JayB

The major unstated premise here seems to be that, even under conditions of open competition, profits can only be realized by cheating consumers. Corporations seek to maximize profits. That leads to pressure from the board of directors, stakeholders, and senior management to do things like what we see today: - resist payouts - increase premium prices every year at an unsustainable rate - establish absolute lifetime maximums (and make these smaller) - establish guidelines on preexisting conditions - make application as difficult as possible That's certainly true - but it's difficult for them to do any of the above unless there are structural impediments to competition that prevent people from comparing company A to company B and switching, not getting their policy from company A in the first place because the word on the street is they don't cover the claims that they're legally obligated to, etc. There are other variables that drive premiums higher, like an aging population, medical innovation, defensive medicine, and cost-shifting from the public onto private payers that insurance companies have little or no control over. What you typically find is that the cost of premiums is highest where the mandates that all policies offered for sale have to satisfy - like guaranteed issue - are the greatest. As things stand now - in some guaranteed issue states, people who don't carry insurance can wait until they're ill to start paying premiums and drop them as soon as they've received the treatment that they need - then start all over again. The end result is that premiums go up for people who stay insured regardless of their health status, fewer people can afford the premiums, and more people go without insurance. In this case, as with those above, the shortcomings of the current regulatory model have more to do with driving up the cost of insurance than insurance companies cheating consumers. I'm sure that this happens given the incentives that you cited, but it'd be interesting to look at what percentage increase in premiums due to cheating consumers is relative to other factors. Unless we have the evidence necessary to conclude that it's impossible to address the problems that you noted by some mechanism other than making profits illegal, or centrally administered price controls - it seems worthwhile to consider other options first. Simply allowing insurers to sell policies across state lines would enable millions of people who can't presently afford insurance to do so.

would your post above indicate support for the system as it currently stands, or simply a support for critical understanding of all viewpoints/analyses? I'd say that it has more to do with support for a critical understanding of the limitations of broad statistical aggregates, particularly those of of dubious quality, when engaging in comparisons of the health care in country A versus country B. Life expectancy and infant mortality are two such measures that, like the WHO data, tell us very little about how any of the variables that come into play when patients are actually being treated compare from one country to the next. There are others that apply within the US, like the oft cited Dartmouth Atlas and the "X die because they lack insurance studies." The latter often compare two demographic cohorts that have massive and sustained differences in diet, excercise, education, income, etc and attribute 100% of the mortality difference between the insured and uninsured to their insurance status. If your aim is to fix what's broken without destroying what works, these things matter quite a bit.

The major unstated premise here seems to be that, even under conditions of open competition, profits can only be realized by cheating consumers.

I'd say that actually: 1)Looking up the rankings. 2)Taking the time to read the methodology WHO used to generate them. 3)Noting a few of the bizarre inversions in the said rankings... Comes much closer to "analysis" than people who have done none of the repeating "37th" over and over. Google away! Read the report - then we can have an informed discussion about whether or not the rankings are actually meaningful.

Scale is more important than structure? Interesting viewpoint - I hope that you'll expand on this point in more detail.

I was actually hoping that you were going to argue that Canada is a more relevant model because the scale of a health system is more significant than the structure. Or something. Disappointing.

Why bother when you know that the US is 37th - that's right, thirty...seventh - on the WHO rankings? Any further analysis is clearly superfluous.

Let me know if this is was intended as an argument or a non-sequiter and I'll repost the figure the value that Google returns when I plug "Malta Population" into the search bar.

Canada ranks 30th on the same report. Odd that we're not debating the merits of adopting a Maltese Health Care System here - 'specially since it checks in 25 places ahead of Canada!

this is what scares me: some form of "compromise". If there isn't a public option that ISN'T tied to private insurance costs, then might as well shoot the dog now. i seriously can't believe we even have these arguments when we are the LAST industrialized country without universal health care (and outspend everyone by a wide margin AND rank 37th, 30fuckin7th, in WHO's country ranking for med care). The WHO also ranks Malta 5th, and Denmark 34th. Morocco 29th and South Korea 58th. Et...cetera. Naturally, I don't expect people who endlessly cite the WHO report to spend much time worrying about the methods and metrics that the WHO uses to compile the said rankings.

