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[dextrous]

There are racist slogans being shouted by middle-aged white men and women...Sarah Palin (!) talking about killing babies with down syndrome...euthanesia...it is quite confusing. The GOPers need to come up with one message--Nazism and Communism are not the same thing, after all!

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Alright Republicans, We Give Up. (from dailykos)
by Stroszek
Sun Aug 09, 2009 at 12:48:52 PM PDT
(From the diaries -- kos)

Dear Republicans,

Over the past week, we have seen your passionate protests and heard your concerns about Democratic proposals for health care reform. We have considered your insightful and well reasoned arguments, and on behalf of progressives everywhere, I am here to say: OK! We give up! We are willing to compromise on the proposals that concern you. You've won! Yay!

In accordance with your cogent and potent criticisms, these are the terms of our concession:

1.We will not euthanize your grandmother. This is the big one, and I really hope you guys appreciate how much of a concession this is on behalf of the progressive movement. Since the days of the Bull Moose Party, progressives have wanted nothing more than to slaughter old people by the millions. That much is obvious. After all, if we wanted senior citizens to have long and healthy lives, why would we have created Social Security and Medicare? Think about it. Death to grannies has long been the core of progressive policy, so it's not without some consternation that we give it up. So there: no euthanizing old people. You've got it.
2.Rahm Emanuel's brother will not kill Sarah Palin's baby. While this will require us to gut HR 3200 "America's Health Choices and Murder Sarah Palin's Baby Act of 2009," we're currently working with Henry Waxman to remove the extensive Sarah Palin's baby-killing provisions from the final bill. While this will probably cost us Andrew Sullivan's support, we recognize that this is a necessary sacrifice for securing broad bipartisan support of health care reform.
3.The government will not nationalize hospitals and other health service providers. This is another big one. Though the U.S. Chamber of Commerce has correctly pointed out that current Democratic proposals involve adopting the British health care system, we now recognize that this is not politically viable. The final bill, accordingly, will not involve the nationalization of hospitals and other health service providers. This will be a major setback to Obama's well known communist agenda, but again, we progressives agree with the Blue Dogs that we need to reach a broad national consensus by responding to Republican concerns.
4.We will make the health care reform bill available for all Americans to read as soon as possible. I know that conservatives and pundits have been eagerly anticipating an opportunity to read the final health care reform bill, and after extensive discussion, we have decided to comply with your request. While we would like to have unseen drafts languishing in committee forever, we have asked Senate Democrats like Max Baucus and Kent Conrad to deliver a bill as soon as possible in order to allow the public to read it. As you know, progressives wanted nothing more than to keep these drafts hidden for as long as possible, but in the interests of transparency and bipartisan consensus, we recognize that it's vital to move the legislative process forward. In fact, it is our hope that Baucus and Conrad will return from the August recess early in order to ensure that the public has as much time as possible to inspect their work.
5.We will not subsidize abortions with your hard-earned tax dollars. Despite the fact that both FactCheck.org and Politifact insist that we already made this concession months ago, we're going to make extra-special-super sure that we did. Just give me a second...
...

...

...

... yep, we did.

6.We will not allow the government to have direct access to your bank account. I know several conservatives I've spoken to are deeply concerned about this measure, and while we progressives are always looking for new ways for the government to unlawfully violate your privacy and steal your money, we have decided to remove this provision from the final bill. While we may include a way for individuals to voluntarily set up an electronic funds transfer with their insurance provider, we will no longer push for government access to all individual bank accounts. You've won this one.
7.We will not provide illegal immigrants with unlimited free health care. Though progressives want nothing more than to provide unlimited social services to illegal immigrants while denying them to everyone else, we now recognize that this plan was, perhaps, a bit inequitable. However, while they will not be receiving unlimited free health care, each illegal immigrant will still receive a pretty pony. I'm sorry, but we have to draw the line somewhere.
8.Private health insurance will not be eliminated. Though, as Drudge recently pointed out with a damning YouTube video, the long-stated Republican goal of moving away from employer-based coverage somehow means "eliminating private insurance" when Obama talks about the same thing, we've decided to preserve private insurance plans for those who want them. However, we have yet to convince ultra-socialist Charles Krauthammer to drop his communist crusade against employer-based (i.e., according to Drudge, "all private") coverage.
9.You will not be issued a "National Health Insurance ID." While we thought this was a fun idea, the final version of the health care reform bill will not require you to have any kind of ID when you're pulled over for drunk driving or found loitering outside of a military base. In fact, you are hereby encouraged not to carry any proof of insurance whatsoever. Trust me, it's a terrible idea!
10.There will be no super-secret-awesome health care program for ACORN employees. Though we love our election-stealing squirrels, we have decided that they'll have to settle for the same options as everyone else.
With these concessions having been made, I trust that we can now move forward on health care reform with a broad, bipartisan consensus. Blue Dogs and Republicans, you can now rest easy knowing that the concerns of the town hall protesters have been met. While the progressive dream of a nation in which old people are slaughtered to pay for the abortions of ACORN-employed illegal immigrants will again have to be deferred, we are willing to settle for a bill without these measures in the name of bipartisanship.

Congratulations, Republicans. You've won this round.

[ruchir]

He he he....

So now you have started believing Dailykos? Is that what it has gotten to now? FYI - Dailykos is THE most hateful left wing website... more than Huffington Post. To see you taking it seriously is a cause for concern.


1. About killing the grandmother. Here is an extract from the bill:

http://www.washingtontimes.com/news/2009/jul/29/a-euthanasia-mandate/

Presidential health care adviser Ezekiel Emanuel, brother of White House Chief of Staff Rahm Emanuel and chairman of the Department of Bioethics at the Clinical Center at the National Institutes of Health, has argued that independent government boards should decide policy on end-of-life care. He also has defended rationing care more strictly for older people because "allocation [of medical care] by age is not invidious discrimination."

....

The situation is even worse in Oregon, which has legalized "assisted suicide." As radio host and author Mark Levin has publicized in his best-seller "Liberty and Tyranny," the Oregon health plan last year refused to pay for a recognized drug to prolong the life of lung cancer patient Barbara Wagner even after her oncologist prescribed it. Yet the same bureaucrats told Ms. Wagner that the plan would indeed cover doctor-assisted suicide if she chose that option.

Saving her life was deemed too expensive, but paying her to die was just fine.

To you it may look innocuous, but this provision will be used to stop giving life saving or pain relieving medicines to elderly. BTW, Obama himself admitted on TV that if his health plan was in action today, Ted Kennedy would have been denied the life saving operation he had. That's Obamacare for you. If you can't understand what universal healthcare ultimately results in, and want to believe sites like Dailykos, feel free.


2. Just do a little bit of homework on Obama's advisors. His science czar, John Holdren, is on record asking for forced abortions and sterilization. That is what Palin was talking about.

http://www.foxnews.com/politics/2009/07/21/obamas-science-czar-considered-forced-abortions-sterilization-population-growth/

As first reported by FrontPage Magazine, Holdren and his co-authors spend a portion of the book discussing possible government programs that could be used to lower birth rates.

Those plans include forcing single women to abort their babies or put them up for adoption; implanting sterilizing capsules in people when they reach puberty; and spiking water reserves and staple foods with a chemical that would make people sterile.

To help achieve those goals, they formulate a "world government scheme" they call the Planetary Regime, which  would administer the world's resources and human growth, and they discuss the development of an "armed international organization, a global analogue of a police force" to which nations would surrender part of their sovereignty.


3. This will be a major setback to Obama's well known communist agenda, but again,...

This is an extract from the Dailykos article. So now they and hopefully you too agree that Obama is on a communist path, and still you and others like you like to believe that he will not nationalize hospitals? This is the same president who nationalized banks, car companies, and you think he won't nationalize hospitals? Why? Just because he or his cohorts said so? He he he... That's too easy man.  If Obamacare passes, hospitals will be nationalize because there won't be any other way out. With nationalization will come huge cuts in doctor salaries. That will mean less doctors and even less quality doctors. Imagine what the scenario will look like. Take example of India - would you like to be looked at by a doctor from govt hospital or a private hospital? Where will you feel more comfortable? Same thing will be replicated here too.


4. Bill available to read?? ?? ?? What is this guy on? This is the same president who has not revealed his educational records and his medical records till date. And Dailykos expects to see the health bill ASAP?  Delay is what Obama is looking for. He know that if people get a chance to read the bill, even moderate Dems will turn against it. So why would he give people enough time to read it? Isn't that why he was rushing it in August to begin with? Just like he rushed his stimulus bill saying that if it is not passed, unemployment will rise to 8%... and after it was passed unemployment is up to nearly 10%? People still believe this guy? It is simply amazing..... 


5. Abortions -- so Factcheck already says that new health plan will subsidize abortions but Dailykos says it won't and we should believe Dailykos... ?? ?? Why?


6. Access to account -- Oh... thank god. What a relief that Obama has now decided to remove the provision of accessing accounts to take money. But just tell me this - why was this provision in the bill to begin with? Yes, why was it in the bill? Had Obama been successful in ramming the bill through without being read, this provision would have passed. What a shame. Sometimes I doubt if Obama ever feels any shame in what he is trying to do and keeps getting caught in the act. I think not.

BTW, this is an FYI -- The Cash for Clunkers program also had a similar deal and probably still does. A buyer took his old car for trade-in. He was watching the accountant feed the info for the program. As soon as accountant went into DOT system, a warning appeared saying that any computer using this program will be considered property of US Govt and can be used to get any financial information being routed through it -> meaning financial info of the buyer. Not only that, the warning said that the information could be access by any US Govt agencies and some foreign agencies too. This was discussed on TV in Fox News and the show host (Glen Beck) contacted DOT about the warning and DOT said that the warning was there and has now been removed. Question -- Has the warning been just removed or has DOT stopped accessing the machines too? No one knows.... So what's the point? The point is to show how disingenuous Obama and his administration really is. They try anything to sneak certain damaging provosion in their bill and will say these provisions are removed, when they are caught. I wonder if this is the same Obama and same Democrat party that cried wolf when Bush brought in eavesdropping measures in Patriot Act.


7. Illegal alien - If Dailykos believes that Obama will let go of his main voting block (the latinos) so easily, good for them.


8. Private health insurance -- So Dailykos believe that private health insurance will not be eliminated. Hmmm.... let me see what does Obama have to say about it

<a href="http://www.youtube.com/v/eGXXR9-imA8&rel=0" target="_blank">http://www.youtube.com/v/eGXXR9-imA8&rel=0</a>

In his own words, Obama wants to eliminate private insurance, and it is not too difficult to see how that can happen. It's pretty simple.

You have a govt health plan which is dead cheap. So, lot of people will switch to it. NO PVT INSURANCE COMPANY WILL BE ABLE TO RUN A HEALTH PLAN AS CHEAP AS GOVT CAN. Also, most of small and medium size business will STOP giving health coverage because now a govt option will be available. So more people will go to govt option (this time forcibly). This will result in private carriers losing lots of customers. So, they will be forced to raise prices in order to keep themselves operational. This will result in more customers being FORCED to leave private plans because of increased prices. Slowly, one by one, all private carriers will go out of business because they will keep losing customers to govt plan.

This will result in Govt MONOPOLY in health insurance. Is that beneficial for people? Same US govt has tried to break monopoly in other industries and will create one in health care industry. Is that a good thing?

If you have a problem with private insurance carrier, you file a lawsuit in courts to get reprieve. What will you do if Govt is providing you insurance? In which court will you file a lawsuit? Where will you get justice? Have you heard of such cases being filed in England or Canada? No. Why? Because you don't win against govt. Because Govt can always come out with laws against filing of such cases. That is the endgame of universal healthcare. You can't fight against it. Is that good for the people?



There is not racist slogan shouting by and Repubs. Anyone doing so it probably a plant by Obama... an Acorn employee or one of Obama supporting union employees. BTW you may not know this but SEIU thugs attacked people questioning Obamacare in town hall meetings. Of course, such news will not be printed on your favorite web site - Dailykos. Or if they are then you might ignore them.

http://newsbusters.org/blogs/matthew-balan/2009/08/07/victim-alleged-seiu-town-hall-assault-st-louis-interviewed-cavuto

On Friday’s Your World program, Fox News Channel’s interviewed Kenneth Gladney, the victim of an assault outside a health care town hall meeting in St. Louis on August 6, along with his lawyer David Brown. A video of the immediate aftermath of the attack (posted earlier on NewsBusters by Seton Motley) showed some of the suspects wearing t-shirts bearing the logo of the SEIU union, which is a member organization of Health Care for America Now!, a left-wing coalition pushing for the passage of ObamaCare [video clips from the segment are available here; audio clips are found here].

[kban1]

Commentary: How insurance firms drive debate 

By Wendell Potter
Special to CNN

Editor's note: Wendell Potter has served since May 2009 as senior fellow on health care at the Center for Media and Democracy, a nonprofit organization that says it seeks to expose "corporate spin and government propa*a." After a 20-year career as a corporate public relations executive, Potter left his job last year as head of communications for one of the nation's largest health insurers, CIGNA Corporation.


Ex-insurance company spokesman Wendell Potter says the industry seeks to drive the health care debate.

 (CNN) -- Having grown up in one of the most conservative and Republican places in the country -- East Tennessee -- I understand why many of the people who are showing up at town hall meetings this month are reacting, sometimes violently, when members of Congress try to explain the need for an expanded government role in our health care system.

I also have a lot of conservative friends, including one former co-worker who was laid off by CIGNA several years ago but who nonetheless worries about a "government takeover" of health care.

The most vocal folks at the town hall meetings seem to share the same ideology as my kinfolks in East Tennessee and my former CIGNA buddy: the less government involvement in our lives, the better.

