Many physicians do not accept new Medicare patients because payment rates are so low. Medicare almost always imposes price-controls to lower costs, rather than promoting innovation and efficiency.

Is that ever true. When my grandmother's doctor retired she had a hard time finding another that would accept the program she was on (MediCare? MediCaid?). One office tolder straight out that the pratice had been limiting itself to 5 patients on the program but had decieded to drop it 3 because the program did not cover their costs. So my grandmother would have to find a different doctor, wait till 3 of the patients left, or pay by some other means. Luckly she found a doctor after a couple of months but he is older and may retire soon too.

PJTV has an excellent video up about the city of Detroit. Watch and see your future. Centralized government programs breed inefficiency, waste, corruption, and sloth. They demonize individual achievement and success since that makes government run programs look poor in comparison. Finally, as entitlements outpace the tax base, the money eventually runs out and you have vote buying thugs in office who know corruption and finger pointing oh so well but have no clue how to fix anything. So they cry for a bailout (why hello California!).

Folks, at some point, this entire country goes bankrupt and there will be no further bailouts. I think we should consider bringing back the practive of tarring and feathering politicians who keep voting for this crap.

"If something cannot go on forever, it will stop."

--Herb Stein, economist

The only question here is whether we will plow into the brick wall at 100 miles an hour or slow down some before that point.

As someone notes, the experiences of Michigan and California suggest that dependent, entrenched, organized voting blocs in this country will angrily refuse to believe or accept frustration of their expectations. Instead, they will believe--and someone will garner votes telling them so--that it is the fault of some "other" out there, who withholds wealth from them.

Contrary to what Mr. Garland writes, the Democrats are eager to pass healthcare reform now because they have wanted to do so for about 50 years, and it is unlikely they will have larger congressional majorities and the white house at the same time for the forseeable future. It is now or (potentially) never. Which us why they will accept the watered down Senate bill and pass it more or less untouched. It's not economics, it is politics driving their decision-making.

Think about General Motors.

"What?" you say. "General Motors was bought by the Treasury Department - well, 61% of it - and they're out of trouble," you think, aloud.

No. They still have the same problem they did before: a pension plan put into effect by a special interest group that didn't have the long-term survival of the company as any of its goals.

That's exactly the problem with Federal programs. So long as the form is filled out and the Federal agent gets paid - this time - then everything is completely and utterly according to plan.

It'll take a famine to wake the stupid. Some idiot at the NYT was comparing support for Stalin to that for Reagan, claiming that Reagan's defense spending was all that was responsible for deficits seeded during his tenure. Again: Congress spends every Federal dollar, and they spent a buck on social programs during Reagan's terms for every defense dollar.

> It's not economics, it is politics
> driving their decision-making.

You smoke dope on holidays?

Democratic politicians are trying to scurry for political cover
to avoid blame. They have promised benefits for 30 years that
they can't deliver to the current population of baby-boom
retirees.

That's tin-foil-hat level conspiracy theory. It's implausible
even on the face of it. Over the last 28 years, Republicans have
been in power for all but four of them. That means that no
Democratic coverup is necessary. If there's a problem, the
absolutely obvious and easy answer is to blame the Republican
administrations for messing things up.

It's a tragedy that President George W. Bush, with Republican majorities for 6 years, actually governed to the left of his democratic predecessor. Then when things went south, it was preceived as a conservative failure, so the voters ran even further left (out of the frying pan, into the fire so to speak).

It's amazing he gets away with it. President Obama campaigned against Bush's fiscal irresponsibility, and turns around and does more fiscal damage in 1 year than Bush did in two full terms.

You smoke dope on holidays?

Nope; booze is how my people roll. I'm right. Garland is wrong. Medicare and Medicaid deficits are not why Dems are pushing so hard for health care reform right now: they are doing it because they think it is what we need to do, have for half a century, and they will probably never have a better chance to do it.

