Kalman is in a scrappy mood

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Zenin- Congratulations, you now sound like a right-winger.

On the other hand, what would work is nothing close to what the rest of the world has. In most countries the solution is to ration care to let the US pay for most of the cost of the development of new technology and new drugs. The Canadian system "works" because Canadians can come to the US when they get tired of waiting in line.

There will be lawsuits over forcing individuals to purchase insurance.

If insurance is required to have "community rating" and no pre-existing condition clauses, the cost of insurance will go much higher, and health young people will be looking for ways to get of insurance, even it means paying fines.

The cost of the program will be much higher than projected. [Think about how accurate the projections of Medicare spending were.] The budget savings are nothing but accounting tricks.

<a href="http://www.nytimes.com/2010/03/21/opinion/21holtz-eakin.html" target="_blank">http://www.nytimes.com/2010/03/21/opinion/21holtz-eakin.html</a>

If the government tries to control costs by reducing fees, at some point MDs will stop taking insurance and operate on a cash only basis. 

Part of the solution in the UK is to import doctors from third-world countries. If the US medical profession starts to resemble the UK's, someday you might have your choice between an MD who supports Hamas and one who supports Hezbollah.

... and tax lawyers are already looking for loopholes.

Obamacare will fail, either because the Republicans finally get some testosterone and find a way to repeal it, or because it survives and turns the country into Greece (or California).

Fact: The rest of the developed world pays half or less then what the US does, and is healthier!

"Insurance" companies need to go: Nothing more then a leech on the American people. Frankly, someone needs to ration care...at least if it's the government the politicians answer to the people, insurance company execs (who do the rationing now) only answer to stock holders. US health insurance companies are the modern day horse and buggy dealers, obsolete at best.

"Fee for service" needs to go: Incentivizing over-treatment, treatments over prevention, chronic treatments over cures and vaccines.

These are absolute must haves or nothing else matters, yet neither of them are ideas the right will go anywhere near. And why would they? It goes against the very core of right-wing belief: "I've got mine, [bleep!] the rest of you!"

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The best that can be hoped for, really, is that this bill blows up the problem even bigger and faster then it otherwise would have, so big that even the asshat right wingnuts can't ignore reality, and will actually put something on the table that can work (eg, something much closer to what the rest of the world has come up with to solve the issue).

I'm curious what you believe "the rest of the world has come up with to solve this issue," because you've made similar assertions throughout this thread. There are about as many different healthcare systems out there as there are nations. When it all takes effect, this bill is pretty close to the systems in place in Switzerland or the Netherlands. With tighter government regulation (I don't think our bill went far enough in this, which will limit our ability to contain costs) and more emphasis on individual coverage through exchanges, ours would very much resemble the latter. The Dutch system is the only one I'm aware of that has had a complete overhaul for a second time, to contain escalating costs in the 90s and early 2000s that had begun to plague their first universal system. (Australia has also had a fair amount of changes made in the last decade relating to their private hospitals, but I wouldn't call this a complete overhaul.)

In fact my ideal health insurance reform, based upon how other nations' systems have performed in practice, would have been simply copying the Dutch system article for article. (I don't care who wants what as their first choice per se; I am curious why you assert that a system like theirs is doomed to failure.) I don't think the bill we have does this adequately and I think we will have to add to it to make cost containment stronger and to completely eliminate the free rider problems associated with voluntary uninsureds.

But since you continue to assert that anything short of single payer is destined to fail, I'm curious what problems you think Western nations that provide universal healthcare through private insurance or a mix of private and public options are facing?

Take a look at this comparison chart, put together to compare the House, Senate, and Senate-as-passed-by-the-House bills.

http://www.kff.org/healthreform/upload/housesenatebill_final.pdf

In particular, check page 17. I believe that's a limit on how much can be charged for essential benefits. Pages 18-20 discuss other rate-related issues. It's not perfect, and it's not complete, but I believe that the bill "stops them from charging you $10,000,000 for" coverage.

Life expectancy is admittedly an imperfect measure of a health care system. But it's worth noting that Switzerland has the 4th best life expectancy in the world at 81.7 years. The Netherlands is 17th at 79.8 years. The US is 38th at 78.2 years. (Between Cuba & Portugal) A difference of 3.5 years seems pretty significant. Why do you think Switzerland has a bottom of the barrel health care system?

I'm just happy that the US has done something to take a step in what I believe is the 'right' direction. Of course, taking insurance companies out of the equation all together would make me much happier, but this is better than nothing! The changes regarding people with pre-existing conditions are really good, I think.

Not that it will personally have much of an impact on my life because I don't live in the US anymore, but as a very accident prone person, I know how quickly medical bills can add up to the unmanageable when you don't have good enough insurance/any insurance. I've always been insured, but it has either had a high deductible or low maximum amount that can be payed out, which has drained me of more money than I could pay by myself.

I know reform won't happen overnight, not everyone will agree with it, it won't be perfect, and there will be snags and delays, but it is better than nothing happening/going backwards (if that was even possible...).

Oh yes, I was agreeing with that. Swiss system seems pretty good to me.

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"Insurance" companies need to go: Nothing more then a leech on the American people. Frankly, someone needs to ration care...at least if it's the government the politicians answer to the people, insurance company execs (who do the rationing now) only answer to stock holders. US health insurance companies are the modern day horse and buggy dealers, obsolete at best.

I agree that the U.S. health insurance industry creates a lot of problems due to their "for profit" motivation that requires them to collect as much money as possible while delivering as few services as possible.

