Tag Archives: Medicare

Medicaid to Ian: Drop Dead!

I adore ekg.  For years she has been my liberal foil, challenging my assumptions and sharpening my arguments.  But lately, she has just seemed …off.  Like virtually every liberal worth his or her bureaucracy, she is wildly in favor of a “public option” in the current health care bill.  The more “publicky,” the better. Medicare for all is the dream, and VA care for all is the fantasy.  Yeah, I don’t get that one either.  But unfortunately, it’s a point that seems so evident to the liberal mind that any opposition seems either evil or crazy.

 

Or racist of course.  We can’t forget that one!

 

So her arguments in support of “health reform” have been of the self evident variety.  Hardly worth the title of “reasoned discussion” at all.  In discussing the case of Ian Pearl, she pulls out the familiar trope of the evil insurance company denying coverage for the wronged, ill, Christ figure.  Her blog on Ian’s plight is one part righteous anger and two parts accusatory anger.

 

But I do take her seriously and try to address her disagreements with my position:

 

Ekg, I don’t want to make you sad, so let me address your points one at a time.

 

Now, you are saying I don’t know what I am talking about because:

 

“1st.. Ian wouldn’t die from the ‘public option’… he would die from having to live in an assisted living home…”

 

So in order to live, Ian needs 24 hour home health care that is currently provided by his health insurance.  Now Ian is about to get the boot, the boot to Medicaid, which does not provide the sort of home health care that Ian needs, according to his parents to stay alive.  So once Ian is on Medicaid, his life will be nasty, brutish, and short.  Now assisted living is how Medicaid handles Muscular Dystrophy patients in Ian’s advanced condition.  So if Ian had never been covered under a private insurance plan, he would have been dead a while ago, correct?

 

But you say Medicaid is not a public option.  But the public option is government healthcare.  Do you think he would have a better deal under another government plan?

 

Which leads us to your second point…

 

”2nd medicaid isn’t the ‘public option’ .. that is what the poorest of the poor get. which no matter how bad(and it’s not), is still better than what millions have now..
The public option is low cost private insurance and it’s only low cost to the payer because the gov’t can purchase larger ‘blocks’ and get a better deal than a single person.”

 

If you’re correct, I’ve been following this issue for several months and have never heard that the public option is really private insurance.  In fact, I’m pretty sure you’re wrong on that, so I will call bullshit until you can show me.  What I think you are getting it confused with are the private plans that will be sold through the exchange.  Those will have standardized basic benefits, prices, and will be subsidized for lower income people.  That is not the” public option.”  The public option is a government plan, not really insurance, with benefits and prices designed by the government.  Now the public option might be administered by a private company, in the same way that Tricare is administered by private insurance companies in different Tricare regions of the country, but it’s not a private insurance plan.  If there is a public option and it is administered by private health insurance companies, which seems likely, the insurance companies still win!

 

So one if us is really, really wrong on our understanding of what the public option is.  As long as we have been going over this issue, that’s pretty damn funny.  I don’t care who ya are…

 

Now I couldn’t help but notice this: 

 

“…healthcare companies pass the buck and raise the price while you cheer them on.. whether it’s because they are exempted under anti-trust laws or any other law doesn’t matter..”

 

I have not been exactly “cheering on” the health insurance companies while they raise prices.  Seeing as I’ve been in the middle of open enrollment at work, I find any cheers quite muted.  I’m trying to recall the last time I cheered price increases by health insurance companies in general and my health insurance in particular… let’s see, there was that time… no…how about… oh no… 

 

I guess no.  No cheers from me.

 

As far as anti trust laws go in general, I find them foolish, since monopolies generally require either control of a particular resource or some sort of government grant that gives a legal monopoly to a company.  Baseball has an anti trust exemption since we don’t want multiple baseball leagues bouncing around the country.  We would rather the current owners suck up all the profits.  For health insurance companies, If Senator Leahy or the President wants to pull that trigger, I say, let ‘em.  Just about everything else in the bill is designed to increase health care costs, so what’s one more? 

