Mitt’s Mea Culpa & Obama’s Waterloo
Mitt Romney has promised that one of his first acts as president would be to dismantle ObamaCare. (“Repeal and Replace ObamaCare” is the operative slogan.) I like to think that his imperative attention to ObamaCare is something more than a deliberate policy program. In part, I suspect, it is an act of expiation, for ObamaCare is to a large extent RomneyCare — the health care reform act that Romney oversaw as governor of Massachusetts — writ large (writ very, very large).
And since RomneyCare has been around a few years longer than ObamaCare (it came online in 2006), it provides an excellent laboratory for seeing what happens to health care when the government takes over. What is happening in the great Commonwealth of Massachusetts today is what will be happening in the U.S. of A. the day after tomorrow unless something is done about this legislative monstrosity eftsoons and right speedily.
This morning, a cardiologist friend of mine sent me a note that contained a link to an excellent article in the Wall Street Journal about RomneyCare as a guide to ObamaCare. By “cardiologist” I mean “former cardiologist,” for like many doctors I know, he has left the practice of medicine in disgust — disgust over the government’s steady encroachment on his income in part, but also disgust over the way government was intruding on the doctor/patient relationship and bureaucratizing the practice of medicine, transforming doctors into wards of the state and patients into abstract consumers of scarce medical “resources” that the government was set to ration. (Why do you think that new government guidelines suggest that regular prostate tests and other screenings are unnecessary? It’s not because those tests don’t pick up pathologies: it’s because they cost money and the government wants to limit its expenditures.)
As I say, he is only one of many doctors I know who have left or are considering leaving the practice of medicine because of ObamaCare. Indeed, a recent study by the Doctor Patient Medical Association reports that 83 percent of doctors have considered quitting because of ObamaCare. But you don’t need me to tell you this: you probably know plenty of doctors who have left or shortly will leave their practices. And the flight of doctors is only one problem: “Even if doctors do not quit their jobs over the ruling,” a precis of the DPMA report notes, “America will face a shortage of at least 90,000 doctors by 2020. The new health care law increases demand for physicians by expanding insurance coverage. This change will exacerbate the current shortage as more Americans live past 65.”
Romney was acting on certain assumptions when he devised this disaster. He may regret the results, but has he questioned those assumptions?
Let’s be clear here, what is referred to as, “RomneyCare” originated in the Mass legislature and was very popular with the general population. The only defense I’ve heard/read from Romney is that the act was Legal. ObamaCare could reasonably called Reid/PelosiCare, which was and is wildly unpopular, except Obama took it as his own. Except for the soft-shoe by the Chief Justice, who was frying other fish, it would be deemed unconstitutional!
A governor that goes against the legislature AND the will of the people needs to have strong evidence that harm will certainly occur. I have seen nothing showing Romney lobbying the Mass legislature or the citizens in support of their health care bill. If you have this information please enlighten me.
“A governor that goes against the legislature AND the will of the people needs to have strong evidence that harm will certainly occur.”
Or he has to believe in individual liberty as a matter of principle.
(Lest I be misunderstood, I am absolutely voting for the guy. The alternative is too horrible to contemplate. But I would never mistake Romney for a committed advocate of limited government.)
“But I would never mistake Romney for a committed advocate of limited government.”
I agree there are far too many big government Republicans. Wherever he was before, Romney took a big step towards smaller government by selecting the leading and most articulate Republican advocate for smaller government and fiscal responsibility as his VP.
Yes, of course individual liberty but what about representative democracy? Is it the Will of the People or is it the Will of the Individual? The people of Massachusetts do indeed seem to want Romneycare. At least, like California, we have barely living, barely breathing examples of what horrible liberal policies do.
“Yes, of course individual liberty but what about representative democracy? Is it the Will of the People or is it the Will of the Individual?”
It is the collective will of the people balanced against the rights of each individual. The courts exist to determine judgements regarding those balances when there is disagreement.
We do not live in a “representative democracy”. That phrase was invented by the leftists as yet another means to dumb down the language in order to tear down our Republic.
There is a vast difference between a “representative democracy” and a Republic.
In a Republic, it is NOT the job of elected officials to carry out the will of the people. They are NOT simply surrogates for a general election.
Their primary responsibility is to the Rule of Law, NOT to the whim of the people.
If you don’t understand this profound difference, and why it matters to liberty, you need to start reading the Founding Fathers.
We are talking Massachusetts here. A state so populated with liberal nitwits that the locals have their own name for them, moonbats. The “giveme” base of the Democrats have no finer example of than the majority of Massachusetts. Unless those of us who live in RI,MD,HI,NY,CA,WA,DE,NJ,OR,IL,CT,MI take umbridge by being lessened in their comparison of moonbattery with Massachusetts, need I point out that not only did they vote for George McGovern, a singular achievement if there ever was one, they returned Deval Patrick to the Governorship for a second term,re-elected Barny Frank seventeen times and think Pocahontas Of Harvard might be a good senator. You simply can’t hang all of RomneyCare on Romney, consider the enviroment.
Massachusetts is one of only a couple of states that I have not visited, I presume this was God’s intention. I’ve often wondered what it would be like to meet someone who voted for Barney Frank. What a bizarre encounter that would be. I would like to think I could be the better person and keep a straight face, but probably not.
“RomneyCare” originated in the Mass legislature and was very popular with the general population”
….Ummm no it was not unless you were a typical democrat fool, or on welfare or unemployed and had no insurance. ANY person with a brain knew exactly what was going to happen. And I was one of the people who spoke out against it every chance I could. But speaking the truth in this “Liberal Utopia” is like saying you would like to see cute furry animals die, Progressve Liberals run away cying when ever the truth is told.
I want out of Massachuestts as fast as I can.
I left Boston in 1981, unfortunately, Maryland is not far off Beantown for moonbats.
Before we spend too much time castigating Romney of the Health Care monster in Mass. Try to remember that Romney was elected as a Republican Governor in what was then the most democratic liberal socialist state in the Nation. Romney influenced as much as he could the birth of this monster but whether he vetoed the bill or not it would still be the law because the legislature had the power to override any veto. By the way Mass is still the same state, stupidity is something that takes generations to overcome. It is a shame that it is now called Romney Care, but that is politics, and dumbassed democrats never like to own what they spawn. To Wit, The CRA of Carter and the modifications to the CRA by Clinton and the mess we are now in can all be directly traced to DEMOCRATS starting with the FHA of FDR, another early day Communist.
Exactly. Romney’s role was one of harm mitigation, keeping the far left legislature from coming up with something far worse. He won’t be so limited as President, since the Tea Party wave of 2010 means he’s not stuck with a radical left wing legislature. Expect a Reagan like performance and Reagan like economic growth / return to an opportunity society.
Obama, on the other hand, still has no clue why his NATIONALIZED health takeover was such a disaster and why the public still hates it (hint it’s the damage to the quality of health care and our economy it represents). That did not stop him from ramming it down our throats, so its yet another reason that miserable failure Obama has to go (it’s OK – he prefers golfing and being a celebrity to the hard work of being a successful president anyways).
I disagree with your assumption that a Reagan like recovery will follow the election of Romney (though I would be very pleased to be wrong). I only say that because historically, whenever a nation’s debt:GDP ratio reaches around 95%, that nation’s economy suffers a steep recline in economic output. We currently have one over 101% (I know, a depressing figure). So while I don’t doubt that a Romney economy will be better then the one we have now, I do doubt that it will be a Reagan recovery (again, if I wake up on January 21 first and we have a GDP of $16,500,000,000,000 I will gladly retract my comment).
It’s called Romneycare,but what he did was arbitrate two competing bills moving through the MA legislature at the time. With Dems having 85% majorities in both houses in the MA legislature, a veto was meaningless as they’d stuff it in his face. And, those MA legislative bodies have quite a reputation; just like IL, many of their leaders are either in jail or have served prison terms. Corruption is worn like a medal of honor. Now, with Obama’s pal, Patrick, as governor, I doubt changes to improve the system will never see the light of day. But, wait! If Obama is reelected his pal might be the next Attorney General of the USA.
That seems to be what the article is about.
Yes, they keep saying “repealing and replacing.”
The “replacing” part has me worried….
My sentiments exactly.
Me too.
Me three.
