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Originally posted by Joemailman
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Say it ain't so Joe. Ugh....C.H.U.D. -
"Occassionally, I would have to clean the razor of accumulated hair and miscellaneous slime......."Originally posted by Joemailman
What the hell is miscellaneous slime? He should have tried a little Penicillin first.After lunch the players lounged about the hotel patio watching the surf fling white plumes high against the darkening sky. Clouds were piling up in the west… Vince Lombardi frowned.Comment
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I don't think don hutson reads the RR, but if he does I would like him to start up the "last known whereabouts of bearsfan4ever" thread again. In all my years reading blogs, that was by far the funniest shit I ever read and it went on for about 15 pages (Old JS site). He started it shortly after we punked the bears on new years eve to round out our 8-8 season....bears fans who had been talking all kinda smack were nowhere to be seen.Originally posted by MJZiggyThe only time success comes before work is in the dictionary -- Vince LombardiComment
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Indeed that one was a classic.Originally posted by bobbleheadComment
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Thanks bobblehead. I was unaware that this subject has already been beaten to death. The way Ty was responding, I would have thought it was brand new territory.Originally posted by bobblehead
As I am new here, I don’t know the history of the characters and threads that well. It would be interesting to hear how you guys would describe each other; somewhat of a Playbill for the characters in this little PackerRats drama.
I am familiar with a few people here from my days on the Marquette threads over at JSOnline…..Otown/Ty, Ayn, Tex. I wonder if Sidney Lanier is here. That guy was Left of Karl Marx, but a pleasure to debate.
I will respond to both Tex and Ty, as they both are asking the same thing…….what is the ANSWER to why I think Education and Healthcare should be improved, and to what degree the Gov’t should be involved.
I always start with the premise that the more competition, the better the product. All you have to do is look at the Petri Dish of Germany after World War II. Cousins, fathers, sons, etc on different sides of the border; look what they came up with as far as automobiles:
And this is just one of many examples. Competition/Capitalism works. So, for Tex, I firmly believe that the cost of both Healthcare and Education can come down, while the quality of the product can go up. As far as education, you claim it works great. What about the “least of these” in our society? I would argue that those in the lowest Socio-Economic groups in our country are not raving about public/government education. I think we can do better, and breaking up the monopolies will expedite this process.
As for Otown, when should the Gov’t step in?…….that is a good question. In fact, Harlan brought up a good point the other day when he mentioned that maybe there would be NO schools in bad neighborhoods, what then? I guess I think that in certain sectors of humankind, we need some kind of oversight. In my other thread, I was asking a legitimate question about the banking industry, and to what degree it is for the “greater good” to not let it fail.After lunch the players lounged about the hotel patio watching the surf fling white plumes high against the darkening sky. Clouds were piling up in the west… Vince Lombardi frowned.Comment
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The way ty was responding...lol. I asked one simple question.
And, i have repeatedly said go back and look.Comment
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Tyrone, it looks like Bobblehead and to a lesser extent, Howard, are trying to paint us as allies in the health care and education realm. Is that as disgusting a thought to you as it is to me?
You may very well be a socialist at heart. At very least, I assume you subscribe to the concept that government is a solver of problems instead of an obstructor of solutions.
I am a true believer in the wonders of the free enterprise capitalist system. In its purest form, however, the form Bobblehead and Howard so fervently support, there are always going to be a portion of the population that fail in the system--maybe because of luck, maybe because of lack of competence, maybe because of laziness or otherwise bad attitude. In the purest form of the system, the only solution to the inevitable suffering of these failures is charity--feel free to correct me on that point if I have overlooked something, B & H. Some would say that suffering is generally deserved, and should be left to social Darwinism if charity falls short of solving it. If that is NOT your position, B & H, please say so, as it is what I get from reading your posts.
I simply believe it is wrong for even the failures in the system who may deserve to suffer to be social Darwinistically ignored. There is a huge chasm of difference between nanny-state cradle to grave social programs which the liberals dream of, and a very limited degree of government--referred to by Ronald Reagan as a safety net.
I further believe that the current situation in both health care and education is at very least, adequate. In fact, virtually no one is left behind in the health care realm, and that goal is being achieved with an absolute minimum of loss of freedom/choice.
