Presidential Weekly Address for February 20, 2010



They were talking health insurance reform on NPR last night, the idea that if insurance costs keep going up, that it will be a part of a death spiral. The more expensive it gets, the more that only sick people will go for decent insurance plans, which means with a greater sick-to-healthy ratio that costs have to be raised again. Whoever the speaker was said that is why there is such a need to broaden the pool of people with health insurance to make the whole concept of insurance work at all.

In the weekly address the president mentioned some republican ideas that they are planning to incorporate and that they are open to more. I don't really see the public option making a come back, but there are parts of health insurance reform that I would like to see, like those through age 26 being allowed to stay on their parents health insurance, which creates solid coverage opportunity between high school, college, and finding a first job.

The president did a town hall in Vegas yesterday and talked a lot about health insurance reform, among other things. More and more senators are signing on to the idea of a public option through reconciliation. And the Health Care Reform bipartisan summit is less than a week away.

2/20/2010 3:13:53 PM

1) Are we going to get one of these threads from you every week?

3) This couldn't go into the eleventy billion page long healthcare thread already?

2) Perhaps the whole "concept of insurance" as we currently view it in regards to health care shouldn't work. It seems to me, that if the system reaches a point (or has reached a point) where it doesn't work because the system is too expensive to attract the ones that pay for it, then perhaps the system needs to fail. Why should we be coming up with ways to make the tax payer subsidize the costs of insurance and the costs of the doctors? If they're charging too much money, then stop paying them and I guarantee they'll fix their prices.

[Edited on February 20, 2010 at 3:30 PM. Reason : adf]

2/20/2010 3:29:54 PM

Yes we should all boycott healthcare, what an awesome idea!!!!!11

[Edited on February 20, 2010 at 3:33 PM. Reason : ]

2/20/2010 3:32:51 PM

Because not paying those that charge too much = boycotting healthcare.

If this is really how you read and understand the world, it's no wonder you're as screwed up as you are.

2/20/2010 3:44:26 PM

my kid has an ear infection. i'll just hold out for a good deal. that's sure to work.

not to mention that in the current system you can't really get an up-front cost before a procedure from a doctor most of the time anyway.

[Edited on February 20, 2010 at 3:53 PM. Reason : .]

2/20/2010 3:48:34 PM

Quote :

"1) Are we going to get one of these threads from you every week?"

Yes. After the first year of this presidency the soap box was full of right wingers saying he was a do-nothing president. For better or worse, he is a do-something president, just maybe not somethings everyone agrees with.

If you think the weekly presidential fireside chats are inappropriate for being soap box threads in their own right, you can leave them alone to die from non-response if you wish. But the first president ever to expand the weekly radio addresses to youtube is something I find pretty cool precisely because it can reach out to internet message boards and social networking sites in ways radio addresses couldn't.

2/20/2010 3:54:26 PM

Quote :

"not to mention that in the current system you can't really get an up-front cost before a procedure from a doctor most of the time anyway."

Which is a huge problem. The simple fact of the matter is, most people have no fucking clue what their doctor is billing, which means most people have no fucking clue why their insurance is so ungodly expensive. People sit around and rail and rail at the insurance companies over how ridiculously expensive their insurance is, but as I pointed out in the other thread, a $300 / person / month premium barely breaks even on lifetime healthcare costs. If something is broken in this system, it's the fact that your family doctor bills $250 for an office visit that they see you for all of 15 minutes, and no body blinks an eye.

Quote :

"Yes. After the first year of this presidency the soap box was full of right wingers saying he was a do-nothing president. For better or worse, he is a do-something president, just maybe not somethings everyone agrees with."

1) Talking and doing are two different things

2) If you're going to do this every week, could you at least keep your gushing to a single thread?

2/20/2010 4:00:31 PM

The weekly addresses are on a range of topics, and if they continue to follow their current trend they'll drop of the soap box first page after a week or two. There is some utility lost in burying things in 50+ page threads, started in a previous year, and since that old health care reform discussion has fallen off the front page I felt no need to bump it back.

2/20/2010 4:07:25 PM

Quote :

"This couldn't go into the eleventy billion page long healthcare thread already?"

