Obama's Townhall in Portsmouth, New Hampshire

[Florestan]

Gentlemen, as I am not American, please enlighten me: what is, in a nutshell, this reform plan? What is it supposed to do specifically?

[Coopmv]

No it isn't.  The economic considerations are certainly important, but the basic desire for reform is to allow every American to have a decent insurance plan and access to medical care.

Did you see the words in italics?  I did not make any blanket statement.

[MishaK]

No it isn't.  The economic considerations are certainly important, but the basic desire for reform is to allow every American to have a decent insurance plan and access to medical care.

Bingo!

Franco,  You have made some very cogent arguments.  I have no doubt O Mensch will call you a right-wing radical

As you could have seen from my response above, I did not do anything of the sort. But once again don't let reality get in your way.

He somehow thinks Fortune does not receive any corporate money.  

When did I say anything that stupid? You claimed Business Week broke the Enron scandal. I corrected your misperception. I never claimed Fortune does not receive corporate money (would be kind of oxymoronic given the title of the rag).

[Franco]

Not only is it not "un-American" to protest government policy it is a right protected in the Constitution.  I seem to remember Cindy Sheehan being a hero of the Left, along with all the other demostrators who called Bush every name in the book - but the Dems were all for that protest.  

There is no crisis, what we don't need is a massive government program that will end up controlling nearly 30% of the economy, but pragmatic regulation of the insurance (end to denying coverage to people with pre-existing conditions) and drug industries (I oppose big-pharma spending billions on marketing drugs we don't need for phantom diseases they attempt to convince us we have - but will induce side effects that will cause real damage to your health).  And to inject more market forces into the equation.  The only way to control costs is to force plans and doctors to compete for patients, not divorcing people from the payment and care options.

The United States is not Europe and hopefully we will not replicate the European economic model.  The only way a governmet run heath care program can save costs is to deny care.  Millions of Canadians leave their country every year to seek treatment they are either denied or on endless waiting lists.  Dialysis is not such an elective treatment, but is routinely denied to elderly patients.  There is no way Obama's plan can do what he claims and not run up huge costs, this according to the CBO (I suppose another biased voice) - or to deny care.

Either way, this is not change I wish to believe in.

[Todd]

I don't get all the extreme fuss over the healthcare "reform" that's being discussed.  It's already being watered down from the more grandiose ideas originally espoused by Obama to be more or less insurance reform only.  I've not read, and will not read, the entire mass of legislation, but from what I've read about it, from a variety of sources, cost control is being jettisoned in part or in total, which is a shame, because that is a bigger problem.

The public option will compete with private insurance, but how effective will it be?  I don't see how it will displace employer paid care, and it most certainly will not displace other government options.  It will require a tax increase, which will have electoral implications for Obama (his "Read My Lips" equivalent?), and if it mandates coverage in any way, it will also result in a coercive transfer of income and wealth from the voluntarily uninsured (mostly young, indestructible types) to the already covered (mostly the older and more infirm), but that's going to be true of any healthcare reform.  

This strikes me as similar to the Bush Medicare Drug program as well; its supporters are claiming that it will do great, or at least good, things, while the cost is not being adequately discussed.  Why do I get the feeling that a another "shocking" revelation about costs will be forthcoming from either the administration or CBO only after any legislation has passed?  Perhaps part of the legislation will deal with overall spending growth effectively as well – and if it passes, I certainly hope that is the case – but if it doesn't, even more substantial changes will be needed later.  Maybe that is part of the strategy?  

Two other things have struck me during this debate.  First, Obama is not a particularly effective leader.  He's leaving too much to Congress rather than presenting a detailed framework and pushing it.  I think the extreme statements that he's handing everything over to Congress are overblown, but he isn't offering the type of leadership he should.  (That applies in other areas, too.)  The silly comparisons to Roosevelt from months ago have rightly faded away.  Second, the cynical political and economic interests opposed to reform have shown themselves to be ridiculous in how far they will fan flames, and the idiots (there's no other word for them) who engage in shouting and threatening people at various forums are embarrassing and hurting the Republican party.  (Not all of them are Republicans, no doubt, but a lot of them are.)

BTW, we've been talking about Obama's health care proposal at least since the election and we have time until after the summer recess to inspect it even more, so it is disingenuous to talk about anything being 'rushed' without 'due diligence'.

