The part that really stood out was the following:

The central cause of runaway health spending is clear. Hospitals and doctors are paid mostly on a fee-for-service basis and reimbursed by insurance, either private or governmental. The open-ended payment system encourages doctors and hospitals to provide more servicesand patients to expect them. It also favors new medical technologies, which are made profitable by heavy use. Unfortunately, what pleases providers and patients individually hurts the nation as a whole.

That's the crux of the health-care dilemma, and Obama hasn't confronted it.

Until this aspect gets addressed, healthcare costs will keep going up no matter who pays (private or government).

Until this aspect gets addressed, healthcare costs will keep going up no matter who pays (private or government).
#2 | Posted by Pirate

This is true. Part of the reason why that is has to do with the fact that alot of what doctors will do is in an effort to c.y.a. They go way beyond what they would otherwise do in an effort to be able to defend themselves if any potential malpractice suit comes their way.

And I guess, in Obama's defense (I can't believe I just typed that), he did say something in the last couple of days about working to deal with the problem of huge malpractice awards.

Many single-payer plans have options to replace fee for service.

"Doctors would have three options for payment: fee-for-service, salaried positions in hospitals, and salaried positions within group practices or HMOs. Fees would be negotiated between a representative of the fee-for-service practitioners (such as the state medical society) and a state payment board. In most cases, government would serve as administrator, not employer."

That still wouldn't really address the issue Corky. Even if all the doctor's went to salaried positions, there is still no incentive to remove unnecessary procedures and services.

But when a writer starts off with, "It's hard to know whether President Obama's health-care "reform" is naive, hypocritical or simply dishonest. Probably all three.", it's easy to see that what he is interested in is hyperbole, not answers.

#4 | Posted by Corky at 2009-06-15 03:49 PM

It's not whining if it's truth!

Until this aspect gets addressed, healthcare costs will keep going up no matter who pays (private or government).

#2 | Posted by Pirate

Correcto mundo!

And the only way to deal with higher costs to any program is to ration out the services.

This has been going on since health insurance started and doctors realized they could just up their fees.
The more we "cure" the system, the worse it gets.

It's not whining if it's truth!

#7 | Posted by frankf55 at 2009-06-15 04:45 PM

Any opinion that doesn't start out with praise for the O-chief and the whiners start spotting their panties.

This has been going on since health insurance started and doctors realized they could just up their fees.
The more we "cure" the system, the worse it gets.

#10 | Posted by Diablo at 2009-06-16 12:26 AM

Insurance removes all the competitive forces from the equation.

And the only way to deal with higher costs to any program is to ration out the services.

#9 | Posted by MURPHY

Or do what every other industrialized nation does. And what the US rightwing taxpayer is cheerfully paying for in Iraq and afghanistan.

Same or better outcomes, lower costs (at least for nations other than Iraq and afghanistan). It's a no-brainer. You'd think that alone would make the NOPpers love it.

Medicare +

"You'd think that alone would make the NOPpers love it."

Oh, they'd love it alright as soon as their prophet from God tells them to but I think Rush's employers have other ideas.

I can look at unsubstantiated hypotheses all day long.

Or, I can look at at least 50 actually up and operating systems. None of which cost *NEARLY* what the American system does. None of which bankrupt a percent or two of their population in a reverse-lottery each year. Most of which have at least as good a net overall outcome as the US, many far better.

The GOPers are like creationists and a lot of other fundamentalists. Facts in front of their noses matter far less than ideology.

The right wingers talk about rationing of healthcare all day long. What they refuse to acknowledge is that healthcare is ALREADY rationed in this country. Some large percentage of Americans have little or none. What they do have access to costs those of us that do have coverage much more.

Fatcats thrive from the changes Democrats and Republicans impose on their people. Every change is another opportunity for a fatcat. All they have to do is change one line surrepticiously in any agreement and they make a killing. Our Government considers the changers identity a paramount secret.

Until we (as patients) and doctors become cost conscious, we're going to be paying more and more.

Most health care is paid for by insurance. When people are insured they do not pay the full costs of the medical care they receive, so they demand the best and pay little attention to the expense. Patients opt for surgery rather than medication or wait-and-see, even when the medical advantages are small.

Insurance removes all the competitive forces from the equation.

