Obama's Blue Pill and Red Pill - Choose Wisely!

Yesterday, President Barack Obama went to a townhall meeting in New Hampshire to clear up some "misinformation" about his health care reform plans. During that session, the president excoriated the health insurance companies for "rationing" care. According to the president:

...right now insurance companies are rationing care.  They are basically telling you what's covered and what's not.  They're telling you:  We'll cover this drug, but we won't cover that drug; you can have this procedure, or, you can't have that procedure.

Well, that's true. But if a company or consumer doesn't like the restrictions that their current health insurer is imposing, they at least have the possibility of switching to another insurer whose formulary is more to their liking.

In any case, after the president condemned stingy insurance companies for limiting drug choices, he probably wasn't expecting this question from the audience:

Q. Good afternoon, Mr. President.  Bill Anderson from New Hampshire.  In reference to what you just said -- I'm presently under the New Hampshire Medicaid system and I have to take a drug called Lipitor.  When I got onto this program they said, no, we're not going to cover Lipitor -- even though I'd been on that pill for probably 10 years, based on the information my doctor feels is right for me. 

And I had to go through two different trials of other kinds of drugs before it was finally deemed that I was able to go back on the Lipitor through the New Hampshire Medicaid system.  So here it is, the Medicaid that you guys are administering and you're telling me that it's good -- but in essence, I'm dealing with the same thing, and you're telling me the insurance companies are doing.  Thank you.

The government health care program doing the same thing that the president accused private insurance companies of doing? Hmmm. The president answered in part:

THE PRESIDENT:  Well, I think that's a legitimate point.  I don't know all the details, but it sounds to me like they were probably trying to have you take a generic as opposed to a brand name.  Is that right?  And it turned out that you did not have as good of a reaction under the generic as the brand name, and then they put you back on the brand name.  Is that what happened?

Q   Correct, to save money.

THE PRESIDENT:  Well -- right.  Look, there may be -- in nine out of 10 cases, the generic might work as well or better than the brand name.  And we don't want to just subsidize the drug companies if you've got one that works just as well as another. 

The president has famously delved into the intricracies of pharmaceutical formularies before:

What I've proposed is that we have a panel of medical experts that are making determinations about what protocols are appropriate for what diseases. There's going to be some disagreement, but if there's broad agreement that, in this situation the blue pill works better than the red pill, and it turns out the blue pills are half as expensive as the red pill, then we want to make sure that doctors and patients have that information available to them. 

Gosh, why don't private insurers think of that? Oh, they did? Who knew? Oh, of course, the president calls that "rationing" when insurers create and use tiered formularies, but it's not "rationing" when government health care programs do the same thing. 

And what about innovation? One way that private health insurers compete for consumers is by offering different formularies and providing access to newer drugs. Last week, Hoover Institution fellow Henry Miller and associate director of the American Council on Science and Health, Jeff Stier, published a sharp op/ed in the Los Angeles Times on the effect that President Obama's proposed health care reforms will have on pharmaceutical research. But first they point out: 

Drugs often improve the span and quality of life in a remarkably cost-effective way, a fact of crucial significance not only to the individual patient but to society as a whole. Innovative new medicines, for example, have helped many patients avoid costly hospitalization. Between 1980 and 2000, the number of hospital days fell by 56% and, as a result, Americans avoided 206 million days of hospital care in 2000 alone, according to Medtap International, which provides health economics and outcomes research services. And a study in 2000 sponsored by the Agency for Health Care Policy and Research concluded that increased use of a blood-thinning drug would prevent 40,000 strokes a year, saving $600 million annually. A 1997 study by the National Bureau of Economic Research found the costs of treatment per episode of major depression fell by 25% from 1991 to 1995.

Another sign of progress is that, in general, new drugs confer an advantage over older ones in reducing mortality. A 2004 National Bureau of Economic Research study of patients who took drugs between January and June 2000 found that a higher percentage of those who took newer medications were still alive in 2002. The estimated mortality rates were directly related to the time that had elapsed since each drug was approved.

However, the climate for drug development is deteriorating. Research and development investments per new drug introduction approximately doubled between the early 1980s and early 1990s, and only about three in 10 drugs approved by the Food and Drug Administration for marketing recoup their development costs.

So what happens when the government prescribes the blue pill? As Miller and Stier explain:

Once the cheap blue pill has been anointed as the one eligible for federal reimbursement, there will be little incentive for companies to pour millions of dollars into developing a new generation of drugs that might in fact prove to be better -- but perhaps only for a small subset of patients. Quite justifiably, the drug industry's trade association, the Pharmaceutical Research and Manufacturers of America, fears "that the federal government will wind up rationing healthcare and dictating what medicines doctors can prescribe to their patients. This may well prevent patients from gaining access to the critically important medicines they need to fight diseases such as cancer, diabetes and heart disease."

Politicians seem determined to squeeze the drug industry, but it is patients ultimately who will feel the pinch. 

Whole depressing LA Times op/ed is here

Disclosure: I own a bunch of biotech and drug pharmaceutical stocks that I bought with my own money and are in my retirement accounts. Sadly that sector's stock values have suffered during the recession too. I was also paid for researching and writing a peer-reviewed report on research conflicts of interest for the American Council on Science and Health. 