Arguments that the plan is being rushed are accurate.  Discussing the "proposal" since the election is simply not enough time for such a massive set of changes.  This is a multi-trillion dollar effort, and adequate discussion and vetting of all issues should take years.  You imply that you know all about the "proposal," which is odd because no one really does.  It has changed since last year and will continue to morph in order to pass, and it will probably be watered down some more.  I've been involved in due diligence on investments in the millions that have taken longer than what's happening now.  Given the magnitude of health care and the implications of reform, a few more months, at least, can't hurt.

[Coopmv]

Bingo!

When did I say anything that stupid? You claimed Business Week broke the Enron scandal. I corrected your misperception. I never claimed Fortune does not receive corporate money (would be kind of oxymoronic given the title of the rag).

It showed your ignorance in business matters when you mentioned Fortune as if it is a totally impartial publication.  I would have bought your argument had you quoted NPR or any other entity that receives no corporate money.

[Franco]

No it isn't.  The economic considerations are certainly important, but the basic desire for reform is to allow every American to have a decent insurance plan and access to medical care.

We already have a system that allows every American to have a decent insurance plan and access to medical care.  A lot of people (esp. young people who perceive themselves and ten feet tall and bullet proof) figure they'd rather spend their money a different way.

[MishaK]

Gentlemen, as I am not American, please enlighten me: what is, in a nutshell, this reform plan? What is it supposed to do specifically?

In a nutshell, vast numbers of Americans today are uninsured or underinsured. Those who are insured are often denied coverage on specious grounds by their insurers. Many American families go bankrupt due to health care expenses after a sudden major illness or injury strikes. Most Americans receive health insurance through their employers due to a tax benefit that favors this scheme. The financial incentives in the privately run health care systems are such that it is often more profitable for providers to prescribe more expensive but not always necessary treatment. Those who do not receive insurance through their employers can try to buy insurance privately, but often find it prohibitively expensive if they qualify at all, or are simply turned down due to age or any health risks or past histories at all. Those who are uninsured and those who are denied coverage or have excessively high co-pays imposed by their insurers often don't get treatment, which in turn keeps driving up the cost of the whole system as illnesses go untreated and preventive care is not administered to large numbers of the population, which then ends up being vastly sicker in the end, requiring more expensive emergency or long term care. Americans above age 65 are covered by a government-plan called Medicare, but due to legislation during the last administration, Medicare lost some of its ability to bargain for better prices with pharmaceutical companies. The combination of all of the above is the cause of the US having the most expensive health care by far, spending more on health care as a proportion of GDP but getting the lowest life expectancy in return among most, if not all OECD countries, while leaving millions without health care coverage at all.

There have been some failed attempts at addressing this moral injustice and financial disaster (most ignominiously the disastrous failure of "Hillarycare" in the first term of the Clinton administration), but essentially this cancer has been allowed to metastasize. The basic proposal right now envisions a limited public option, not a true single-payer system as in most of Europe, but one that would provide coverage to most uninsured Americans and would provide a cheaper alternative to many employer-plans offered to small business. Any American who enjoys good health insurance through the employer or in the private market would be completely free to keep that coverage. In addition there would be regulations that would prevent private insurers from denying coverage and which would require private insurers to accept all customers regardless of age or prior health history. Naturally, all this has the pharmaceutical and insurance companies up in arms as it will no doubt reduce their massive profit margins by requiring them to insure more costly sicker and older individuals, eliminating their ability to deny coverage to unfavorable customers and siphoning off a percentage of their customers who would take the public option over the private ones. Gigantic sums of money are being thrown by the industry at the media and politicians in order to prevent the emergence of a system that would still lag behind what every European takes for granted.

[Coopmv]

Not only is it not "un-American" to protest government policy it is a right protected in the Constitution.  I seem to remember Cindy Sheehan being a hero of the Left, along with all the other demostrators who called Bush every name in the book - but the Dems were all for that protest.  

There is no crisis, what we don't need is a massive government program that will end up controlling nearly 30% of the economy, but pragmatic regulation of the insurance (end to denying coverage to people with pre-existing conditions) and drug industries (I oppose big-pharma spending billions on marketing drugs we don't need for phantom diseases they attempt to convince us we have - but will induce side effects that will cause real damage to your health).  And to inject more market forces into the equation.  The only way to control costs is to force plans and doctors to compete for patients, not divorcing people from the payment and care options.