Yo tu tambien. The function of Sarah Palin, and the dozens of patriotic legislators from the Tea Party movement need to function as a whip on the Republicans to keep them on task if we do win in November. “replace” had to be part of the mantra to avoid endless demogoging with the Left Wing media but the replace better be darn market focused and efficent. This communist cabal has to be ripped out by the roots, starting with their many money source the public sector unions and continued into the full panoply of the government bureacracy at all levels.
I was thinking it, shoulda said it, but you did for me.
That’s why Ryan’s there.
This worries ALL of us who spot that nasty little caveat.
I HOPE the replacement is
1. removal of cross-state barriers to insurance
2. TORT REFORM.
I can’t help wondering, though, about all these physicians who can afford to quit partway through their careers. Overcharge, much?
“Partway through their career” might be age 71, as in the case of my dad, who sold his practice and moved to Africa so he could do medicine instead of bureaucracy. He has the money because he worked 80+ hour weeks for 45 years.
Of course, not all doctors work that hard or can afford to retire. But as demand goes up and supply goes down, one way or another the price will go _______
“Quit” means “quit medicine.” Doctors are smart people, they can do lots of things. Maybe they become plumbers and earn even more money.
I was going to write something along that line, as I also have a grasp of the obvious. I would add their strong work ethic, attention to detail . . . Most of the good ones will go the duds will remain.
This is a universal truth. Make any job unpleasant enough, and the competent performers, who always have alternatives, will leave. What remains are the trapped (two years to retirement, sick wife needs insurance, etc.) and the duds.
What I used to call the negative filter effect.
Worked in an industry that had periodic seasonal layoffs of machinists and other skilled technical folks. Most of them drew unemployment and waited for the callback, but the very best immediately took on other equal or better jobs and never came back. And the jobs did not necessarily pay better, but conditions were more favorable and without the uncertainty of those market driven layoffs.
Doctors already have second jobs – data entry clerks. They can no longer have a clerk enter their notes into med records; they must do it themselves.
I have a friend who is both a doctor and a successful gun dealer. He can quit either one and live off of the other if he wishes.
I know an orthopaedic surgeon who went into law.
Maybe you do not know exactly how the doctor gets paid in todays world. Me and my doctor are good buddies, let me enlighten you.
I am a 50% DV from Vietnam and am now 75 years old, Steve has been my doctor since he became a doctor. Steve works from 6am till 11pm six days per week and has for the entire twenty three years that I and my family have been with him.
When I see the doctor it used to cost me personally $12.00 the rest is paid by my insurance company after they hassle Steve for a couple months and then discount the bill according to how many of their clients see Steve.
Steve has already told me that if this ObamaCare is implemented he is going to become one of my direct customers, you see I hold the patents on MicroDermabrasion Technology. Steve is going to quit medicine and go into Aesthetic Services, A Medical Spa where he will have a business that will be independent from the government, sort of.
Bureaucrats will be the death of the Nation sooner or later…..
The obvious answer is management. At least they’ll get paid for doing all that paperwork, instead of being expected to do it for free.
No one is stopping you from paying exactly what you want, if you can find a doctor willing to accept what you offer. Why do I never hear anyone say this when they buy an iPad at a 35% markup? Being a doctor is hard, and only those with specialties make the major money (they all do well).
If you listen to Rush Limbaugh, he often comments that he pays cash for all of his medical costs and he says he always gets a deal – less paperwork for the doc and he gets paid immediately.
You seem to think that because these people leave the practice of medicine they are just going to quit working. You couldn’tbe more wrong. These people, these doctors, are very, very smart and quite accustommed to hard work and extremely long hours. They’ll do quite well in any endever they choose to persue. We, on the other hand will be stuck with a shortage of qualified health care Providers. You write of “overchargig”. Should the person whom can save your life be paid less than a rapper or a ballplayer? And if that lifesaver is not proprly compensated can you blame him for seeking another vocation?
Why doctors don’t stop accepting all forms of insurance, have patients sign a ‘no malpractice suit’ waiver for all diagnoses, and accept only cash on the barrel is beyond me.
Leave the insurance based system as it isn’t one designed to deal with medicine nor with sickness, especially when chronic diseases are added in. The idea of getting third parties of any sort, public or private, between you and your doctors is nuts and puts in artificial price points for not just services but durable goods and medications.
The cost of medical care only went on its steeply upward slope after the employer based tax write-offs were not repealed after WWII and then the Johnson Administration put the M&Ms into place… then the price necessarily skyrocketed as government was never, ever going to pay the full cost of anything. And wealth transfer from the poor and young so that the older (and presumably ones who should be better prepared for late life problems) population is a lose-lose for society: it impoverishes the young for what they don’t need and takes out the responsibility to prepare for the unexpected off of the shoulders of young and old alike. Laundering money for a ‘private’ based system with public funds still has government overhead to it (regulations on what can and can’t be in a policy, what the minimums are, etc.) which is something the government has demonstrated it sucks at… for decades.
Any ‘help’ that removes self-responsibility and self-reliance is worse than no help at all. Time to stop letting government tell us what is ‘right’ and start figuring that out on our own… for at least if you or I screw up we won’t have millions of others following us into an economic abyss and can serve as lessons of ‘what not to do’ to others. And for the truly poor, needy and those without family, may I suggest charity and volunteer work? It is uplifting, feels good, connects you with your fellow man, gives comfort that no bureaucrat can, and builds a stronger society and a stronger self in the doing. No government will do that for you. Only you can do that. Only you can build society, not government.
Well, for one thing, the way rules are set up, a doctor has to pretty much completely drop out of the insurance payment system all at once, switch over to a 100% cash-on-the-barrel practice. The vast majority of people have medical insurance through their work and aren’t in a position to pay cash, or at least not much cash (remember, employer provided health insurance has a favored tax status, paying your own bills not so much). Plus, no doctor has a really self-sufficient practice – they have their speciality and rely on other practices or labs to handle things outside it. You go to your GP for a checkup and he wants blood work to check your thyroid function, that test is done by a lab that probably takes insurance. If the test shows something odd, he refers you to an endocrinologist who probably takes insurance.
So you, his patient, need to be enrolled in the medical insurance scheme or else you are being vastly overcharged. Once you enroll in the scheme, it’s financial disadvantageous for you to go to a doctor who doesn’t take your insurance.
The way most doctors get out of it is by going into a speciality that insurance doesn’t cover anyway, like Plastic surgery or longevity medicine.
Another part most people don’t know is, Medicare, for example, you CANNOT decline to take Medicare patients and then see them and charge them (like you used to be able to – they would pay and then submit for reimbursement). So, if you drop out of Medicare, you have to drop all your Medicare patients. Right now, we’re just not ready to abandon our patients like that, but if Obama is reelected, we probably will shut down our practice. We have choices, we worked hard to become educated and have “hobbies” that pay pretty nicely if we did them full-time.
People smarter than I am, who have great knowledge of the health insurance system, say that changing the third-party payer system into a system that brings the health care consumer (you) closer to the health care decisions (you and your doc) as well as the financial responsibility for those decisions (back to you) is the best way to revise the system. Moving back to making health insurance an actual INSURANCE product and not the “third party pays all” system is the only way to save it. This means CATASTROPHIC coverage, not coverage for every sniffle.
One illustration that really stands out for me is colds. When I lived in the northern states where we have winter and it’s cold and people catch colds pretty regularly, there is no point in going to the doc for a cold. Period. I remember the receptionist asking if I had the symptoms for more than two weeks. No? Then rest in bed, drink fluids and take some OTC medicine. It’s a COLD! When I moved south, I found that every time I walked into a doc’s office 2/3rds of the people there had COLDS! And the docs down here will dispense antibiotics for a cold because the patients demand it. Why? ‘Cause the insurance company will pay for it. Believe me, if the patient had to pay $50 to see the doc and another $50 to pay for the drug, they’d rest in bed, drink fluid and take OTC meds. Don’t believe me? Ask my sister who has no health insurance. She has to be awfully sick to go to a doc, because she’s paying the bill.
Do I have sympathy for people who get cancer, have accidents, have potentially life-changing or life-threatening illnesses? Absolutely. That’s what catastrophic coverage is for. But when health insurance will pay for every little thing we may want to go to the doc about, we tend to go to the doc a whole lot more often. And I guarantee that when/if we end up with socialized medicine, we will find that the insurance will be required to pay for all kinds of things it currently does not, and there won’t be any money to pay for things it will right now – like end-of-life care for Granny.