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  • ||

    There are no generics for Lipitor. The guy was on completely other drugs that were not effective. Basically, they experimented on him out of cost considerations.

    But no, government doesn't ration.

  • ||

    SugarFree, yeah, that's what I thought. But why did the guy tell Obama he was correct in saying that they were merely substituting generics for brand names?

  • ||

    "Drugs often improve the span and quality of life in a remarkably cost-effective way, a fact of crucial significance not only to the individual patient but to society as a whole. Innovative new medicines, for example, have helped many patients avoid costly hospitalization. Between 1980 and 2000, the number of hospital days fell by 56% and, as a result, Americans avoided 206 million days of hospital care in 2000 alone, according to Medtap International, which provides health economics and outcomes research services. And a study in 2000 sponsored by the Agency for Health Care Policy and Research concluded that increased use of a blood-thinning drug would prevent 40,000 strokes a year, saving $600 million annually. A 1997 study by the National Bureau of Economic Research found the costs of treatment per episode of major depression fell by 25% from 1991 to 1995."


    But drug companies are evil and driving up costs by stealing money!! Government run healthcare will perminently give us cutting edge treatment circa 1995 rationed in small quatities to those lucky enough to be connected or to live long enough to get to the front of the que. But we won't have any more uninsured and we will have finally gotten those evil greedy pharma companies.

  • Naga Sadow||

    Blue pills? Red pills? Obama is Morpheus?

  • ||

    "But why did the guy tell Obama he was correct in saying that they were merely substituting generics for brand names?"

    Because he probably didn't know any better and was confused. The poor guy is probably on several medicines and just got confused under the glare of talking to the President on national TV about what drug was generic and what was not.

  • ||

    Tulpa,

    Probably didn't know the difference, or the pharmacy fudged it. I imagine he was on a generic statin and they just implied it was the same thing.

    I never use brand names if I can help it. I get rotated on and off generics all the time, especially my blood pressure medication. As a diabetic, beta blockers are contraindicated; a dozen different doctors had tried to prescribe them to me over the years.

  • Warty||

    Did Obama just tell the guy not to worry, because Medicare is smart enough to take care of everyone?

  • Mark T||

    The idea that we can just switch from one insurer to another is nonsense. One, once something goes wrong, no other insurer wants you, and two, they have an antitrust exemption, and have pretty much divvied up these markets to suit themselves. If you think they are in competition with one another, I have a policy I want to sell you.

  • ||

    Mark T,

    If that is true, then isn't the sollution to make insurance companies compete? How is giving the government a monopoly a good idea?

  • 24AheadDotCom||

    What you won't hear from Reason: Obama lied about the number of uninsured. Reason doesn't care about subsidies, just as long as they're going to the right type of companies.

    Disclaimer: I'm now employed as a lobbyist by the Chu Wan Sun Zhin Wa Lead Smelting Company and their subsidiaries the Chu Wan Sun Zhin Wa Political Education Through Work Children's Initiative and the Chu Wan Sun Zhin Wa Happy Fun Toy Company.

  • Xeones||

    Shut the fuck up, LoneWacko.

  • ||

    Mark T: Note that I wrote "have the possibility of switching."

    If you're interested you might take a look at my brief stab at real health care reform in my column "Markets, Not Mandates" and my 2004 article "Mandatory Health Insurance Now".

  • Paul||

    I never use brand names if I can help it. I get rotated on and off generics all the time, especially my blood pressure medication.

    Sugarfree,

    You have blood pressure problems and you read Reason?

  • ||

    Paul,

    I don't bottle things up inside. :-)

  • JB||

    Obama: 'Well, it's ok when the government does something because I say so. It's hopey-changey bullshit you better believe in or I will send Pelosi to call you a Nazi.'

  • ||

    SugarFree manages his blood pressure with cathartic writings about a certain lobbyist for Chinese lead toys.

  • ||

    Umm, pardon me, but what country's health care system are you taking about here? Because it sure isn't the US:
    "But if a company or consumer doesn't like the restrictions that their current health insurer is imposing, they at least have the possibility of switching to another insurer whose formulary is more to their liking."
    Just talking about drugs here, if you get your insurance through your job, chances are you are offered only one plan or a couple of kinds of plan from one company (like a PPO and PMO, both from UHC, for instance). If you don't like their formulary, your choices are a) get your insurance on the open market, if you can get any at all, leaving your employer's subsidy behind and probably resulting in new huge deductibles, b) get a new job, with new insurance, c) go with your spouses insurance (if you're married and they have insurance), d) bankrupt yourself so you qualify for state aid (if it's there.)
    Hmmm, those all sound really great.
    Oh, wait, you use the word "possibility". That explains it. Like the "possibility" that Lipitor-bearing monkeys might fly out of my, uh, medicine cabinet.

  • ||

    "Hmmm, those all sound really great."

    But of course Obama is going to use unicorn farts to make it all better right? Even if you are right, that just means insurance companies are as bad as the government. Since the insurance companies can't tax me or send me to jail, I will take my chances with them.