That point couldn't have been made clearer than by the man standing in line to get free care at Remote Area Medical's recent health care "expedition" at the Wise County, Virginia, fairgrounds, who told a reporter he was dead set against President Obama's reform proposal.

Even though he didn't have health insurance, and could see the desperation in the faces of thousands of others all around him who were in similar straits, he was more worried about the possibility of having to pay more taxes than he was eager to make sure he and his neighbors wouldn't have to wait in line to get care provided by volunteer doctors in animal stalls.  Watch Potter interview with Sanjay Gupta »

Friday morning my former CIGNA buddy sent me an e-mail challenging something he said his wife heard me say in a radio report about my press conference in the Capitol on Wednesday with Rep. Louise Slaughter, D-New York, chairwoman of the House Rules Committee.

"She heard you say that these protestors are funded by the insurance companies. Frankly, nothing would surprise me, but certainly not each and every person," he wrote. "If there was a meeting near me, I certainly would tell my local representative how I feel about this entire subject (and it wouldn't be pretty), and I certainly am not funded by anyone. So I am ultimately wondering what proof there is that seemingly ordinary Americans are finally protesting what is going in Washington and there are all of these suggestions of a greater conspiracy."

If the radio report had carried more of my remarks, he might have a better understanding of how the health insurance and its army of PR people are influencing his opinions and actions without his even knowing it.

Until I quit my job last year, I was one of the leaders of that army. I had a very successful career and was my company's voice to the media and the public for several years.

It was my job to "promote and defend" the company's reputation and to try to persuade reporters to write positive stories about the industry's ideas on reform. During the last couple of years of my career, however, I became increasingly worried that the high-deductible plans insurers were beginning to push Americans into would force more and more of us into bankruptcy.

The higher I rose in the company, the more I learned about the tactics insurers use to dump policyholders when they get sick, in order to increase profits and to reward their Wall Street investors. I could not in good conscience continue serving as an industry mouthpiece. And I did not want to be part of yet another industry effort to kill meaningful reform.

I explained during the press conference with Rep. Slaughter how the industry funnels millions of its policyholders' premiums to big public relations firms that provide talking points to conservative talk show hosts, business groups and politicians. I also described how the PR firms set up front groups, again using your premium dollars and mine, to scare people away from reform.

What I'm trying to do as I write and speak out against the insurance industry I was a part of for nearly two decades is to inform Americans that when they hear isolated stories of long waiting times to see doctors in Canada and allegations that care in other systems is rationed by "government bureaucrats," someone associated with the insurance industry wrote the original script.

The industry has been engaging in these kinds of tactics for many years, going back to its successful behind-the-scenes campaign to kill the Clinton reform plan.

A story in Friday's New York Times about the origin of the absurdly false rumor that President Obama's health care proposal would create government-sponsored "death panels" bears out what I have been saying.

The story notes that the rumor emanated "from many of the same pundits and conservative media outlets that were central in defeating Bill Clinton's health care proposal 16 years ago, including the editorial board of The Washington Times, the American Spectator magazine and Betsy McCaughey, whose 1994 health care critique made her a star of the conservative movement (and ultimately, the lieutenant governor of New York)."

The big PR firms that work for the industry have close connections with those media outlets and stars in the conservative movement. One of their PR firms, which created and staffed a front group in the late '90s to kill the proposed "Patients' Bill of Rights," launched a PR and advertising campaign in conservative media outlets to drum up opposition to the bill.

The message: President Clinton "owed a debt to the liberal base of the Democrat Party and would try to pay back that debt by advancing the type of big government agenda on health care that he failed to get in 1994."

The industry goes to great lengths to keep its involvement in these campaigns hidden from public view. I know from having served on numerous trade group committees and industry-funded front groups, however, that industry leaders are always full partners in developing strategies to derail any reform that might interfere with insurers' ability to increase profits.


So the next time you hear someone warning against a "government takeover" of our health care system, or that the creation of a public health insurance option would send us down the "slippery slope toward socialism," know that someone like I used to be wrote those terms, knowing it might turn many of the very people who would benefit most from meaningful reform into unwitting spokespeople for the industry.

http://www.cnn.com/2009/POLITICS/08/17/potter.health.insurance/index.html

[ruchir]

Mr. Wendell Potter,

If the radio report had carried more of my remarks, he might have a better understanding of how the health insurance and its army of PR people are influencing his opinions and actions without his even knowing it.

Mr. Potter, can you or someone else do some research and tell me what your comments were in 2008 when ACORN members were so-called guarding voting booths with sticks in their hands? It's all on videotape so don't bother denying it.

Mr. Potter, can you or someone else do some research and tell me what you comments were when a black person selling anti-Obamacare lapel pins and flags was beaten up by SEIU union members and had to be hospitalized?

Now, above 2 points may look unrelated to the comment I have quoted, but it isn't. The point is that Obama has had a history of organizing community to suit his end. In fact, he made a career out of it. His community organizing was considered as the best possible qualification for his presidential candidacy. Now, when people who are anti-Obamacare are organizing and making their voice heard, you seem to have a problem with it?

ACORN and SEIU were tools that Obama used to organize people and garner votes as a candidate. So, what's the problem if anti-Obamacare people are organizing into a robust group and demanding some answers that neither Obama nor any of his cabinet members seem capable of providing? Why is support for Obamacare in general and Govt health option in particular is falling day by day? If Govt health option is such a great idea then why can't Obama articulate it in such a way that entire nation stands behind him? Or at least majority does?

Mr. Potter, it is within your rights to speak your mind, but before you start blaming insurance companies of organizing dissent against Obamacare, first ask this question - If Obamacare is really really the best way to go toward reforming US health care then why isn't Obama able to articulate that? Obama won 52% votes. Why does he not have even that much support for his health care reform plan?

Simple question.....

The higher I rose in the company, the more I learned about the tactics insurers use to dump policyholders when they get sick, in order to increase profits and to reward their Wall Street investors.

A very good example from you.

So, why can't Obama simply stop insurance companies from dropping sick people off their coverage? Why does he have to go about providing an govt option?

The best way to reform an industry would be to study the industry, pinpoint the exact areas that are broken, work out the best way to reform the broken areas, implement the reforms. Where in all this does the govt option fits in?

It's like saying - Gee, the financial industry is broken, so in order to fix what is broken govt should come out with an alternative financial market or govt banks to provide a competing option to pvt banks.

Or like saying - Gee, the agriculture industry is broken, so in order to fix what is broken govt should buy off a part of cultivable land all over US and start govt sponsored farming to provide a competing option to US farmers.

I explained during the press conference with Rep. Slaughter how the industry funnels millions of its policyholders' premiums to big public relations firms that provide talking points to conservative talk show hosts, business groups and politicians. I also described how the PR firms set up front groups, again using your premium dollars and mine, to scare people away from reform.

As I said, when Obama did it, it was all okay because it was community organizing - the 'in' thing. When Obama took donation money from financial, health and other industries, it was all okay because it was just political donations.

Now, if health care industry is trying to organize public opinion, it is wrong? Why?

By the way, this is for your information Mr. Potter, but a big chunk of health care industry companies are already behind Obamacare, because they will end up earning huge contracts from Obamacare should it pass. Maybe this little attention slipped your eyes.

So, when Obama through Robert Gibbs, provided talking points to CNN, NBC, ABC, CBS, and all assorted newspaper, that's all good because he is the president, but if a few companies provide talking point to a few talk show hosts, suddenly that is bad? Wow....

What I'm trying to do as I write and speak out against the insurance industry I was a part of for nearly two decades is to inform Americans that when they hear isolated stories of long waiting times to see doctors in Canada and allegations that care in other systems is rationed by "government bureaucrats," someone associated with the insurance industry wrote the original script.

This article should be sufficient to tell you whether it is isolated stories about long lines in Canada or a norm:

http://www.google.com/hostednews/canadianpress/article/ALeqM5jbjzPEY0Y3bvRD335rGu_Z3KXoQw

Excerpts:

"We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize," Doing said in an interview with The Canadian Press.

"We know that there must be change," she said. "We're all running flat out, we're all just trying to stay ahead of the immediate day-to-day demands."

The pitch for change at the conference is to start with a presentation from Dr. Robert Ouellet, the current president of the CMA, who has said there's a critical need to make Canada's health-care system patient-centred. <<this means the current system is not patient-centered. isn't this what all anti-obamacare people are saying, Mr. Potter? and you think they are reciting talking points?>>

...

Ouellet has been saying since his return that "a health-care revolution has passed us by," that it's possible to make wait lists disappear while maintaining universal coverage and "that competition should be welcomed, not feared." <<more proof that waiting lists are a norm, not exception in canada.>>

...

"(Canadians) have to understand that the system that we have right now - if it keeps on going without change - is not sustainable," said Doig. <<there you go, Mr. Potter. for all your time spent in health industry, you made the mistake of not accepting the truth about canadian health care system. this fact is very disturbing to me, Mr. Potter, and i am cringing at your motives behind writing this article.>>

A story in Friday's New York Times about the origin of the absurdly false rumor that President Obama's health care proposal would create government-sponsored "death panels" bears out what I have been saying.

He he he he...... 

More hot air from your reporting Mr. Potter. The following link should do it for you.

http://briefingroom.thehill.com/2009/08/13/finance-committee-drops-end-of-life-provision/

Excerpts:

The Senate Finance Committee will drop a controversial provision on consultations for end-of-life care from its proposed healthcare bill, its top Republican member said Thursday.

The committee, which has worked on putting together a bipartisan healthcare reform bill, will drop the controversial provision after being derided as "death panels" to encourage euthanasia by conservatives.


I mean, really Mr. Potter, all Sarah Palin had to do was write about death panels on her face book page, and that was enough for Obama to take notice and talk about it, and ultimately the related portion dropped from the bill.

Just imagine, Mr. Potter, Sarah Palin, whom every liberal considers a dumb woman, was able to affect a change in Obama's most important bill simply by writing about it on her facebook page. What does that say about the effect she wields on the president and the congress and what does it say about Obama, Dems, liberals and their health reform bill. Just imagine.....

[CLR James]

Ruchir,

Let me, on behalf of Mr. Potter, attempt to answer some of your questions:

Mr. Potter, can you or someone else do some research and tell me what your comments were in 2008 when ACORN members were so-called guarding voting booths with sticks in their hands? It's all on videotape so don't bother denying it.

Mr. Potter, can you or someone else do some research and tell me what you comments were when a black person selling anti-Obamacare lapel pins and flags was beaten up by SEIU union members and had to be hospitalized?

Now, above 2 points may look unrelated to the comment I have quoted, but it isn't. The point is that Obama has had a history of organizing community to suit his end. In fact, he made a career out of it. His community organizing was considered as the best possible qualification for his presidential candidacy. Now, when people who are anti-Obamacare are organizing and making their voice heard, you seem to have a problem with it?

ACORN and SEIU were tools that Obama used to organize people and garner votes as a candidate. So, what's the problem if anti-Obamacare people are organizing into a robust group and demanding some answers that neither Obama nor any of his cabinet members seem capable of providing? Why is support for Obamacare in general and Govt health option in particular is falling day by day? If Govt health option is such a great idea then why can't Obama articulate it in such a way that entire nation stands behind him? Or at least majority does?

Mr. Potter, it is within your rights to speak your mind, but before you start blaming insurance companies of organizing dissent against Obamacare, first ask this question - If Obamacare is really really the best way to go toward reforming US health care then why isn't Obama able to articulate that? Obama won 52% votes. Why does he not have even that much support for his health care reform plan?

Simple question.....

There are nuts on both sides, but the so called republican base, in recent times, has been comprised of the dregs of this earth: uneducated, fanatic, ill-informed, marked by an intolerant mob mentality bordering on schizophrenia. Your 'robust group' is motivated by irrational fears, prejudices, and racist hatred. Many of them do not even know that Medicare is a government program. Therein lies the crucial difference. Obama organized a community. What the right has come up with is a lynch mob.

A very good example from you.

So, why can't Obama simply stop insurance companies from dropping sick people off their coverage? Why does he have to go about providing an govt option?

The best way to reform an industry would be to study the industry, pinpoint the exact areas that are broken, work out the best way to reform the broken areas, implement the reforms. Where in all this does the govt option fits in?

It's like saying - Gee, the financial industry is broken, so in order to fix what is broken govt should come out with an alternative financial market or govt banks to provide a competing option to pvt banks.

Or like saying - Gee, the agriculture industry is broken, so in order to fix what is broken govt should buy off a part of cultivable land all over US and start govt sponsored farming to provide a competing option to US farmers.

The government option has been discussed because there are about 40 to 50 million uninsured people in the United States. Emergency rooms cannot take care of all of them, especially in relation to complicated cases. Most civilized nations do something about their economically weak populations. Before you launch into another republican cant about poor people are lazy and therefore do not deserve healthcare, let me ask you: the US is now 34th in the world in terms of child mortality rates. It was 12th in 1960. Why? Should infants now earn their coverage premiums before they are born? Why do medicines cost obscenely high in the United States compared to the rest of the world? Why must we live by the rules set by a Big Pharma- Big Insurance nexus? Why do companies like GM, as it did three years ago, shift millions of jobs to Canada to avail universal healthcare there? It is naive to think that the president of the United States can arbitrarily stop insurance companies from dropping people. First of all, the legality of these moves are settled by law and it is congress that makes law, not the president. Secondly, if he did find a way to do that, people like you will cry that he is impinging on the rights and liberties of free business enterprises in the free market. The public option is a bargaining chip.

As I said, when Obama did it, it was all okay because it was community organizing - the 'in' thing. When Obama took donation money from financial, health and other industries, it was all okay because it was just political donations.

Now, if health care industry is trying to organize public opinion, it is wrong? Why?

By the way, this is for your information Mr. Potter, but a big chunk of health care industry companies are already behind Obamacare, because they will end up earning huge contracts from Obamacare should it pass. Maybe this little attention slipped your eyes.