Trust: I think Ross Douthat made a good point along the lines of what you mention. Republicans had about a dozen years on charge after they killed Clinton's health care bill to set the agenda on health care, and failed to do so. They could have pushed for many of the market based reforms they prefer, and did not. Where they failed to act, Democrats are, and conservatives are going to be unhappy with the results. It's their own fault.

@Whatever

It's a paradox. Platform-wise, republicans have a better agenda. In reality however, it doesn't work. Two examples:
1. Welfare reform: republicans supported it because it moved us to the right, democrats supported it because it was headed by democrat Bill Clinton.
2. Prescription drug benefit: democrats supported it because it moves us to the left, republicans supported it becaue it was headed by republican George W. Bush.

Moral of the story: it's easier for a Democrat to move the country right, and easier for the Republican to move the country left. The reason is the bipartisan support one gains because one's party supports them because they are the same party, whereas the other party supports it because of the content.

If Clinton would have done prescription drugs it ould have failed because republicans wouldn't have supported it, and if George W. Bush would have tried to reform welfare the democrats would have crucified him (the way the crucified him over social security solutions).

Basically, either party moves us left, so we're basically screwed in the long run.

Trust: When we had Clinton, a DLC/moderate/pro-business Democrat in the White House (remember, he promised to "end welfare as we know it") and Gingrich, a smart small-government conservative, running the House (and driving the legislative agenda) we ended up with a fair amount of sensible, fiscally sound legislation. That's the only time I recall the Federal government paying attention to both revenues and expenses. On its own, neither party is very attentive to both of sides of the balance sheet.

@Whatever

You are correct, Clinton did promise to end welfare as we know it. However, as you also recall, it was his insane Health Care socialization plan that killed his party. But, for the most part, things worked out...Clinton was a moderate, and the republicans would not let him move left. On the flip side, they let Bush move left since he had an (R) by his name.

I think Gingrich did more good for the country than he got credit for. He was asked at a town hall meeting "how come we had surpluses with Clinton and deficits with Bush" and Gingrich responded "I remember the balanced budget in the 90s, because I wrote it, and the republicans have since lost their way."

Too bad Gingrich was so effectively demonized by the left to the point of being unelectable. If you read his writings or listen to his speeches, he really is the one who has realistic solutions to our problems.

I was in a group of graduate students that got to have a meeting with Congressman Ray LaHood (R-IL) in 1996, after Clinton was relected. A student asked Mr. LaHood what he thought should be done about President Clinton taking credit for what the Republicans do. Mr. LaHood had a good answer: "Nothing. Bill Clinton is our president, and we don't have enough votes to override his veto. If we want to get anything done, we need him to sign legislation, and we can't ask him to do that without letting him share in the credit."

Conversely, any republican or democrat that votes for Obama's (or voted for Bush's) big spending must share in the blame.

they are doing it because they think it is what we need to do, have for half a century, and they will probably never have a better chance to do it.

No, they are doing it because they want to dictate every possible detail of every individual life.

They are power-seeking nannies who believe that they know better than we how to live our lives, and they're going to save us from ourselves whether we like it or not.

I hate hate hate agreeing with Brian.

> they think it is what we need
> to do, have for half a century,
> and they will probably never
> have a better chance to do it.

This is just such a spectacularly weird thing to say. It's like saying the reason Mike Tyson raped that girl in 1991 was because he didn't think he'd get the chance to do so after the turn of the millenium: It explains nothing and excuses less.

I hate hate hate agreeing with Brian.

It gets easier after the first few times.

It explains nothing

Surely you must be aware of this: Democrats have long wanted to extend health coverage to all Americans. Because single payer is too much of a leap, they opted for a mandate + subsidies. Hope that clears things up.

> Democrats have long wanted
> to extend health coverage
> to all Americans.

You can't hear your inanity. You're all zombied-out. It's like the koan-chanting Krishnas we used to face in the airport, only without the brightly-colored uniform.

We all understood you ten laps ago, Dude; Some Dems have wanted to do this for a long time. Got it! We grok! You were perfectly clear and well-appraised!

So what? WHERE WILL THE MOTHERFUCKING VALUE FOR THIS COME FROM? DO YOU SINCERELY BELIEVE TELLING PEOPLE CARE HAS ZERO PRICE WILL MAKE IT MORE PLENTIFUL?