  • ||

    I take drugs not covered by my insurance plan. Shockingly, I pay for them with something called MONEY. That's the pittance I have left over from my job after the federal, state and local mug me every two weeks.

    What happens when the government rations drugs? Will the doctor even prescribe something that is not "approved"?

  • Rich||

    Not to put too fine a point on it, but

    Oh, wait, you use the word "possibility". That explains may explain it.

  • ||

    SugarFree is of course right that Lipitor has no generics on the market right now, so the Medicare group was telling him not to take a generic but to try a cheaper, different drug.

    I'd add that FDA regulation of generics requires testing to show that the generic works the same as the brand name drug, and requires it to have the same ingredients. If a person is having different reactions to a generic than to the brand name, it's either due to a regulatory failure or a placebo-type effect.

    If the president thought from that story that the guy was on generics, the president is either being dishonest or doesn't know enough about the pharmaceutical industry to opine on it intelligently.

  • ||

    Well, that's true. But if a company or consumer doesn't like the restrictions that their current health insurer is imposing, they at least have the possibility of switching to another insurer whose formulary is more to their liking.

    Well that's true. Assuming you aren't like the majority of people whose employer makes that choice and you have no control over it.

  • ||

    Let's try it again with the right HTML

    Well, that's true. But if a company or consumer doesn't like the restrictions that their current health insurer is imposing, they at least have the possibility of switching to another insurer whose formulary is more to their liking.

    Well that's true. Assuming you aren't like the majority of people whose employer makes that choice and you have no control over it.

    Why do the anti-reform people continue to ignore this very very important point?

  • The Gobbler||

    "Disclaimer: I'm now employed as a lobbyist by the Chu Wan Sun Zhin Wa Lead Smelting Company and their subsidiaries the Chu Wan Sun Zhin Wa Political Education Through Work Children's Initiative and the Chu Wan Sun Zhin Wa Happy Fun Toy Company."

    I just shit myself laughing.

  • ||

    But of course Obama is going to use unicorn farts to make it all better right?

    That's still a better option than the magic market fairy you think is a solution.

  • ||

    @ChicagoTom -

    I don't ignore it, but that's why I favor the sorts of reform Reason usually is pushing--taking steps to delink employer health care, improving portability, and encouraging the HSA + high deductible insurance option.

    Why do the pro-reform folks point to overgrown insurance bureaucracies as a bad thing, and then propose to solve the problem with...a government overgrown bureaucracy?

  • ||

    If the president thought from that story that the guy was on generics, the president is either being dishonest or doesn't know enough about the pharmaceutical industry to opine on it intelligently.

    Should the President know every medication that has a generic available?

    He probably did think that they wanted him to take a generic instead of what really happened...they made him take a cheaper less effective...

    but let's look at the ultimate outcome...Medicare finally approved Lipitor for this guy. Private insurance would most likely tell him to pound sand if lipitor isn't on their list. So I think +1 for medicare here.

  • Paul||

    Well that's true. Assuming you aren't like the majority of people whose employer makes that choice and you have no control over it.

    ChicagoTom, welcome to the forum. Please have a look around to see what some of the proposed reforms to de-couple employers from health insurance are.

  • ||

    I don't ignore it, but that's why I favor the sorts of reform Reason usually is pushing--taking steps to delink employer health care, improving portability, and encouraging the HSA + high deductible insurance option.

    I favor those things too. It boggles my mind why no one is seriously trying to decouple health insurance from employment.

    But as for HSA's. If I cant afford insurance, how am I expected to fully fund a Health Savings account?

    One of the problems right now is the large (and getting larger -- bigger co-pays, bigger % of the co-insurance being payed by the patient) out of pocket expenses that the insured have to deal with.

  • ||

    ChicagoTom:
    Well that's true. Assuming you aren't like the majority of people whose employer makes that choice and you have no control over it.

    I can't deal with every aspect of health care reform misinformation in one blog post. ;-)

    But as I suggested to Mark T. above you may want to look at my fuller real health care reform proposals in my column "Markets, Not Mandates" which includes the most important reform -- that employer-based health insurance be abolished.

  • ||

    @ChicagoTom -

    Should the President know every medication that has a generic available?

    No--he should know that if a guy is on a medication that has significantly different effects from the brand name, he probably isn't talking about a generic.

    To take a well known OTC drug: If I'm taking Advil for bunion pain, and I switch to generic ibuprofen, it should work exactly the same. If I switch to Tylenol or generic acetominophen, it's expected to work differently.

    If I tell you, "I switched from Advil to another drug and it worked very differently," it should be obvious that the drug I switched to was not generic ibuprofen.

  • EscapedWestOfTheBigMuddy||

    But of course Obama is going to use unicorn farts to make it all better right?

    That's still a better option than the magic market fairy you think is a solution.



    No Tom, a broken health provision system with less freedom is not better than a broken health provision system with more freedom.

    It simply isn't.

    Especially since there is no going back from nationalization, while there is room to experiment with different free and hybrid systems.

  • Gunboat Diplomacy||

    "I take drugs not covered by my insurance plan. Shockingly, I pay for them with something called MONEY. That's the pittance I have left over from my job after the federal, state and local mug me every two weeks."