Who wants to try to make any sense of such a long thread?
I enthusiastically support a reversal on this apparent policy. Long threads fucking suck.

Quote :

"There is some utility lost in burying things in 50+ page threads, started in a previous year"

I could not agree more.
In my opinion, the slowness, the long threads, and the scarcity of new threads are the worst things about The Soap Box.

2/20/2010 4:26:48 PM

"The Polling Contradiction

In the latest NEWSWEEK Poll, the majority of Americans are opposed to President Obama's health-care reform plan—until they learn the details."

http://www.newsweek.com/id/233890

This part I thought was key:

Quote :

"As Democrats struggle to salvage health-care-reform legislation, a new NEWSWEEK Poll shows that while a majority of Americans say they oppose Obama's plan, a majority actually support the key features of the legislation. The findings support the notion that Democrats have not done a good job of selling the package and that opponents have been successful in framing the debate. The more people know about the legislation, the more likely they are to support major components of it."

Quote :

"It found that the majority of Americans supported five of those provisions, three by particularly large margins. Eighty-one percent agreed with the creation of a new insurance marketplace, the exchange, for individual subscribers to compare plans and buy insurance at a competitive rate. Seventy-six percent thought health insurers should be required to cover anyone who applies, including those with preexisting conditions; and 75 percent agreed with requiring most businesses to offer health insurance to their employees, with incentives for small-business owners to do so."

2/20/2010 4:47:34 PM

76% of those polled do not understand how insurance fucking works. should we really listen to anything else they have to say?

2/20/2010 4:58:26 PM

You have a point, all governing is a balance between the expertise of those elected and listening to the will of the people. At the very least, almost everyone in America knows more about the health care & health insurance industries on the macro level than they knew a year ago.

2/20/2010 5:18:57 PM

you didn't get my point. 76% of those polled thought insurance companies should have to accept people w/ pre-existing conditions. Thus, 76% don't understand how insurance works

2/20/2010 5:24:12 PM

^Now that it is more spelled out, I see what you're saying.

Mandatory insurance for all fixes the sick-to-health ratio to prevent the death spiral previously mentioned, and overcomes the problem of people waiting until they're sick to buy insurance.

http://thehill.com/blogs/blog-briefing-room/news/82461-reid-dems-will-use-50-vote-tactic-to-finish-healthcare-within-60-days

Quote :

"Democrats will finish their health reform efforts within the next two months by using a majority-vote maneuver in the Senate, Majority Leader Harry Reid (D-Nev.) said. Reid said that congressional Democrats would likely opt for a procedural tactic in the Senate allowing the upper chamber to make final changes to its healthcare bill with only a simple majority of senators, instead of the 60 it takes to normally end a filibuster."

I'll be happy if I don't hear the word filibuster against for a year after this.

"Reid said that the final Democratic bill is likely to be unveiled Monday night."

Looks like the dems are going to be bringing a proposal to the table for the summit on the 25th, I wonder how it will compare with what the GOP will bring?

[Edited on February 20, 2010 at 5:45 PM. Reason : .]

2/20/2010 5:41:53 PM

and yet it still fundamentally misunderstands the purpose and nature of insurance. It fixes nothing. It exacerbates the problem. Only in America can we say it is a "problem" when people refuse to buy something they don't feel they need.

No, the problem today is too much insurance. And yet the "solution" is to create more insurance. It takes a liberal to propose something that fundamentally stupid.



^ wow, looks like the liberals are going to fundamentally abuse the whole purpose of reconciliation. What a shocker. Hey, let's use something that only applies to BUDGETS and apply it to a social program. That'll fly really well! That's why they are called "liberals." Rules are meant to be broken, right? I guess they are intent on not getting re-elected.

[Edited on February 20, 2010 at 5:48 PM. Reason : ]

2/20/2010 5:43:27 PM

"Only in America can we say it is a "problem" when people refuse to buy something they don't feel they need."

That is an argument against the broader concept of social safety nets altogether such as social security & all the rest, which for better or worse, our society has embraced for reasons of equity, compassion, and seeking the positive externalities associated with having them vs the avoiding the negative ones created by their absence. If you want to start a thread discussing whether the US should have social safety nets or not, I think it could produce some interesting discussions.