Your twin visitor didn't get back to me about any of this last time, so here's a cut and paste. Whereas you used the word coverage, we are of course talking about "insurance":

Dear BS person (10490am), what makes you think insurance protects people? Isn't insurance just a billing arrangement? Why do you imagine that suddenly everyone is so tremendously concerned with everyone else's well-being such that they want to pay for it, no matter what the cost or obscurity of the care?

Is your need to think of yourself as a compassionate human being so desperate that you really need to do this? Do you daydream that there's been some grandiose change in human nature lately --perhaps since your own precious arrival on this planet-- such that this makes a lick of sense? Has adult life shown you any, ANY moral dilemma for which the solution is to forcibly spend OTHER people's money?

DO YOU SINCERELY BELIEVE TELLING PEOPLE CARE HAS ZERO PRICE WILL MAKE IT MORE PLENTIFUL?

I'm not saying that. Getting anything done costs money. My taxes will go up as a result; yours probably will, too. I'm OK with that arrangement. I knew what I was voting for.

...

The health and economic well-being of our society is threatened by our current healthcare system. It's too expensive, covers too few people, and creates too much uncertainty in the lives of too many. >We spend over twice what most other nations in the developed world spend, and don't see better outcomes for that money.. I'd say we're emphatically not getting good value for our healthcare dollar; it's time to do things differently.

Sorry about the HTML tag issues, everyone.

Healthcare outcomes are repeatedly cited to claim that the expense of US healthcare is wasted, and that only governments deliver inexpensive, quality care. This is supported by an intentionally biased interpretation of the statistics.

USA Healthcare is First - Infant Mortality is Low

John Stossel presents this well. "Why the U.S. Ranks Low on WHO's Health-Care Study" (at the above link) analyzes that life expectancy is a bad measure of a country's health-care system. The US has far more fatal transportation accidents than other countries. Our homicide rate is 10 times greater than in the U.K., eight times greater than in France, and five times greater than in Canada.

When you adjust for these fatal injury rates, U.S. life expectancy is actually higher than in nearly every other industrialized nation. That doesn't show a health-care problem.

The infant mortality statistics are also carefully biased. The US counts every live birth, however premature, toward its statistics, even if the infant lives only a few hours. European countries may only count infants that live at least a day or which meet other health criteria. So, they claim fewer infant deaths, which dramatically changes the statistics for infant mortality and average life expectancy.

Critics claim that the US is spending too much compared to the numbers reported by foreign national health systems. I don't believe that those systems are including all of their costs. Government programs do not accurately report what they spend

How is this for bias? The WHO (the U.N. World Health Organization) ranks the U.S. first in specific quality of care (many factors of patient satisfaction), then lowers the U.S. rank to 37th for "overall quality" because that care is more expensive, and is not being provided as a government service (!). Then, critics cite the lower rank to claim that U.S. healthcare delivers less, despite spending more. This is ironic and fraudulent.

Then, critics cite the lower rank to claim that U.S. healthcare delivers less, despite spending more. This is ironic and fraudulent.

So we spend twice as much for the same outcomes?

> I'm OK with that arrangement.

You're "OK" spending other people's money when they're against it. You're cool with that.

You're "OK" spending other people's money when they're against it. You're cool with that.

It's the nature of taxes. They go where Congress designates them, and it's certain that no person is happy with every expenditure. So yeah.

YOU CAN'T HEAR THIS

Why do you think we all care for each other so much? Or that we should? So much that we can, or should, cut blank checks?

You live in candyland.

It's the "nature of taxes".

I have it! New program! We'll all be eternally responsible for each other's health! It'll be great! Sign here!

You live in candyland.

LOL. Where does that make you live? Neverland? Aren't you someone who thought we were going to build a successful liberal democracy in Iraq?

I have it! New program! We'll all be eternally responsible for each other's health! It'll be great! Sign here!