 

But the issue isn’t anti trust, it’s ERISA.  The federal law governing health plans gives a specific exemption from common contract law.  Under normal (and by this I mean both common and various state laws, although they may differ in specifics) contract law, a contract entered in good faith, even if there are flaws in the actual contract, such as doting the i or crossing the t , is still a valid contract.  Not so for health plans under ERISA.  The insurance company can retroactively cancel the contract of any member for any sort of contractual error.  They certainly have an incentive to dump high cost (i.e. really sick) patients if they can legally get away with it, and thanks to federal law, they can!

 

I guess lobbying really does pay.

 

Inevitably, when these hard luck rescission cases become big news, like Ian Pearl’s case or others that have become a cause celebre  for big government types such as the cases of Robin Beaton and Otto Raddatz’s, the reason they lost their health care was because of rescission; because the law allows them to.  Big government liberals easily forget the real villains in those cases:  ERISA.

 

Health Insurance II:  This time it’s personal.

 

“the quote you used was the PC/CYA reply to being asked why the VP would call someone like Ian or Chuck a fucking “dog”… which is something else you know, but chose to ignore because it doesn’t further your cause..

seriously.. how can you continue to protect an industry that would treat your wife the same way if she was diagnosed with MS tomorrow is simply beyond me..she would just be their new ‘dog’ to rid themselves of..”

 

 

Although I find myself offended at the term “dog” being used for either my wife or Chuck ( Ian I don’t know.  Sorry Ian, I’m sure you’re a nice guy and all…), the context seems to refer to the accounts, rather than the individuals.  But lets assume the worse.  The health insurance execs are meanies, they hate Ian, Chuck, and my wife and think they are dogs, and of course, hope they all die before too much money is spent on the sickly, when it could be much better spent on fabulous executive bonuses.   THIS is one of the key differences between people who trust the free market (as opposed to individual companies or executives) and people who trust the good naturedness of big government (stand by, teachable moment here): 

 

I don’t care that companies may hate me, are greedy, or that they are looking out for their own self interest.  Of course they are!  They are in business to make a goddamn buck!  Not to wipe the tears from our eyes and give us a shoulder to cry on. 

 

But it’s an observation that predates Adam Smith’s invisible hand:  Businesses and individuals in business are conducting commerce for their own ends.  However the result of that is that everyone’s interests are satisfied.  You want a widget, and a greedy company wants to make money by selling widgets.  Money and Widgets are exchanged, and voila!  Everyone gets what they want!  Contracts?  Same thing.  There is a centuries old body of law governing, “lets make a deal” between people.  As a general rule, it works pretty well.  It would probably work pretty well with health insurance too if our government allowed it. 

 

But if your thinking on private enterprise and business is totally dependent on companies being filled with nice guys and gals who think providing profits to their shareholders is less important than holding your hand and skipping through the meadow on a spring day, then you are pretty much going to hate capitalism and the free market.

 

And of course, let’s really get personal:

 

“.. you are as much of an accomplice in this as the ones who do it knowingly.. you have a president who will work with you.. but instead the GOP shat in his hand and walk over to tongue-kiss the insurance companies because they have the money to rile up the rank and inbred and to fund their re-election bid…”

 

 

 

Wow!  Me!  Personally responsible for Ian Pearl’s unfortunate condition, or responsible for the Republicans in Congress sitting on their hands and not embracing the President’s wack-a-nut health plan?  Either way, it’s a lot of responsibility to rest on my shoulders.  In any case, it was the President who spent the summer playing “wash the molars” with the health insurance companies, not the Republicans.  All the poor health insurance companies wanted was forced, mandatory requirement that everyone in the country get health insurance, a windfall worth billions to them.  That’s why they kept their mouths shut all summer and generically praised “health reform.”  Particularly after it looked like the Public Option was off the table. 