    I have been enjoying the healthcare debate while taking care of my geriatric German Shepherd.

    The insurance plan I have at work is one of those catastrophic plans (entirely employer paid) coupled with an HSA. It's from UHC. I pay the first $2,000 and they cover everything above that. So if something happen, I'm out 2 grand.

    My dog has no health insurance, so everything is out-of-pocket. Currently, she is treated at the University of Minnesota Small Animal Clinic. They are considered the Mayo Clinic of veterinary hospitals.

    Last month, I dropped $1,100 on puppy health care (she sees both a gynecologist and a dermatologist). This month, I figure I'll drop around $800. In only two months, I'll have spent just $100 less than what I'll have to pay for my own health care - should I need it - on a dog.

    I am not asking the government to cover my dog's medical care. I am not asking the government to cover MY medical care.

    It's called America. And Obama wants to fuck that up.

  • ||

    What happens when the government rations drugs? Will the doctor even prescribe something that is not "approved"?

    Not to worry Sug. Diabetics, like you, who will be a constant drag on the the new health regime will simply be re-educated to understand that your condition is one that can be better managed through diet and early death.

  • ||

    That is a very thoughtful post Gunboat Diplomacy. But, did we really have to hear about your dog's OBGYN? I mean honestly, was that little gem necessary?

  • ||

    Why do the anti-reform people continue to ignore this very very important point?

    Because all you propose to replace it with is a bureaucracy that is supposedly accountable to a vote.

    A whole lot more people were mad about the Iraq War than will ever be mad about generics for Lipitor; look how that worked out.

  • ||

    "Diabetics, like you, who will be a constant drag on the the new health regime will simply be re-educated to understand that your condition is one that can be better managed through diet and early death."

    Post of the day maybe the week. HAHAHAHA>

  • ||

    The insurance plan I have at work is one of those catastrophic plans (entirely employer paid) coupled with an HSA. It's from UHC. I pay the first $2,000 and they cover everything above that. So if something happen, I'm out 2 grand.

    Actually, aren't you out 2K anyway? My HSA doesn't rollover. (Which is fucking bullshit, by the way.)

  • ||

    Post of the day maybe the week.

    Your Anti-Diabetism sickens me.

  • ||

    ChiTom,

    Lipitor isn't exactly an obscure drug. Patent laws, another non-obscure topic for an accomplished constitutional lawyer like Obama, prevent generics from coming on to the market for many years after a drug is introduced.

    I mean, my job has absolutely nothing to do with health care, and I've never taken a prescription drug other than antibiotics in my life, and I immediately thought, "isn't Lipitor awfully new to have generics available?" when I read this. So I'd expect a guy who's essentially campaigning to be at the head of the national health care system to be at least as informed as I am.

    And if he doesn't know the answer, he should ask for clarification rather than jumping to conclusions as he did.

  • Gunboat Diplomacy||

    "That is a very thoughtful post Gunboat Diplomacy. But, did we really have to hear about your dog's OBGYN? I mean honestly, was that little gem necessary?"

    I didn't go into treatment details as I did in a post a couple of weeks ago. I figured that was favor enough.

  • ||

    SF,

    You are just going to have to get over it and stop demanding stuff that doesn't make you better. The President said so.

  • ||

    "I didn't go into treatment details as I did in a post a couple of weeks ago. I figured that was favor enough."

    And on behalf of a greaful nation, I thank you for that.

  • Gunboat Diplomacy||

    "Actually, aren't you out 2K anyway? My HSA doesn't rollover. (Which is fucking bullshit, by the way.)"

    I don't put shit into my HSA for that very reason. Out-of-pocket, just like the dog.

  • ||

    Maybe I'll finally get treatment for my insulin addiction.

  • ||

    Why do the anti-reform people continue to ignore this very very important point?

    We're not anti-reform. We're anti-gummint insurance. Many of us don't want to have our current, very good private insurance replaced with one that will undoubtedly ration care as a means of meeting budgets and very likely provide for sub-standard care. The sponsors of O-Care have made it very clear that they want as little competition as possible.

    Many of us favor the options that were listed in John Mackey's op-ed posted earlier today. We believe that we're better served by organizations that have to compete for our health care dollars. we believe that choice, above all else, is the best possible solution for providing health care.

    Can you spot the difference?

  • Gunboat Diplomacy||

    And on behalf of a greaful nation, I thank you for that."

    Of course I could tell if you'd like, but what I have to do now makes what I related two weeks ago sound like a a recipe for lemon meringue pie.

    PS It's no surprise that a lawyer never learned to spell grateful. ;-)

  • ||

    No--he should know that if a guy is on a medication that has significantly different effects from the brand name, he probably isn't talking about a generic.

    And based on the phrasing of the question, I don't think it was that obvious that the questioner wasn't talking about generics.

    Furthermore, Obama repeats what he thinks happened and the guy confirms what Obama (apparently wrongfully) thinks:

    don't know all the details, but it sounds to me like they were probably trying to have you take a generic as opposed to a brand name. Is that right? And it turned out that you did not have as good of a reaction under the generic as the brand name, and then they put you back on the brand name. Is that what happened?

    Q Correct, to save money.