I'm holding out for the retro-retro-restrospective in which we're treated to footage of boomers whistfully commentating on a film composed of a panel of boomers whistfully commentating about their experiences at Woodstock while watching documentary footage of the actual event. Perfect recursive loop of eternal self-absorption. That'd capture and dramatize the concrete cultural legacy of the event far better than any retrospective produced thus far.

Word. I was thinking the same thing. You mean you didn't like the Alpinist piece where she quoted Christina Aguilera lyrics and described the spiritual enlightenment and egoless state derived from an unelaborated vaguely alluded to personal crisis that created a tortuous personal introspection that caused her to jump from airplanes in fancy suits and ultimately led to a solitary personal journey up the Diamond with two different photographers and which begat the death of the ego and the self? As I was reading that piece I couldn't help but remember all of the anecdotal evidence that I'd heard that spending your time focusing on helping other people is much better for your mental health than an obsessive focus on your own emotional state. Not sure if logging 500 hours ladling up beef-stroganoff for transients in a Moab soup kitchen would have provided much in the way of dramatic photos or compelling narratives, but seems like it might have worked just as well for feeling better about being a fit, attractive, intelligent, educated, talented lady that lives in a pretty decent country and makes her living traveling around the world and climbing in beautiful places. The obsessive-risk-induced-hermetic-focus-on-platonic-gradations-in-one's-own-mental-state-as-a-path-to-enlightenment deal doesn't really resonate with me either, but AFIK no one can touch the guy that I mentioned above when it comes to writing terribly about climbing...

Worse than most of Pat Ament's stuff?

Medved: Caller: Medved: Right. So you can just switch plans if you don't like it! That is, unless you are: -old -sick -have a family history of illness -have ever been sick before etc. Better to have some insurance industry goon bending me over than a government bogeyman The second point he makes is even more obvious. I definitely feel better knowing that if my insurance sucks, I have the option of just paying for, say, heart bypass surgery out of my own pocket! Thank god I have the option of shelling out that extra 150,000 I had laying around for a rainy day, I mean that's why you save money, right? Just in case? Yep, the best product they can afford, beautiful system- to each according to his wallet. Just like, you don't get to buy that BMW until you make enough money, in this case, you don't get the good treatment until you work for it. If you make less than $40K a year, at least you have the freedom to buy a plan that will help delay your bankruptcy for a year or two in the event you get sick or have multiple injuries. That is, if they decide to cover it. And just bask in the freedom to switch to an equally expensive plan of a competitor that will offer equally incomplete coverage for you, AND your family! Best of all, you don't HAVE to support these insurance companies if you don't WANT to! If that doesn't sound good, then maybe you just need to work harder! Is it really true that all insurance plans offer equal value for money? That there's no way to expand the number of options that people have nor the ease of changing from one plan to the next other than via the government creating a health insurance company that they own and operate? Or that this is the only conceivable mechanism for providing coverage to folks that can't currently get it? Sufficient - perhaps. Necessary? I'm not so sure. That it represents the optimal mechanism for doing so is even less clear. I lived right next door to a hospital in NZ from October through March, and conversations about who got treated for what and how were a staple of daily conversation. This doesn't make me an authority, but it's not like I'm speaking from a position of complete ignorance when it comes to the merits of one system versus the next. Different people will take away different lessons from hearing the details of a gazillion different cases in a single-payer environment vs the environment we have here, but my observation was that if you have an accident or illness that mostly requires labor-inputs to fix, and the diagnosis/treatment are obvious - the system over there will be pretty good at taking care of you. If you have extreme trauma - all things being equal, you'd be more likely to survive the experience in the US. If you have a chronic condition that requires expensive diagnostic tests or treatments, especially imaging or expensive drugs, and/or your disease has some subtle manifestations and/or requires seeing a specialist - I think you're quite a bit more likely to suffer more and die sooner than you would here. If you have a premature/sick fetus/baby - my sense that it's less likely to survive in NZ than it is here, particularly if you're located a long way from Auckland. It didn't look like prevention was a particular strength of their medical system either, given the regularity with which advanced pathologies that showed up in the ER. Also not a terribly good place to be if you're over a certain age and have a condition that'd be particularly costly to treat - although New Zealanders did seem to be considerably more stoic and philosophical about calling it quits than we are. Also on the plus side - everyone was covered. I don't mean to understate the significance of that. Just to suggest that, at least from my perspective, it wasn't free from some fairly substantial tradeoffs that came along with the particular mode of providing that coverage via single-payer/provider model. Part of that stems from the fact that if forced to chose I'd rather be broke than dead, but I realize that not everyone shares that opinion. You are understating, grossly so, the significance of universal coverage verse the sorry state in the U.S. And the 'trade offs'? Nothing more than unsubstantiated conjecture on your part. I thought I made it clear that I was stating a personal opinion and sharing my own impressions based on what I observed. The fact that I was actually there to make the observations, discuss the merits of the system with native physicians, docs from overseas, etc doesn't make them any less subjective - but it makes it quite unlikely that my conjectures on this front are derived from a base of ignorance that's larger than your own. I'm pretty sure that if there's a apples-apples data-set that'd allow for a comparative evaluation of things like age-adjusted survival rates for cancer, heart-attacks, strokes, specific vehicle trauma's, etc that they'd bear out my conjectures - but if you can get your hands on data that proves otherwise, I hope that you'll share it.