So, when Obama through Robert Gibbs, provided talking points to CNN, NBC, ABC, CBS, and all assorted newspaper, that's all good because he is the president, but if a few companies provide talking point to a few talk show hosts, suddenly that is bad? Wow....

Your piety knows no bounds. You accuse Obama (who is a politician in a political system that he did not define) of being less than ideal in a world that is not ideal. Secondly the outrage comes from a qualitative understanding of 'organizing public opinion,' not the simple fact that everybody has a right to organize opinion. You seem to have such a rosy view of mega corporate entities pouring millions of dollars to hoodwink people. These are some of their signal achievements in the past: smoking does not cause cancer (till there was a whistle blower), teaching school students that Big Mac food is full of 'goodness' (and causing an epidemic of teenage obesity and diabetes in the US), or convincing the people that corn was a vegetable. As far as the insurance companies are concerned, it is in their interest to lie and lobby. They are lying and lobbying.

This article should be sufficient to tell you whether it is isolated stories about long lines in Canada or a norm:

http://www.google.com/hostednews/canadianpress/article/ALeqM5jbjzPEY0Y3bvRD335rGu_Z3KXoQw

Once again, it is not a perfect world. And yet, Canadians, all Canadians, can stand in line. 50 millions Americans, children included, cannot.

Excerpts:

"We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize," Doing said in an interview with The Canadian Press.

"We know that there must be change," she said. "We're all running flat out, we're all just trying to stay ahead of the immediate day-to-day demands."

The pitch for change at the conference is to start with a presentation from Dr. Robert Ouellet, the current president of the CMA, who has said there's a critical need to make Canada's health-care system patient-centred. <<this means the current system is not patient-centered. isn't this what all anti-obamacare people are saying, Mr. Potter? and you think they are reciting talking points?>>

...

Ouellet has been saying since his return that "a health-care revolution has passed us by," that it's possible to make wait lists disappear while maintaining universal coverage and "that competition should be welcomed, not feared." <<more proof that waiting lists are a norm, not exception in canada.>>

...

"(Canadians) have to understand that the system that we have right now - if it keeps on going without change - is not sustainable," said Doig. <<there you go, Mr. Potter. for all your time spent in health industry, you made the mistake of not accepting the truth about canadian health care system. this fact is very disturbing to me, Mr. Potter, and i am cringing at your motives behind writing this article.>>

Again, not a perfect world, but isn't the American system far worse? Isn't it heading towards an iceberg? If the healthcare problem is not solved, it is well poised to bankrupt the country within a generation.

He he he he...... 

More hot air from your reporting Mr. Potter. The following link should do it for you.

http://briefingroom.thehill.com/2009/08/13/finance-committee-drops-end-of-life-provision/

Excerpts:

The Senate Finance Committee will drop a controversial provision on consultations for end-of-life care from its proposed healthcare bill, its top Republican member said Thursday.

The committee, which has worked on putting together a bipartisan healthcare reform bill, will drop the controversial provision after being derided as "death panels" to encourage euthanasia by conservatives.


I mean, really Mr. Potter, all Sarah Palin had to do was write about death panels on her face book page, and that was enough for Obama to take notice and talk about it, and ultimately the related portion dropped from the bill.

Just imagine, Mr. Potter, Sarah Palin, whom every liberal considers a dumb woman, was able to affect a change in Obama's most important bill simply by writing about it on her facebook page. What does that say about the effect she wields on the president and the congress and what does it say about Obama, Dems, liberals and their health reform bill. Just imagine.....

It is for politic, consensual reasons that the element was dropped. It was proposed by a Republican. This is what Paul Krugman has to say about the whole thing:

See http://www.nytimes.com/2009/08/14/opinion/14krugman.html

"Right now, the charge that’s gaining the most traction is the claim that health care reform will create “death panels” (in Sarah Palin’s words) that will shuffle the elderly and others off to an early grave. It’s a complete fabrication, of course. The provision requiring that Medicare pay for voluntary end-of-life counseling was introduced by Senator Johnny Isakson, Republican — yes, Republican — of Georgia, who says that it’s “nuts” to claim that it has anything to do with euthanasia.

And not long ago, some of the most enthusiastic peddlers of the euthanasia smear, including Newt Gingrich, the former speaker of the House, and Mrs. Palin herself, were all for “advance directives” for medical care in the event that you are incapacitated or comatose. That’s exactly what was being proposed — and has now, in the face of all the hysteria, been dropped from the bill.

Yet the smear continues to spread. And as the example of Mr. Gingrich shows, it’s not a fringe phenomenon: Senior G.O.P. figures, including so-called moderates, have endorsed the lie."

Sarah Palin is the prophet saint of these ignorant, uneducated, bigoted herds that make up the republican base in cattle country. The republican party, including those who know better, has towed the line in a cynical manner. This is not what one would call civilized politics. It is pure fear mongering. Everybody knows that health care has to be rationed. All countries do that. With the population growth, increase in life spans, there is simply not enough doctors and facilities to go around. When resources are limited, there is indeed the need for 'counselling' (not directing) patient families and sometimes patients themselves to desist from needless, exorbitantly expensive drugs just to prolong life for a few days or hours. What Palin has done is to give it a face (grandma) and sentimentalize the issue. Hence, grandma will be kept breathing like a vegetable on a ventilator while scarce medical resources will be taken away from needy children. The funny thing is that people are up in arms when the government proposes to do the counseling. Insurance companies habitually deny treatment to grandma.

The health care problem is indeed a very grave one. There has to be serious debate on this. I do not think the democrats have all the answers, but if Palin is allowed into the debate, it will be disastrous. She does not bring any brains to the table.

[ruchir]

There are nuts on both sides, but the so called republican base, in recent times, has been comprised of the dregs of this earth: uneducated, fanatic, ill-informed, marked by an intolerant mob mentality bordering on schizophrenia. Your 'robust group' is motivated by irrational fears, prejudices, and racist hatred. Many of them do not even know that Medicare is a government program. Therein lies the crucial difference. Obama organized a community. What the right has come up with is a lynch mob.

The so-called democrat base is comprised of people who live in gutter, speak gutter language, think gutter things, eat and drink gutter water. Want examples? Just look at the comments made from the left on Sarah Palin.

If left thinks Sarah Palin is not fit to be a VP, so be it. No harm in that. But do you have to denegrate and ridicule her by calling her a slut, a prostitute? Do you have to make fun of her kids? Do you have to say that her 14 year old daughter was 'knocked up' by ARod? Do you have to say that her autistic child is not hers? Do you have to say that she and her husband are splitting when they are not?

So tell me, dear CLRJ, who is uneducated? Who is fanatic? Who is ill-informed? Who has mob mentality?

CLRJ, do you have any research or study that shows that republicans are all that you are claiming they are? Or are you simply believing the words of Obama-media and Obama-bites?

Those 70 year old ladies are mob? They look uneducated to you?

I think you should come out of your racist and hatred driven mentality against anti-Obama crowd. Just because you don't agree with him dose not make you all the adjectives that you have coined here.

Can you please give me one example of why anti-Obamacare crowd is a lynch mob? I can give you numerous examples of what blacks were saying about Bush and no one called those blacks racists or any of the adjectives you have used here.

Time to grow up, CLRJ. Or maybe you are so stunned at the outpouring against Obama (something you and people like you never dreamt of), you are so stunned that people are asking intelligent questions that Obama is not able to answer and this is the way you are venting!!!!

I am surprised to see these kind of words from you CLRJ... never thought this was in your mind.

The government option has been discussed because there are about 40 to 50 million uninsured people in the United States. Emergency rooms cannot take care of all of them, especially in relation to complicated cases. Most civilized nations do something about their economically weak populations. Before you launch into another republican cant about poor people are lazy and therefore do not deserve healthcare, let me ask you: the US is now 34th in the world in terms of child mortality rates. It was 12th in 1960. Why? Should infants now earn their coverage premiums before they are born? Why do medicines cost obscenely high in the United States compared to the rest of the world? Why must we live by the rules set by a Big Pharma- Big Insurance nexus? Why do companies like GM, as it did three years ago, shift millions of jobs to Canada to avail universal healthcare there? It is naive to think that the president of the United States can arbitrarily stop insurance companies from dropping people. First of all, the legality of these moves are settled by law and it is congress that makes law, not the president. Secondly, if he did find a way to do that, people like you will cry that he is impinging on the rights and liberties of free business enterprises in the free market. The public option is a bargaining chip.

CLRJ, have you done any kind of homework on the figure you are quoting for uninsured people?

Is is 40 million or 50 million? Difference of 10 million is a huge one.

Anyway, there are about 20 million people who are in USA illegally and this Obamacare would give them insurance sponsored by tax payer money. Every anti-Obamacare person is against this.

There are about 10 million people who are not insured by choice. The are usually young and healthy people, between 18 and 35 years age. What about them? Research shows that 90% of these people make $50,000 or more. Meaning they can buy insurance if they want to.

Now remaining 10 million people. Why would you want to put 307 million people at a disadvantage, in order to give a service to 10 million people?

Canada and England provide universal health care. What is happening to that health care? Have you bothered to find out or you are just buying what Obama-media is saying? The chief of Canada health care is saying that their health care system is "imploding". IMPLODING is the word she used. Would you like a similar system in US just because some 10 million people are uninsured because they are too poor?

England health care is refusing certain operations to elderly, refusing certain cancer medicines to women with breast cancer, for god sake refusing cortizone pain killing injections !!!!!!!!!!! Is that what you want in USA? That's what will evntually happen if govt controls health care.

So, my question again, why do you want to put 307 million people at disadvantage, if you want to provide a facility to 10 million people. If you have figured out that the problem is to provide insurance coverage / health care to these 10 million people then work on that. No point in overhauling something that is not broken to begin with. Sure health care system in US needs improvement.... but is does not need overhaul.


Why do medicines cost more in US than world -- who invents all these medicines, CLRJ? In which nation does most of the medical and medicinal innovations and discoveries happen? In USA. It is the US companies that come out with most new medicines. Companies all over the world simply produce GENERIC medicines. That's why they are cheaper over there. Generic drugs are cheaper in US too. But for 10 years after a drug is approved, the pharma company has the only rights to sell it. It has to recoup the billions of dollars it spends in research and development of the drug. That's why it is costly. It is simple math.

BTW, it is the same evil drug companies that have programs where they give free medication to those patients who can't afford to pay for it. You may not know it, but that's the truth.

Also, CLRJ.... life is tough. You don't always get what you expect in life. Life is supposed to be like that. Everyone in the world can't have a rosy life. They can hope and try, but that doesn't mean they SHOULD get a govt provided rosy life. There are poor people who can't afford expensive medicines. Tough luck... what else can you say? To help people like these there are many sponsorship programs operated by pharma companies, by Red Cross, by various charitable institutions who sponsor purchase of such medicines.


Move to Canada -- Just because GM moved it's jobs to Canada makes canadian health care system better than US? Wow.... that's some logic coming from you CLRJ... and unexpected too. Canada health care is CHEAPER, but not better. The aim in US should not be to just make things cheaper, but to make better quality things available to most. Since when was a cheap product or service better than a comparative costlier service?

CLRJ, do you know that there is a medical lottery system in Canada? Not sure if you know about this, but this is the utter truth about Canadian health care that you think is better. In sparsely populated areas of canada, there are no govt doctors or hospitals. So how do people living there get health care? The county official drop their names in a lottery box every year and the names that are picked from the box are assigned to the nearest available doctor and hospital. Those who are not picked are left to pay for their own health. The biggest thorn in the eye is that these people can not pick and choose their own family doctor through an outside plan because ALL doctors associated to the govt plan are supposed to treat only those patients that are assigned to them by county officials.     Take that, US health care....

Your piety knows no bounds. You accuse Obama (who is a politician in a political system that he did not define) of being less than ideal in a world that is not ideal. Secondly the outrage comes from a qualitative understanding of 'organizing public opinion,' not the simple fact that everybody has a right to organize opinion. You seem to have such a rosy view of mega corporate entities pouring millions of dollars to hoodwink people. These are some of their signal achievements in the past: smoking does not cause cancer (till there was a whistle blower), teaching school students that Big Mac food is full of 'goodness' (and causing an epidemic of teenage obesity and diabetes in the US), or convincing the people that corn was a vegetable. As far as the insurance companies are concerned, it is in their interest to lie and lobby. They are lying and lobbying.

Does your piety know bounds, CLRJ? Does it?

The people who are agitating against Obamacare also live in a political system that they didn't define and in a world that is not ideal. Such standards are not just for Obama but for EVERY american. You seem to have forgotten that.

Sure, many companies try to cheat, but so did Obama. Oh... you didn't know Obama told lies to Americans? You didn't know that? Well, Obama said on CNN that he wasn't present in the church when Rev. Wright gave those nasty, racist sermons. Then on ABC interview he said that yes, he was present in the church when some of those sermons were given.

So, just like mega corporates are lying and lobbying, so was Obama. Obama is even more stupid. In one sentence he says that "I was not there, I don't know all the facts but Cambrige police acted stupidly.". Ok.... you weren't there, you don't know the facts, and you still think police acted stupidly? Can there be a more racist thing to say against a white officer arresting a rich black man?

Obama said that AARP had approved his health care bill, and AARP on the same day denied they approved ANY health bill.

Obama is everything you claim mega corporates to be. He lies and he lobbies.

Again, not a perfect world, but isn't the American system far worse? Isn't it heading towards an iceberg? If the healthcare problem is not solved, it is well poised to bankrupt the country within a generation.

NO.... American system in better than Canadian. When a Canadian is refused an operation by canadian health system, he comes to US to get that operation done. Have you heard of Americans going elsewhere to have operations done?