There are two kinds of government intervention: spending--which, yes, does bring with it some degree of government influence, and regulation--which is a direct exertion of government influence, resulting in clear loss of freedom/choice. To me, it's obvious which of these is the more deleterious and the more contrary to conservative, and indeed, American principles.
Yet you guys advocate blatantly having the government stick its nose in our business, grabbing our freedom to choose not to pay for health insurance, and toss it in the trash. THAT is government regulation! How can you possibly condone it?
What I advocate--and basically what we see in place today--is not even direct government spending. It is a miniscule step beyond mere charity. It is merely allowing prices to rise a small and manageable amount WITHIN the free enterprise system to accomodate a bit of compassion for the undeserving poor. How do you perceive that as wrong? I'd really like to know. The expense can be looked at as a cost of preserving freedom and normalcy--similar to writing off bad debts or shoplifting expense. If that expense ever rises to a level that is not manageable and tolerable, then and only then will some kind of tough choice need to be made within the free enterprise system--that's a fancy way of saying, "if it ain't broke, don't fix it".
I guess I didn't even address education. IMO, the same "if it ain't broke, don't fix it" idea applies there too. Also, I see that as a lot less important than health care.What could be more GOOD and NORMAL and AMERICAN than Packer Football?Comment
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Nope, howard is not in agreement with you. Tex, we agree on certain things and we disagree on certain things, but I think we both agree that gov't is incredibly inefficient if they are left in charge of it all.Originally posted by HowardRoarkThe only time success comes before work is in the dictionary -- Vince LombardiComment
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Originally posted by Tyrone BiggunsAfter lunch the players lounged about the hotel patio watching the surf fling white plumes high against the darkening sky. Clouds were piling up in the west… Vince Lombardi frowned.Comment
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This was the first post on my healthcare thread and just like I said, it says it all.
This author says it better than I can: (though long)
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Blame Congress for HMOs
by Twila Brase
Published in Ideas on Liberty
by the Foundation for Economic Education
February 2001
Only 27 years ago, congressional Republicans and Democrats agreed that American patients should gently but firmly be forced into managed care. That patients do not know this fact is evidenced by public outrage directed at health maintenance organizations (HMOs) instead of Congress.
Although members of Congress have managed to keep the public in the dark by joining in the clamor against HMOs, legislative history puts the responsibility and blame squarely in their collective lap.
The proliferation of managed-care organizations (MCOs) in general, and HMOs in particular, resulted from the 1965 enactment of Medicare for the elderly and Medicaid for the poor. Literally overnight, on July 1, 1966, millions of Americans lost all financial responsibility for their health-care decisions.
Offering "free care" led to predictable results. Because Congress placed no restrictions on benefits and removed all sense of cost-consciousness, health-care use and medical costs skyrocketed. Congressional testimony reveals that between 1965 and 1971, physician fees increased 7 percent and hospital charges jumped 13 percent, while the Consumer Price Index rose only 5.3 percent. The nation's health-care bill, which was only $39 billion in 1965, increased to $75 billion in 1971.1 Patients had found the fount of unlimited care, and doctors and hospitals had discovered a pot of gold.
This stampede to the doctor's office, through the U.S. Treasury, sent Congress into a panic. It had unlocked the health-care appetite of millions, and the results were disastrous. While fiscal prudence demanded a hasty retreat, Congress opted instead for deception.
Limited by a noninterference promise attached to Medicare law--enacted in response to concerns that government health care would permit rationing--Congress and federal officials had to be creative. Although Medicare officials could not deny services outright, they could shift financial risk to doctors and hospitals, thereby influencing decision-making at the bedside.
Beginning in 1971, Congress began to restrict reimbursements. They authorized the economic stabilization program to limit price increases; the Relative Value Resource Based System (RVRBS) to cut physician payments; Diagnostic-Related Groups (DRGs) to limit hospitals payments; and most recently, the Prospective Payment System (PPS) to offer fixed prepayments to hospitals, nursing homes, and home health agencies for anticipated services regardless of costs incurred. In effect, Congress initiated managed care.