For some reason whenever the discussion turns to the relative risks of cragging vs alpine climbing, I think of Goran Kropp and his tragic death at Vantage a few years ago. If we're dealing in broad generalities, alpine climbing is definitely has more objective risks than cragging. But...how about roped climbing at the crags vs low-end scrambling, etc, etc, etc. No matter what aspect of climbing or any other risky sport you're into, in just about every case it's possible to tweak and minimize the risks so that they at least have the appearance an acceptable tradeoff relative to their benefits for whatever stage of life you're at, but it's never possible to eliminate them completely. In attempting to do so, it's possible that you're hastening your path to the grave in other ways that are less obvious but equally significant. I made a conscious effort to try to push things harder than I might have otherwise when climbing and elsewhere over the past ten years so that I when the time came to scale back the risks, I'd have enough of skill, experience, confidence, competence etc to enjoy most of the same stuff with plenty of margin. Hopefully I've stacked the deck enough to tip the odds in my favor, but this and other accidents make it clear that there's an element of wishful thinking in that plan. While its clear that losing a parent in a preventable accident represents a staggering tragedy for a child, abandoning all of the joys and passions and challenges that make you who you are, and that they might derive a lifetime's worth of joy and memories from sharing with you also has a certain cost for both parent and child. Seems like most folks find a way to stay alive for their kids without killing big parts of themselves in the process.

Medved: Caller: Medved: Right. So you can just switch plans if you don't like it! That is, unless you are: -old -sick -have a family history of illness -have ever been sick before etc. Better to have some insurance industry goon bending me over than a government bogeyman The second point he makes is even more obvious. I definitely feel better knowing that if my insurance sucks, I have the option of just paying for, say, heart bypass surgery out of my own pocket! Thank god I have the option of shelling out that extra 150,000 I had laying around for a rainy day, I mean that's why you save money, right? Just in case? Yep, the best product they can afford, beautiful system- to each according to his wallet. Just like, you don't get to buy that BMW until you make enough money, in this case, you don't get the good treatment until you work for it. If you make less than $40K a year, at least you have the freedom to buy a plan that will help delay your bankruptcy for a year or two in the event you get sick or have multiple injuries. That is, if they decide to cover it. And just bask in the freedom to switch to an equally expensive plan of a competitor that will offer equally incomplete coverage for you, AND your family! Best of all, you don't HAVE to support these insurance companies if you don't WANT to! If that doesn't sound good, then maybe you just need to work harder! Is it really true that all insurance plans offer equal value for money? That there's no way to expand the number of options that people have nor the ease of changing from one plan to the next other than via the government creating a health insurance company that they own and operate? Or that this is the only conceivable mechanism for providing coverage to folks that can't currently get it? Sufficient - perhaps. Necessary? I'm not so sure. That it represents the optimal mechanism for doing so is even less clear. I lived right next door to a hospital in NZ from October through March, and conversations about who got treated for what and how were a staple of daily conversation. This doesn't make me an authority, but it's not like I'm speaking from a position of complete ignorance when it comes to the merits of one system versus the next. Different people will take away different lessons from hearing the details of a gazillion different cases in a single-payer environment vs the environment we have here, but my observation was that if you have an accident or illness that mostly requires labor-inputs to fix, and the diagnosis/treatment are obvious - the system over there will be pretty good at taking care of you. If you have extreme trauma - all things being equal, you'd be more likely to survive the experience in the US. If you have a chronic condition that requires expensive diagnostic tests or treatments, especially imaging or expensive drugs, and/or your disease has some subtle manifestations and/or requires seeing a specialist - I think you're quite a bit more likely to suffer more and die sooner than you would here. If you have a premature/sick fetus/baby - my sense that it's less likely to survive in NZ than it is here, particularly if you're located a long way from Auckland. It didn't look like prevention was a particular strength of their medical system either, given the regularity with which advanced pathologies that showed up in the ER. Also not a terribly good place to be if you're over a certain age and have a condition that'd be particularly costly to treat - although New Zealanders did seem to be considerably more stoic and philosophical about calling it quits than we are. Also on the plus side - everyone was covered. I don't mean to understate the significance of that. Just to suggest that, at least from my perspective, it wasn't free from some fairly substantial tradeoffs that came along with the particular mode of providing that coverage via single-payer/provider model. Part of that stems from the fact that if forced to chose I'd rather be broke than dead, but I realize that not everyone shares that opinion.