Hey stop with that crazy common sense ehhh..haha
Same here in Canada where I live …folks going to emergency for nothing according to our provincial medical folks.
I’m 56 and yes fortunate for sure to have super health but I also work at it daily.
And never never go to emergency for snifles.
Hvae not been since an accident 17 years ago.
Hey it’s Canada…..minus a million some years so snifles are normal.
What an excellent analysis of the current 3rd party payer system!!
If you are going to pay my electric bill, and I only have to give you $35.00 a month towards it – of course I don’t care if I keep my A/C at 65 degrees, even if I am not home.
If Romney makes it to the Presidency and he does repeal Obamacare, that’s great! But what what will he try to replace it with? People should keep this article handy so they can remember Romney isn’t a staunch Conservative. He will have to be kept on a tight leash….a VERY tight leash.
Something even more important to remember is, any repeal of ObamaCare must originate in Congress. If they don’t send him a repeal bill he can’t sign one. Get on and stay on your senators and representative.
Hey Robert, how is it that Romney would have to deal with congress when Obama simply ignores them and tells his overlords to do as he commands and gets away with it? Different rules for communists and Rinos? Do you forsee a return to constitutional government under Romney when being a dictator seems to be much less of a burden on a President? Dream Act, just for starters.
There were some very practical and reasonable alternatives that were floated about as alternatives to the tyrannical monstrosity that eventually was shoved down our throats by the Reid/Pelosi Congressional Soviet.
Allowing insurance companies to compete across state lines, disallow coverage for routine checkups and procedures…do you file an insurance claim for an oil-change or when you buy a new set of tires?
And the preliminary “crisis” of the costs of medicines,(remember the importation of drugs from Canada?), hasn’t been addressed.
A lot of these approaches should have been tried first, but the nationalization of health care has been a long-held policy goal of the DemocRat party, and doing what might work was not a priority for them…asserting control WAS.
What we needed was a tune-up, and what the DemocRat Socialist Collective did was replace the entire power-train…and not a particularly GOOD powertrain, either.
Let us all hope & pray you are correct about a Romney/Ryan landslide. If that happens holding the House and taking the Senate are virtual locks.
We needed health care reform, no doubt. What we did not need was health care reform written by socialists. A free market will find the best compromise between cost and quality. The federal gubmint, with its infinite ability to break an iron wedge, will FUBAR the American health care system.
Let “progressive” states like Mass. experiment. Let states be laboratories. Keep the federal gubmint OUT of health care to the furthest possible extent.
We shouldn’t lose sight of the fact that RomneyCare was not created with the same ultimate goal in mind as ObamaCare. ObamaCare’s ultimate goal is to serve as the initiating vehicle for effectively taking eventual total control of the entire national economy and the life of the individual citizen. Certainly Romney did not have that vision in mind when he championed the ill-advised RomneyCare. If the negative effects of RomneyCare impact the Massachusetts citizen sufficiently adversely then he/she can leave the commonwealth. You will never be able to run and hide from the exponential growth of enslavement and ruin that ObamaCare precipitates, which is exactly what its Marxist originators intended.
Pretty scary stats. Here is another one. Everyone seems to agree that the US spends 16% of GDP on health care. I’m an American long resident in Australia where there is both universal government health care and a private system that together cost about 8.5% of GDP. The health outcomes are very similar, so where is the extra money going? I would suspect it goes to all kinds of non medical costs associated with administration, but I don’t know. What I do know is this. Both I and friend in the US use exactly the same mask with a CPAP machine. I saw the bill for a mask for $511. My friend paid $50, Medicare the rest. Amazon price for the same thing $50 on sale, $100 normally. As Dirty Harry would say, “Marvelous!”
The M&M Usual, Customary, and Reasonable (UCR), what M&M will pay for something dictates all costs; nothing will sell for less and “elite” practices that have either very wealthy or very well insured clients will charge as much more as the private insurance will pay or the market will bear. This is the part that the left never gets; whenever the government pays for something, the cost is whatever good lobbyists and political operatives can get the government to appropriate for it.
Medicare didn’t pay the rest, I guarantee you.
They paid whatever the little schedule says they’ll pay, which was probably $2.15 since your friend paid the copay, and they say the mask is worth $52.15.
I had a hip done. The charge for the hip itself was $65,000. Blue Cross gave them $8,400, which, considering all the lawsuits over devices, (which if one DIDN’T get, one would not be able to sue, on account of being DEAD, already)really wasn’t that expensive.
Go into a doctor’s office, tell him you’re paying CASH, and see what the real price is (If he says list price, go find another doctor, because he’s a greedy bastard, and your health is the last thing on his mind). My internist, who I’ve known for over twenty years, now gets $53 for an office visit. After the copay, that’s $3, for all the expense of billing, etc. I’ve started just giving him $60 cash. He smiles every time I do. I don’t care if the insurance company is happy, but I REALLY want HIM happy. For ten bucks, I get to be a bigshot.
Since Medicare and Medicaid think paying 25% of the bill seems fair to them, what makes you think the price just won’t be 5 times as great?
Bureaucrats vs. Doctors: who do you think will outsmart whom?
I am always extremely skeptical of those % of GDP stats. In EVERY other area they are horrendously inefficient, so how are they suddenly magically efficient?
Outcomes can be deceptive too, we have more deaths from car accidents, we count premie deaths (most other countries do not). Also, our culture is far more complex then Australia, as well as being much larger. But it’s almost a given that the Australia health system as well as Medicare are probably paying $200 for that CPAP, not the $100 they could buy it for on Amazon.
Is there a single source for the statistics quoted? The radical increase in costs as well as the reduction of other state spending was probably never predicted when the legislation was being considered. If they had projected those values, the legislation would never have passed.
The donks would’ve passed it, no matter what.
If you think reality even entered into the conversation, you either were in a coma during the passing, or you are a sympathy troll.
Everything was KNOWN, by everyone with a brain, beforehand. They just didn’t care.
Roger:
I don’t believe Obama has any intention of giving up the White House. The Left has been waiting for this for too long. An election is not going to decide the thing. It’s about to get very ugly.
My feelings exactly!
A landslide? Oooh, I have a big pile of dirt that’s shovel-ready!
If Romney regrets RomneyCare I would expect him to come out and say so. Instead, the last things I’ve heard him say about it were quite the opposite of regret.
And his supporters insist that the operative difference between RomneyCare is that it’s a state program while ObamaCare fails because it’s federal. Nobody seems to address that RomneyCare, too, is a failure.
I totally agree.
Part of why the Ryan pick was so inspired is that he is a guy who treats you like an adult and tells it like it is. Guess what? People want that and respond to it.
So what should the Romney of Romneycare be doing? Honing his message, right now, that treats us like adults and tells us the way it is: he made a mistake in Massachusetts, he’s learned from that awful mistake, and he won’t allow a similar disaster to unfold on a nationwide scale.
My three step health care reform in a nutshell is this:
1. Raise the Medicaid threshold well into the middle class (say $45,000 year household income) If people making up to $22.50/hr and still can’t or won’t buy health insurance, then ok, enjoy going to the clinics and not running to your GP every time you have the sniffles. SHUT UP CONSERVATIVES.
2. Take many of the basic services OFF of insuarance totally like was mentioned above. Look at LASIK eye surgery, costs have decreased by half while the procedure has gotten much better, because people pay out of pocket for it and doctors have to COMPETE for patients in the free market. So basic physcials, mammograms, having a tooth filled etc. would now be a competitive market. SHUT UP LIBERALS.
3. Everyone contributes (and I mean everyone) to a “National Catastrophic Care Fund” which kicks at a certain level for cancer, serious accidendts etc. I say 1% tax like Medicare.
(Note I leave Medicre out of this for now, as it will have to be addressed on its own.
My simple idea for some sort of health care reform without the Byzantine monstrosity known as Obamacare.
Or the government could just let us buy insurance across state lines and do something about stupid lawsuits, which are helping Ostupid bankrupt us, while making lawyers rich. If your bellybutton isn’t EXACTLY centered, why is that worth a lawsuit?
How about not paying for sex changes, abortions, the pill, Viagra (even for prison inmates, fer chrissakes!)and condoms? If it’s none of my business whom you screw, then I shouldn’t have to pay for it.