#12 | Posted by 726

Do you think insurance loves to just pay whatever fee doctors/hospitals charge?

In any case, I know business owners who can shop with 5 independent carriers trying to get their business.

The system needs reform but the fact that I can get 5 "competitive" quotes is one thing that I would argue is good about the system.

You'd think that alone would make the NOPpers love it.

#13 | Posted by northguy3

The trouble is that Obama won't even consider it, because any such talk has been shouted down by the shrill voices of the pundits and their followers, that it's COMMUNIST. The way it's looking now, health care is only going to be fixed when less than half the population can afford it...IF those who can't afford it still have the privilege to vote by then.

the fact that I can get 5 "competitive" quotes is one thing that I would argue is good about the system.

#20 | Posted by eberly

Are they really competitive if all they're doing is giving you a low rate to get you signed up, knowing that they can raise the premium next year, because unless your a business with a significant # of employees it's not worth the time to chase new rates every year? I would guess there isn't a significant enough difference between the "competitive" quotes for most small businesses to even waste their time.

I'm very concerned with all this. The devil is in the details. When they say a government insurance to compete with commercial ones, and they say all have to get healthcare, I think there are ways to do both of those that would end up being good for the country, the individual, and prices overall. There are also ways to do them that would make us end up with horrible health care, rationing, and a huge government bureaucracy.

I'm not no quick to pick sides on this one.

It seems to me that, if the gov't plan includes too much rationing, horrible health care, etc., then people will just switch to private plans like they have today. There is a reason the ultra-profitable insurance companies are scared to death of this competition.

Until you get the patient on the hook for most of the cost of health care, you will never control costs. It's having insurance that tells people to run to the emergency room every time their nose starts to run or Timmy falls off his bike. And having the government as the single payer will merely result in rationing services, and drugs, and seeing a collapse in people going into medicine.

"And having the government as the single payer will merely result in rationing services, and drugs, and seeing a collapse in people going into medicine."

Yeah, cuz that is what happened in every single other country that instituted health care.

Riiight. It will actually alleviate the crowd at the ER because people will have access to clinics and doctors' offices where treatment is more efficient, better for the patient and best of all cheaper. Many expensive, serious illnesses will be caught early when it is easier and cheaper to treat.
Many people like diabetics will be able to have access and the drugs they need even if they are unemployed. We already spend more than any other country, per capita, so RisR's dire warning is obviously just more scare tactics.

What is the purpose of insurance if we are expected to pay for an ever increasing portion of the costs?

and

What is an appropriate deductible? $1,000? $3,000? 10,000.

Insurance companies keep moving the goal posts they do not even consider insurance a safeguard against illness anymore.

Insurance companies consider their product as a way to "finance" medical costs. This implies you will pay a majority of your expenses while insurance companies negotiate that cost for you.

This is not health care insurance anymore, it's financial planning now

The Right-winger is totally unaware - I mean oblivious to! - the reality of single payer health care. They run to emergency rooms with runny noses - and emergency rooms must take them - because lesser medical care is out of reach for them. Single payer will give everyone a chance at services and maybe this nation's healers will again go into healing because they WANT to heal, not just as a means to a new BMW. herm

I don't buy the garbage that single payer is cheaper. The british pay tons of taxes and get horrible health care. They wait for months to get treatments, and they have the worst dental in the world, to the point that people pull their own teeth out.

competition forces efficiency. Large bureaucracies just don't care about costs and the people who work for them are so miserable, they don't care about you. Forget trying to appeal decisions in any reasonable amount of time.

The system we have now is worse because it's both inefficient and loaded with bureaucracy thanks to the democrats, and it doesn't have any of the efficiencies of a single-payer system. At least we don't have rationing.

"(C)ompetition forces efficiency." How do YOU select a physician? herm

"The right wingers talk about rationing of healthcare all day long. What they refuse to acknowledge is that healthcare is ALREADY rationed in this country. Some large percentage of Americans have little or none."

Right on, Billy Jack! Let's have caviar and Lambourghinis for all Americans, too!

A line to show how the rigid right equates the necessities and the luxuries of life:

"Let's have caviar and Lambourghinis for all Americans, too!"

Dat ol debbil probably can't distinguish water from champagne either. herm

Insurance companies keep moving the goal posts they do not even consider insurance a safeguard against illness anymore.