The fear is that what is being tabled is a "trojan horse"... Oh I see, so all the arguments about how these proposals are going to take away people's freedom and all that is based on a hypothetical fear rather than the legislation that's actually being proposed? Now I get it. Wow...Great stuff...God, this country is stupid. Being the rational guy that I am, I'll convert to an employer sponsored plan to capture the tax subsidy that I'm not currently entitled to as an individual paying premiums out of pocket. Given that unless I open my own business, my total compensation will be a combination of money-wages + benefits, I have an interest in maximizing the benefits of health insurance while minimizing the costs. If all employers have to satisfy federal guidelines for the plans they offer in five year, per the current legislation, there's a very real risk that I'll be forced to fork over quite a bit more money for a plan that's been distorted by an infinite number of lobbying groups that secured special favors from the government. That could be the unions that are currently trying to keep Safeway style prevention incentives out of health insurance plans, or the Unified Confederation of Boutique Fertility Clinics that want 84 year old monks forced into carrying insurance that covers what they're selling. Either way, that's going to translate into higher premiums and and lower cash wages - so I do have that at stake. I also suspect that in the hunt for revenue to fund whatever plan they've proposed, on top of the general hostility that most advocates of single-payer and/or public-option plans have to catastrophic/HSA plans - they'll be legislated out of existence. Massachusetts imposed a $2,000/$4,000 cap on out of pocket expenses for plans that can be sold there. Couple that with a laundry list of other mandates and you've got one of the most expensive insurance markets in the nation with no mechanism for containing premiums other than price controls. You can use price controls to hold down nominal prices, but not the actual costs, and when the prices no longer cover the costs of bringing forward the goods and services that go into providing care - the inevitable result is shortages, since there's no longer a mechanism for coordinating supply with demand. In MA, one consequence of the reforms is that more people have insurance, which is great. Unfortunately - there weren't enough primary care physicians in the state to begin with, thanks largely to Medicare's RBRVS price fixing scheme and whatever other factors make MA a crappy place to be a PCP - and now it's next to impossible to get a PCP if you don't already have one. As in, "even some tenured medical professors at Brigham and Women's hospital can't get a PCP" hard. End result - it's much harder to get a timely appointment if you're feeling sick, even if you can get a doctor - and guess what happens to ER volumes when people can't wait six weeks to see their family doc? They've moved in a particular direction, and it hasn't been down. Lower costs and better care? Actually, no - and heaven help the folks that depend on Boston Medical Center for their care, since that hospital has about two years before financial collapse under the new MA plan. Given that large elements of the MA plan seem to have served a template for the plan the democrats are putting forward, there's plenty to be concerned about even if I can still buy catastrophic coverage for the foreseeable future...