    So maybe the guy asking the question is confused as well? Since he confirms that he was asked to go on generics

    But regardless, the guy got his Lipitor from Medicaid/Medicare -- what would he have gotten from private insurance under the same circumstances?

  • robc||

    Not to put too fine a point on it

    Say Im the only bee in your bonnet.

  • robc||

    It boggles my mind why no one is seriously trying to decouple health insurance from employment.

    Maybe you arent, but Im fucking serious about it.

  • ||

    Many of us don't want to have our current, very good private insurance that currently rations our treatments and limits which doctors we can and cant see and which treatments they will or will not cover as a means of returning profits to shareholders replaced with one that will undoubtedly ration care as a means of meeting budgets and very likely provide for sub-standard care. The sponsors of O-Care have made it very clear that they want as little competition as possible.

    Fixed that for completeness.

    The public option being proposed would be optional and wouldn't replace your insurance. You wouldn't have to be in that plan. So what's the problem again?

    A public option is trying to actually add competition -- considering most insurance markets are saturated (dominated by only a couple of insurance companies)

  • ||

    Maybe you arent, but Im fucking serious about it.

    I'm serious about it too. I am all for decoupling insurance from employment. There is no valid reason for it.

  • ||

    Many of us favor the options that were listed in John Mackey's op-ed posted earlier today. We believe that we're better served by organizations that have to compete for our health care dollars. we believe that choice, above all else, is the best possible solution for providing health care.

    I support many of them as well. But why does it have to be either or.

    Let's change the restrictions and alow a non-profit insurance option to compete with the for profit ones.

  • robc||

    Actually, aren't you out 2K anyway? My HSA doesn't rollover. (Which is fucking bullshit, by the way.)

    I believe that is an FSA or something. There is a category for them, for get the name, I know UofL has the same deal. Most roll-over.

    I think it depends on the size of the "company" (in quotes for your situation). The rollover HSAs may only be available for

  • robc||

    I'm serious about it too.

    Then why did you say no one is serious about it? Are we not men?

  • ||

    So I'd expect a guy who's essentially campaigning to be at the head of the national health care system to be at least as informed as I am.

    These kind of statement are so silly.

    Obama isnt going to run anything personally.

    Just like he isn't running GM.

    Any Federal level health care plans are going to be run by people who are at least as informed as you and I about health care

  • ||

    Then why did you say no one is serious about it? Are we not men?

    I meant no politicians are seriously trying to change the laws that couple health insurance and employment.

  • robc||

    Let's change the restrictions and alow a non-profit insurance option to compete with the for profit ones.

    That happens now.

  • robc||

    I meant no politicians are seriously trying to change the laws that couple health insurance and employment.

    Ron Paul?

    Dont know for sure, but there has to be at least 1. Right?

  • ||

    @ChicagoTom-

    Let's change the restrictions and alow a non-profit insurance option to compete with the for profit ones.

    A public option isn't a "non-profit insurance option", and the current bill is far from the government setting up its own non-profit in fair competition. Just the 3 biggest problems:

    1. The plan currently on the table sucks down taxpayer dollars--not only is it non-profit, it'll run at a huge loss paid by government debt. That's not real competition.

    2. The plan currently on the table imposes harsh regulations on the sort of insurance companies can offer, which will probably outlaw the options you say you support. Again, not fair competition.

    3. When a non-profit corporation fails, it goes bankrupt and dies. When a government welfare scheme fails, it becomes a zombie and sucks up money from more productive uses to prop it up.

    If the statement you just made is accurate, you should be opposed to all the plans currently on the table.

  • ||

    The plan currently on the table imposes harsh regulations on the sort of insurance companies can offer, which will probably outlaw the options you say you support. Again, not fair competition.

    Such as?

  • ||

    The plan currently on the table sucks down taxpayer dollars--not only is it non-profit, it'll run at a huge loss paid by government debt. That's not real competition.

    I don't object to subsidized health insurance.
    Roads run at a loss too, and tax dollars are spent to maintain them. Health care for citizens of the US is as valuable as roads.


    When a non-profit corporation fails, it goes bankrupt and dies. When a government welfare scheme fails, it becomes a zombie and sucks up money from more productive uses to prop it up.

    How are you defining failure? Not being in the black?

    Is welfare a failure? I don't think so. It provides aid to the poor. It doesn't make money, it taxes people (yes it is wealth redistribution). That's the whole point of welfare.

  • robc||

    ChiTom,

    Such as?

    From an article on cnn.com:

    The Senate bill would require coverage for prescription drugs, mental-health benefits, and substance-abuse services. It also requires policies to insure "children" until the age of 26. That's just the starting list. The bills would allow the Department of Health and Human Services to add to the list of required benefits, based on recommendations from a committee of experts.

  • ||

    Let's change the restrictions and alow a non-profit insurance option to compete with the for profit ones.



    Already exists (Blue Cross/Blue Shield is non-profit)

  • robc||

    Many but not all Blue Cross/Blue Shield franchisees are non-profit.

  • ||

    But why does it have to be either or.