Your outrage is cute, Crid. What did you think we were going to get when we elected Obama and massive Democratic majorities in Congress who promised to do this exact thing? Like Bush said, elections matter. Ya'll got crushed, your team hasn't played ball on this bill, and shocker - are getting legislation passed you don't like. That'll happen.

> What did you think we were going
> to get when we elected Obama

What did Miss Black Rhode Island think was going to happen when she went to a beauty contest to be judged by a psychopathic idiot?

Swear to God, Whatever, you are autistic. There are certain emotional and social cues which you are flatly incapable of discerning. It's fucking nutty, because it speaks to the lunacy of your whole team.

Did I forget to include "globally-famously VIOLENT" psychopathic idiot? Sorry.

Thing is, this will be much worse. The horror of this will terrorize hundreds of millions over generations.

What did you think we were going to get when we elected Obama and massive Democratic majorities in Congress who promised to do this exact thing?

What you mean we, white man? I didn't vote for this cockholster and his retarded band of communist-party throwbacks and hippie retreads.

Like Bush said, elections matter. Ya'll got crushed, your team hasn't played ball on this bill, and shocker - are getting legislation passed you don't like.

Correction - Republicans were locked out of the negotiations.

And ANY legislation passed on this issue as going to be legislation I don't like.

I don't know about you, but I'm already losing nearly 50% of my not at all large income to taxes. I don't care to lose more.

The horror of this will terrorize hundreds of millions over generations.

Right. Making health insurance more affordable and accessible to people = a horror terrorizing millions. Just like an invasion of zombies.

What you mean we, white man?

We, the people. Obama and Congress were duly elected following the laws of our land. Don't like it, try again in a few years. I had to deal with Bush for 8. It's how it goes when you lose.

Correction - Republicans were locked out of the negotiations.

Democrats really wanted to be able to call this bill bipartisan. They would have gone to significant lengths to get Republican support in the Senate.

> Making health insurance more affordable
> and accessible

You aren't doing that. You can't do that: It's not possible. It's not possible to simply announce that something with the value of X is now Y and expect people to pay for it. The world doesn't work that way, and markets ignore such foolishness, legally or otherwise. People want what they want, whether they're brilliant join specialists or Guatamalan ass-wipers.

And it's interesting to me that you persist in pretending this is about "insurance" (contracts / paperwork / definitions") instead of "care" (medication / expertise / asswiping). Like all lefties, you wanna belief the whole world is about clever and dastardly manifestations of power.... But AHA! You're wise to the tricks of your enemy, and you won't be fooled any more!

> Democrats really wanted to be able
> to call this bill bipartisan

Tyson would have been much happier if Miss Black Rhode Island had admitted that she was really asking for it.

PS — Did I cover this? No?

> So we spend twice as much for
> the same outcomes?

We pay what the market will bear. If those prices mean so much to you, why don't you move their? Although you'd still be living under the United States military umbrella, just like the nations (whose names you fail to specify).

We hope your proud. This is very much like the breadwinning father of the house moving in with his adult, ne'er-do-well son over the garage to smoke dope and play video games.

You don't like the price of something, so you destroy the market that brought it to you. You are just not a nice guy.

You recently described your preferred holiday inebriants. Much is explained (per Drudge).

Commenter 'whatever' linked to a graph at The Atlantic about per capita healthcare spending and life expectancy at birth. He states "We spend twice as much for the same outcomes."

() Unfortunately, the graph lists only generally where the data comes from, and not the report that produced the result. We can't check their methods and assumptions.

() Life expectancy at birth is a bad measure of healthcare results, because it is exactly the countries with public healthcare who throw out premature births and births where the child dies within 24 hours. Each time the US includes such a birth, it lowers our life expectancy statistic and raises our infant mortality statistic.

It is almost as if the relevant departments want US healthcare to look bad. I haven't seen any statistics from those agencies that make an apples to apples comparison.

() The US has more accident and crime related death than Europe. This also lowers the life expectancy statistic, but has nothing to do with healthcare.

() For particular diseases, such as cancer, US citizens pay more and do better. This doesn't show ineffective healthcare. It shows that people are willing to pay a lot to live longer, if they have the money and the option.