[video:youtube]hVimVzgtD6w

"Flyboys" was a pretty good read. Covers the rise of Japanese millitarism, the war in the Pacific in general, and what happened to a handful of naval aviators that the Japanese captured late in the war, and the considerations and key characters involved in the decision to use fire-and-nuclear bombing on Japanese population centers. The author clearly made an effort to be impartial in his treatment of Japanese/American conduct and motives, and whether you find this treatment laudable or objectionable will probably be conditioned by the perspective that you bring to the book. Plus you'll probably always be able to blurt out "Curtis LeMay" whenever certain questions come up in trivia games.

Better to deal with the the rationing party that's in conflict with your interests (trying to extract as much money from you while providing the least costly product) directly, eh? Yeah, 'cause that's what's likely to happen for people that are struggling to make ends meet and as a result are uninsured or under-insured... Great if you're healthy. How old are you again? Isn't this the opposite of what this bill seeks to institute? Which one is the giant conflict-of-interest laden cabal? The insurance and pharma industry or the government, I forget. Anyway, it's so easy and quick to research, shop, and change providers whenever you want, right? Especially for poor folks (aka the uninsurable). Don't most, if not all the Democratic bills retain consumer control over what plan they choose? Just explaining that the Republicans have fielded an option, and explaining why on balance I prefer it to what the Democrats have proposed. I'd like to see us go more in the direction of the Whole Foods plan, and less in the direction of Medicaid for All for a variety of reasons. One of the main concerns I have with the Democrat's plan is the provision that stipulates that all employer sponsored plans have to satisfy a set of federal guidelines after a five year period that would start at some indeterminate point. Great mechanism to guarantee an income stream for people that sell stuff that the Federal board forces everyone to pay for - "Infertility coverage for all!" - not such a hot idea if the goal is to keep premiums affordable for as many people as possible. Unions that want to exempt plans with incentives for not smoking, maintaining a healthy weight, and all of the other most important and cost effective prevention mechanisms out of any Federally approved plan. This is clearly rational and defensible from the union's perspective, or else they wouldn't already be lobbying for such things, but again - I'm not sure that it's quite as beneficial for everyone else. Will the Whole Foods plan, and others like it make the Federal cut? I'm not optimistic. Ditto for the catastrophic/HSA combo that makes the most sense for us and quite a few other people. Make direct, annual, income-indexed infusions to the HSA accounts and income indexed tax-credits/vouchers to the mix and the pool of people that they'd work for expands to include a big chunk of the population. There are already mechanisms out there to help insure that the uninsurable get the care that they need. I'm just not convinced that going in the direction that the folks in favor of a single payer model tend to advocate is the best way to do so. BTW - I'm 36 and in relatively good health - but I recognize that that could change at any time. I'd still much rather save hundreds of dollars each month and use the funds to enjoy the health that I've currently got, and pay the $10,000 max out of pocket with savings and/or borrowing when I have to than send the money to either an insurance company or the government for care that I'm not using, and may never use. I carry high deductibles on all insurance for that very same reason.