It is for politic, consensual reasons that the element was dropped. It was proposed by a Republican. This is what Paul Krugman has to say about the whole thing:

See http://www.nytimes.com/2009/08/14/opinion/14krugman.html

"Right now, the charge that’s gaining the most traction is the claim that health care reform will create “death panels” (in Sarah Palin’s words) that will shuffle the elderly and others off to an early grave. It’s a complete fabrication, of course. The provision requiring that Medicare pay for voluntary end-of-life counseling was introduced by Senator Johnny Isakson, Republican — yes, Republican — of Georgia, who says that it’s “nuts” to claim that it has anything to do with euthanasia.

And not long ago, some of the most enthusiastic peddlers of the euthanasia smear, including Newt Gingrich, the former speaker of the House, and Mrs. Palin herself, were all for “advance directives” for medical care in the event that you are incapacitated or comatose. That’s exactly what was being proposed — and has now, in the face of all the hysteria, been dropped from the bill.

Yet the smear continues to spread. And as the example of Mr. Gingrich shows, it’s not a fringe phenomenon: Senior G.O.P. figures, including so-called moderates, have endorsed the lie."

Sarah Palin is the prophet saint of these ignorant, uneducated, bigoted herds that make up the republican base in cattle country. The republican party, including those who know better, has towed the line in a cynical manner. This is not what one would call civilized politics. It is pure fear mongering. Everybody knows that health care has to be rationed. All countries do that. With the population growth, increase in life spans, there is simply not enough doctors and facilities to go around. When resources are limited, there is indeed the need for 'counselling' (not directing) patient families and sometimes patients themselves to desist from needless, exorbitantly expensive drugs just to prolong life for a few days or hours. What Palin has done is to give it a face (grandma) and sentimentalize the issue. Hence, grandma will be kept breathing like a vegetable on a ventilator while scarce medical resources will be taken away from needy children. The funny thing is that people are up in arms when the government proposes to do the counseling. Insurance companies habitually deny treatment to grandma.

The health care problem is indeed a very grave one. There has to be serious debate on this. I do not think the democrats have all the answers, but if Palin is allowed into the debate, it will be disastrous. She does not bring any brains to the table.

Sarah Palin is the prophet saint of these ignorant, uneducated, bigoted herds that make up the republican base in cattle country.

but if Palin is allowed into the debate, it will be disastrous. She does not bring any brains to the table.

This is enough for me to completely discount anything Krugman is saying. This is a guy who resorts to demeaning and ridiculing the other side when he can't win the substantiative argument. Simple as that. No point talking about him.


However, what Palin said was usage of an analogy. Using extreme words to get attention, something that Democrats used to do a hell of a lot against Bush, like calling him Nazi, a killer etc.

What Palin was referring to was the fact that Obama has advisors who are on extreme left. Read history of Ezekiel Emanuel, Rahm's brother. He is Obama's health advisor. He had come out with a formula to calculate "Quality Adjusted Life Years".

http://en.wikipedia.org/wiki/Ezekiel_J._Emanuel

Emanuel co-wrote, "The complete lives system discriminates against older people. Age-based allocation is ageism. Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years. Treating 65-year-olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not." Also: "When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated."

----

So, CLRJ, it was not just about death panels, it was about how health care would be dispersed to elderly in the society. Read the above paragraph and tell me if it does not sound like early death bells for elderly in US, once Obamacare passed as it was written earlier.

The above is what Sarah Palin was talking about. And surely when Dems got around reading it even they found it disturbing otherwise they would not have removed it.

[flute]

ruchir,  I read CLR's post and I don't see any personal references to you or your style of posting except one inoffensive one, but your post seems to be so full of them, you seem to start every paragraph with a dig at the other poster. WHY?

It is easy to start a thread like below

http://www.cricketvoice.com/cricketforum2/index.php/topic,21515.msg283836.html#msg283836

but much much harder to follow it in letter and spirit. I hope you will follow your own suggestion in good spirit. Now, I hope you don't turn around and claim that your suggestion does not apply to accusing the other poster  of " racist, hatred driven mentality"

[WicketView]

I have not followed the happening in details. Hence I have the following questions :

Will the insurance companies be decreed illegal as part of the proposed plan? Will it not give people the option of choosing between the govt provided health care and the private insurance companies, or even no insurance?

My impression, admittedly without a really thorough research, was that the answer to all of these questions was "No". People will have an extra option of using the govt. insurance. If so, I don't understand why this is a takeover? After all, if the benefits of private insurance companies are much better won't everyone who can afford them go for it? So the private insurance companies would not have anything to lose if they are confident of their benefits.

I can see the concern of people who feel their money in the form of taxes will be used for something that they feel will not work/ or they do not care about. Or that they feel that the system will not be capable of handling the larger number of patients who will avail of the health services. Can someone break down the point of concern for me?

Ruchir,
One question that immediately interests me is your reference to Ezekiel Emanual and his complete lives thing and the death panel interpretation. If you read the paragraph before the one you quoted from the wikipedia, it talks about the title of the article  "Principles for allocation of scarce medical interventions". My guess is that this would refer to cases where you have to make a choice ... you have one organ available and you have to choose between two people. It is an unfortunate no-win situation. What code of ethics would you choose to answer a question which has no good answers? One may prefer a different code, that may be justifiable, but the term "death panels" is obviously a malicious, misleading term designed to conjure up horrific images. Without commenting on one's intelligence, it may not be a stretch to say that attributing such statements to the lack of intelligence is actually being charitable, the alternative might actually be far worse.

[CLR James]

Ruchir,

I do not see any reason to reply to your post. It is full of subjective hyperboles, patent untruths, and very little substantive reasoning. I cited the number of uninsured was between 40 to 50 million because it was 40 million several years ago. Your break up (20+10+10) was breathtaking. You shot Krugman without any solid refutation of his arguments. The list goes on....

As for democrats. You have to go to the cyber world in order to fetch flimsy evidence. On the other hand, irrational white beef country anger in real life is well and widely documented. As is the rise in hate group memberships.

[kban1]

CNN Truth Squad: Will health bill let Uncle Sam into your bank account?

Posted: August 12th, 2009 07:59 AM ET

The Statement: Twice during a Pennsylvania town hall meeting with Sen. Arlen Specter on Tuesday, constituents urged him to fight a provision of pending health care legislation that one woman said "gives the government access to private individual bank accounts at their free will."

"I do not think the government has the right to do that," she said. "I would think I would have to brush up on my Constitution, but I would think that's unconstitutional. I know definitely it's un-American."

(Get the facts and the verdict after the jump)

The Facts: The woman cited section 163 of the more than 1,000-page bill now before the House of Representatives. The section, titled "Standards for financial and administrative transactions," calls on the government to set "comprehensive, efficient and robust" rules for electronic transactions with as little need for paperwork as possible. It's being painted by opponents as a measure that would give the government access to bank accounts and records, and it's one of the items on a list of allegations about the bill that has been widely circulated online.

But the purpose of the measure is to set up a standardized payment system between insurers and doctors' offices, according to the House Ways and Means Committee report on the bill. It would require procedures to "enable the real-time (or near real-time) determination of an individual's financial responsibility at the point of service and, to the extent possible, prior to service," and authorize electronic payments and require systems to be set up for "near real-time adjudication of claims," the legislation states.

The Verdict: False. The provision cited doesn't affect individuals, but companies involved in medical billing.

http://politicalticker.blogs.cnn.com/2009/08/12/cnn-truth-squad-will-health-bill-let-uncle-sam-into-your-bank-account/

[kban1]

CNN Truth Squad: Will dental insurance be offered under the proposed Health Insurance Exchange?

Posted: August 12th, 2009 04:14 PM ET


The Statement: Mike, from Bristol, Connecticut, told CNN that "I've heard dental service will not be covered under the Health Insurance Exchange. Seems like we have to wait for a tooth to become life-threatening before it is considered health care. Why is my mouth not considered part of my health?"

The Facts: Under the administration's health-care overhaul, people can keep their own health insurance. Under a proposed Health Insurance Exchange, uninsured people can pick from private and public options for health care, and the proposed public option in one House bill offers dental care.

The proposed "basic" public plan would cover dental/oral health for "children under 21 years of age." Adults could get coverage under another "premium-plus" public plan that would cost more.

These are spelled out in H.R. 3200 — America's Affordable Health Choices Act of 2009 — on pages 28 and 86-87.

There are doubts among health-care policy experts that dental care will see the light of day in the public plan.

Professor Debra Street, an expert in health-care policy at State University of New York-Buffalo, is among those who doubt dental coverage will end up in the final public option if such an option is in the final bill hammered out by lawmakers.

That's because of the track record with other federal health-care programs. Dental coverage hasn't been available in Medicare and it hasn't been well-funded in Medicaid, where coverage differs state by state, Street said.

The details of the plan are still undetermined as lawmakers work to shape the legislation.

The Verdict: True but incomplete. The basic public plan in the House would only cover dental care for children under 21, but an adult could pay extra for the coverage.

http://politicalticker.blogs.cnn.com/2009/08/12/cnn-truth-squad-will-dental-insurance-be-offered-under-the-proposed-health-insurance-exchange/#more-64289

[kban1]

CNN Truth Squad: Say goodnight, Grandpa

Posted: August 12th, 2009 06:16 PM ET


The Statement: The health-care bill now before the House of Representatives requires doctors to encourage the elderly to give up medical care "because you're no longer a working citizen who will be paying taxes," as one woman put it at a meeting with Pennsylvania Democratic Sen. Arlen Specter on Tuesday. That claim has been spread through a variety of sources, from radio talk shows and e-mail to a Facebook message from former Republican vice presidential candidate Sarah Palin, who vowed never to let government "death panels" determine whether her parents or her infant son — who has Down syndrome — were "worthy of health care."

The "60 Plus Association," a group led by singer Pat Boone, warns in ads that if the House bill passes, "The government, not doctors, will decide if older patients are worth the cost." And former House Speaker Newt Gingrich defended Palin during appearance on ABC's "This Week," saying the Obama administration is "asking us to trust turning power over to the government, when there clearly are people in America who believe in establishing euthanasia."


The Facts: What the critics are citing is Section 1233 of a 1,000-page version of the bill now before the House of Representatives. The provision, located nearly halfway through the bill, would require Medicare to pay doctors for consultations with patients about "advance care planning," such as the drafting of living wills. Those consultations would include "an explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice."

Critics say that the health bill would lead to rationed care, giving the government an incentive to deny treatment to the elderly in favor of healthier, more productive people — and that Section 1233 is meant to encourage seniors to give up treatment and die.

But the American Medical Association, which has endorsed the bill, says it "would not mandate that patients take advantage of this benefit."

"The new Medicare benefit would allow doctors to be compensated for such consultations every five years, and more frequently if a patient has a life-limiting illness or health status changes," the organization says.

And the National Hospice and Palliative Care Organization says the consultations would be voluntary, not mandatory.

"No one is required to undergo the consultation," the organization says.

Sen. Johnny Isakson, R-Georgia, opposes the House bill and the proposal put out by the Senate Health, Education, Labor and Pensions Committee. But he got similar language added to the Senate bill, which would allow patients enrolled in Medicare's long-term care program to seek their own consultations on drafting living wills and obtaining powers of attorney, and called comparisons of end-of-life consultations to euthanasia "nuts" during a recent interview with the Washington Post.

The Verdict: False.As Specter put it Tuesday, "That's a vicious, malicious, untrue rumor."

http://politicalticker.blogs.cnn.com/2009/08/12/cnn-truth-squad-say-goodnight-grandpa/

[kban1]

CNN Truth Squad: Will college students who can't remain on parents' insurance policies because of age be insured under the Obama plan?

Posted: August 13th, 2009 04:06 PM ET

The statement: From David Morris of Portland, Maine: "I'd like to know if under Obama's insurance reform plan, if students like me who turn 25 and can't be on their parents' insurance anymore while they're full-time students will be covered."

The facts: Many college students find themselves in a bind when they end up dropped from family insurance policies after they reach a certain age and can't afford their own insurance.

The Obama administration is backing a health-care overhaul that would help bolster coverage for college students and other young adults, according to his administration and a private foundation that supports universal health-care reform.

Three main facets address this point:

– At present, the age of dependency for young people to retain private insurance coverage from parents varies from state to state.

But the Affordable Health Choices Act passed by the Senate's Health, Education, Labor and Pensions Committee would allow coverage for dependent young adults — including students — under their parents' private insurance policies to age 26. Linda Douglass, communications director in the administration's Office of Health Reform, thinks such language will make it to a House bill.

Twenty-six U.S. states have laws limiting age of dependency status for young adults, according to the Commonwealth Fund, a New York-based private foundation aimed at promoting a high-performing health-care system and researching health-care issues. It says the limiting age of dependency status ranges from 24 in four states to 30 in two of them, with most at 25 and some at
26.

– Douglass said uninsured college students would be able to get access to the health insurance exchanges proposed in Senate and House legislation. In the proposals, people can shop for various health plans, such as a public insurance option and private insurance plans. An inexpensive insurance policy geared to young adults and focused on prevention is in the works, she said.

– At present, young adults in low-income families lose Medicaid when they turn 19. But under House and Senate proposals, people in their 20s could also gain eligibility for Medicaid — the federal program for certain low-income individuals and families administered by states — because the income eligibility limits would be expanded to include adults with incomes up to 133 percent or 150 percent of the federal poverty level.

The fund — which addressed these issues in a report titled "Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help, 2009 Update" — says proposals being considered by Congress would help 13.2 million uninsured young adults, including full-time students who lose coverage under their family's insurance.

"It would help young adults get coverage they lack right now," said Sara R. Collins, vice president of the Commonwealth Fund's Affordable Health Insurance program.