How about not paying for interpreters for illegals? Hell, why not refuse treatment to illegals? That would probably solve most of the problem right there!
So here would be a brilliant Mitt move -
Come out and publicly discuss the fact that huge numbers of doctors are considering quitting. Talk about the issue, explain why it is, and what the ramifications are, clearly, so all America can understand…
And respectfully and passionately ask them not to (leave practice). Tell them “help is on the way”. That, difficult though it may be, we need them to stick it out until January, for their sake and all of ours.
What a body blow that would be – In one fell swoop, the entire population would see a HUGE and terrible effect of ObamaCare, and be handed not just a way, but the only way to stop it from happening. And Democrats would have to explain why it is that so many doctors are leaving, and tell us just what they intend to do about it. Think any Dems are hoping to spend September talking about that??
Anyone who knows the campaign, forward this with my compliments.
If Romney were to talk up these points, describe how Massachusetts is foundering because of the ambitions of the plan, and finally admit he was wrong to have made it law in the state he was responsible for, then we can take him seriously as a reformer. I don’t buy this crypto-penitant angle.
Reply to ajacksonian:
Doctors would not be allowed to do what you suggest. At least not in any numbers and never officially. Practicing without a license. If they didn’t take the hint people with badges, sticks, guns and tazers would stop them. The SCOTUS has put its stamp of approval on these methods of control for a long time.
For this argument to make that (Romney landslide) happen this argument and many like it must make it to the people. In order for that to happen, it must make it through the MSM. And the MSM are propagandists, actively subverting the interests of the American people and what is left of any standards of Journalism in a clear effort to generate a propaganda climate for Democrats. And what ever argument that does get through to the American people will be forced to compete with a fog of deception created by Obama and enabled by the Media.
Preach to the choir if you must, for to whom else would we preach? But make no bones about it. Facts and the truth are being actively subverted.
Good luck.
To extend my point, I think we have a larger problem on our hands than defeating Obama and repealing Obamacare.
We need to be able to reach the American people with facts and arguments on behalf of small-government, conservative principles and an elimination of the ideological blockade by the MSM.
If we can’t bring that about, in 4 years the Democrat/Progressive/Lib-terd/crypto-socialist block and the MSM will find a way to promote yet other cyphers for evil in elective offices.
“For ObamaCare is to a large extent RomneyCare”
Yes and I’m far more likely to support Communalistic policy the closer I get to home.
In other words, the Federal Government should have supreme authority in a few, narrowly defined, areas. Like delivering the main, foreign affairsm trade and military.
However, government functions such as education, welfare, housing, transportation, energy, environment, et. al., should be funded, and administered, by local and State governments, with the emphasis on local.
THIS. 10th Amendment trumps. If MA wants gov’t health care, let ‘em have it. BUT not at the Federal level and NOT if they expect me and my state to bail them out when they go broke.
I think Romney knows the difference. If not, we’ll make sure he learns. Fast.
It bears repeating that in Canada with universal health care, the above has already happened. The federal budget and all provincial (state) budgets are 50 + % for health and have been for a long time. Services continue to be cut and waiting lists (rationing ) increase.
Another little quirk in the Canadian medical system as practiced in the racist Province of Quebec is the fact that medical school graduates do not have the right to decide where they open their practice. As a matter of fact a new doctor will not get his license unless he/she agrees to work for a period of time in what are known as “The Regions” meaning out in the boondocks somewhere where there is a chronic doctor shortage, far from family, friends, and familiar territory. Not where many new doctors want to set up their practice so consequently many of them head for other jurisdictions upon obtaining their MD. The doctor and nurse shortage in Quebec is further acerbated by the machinations of Quebec’s notorious one-legged rocket scientist of a Premier Lucien Bouchard, who along with his health minister in 1995 decided they could balance the province’s medical budget by closing smaller hospitals and offering early retirement to many, many doctors and nurses. They took them up on the offer and we’ve been suffering ever since.
Also, I don’t know about your part of Canada but in Southern Ontario, which is one of the more populated areas in the country, family doctors are almost as rare as hen’s teeth. The shortage of family doctors has been ongoing for a good 20 years now. Despite talk of changes and improvements that have been going on almost as long, the reality is that a very significant percentage of people in this province go to walk-in clinics or emergency rooms, not to a regular family doctor. Naturally, that completely undermines any continuity of care. You basically start over every time you seea doctor who is almost always someone you’ve never met before.
And while the provincial government keeps some kind of records of your care, I have the distinct impression that these are NOT available to doctors. Otherwise, I wouldn’t expect to have to give my medical history anew every time I go to a walk-in clinic.
“Massachusetts spends more per capita on health care than any other state and therefore more than anywhere else in the industrialized world.” Why? Because of the horrendous inefficiencies built into socialized medicine.
You don’t need me to tell you that Massachusetts’ health care is not the most socialized medicine in the world, far from it; so you need an additional reason for why it is so expensive.
What I’d like to know is: is this a specifically Massachusetts pathology, or a general American pathology compounded by Romneycare?
Massachusetts has some of the highest rated hospitals/medical schools in the country. Massachusetts also has extremely expensive Medical State Mandates, that add at least 30% to the cost of a premium. IVF is mandated, that alone adds 10-15% to everyone’s “private” or “public” individual premium.
As time has gone on the Legislature has voted in more and more mandates, and more and more “providers”.
Until there is a “universal” standard of what should be covered, more than 2400 mandates for our 50 states (some the same, some different) will make it impossible to bring in inter-state policies. That was suppose to be done by the Secretary of HHS, but instead she defaulted to each states existing mandates, while adding a host of Federal Mandates. Even if your state has only 20 mandates, and each adds less than 1% to the premium cost, that can still mean that your premium will go up 10-15% as in individual Person or “Family”. If each state was forced to review it’s mandates, and to standardized it’s basic services, while offering “individual” cafeteria items, we might have a chance – but that brings up a “State Rights” issue, so it would have to be completely voluntary. So the Massachusetts Legislature will continue to add and expand providers and “medical” services, the premiums will continue to go up, doctors will tell you that they can’t see you for a “sick” visit for a week, (and since they are mandated to treat you within 48 hours, will send you to the ER), the ER usage will continue to rise, and even though there is a “co-pay”, patients will continue to have it billed and not paid. I can anticipate that my cardiologist, gastro, and neurologist will retire, or drop me as a patient once I reach 65, and I will not be able to find replacements. (My Gastro has already retired and is opening a “non-surgical” face lift boutique, she could not recommend anyone, because she knows that most in the field are not taking new patients, and the younger specialists are choosing to not open practices.
Roger,
I too have felt this will be a memorable election on par with the Reagan/Carter election. I have come to understand how the ‘Intellectual Elite’ think (bye the bye, I have come to think of the phrase ‘Intellectual Elite’ as an oxymoron). Nobody likes a smartass and that is what the Democrat party seems to be full of. And as with most smartasses they don’t realize they’re pissing most everybody off. They are brimming with hubris and as we all have heard “Pride goes before destruction, a haughty spirit before a fall” and these boys and girls have haughty up the wazoo. They are blind to their own fallibility and the growing unattractiveness of their ideas. When you walk with your nose in the air you don’t see the cliff until your on the way down.
“…regular prostate tests and other screenings are unnecessary? It’s not because those tests don’t pick up pathologies: it’s because they cost money and the government wants to limit its expenditures.”
It’s worse than that. The PSA test is cheap, especially when it is taken as part of test battery. But the government doesn’t want a patient to verify, through a biopsy, that he may have prostate cancer. Even worse government considers prostate cancer to be so slow in developing, the patient is more likely to die from other causes, than from the cancer, and therefore surgery shouldn’t be considered. Now that is based on statistical averages. The problem is if your parents lived to over 90, your life expectency is far higher than average. And it doesn’t take into effect the dread people must live under knowing they have a cancer living inside them without the option of removing it.
That is not a quality of life I want to live under.
Regardless of the merits of either program, I think it’s important to keep in mind the federal-state powers distinction involved, here. Obamacare is, quite simply, an unprecedented usurpation of power to regulate one sixth of the nation’s economy by mandate. The constitionality of Obamacare was, in part, addressed by the SCOTUS, but the issue obviously remains highly controversial.
By contrast, the power of the states to enact such programs are not nearly so constitutionally suspect. Thus, although it is clearly a failed program, Romneycare was well within the powers of the Commonwealth of Massachusetts.