() When people cite the low costs of Medicare administration, they do not include activities that support Medicare but are not included in the spending figures. All governments have the incentive to under-report their healthcare costs. Despite Medicare's supposed efficiency, it suffers large losses to error and fraud, underpays for the care it proimises to deliver, and is so well planned that it is rapidly going broke. That is all within the government's control. They must like the situation.

() It is easy to spend less on healthcare and have great statistics: give the government a monopoly on paying for the care and for compiling the statistics. Cuba routinely issues infant mortality statistics that are lower than the US. I don't believe it.

() Britian is a great example of controlled costs with poor delivery.
Lack of British Maternity Care

Quip: We find do-it-yourself is much cheaper.

"Almost 4,000 women (up 15% this year) gave birth outside maternity wards lacking midwives and hospital beds. Overstretched maternity units shut their doors to an additional 553 women in labor last year."

() And more from Britain
legalinsurrection.blogspot.com/2009/08/new-health-care-scandal-in-britain.html

"The Patients Association in Britian reports hundreds of thousands in the past six years received nursing care that was often neglectful, demeaning, painful, and sometimes cruel.

Elderly people were left in pain, in soiled bed clothes, denied adequate food and drink, and suffered from repeatedly cancelled operations, missed diagnoses, and dismissive staff."

() I'll repeat my point from above. The WHO ranks the US #1 in care delivery that is important to patients. It issues another ranking at 37th because this quality of care costs more! How do socialists explain that ranking and re-ranking? The only counter to this evaluation, by the WHO itself, is the flawed infant mortality and life expectancy statistics.

It is a great irony that socialists now style themselves as businesspeople and efficiency experts. Let them run things, and everything will be cheaper and just as good. Aren't these the people who want to reduce world population?

Right. Making health insurance more affordable and accessible to people

It's cute how you actually believe that.

Because even if it were possible for government to do it (which it can't), the bills presented (what we know of them) will do precisely the opposite.

We can be guaranteed that whatever crosses Obama's desk is going to decrease the availability of medical care, increase the cost of said care, increase the time between diagnosis and treatment, increase the wait time for diagnosis, declare more and more cases "hopeless" and denied treatment entirely.

Oh, and increase taxes on everyone too.

You are either willfully blind or just plain dumb if you believe that the goal is anything like making health care available and affordable.

This Garland boy's got it goin' on.

I had to deal with Bush for 8. It's how it goes when you lose.

Some comparison. The Iraq war was presented to Congress. The Dems had plenty of say, and most of them voted for it, no matter how much they'd like to disavow their votes today. The health care bill was cobbled together of sweetheart deals between Dems debated behind closed doors in a smoke-filled room. So no. It's not "how it goes when you lose." It's how it goes when Republicans lose.

We pay what the market will bear.

Two problems with this statement:

1. You assume that health insurance is purchased on something approximating a free market. This is simply not the case.

1a. Within most states, one, or a few insurers dominate the market. There is no real competition there.

1b. We don't negotiate with them, either. Most people select among a few options offered by their employers.

1c. If you happen to work for a really big company or are part of a union (many of your pals in the industry can attest to this), you pay less for your coverage then if you work for a small company or (even worse) yourself.

1d. People who don't buy any insurance are still priced into the costs insurers have to pay because the costs of the uninsureds' primary care via emergency room are passed on by hospitals.

Still want to argue we pay what the market will bear? I've given you an easy numbering/lettering system you can use to refute my points.

2. This assumes that a market is the best way to pay for people's health care. I'm not sure that's the case. The market means that insurers are incentivized to deny care, exclude the sick, and otherwise pay as little as possible. At the same time, they have people over a barrel - anyone who has any desire to be financially responsible needs to have health insurance. God forbid you get sick and need to buy insurance on the open market.

P.S. I think Kaus is making interesting points here as usual:

http://www.slate.com/blogs/blogs/kausfiles/archive/2009/12/26/kf-spreads-the-germs-of-truth.aspx