The verdict: True. The Obama administration health-care overhaul includes proposals that would help provide coverage for full-time students who under current laws would be dropped from their parents' insurance plans at age 25. Lawmakers continue to huddle over versions of the health-care overhaul plan, and it is too soon to know the final shape of the legislation and the fate of these proposals.

http://politicalticker.blogs.cnn.com/2009/08/13/cnn-truth-squad-will-college-students-who-cant-remain-on-parents-insurance-policies-because-of-age-be-insured-under-the-obama-plan/

[kban1]

CNN Truth Squad: Will new health bill cover illegal immigrants?

Posted: August 13th, 2009 05:04 PM ET

The statement: Questions about whether those in the United States illegally would be covered by the health-care bill now before the House of Representatives have been a staple of the raucous public meetings some members of Congress have been hosting during their August break. At least two people raised the issue at a forum held by Sen. Ben Cardin, D-Maryland, on Wednesday, and Cardin's insistence that "Illegal aliens will not be in this bill — period — the end" was met with a round of jeers.

The facts: The bill, HR 3200, specifically bars coverage for illegal immigrants. Section 246, which is included in the part of the bill that sets up a health insurance exchange, forbids payments "on behalf of individuals who are not lawfully present in the United States." But critics say there is no way to enforce that provision, and the Democratic majority in the House has turned back at least one Republican effort to stiffen citizenship checks.

Henrie Treadwell, a professor of community health and preventative medicine at Atlanta's Morehouse School of Medicine, calls the issue a "red herring." The existing health-care programs Medicare and Medicaid already require those enrolled to provide "a substantial number of documents" to show they're U.S. citizens or legal residents, she said.

On the other hand, doctors are obligated to treat people who show up in emergency rooms regardless of citizenship. Many of the estimated 10 million illegal immigrants in the United States are getting treatment at emergency rooms already, with the costs absorbed by hospitals and state and local governments, Treadwell said.

"It is certainly not just something that disappears," she said. "We are paying now for care that is not preventive, and we are paying millions."

Some Republicans argue that the measure has left a loophole for undocumented relatives of legal residents to be covered. But Treadwell disputes that, telling CNN that based on her reading of the bills, "There is no loophole currently." The language in Section 242 of the House bill limits benefits to family members who are citizens or legal residents, she said.

In addition, a widely circulated e-mail critical of the bill states that a non-discrimination clause in Section 152 would require illegal immigrants to be covered by a public health insurance plan. But the first line of that provision forbids discrimination "except as otherwise explicitly permitted by this act."

The verdict: False. The language of the House version of the bill as it is now written restricts coverage to U.S. citizens and legal residents — and as far as illegal immigrants are concerned, "It simply is not a truthful argument that they will be covered," Treadwell said.

http://politicalticker.blogs.cnn.com/2009/08/13/cnn-truth-squad-will-new-health-bill-cover-illegal-immigrants/#more-64463

[kban1]

CNN Truth Squad: No eye care until you're blind in one eye?

Posted: August 17th, 2009 03:02 PM ET

The Statement: Florence Mackie of North Carolina writes to CNN, "I got a disturbing e-mail that said the new health bill would not help a person with macular degeneration until they lost the vision in one eye first." She asks, "Is this true?"


The Facts: Macular degeneration is a disease that gradually destroys sharp, central vision. Chances of suffering from it increase with old age. Age-Related Macular Degeneration (AMD) http://www.cnn.com/HEALTH/library/macular-degeneration/DS00284.html is the leading cause of blindness for people age 65 and older and affects more than 10 million Americans, according to the American Medical Association.

Whites are "much more likely" to lose vision due to AMD than African-Americans, and women "appear to be at greater risk than men," according to the National Eye Institute at the National Institutes of Health.

There is no final version of health-care legislation in either the House or the Senate. But each chamber has a version of a bill that is available to be read online . The House bill has more than 1,000 pages; the Senate bill has more than 600.

Neither bill contains the words "macular," "degeneration," or "sight." Neither establishes special rules over eye health.

The rumor appears to stem from concerns expressed by some conservatives earlier this year during the battle over stimulus legislation.

In a commentary published by Bloomberg News on February 9, former New York Lt. Gov. Betsy McCaughey wrote, "In 2006, a U.K. health board decreed that elderly patients with macular degeneration had to wait until they went blind in one eye before they could get a costly new drug to save the other eye. It took almost three years of public protests before the board reversed its decision."

She added, "If the Obama administration's economic stimulus bill passes the Senate in its current form, seniors in the U.S. will face similar rationing."

The example seems to have been taken out of context by opponents of the current health care reform plan, who are suggesting that impending legislation would target macular degeneration.

The Web site wpcva.com, shared by several Virginia newspapers, published an opinion piece this month from a Virginia resident stating that under the House bill, "Surgery to correct macular degeneration would be denied until the patient lost sight in one eye."

Chain e-mails are having a substantial effect on the health care debate. On the Obama administration's "Reality Check" Web site, which the administration says is aimed at counteracting myths about health care, one of the top two videos is headlined, "The return of the viral e-mail."

The Verdict: False. There is no such rule in the health care legislation working its way through Congress.

http://politicalticker.blogs.cnn.com/2009/08/17/cnn-truth-squad-no-eye-care-until-youre-blind-in-one-eye/

[kban1]

CNN Truth Squad: Will reform plan mandate prices for doctors' services?

Posted: August 19th, 2009 03:29 PM ET

The statement: Cindy of Covington, Georgia, asked CNN: "Why doesn't the government make mandatory prices for doctors and their services? That is the problem! They all charge outrageous prices and they vary from place to place. Will that change under the new plan?"

The facts: President Barack Obama and health reformers in Congress are trying to influence how prices get set by creating a government-run public insurance option that would compete with private plans in a so-called Health Insurance Exchange. They say private doctors, private hospitals, and private insurers will be free to set their own prices.

The public insurance option would be a government-funded, government-run health care program similar to Medicare — the government health insurance program for people age 65 and older — and doctor participation in the plan would be voluntary.


"On the public option, there are various approaches coming from the different committees, but all aim to achieve the goal of increasing choice and competition, which will have the effect of lowering prices," the White House press office said.

Skeptics and opponents of reform argue that private companies might not be able to compete against the government plan. They say government isn't going to pay enough to hospitals and doctors for procedures and costs will be passed along to private consumers. The more people who enroll in the government plan, the fewer people there will be to offset these costs — an environment that would ultimately drive all private insurers out of business, critics say.

"If the new government-run plan were to offer artificially low premiums, over time, it could be a step toward a single-payer system," said Robert Zirkelbach, spokesman for America's Health Insurance Plans, the national association representing nearly 1,300 member companies providing health insurance coverage to more than 200 million Americans.

Henry Aaron — a health care expert and senior fellow of economic studies at Brookings Institution, the nonprofit public policy research organization — said "one can speculate on how the law evolves into the distant future," but he said the plan "would establish exchanges" and the "exchanges are not price-setting agencies."

Obama has repeatedly said the plan offers a "marketplace," with a "menu" of "options" — private insurers and the public option.

One of the reform bills, House Bill 3200, says the "Secretary of Health and Human Services shall provide for the offering of an Exchange-participating health benefits plan that ensures choice, competition, and stability of affordable, high quality coverage throughout the United States."

The American Medical Association, the professional group representing physicians, addresses this issue in a statement supporting House Bill 3200. It says "the legislation does not make private insurance illegal" and that the Health and Human Services secretary "would be required to establish payment rates only under the public health insurance option."

The Verdict: False. Health care reformers say they are promoting competition between insurers, not a mandatory pricing system.

http://politicalticker.blogs.cnn.com/2009/08/19/cnn-truth-squad-will-reform-plan-mandate-prices-for-doctors-services/

[kban1]

CNN Truth Squad: Is health care rationing in the cards?

Posted: August 18th, 2009 04:45 PM ET

The Statement: Jason Rogers of San Antonio, Texas: "Four years ago my father was diagnosed with terminal brain cancer. After 18 months, we fought that disease with everything we had. Under a public option or government-run health care system, would that type of care be possible? Is it something that 10 years from now we're going to have to sacrifice or come up with a tremendous amount of cash to pay for it because it would be rationed under our government-run health care system?"

The Facts: There is no explicit reference in any version of the legislation to rationing health care and the White House said it doesn't intend to institute a rationing policy. "There are a number of different bills making their way through Congress right now, but we do know this: The reform bill that the president signs will not lead to rationing. It will be fully paid for and it will bring down costs over the long term," the White House said.

But despite the administration's intent, some skeptics believe costs could rise and that shortfalls would create the environment for rationing.

The Cato Institute, a public policy research center, said in a report in June that when Medicare Part A was launched in 1965, the government estimated it would cost about $9 billion per year. But Cato said that by 1990, the cost was closer to $67 billion.

It also said that when the Massachusetts Commonwealth Care was put into place in 2006, it was expected to cost about $725 million annually, but the expected cost for 2009 is almost $1 billion. But Massachusetts officials dispute the Cato figures, saying that the program actually will have cost about $800 million for the 2009 fiscal year when all claims are processed.

"The Congressional Budget Office estimates that existing government health programs would require income-tax rates to rise as high as 66 percent by mid-century," said Michael F. Cannon, Cato's director of health policy studies. "President Obama's new entitlements would require even higher taxes. American voters will not tolerate tax rates that high. Since the government will be the only entity with any incentive to control costs — patients and health-care providers will all be spending other people's money — the government will have to ration care."

President Barack Obama on August 14 spoke at a town hall meeting in Belgrade, Montana, where he raised the issue of rationing in discussing the elimination of "waste and inefficiencies" in Medicare.

"So what we've proposed is not to reduce benefits — benefits on Medicare would stay the same — it's not to ration. What we are asking is that we eliminate some of the practices that aren't making people healthier."

Speaking on August 15 at a town hall meeting in Grand Junction, Colorado, Obama shot back at the claims by some opponents of reform that the administration is trying to ration care.

"Well, that's what's going on right now," Obama said about rationing and restrictions. "It's just that the decisions are being made by the insurance companies."

The White House's health-care reform reality check Web page says reform will stop rationing, not increase it.

Kavita Patel — who works with White House Senior Advisor Valerie Jarrett and worked as a physician — says on that page that the administration wants to combat rationing by insurance companies.

"We want to make sure that people with pre-existing conditions are not denied coverage," she says. "That happens — right now, as we speak. People get kicked out of their insurance plans because they have increased medical costs and they're deemed to be unworthy of coverage. We need to make sure that those people, people like you and me, also have access in case we do get sick, and in case we do lose our jobs, and in case we do need to change from one employer to another."

Verdict: In dispute. The Obama administration doesn't intend to ration health care, but critics fear that high costs could set the stage for rationing.

http://politicalticker.blogs.cnn.com/2009/08/18/cnn-truth-squad-is-health-care-rationing-in-the-cards/

[ramshorns]

Just for the sake of Rush Limbaugh's,  Sean Hannity's of the world and their irrational ill informed radio followers I want Obama to win again.  I know he will win again.  So 7 more years for them to rut in misery.  I am loving it.

[kban1]

Is Britain's Health-Care System Really That Bad?

By Eben Harrell / London

In recent weeks, opponents of Barack Obama's health-care-reform plans have criticized Britain's National Health Service (NHS) in an effort to counter the President's proposals for greater government involvement in health care. Republican Senator Chuck Grassley of Iowa suggested that his Democratic colleague Edward Kennedy would have been left to die in Britain because doctors would have refused the 77-year-old treatment for his brain tumor, and former House of Representatives Speaker Newt Gingrich wrote in an article that British health care is run by "Orwellian" bureaucrats who put a price tag on life. Meanwhile, the lobby group Conservatives for Patients' Rights (CPR) has been running scare ads with horror stories from British patients on its website. TIME takes a look at what the NHS is really all about.

What is the NHS?
The NHS is a rare example of truly socialized medicine. Health care is provided by a single payer — the British government — and is funded by the taxpayer. All appointments and treatments are free to the patient (though paid for through taxes), as are almost all prescription drugs. The maximum cost of receiving any drug prescribed by the NHS is $12. (Read "The Year in Medicine 2008: From A to Z.")

How was it formed?
The NHS officially came into being in July 1948, in the wake of World War II, to replace an inadequate system of volunteer hospitals that had, during the war, come to rely on government funding. Doctors and conservative politicians vehemently opposed the NHS in the run-up to its formation, using many of the arguments that opponents of greater government involvement in the U.S. cite today. According to Geoffrey Rivett, author of From Cradle to Grave — The First 60 Years of the NHS, the then head of doctor's body the British Medical Association (BMA), Charles Hill, gave a radio address in 1948 in which he asked, "Do you really want the state to be your doctor?" Today, the BMA is a champion of the NHS and resists any privatization initiatives. In a statement on Aug. 14, BMA chairman Dr. Hamish Meldrum said, "The NHS is not perfect. But the market-style philosophy of the U.S. is a lesson we could do well without."

How does NHS health care compare with U.S. health care?
Like most developed countries, Britain ranks above the U.S. in most health measurements. Its citizens have a longer life expectancy and lower infant mortality, and the country has more acute-care hospital beds per capita and fewer deaths related to surgical or medical mishaps. Britain achieves these results while spending proportionally less on health care than the U.S. — about $2,500 per person in Britain, compared with $6,000 in the U.S. For these reasons, the World Health Organization (WHO) ranked Britain 18th in a global league table of health-care systems (the U.S. was ranked 37th). However, there are measures by which the U.S. outperforms Britain: for instance, the U.S. has lower cancer mortality rates. (See how to prevent illness at any age.)

Does private health insurance exist in Britain?
Yes, and it works in a similar way to health insurance in the U.S. Many employers offer private health-insurance plans as a perk to workers — a minority of patients opt out of the NHS system to receive their medical treatments privately. Private patients can choose their specialists and avoid waiting lists for non-emergency procedures; NHS patients wait an average of about eight weeks for treatments that require admission to a hospital, four weeks for out-patient treatments and two weeks for diagnostic tests. While NHS patients have a choice of hospitals, they cannot always choose their specialist.