[Edited on February 20, 2010 at 5:51 PM. Reason : .]

2/20/2010 5:48:21 PM

the fuck? Arguing that insurance should function like insurance is argument against "social safety nets?" That's fucking rich, dude

2/20/2010 5:49:26 PM

Quote :

"75 percent agreed with requiring most businesses to offer health insurance to their employees, "

Did these respondents think that the business was going to pay for their health care or just offer a plan that the employee could pay for?

Quote :

"Mandatory insurance"

Again, where does the Constitution grant the federal gov't the right to force someone to purchase a good or service from another private person or firm?

Quote :

"Democrats will finish their health reform efforts within the next two months by using a majority-vote maneuver in the Senate,"

If the democrats ram through this turkey of a bill, their consequences in November will be staggering. Will democrats stay in Obama's boat as it goes over the falls?

2/20/2010 10:49:11 PM

Quote :

"but there are parts of health insurance reform that I would like to see, like those through age 26 being allowed to stay on their parents health insurance, which creates solid coverage opportunity between high school, college, and finding a first job."

We already have that. I'm on my parents' BCBS until 26, and I'm not in school.

Quote :

"For better or worse, he is a do-something president, just maybe not somethings everyone agrees with."

Agree with 1337 b4k4; he's given countless speeches, whining to the GOP and giving pep talks to the Dems, as well as promoting various Congressmen on the eve of their elections... He's trying to bully things through Congress by keeping a segregated legislative branch. Yea...he's a "do-something" president, all right.

2/20/2010 10:59:12 PM

http://www.fivethirtyeight.com/2010/01/1-reconciliation-2-3-profit.html

Quote :

"Let's take another look at that Kaiser poll I cited earlier today and look at the popular elements of the health care bill -- those which poll at a net favorability of +10 or better."

This seems to me to go along with that poll newsweek cited saying that americans much prefer the bill when they know the specifics of what is in it.

For those who challenge the idea of reconciliation, its not that you don't have a point, but the GOP have gridlocked on such an extreme level in terms of filibuster threats, holding up nominations, and turning against bills they sponsored once dems start signing on, that there are few choices left.

I don't know much about the history of reconciliation, so I can't make much of a "bush did it too argument", but I think the level of gridlock alone justifies its consideration. Here is a Bush did it too argument, but like I said I don't know much about its history so I can't argue for its accuracy, and you have to consider the source.

http://www.dailykos.com/story/2010/2/20/839110/-The-Bush-Republicans-used-reconciliation-to-drown-us-in-debt

Quote :

" * Prior to 2001, good or bad bills aside – every single bill passed through reconciliation REDUCED the deficit; * Not one, but two of the major Bush tax DEFICIT BALLOONING cuts were passed under reconciliation; * The combined addition to the deficit of JUST THESE 2 tax cuts were over $2.3 TRILLION over a ten year period. And how close were these two votes? The 2003 budget busting tax cuts were passed 51-49 and the 2001 budget busting tax cuts passed with less than 60 votes (58-33), and not one single Republican voted against the bill. Also, the ANWR oil drilling bill was passed under reconciliation by a vote of 52-47 and yet another tax bill in 2005 was passed in reconciliation, by a 54-44 vote, with only 3 Republicans voting against it. "

2/21/2010 12:07:22 AM

the problem is that most of the elements in the monstrosity you call a healthcare bill cannot be voted on using reconciliation, as they have nothing to do with the budget. Once the pubs pick out every single non-budget-related piece of that bill, it will resemble nothing like the original, and it will, in all likelihood, be nothing more than a massive tax increase that will do NOTHING to solve the problems we face. 17 of the 21 things mentioned there would not be allowed to be passed via reconciliation.

If the democrats want to go down that road and get ass-raped in November, be my guest, but don't say I didn't tell you so. This bill IS unpopular, no matter how you try to sugar coat it with misleading polls

Now, let's look at your bullshit poll, shall we?

Most keep existing plans: that won't happen, as people will be required to purchase a plan from the exchange if they don't want their employers' plan. Moreover, all plans will have to meet the exchange's requirements, so what are we really accomplishing.