    If I read you correctly, becasue:

    -You can't truly compete with a entity that can tax and print money at will
    -Guvmint services have typically been sub-standard
    -The guvmint can't afford this to begin with
    -It will only grow larger, in both resources consumed and scope
    -You shouldn't start trusting the guvmint to not screw up just becasue your guy is in charge.

  • ||

    The public option being proposed would be optional and wouldn't replace your insurance. You wouldn't have to be in that plan. So what's the problem again?

    I don't believe it will stay an option for long. I also firmly believe that .orgs like the one I work for will throw us under the bus if they can get out from providing insurance, so they can pocket the savings.

  • ||

    The public option being proposed would be optional and wouldn't replace your insurance. You wouldn't have to be in that plan.

    This overlooks the following:

    (1) The public option is intended, as has been admitted by many of its proponents in Congress, as a stalking horse for single-payer.

    (2) The public option is part of a package of mandates that will drive up the cost of private insurance.

    (3) The public option will be subsidized and will certainly undercut private insurance.

    (4) Everyone, but everyone, admits that there will be significant migration to the public option as employers stop offering insurance because their employees can now get it elsewhere.

    So, yes, the public option will, in time, replace your insurance.

  • ||

    So, yes, the public option will, in time, replace your insurance.

    But Obama said he wouldn't make you give up your insurance. He didn't say anything about using your tax money to 'encourage' your employer to make you give up your insurance. You're just too racist to see how totally honest that is.

  • ||

    For all you Atlantic haters (I'm a subscribing one!), they finally let a good article slip through the cracks:

    http://www.theatlantic.com/doc/200909/health-care/1

  • ||

    But Obama said he wouldn't make you give up your insurance.

    Obama says lots of things. Usually at the exact moment he is doing the exact opposite from what he says he is doing (or not doing).

  • ||

    Is welfare a failure?

    When it provides a way of life? Yes. When it's temporary assistance, not so much.

    The former is precisely what Obama is offering, all the while telling us he's doing this becasue of the people who don't have insurance. If that's all it was, then he should be talking about the guvmint being the insurer of last resort and then only for catastrophic care.

    He isn't doing that. If he was, then he'd at least appear to be honestly discussing the issue.

  • ||

    So, yes, the public option will, in time, replace your insurance.

    The public option is intended, as has been admitted by many of its proponents in Congress, as a stalking horse for single-payer.

    Single payer can't exist with private insurance? Doesn't france have a system like that already? Basic coverage for everyone and supplemental private insurance. Why would that be terrible?

    The public option is part of a package of mandates that will drive up the cost of private insurance.

    The insurance companies slit their own throats on this one. The reason for the mandates are the growing unwillingness of insurance companies to cover procedures people need.

    This is where I don't understand the argument. The reason people are unhappy is because of the way insurance currently works. They try their hardest to deny expensive payouts to their customers, and make sick people jump through hoops appealing denied claims. And somehow I'm supposed to think "wow how terrible would it be for these companies to be forced to provide coverage for health care" ? Fuck them. They are profiting off of the suffereing of others (and adding to it) They should have been better actors from the begining.


    The public option will be subsidized and will certainly undercut private insurance.

    That's a feature not a bug. It will force health insurance companies to become more efficient and more competive with their pricing. Right now premiums increases are outpacing their costs by far and their profits are growing every year. People and small businesses are being priced out of the market.

    Everyone, but everyone, admits that there will be significant migration to the public option as employers stop offering insurance because their employees can now get it elsewhere

    Which kind of proves that there is a need for the public option.

    Insurance companies are going to have to adapt to a new market space and quite possible survive on less profits. They might have to make money on the gaps of public insurance. So be it.

  • ||

    Roads run at a loss too, and tax dollars are spent to maintain them.



    Luckily the federal money is all user fees, though local money is not. But yes, you may note that Reason has linked an article right now about how roads shouldn't be subsidized, and that is the official position of reason as well.

    Is welfare a failure? I don't think so. It provides aid to the poor. It doesn't make money, it taxes people (yes it is wealth redistribution). That's the whole point of welfare.



    We have this thing called Medicaid. No one here's arguing against it or welfare.

  • ||

    The reason people are unhappy is because of the way insurance currently works. They try their hardest to deny expensive payouts to their customers, and make sick people jump through hoops appealing denied claims. And somehow I'm supposed to think "wow how terrible would it be for these companies to be forced to provide coverage for health care" ? Fuck them. They are profiting off of the suffereing of others (and adding to it)



    This problem has nothing to do with profits. It exists in a non-profit health insurance company, it exists in a mutual, and it would exist in a public option. Everybody has an incentive that everybody else's claims get denied, so you get low premiums, while yours get approved, so you get coverage. Of course, that's because those other people are malingering idiots who lie and don't take care of their health and have fake, made up diseases or things that they could live with, totally unlike you, who would only use health care when it's a total necessity. For safety's sake, it's good to bargain and form groups with other people like you prone to the same diseases to make sure that your problems get covered. With Medicare, all the elderly can band together because they're just making sure that everyone not on Medicare subsidizes them. Expand Medicare to everyone, and we'll all be in the same boat fighting against each other.

    That's a feature not a bug. It will force health insurance companies to become more efficient and more competive with their pricing. Right now premiums increases are outpacing their costs by far and their profits are growing every year.