See 10 players in health-care reform.

See TIME's health and medicine covers.

Is it true that NHS bureaucrats put a price tag on life?
The short answer is yes. The NHS has a body called the National Institute for Health and Clinical Excellence (NICE) that decides which new treatments and drugs the NHS should pay for. One of the factors NICE considers when deciding whether to approve funding for a new treatment or drug is cost-effectiveness. To determine the dividing line between what is cost-effective and what isn't, it must set a threshold. Taking its lead from Britain's Department of Transport — which has a cost-per-life-saved threshold for new road schemes of about $2.2 million per life, or about $45,000 per life year gained — NICE rarely approves a drug or treatment that costs more than $45,000 per life year gained. In short, NICE does not want the NHS to spend more than $45,000 to extend a citizen's life by one year.

While NICE's decisions have angered some doctors and patient groups — particularly some oncologists who say they are unable to prescribe expensive, life-extending cancer drugs — mainstream politicians, the media and most Britons accept NICE's rare rejections as a necessary compromise to keep universal coverage affordable in the face of rising health-care costs. As NICE chairman Sir Michael Rawlins recently told TIME, "All health-care systems have implicitly, if not explicitly, adopted some form of cost control. In the U.S., you do it by not providing health care to some people. That's a rather brutal way of doing it." (See the top 10 medical breakthroughs of 2008.)

Is it true that old people receive inferior care on the basis of their age?
NICE uses what it calls "citizens councils" to help it sort through difficult ethical issues, and one of the decisions the councils have made is that age should not be a factor in the institute's approval process — that is to say, a year of life should be considered as valuable to a 77-year-old as to a 12-year-old. In every part of the system, a 77-year-old has the same access to treatment as anyone else in Britain. (See the most common hospital mishaps.)

What about the ad by lobby group CPR that interviews a British woman who developed cervical cancer after being refused a Pap test because she was too young, and another for a woman whose mother died while waiting for treatment for kidney cancer? Are these experiences typical?
As mentioned above, cancer treatment is one area in which British patients probably receive inferior treatment to Americans who have comprehensive health insurance. However, Britain's policy of beginning cervical-cancer screening at age 25 is in accordance with WHO guidelines, which are based on evidence that screening below that age produces false-positive results that can lead to unnecessary and dangerous surgical interventions. Overall, the WHO has found that the risks posed by false positives outweigh the benefits of earlier screening.

It's also true that Americans who have comprehensive health-insurance plans do, in some cases, have access to a greater range of cancer treatments, without waiting lists. The two British women used in the CPR ads have since told various newspapers that their views were inaccurately portrayed. While both have complaints about how cancer is treated within the NHS, they support the service as an institution. The woman who developed cervical cancer (it is now in remission) told the Times of London, "My point was not that the NHS shouldn't exist or that it was a bad thing."

That view seems typical. It's a British pastime to complain bitterly about the NHS but remain fiercely protective of its existence. A recent "We Love the NHS" Twitter campaign has received thousands of messages of support, including from British Prime Minister Gordon Brown, whose eyesight was saved by British doctors after he was involved in a rugby collision as a young man and whose son suffers from cystic fibrosis. The leader of Britain's right-wing Conservative Party, David Cameron, expressed his support for the health service on Aug. 14: "One of the wonderful things about living in this country is that the moment you're injured or fall ill — no matter who you are, where you are from or how much money you've got — you know that the NHS will look after you."

http://www.time.com/time/health/article/0,8599,1916570-2,00.html

[kban1]

The Real Issues of End-of-Life Care

By Kate Pickert

The health-care-reform bill the U.S. House of Representatives will debate when it returns from recess next month contains a provision that would have Medicare reimburse doctors for counseling patients on end-of-life care every five years. Opponents of health-care reform have latched onto the provision, claiming it would lead to forced euthanasia or "death panels" to decide whether lifesaving care for the elderly is cost-effective — despite the fact that the bill says nothing about either of these frightening issues. In fact, geriatricians — doctors trained specifically to care for the elderly — support the provision, arguing that it will encourage patients to express their own preferences rather than leave doctors and family members to guess what they want once they're no longer able to say so themselves. There are only about 7,500 geriatricians in the U.S., and one of them is Dr. Laurie Jacobs, vice chairman of the Department of Medicine at Albert Einstein College of Medicine and Montefiore Medical Center in New York City. Jacobs, who has been a practicing geriatrician since 1988, talked to TIME about why end-of-life counseling is important, when it should start and how to talk to patients and families about planning for death. (Read "If a Health-Care Bill Passes, Nurse Practitioners Could Be Key.")

Does this House provision for funding end-of-life counseling concern you?
This provision says that people should talk about what their goals of care are and what they want at the end of life. That could be anything. This is an opportunity for patients and physicians to share information with each other and come up with a plan. It is one of the special things about being a physician. You get to know your patient and what matters to them, and their inner thoughts, and their lives, and that's a very special role that most physicians value and that patients appreciate.

How important is Medicare reimbursement for doctors counseling patients about end-of-life care?
For some people one conversation is enough, and you get the whole picture and they tell you exactly what they want. For other people, 10 conversations in 10 weeks won't suffice. Coverage for this is expensive, but I think offering it is a wonderful first step in highlighting the importance of it by paying for it.

What kind of end-of-life-care counseling do you provide to your patients? How does it work?
Many patients have chronic illness and some disability or medical issue, and part of providing care is to speak with them about what to expect with their illness, what alternatives exist, and to have a conversation about what their preferences are. This shouldn't just happen at the end of life. You should get to know people and have these conversations throughout providing care. I like to talk individually with the patient if they are comfortable with that. If they are more comfortable with having family members there at the time, then I do it with the group. What I need to know from the patients is how they view their illness in the context of their life. Did they know somebody else with the same condition and therefore they have some [preconceived] idea about this? What are their values? How to they want to live their life? I also talk to them about whether there is someone who could make decisions for them if they are unable in the future.

How often do you provide end-of-life counseling?
It comes up very frequently in our practice, either with new patients who present very ill, or patients we have known for a very long time that have encountered a new serious condition that may be life-threatening. Death is not an option. Everyone is going to die at some point.

How important is for you to talk with people about options like hospice or do-not-resuscitate orders? This must be really stressful for patients and their families.
That's why it's so important to talk about values and preferences long before you are at the moment of having to do an intervention. If I have a patient who has early dementia, they still may be able to participate in a conversation about what matters to them, how they want to live their life, who they want to make decisions, and it may be 10 years before the point at which an illness happens and an intervention may be required. So, it enables me to get a sense of who they are and what's important to them. When you talk to family members when a patient cannot participate in the conversation, it's even more difficult. If it was for themselves, they might say, "Gee, I don't want to go through that," but they are afraid to limit options for family members, and I can understand that. If a proxy knows that the patient always said, "This is how I want to live my life, this is how I want my life to end," they feel very much more comfortable in making those decisions. So I think the fact that there is some national conversation about this is good in that it starts people talking to their friends and family about what is important to them.

How often does money come up with families or patients when you are talking about end-of-life care?
This is a question that medical students often ask. Health-care finance and social issues regarding health-care expenditures nationally are policy issues, and they are never to be decided at the bedside.

http://www.time.com/time/health/article/0,8599,1916656,00.html

[kban1]

Ex-executive accuses insurance giant of 'purging' customers

 
PHILADELPHIA, Pennsylvania (CNN) -- Wendell Potter says he is finished defending the insurance industry, which he says is "beholden to Wall Street."

At a hearing last week before the Senate Commerce Committee, the former vice president of corporate communications at the insurance giant Cigna testified, "I know from personal experience that members of Congress and the public have good reason to question the honesty and trustworthiness of the insurance industry."

The committee's chairman, Jay Rockefeller, D-West Virginia, told Potter, "You are better than Russell Crowe on 'The Insider,' " referring to the award-winning 1999 film about cigarette company executive Jeffrey Wi*, who blew the whistle on the tobacco industry's practices.

In his testimony and during an interview with CNN, Potter described how underwriters at his former company would drive small businesses with expensive insurance claims to dump their Cigna policies. Industry executives refer to the practice as "purging," Potter said.

"When that business comes up for renewal, the underwriters jack the rates up so much, the employer has no choice but to drop insurance," Potter said.

CNN obtained a transcript of a 2008 Cigna conference call with investors in which company executives use the term "purge."

But in an e-mail to CNN, Cigna spokesman Chris Curran denied the company engages in purging.

"We do not practice that. We will offer rates that are reflective of the competitive group health insurance market. We always encourage our clients to compare our proposed rates to those available from other carriers," Curran wrote.
Cigna had revenue of $19.1 billion in 2008, according to the company Web site.

"It was almost like an electrical jolt," Potter said.
At the event, Potter took pictures of doctors offering free health care to the uninsured.

"The volunteer doctors were seeing patients in barns, people in animal stalls," Potter said. "It changed it for me."
He says he finally decided to quit in 2007 after Cigna's controversial handling of an insurance claim made by the family of a California teenager, Nataline Sarkysian.

The Sarkysian family made repeated appeals at news conferences for Cigna to approve a liver transplant for the 17-year-old, who had leukemia. Cigna initially declined to cover the operation, then reversed its decision.
Sarkysian died hours after the company's reversal.

As Cigna's spokesman during the controversy, Potter had no role in the decision to deny coverage. But he was inundated with angry phone calls.

"After she died, my voice mail and my e-mail inbox were just filled with messages from people who were just outraged, " Potter said.

Now a senior fellow on health care for the nonpartisan watchdog group Center for Media and Democracy, Potter writes a blog on health care reform. In particular, he is keeping an eye on efforts to defeat legislation that would give Americans the option of joining a government health care plan, something he now supports.

He says he witnessed how the insurance industry torpedoed health care reform efforts during the Clinton administration.

"They conduct what I call duplicitous PR campaigns. They'll say what people want to hear," Potter says. "It's how they operate. You cannot trust these guys."

Potter is also taking aim at some of the TV commercials aired by groups opposed to changes. One such ad caught Potter's eye. Run by the conservative organization Patients United Now, the ad says that "now, Washington wants to bring Canadian-style health care to the U.S."

"Sometimes you'll see misleading information. And sometimes you'll see outright lies, like that [ad] is," Potter said, referring to the spot.

Patients United Now spokeswoman Amy Menefee disagreed. "We're not saying there's a Canada health care act of 2009," Menefee said. "It is a trend. It's trending in that direction."
 
Potter notes that the leading proposals for health care in Congress do not seek to set up Canadian-style health care in the United States. He says claims that overhauling the system would lead to "rationing" of care are missing his point.

"What we have is rationing by corporate executives who are beholden to Wall Street. And it happens all the time," Potter said

http://www.cnn.com/2009/US/07/02/insurance.purging/index.html?imw=Y&iref=mpstoryemail

[ruchir]

ruchir,  I read CLR's post and I don't see any personal references to you or your style of posting except one inoffensive one, but your post seems to be so full of them, you seem to start every paragraph with a dig at the other poster. WHY?

It is easy to start a thread like below

http://www.cricketvoice.com/cricketforum2/index.php/topic,21515.msg283836.html#msg283836

but much much harder to follow it in letter and spirit. I hope you will follow your own suggestion in good spirit. Now, I hope you don't turn around and claim that your suggestion does not apply to accusing the other poster  of " racist, hatred driven mentality"

Can you quote any specific portion where I have ridiculed CLRJ personally, except asking questions?

[ruchir]

Ruchir,

I do not see any reason to reply to your post. It is full of subjective hyperboles, patent untruths, and very little substantive reasoning. I cited the number of uninsured was between 40 to 50 million because it was 40 million several years ago. Your break up (20+10+10) was breathtaking. You shot Krugman without any solid refutation of his arguments. The list goes on....

As for democrats. You have to go to the cyber world in order to fetch flimsy evidence. On the other hand, irrational white beef country anger in real life is well and widely documented. As is the rise in hate group memberships.

That's a very easy out when you can't debate substantively. Nothing that I have said is hyperbole. In fact, in my previous posts I have given examples and link, something that you conveniently forgot to do in your post.

My breakup of 40 million is breath-taking? Sure it will look like that to you because it is true. You can check it out yourself.

How is my shooting Krugman any different from his shooting Palin. Can you please explain that to me? Krugman says nothing substantive in his article except running down Palin. He has absolutely nothing substantive. If he has, please point it out to me.

So, you can think of anti-Obamacare feelings as whatever you want to. You are free to do that.

[flute]

ruchir,  I read CLR's post and I don't see any personal references to you or your style of posting except one inoffensive one, but your post seems to be so full of them, you seem to start every paragraph with a dig at the other poster. WHY?

It is easy to start a thread like below

http://www.cricketvoice.com/cricketforum2/index.php/topic,21515.msg283836.html#msg283836

but much much harder to follow it in letter and spirit. I hope you will follow your own suggestion in good spirit. Now, I hope you don't turn around and claim that your suggestion does not apply to accusing the other poster  of " racist, hatred driven mentality"

Can you quote any specific portion where I have ridiculed CLRJ personally, except asking questions?

see below..your entire post is replete with personal taunts..

I think you should come out of your racist and hatred driven mentality against anti-Obama crowd.

[RicePlateReddy]

How is my shooting Krugman any different from his shooting Palin. Can you please explain that to me? Krugman says nothing substantive in his article except running down Palin. He has absolutely nothing substantive. If he has, please point it out to me..

He made these solid, relevant, points in the brief extract that CLRJ posted:

1. "The provision requiring that Medicare pay for voluntary end-of-life counseling was introduced by Senator Johnny Isakson, Republican — yes, Republican — of Georgia, who says that it’s “nuts” to claim that it has anything to do with euthanasia."