The United States is not Europe and hopefully we will not replicate the European economic model.  The only way a governmet run heath care program can save costs is to deny care.  Millions of Canadians leave their country every year to seek treatment they are either denied or on endless waiting lists.  Dialysis is not such an elective treatment, but is routinely denied to elderly patients.  There is no way Obama's plan can do what he claims and not run up huge costs, this according to the CBO (I suppose another biased voice) - or to deny care.

Either way, this is not change I wish to believe in.

Todd,  Your arguments show that I am not alone in my skepticism about the healthcare reform issues that have been tabled to date.  I applauded Obama when news first came out that a quasi government insurance company will be set up to compete with the private insurers.  That scared the craps out of UnitedHealth and Wellspoint and they stepped up their lobbying efforts.  When I posted that BusinessWeek article that chronicled how the insurers, through Tom Daschle, a Democrat and formerly Senate majority leader, have had a major say on how the reform bill will look like, it was brushed aside as nonsense as if BusinessWeek has not done its own extensive research before publishing the article.  It sounds like a done deal to me as far as how the insurers will be running their business (as usual) after the reform, as we know Congress is controlled by the lobbyists, not by you and me, the voters.  

[Franco]

The moral and economic injustice, as I see it, is strapping future generations with trillions of dollars of debt and leaving them a economy with fewer forces that lead to increasing jobs and wealth growth.

[Todd]

Any American who enjoys good health insurance through the employer or in the private market would be completely free to keep that coverage.

This is not necessarily true.  There's a very good possibility that some employers will opt to drop health coverage while incurring the penalties.  If it makes them more profitable, it could be the rational thing to do.  This wouldn't be a frequent occurrence, and it will not be adopted by giant companies most concerned about attracting top talent, but it almost certainly will happen, forcing people to use the public option against their wishes.  

[Coopmv]

I don't get all the extreme fuss over the healthcare "reform" that's being discussed.  It's already being watered down from the more grandiose ideas originally espoused by Obama to be more or less insurance reform only.  I've not read, and will not read, the entire mass of legislation, but from what I've read about it, from a variety of sources, cost control is being jettisoned in part or in total, which is a shame, because that is a bigger problem.

The public option will compete with private insurance, but how effective will it be?  I don't see how it will displace employer paid care, and it most certainly will not displace other government options.  It will require a tax increase, which will have electoral implications for Obama (his "Read My Lips" equivalent?), and if it mandates coverage in any way, it will also result in a coercive transfer of income and wealth from the voluntarily uninsured (mostly young, indestructible types) to the already covered (mostly the older and more infirm), but that's going to be true of any healthcare reform.  

This strikes me as similar to the Bush Medicare Drug program as well; its supporters are claiming that it will do great, or at least good, things, while the cost is not being adequately discussed.  Why do I get the feeling that a another "shocking" revelation about costs will be forthcoming from either the administration or CBO only after any legislation has passed?  Perhaps part of the legislation will deal with overall spending growth effectively as well – and if it passes, I certainly hope that is the case – but if it doesn't, even more substantial changes will be needed later.  Maybe that is part of the strategy?  

Two other things have struck me during this debate.  First, Obama is not a particularly effective leader.  He's leaving too much to Congress rather than presenting a detailed framework and pushing it.  I think the extreme statements that he's handing everything over to Congress are overblown, but he isn't offering the type of leadership he should.  (That applies in other areas, too.)  The silly comparisons to Roosevelt from months ago have rightly faded away.  Second, the cynical political and economic interests opposed to reform have shown themselves to be ridiculous in how far they will fan flames, and the idiots (there's no other word for them) who engage in shouting and threatening people at various forums are embarrassing and hurting the Republican party.  (Not all of them are Republicans, no doubt, but a lot of them are.)





Arguments that the plan is being rushed are accurate.  Discussing the "proposal" since the election is simply not enough time for such a massive set of changes.  This is a multi-trillion dollar effort, and adequate discussion and vetting of all issues should take years.  You imply that you know all about the "proposal," which is odd because no one really does.  It has changed since last year and will continue to morph in order to pass, and it will probably be watered down some more.  I've been involved in due diligence on investments in the millions that have taken longer than what's happening now.  Given the magnitude of health care and the implications of reform, a few more months, at least, can't hurt.