    Health insurance profits aren't large. Proof: Non profit insurance companies don't have lower rates. Nor do mutual insurance companies, where the only "owners" are the policy holders. Both of those sorts of companies exist; if profits were the cause of the problem, then you could switch to non-profit or mutual health insurance and solve the problem. Indeed, all employers would have a massive incentive to switch to such plans.

  • Vanessa||

    "If the president thought from that story that the guy was on generics, the president is either being dishonest or doesn't know enough about the pharmaceutical industry to opine on it intelligently."

    Pretty much what I was thinking.

  • ||

    @ChiTom -

    Which kind of proves that there is a need for the public option.

    Insurance companies are going to have to adapt to a new market space and quite possible survive on less profits. They might have to make money on the gaps of public insurance. So be it.


    If I rob a bank, and then give away widgets for free, this doesn't mean that the widget-maker down the street is inefficient. The market isn't free when force is used to put a thumb on the scale.

    There is no free market, and no real competition, when one of the competitors can print its own money while forcing others' products off the market. The few government industries that compete relatively freely (1) are in serious financial trouble, like the post office, and (2) don't regulate their competitors very strongly. If you fixed maximum prices on UPS and FedEx, you wouldn't have UPS and FedEx to provide an escape when USPS won't cut it.

  • ||

    Let's change the restrictions and alow a non-profit insurance option to compete with the for profit ones.


    Assuming that the government isn't subsidizing the non-profit, forcing doctors and hospitals to charge them less, or otherwise biasing the laws in their favor, go for it.

    Look. Nobody is stopping you from forming whatever kind of health coop you want, free from federal interference. We just don't think you should get tax dollars to subsidize your coop.

  • ||

    I also firmly believe that .orgs like the one I work for will throw us under the bus if they can get out from providing insurance, so they can pocket the savings.

    They don't pay for your insurance, you do. Will your employer really be able to tell everyone, OK, you all get $X pay cut? If they can get away with that I wonder what keeps them from doing it anyway. Goodwill?

  • Vanessa||

    "But regardless, the guy got his Lipitor from Medicaid/Medicare -- what would he have gotten from private insurance under the same circumstances?"

    Generally, with private insurance, if a patient tries a couple of drugs that are on the formulary, and the drugs don't work, they can have their doctor submit a document explaining the circumstances and receive a drug that is not on the formulary. Sometimes, the co-pay is higher, but generally they can receive it. For example, I have a $20 co-pay for name brands on my insurance formulary, and a $35 co-pay for brands that are not on it, and I can receive them if my doctor makes the request.

  • Vanessa||

    "It boggles my mind why no one is seriously trying to decouple health insurance from employment."

    Yup. Mine too.

  • ||

    "The public option will be subsidized and will certainly undercut private insurance."

    That's a feature not a bug. It will force health insurance companies to become more efficient and more competive with their pricing.


    Every heard of "dumping"? What you are effectively advocating is that the US government "dump" below-cost health care on the market, under the false premises of "encouraging competition", but with the true (and admitted) agenda of driving the private companies out of business.

    You know the real goal is to drive private health insuranceo ff the market. You know we know it. And we know you know it. So why are you even bothering with this "competition" bullshit.

  • The Ghost of Hunter S. Thompso||

    "As your attorney, I advise you to take a hit out of my little brown bottle in my shaving kit" - Dr. Gonzo, from Fear and Loathing in Las Vegas

  • ||

    It boggles my mind why no one is seriously trying to decouple health insurance from employment.

    Yup. Mine too.



    Umm, duh? Were any of y'all paying attention to the Presidential election we just had? Obama only ran $75B worth of ads demonizing McCain's proposal to replace the employer deduction with an equivalent personal tax credit to decouple health insurance. Polls showed that it was the most effective ad buy of the campaign. The same sort of fear and resistance towards changing Americans' current health care that's helping oppose the current proposal made that proposal very unpopular.

    Decoupling insurance from employment is, on the whole, unpopular, and McCain's defeat and defeat with it as a signature issue and focus of attacks killed it for another generation. Yeah, yeah, grumble, none of y'all liked McCain anyway, sure, but please don't tell me that you're surprised that no one's proposing something that got McCain spanked in the polls.

  • ||

    Although I guess I should point out that the Wyden-Bennett legislation goes somewhat in that direction but, again, it's likely to be unpopular.

  • ||

    It sickens me that no one has mentioned the blue pill/red pill conspiracy of the machines to turn us into energy producing catatonics! It sickens me.

  • robc||

    The reason for the mandates are the growing unwillingness of insurance companies to cover procedures people need.

    Absolute bullshit.

    At least one state mandates hair replacement. How is that a result of unwillingness to provide a need?

  • ||

    They don't pay for your insurance, you do.

    I fully understand that. Give me some credit, will ya?

    Will your employer really be able to tell everyone, OK, you all get $X pay cut? If they can get away with that I wonder what keeps them from doing it anyway. Goodwill?

    Sure. Many .orgs are cutting pay this year. I'm not getting a raise this year, but my 403b matching contribtion is still going, so I won't complain *too* much. I know of other .orgs in much worse shape than mine, some have gone under, and I still have a job. (Counting blessings....)