2. "And not long ago, some of the most enthusiastic peddlers of the euthanasia smear, including Newt Gingrich, the former speaker of the House, and Mrs. Palin herself, were all for “advance directives” for medical care in the event that you are incapacitated or comatose. That’s exactly what was being proposed — and has now, in the face of all the hysteria, been dropped from the bill."

Krugman is a nobel prize winner and a rare intellect, often a dissenter, as we have seen in his shrills about the financial handling.

Do you truly not see this sensationalistic catering to the least common denominator through mythical assertions, exemplified by Palin?

IMO there are some serious and valid criticisms to the health care proposal, but these will never make the sound bytes and/or galvanize the "base". The GoP (no friend of KoP) will continue its drumbeat of scary, misleading portrayals. The Dems will be busy battling these for public perception and because , gosh, the CNN Opinion Research Poll shows a lack of faith/trust. The true issues that require extensive debate and closer scrutiny, go for a six!

Whatever requires a paragraph to explain with pros and cons and numbers and growth rates will lose the attention span of 90% of America. So any criticism has to be boiled down to sensationalistic, misdirected junk that comfortably fits into a tweet: "omg socialists kill grandma".

[ruchir]

ruchir,  I read CLR's post and I don't see any personal references to you or your style of posting except one inoffensive one, but your post seems to be so full of them, you seem to start every paragraph with a dig at the other poster. WHY?

It is easy to start a thread like below

http://www.cricketvoice.com/cricketforum2/index.php/topic,21515.msg283836.html#msg283836

but much much harder to follow it in letter and spirit. I hope you will follow your own suggestion in good spirit. Now, I hope you don't turn around and claim that your suggestion does not apply to accusing the other poster  of " racist, hatred driven mentality"

Can you quote any specific portion where I have ridiculed CLRJ personally, except asking questions?

see below..your entire post is replete with personal taunts..

I think you should come out of your racist and hatred driven mentality against anti-Obama crowd.

Guilty as charged, my friend. Sorry.

[kban1]

Nothing that I have said is hyperbole

 

Here are your pronouncements (in italics & bold)


1. About killing the grandmother

False -- read article above. What Obama's advisers believe personally (assuming your interpretation is correct, which is highly doubtable) is irrelevant to the discussion about the legislative bill. For the record, this provision was introduced by a Republican congressman from Georgia.


4. Bill available to read?? ?? ?? What is this guy on? This is the same president who has not revealed his educational records and his medical records till date. And Dailykos expects to see the health bill ASAP?    ;DDelay is what Obama is looking for. He know that if people get a chance to read the bill, even moderate Dems will turn against it. So why would he give people enough time to read it? Isn't that why he was rushing it in August to begin with? Just like he rushed his stimulus bill saying that if it is not passed, unemployment will rise to 8%... and after it was passed unemployment is up to nearly 10%? People still believe this guy? It is simply amazing.....   

False -- here are the links to the House and Senate versions of the Bill. Please read.

House Bill: http://i2.cdn.turner.com/cnn/2009/images/08/14/house.health.care.bill.pdf
Senate Bill: http://i2.cdn.turner.com/cnn/2009/images/08/14/senate.health.care.bill.pdf


5. Abortions -- so Factcheck already says that new health plan will subsidize abortions but Dailykos says it won't and we should believe Dailykos... ?? ?? Why?

False -- read below (included in quotes to distinguish)

All Things Considered: Abortion In The Health Care Bills: What's True?

August 11, 2009

Melissa Block speaks with Robert Farley, staff writer for Politifact.com, about what is being said regarding abortion in the health care bills before Congress, and whether the claims are true or not.


MADELEINE BRAND, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Madeleine Brand.

MELISSA BLOCK, host:

And I'm Melissa Block.

The fury over health care continues to boil over at town hall meetings. Senator Arlen Specter today got an earful from constituents in Lebanon, Pennsylvania, including this question.

Unidentified Woman: I did not want to pay on a health care plan that includes the right for woman to her unborn baby.

(Soundbite of applause)

Unidentified Woman: Is it true that this plan is in the health care bill?

(Soundbite of applause)

BLOCK: Senator Specter pointed out that the Senate has not yet voted on a bill. One idea he said, is to have options.

Senator ARLEN SPECTER (Democratic, Pennsylvania): If you want to have a health care plan, which does not have payment for abortions, you can have that one where you'll not be charged for somebody who has an abortion. Now if you want a different health care plan, an option where you can have payment for abortion and you pay for it, because there'd be a little bigger premium, you have the choice of being in one plan or the other.

BLOCK: We're going to truth-squad this issue now with Robert Farley, who's written about this for the nonpartisan fact-checking Web site politifact.com. Robert, welcome to the program.

Mr. ROBERT FARLEY (Staff Writer, politifact.com): Oh, thanks.

BLOCK: And let's talk about the bill that has been approved in the House. It includes an amendment from Democratic Congresswoman Lois Capps in trying to make the bill abortion neutral. First of all, in the public plan under that bill, is abortion coverage required?

Mr. FARLEY: It's not required but it is allowable.

BLOCK: Okay. So not prohibited, not mandated.

Mr. FARLEY: That's right. There are lots of versions, as you know, of the health care plan that are kicking around in Congress. But interestingly, none of them initially even mentioned the word abortion until this latest version took on this issue last week.

BLOCK: We should explain that the public plan that's being discussed for health care is not like Medicaid. It's not government-funded, but there would be some government subsidies for low-income people to buy insurance. So that does bring up the money question that that questioner in Pennsylvania was alluding to. Would taxpayer dollars, in fact, be paying for abortion through subsidies to those people who are insured?

Mr. FARLEY: Well, this Capps Amendment seeks to answer that question by segregating the money that would be used to cover abortions. It would specifically prohibit federal dollars from being used to subsidize abortions. Any of that money that would be used for abortion coverage would have to be paid through the premiums paid by an insured person.

BLOCK: So not from government funding.

Mr. FARLEY: That's the idea.

BLOCK: Robert, you heard Senator Specter's explanation there of the two options given to people - truth-squad that for us, did he have it right?

Mr. FARLEY: Yes. According to the Capps Amendment, there would be options available for people who wanted to have abortion coverage, as well as for those who do not. In fact, it's required that every region offer one of each type plan.

BLOCK: One that offers it and one that does not.

Mr. FARLEY: Exactly, yes.

BLOCK: You know, abortion rights advocates point this out, that if you look at private insurance plans now most of them cover abortion. And they say, look, if you take that away, you will be taking benefits away from people who get them now.

Mr. FARLEY: Exactly. Studies have shown that somewhere between 45 and 80 percent of the women who have health care coverage through their companies currently get abortion coverage. And so, the argument then is that if the government plan were to disallow that, you would essentially be stripping that coverage from people who already - who currently get that.

BLOCK: Well, when you put the statements that are being made out there through your Truth-O-Meter, as you call it on politifact.com, where do you end up on this question of abortion and plans for heath insurance overhaul?

Mr. FARLEY: Well, we specifically looked at the question of whether federal tax dollars will be used to subsidize abortions. And that kind of language isn't in any of the versions of the plan that are kicking around in Congress. And specifically, the House version, with the Capps Amendment, states that no federal funds could be used to subsidize abortions. And so we ruled that false.

BLOCK: Robert Farley, thanks very much.

Mr. FARLEY: Well, thank you.

BLOCK: Robert Farley is the staff writer for politifact.com.

6. Access to account -- Oh... thank god. What a relief that Obama has now decided to remove the provision of accessing accounts to take money. But just tell me this - why was this provision in the bill to begin with? Yes, why was it in the bill? Had Obama been successful in ramming the bill through without being read, this provision would have passed. What a shame. Sometimes I doubt if Obama ever feels any shame in what he is trying to do and keeps getting caught in the act. I think not.

False -- read article above


7. Illegal alien - If Dailykos believes that Obama will let go of his main voting block (the latinos) so easily, good for them.

False -- read article above


Why do medicines cost more in US than world -- who invents all these medicines, CLRJ? In which nation does most of the medical and medicinal innovations and discoveries happen? In USA. It is the US companies that come out with most new medicines. Companies all over the world simply produce GENERIC medicines. That's why they are cheaper over there. Generic drugs are cheaper in US too. But for 10 years after a drug is approved, the pharma company has the only rights to sell it. It has to recoup the billions of dollars it spends in research and development of the drug. That's why it is costly. It is simple math.

False --

New drugs enjoy patent protection for 17-20 years, which is when they recuperate their R&D costs. During this time, generic brands CANNOT duplicate these brand names in any country with strong enorceable IPR laws like UK and Canada.

The reason the same drugs are much cheaper in UK and Canada is because Pharma companies do not and cannot command the prices they charge in the US in those countries.

Why ? --because those countries --their national health boards that negotiate on behalf of their health systems tell the drug companies flat out that this is not the price we are willing to pay for these drugs, this is what we will pay. The drug companies then lower their prices --there is a pricing mechanism at work.

The reason this does not happen in the US is because drug companies consistently lobby the Congress to prevent any sort of curb /control on prices.

Thus, we have the ironical situation where the drug companies charge more in the US, and almost half of that in UK, and Canada even after accounting for shipping costs and despite the fact that the US is the largest pharma market in the world.


NO.... American system in better than Canadian.

Not when measured against quantifiable metrics.

"In the United States, every person spends on average $6,714 for health care. That's significantly higher than in the United Kingdom, where $2,760 per person is spent; or in France, where the cost is $3,449 per person; or in Canada, where medical costs are $3,678 per person, according to the Organisation for Economic Co-operation and Development"

"For example, the United States ranks 50th in life expectancy, and 180th infant mortality (meaning 179 countries have higher infant mortality rates such as Angola and Turkey and 43 countries have lower infant mortality rates such as France and Sweden) according to the CIA World Factbook."

http://www.cnn.com/2009/HEALTH/06/18/ep.health.reform.basics/index.html?iref=newssearch

WHO ranks US at No 37, CAnada at 30, abd UK at 18  (http://www.photius.com/rankings/healthranks.html)
Rank       Country 

1         France
2         Italy
3         San Marino
4         Andorra
5         Malta
6         Singapore
7         Spain
8         Oman
9         Austria
10        Japan
11        Norway
12        Portugal
13        Monaco
14        Greece
15        Iceland
16        Luxembourg
17        Netherlands
18        United  Kingdom
19        Ireland
20        Switzerland
21        Belgium
22        Colombia
23        Sweden
24        Cyprus
25        Germany
26        Saudi Arabia
27        United  Arab  Emirates
28        Israel
29        Morocco
30        Canada
31        Finland
32        Australia
33        Chile
34        Denmark
35        Dominica
36        Costa Rica
37        United States of America
38        Slovenia
39        Cuba
40        Brunei
41        New Zealand
42        Bahrain
43        Croatia
44        Qatar
45        Kuwait
46        Barbados
47        Thailand
48        Czech Republic
49        Malaysia
50        Poland
51        Dominican Republic
52        Tunisia
53        Jamaica
54        Venezuela
55        Albania
56        Seychelles
57        Paraguay
58        South     Korea
59        Senegal
60        Philippines
61        Mexico
62        Slovakia
63        Egypt
64        Kazakhstan
65        Uruguay
66        Hungary
67        Trinidad and Tobago
68        Saint     Lucia
69        Belize
70        Turkey
71        Nicaragua
72        Belarus
73        Lithuania
74        Saint Vincent  and the   Grenadines
75        Argentina
76        Sri  Lanka
77        Estonia
78        Guatemala
79        Ukraine
80        Solomon   Islands
81        Algeria
82        Palau
83        Jordan
84        Mauritius
85        Grenada
86        Antigua   and Barbuda
87        Libya
88        Bangladesh
89        Macedonia
90        Bosnia-Herzegovina
91        Lebanon
92        Indonesia
93        Iran
94        Bahamas
95        Panama
96        Fiji
97        Benin
98        Nauru
99        Romania
100       Saint Kitts and Nevis
101       Moldova
102       Bulgaria
103       Iraq
104       Armenia
105       Latvia
106       Yugoslavia
107       Cook Islands
108       Syria
109       Azerbaijan
110       Suriname
111       Ecuador
112       India
113       Cape Verde
114       Georgia
115       El   Salvador
116       Tonga
117       Uzbekistan
118       Comoros
119       Samoa
120       Yemen
121       Niue
122       Pakistan
123       Micronesia
124       Bhutan
125       Brazil
126       Bolivia
127       Vanuatu
128       Guyana
129       Peru
130       Russia
131       Honduras
132       Burkina   Faso
133       Sao Tome and Principe
134       Sudan
135       Ghana
136       Tuvalu
137       Ivory Coast
138       Haiti
139       Gabon
140       Kenya
141       Marshall Islands
142       Kiribati
143       Burundi
144       China
145       Mongolia
146       Gambia
147       Maldives
148       Papua New Guinea
149       U*a
150       Nepal
151       Kyrgystan
152       Togo
153       Turkmenistan
154       Tajikistan
155       Zimbabwe
156       Tanzania
157       Djibouti
158       Eritrea
159       Madagascar
160       Vietnam
161       Guinea
162       Mauritania
163       Mali
164       Cameroon
165       Laos
166       Congo
167       North Korea
168       Namibia
169       Botswana
170       Niger
171       Equatorial Guinea
172       Rwanda
173       Afghanistan
174       Cambodia
175       South     Africa
176       Guinea-Bissau
177       Swaziland
178       Chad
179       Somalia
180       Ethiopia
181       Angola
182       Zambia
183       Lesotho
184       Mozambique
185       Malawi
186       Liberia
187       Nigeria
188       Democratic Republic of   the Congo
189       Central   African   Republic
190       Myanmar


Bottomline: The US spends more per capita, more as a percent of GDP, and ranks lower (compared to UK & Canada).