Every time I see a Hovercraft ad my blood pressure rises,…”and Medicare will pay all costs”…..
If my home insurance plan was required to pay for every repair I make, for termite prevention programs, emergency calls for plumbers and electricians, lawn care, weed eradication, landscaping, new paint, re-modeling, home security systems, etc, etc, etc, if it was required to pay for all these on MY home AND on my neighbor’s home, who has no job and can’t pay his bills already, do you think the cost of my insurance might go up? And, they wonder why their brilliant, caring, plan is unpopular?
With respect, your information on the PSA test is not current. I agree with you politically, and I certainly would not want the government to make this decision, but many doctors are themselves forgoing the PSA test because it is very unclear that that particular test improves any real outcomes. There are sufficient false positives, false negatives and sufficient complications to biopsies to make it a very tough call. Read the last chapter or two of ‘The Emperor of Maladies’ for good info on the phenomenon of how some cancer screening tests may not improve outcomes while others certainly do.
Absolutely correct. Many men are maiming themselves to treat cancers that would be unlikely to ever cause symptoms. This is why a federal task force recently recommended doing away with PSA screening.
On the flip side my father-in-law had a PSA test and then a biopsy and was found to have a very fast spreading malignant cancer that men don’t survive by more than a couple years and the last year being horrible. He had his prostate removed and is now cancer free for 4 years. There are two basic types of prostate cancer, one slow growing and that is what everyone is basing this on. The other is very fast spreading and very deadly.
Don’t paint with such a wide brush please.
I usually agree with Roger, but in this instance the claim that the government’s conclusions about the cost/benefit of particular examination procedures seems to be based on sound science, not a secret desire to send Americans to early graves. There is already too much paranoia about secret government intentions to harm us.
Then why is the latest estimates of Obamacare cost showing it to be 3 to 4 times as expensive as claimed when it was passed?
Oops, my fault for reading faster than my brain was running. As for the scientific cost benefit analysis I can’t help thinking that these are the same people who don’t want woman’s breast exams done for the same reason. This association makes me believe in collusion if only for desire of outcome. Save money.
Ditto Vince, the benefit of early detection is grossly exaggerated and the harm done by unnecessary treatment for greater than admitted. This has been known for some time. What you have going on in this debate is dueling philosophies of health. But it just points out the folly of “public health policy.” Each person has to decide for himself whether he wants this type of thing based on the cost/benefit and his view of how to best stay healthy. To see Conservatives carp about government agencies taking away their benefits is sad.
If you want to know how doc care is rationed, watch the first episode of Dr. Martin.
1. Some centralized bureaucracy decide there is a slot available, and send you there. If you don’t like the location, tough luck, wait some more for the next avaiable location.
2. A local committee will decide your fitness to serve them.
3. The patients of your covered area have to go to see you, unless they decide to drive ways away and have permissions to see another doc.
Funny, in a democracy, we have to operate under “mandates”. King’s mandates? Mandates of Heaven? I don’t even care what Obamacare covers, how high the premiums are going to get. I care about being “mandated” to do things I may or may not want to do.
An article at Retired Doc discusses the medical rationing which will be imposed on all medical care. Not just on Medicare services, but on all medical services. Quality Adjusted Life Years (QALY) is supposed to guide the difficult allocation of two few resources to too many needy people.
Fair Distribution of Life-Years
Ezekiel Emanuel is director of the Clinical Bioethics Department at the US National Institutes of Health and an architect of ObamaCare. His brother is Rahm Emanuel, Obama’s former Chief of staff. Ezekiel Emanuel wrote in The Lancet medical journal Jan 2009 [edited]:
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Allocation of healthcare by age is fair, unlike allocation by sex or race. Even if people aged 25 receive priority over those aged 65, everyone who is now 65 was previously 25.
It would be ageist to treat 65-year-olds differently because of stereotypes or falsehoods. It is fair to treat them differently because they have already received more life-years.
=== ===
Our politicians have maintained themselves in power by making promises, essentially buying votes. The promises had to be dramatic and simple. The medical care promise has been “pay into the system, and we will do everything possible to keep you alive and functioning as you become old and sick”.
“Everything possible” used to be quite limited for almost everyone. Now, expensive treatments produce some extension of an enjoyable life. More of a problem, some very expensive treatments cure a few percent of people who would have died, but we can’t tell in advance who will benefit. The politicians can’t keep their promise, yet that promise is essential to remaining in power.
Politicians can’t keep their promise because they did not collect and save enough money (resources) to provide the promised future medical care, either at past or current costs. They didn’t save anything; they immediately spent all available cash on their own incomes and schemes and on other vote buying. Any care now for the old must be pay-as-you-go by the current working population. The government told the now-old that the government was saving for their future care, but it actually saved nothing. The old were robbed when they were young, and they will be quite angry if they ever figure this out.
The political solution must be complicated, sly, and involve middlemen to take the blame instead of the politicians.
The first principle of government is to continue buying votes. Quality Adjusted Life Years (QALY) is better understood as Quality Adjusted Voting Years (QAVY). There is just so much money available to be spent on people who can supply votes. If the money runs out at $10,000 per QAVY, then $15,000 is too expensive and will be denied.
When “everything possible” was limited, the collectivist (Marxist/Socialist) nature of government healthcare was tolerable to most people. The program was costly and complicated, but everything possible would be done in the end. Now, it is clear that most people will die sooner for lack of funds, sooner than “everything possible”. People may complain that this was not the deal they made. If they are going to be sick or die anyway, maybe they could have enjoyed their money rather than contribute it to this scheme. Maybe they could have done better. Maybe they could have saved their money and apply it now to options that the government does not see as QAVY effective.
A bad part of ObamaCare is its control of all insurance contracts, other than for elite politicians and union members. All health insurance must provide a list of services specified by government. Strangely, coverage limits still vary according to the cost of the insurance. These broad requirements make the insurance expensive. Government subsidies are supposed to make the insurance less expensive. Where are the subsidies supposed to come from?
Richard Epstein:
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[edited] Extensive federal regulations specify the kinds of coverage that any health insurance carrier has to supply: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services, chronic disease management, and pediatric services.
=== ===
There is a strong bias toward supplying almost-free services that a person might use in their young life, and away from providing cheaper coverage only for catastrophic care. People will pay a large amount each year and will want a large amount of almost-free services in response. They may regard this as a good deal while they are young, as they collect a stream of moderate-cost services. They will see QAVY restrictions when they become old and expensive.
Another bad part of ObamaCare is to limit the choices of people both inside and outside of the system. A free market in health care is likely to provide some less expensive options, including catastrophic care plans for much less money. Government needs to keep everyone in a standard and expensive insurance contract so it can extract artificially large insurance payments from the young to provide cash for delivering health care to the old. This is a stealth tax administered by the insurance companies, applied to the young. This is how the young will be robbed. Maybe they will figure this out when they become old.
Our Democrat politicians have found a durable principle to cement a bond between the generations. Current producers will pay taxes to support the old. In return, they will gain the right to tax their children to support them. The enduring principle is inter-generational theft under the color of law.
Obamacare Bails Out Medicare
Oh, QALYs are even worse than you think.
Back in the day, during my short stint in academic medicine, I published a few articles on health care economics. One of my areas of interest was QALYs. You have mentioned the “Life-year” part of the calculation, but QALY calculations not only devalue care for the aged, they devalue the worth of ANYONE with ANY “imperfection”. That’s the “Quality-adjusted” part of that acronym.
There is a QALY discount for people who wear glasses. There is one for mild headaches. A really big discount if you use a cane to get around. Virtually every outcome that is less than perfect is discounted, and that person’s life is worth less.
In academia these esoteric calculations were bandied about as ways to judge the effectiveness of a treatment, and where to focus limited dollars in order to get the biggest bang for the buck. But there was simply no way to get around the fact that they were assigning value to human beings based on qualities that are completely counter to what we as a people see as the worth of an individual. Certainly it was counter to my beliefs as a Christian.
I quit academia, and I never looked back. But I completely believe that those types of chilling conversations and may others like them continue to happen to this day. We are populations to the elite in government and medicine- statistics to be managed. Never forget that.
And the press laughed at Sarah Palin when she talked about Death Panels deciding who was worth caring for.
