million of whom converged on D.C. on 9/12/09 -- may also be betrayed by Republican leadership who appear more interested in appearing to "compromise" and avoid being "called out" by the President. But there is no surprise here. This is how "Romney Care" came to Massachusetts. Cloaked in the silky robe of "compromise" so that the politicians from both parties could join arm and arm but not admit that no matter what letter was behind their name, they were really all about more government power and less individual power.

Thankfully Americans are waking up and coming out of the woodwork and this is a chance for the Republican Leadership to take a break from that "leadership" and start following the American People. This is a chance for them to DEMONSTRATE that they heard the message of their miserable defeats of the 2006-2008 elections for abandoning the founding principles of their party: individual liberty, limited government and strict constitutionalism. This is their chance to shine or be swept away for good with the Democrats in 2010.

But among the detractors in the debate, the President is far more guilty as he pushes his health system reform plan. There is the standard sleight of hand: "if you like your doctor or your health care plan -- you can keep them". That trick is easy to dissect. The fact is that the President will make any plan or doctor that is not government-approved disliked by the vast majority of Americans. For doctors, he will support an inaccurate "report card" system that allows doctors to be labeled as "bad" (who would "like" that doctor?). Doctors will not be graded on true medical quality, but on how well they comply with rationing protocols and how well they provide government-approved, one-size-fits-all medical care. For your insurance, his plans will force any insurance plan that is not government approved out of business. His plans will tax every person who dares to buy an insurance plan that is not approved by the government up to 2.5% of income. In fact, his plans would make any change to your health insurance policy or choice illegal after 2013.

He also likes to distract people by claiming that since the words "death panel" and "illegal immigrant insurance coverage" are not actually in the bill, then anyone who discusses those topics are kooks using scare tactics or are themselves "misleading". Of course, he doesn’t point out how his chief health care adviser, Dr. Ezekial Emanuel, has written extensively to indicate that babies and the elderly (over 65) should not receive as much medical care since they are not as valuable to society. Emmanuel’s "Complete Lives" system supports use of "lotteries", "ageism", inaccurate estimates of "prognosis" and the likely need of a few to die to "save the most lives". Emmanuel applies this to "scarce medical resources" -- which is about to become the standard condition as government seeks to slash medical spending to European levels. Obama has not told America how the Federal Coordinating Council on Comparative Effectiveness will create rationing protocols. These protocols will be linked to "incentives" for proper implementation by doctors. Or, put another way, if a doctor refuses to ration care, they will be penalized through a withheld "incentive". He fails to mention that a five member panel elected by no one will make these final decisions (The Independent Medicare Advisory Council -- IMAC).

But the biggest bait and switch has been the selling of the public option as a key component of health system reform. He started this in the spring. But it has been clear from the beginning that the insurance companies would never allow this to happen. In fact, the insurance companies have been spending at least $12 million to support health care reform created by them and about a dozen other special interests over the last several years. So, much to the chagrin of many who hoped the public option would be a Trojan horse for a single payer system, Obama began throwing that plan under the bus as described by Salon.com*. Of course this had long been planned since the real goal has always been a mandate of each and every person to buy health insurance from private companies. That is why liberal blogger Greg Palast is also complaining about the betrayal of Obama and calling him a charming liar and his health care approach "fascist" — on Air America too!

He uses another great deception to sell this as a means to get rid of "pre-existing conditions". As it turns out the trade off is that everyone must buy insurance -- while ignoring the fact that 30 states have state subsidized policies for those with pre-existing conditions that work. Mandated will be insurance that will be created by the government, approved by the government, the purchase of which will be enforced by the government. In fact, the rationing rules created by the government will also apply to private insurance. The insurance companies will receive free customers courtesy of the government mandate and will be guaranteed profits in perpetuity. Obama then gets to claim a victory for Democrats in 2010 after he announces what will be hailed as "the September compromise" -- perhaps even in the name of the recently passed Senator Kennedy who put his seal of approval on the same plan introduced by then-Republican-Governor Romney in 2005.

Perhaps the President waited so long to disclose the mandate to prevent the discovery that the model is a proven failure in Massachusetts. While the president likes to claim that his plans will lower health care costs, in Massachusetts health insurance premiums went up 10-12% (from its rate which was already top five in the nation at the start of the program). He also doesn’t mention that the cost for the plans will go up far higher for the rest of the country since we all will likely end up with Massachusetts-style plans. This will occur because bureaucrats, politicians and special interests will work to ensure "everything" is covered (chiropractors, acupuncture, marriage counselors, autism, mental health, in vitro fertilization etc.). He hopes people won’t realize that they won’t have a choice to buy a plan to cover only the things they think they may really want to pay for or need and avoid those they will never use (like obstetrics care for a post-menopausal woman).

He hopes you don’t find out that the mandate plan doesn’t cover everyone -- 20% of the uninsured were "released" from the Massachusetts tax penalty since they couldn’t afford the plan. Oh, yes, he also doesn’t mention the 2.5% tax penalty for failure to purchase -- breaking his promise not to raise taxes on those earning less than $250,000. He also doesn’t allow time for people to realize that a mandatory purchase of health insurance is itself a tax -- the government forces you to buy it after all! He wants to dazzle you with gauzy, feel-good references to "shared responsibility" as a code word for raising taxes and mandating the purchase of a product merely because you have been born. It would cause trouble if Americans learned that 30,000 legal, tax-paying non-citizen residents of Massachusetts will receive less care now (rationing) to save about $130 million for the state. Why? Oh, they state is looking to spend about $2.1 billion of its $31 billion budget to subsidize people to buy health insurance since even the politicians realized that not everyone could afford it. That is another thing he is looking to hide: young people who will are trying to start a life or provide for their family will be required to use their money to buy an over-priced health insurance plan that covers things they don’t want. They will also have to pay the same rate as older and sicker people even if they are healthy and young.