Insurance companies consider their product as a way to "finance" medical costs. This implies you will pay a majority of your expenses while insurance companies negotiate that cost for you.

This is not health care insurance anymore, it's financial planning now

Insurance is still insurance. You pay a little for the promise of the ins company paying a lot.

If you claims are under a certain threshold then it might seem to you that it is a way to "finance" medical costs.

With most people in a given year??? yes, that is all it is.

But it doesn't take very many $500K claims to turn that all upside down. I have seen tons of them. I have seen 6 people rack up 70% of the claims dollars in my state once.

Are they really competitive if all they're doing is giving you a low rate to get you signed up, knowing that they can raise the premium next year, because unless your a business with a significant # of employees it's not worth the time to chase new rates every year?

No. each year you can do this. Any all the carriers know this.

I would guess there isn't a significant enough difference between the "competitive" quotes for most small businesses to even waste their time.

you "guess"?

there is a huge difference at many times.

you guess, hope and wish, for things to be true because you want to believe it.

Ive worked all over the country in many offices all who have Health Insurance, and in every single one there were at least two people who go to the doctor probably once or twice a month. Maybe that is a coincidence but I doubt it.

No question that if they had to pay more out of pocket that they would probably not go as often.

Does that drive up the cost? Not sure

"I don't buy the garbage that single payer is cheaper. The british pay tons of taxes and get horrible health care. They wait for months to get treatments, and they have the worst dental in the world, to the point that people pull their own teeth out."

Britain doesn't have single payer, they have actual socialized medicine where the doctors are actually employed by the government. France has single payer and their health care system is considered by many to be the best in the world.

When will someone take my challenge and show us all how corporate profits actually make us healthier.
How high CEO pay helps sick people get well.

The ultimate goal of our present health care system is profit. Insurance companies are corporations and corporate officers are duty bound to make their companies earn the most profit possible. They owe their allegiance to stock holders not patients.

A single payer, government insurance system would make patient outcomes the ultimate goal of the system and would eliminate profit, unnecessary high salaries, marketing, etc. and thus save big $$$$.
70% of Americans favor it so why do we let our Congress ignore us????

Iranians are in the street demading their rights, Americans should be too!

you guess, hope and wish, for things to be true because you want to believe it.

#33 | Posted by eberly

I do a comparison every 2-3 years. NOBODY ever beats what I already have without cutting benefits someplace, so I would say it's a pretty EDUCATED guess. None-the-less, they still increase my premiums 7-15% every fucking year. Most insurance is a scam, but also a necessary evil.

The European heat wave of 2003 killed around 35,000 people. Much of the heat was concentrated in France, where nearly 15,000 people died[citation needed]. In Portugal, the temperatures reached as high as 48 C (118 F) in the south.

AND did you also know that IF we also had the things you mention and, of course ASSUMING that US senators had to use the same plan they are trying to ATTACK US WITH

that TED kennedy would be most likely DEAD today because he has been using experimental drugs that may or may not have been ALLOWED by the government...

Iranians are in the street demading their rights, Americans should be too!

#36 | Posted by danni at 2009-

except that health care is a right only in the minds of progressives who use it like they do everything else they control

POWER and control...

"that TED kennedy would be most likely DEAD today because he has been using experimental drugs that may or may not have been ALLOWED by the government..."

Most insurance companies will not pay for experimental drugs so Kennedy is lucky he's rich.

except that health care is a right only in the minds of progressives who use it like they do everything else they control"

Never mind "health care" I'm talking about the obvious conflicts of interest with Congressmen and Senators receiving large contributions from health care industry, spouses employed by them, etc. while they IGNORE THE VOTERS. I would think even you would want Congress to listen to voters.

here is more proof young lady.
we should learn from these people and the lessons they are trying to tell us.

I agree with you 200 percent on your last point

as I said...IF they told us that CONGRESS will go on the SAME PlAN they want us to go on..
THEN I will be more agreeable but that NOT HAPPENING is about as safe a bet as you can get..

spouses employed by them, etc

AMEN SISTER

and start with CHRISS DODD and his wife

#44 | Posted by afkabl2 at 2009-06-17 01:47 PM | Reply | Flag:NEVER thinks outside of the partisan box.