The following post is now in its rightful place ...   

Todd,  Your arguments show that I am not alone in my skepticism about the healthcare reform issues that have been tabled to date.  I applauded Obama when news first came out that a quasi government insurance company will be set up to compete with the private insurers.  That scared the craps out of UnitedHealth and Wellspoint and they stepped up their lobbying efforts.  When I posted that BusinessWeek article that chronicled how the insurers, through Tom Daschle, a Democrat and formerly Senate majority leader, have had a major say on how the reform bill will look like, it was brushed aside as nonsense as if BusinessWeek has not done its own extensive research before publishing the article.  It sounds like a done deal to me as far as how the insurers will be running their business (as usual) after the reform, as we know Congress is controlled by the lobbyists, not by you and me, the voters.   

[Coopmv]

We already have a system that allows every American to have a decent insurance plan and access to medical care.  A lot of people (esp. young people who perceive themselves and ten feet tall and bullet proof) figure they'd rather spend their money a different way.

A somewhat related question:  Are the 45MM uninsured or under-insured all citizens or legal residents of the US?  There are probably close to 20MM illegals here and many of them use hospital emergency room services.  I don't think the Administration has any plan to deal with this issue and how will enforcement work?

[MishaK]

It showed your ignorance in business matters when you mentioned Fortune as if it is a totally impartial publication.  I would have bought your argument had you quoted NPR or any other entity that receives no corporate money.

I never made such a claim. I never claimed Fortune was impartial. I see you have a foible for fighting straw men.

We already have a system that allows every American to have a decent insurance plan and access to medical care.  A lot of people (esp. young people who perceive themselves and ten feet tall and bullet proof) figure they'd rather spend their money a different way.

That is BS. Almost 46 million Americans have no health insurance. Most uninsured are members of working families, and most have incomes above the poverty line.  Even so, many people can’t afford to buy health insurance.  Those without coverage often don’t get the care they need. Uninsured Americans are nearly eight times more likely than people who have insurance to skip health care because they can’t afford it. And, this can lead to more serious illnesses that need to be treated in an emergency room or the hospital. These services cost much more than it would cost to treat the original problem. About half of uninsured adults with chronic health conditions go without recommended health care or medicines because of cost.

This is precisely the reason why we need universal coverage not just from a moral but from a financial standpoint. The untreated uninsured who don't go in for preventive care end up costing all of us a fortune down the line through our increased treatment fees, premiums and taxes that have to cover the emergency room services they end up receiving. We all lose and pay through our noses for every American we leave out of our system.

The public option will compete with private insurance, but how effective will it be?  I don't see how it will displace employer paid care, and it most certainly will not displace other government options.  It will require a tax increase, which will have electoral implications for Obama (his “Read My Lips” equivalent?), and if it mandates coverage in any way, it will also result in a coercive transfer of income and wealth from the voluntarily uninsured (mostly young, indestructible types) to the already covered (mostly the older and more infirm), but that’s going to be true of any healthcare reform.  

There is no read my lips here. He always said upfront that he was going to undo the Bush tax cuts for the top 2%. Re: the nonsense about the uninsured, see above. It isn't the young and healthy who make up the bulk of the uninsured. Most employers don't provide health benefits. Count yourself lucky if you were unaware of this.

This strikes me as similar to the Bush Medicare Drug program as well; its supporters are claiming that it will do great, or at least good, things, while the cost is not being adequately discussed.  Why do I get the feeling that a another “shocking” revelation about costs will be forthcoming from either the administration or CBO only after any legislation has passed?  Perhaps part of the legislation will deal with overall spending growth effectively as well – and if it passes, I certainly hope that is the case – but if it doesn’t, even more substantial changes will be needed later.  Maybe that is part of the strategy?  

It's really the precise opposite. Bush got rid of Medicare's ability to bargain for better prices. It was indeed a disaster, but everyone how bothered to look at it knew that it would be.

Two other things have struck me during this debate.  First, Obama is not a particularly effective leader.  He’s leaving too much to Congress rather than presenting a detailed framework and pushing it.  I think the extreme statements that he’s handing everything over to Congress are overblown, but he isn’t offering the type of leadership he should.  (That applies in other areas, too.)  The silly comparisons to Roosevelt from months ago have rightly faded away.