    But yeah, they would see that as a bonus to the bottom line. I work in the performing arts. We *never* work in the black.

  • ||

    The reason people are unhappy is because of the way insurance currently works. They try their hardest to deny expensive payouts to their customers, and make sick people jump through hoops appealing denied claims. And somehow I'm supposed to think "wow how terrible would it be for these companies to be forced to provide coverage for health care" ? Fuck them. They are profiting off of the suffereing of others (and adding to it) They should have been better actors from the begining.

    Ya know Tom, I could take you more seriously if you would just come clean and admit you have a bug up your ass over insurance comapnies, which is why you are so in favor of the public option.

    It's pretty gotdamn transparent, so fess up, will ya?

  • ||

    Will your employer really be able to tell everyone, OK, you all get $X pay cut? If they can get away with that I wonder what keeps them from doing it anyway. Goodwill?

    They don't need to. Many people don't realize that insurance is factored into your overall compensation, but is not listed as part of your salary or hourly rate. So if you are making $90,000/year, you actually could be costing your employer anywhere from $100,000 or more (depending on what insurance plan they buy).

    What many companies will do, I imagine, is pass off the health costs onto the public option, and then not go in and raise your salary.

    And I would imagine that many people won't even notice, making the public option an ever greater win for companies, as they--across the board--reduce all of their employee's compensation without anyone raising a stink, because all people see is their "salary" numbers.

  • ||

    Here's that asshole brotherben with another observation: healthcare threads here are shot full of speculation about the government's intentions. They want to eventually make it single payer. They want to make it socialist. They want to punish and bankrupt doctors and the damned greedy insurance companies. Then there's all the speculation about what the results might be if this bill is implemented.

    When the Global Warming zealots come in here and offer these types of speculative arguments, they are shouted down and ridiculed and belittled.

    Why is it okay for you fellas to argue speculatively, but wrong for anyone that opposes your position to do the same?

  • Gilbert Martin||

    "They want to make it socialist"

    Here's news bulleting for you:

    It IS socialist regardless of whether it ever evolves into a single payer system or not.

    It is deliberate wealth redistribution from the outset - and that is socialist.

  • ||

    Insurance companies have been doing the same thing for 20 years. I am in the field of medicine and the ones who tell you what you can have is the insurance companies, and employers in some cases. Just a little red tape, and jumping through hoops. I am also quite sure that there were other medications on the formulary that would have been acceptable.
    Physicians have been jumping through these hoops for years, as have consumers.

  • ||

    Perhaps the funds should come out of the state lotteries, since they aren't doing the school systems which they were designated for any good. Redistribute the wealth----the schools already suck!

  • mark||

    It is deliberate wealth redistribution from the outset - and that is socialist.

    Why are conservatives so selfish? </i keed i keed>

  • mark||

    don't tell me that you're surprised that no one's proposing something that got McCain spanked in the polls.
    Patients' Choice Act
    Patients' Choice Act
    Patients' Choice Act

    Sorry but it needs to be repeated if it has any chance of defeating Tentacle Monster Health Care Act of 2009.

  • GILMORE||

    Disclosure:

    Ahh, sweet, sweet disclosure, I have missed you so.

  • ||

    Many people don't realize that insurance is factored into your overall compensation, but is not listed as part of your salary or hourly rate. So if you are making $90,000/year, you actually could be costing your employer anywhere from $100,000 or more (depending on what insurance plan they buy).



    Yes, this is certainly true. But your next part does not follow.

    What many companies will do, I imagine, is pass off the health costs onto the public option, and then not go in and raise your salary.



    Ah, so you're staying that it will act as stimulus to reduce unemployment by reducing the cost of labor. (By borrowing against the government.)

    Because otherwise your argument doesn't make sense at all. These things are symmetrical. You can only argue that they wouldn't raise your salary in such a situation if you would equally argue that they wouldn't cut your salary if an invisible "employer tax" that didn't show up on your paystub was increased, or equivalently if the insurance rates that they paid (but didn't show up on your paystub) increased.

    The alternative to it not affecting salary is that it affects unemployment.

  • ||

    I am on 12 doctor ordered prescriptions. I have had over 15 surgeries including 2 open heart. Medications have kept me going since 1966. I'm now going on 82. At 80 I came out with a book. Fortunately I get VA and Medicare. Yet I had to pay over $2,000 last year out of pocket. One reason is tghat the VA only allows generics and if an outside specialist determines a procedure, the VA cannot furnish what you need and Medicare would not cover it either. So a recent procedure cost me nearly $1,000. JUst for one shot in the spine. Not covered.

  • Medic001||

    Just slit your wrist now America, and save the Government Billions of dollars.

  • Medic001||

    Ohh wait. We're taking health care advice from an obese surgeon general, an alcoholic and smoking president....yahhh great advice...just great.

  • Chris||

    If the President thinks there are drugs for common illnesses that have the same effects and differ only in cost, then he's living in an illusory world. If only he'd taken the red pill, he would've stayed in Wonderland, and his doctor could show him just how deep the rabbit hole goes.

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