1000 pages of obfuscated legalise babble. Nobody but a herd of lawyers can (or will) even attempt to read that POS. yes but its a Republican plan therefore like any good partisan he hasn't read it either, he just knows it has to be good. On that note, i got a good laugh listening to Hannity along with Ann Coulter and Dick Morris "analyze" each line of Obama's plan yesterday. Like you said, those bills are pretty complicated but thank goodness we had such impartial legal 'experts' on the case to decipher it for us laymen. Hey you'll never guess what their findings were!? Is it that hard to punch the bill's name into Google? Enter "Patient's Choice Act" and there are summaries aplenty. I first read about the bill in the WSJ in May, and that article is link number four: http://online.wsj.com/article/SB124286548605041517.html Here's a quick non-republican analysis: http://voices.washingtonpost.com/ezra-klein/2009/05/ask_the_expert_eight_thoughts.html Here's what the CEO of crunchy-icon Whole Foods has to say about reforming health care. http://online.wsj.com/article/SB10001424052970204251404574342170072865070.html IMO the less involvement that conflict-of-interest laden third-party rationing agents have in influence what kind of treatment I get and when, the better. I'd also much rather pay hundreds of dollars into an account that I own and control, and have the un-used balance accumulate, than hand it over to either an insurance company or the government. I also think that it makes much more sense to use health insurance as....insurance...to keep from going under in the event of a medical catastrophe, rather than a monthly pre-payment scheme. I'd also like to be able to buy insurance in a national market, as opposed to being limited to the choices that any given state regulator thinks that I should have. For the people that are uninsurable, IMO it makes much more sense to give them income indexed vouchers that cover most of their costs, and let them decide which providers/treatments work best for them than it does to give the money directly to giant, conflict-of-interest-laden cabal. IMO giving individuals as much control as possible over their health care dollar appeals to me on principle, and I think it also has quite a few practical benefits that come along with it. Whoever offers a plan that's closer to that model will get my support. At the moment, and for the foreseeable future, it looks like that'll be the Republican party. If you like a single-payer, government-as-uber-HMO model, or just think that maximal government control over the entire sector a better way to go - then it makes sense to support the Democrats. If you fall into that camp, it's perfectly fine under these conditions to say that "The Republicans don't have anything to offer that I like and/or approve of." Saying that they haven't offered up anything other than opposition just isn't accurate though. If you want to notch the claim down a bit and state that they have done a miserable job of presenting their plan, arguing on it's behalf, then I'd agree with you. Summary (one is always needed with this poster): Let the individual regulate the industry. Pit individuals against huge corporations. It's worked so well in the past.... The only case where the deck is stacked in those cases where the government plays favorites and uses tarriffs, subsidies, and other mechanisms to insulate favored businesses from competition. Otherwise it's a case of pitting huge corporations against...huge corporations. Or whoever else wants to try to provide the best deal. Most of us manage to secure our food, clothing, and shelter just fine in cases where the government restricts it's role to that of a referee enforcing a uniform set of rules designed to limit the role of force or fraud in exchanges between two parties. For those that can't afford to pay for the entire cost of these things on their own, vouchers that let them choose from businesses that have to compete for their business seem to produce better results than forcing them into a centrally administered government monopoly and/or price fixing scheme. When and If I find myself in a position where I can't afford food, clothing, or shelter I'd much rather take my chances against corporate titans and anyone else trying to sell me the things that I need armed only with vouchers than I would contending with a public monopoly that can completely take me for granted. Section 8 vouchers vs public housing complexes, food-stamps vs bricks of spam and cans of welfare cheese, choice of schools vs being forced to send your kid to whatever the government can provide, no matter how bad? It's not clear to me that people are objectively worse off when the government limits its assistance to paying for essential services on behalf of people who aren't able to pay them themselves, rather than the government providing the services. There are cases where government providing the service makes sense for political or technical reasons, but it's far from clear that medicine is one of them.

1000 pages of obfuscated legalise babble. Nobody but a herd of lawyers can (or will) even attempt to read that POS. yes but its a Republican plan therefore like any good partisan he hasn't read it either, he just knows it has to be good. On that note, i got a good laugh listening to Hannity along with Ann Coulter and Dick Morris "analyze" each line of Obama's plan yesterday. Like you said, those bills are pretty complicated but thank goodness we had such impartial legal 'experts' on the case to decipher it for us laymen. Hey you'll never guess what their findings were!? Is it that hard to punch the bill's name into Google? Enter "Patient's Choice Act" and there are summaries aplenty. I first read about the bill in the WSJ in May, and that article is link number four: http://online.wsj.com/article/SB124286548605041517.html Here's a quick non-republican analysis: http://voices.washingtonpost.com/ezra-klein/2009/05/ask_the_expert_eight_thoughts.html Here's what the CEO of crunchy-icon Whole Foods has to say about reforming health care. http://online.wsj.com/article/SB10001424052970204251404574342170072865070.html IMO the less involvement that conflict-of-interest laden third-party rationing agents have in influence what kind of treatment I get and when, the better. I'd also much rather pay hundreds of dollars into an account that I own and control, and have the un-used balance accumulate, than hand it over to either an insurance company or the government. I also think that it makes much more sense to use health insurance as....insurance...to keep from going under in the event of a medical catastrophe, rather than a monthly pre-payment scheme. I'd also like to be able to buy insurance in a national market, as opposed to being limited to the choices that any given state regulator thinks that I should have. For the people that are uninsurable, IMO it makes much more sense to give them income indexed vouchers that cover most of their costs, and let them decide which providers/treatments work best for them than it does to give the money directly to giant, conflict-of-interest-laden cabal. IMO giving individuals as much control as possible over their health care dollar appeals to me on principle, and I think it also has quite a few practical benefits that come along with it. Whoever offers a plan that's closer to that model will get my support. At the moment, and for the foreseeable future, it looks like that'll be the Republican party. If you like a single-payer, government-as-uber-HMO model, or just think that maximal government control over the entire sector a better way to go - then it makes sense to support the Democrats. If you fall into that camp, it's perfectly fine under these conditions to say that "The Republicans don't have anything to offer that I like and/or approve of." Saying that they haven't offered up anything other than opposition just isn't accurate though. If you want to notch the claim down a bit and state that they have done a miserable job of presenting their plan, arguing on it's behalf, then I'd agree with you.