That is sadly at least in part true. But this battle still has a long ways to go, so I wouldn't count any of the combatants out yet.

Second, the cynical political and economic interests opposed to reform have shown themselves to be ridiculous in how far they will fan flames, and the idiots (there’s no other word for them) who engage in shouting and threatening people at various forums are embarrassing and hurting the Republican party.  (Not all of them are Republicans, no doubt, but a lot of them are.)

Seconded.

Arguments that the plan is being rushed are accurate.  Discussing the “proposal” since the election is simply not enough time for such a massive set of changes.  This is a multi-trillion dollar effort, and adequate discussion and vetting of all issues should take years.  You imply that you know all about the “proposal,” which is odd because no one really does.  It has changed since last year and will continue to morph in order to pass, and it will probably be watered down some more.  I’ve been involved in due diligence on investments in the millions that have taken longer than what’s happening now.  Given the magnitude of health care and the implications of reform, a few more months, at least, can’t hurt.

Yes and no. We have been talking quite specifically about the plan for at least seven months now with varying intensity. The dictum used to be that the longer the fight takes, the more likely it is that the pharma and insurance industry will win in its efforts to scuttle meaningful reform. I am not sure that holds entirely true. We will see how this plays out. In the end you may very well be right and a prolonged process may help expose the shenanigans of the industry and turn both public and congressional support more strongly in favor of reform. It is certainly an endurance battle.

Not only is it not "un-American" to protest government policy it is a right protected in the Constitution.  I seem to remember Cindy Sheehan being a hero of the Left, along with all the other demostrators who called Bush every name in the book - but the Dems were all for that protest.  

Protest is fine. But disruption for the sake of shutting up supporters and calling congresspeople and senators names to their faces while bantering nonsense devoid of reality is not free speech its grounds for admission to the loony bin. BTW, Cindy Sheehan was of interest only in the beginning, then she went off the deep end a bit and the Dems really stopped caring about her very fast. That wasn't a very good example.

There is no crisis, what we don't need is a massive government program that will end up controlling nearly 30% of the economy, but pragmatic regulation of the insurance (end to denying coverage to people with pre-existing conditions) and drug industries (I oppose big-pharma spending billions on marketing drugs we don't need for phantom diseases they attempt to convince us we have - but will induce side effects that will cause real damage to your health).  And to inject more market forces into the equation.  The only way to control costs is to force plans and doctors to compete for patients, not divorcing people from the payment and care options.

Your numbers are bogus. How is a government plan that would cover only a portion of an industry that does not itself make up 30% of the economy end up causing a 30% takeover of the economy? Did you even think before you wrote that? Coopmv talks about unhinged leftists who have no grasp of economics. You seem to want to prove to him that there are plenty on the right who merit that description.

The United States is not Europe and hopefully we will not replicate the European economic model.  The only way a governmet run heath care program can save costs is to deny care.  Millions of Canadians leave their country every year to seek treatment they are either denied or on endless waiting lists.  Dialysis is not such an elective treatment, but is routinely denied to elderly patients.  There is no way Obama's plan can do what he claims and not run up huge costs, this according to the CBO (I suppose another biased voice) - or to deny care.

a) Europe has better health care that covers more people less expensively and results in longer life expectancy than the US. Why do you object to that?

b) You may have noticed that Canada is not in Europe. The Canadian system is very different from either the European one or the one proposed in the US right now. Nothing along the lines of the Canadian system is being proposed! This is a straw man argument. (Leaving aside right now the grossly exaggerated claims of Canadians leaving their country to get healthcare.)

[Coopmv]

a) Europe has better health care that covers more people less expensively and results in longer life expectancy than the US. Why do you object to that?

b) You may have noticed that Canada is not in Europe. The Canadian system is very different from either the European one or the one proposed in the US right now. Nothing along the lines of the Canadian system is being proposed! This is a straw man argument. (Leaving aside right now the grossly exaggerated claims of Canadians leaving their country to get healthcare.)

O Mensch,  Do you have friends in Europe to make the above claims.  I have good friends in UK, Denmark and Germany who told me about the bureaucracy and the long lead-time they have to put up with when they need surgeries.