It’s true- I was very nearly part of that myself. But it’s not so well-defined as a death panel- rather, it infests the thinking of health economists and ethicists at a more fundamental level, through publications and conferences. That makes it all the more insidious and hard to track down.
To Dana,
Agreed. QALY is a brutal application of Utilitiarianism – The greatest good for the greatest number.
Brutal because it trades one person’s welfare against another’s. First, it treats medical care as a fixed resource to be distributed in the “best” way. Try to forget that the resource is now limited because of government intervention and theft. “Best” is in the eye of the ruler. The ruler wants as many productive taxable years as possible. So, the medical resource is to be distributed according to who can be made productive, rather than just dividing it equally. Brutal, because it limits what an individual can spend on himself, as this diverts some of the medical resource outside the ruler’s plans.
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[From the link, edited] Utilitarianism cannot protect the rights of minorities. Americans in the eighteenth century could justify slavery on the basis that it provided a good consequence for a majority of Americans. Certainly the majority benefited from cheap slave labor even though the lives of black slaves were much worse.
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There is a similar justification for taking as much as possible from “the rich”. Why should they keep their wealth, however properly and productively earned, when everyone else could be so much happier. It is the justification of a thief with a large family.
On the “Doctor Patient Medical Association”: http://www.sourcewatch.org/index.php?title=Doctor_Patient_Medical_Association
“The Doctor Patient Medical Association (DPMA) and the Patient Power Alliance (PPA) work to repeal health care reform and call themselves a ‘a nonpartisan association of doctors and patients dedicated to preserving free choice in medicine.’ The organization is a member of the National Tea Party Federation and the ‘American Grassroots Coalition.’”
The DPMA and similar groups want to repeal PPACA. They and I do not consider the collectivization of healthcare to be a desireable change, and certainly not a “reform”.
Tea party groups are non-partisan in that they do not follow the dictates of a Republican establishment. They have run and won primaries against establishment Republican opponents. Clearly, the usual tea party sentiment is closer to the current Republican position.
“The DPMA and similar groups want to repeal PPACA. ”
I’m always amused when I see the official acronym for ObamaCare: PPACA. It reminds me a great deal of the word “PeePeeCaCa”, which is apparently a word widely used in parts of Europe to mean “nonsense” (although that is a very polite translation; it is apparently used more in the way we would use “BULLSHIT!”)
The point and genius of federalism is that states are allowed to do things that the federal government is not. If the residents of Massachusetts want Rombamacare, that is their prerogative. Meanwhile, if State X wants to have completely open market health care, including not licensing doctors, that’s their prerogative.
Or at least, that USED to be the case. From the sounds of it, ObamaCare is a done deal. Unless Romney repeals it – and doesn’t replace it with “Son of ObamaCare” – it looks like health care is now primarily a federal responsibility.
The other great difference is that Romneycare was a state program, not a federal one. That is not a small distinction. One of the purposes of federalism is too keep things small and local enough that voters can keep control, rather than letting it get swallowed into the great mother of all bureaucracies that is the federal government.
It has seemed to me that Romneycare quickly expanded beyond Romney’s intentions, once the liberal mandarins of Massachusetts got their claws in it and loaded it up with all their pet programs. That speaks to Romney’s naivety, but not his malice. Maybe he has learned his lesson.
And in any case, even if Romneycare is a disaster, it provides yet another example of the importance of federalism, which is that limits the scale of a disaster, and lets the other states learn from the misfortunes of one.
“And people wonder why I predict Romney/Ryan will win by a landslide.”
Herr Hussein Obama’s campaign strategy is inadequate to maintain him in a serious action such as Mitt Romney and Paul Ryan will put to him. He has corruption in the coop, hate on the hoof, taqiyya on the tongue and bats in the belfry — that’s his campaign strategy. He can probably maintain himself in the type of fighting Mitt Romney and Paul Ryan will give him in Mexifornia and a few states on the North East front. After that it will make no difference how many thousands of dead he has voting for him early and often, and if Americans want America and the Presidency back, Mitt Romney and Paul Ryan will give it to them. Mitt Romney and Paul Ryan will make Obama howl.
In Ontario (Canada) 45% of government expenditure is on the health monopoly. And it is increasing yearly.
It took almost 18 months from diagnosis to final treatment for my cataract surgery.
I cannot help but think thinks would be faster in the USA.
Probably less than a week.
I live in a border state and we get quite a few folks from Alberta for surgical care, mostly orthopedic surgeries e.g. knee & hip replacements. There is a lot of oil money up there, but they can’t buy themselves healthcare. Also, some of my colleagues have been heavily recruited to fly up and cover Fort McMurray as locum tenens, I’m not even sure how that would work or who pays.
Government run anything sucks and we deserve whatever happens to us when we entrust our healtchare to a mindless bureaucracy like the federal government. Have we not learned anything over the last 100 years about failure. All these massive programs are broke and are burying budgets right and left, and at every level of government. The pay as you go pension model, the corrupt public pensions, the crony capitalists and their government enablers. The more we rip government out of our lives the better.
As AzA said above, there is a HUGE difference between RomneyCare and ObamaCare… It’s a STATE issue not a FED issue. If the people of MASS wanted RomneyCare, then voted for it, and Romney approved it on that basis, then he probably did what he had to do. That has been his point from the beginning. Healthcare reform of this sort does not belong within the federal gov’t.
And BTW, Romney doesn’t have to wait for a bill to make its way to his desk to shelve this thing. He’s already said he’ll use his Executive Authority to stop it until it can be repealed
“Even if doctors do not quit their jobs over the ruling,” a precis of the DPMA report notes, “America will face a shortage of at least 90,000 doctors by 2020. The new health care law increases demand for physicians by expanding insurance coverage. This change will exacerbate the current shortage as more Americans live past 65.”
You never, EVER, hear Obama or the liberals talk about this. They’ve just added over 30 million people to healthcare under ObamaCare, so where are all the doctors for these people going to come from? What about all the specialists that will be needed, not to mention all of the diagnostic tests and medical exams these people will need? Who is going to do all of this and who is going to pay for it?
You are. Big time. And you don’t have to take my word for it. Just look how expensive socialized medicine is in places like England or Canada and look at how high the taxes have to be to pay for it all. Nothing is free, my friends, espcially when it’s “given” to you by our Federal government. Somebody is going to get stuck with the bill, and that “somebody” is YOU, espcially when all the heavy taxes that support ObamaCare begin in 2014.
So you will be paying a lot more money for worse service. What’s not to love? November. It’s the last chance we have of stopping this madness.
For people who currently have insurance, Obamacare will have a very negative impact on their health care. Many have already seen this in the form of increased deductibles, restrictions on which doctor one can see, and higher premiums. This will get worse, until it reaches the point that small businesses (who aren’t required to provide insurance under the law) and even some large businesses (who may find the fines are worth paying) decide to discontinue providing health insurance and force their employees into the exchanges where they’ll have to buy their own.
And, of course, your wait time to see the doctor will increase substantially, and there’s no way to address the doctor shortage in the short-to-medium term (the next 20 years or so).
At least Canada and the UK are honest about their health-care rationing.
Romney/Ryan have a hammer and a bell; They’re ringing out freedom and justice.
They’re ringing out love and respect for their brothers and sisters all over this land.
They’ll be ringing it morning and evening, every day up to election day and beyond.
Ignore it at your peril.
{Thanks to Peter, Paul, and Mary for their inspiration.}
I was talking with a liberal colleague yesterday and her assertion was that ‘everyone in Mass. loves RomneyCare”. I’ve yet to see anything in print that backs that up. Anyone?
Romney/Obama Care
Democrat Timothy Cahill was Massachusetts’ State Treasurer. He said on 3/16/10:
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[edited] Implementing the MA health insurance reform nationwide will threaten to wipe out the American economy within four years.
Our experiment has nearly bankrupted Massachusetts. Only federal aid is sustaining our law. We’re being propped up so that Obama can drive a similar plan through Congress.
=== ===
I’m guessing your friend is either quite rich or quite poor — in other words, insulated from tax pain and medical costs either way. I’m also guessing that the citizens of Massachusetts are increasingly falling into one of those two categories.