[RicePlateReddy]

The US spends more per capita, more as a percent of GDP, and ranks lower (compared to UK & Canada).

True, that. The increased costs are primarily due to:

1. Insurance companies optimizing their payout at the detriment of the patient.

-- It has simply  spiraled out of control here in the last decade. These guys are the worst IMO.

2. Lawyers and malpratice claims straining the systems.

-- A pity nothing is being done about this. I read a great suggestion from my favorite medical expert - Atul Gawande. He suggested contributing a slightly smaller amount from doctor's pay towards a "patient relief fund", monitored by doctors, that is run in a way so pay-ins equal pay-outs. Have an Appeals Board comprised predominantly of doctors addressing malpractice and negligence grievances. Make even more payouts, a few perhaps even compassionate no-fault, and eliminate the lawyers.

3. Pharma companies making a killing.

-- However this allows them to have sizeable R&D budgets and undertake extensive studies and trials. It has worked very well. With all its ills, the US is by far the leader in new drug research and the ultra-capitalistic system has paid off. With 2 above, the class action law suits against pharmas can also be reduced and better price handling (as you have mentioned, kban) will also reduce costs.

4. Doctors are paid too much.

-- Limited truth in this. The doctors complain that for the hours they put in and the extensive course of study, they have to be paid what they are paid, and this also rings true. However, both angles can be addressed.

Today the doctor education and training is 4 years undergrad + 4 years med school + 3 years residency, for almost everyone, not to count fellowships for specialization. A min of 8 years of loans followed by 3+ years of $30k salary. The 4 years of undergrad education should be reduced -- as we know in India, it takes 5.5 years for an MBBS, and it is not clear that all 4 years of undergrad education helps the doctors much.

Secondly, the AMA can increase its quota of doctors across the universities. I don't buy that quality decreases if the number is increased a little. The supply pool can expand - it will lead to natural competition, and the number of work hours argument (especially during residency) can be reduced.

[kban1]

2. Lawyers and malpratice claims straining the systems.

-- A pity nothing is being done about this. I read a great suggestion from my favorite medical expert - Atul Gawande. He suggested contributing a slightly smaller amount from doctor's pay towards a "patient relief fund", monitored by doctors, that is run in a way so pay-ins equal pay-outs. Have an Appeals Board comprised predominantly of doctors addressing malpractice and negligence grievances. Make even more payouts, a few perhaps even compassionate no-fault, and eliminate the lawyers.

I like the solution that you are proposing.

However, the following facts are worth noting as to the magnitude of this problem.

1) Malpractice issues directly affect 1-2% of our healthcare costs. A negligible amount in the overall picture.

2) Indirectly --and by indirectly I mean physicians ordering a battery of tests to avoid the chance of malpractice, the costs are higher. The estimate for direct and indirect costs has been 4-6% of total healthcare costs, which if all dollars could be applied on a 1:1 basis, would help provide insurance to about 4 million people.

Unfortunately, despite the point noted in point 2 above, the states that have instituted tort reform by capping the judgment amounts, have seen no decrease in healthcare costs. Neither have malpractice costs come down.

At this point the medical-insurance -medicine combine is a trillion dollar industry (much like the military-industrial complex in the US) and I dont see any how these steps, as miniscule as they are compared to the overall health care costs, will make a difference or bring about any self regulation (oxymoron) in costs --especially in light of the the no change seen in states that have effected tort reform wrt malpractice suits.

At best, this is nothing but a red herring that the insurance industry regularly puts out as a means to distract debate and obfuscate the real issues --their own bottomline.

Which is exactly why, supposed champions of competition and capitalism are so much against the competition that an alterantive public option would bring about. They decry it by calling it socialism, whereas it is anything but. Competition is a market solution, not a socialistic one --even competition brought about by the government.

[kban1]

Big Pharma Spends More On Advertising Than Research And Development, Study Finds

ScienceDaily (Jan. 7, 2008) — A new study by two York University researchers estimates the U.S. pharmaceutical industry spends almost twice as much on promotion as it does on research and development, contrary to the industry’s claim.


--------------------------------------------------------------------------------
The researchers’ estimate is based on the systematic collection of data directly from the industry and doctors during 2004, which shows the U.S. pharmaceutical industry spent 24.4% of the sales dollar on promotion, versus 13.4% for research and development, as a percentage of US domestic sales of US$235.4 billion.

The research is co-authored by PhD candidate Marc-André Gagnon, who led the study with Joel Lexchin, a long-time researcher of pharmaceutical promotion, Toronto physician, and Associate Chair of York’s School of Health Policy & Management in the Faculty of Health.

 “In our paper, we make the case for the need for a new estimate of promotional expenditures by the U.S. pharmaceutical industry,” says Gagnon. “We then explain how we used proprietary databases to construct a revised estimate and finally, we compare our results with those from other data sources to argue in favor of changing the priorities of the industry.”

The study is important because it provides the most accurate image yet of the promotional workings of the pharmaceutical industry, says Lexchin.

The authors examined the 2004 reports of IMS Health (IMS) and CAM Group (CAM), two international market research companies that provide the pharmaceutical industry with sales/marketing data and consulting services. IMS obtains its data by surveying pharmaceutical firms, while CAM surveys doctors, which explains important discrepancies in the data they provide.

The researchers used 2004 as the comparison year because it was the latest year in which information was available from both organizations.

CAM reported total promotion spending by the U.S. pharmaceutical industry as US$33.5 billion in their 2004 report, while IMS reported US$27.7 billion for the same year. The authors observed, however, important differences in figures according to each promotion category. By selectively using both sets of figures provided by IMS and CAM, in order to determine the most relevant data for each category, and adjusting for methodological differences between the ways IMS and CAM collect data, the authors arrived at US$57.5 billion for the total amount spent on pharmaceutical promotion in 2004. The industry spent approximately US$61,000 in promotion per physician during 2004, according to Gagnon.

“Even our revised promotion figure for 2004 is apt to be understated, as there are other promotion avenues that are not likely to be taken into consideration by IMS or CAM, such as ghost-writing and off-label promotion,” says Gagnon. “Also, seeding trials, which are designed to promote the prescription of new drugs, may be allocated to other budget categories.”

IMS and CAM data were used for comparison purposes because data from both are publicly available, both operate globally and are well regarded by the pharmaceutical industry, and both break down their information by different promotion categories. Most importantly, the two organizations use different methods for gathering their data, allowing the researchers to triangulate on a more accurate figure for each promotion category.

The authors focused their study on the United States because it is the only country in which information is available for all of the major promotion categories, and it is also the largest market for pharmaceuticals in the world, representing approximately 43% of global sales and global promotion expenditures.

Gagnon’s and Lexchin’s new estimate of total promotional costs is also consistent with estimates of promotional spending by the U.S. pharmaceutical industry from other sources they scrutinized, including reports by Consumers International, a non-governmental organization which represents consumer groups and agencies worldwide; Office of Technology Assessment, which extrapolated results from the cost structure of Eli Lilly, a global pharmaceutical company; Marcia Angell, former editor-in-chief of the New England Journal of Medicine, who extrapolated data from Novartis Inc., a company which distinguishes marketing from administration expenditures in its annual reports; and the United Nations Industrial Development Organization.

As well, note the authors, the number of meetings for promotional purposes has dramatically increased in the U.S. pharmaceutical industry, jumping from 120,000 in 1998 to 371,000 in 2004, further supporting their findings that the U.S. pharmaceutical industry is marketing-driven.

Thus, the study’s findings supports the position that the U.S. pharmaceutical industry is marketing-driven and challenges the perception of a research-driven, life-saving, pharmaceutical industry, while arguing in favour of a change in the industry’s priorities in the direction of less promotion, according to Gagnon and Lexchin.

Their study, “The Cost of Pushing Pills: A New Estimate of Pharmaceutical Promotion Expenditures in the United States,” appears in the January 3, 2008 issue of PLoS Medicine, an online journal published by the Public Library of Science.

http://www.sciencedaily.com/releases/2008/01/080105140107.htm

[RicePlateReddy]

Here is Gawande's great article on health care cost. A very long read (hence not cutting and pasting), but well worth reading in its entirety.

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

[keep-it-cool]

This part, I can vouch for.

Nothing that I have said is hyperbole

 

Here are your pronouncements (in italics & bold)

Why do medicines cost more in US than world -- who invents all these medicines, CLRJ? In which nation does most of the medical and medicinal innovations and discoveries happen? In USA. It is the US companies that come out with most new medicines. Companies all over the world simply produce GENERIC medicines. That's why they are cheaper over there. Generic drugs are cheaper in US too. But for 10 years after a drug is approved, the pharma company has the only rights to sell it. It has to recoup the billions of dollars it spends in research and development of the drug. That's why it is costly. It is simple math.

False --

New drugs enjoy patent protection for 17-20 years, which is when they recuperate their R&D costs. During this time, generic brands CANNOT duplicate these brand names in any country with strong enorceable IPR laws like UK and Canada.

The reason the same drugs are much cheaper in UK and Canada is because Pharma companies do not and cannot command the prices they charge in the US in those countries.

Why ? --because those countries --their national health boards that negotiate on behalf of their health systems tell the drug companies flat out that this is not the price we are willing to pay for these drugs, this is what we will pay. The drug companies then lower their prices --there is a pricing mechanism at work.

The reason this does not happen in the US is because drug companies consistently lobby the Congress to prevent any sort of curb /control on prices.

Thus, we have the ironical situation where the drug companies charge more in the US, and almost half of that in UK, and Canada even after accounting for shipping costs and despite the fact that the US is the largest pharma market in the world.

A) Most new drugs are not necessarily invented in the US. Around 50% of all new drugs are inlicensed mainly from Japanese & European companies. The invention happens elsewhere. It is a fact that Big Pharma companies have the financial muscle to carry out the expensive development process. But this is true of a GSK Plc, Astra Zeneca & Novartis as well - these are not US companies. But, yes, the fact that they make a lot of money in the US helps.

B) The higher pricing in the US can be attributed to the patented v/s generics factor only when comparing with companies such as India or other emerging economies. If anything, the patent law is even more stringent in Western Europe - for instance, a generic company is able to start working on a patented product much later in Europe than in the US. Despite this, prices are lower in Europe than in the US. There are two factors at work here:

a) The US consumer has a mindset that anything new (patented) is better than older products (or generics) - this is scientifically false

b) The US consumer can afford to have this mindset because he does not pay out of pocket.

While European consumers also have insurance or government support, the payors out there are much more active in determining pricing. For instance, as Kban said, the NHS is very active in the UK - negotiates hard with Big Pharma, does not take on products just because they are new. Surely, the NHS is better equipped to decide / negotiate than individuals. In Germany, government regulation has allowed insurance companies to ask for tenders from companies. In one shot, the entry barriers that helped incumbents have broken down ...new companies do not have to build up a huge sales force and entice doctors with incentives, free samples etc to prescribe their products. If the drug regulator decides that your product is the same therapeutically as a branded one, you are free to tender. It automatically brings prices down without compromising on quality of medicines or healthcare. If anything, the funds left over can be used to improve other aspects of healthcare (medicines are only one small part of overall healthcare spend).

[keep-it-cool]

Why do medicines cost more in US than world -- who invents all these medicines, CLRJ? In which nation does most of the medical and medicinal innovations and discoveries happen? In USA. It is the US companies that come out with most new medicines. Companies all over the world simply produce GENERIC medicines. That's why they are cheaper over there. Generic drugs are cheaper in US too. But for 10 years after a drug is approved, the pharma company has the only rights to sell it. It has to recoup the billions of dollars it spends in research and development of the drug. That's why it is costly. It is simple math.

Further to my previous post, here is a study.

It found that U.S. companies actually discovered fewer new drugs than you’d expect, given their proportion of R&D spending. Europe brought more new treatments to market than would have been expected from its proportion of R&D dollars. And Japanese drug makers were the most productive.

[Cover Point]

there are a few key issues that really drive costs up in the US and unless they are addressed nothing will happen

1) lack of transparancy of the key costs of medical care.
    When i go to see a doctor, I never see what his "fee" is going to be. I rely on paying my $10 co pay and then expect the insurance company to manage the difference. So I as a consumer have no incentive to ask my doctor for a fair price. The doctors inturn charge a large sum .... maybe $200 for a 15 min visit and then it is between the insurance company and them to see what fraction gets paid out. In such cases if someone who may not want to have insurance or does not have insurance wants to go and see a doctor ... he has to pay the $200 ... while the true cost the doctor should be charging must be a fraction (price he would get from the insurance co).

When i go to buy a car for example, i dont automatically buy a beamer .... since i have to pay the full amount. More apt comparison would be that when we go to buy over the counter drugs .... i have a choice to pay premium for name brand ibuprofin (Advil) or just buy the store brand for a fraction. Some chose to lower costs while others want brand name.

Such choice does not exist in selecting a doctor. For me the ONLY thing I want to see if the "perception" of the best doctor.

2) Malpractice . Well documented ... and something absolutely has to be done!!!

3) doctors ability to diagnose vs them doing just unlimited number of tests.

4) I am aghast at the bills you see from hospitals. When my daughter was born the bill (billed to the insurance company) was $22000 ... that was 4 years ago.  That was for a 2 day stay at the hospital and all normal and regular delivery.

I can guarantee you ... if people actually had to pay a part of the cost ... they would check and ensure that they go to a place with more competitve cost.

I went to the ER a couple of months ago after being hit by a ball on the face. (thanks to Dlee for coming to help). I needed a few stitches ..... but the hospital billed the insurance close to $2500 for something as small as that. This after they botched the stitches and i had to go back to get t hem redone.

again ... if I knew the exact cost .... I would shop around ... just as people do in India but since the costs are hidden they can charge anything they want.