 

But a funny thing happened on the way to negotiations; the individual mandate and the fines to enforce it got weakened.  Weakened enough that suddenly the other higher costs enclosed in the health plan suddenly seem to outweigh the lesser amount of new customers the health insurance companies were expected to have the federal government  herd their way.  It is about self interest after all.  That’s what makes the world go round.  As fun as it would be to blame the Republicans for all this, or any of this for that matter, it’s strictly an inter-party squabble.  It’s Democrats versus the President.  Republicans?  They’re just out in the bleachers, yelling, “You lie” occasionally.

 

 

As for Ian, I don’t have a solution for him.  In that way, I’m no different than ekg.  I would have supported eliminating the part of ERISA that allows these situations to happen in the first place.  He would have either not lost his insurance, or if he had, his parents would have been able to sue the company in court.  That’s not an option available to him under current law.  But even if the Congress were to magically take an interest in that, I doubt it would be done in time to help Ian. 

 

Other than that, I only have Ian’s parent’s word that care under Medicaid is a “death sentence.”  I don’t know if that is their take on their son’s situation or a doctor’s opinion, but in any case, I hope they are wrong.  He’s getting the liberal dream:  government healthcare.  No greedy health insurance companies involved.   It’s government healthcare for Ian soon, and government healthcare for all of us eventually if the President has his way.  But If both Medicaid and Medicare, would have Ian die, why should this be shoved down my throat?  It’s funny that the biggest supporters of government healthcare suddenly are frightened by the thought of someone actually getting it.


My reply to lil mike

ekg here…what you’re about to read is  what lil Mike and I do, this is where we are in our comfort zone and where we excel. It’s long, it’s tedious, but the final result is an all out information explosive.. We have done this kind of exchange for years on muchedumbre.com. When we started ‘blogging’, we forgot that which made us great… the quote/reply debate, because it’s hard to get into that sort of debate in a ‘blog-comment’ section..

well, not anymore…

Here is my rebuttal to Lil Mike’s

Public Option? -> Only Option

Feel free to join in the debate in the comment sections.

..

” But one thing is clear, if it’s going to be reform in any way that Obama and the far left of the Democratic Party care about, it’s got to have the “Public Option.”  Right now the administration is having it both ways.  On the one hand it’s saying that it has no intention of driving private insurers out of business, but on the other hand, reassuring Congressional Democrats that the President is still committed to having a public option as part of his vision of health care reform.

Why the Public Option?  The formal answer was included in Obama’s letter to Senators Kennedy and Baucus:

“I strongly believe that Americans should have the choice of a public health insurance option operating alongside private plans. This will give them a better range of choices, make the health care market more competitive, and keep insurance companies honest.”

Competition?  There are approximately 1300 health insurance providers in the US.  Really, will 1301 really make the difference and suddenly lead to “a better range of choices, make the health care market more competitive, and keep insurance companies honest?”  That’s all it would take, just one more provider?  The idea is so ridiculous that you would have to be a White House journalist to buy it.”

Ok, will one more provider really make a difference? Absofuckinglutley!  Yes, 1300 companies offering the same shitty product would actually have to offer a better option if a bigger and better player came on to the scene. Your debate isn’t whether the Government can offer a product that will make the other companies provide a better choice, your argument is… Should the Government offer that product at all.. So let’s not play games with throwing in all this other stuff..

“What makes the public option the crown jewel of any health care reform plan?  It’s the camel’s nose under the tent for single payer government healthcare.  No, this isn’t just Republican scare-mongering.  I can hardly imagine any other conclusion for the insistence on a government healthcare plan.  And it’s easy to see how it would happen.  The logic is this:  One of the keys of health care reform is an individual mandate, but you can’t very well have one if people cannot afford to buy health insurance, so you have to provide an option for people too poor to pay.  Enter the public option.  An analysis of several public option scenarios shows that premiums could be 30 to 40 percent less than comparable private plans.  That of course hinges on the government paying reimbursement rates comparable to Medicare, which are 70-80 percent of what private insurers pay.”