The current version Romneycare it has no resembles to the original Heritage Foundation/Romney experimental Mass Healthcare Plan. What The original plan envision was, gradually transfer public insurance system to open market forces. What Romney and The Heritage foundation didn’t want to acknowledge is that the left especially Mass Democrats(closet Marxists) will ever give up state control over healthcare. It is a matter of fact that Romney’s every veto over Romneycare was overridden by the state democrat legislation. More over since the election of governor Urkel a.k.a Patrick Romneycare turned into financial black hole. If it weren’t for Obama’s Billions of stimulus dollars and shady funding scheme to keep the plan a float and also keep his buddy Patrick in office. Massachusetts would be in bankruptcy much earlier than California. Hopefully Romney has learned his lesson, that is never trust a Marxist.
I have recently been through some major medical procedures while covered by insurance (lucky I was covered), and previously I went uninsured for a big part of my life. A couple things about medicine.
The miss-pricing of things in medicine is major. How much a service costs varies enormously by the social framework in which it is delivered. The same thing can easily cost ten times more in another setting, and price differences of three to four times are common.
It is apparent that some big medical companies have managed to get control of the system, most conspicuously the drug companies. They manage, somehow, to get doctors to use the drugs that are a lot more expensive because they are still covered by patents, while ignoring the sometimes very effective and inexpensive off patent alternatives.
We need tort reform in medicine to limit the legal expenses involved with medicine.
Most of the time most patients pay no attention to cost, and most physicians are either unaware of cost or indifferent to it. As getting consumers to pay attention to both the effectiveness of the therapy and the cost would be a major boon, it is unfortunate that most people want the security blanket that goes with having somebody else pick up all the cost. That, I think, is the major obstacle in the way of getting a cost effective and efficient delivery of medical services.
In this discussion of participation mandates and forced decisions and state-controlled costs of a service on which our lives depend, it is well to remember that freedom is indivisible. Want to live free in a free country, as the United States used to be? Then say no fascism, all forms of CommieCare, and tell the vapid politicians: The solution to high health care costs is competitive private enterprise.
Get government out of the medical business! Think of the money we’ll save, as patients and as taxpayers! A no-brainer, for the so-called elites in Washington who checked their brains at the door.
Kill sacred cows! For starters, reform tort law; cut the ambulance chasers down to size. Screw Big Pharma; open the drug market to certified international providers. Screw insurance monopolists; open the health insurance market to national competition, not just in geographical areas. Screw the bureaucracy; abolish the mindlessly excessive federal regulations which are strangling the medical profession. Screw the AMA; end its malignant, medieval guild system of restricting doctor certification, to raise prices by limiting supply. Above all, empower patients, as Paul Ryan proposes! Give people vouchers to choose their care providers. Common sense! Has to be, or I wouldn’t have thought of it.
“it provides an excellent laboratory for seeing what happens to health care when the government takes over.”
Sorry Mr. Kimball, that is just inaccurate. As an analogy, you are saying that because mounting twin turbos on your lawnmower did not improve the performance in a noticeable manner, there is no point in putting twin turbos on your LFA.
Obamacare is seriously fooked up but comparing in to Romney care is comparing apples to watermelon. For that comparison to be valid, Taxachusettes is being compared to the USA. Fly over America is frothing at that.
America has a bottom up health care system. If I’m allowed to call it a ‘system’. Lots of people make serious money off this “System” ( yes, those are sneer quotes). What Obamacare does is try to keep all those people happy ( money coming in) While designing a new system that shovels money at a new crowd (insurance companies).
Naturally, this will require a bunch of long green as the mobsters say. Since the Feds have the power to send armed men to your house and rob you (it’s called taxes) the left anticipated no problem with harvesting the funds.
Then the victims started to crayfish on them. Taxpayers know what is going on. It was taxpayers that coined the phrase Internal Robbery Service. Taxpayers are also voters. So they are getting paybacks on the crooks via the voting booth. That started in ’08. Showed a little strength in ’10. will be a serious factor in ’12. If taxpayers can keep their mad up they will dominate in ’14 and rule in ’16.
So keep up the good work Mr. Kimball.
Celer, Silens, Mortalis.
The yellow bellied Repubs repealing O-Care? Don’t make me laugh, Boehner can’t repeal because he’s too busy crying tears about the mean knuckle draggers and Romney is obviously still gaga about Socialistic Medicine. The ACA is here to stay.
I hear your pain, Westie, but I encourage you NOT to give up. You have to vote for Romney-Ryan, because they MIGHT repeal it. You have to vote for Republican Senate candidates, too.
If you and everyone like you does, then those men you label as cowards won’t be so scared.
Or rather, they’ll fear us, not the Democrats. Even if they’d prefer to go-along-to-get-along, turning out en masse will demonstrate that we have their backs in the general election if they do what we say, and conversely, we will destroy them in the primary if they step out of line.
Yes but it’s medicine that is in a crisis, both Romneycare and Obamacare are reactions to the crisis already underway.
Now, perhaps both MAKE THINGS WORSE instead of better, but they created no new problems that I am aware of.
Medicine is a field in crisis for two reasons. First, it has a bunch of entirely outdated pre-scientific assumptions and conventions about “practice”, and fails for that reason. Second it has a number of somewhat effective techniques available that entirely outrun the average person’s ability to pay for them. There is NO proposed solution to fix this, how could there be?
Here is a fascinating article comparing the Cheesecake Factory to your local hospital, and guess who wins?
http://www.newyorker.com/reporting/2012/08/13/120813fa_fact_gawande?currentPage=all
Dr. shortage?
No problem for Dr. Obama and his panels.
They will make the practice of medicine so simple that the receptionist will diagnose you after you fill out a symptom questionnaire on a ipad, and a nurse practitioner or physician’s assistant or other ‘health care provider’ will write the script.
If it doesn’t work, you will come back, and get a different script, or even, if the cookbook says they can, and they have the time to make the call to LaTonya at the Federal Call Center in Atlanta, who, checking her own cookbook algorithm, may approve some sort of imaging test that has been worked out to provide the optimal ratio of cost to quality adjusted life years for 51% of the population with the same symptom complex.
I don’t see any need for doctors here.
I wonder how many Massachusetts doctors are contemplating moving across the border to neighboring Rhode Island, New Hampshire, Vermont, and New York. At least they have this choice.
When the whole nation is enslaved to Obamacare, where will doctors move to if they wish to retain their professional independence?
They’ll retire early, go into management, or become plastic surgeons. That’s what my colleagues have done. Of course, their children will never even darken the door of any medical school.
Wow, his first step is to dismantle a program almost identical to the one that he set up in Massachusetts, a program based on a mandate. That’ll fix everything, won’t it? What a radical dude this Rawmoney is, just what the reich-wing ordered!!
Rawmoney’s program in Massachusetts was conceived in a CONservative think tank as an alternative to attempts by Clinton to do something to attack the incredible failure of the American health care system to provide health care to all and at an affordable price. That terrible failure (of the “free-market” medical system in America) continues to be a destroyer of lives AND jobs due to the burden it places on businesses and governments across the country. And, the current CONservatives solution; N.O.T.H.I.N.G., just as it’s been for 50 years. Nixon was the last Republican to even attempt a solution. He had a health care program to the LEFT of Obama but it didn’t pass thanks to Ted Kennedy holding out for his plan.
So, what happened to “repeal and replace”, the cheap, empty campaign slogan the Repukes used to capture the House in 2010??? There plan is no plan, just as it’s been forever while millions of Americans suffer. “Death panels”?, they’re called HMO’s.
thanks for demonstration how the massively uninformed can impact things. Death panels are a necessary part of any system of socialized medicine. No, no one calls them by that name; that would be crass. But, by any title, saying ‘no’ is an inherent part of nationalized health care for a simple reason – no nation, not even one as rich as this one, can say ‘yes’ to everything.
Countries with socialized systems routinely say no to a variety of patients re: a variety of treatment options, procedures, and medications. We’ve become spoiled thinking the health care system owes us, whether we can pay or not. And, the system usually acts toward prolonging life, even when the only thing being prolonged is an old person’s suffering.
You are a fool and your use of “rawmoney” shows to be a simple one at that. The market we have — and calling it a free market is simply false — is anything but a failure. It allows the people with the lousiest health habits to have access to the newest and most innovative procedures on the planet. As it is, our market is controlled by govt. You think that only 2-3 companies can offer health insurance in your state by accident? Wake up. You think docs perform tests no one thinks you need for the sake of running up your bill? Wise up.