[Herman]

It showed your ignorance in business matters when you mentioned Fortune as if it is a totally impartial publication.  I would have bought your argument had you quoted NPR or any other entity that receives no corporate money.

Why do you misrepresent matters? He said:

Business Week, like all other major publications, is beholden to the interests of its advertisers from which it derives the overwhelming majority of its revenues. BTW, the first to investigate Enron's shady dealings was a reporter at Fortune, not BW.

[Coopmv]

Why do you misrepresent matters? He said:

He made it sound like Fortune was the more impartial publication.  A bad example that did not bolster his case ...

[Todd]

There is no read my lips here. He always said upfront that he was going to undo the Bush tax cuts for the top 2%. Re: the nonsense about the uninsured, see above. It isn't the young and healthy who make up the bulk of the uninsured.

I'm not sure this is the case, because the idea that only the top 2% will pay for expanded coverage in the long-term is not viable, and in the short-term is unknown (the legislation isn't final, after all).  Beyond that, it's still possible politically to label him a tax hiker.  That always has political implications.

With respect to the uninsured, it is not nonsense.  There are in fact younger people who opt out of coverage.  Hell, I've worked with some over the years.  They don't represent the biggest issue, of course, but forcing coverage on people does result in a transfer of income.

It's really the precise opposite. Bush got rid of Medicare's ability to bargain for better prices. It was indeed a disaster, but everyone how bothered to look at it knew that it would be.

You misunderstood the point.  The point is that the benefits that people say will occur because of the policy are overstated, and, more importantly, the costs are understated.  Maybe this time will be different, but I very seriously doubt it.

[MishaK]

The moral and economic injustice, as I see it, is strapping future generations with trillions of dollars of debt and leaving them a economy with fewer forces that lead to increasing jobs and wealth growth.

Why don't I see you clamoring for reducing the ridiculous Pentagon budget then? Point is the plan will largely pay itself through reduced costs, increased taxes on the wealthy and lower costs to employers and beneficiaries who then have more disposable income to use on spending which generates jobs and tax revenues. Your analysis is far too simplistic.

This is not necessarily true.  There's a very good possibility that some employers will opt to drop health coverage while incurring the penalties.  If it makes them more profitable, it could be the rational thing to do.  This wouldn’t be a frequent occurrence, and it will not be adopted by giant companies most concerned about attracting top talent, but it almost certainly will happen, forcing people to use the public option against their wishes.  

Fair enough point, but somewhat irrelevant. More and more employers are dropping health benefits anyway due to the runaway costs. The reasonable estimates I have seen show that the numbers that would be affected by the scenario you propose are very negligible.

O Mensch,  Do you have friends in Europe to make the above claims.  I have good friends in UK, Denmark and Germany who told me about the bureaucracy and the long lead-time they have to put up with when they need surgeries.

You have very odd friends. The UK is a different and very dysfunctional system. I grew up in Germany (first 18 years of my life), my sister and parents and extended family live there, I went back to Frankfurt for three years, during which time both I and my wife received superb health care at lower cost (in fact my wife is planning to deliver our first child in Germany during her Fulbright fellowship next year due to her bad experiences with doctors here), I have good friends and extended family members who are doctors and dentists both here in the US and in Germany. Service in Germany is more efficient, more reliable, lest costly and less prone to error or overtreatment than in the US.

He made it sound like Fortune was the more impartial publication.  A bad example that did not bolster his case ...

No, I did not. I corrected your claim that BW broke the Enron scandal. You have reading comprehension issues.

[Coopmv]

You have very odd friends. The UK is a different and very dysfunctional system. I grew up in Germany (first 18 years of my life), my sister and parents and extended family live there, I went back to Frankfurt for three years, during which time both I and my wife received superb health care at lower cost (in fact my wife is planning to deliver our first child in Germany during her Fulbright fellowship next year due to her bad experiences with doctors here), I have good friends and extended family members who are doctors and dentists both here in the US and in Germany. Service in Germany is more efficient, more reliable, lest costly and less prone to error or overtreatment than in the US.

You have the upper hand if you were originally from Germany and have recently visited.  My Danish friends cannot be lying about their healthcare and mind you it is the kind of socialized medicine you love.  You can't have it both ways ...