I read your Lewin Group PDF analysis it was interesting.. until I Googled them and found out that..

Lewin Group is) part of Ingenix, which is owned by United Healthcare Group, the insurance behemoth that has been buying up insurance companies left and right, expanding its reach into just about every segment of the health-insurance market. Its flagship, UnitedHealthcare, helps make it the largest health insurer in the country. It’s a safe bet that United is not too keen on a public plan that might shrink its business.

Now I don’t find them credible in this discussion..Sorry about that but seriously, you wouldn’t allow me to use Rahm’s notes as actual unbiased data would you?But let’s address this ‘fear-mongering’ warpath scream of “Single Payer Healthcare-Oh My”..  Why is it that every time a Democrat tries to do anything you Pub’s start screaming ‘Government take-over!” “Government Control” “States Right!” and“Give me Liberty” , when after 8 years of massive Government abuse, Lenin-ish intrustion, insane Government spending,  and obscene Government entitlements there was nothing but the sound-bite of “If you’re not with the President, you are with the terrorists” to anyone who raised a fart of a question?

But now, Oh My God! We’re killing health care…!! We’re taxing people too much..!! Businesses will crumble..!!

really?

Did you know that Bush’s medicare proposal was…

…aimed to inject market forces into Medicare by encouraging beneficiaries to enroll in government-subsidized private health plans that would compete directly with the traditional government-run, fee-for-service program. The drug benefit would be the chief inducement for seniors to make the switch to private plans.

Maybe I missed it, but were there Fox News sponsored Tea-parties for that?

Something else I just found out (by the way, this is why Mike and I do this so well… during our hunt for facts we often find other facts that come in handy in other debates) “The Patriot Act and Department of Homeland Security was the brainchild of one William Jefferson Clinton.” Sure the website is a little nutty and over the top in it’s ‘doomsday’ opinions, and in all seriousness I shouldn’t link it because you will use it against me, but what the hell.. it pretty much spells out everything I’m saying about what the Pubs were happy to do with a Pub leader and shit themselves when it’s a Democrat doing the same thing. Best of all, it does it with the same chicken-little hyperbole you guys are using now..

In short, Bush’s encouragement to beneficiaries to enroll out of their private plans and into the government plan didn’t bring about “Single-Payer Storm troopers” and neither will President Obama’s. But if… if it did, once again you can thank Bush for that ummm…camel nose under the tent… since he started the ball rolling… 😉

Of course I loathe the ‘It’s Bush’s fault” argument.. It was fun for a few years there, but now it’s just old,crusty and only garners a slight roll of the eyes… The problem is, there are just so many fucking things that are his fault and you Pubs are just now finding that out because Obama is following in his footsteps on alot of them. So as loathsome as it is to say.. it’s still applicable.

Moving on…


“So one of the ways the Obama plan controls costs is just by paying the doctors and hospitals less.  I’m sure that will make a great incentive for people to go into the medical field.  And who wouldn’t want to be taxed to subsidize their competitor?”

President Obama will pay doctors less and therefore who would ever go into the med field.. An addendum to this argument is the.. “we will become a 3rd world health care system because there will be no incentives (money) for research”… OK 1st, we already are below many 3rd world countries when it comes to our health care and as for the rest? Well,  I can think of one disease that if it wasn’t for the French, not only would we still be calling it GRID, who knows when someone would have been able to isolate the AIDS retrovirus. Hell, it was a German who discovered that HPV was the leading cause in cervical cancer…

As for being paid less? When did we lose that ‘country doctor’ mentality of people becoming a doctor to help people? Was it around the same time insurance companies first started popping up? I’d really love to see a study on the correlation of the emergence of insurance companies and their control and doctors treating people less because it’s what they dream of doing and more to try and become a million by the time they are 30.