So I take it you are all for this new policy because of the originator? I have nothing to hide, the gov. knows everything there is to know about me. Just wondered if there would be the outrage that there was when Bush was pulling this kinda shit. Guess I was right. No, my quote was exactly the response given by conservatives to those who raised concerns when the Bush admin wanted to eavesdrop on American citizens and tap phones. For the record I think it's completely legitimate, warranted in fact, to question what the Obama admin intends to do with the information it's requesting, but the context of the issue is a bit different in this case. I admit I'm skeptical of the Obama health care proposals but I do want to see something pass that addresses the problems with the system. The Republicans clearly have nothing to offer on the issue... Really? http://thomas.loc.gov/cgi-bin/query/z?c111:S.1099:

This was not a premise of this article. Gawande clearly stated so by comparing McCallen's per capita Medicare costs to El Paso's, an area with nearly identical demographics, culture, and health statistics. "Nearly identical" depends on the statistical filter that you put the populations through, and it's possible that the filter that Gawende used failed to capture some of the key variables driving the cost-of-care variations between these cities. Any time that you have two nearly identical data sets generating outputs that are significantly different from one another, despite having been fed through the same model, it's at least worth asking if there's a variable that the model in question doesn't capture that's driving the said differences. Eliminate altitude from variables included in the the differential rates of medical oxygen use in different regions, for example, and it's possible to completely miss the key variable driving rates of oxygen use in Denver that are several fold higher than in Dallas. There's a more careful analysis of the differences between the locales studied in the Gawende story here: http://www.thehealthcareblog.com/the_health_care_blog/2009/06/mcallen-is-now-a-tale-of-three-counties.html Having said that - it's possible that that self-dealing on the part of physicians is the single most important driver of cost-differences between McCallen and El Paso - and that this analysis will stand up to even the most detailed and rigorous scrutiny. I found Gawende's analysis much less compelling on that front than most people, but I'll concede that it's possible that Gawende is right. Even if that's the case, I'm not sure that this evidence (or the much larger data set generated by the Dartmouth Atlas) supports the claim that this is the best explanation for all regional variation in medicare spending patterns, much less that we can safely extrapolate conclusions derived from this data to all medical spending. I'm even less confident that we'd be well served by using such data to impose rigid, aggregate driven constraints on how physicians operate if the goal is to reduce costs without compromising the quality of care for individuals.

I'd like to see people live longer, healthier lives, and reduce the costs of medical care as well. There's good evidence that certain kinds of preventive care help people live longer and stay healthier, but the evidence that preventive care saves money is, on balance, broadly negative. http://content.nejm.org/cgi/content/full/358/7/661 Moreover - a great deal of the most important preventive measures are things that doctors have very little capacity to influence in a meaningful way. Obesity, smoking, drinking, stress - etc. I haven't seen an analysis of the relative importance of say lifestyle factors vs screenings - but I'd wager that these are much more significant drivers of costs and mortality than most of the risk factors that doctors can actually do something to help mitigate. One model that might work on both fronts is coverage that rewards people for maintaining a healthy weight, quitting smoking, getting regular screenings, etc. Safeway already has a plan like this - at least for non-union employees - and I suspect that they're not alone. It'd be interesting to learn what, if anything, is preventing other insurers from following suit. I suspect that for most insurers, for paying for screenings as part of a broader set of preventive incentives would pencil out, even if the only thing that really saves them money are the lifestyle changes that they reward with lower premiums.