He doesn’t want you to know that in Massachusetts, government panels are creating cost control boards that will give doctors a fixed budget to spend on their patients. The doctor will get a percentage of whatever care they withhold from the patient. There are also direct rationing protocols being set up in the name of "efficiency" and the public hospitals are under threat of closing the doors since their government subsidies for caring for the poor was removed as they are "all insured now". He doesn’t want Americans to discover that in Massachusetts there are not enough doctors to take care of patients (after years of reimbursement rates set at artificially low numbers by Medicare). Hiding the fact that patients are waiting months to see a specialist and up to a year to find a primary care doctor as nurses are rapidly recruited to take the place of doctors.

But that is all part of the game plan. Keep America distracted with meaningless debates about the public option and who used the words "you lie". Accuse anyone who disagrees with his plans for "change" of being a fear monger using scare tactics. Erect straw men "special interest" opponents that don’t exist while making deals with drug companies to cut 2% ($80 billion) of their expected $3.5 trillion drug take over ten years. Make deals with hospitals to cut 0.5 percent of their $26 trillion take and insurance companies to give them free business. Set government rules for rationing care that each of these insiders must follow but can live with since it will mean less money spent on patients and drug companies protected from attack. Make deals with the AMA to endorse the plan early (contrary to the fact that the majority of the plan contradicts AMA policy) so the AMA can grow its $70 million annual take from owning the codes that determine how doctors and hospitals are paid. In fact hold the AMA hostage if they refuse to do so buy threatening (again) to allow the planned 40% cuts to Medicare physician payments to occur. Could the AMA monopoly on coding be threatened by turning over the entire coding franchise to the World Health Organization (WHO)?

Sounds like the only change we have is the one we were all warned about by another "WHO": "Meet the new boss, same as the old boss". When will America learn not to get fooled again? Time to start calling REPUBLICAN Senators and Congressmen too (along with the Democrats) and tell them to listen to the million people that showed up on their door step on 9/12/2009. Tell them to remember who they work for, what freedom is, and to say "no" to the individual mandate.

* "This is how things always work. The industry interests which own and control our government always get their way. When is the last time they didn't? The "public option" was something that was designed to excite and placate progressives (who gave up from the start on a single-payer approach) -- and the vast, vast majority of progressives (all but the most loyal Obama supporters) who are invested in this issue have been emphatic about how central a public option is to their support for health care reform. But it seems clear that the White House and key Democrats were always planning on negotiating it away in exchange for industry support. Isn't that how it always works in Washington? No matter how many Democrats are elected, no matter which party controls the levers of government, the same set of narrow monied interests and right-wing values dictate outcomes, even if it means running roughshod over the interests of ordinary citizens (securing lower costs and expanding coverage) and/or what large majorities want.

Source: http://www.campaignforliberty.com/article.php?view=217

So after reading the article, here's how I answered my friend's question:

I take issue with some of what he says, and I think the part about Dr. Emanuel has been discredited as taken out of context, but I think there is certainly a risk of this kind of horrible compromise taking hold if some of the proposals, like the Baucus plan, go forward without necessary amendment.

I actually think that Congress should ban employer or insurer termination of any employee plans when the new legislation takes effect, but allow consumers to buy any insurance plan they like & can afford across state lines. And create a public option, subject to all the same regulations applicable to other insurers, as Potter describes, to ensure an affordable low cost, and here's the key - low administrative overhead, alternative plan with comprehensive coverage. I would fund it by premiums, but that's also why I'd open it up to everybody and not limit it to just the poor, whose care is frankly, going to have to be subsidized. I would take the arguments of cost and rationing head on ... the reality is that some folks will have to pay more than they are paying now and that obviously you can't provide every service willy nilly to whoever wants it whenever whatever. But care is rationed now - by income strata. If you're rich you afford more, if you're poor, you get sicker or die quicker. But it is morally indefensible to just let folks die & do nothing like we do now. In my view, if the cost go up, that's just the price of doing the right thing ... While we should do what we can to keep the program's price tag down as much as possible, and perhaps tax the wealthy & those with excess cadillac plans first, if it costs more to do this, then we as a nation still have to stand up & do the right thing. My educated guess is that there is more than enough money available in the padded bonuses of health care industry and wall street executives, and in administrative and competitive savings, to pay for all of it. I also think the CBO underestimates savings truly focusing on prevention would create in lowering future costs, preventing dramatic tragic & the most costly outcomes, and generally keeping more workers actively working & paying taxes. The reality is that in order to create a more equitable system you have to reign in insurance companies excessive profits and bloated spending through either harsh regulation &/or a viable truly competitive alternative to keep them honest. That is where the real fight is ... the one that we the public must insist we win!

Of the plans currently being considered, that's why I support HR 3200, for the reasons that Mr. Potter laid out in his Congressional testimony:
http://www.youtube.com/watch?v=GBFKkXDSKWw

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