In short, I don’t know what President Obama’s plans on the pay scale for doctors and hospitals is. I know that right now we spend more money on administration costs than just about anything else. Medicare proves that you only need to spend 2% on admin costs and still function admirably.. $230 billion a year is spent in California alone on administration costs, Obama’s plan cost less than 1/2 that for the entire country.. so why those  massive saving would not trickle down throughout the system is beyond me.  To me, it would seem that if $25 from every $100 doctor visit that went to insurance administration now, was cut to $2, the doctor would be seeing a hell of alot better of a return.

“First, the same analysis shows that depending on the premium rate for the public option, 119 million people could lose their private health insurance…If the public plan has lower premiums, what do they care what rate their doctor gets paid at?  Others would find themselves dumped.  Why would companies want the expense of maintaining their own health insurance coverage when a public plan can offer lower premiums?”


I addressed this somewhat above when I brought Bush’s plan to get people off the private rolls and onto the public ones  to your attention already, but that’s not my argument against it, a bad plan is a bad plan no matter who the President is, something the Republican  religion doesn’t like to admit..My argument is this… I believe you are wrong.. those insurance companies will be forced to compete with the new plan.. they will have to offer something else, whether it be a lower premium or more coverage or an annual trip to Bermuda..whatever.. I mean do you seriously think they’ll just keel over and die? Hell no, they’ll find something that their competitor doesn’t have and offer it..

Back in the 90’s I was fired for being pregnant, lost my insurance(not that I had prenatal anyway), and was forced to go on Medicaid. HMO’s were exploding at that time and you were forced to pick either an HMO or straight medicaid. There was many HMO’s to chose from  and they all pretty much offered the same plans as each other and medicaid but since there was competition, the HMO’s decided to offer other incentives to get people to enroll in their plan. It was piddly shit like  children vitamins each month with this one, free contacts with that one, free vitamins,contacts and bubble gum with the other..(ok, not really on the bubble gum.. but you get the point).. the catch was you had to use their doctors,their hospitals and their pharmacies. Or you could stick with medicaid and go with pretty much whoever you wanted. I liked my doctor and she took medicaid so I chose that path. So when you tell me that a government sponsored plan will not only force people out of their private plan but will force private plans to close up shop and move away.. I laugh! These companies want to succeed today just as much as they want to succeed tomorrow and they will find a way to entice employers to keep paying them.. Whether that be free vitamins or a free trip to Bora-Bora for the employer who signs up the most employees onto their plan.Most, if not all, will adapt and  survive… and those that don’t? Well, you don’t mind when they fall in a full capitalistic society do you?

So why is a Public plan the only option? Because without it there is no change.. With it there is a crack in the monopoly-like hold insurance companies have on this country and it’s leaders. They have never had to worry about regulation and competition before and now they are throwing out all the buzz words that make  conservative hard.. “Socialism”..”Government sponsored”..”Government entitlement”… and to that I say Pshaw! Look what the debate has already done for health care… before a person was actually denied  treatment for her cancer because her insurance company said an outbreak of pimples in her past constituted a ‘pre-existing conditions’.Pimples!  But now all of a sudden insurance companies are screaming that sure,  they can get rid of the pre-existing conditions clause. The debate alone is forcing other companies to offer more benefits at a lower cost to women in some states.. The debate alone is changing health care for the better.. If the debate is cleaning up health care and the conglomerate-do-as-they-please  hold on health care that the insurance companies have.. then I am encouraged as to what an actual Public Plan will be able to do.

So, the cost factor? One state already pays 1 and 1/2 times more for just the administrative costs than the public plan for an entire country.

The reduction of doctor’s fee and hospital costs? The savings from the decrease in administration costs should increase what the medical providers see.

The loss of research and cutting edge medicine? You walk into the  Pasteur Institute and tell them they’re a 2nd tier institute.

Socialism? Please.. George Socialist Bush!

The loss of a free market? No, more like the opening of a closed market and forcing it to become competitive to survive..

Yes… Public Option? is the only Option

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