Bill would reduce the deficit: Not an actual part of the bill, nor will it actually happen, so that's bullshit.

Millionaires' tax: People are ALWAYS for taxes on SOMEONE ELSE

Cover 31 million [uninsured]: also is not an actual part of the bill. Also, it won't happen. People won't be able to afford the insurance AND the medical bill. As has been proven in Mass.

Taxes on insurers, drug makers: People are ALWAYS for taxes on SOMEONE ELSE

2/21/2010 12:27:00 AM

Quote :

"If something is broken in this system, it's the fact that your family doctor bills $250 for an office visit that they see you for all of 15 minutes, and no body blinks an eye."

When you come in for a 15 minute ear infection, it's true that your Dr. may bill your insurance $150 ($250 is crazy) for the visit. However, ESPECIALLY in family practices, you are lucky if the insurance company pays you $35 for the visit. The Dr.'s have to jack the price of a visit up that high to subsidize the insurance companies that don't pay. Now, specialties like gastroenterology and endocrinologists see BIG $$. That's why there is an expected crisis in the heathcare system 10 years from now because no one wants to gets a M.D. in Internal or Family Medicine because it just doesn't pay.

2/21/2010 8:35:54 AM

The president is an alarmist. I cant imagine insurance premiums are increasing as more people are demanding thier insurance cover more and are consuming more. College tution is rising faster.

Now remember kids, Obama is pro freemarket and business.

If our govt forces insurance companies to cover those with pre existings and not allow them to charge more... its game over. And in a decade the same assholes will call it a failure of the free market.

I too agree that every proposal Ive seen from the dems is just a lot more of what is causing the problem. Too much insurance, not enough personal accountablity.

The calls to expand medicaid are mindnumbing. They are bankrupting states. Its like asking for more cancer.

^good post. Its clear some clearly dont understand how billing/reimbursements work currently. And the reason you only see your doctor for 15 mins (which is a lot) is because 1. there is a shortage of doctors with high demand, 2. reimbursments either are cut or dont keep up with costs. So in order to stay open you have to see a ton of patients. The docs can only see so many a day so they have to have their staff do most of the work/data collection. And you inflate your billing chart just as a hedge against reimbursment rates. Where did this start? A little evil company that runs medicare decided to look at the average code by region and set their adjustments. And seeing how Drs tend to sure thier heads, they adapted to stop the reimbursement cuts.

What scares me in all of this, is if they FORCE doctors to take govt insurance or see patients. This will, no doubt, have the publics approval. Bc there will be a huge outcry when they cut medicare reimbursements 40% and everyone drops it. THat will save a TON of money though. Hopefully, after that, people will get used to bringing in thier wallets for thier routine care and not a piece of paper they dont understand. See whoever they want and apply real market pressure on Drs.

2/21/2010 9:33:11 AM

Yes! At my old office we stopped seeing all new Medicare patients. We'd spent over an hour for a physical for them and their 28 problems and then get reimbursed $65 if we were lucky. The Dr. would not compromise care for existing patients and would lose money by seeing more Medicare patients so we just stopped seeing them. And I can tell you that at LEAST once a week a new Medicare patient would be on the phone in tears, telling us we're the 15th Dr.'s office she called who wouldn't accept Medicare and she didn't know where to go or what to do. Expect WAY more tears and frustration by the baby boomers in the next 10 years.

And don't even get me started on Medicaid. They never have and NEVER will see those patients because the reimbursement is next to nothing (literally) and the patients tend to be more difficult than they're worth (generalization, I know, but true). If the government starts mandating acceptance of government plans w/o major overhaul, the healthcare industry will collapse much sooner than expected.

2/21/2010 9:56:04 AM

Unfortunately Im in a poorer area and see a ton of medicaid. I know what you mean about the problems with medicaid. Believe me. We went back over our books to look at who our no shows were. Almost 80% were medicaid. So we not only lose money by doing their exams, when they dont show up we lose even more. We are one of two eye docs that take it in our area. If I end up buying one of our practices, Ill drop it first thing. I think we get 115 for a complete exam AND a pair of glasses total. And that is after you spend countless hours trying to get thier info and they show up with a different card or have switched to another medicaid. (VA has 3) Some even require us to call their PCP to get the referral. Thus eating up OUR time, the PCPs time, and our patients time. And for what? Its not worth the money, it isnt.