However, this is only at best half of the problem. The health care delivery industry (hospitals especially) need reform as well in order to contain costs. Up until the 1970's most hospitals were run by non-profit institutions. Today, most hospitals are run as for-profit businesses. Competition between hospitals has created massive cost increases caused by duplication of services.

One might think that competition would reduce costs, but it doesn't work that way in the health care industry.

Here's how this things are done by hospitals these days and how it drives up costs:

Hospital A serving a community has a cardiac unit that performs open heart surgery including transplants. Hospitals B & C decide that to "be competitive" they need to have "top of the line" cardiac units as well. So three hospitals serving the community now have this service.

Unfortunately, the number of patients needing open heart surgery and/or transplants is roughly equal to the number of beds/surgeons/operating rooms/etc. hospital A had been providing. No expansion into other facilities was really necessary to serve this demand.

But hospitals B & C knew the current insurance system would pay pretty much anything all three hospitals would charge to make a profit on services ("reasonable and customary rates") - even if that cost is based on 2/3 of all available beds in the three "top of the line" cardiac unit being empty most of the time. So there was no incentive that prevented hospitals B & C getting into this game. The profitability of all three hospitals was (and still is) guaranteed by the health insurance system. Hospital A loses nothing and hospitals B & C are financially rewarded for duplicating a service that met 100% of the demand all on its own.

Result? Now there is 3 times the needed capacity for open heart surgery and transplants in the community. All three hospitals offer this service and all three now charge three times the rate Hospital A charged when they had the market to themselves.

(This happened in my own community of Madison,WI when a law was repealed that gave the local government the power to disapprove the addition of new high-cost services proposed by any hospital if the demand for that service was already being fully served by other hospitals in the city. Now both the cost of services and the number of empty beds have skyrocketed.)

This is just one example of runaway provider costs. Unless health care providers are forced to eliminate duplication of services and other wasteful practices that raise costs without improving quality of care, the U.S. will continue to pay more for health care than any other industrialized nation.

Ten inconvenient truths about Obamacare

http://www.washingtonexaminer.com/politics/Ten-inconvenient-questions-about-Obamacare-88853462.html

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Ten inconvenient truths about Obamacare

More like "Ten lies perpetrated by conservative think-tanks about health care reform"

In the link you provided for infant mortality, the UN ranked Switzerland #9. (CIA included a number of nations with populations in the tens of thousands, which bumped them to #16... but we are probably not discussing Anguilla as one of the top 20 players). Half of the countries above them are highly urbanized islands or nations with the population of a large US suburb. They're #4 in overall life expectancy.

What performance measures are they failing at to offset these other great results?

It looks like the WHO ranks them 20th overall because, despite having fantastic performance, they have marginally higher costs and don't have as progressive a distribution of payment (recall that the WHO rankings of health care systems give a quarter weight to total cost and distribution of cost).

Frankly if it buys superior results and service at the cost of a couple hundred extra bucks per year, I don't care. Conversely, for the WHO to rank Morocco above Canada on the basis of the former spending just 1% of its GDP on health care, despite Morocco having an infant mortality rate 6 times that of Canada and a life expectancy 9.5 years shorter, shows me that the WHO rankings are a joke.

Cost matters but those ranking place too much emphasis on cost and cost distribution and not enough on quality of service. You can get a good health care ranking by just not spending any money on your citizens' health, and having the upper class foot the bill for the meager amount of resources that you do spend. There's probably political reasons for the scoring system (don't want the list to show developed nations always having better health care than developing nations), but let's be serious: would you rather get treated in a country like Canada (#30), Denmark (#34), and the US (#37)... or a country like Oman (#8), Colombia (#22), and Morocco (#29)?

I don't think anyone here is confusing life expectancy with quality of care. But it's worth noting that before Canada started their nationalized system their life expectancy was two years shorter than the US, now it is two years longer.

RE: cost issues- I wonder how much of our costs reflect higher US physician & nurse salaries? It wouldn't be wise to cut physician salaries. Top students in the US, have too many less socially productive but more lucrative opportunities.

Did y'all hear that there will also be a 10% tax on using a tanning bed? Also, restaurants with 10 or more locations will be required to post nutritional information about each of their products on the menu, as well as info about how many calories people should eat a day (surprisingly, a lot of folks don't seem to know that...).

I am very very very happy to hear about both of those. Maybe it will make people think before they fry themselves and put themselves at a much higher risk for skin cancer, or think before they eat that double cheeseburger with x-tra large fries and a monster coke and die of a heart attack or diabetes. Or maybe not. But both will help spread awareness and maybe deter some people from making decisions that are bad for their bodies.

I don't mind taxes for people making unhealthy decisions. In fact, I'm a huge fan and think that more stupid behaviors should be taxed. It will help pay for their cancer treatments or triple bypass surgery later on.

I am in close agreement with catlike. Doctors in other countries make less money buy also deal with less crap. I think it would be a fair tradeoff for our doctors to make less money while at the same time coming out of school with less debt, dealing with less administrative hassle, getting better cooperation from payers, and (if there is a difference between the EU and here) being a little more protected from lawsuits.

Modernizing the records system would help too.

The US doesn't spend $4,000 per capita more than other countries because of one glaring problem. It's a lot of problems put together.

Health insurance reform can be a partial solution but the health care system must also be reformed at some point. Trying to do both at once may have been over-ambitious (the support of the medical community was instrumental in passing insurance reform) so I'm not criticizing that decision as an immediate strategy; hopefully the long term goals cover additional aspects.