You actually think that reforming liability laws and allowing more cross-state insurance company sales is going to solve the health care crisis? AND, you think that our current system is “controlled by the government”??? Obamacare is the biggest windfall for HMO’s in history.
AND, here’s the part I love, you are actually dumb enough to put this kind of drivel down and expect to be taken seriously.
It’s YOU that needs to wake up. There’s MASSIVE rationing going on in the current system and it’s the result of the HMO’s that provide most of the coverage. Both patients and doctors have to struggle to get services and payment from this monster.
As far as outcomes in this system you think is so grand, the U.S. ranks BEHIND CUBA in overall effectiveness of our health care system and we aren’t even CLOSE to as effective as all of the other industrial democracies (that all have SOCIALIZED medicine) while costing DOUBLE per capita the next most expensive system (Switzerland). We stand alone as the only country where you can get sick, lose your job, lose you health insurance, and LOSE YOUR HOME as a result. That’s the system Obama and others have tried to fix. And, to call their tepid reforms “a government take-over of health care” as clowns like you do is the height of absurdity. It’s not now nor has it ever been “government controlled”. Yes, there’s a portion that is government-run, and yes, there are government regulations but this is by and large a market-controlled health care economy.
It will stay that way thanks to the clueless cretins like you that get drunk on the kool-aid and slobber all over themselves while millions continue to suffer this broken system.
To Obi-jonKenobi,
Why do you think that Cuban healthcare is better than the US. Is it because the totalitarian state of Cuba reports statistics which say so? Why should we believe them?
Your attempt at somehow associating Romney with Fascism is shockingly ignorant. Forgetting all of Hitler’s racist madness, who’s policies do you think he would side with? Without a doubt Obama, Hitler, Mussolini and Stalin were progressives! They wanted the government to dictate to business what they should make, what they should pay, they saw themselves as heroes of the working class (this is in the case of Fascism).
What’s “shockingly ignorant” is your description of fascism.
Get a clue.
Oh, wait, you wouldn’t know where to even look.
The premise of the article is flawed. Obama is not running on Obamacare, he is running against Ryan now (“he will gut Medicaire and leave seniors to die”) and against “millionaires and billionares”…and it might work because most voters are too simple-minded and/or lazy to think through the issues and alternatives. “Millionaires and billionaires”…it’s a mantra with POTUS. Call it the “nursery rhyme” election…which may turn out to be just the right level.
Repeal is fine, far as it goes. But replace? With what? No, just repeal and stop there. Fight the political urge to go a step beyond what is necessary.
So one of the main problems of the US health care system (despite Euro propaganda) is that everyone gets treated, just that some get inefficient treatment because they go to the Emergency room to get it. But the Canadian solution leads to that very problem! Ahh the unintended consequences of government!
What a strange article. Romney has never repudiated Romneycare and any betting person, knowing anything about him, would bet that one of the big reasons he wants to repeal obamacare is because he wants to redo it, using of course “the lessons” he learned from Romneycare. The lessons of course, won’t be that government intervention in markets is bad, but more likely that Romney shouldn’t listen to anybody but himself when implementing his big government interventionist programs.
Anyone who thinks that Mitt Romney is a proponent of small government is a blind fool.
The most important thing that government can do for the health care industry is to dismantle all of the handcuffs and roadblocks it has already implemented, even BEFORE obamacare upped the anti to nuclear level. Prime among those things should be allowing interstate competition among health plans, removing all taxation from medical products and services, and allowing ANY kind of plan the insurers can come up with, particularly high deductable plans. Reining in the FDA would be a big help as well.
As is the case in virtually every area, government is the PROBLEM, not the solution. If you ever are confused about the right course of action on any topic, just listen to what the bureaucrats advise. Then do the opposite.
“America will face a shortage of at least 90,000 doctors by 2020.”
So?….let’s just import them from Cuba!!
I know that was a poke at the fabulous Cuban healthcare system (not!).
But FWIW, to practice in America one must have completed an American residency. I don’t really see that changing.
Roger, you were, indeed, one of the first to predict a landslide. At the time, my gut agreed, but the numbers didn’t. Now the numbers are starting to show the early stages of a preference cascade. By November, it’s not going to be close. Not because Romney is that great, but because President Jarrett is so spectacularly awful.
Romney took a step forward when he explicitely stated he would repeal obamacare, and a bigger step forward when he picked the foremost opponent of Obamacare, ryan, as his vp. The only step he hasn’t taken yet is renounce his former support for Romneycare, and one of his aides made an incredibly boneheaded statement when they initally answered the “romney killed my wife” add by saying she would have been OK in MA under romneycare. I can understand that partly, no politician likes to admit they were wrong, and also no governor likes to go against the vast majority of both the populace and the legislator in MA who wanted romneycare at the time.
I think one way for him to partially answer this is to explicitely say that romneycare might have been both popular and OK in MA, implimented at the state level. But what may be popular in MA is horrible, and unpopular for the rest of the nation, implmented at the fed level. This would allow him to seperate romneycare from obamacare, without him completely renouncing romneycare, and it would have the additional virtue of being mostly true.
Repeal ObamaCare? Take a larger perspective. Repeal Obama.
Lets all suspend our practices for one year or untill Obamacare is junked. We are feeding the beast that feeds off us. First don’t be stupid then do no harm.
Graphic – A LANDSLIDE IS COMING
I didn’t read every post, but I didn’t see any mention of the AMA’s (American Medical Association) work over the years limiting the number and capacity of medical schools to keep competition down. If there’s an excess of demand from patients who want every sniffle treated, there’s also an intentionally limited number of doctors available. Not to mention an excess of doctors who prefer making a lot of money as “specialists”, rather than only a moderately lot as GP’s.
There are a lot of problems with medicine in this country. Obamacare will be an unmitigated disaster if not overturned, but without tort reform, a nationwide insurance market, and some real competition in the field of medicine itself, and merely going back to the status quo is simply participating in a slower moving disaster. There is no way we can continue to have the health care businesses continue to suck up a sixth- and growing- share of our economy forever.
That’s not true. The AMA has nothing to do with the number of medical schools. They’re just an irrelevant organization of academics and left-leaning primary care practitioners with no credibility among the general population of doctors, though the media breathlessly reports on everything they have to say because it usually fits their narrative. The only reason why JAMA is still published is that it is circulated to medical students for free and has great art on the cover.
The federal government requires that foreign doctors complete an American residency program. There is your rate-limiting factor. Residencies and med schools are fabulously expensive to run- $100,000 per year per medical student. Several states can’t even afford to have a medical school at all, and ship them off to other states & private schools to educate. One doesn’t have to conjure up conspiracy theories to explain the shortage of physicians, it’s just simple math.
We have too many doctors, not too few. A huge percentage of the work done by doctors should be done by people with significantly less training.
General practitioners should manage large teams of PA’s and nurses who have the training to diagnose maladies that constitute 90% of the medical practice. The key thing is that they should be trained to regognize when something is out of the ordinary that requires the person with the 12 years of advanced education.
Seeing an actual doctor should be a rare event.
And it would also help if we would stop telling people who overeat or abuse substances that they are sick, and then put them on midical regimens that costs thousands of dollars a year. There probably are a few people who are obese because of genetic conditions or who have a genetic predisposition to addiction. That would probably be about one in a hundred.
Common sense would cut medical costs in half, at least, without making any structural change to the system at all. But then, the people who benefit (NOT the patients) wouldn’t make as much easy money, would they?
After taking care of that problem, allowing interstate competition for health plans, and fixing the obscenty of the corrupt medical malpractice industry would cut costs in half again.
btw, you can largely do this on a pesonal level for yourself. Get the highest deductable insurance plan you can find, and don’t buy into the scare tactics that tell you to spend 3,000 a year to have somebody tell you that your sniffles are sniffles. Lots of people will tell you that you are gambling with your life, of course. Use your common sense to evaluate what they say. Maybe if you have a huge growth on your neck or pee blood, you actually should see a doctor. For the sniffles, probably not.
“While you’re pondering what that is going to mean for your dotage and the health care provided for your children….”
Neither dotage nor children, fortunately, are always inevitable.
I know Physician who values every life.
The Great Physician.
The only benefit I can see in all of this, as people give up on the medical system entirely, is that they will discover the benefits of proper nutrition and natural cures that have worked for decades or even for centuries.