I wouldnt mind taking it and only seeing a limited number a day or just a day a month. However, other docs have tried that and end up getting threatend with discrimination. hahah. Shit they arent doing it for the money, they are doing it to at least offer some service and to get threatened just makes them drop it completely.

Oh, did you offer the people in tears to pay cash for thier service and bill medicare themselves? Its usually weeds out just how bad they need to see someone.

[Edited on February 21, 2010 at 11:23 AM. Reason : .]

[Edited on February 21, 2010 at 11:26 AM. Reason : .]

2/21/2010 11:22:25 AM

Quote :

"When you come in for a 15 minute ear infection, it's true that your Dr. may bill your insurance $150 ($250 is crazy) for the visit. However, ESPECIALLY in family practices, you are lucky if the insurance company pays you $35 for the visit. The Dr.'s have to jack the price of a visit up that high to subsidize the insurance companies that don't pay. Now, specialties like gastroenterology and endocrinologists see BIG $$. That's why there is an expected crisis in the heathcare system 10 years from now because no one wants to gets a M.D. in Internal or Family Medicine because it just doesn't pay."

Sorry I wasn't clear. I'm well aware of why they bill what they do, and I don't blame them for trying to keep the average rate up so that they can be compensated at least enough to cover their costs. I was pointing out the problem that insurance is in the system as a whole. We have a system which is rigged to generate ever increasing costs as less and less is paid for by the people consuming the services and more and more the costs have to be increased so that the negotiated amounts can be reasonable. If instead of the system we have now, your family doctor just billed you $50, they would get more than the insurance company pays them, and your health care costs would be less overall. The problem is, if every doctor actually billed you $50, the insurance companies would reimburse $5.

2/21/2010 12:16:17 PM

The solution to many of the problems with our system is changing the tax code, but no politician talks about it, and I don't know why. I keep hearing stories about people that lose their jobs and have to pay ridiculous COBRA rates (and in 18 months, have no coverage at all), or stay in a bad job because they (or a family member) has some extremely expensive to treat condition, and they can't afford to lose the benefits.

Now, the answer to these problems from progressives/liberals/whatever would be "extend COBRA benefits! subsidize health care! make it illegal for an insurance company to deny someone with a pre-existing condition" or, from the right, "give more tax credits to businesses that provide health benefits!" Both sides completely miss the root problem, which is that the tax code has caused health insurance to be connected with employment, and in this period of ever increasing unemployment, the flaws of the system are exposed.

2/21/2010 1:25:44 PM

^actually both sides have made this point. the public option and medicare buy-in were attempts in that direction that were shot down on the dem side. HSA's fill a similar role. and people on both sides at various times have suggested getting rid of health benefit tax exemption. but it's kind of a third rail, because in the short-term it would drastically raise the cost of doing business for those that provide insurance for their employees.

and responding to a point above about abusing the senate rules or whatever. it is called reconciliation for a reason. ezra klein puts it better than me:

Quote :

"This is actually the sort of situation reconciliation was designed to address, as Brookings' Henry Aaron explains here (http://content.nejm.org/cgi/reprint/NEJMp1001616.pdf?ssource=hcrc). Budget reconciliation is called "reconciliation" because it's supposed to speed the, well, reconciliation of the differences between two budget bills. That's exactly what's left to do with the health-care reform bills, which were indeed part of the 2010 budget and whose passage is expected in the 2011 budget. Because this is what the process is actually meant to do, it doesn't present the manifold problems of using reconciliation for the entire bill. Things like the insurance market reforms have already passed with 60 votes in the Senate and 220 in the House. They're done. What's left are some tweaks to the way the bill spends and raises money (that is to say, tweaks to its budget implications) that are needed in order to, yes, reconcile the two bills. Reconciliation works for this because reconciliation was designed to do this."

2/21/2010 1:38:27 PM