National Health-Care Agenda Advances
Advocates of universal coverage saw this financial crisis as an opportunity to advance national health care through the fledgling HMO. Legislation encouraging members of the public to enter HMOs, where individual control over health-care decisions was weakened, would likely make the transition to a national health-care system, where control is centralized at the federal level, less noticeable and less traumatic. By 1971, the administration had authorized $8.4 million for policy studies to examine alternative health insurance plans for designing a "national health insurance plan."2
Senator Edward M. Kennedy, a longtime advocate of national health care, proceeded to hold three months of extensive hearings in 1971 on what was termed the "Health Care Crisis in America." Following those hearings, he held a series of hearings "on the whole question of HMO's."
Introducing the HMO hearings, Kennedy said,"We need legislation which reorganizes the system to guarantee a sufficient volume of high quality medical care, distributed equitably across the country and available at reasonable cost to every American. It is going to take a drastic overhaul of our entire way of doing business in the health-care field in order to solve the financing and organizational aspects of our health crisis. One aspect of that solution is the creation of comprehensive systems of health-care delivery."3
In 1972, President Richard M. Nixon heralded his desire for the HMO in a speech to Congress: "the Health Maintenance Organization concept is such a central feature of my National Health Strategy."4 The administration had already authorized,without specific legislative authority, $26 million for 110 HMO projects.5 That same year, the U.S. Senate passed a $5.2 billion bill permitting the establishment of HMOs "to improve the nation's health-care delivery system by encouraging prepaid comprehensive health-care programs."6
But when the House of Representatives refused to concur, it was left to the 93rd Congress to pass the HMO Act in 1973. Just before a voice vote passed the bill in the House, U.S. Representative Harley O. Staggers, Sr., of West Virginia said,"I rise in support of the conference report which will stimulate development of health maintenance organizations. . . . I think that this new system will be successful and give us exciting and constructive alternatives to our existing programs of delivering better health services to Americans."7
In the Senate, Kennedy, author of the HMO Act, also encouraged its passage: "I have strongly advocated passage of legislation to assist the development of health maintenance organizations as a viable and competitive alternative to fee-for-service practice. . . . This bill represents the first initiative by the Federal Government which attempts to come to grips directly with the problems of fragmentation and disorganization in the health care industry. . . . I believe that the HMO is the best idea put forth so far for containing costs and improving the organization and the delivery of health-care services."8 In a roll call vote, only Senator Herman Talmadge voted against the bill.
On December 29, 1973, President Nixon signed the HMO Act of 1973 into law.
As patients have since discovered,the HMO--staffed by physicians employed by and beholden to corporations--was not much of a Christmas present or an insurance product. It promises coverage but often denies access. The HMO, like other prepaid MCOs, requires enrollees to pay in advance for a long list of routine and major medical benefits, whether the health-care services are needed, wanted, or ever used. The HMOs are then allowed to manage care--withhold access to dollars and service--through definitions of medical necessity, restrictive drug formularies, and HMO-approved clinical guidelines. As a result, HMOs can keep millions of dollars from premium-paying patients.
HMO Barriers Eliminated
Congress's plan to save its members' political skins and national agendas relied on employer-sponsored coverage and taxpayer subsidies to HMOs. The planners' long-range goal was to place Medicare and Medicaid recipients into managed care where HMO managers, instead of Congress, could ration care and the government's financial liability could be limited through capitation (a fixed payment per enrollee per month regardless of the expense incurred by the HMO).
To accomplish this goal, public officials had to ensure that HMOs developed the size and stability necessary to take on the financial risks of capitated government health-care programs. This required that HMOs capture a significant portion of the private insurance market. Once Medicare and Medicaid recipients began to enroll in HMOs, the organizations would have the flexibility to pool their resources, redistribute private premium dollars, and ration care across their patient populations.
Using the HMO Act of 1973, Congress eliminated three major barriers to HMO growth, as clarified by U.S. Representative Claude Pepper of Florida: "First, HMO's are expensive to start; second, restrictive State laws often make the operation of HMO's illegal; and, third, HMO's cannot compete effectively in employer health benefit plans with existing private insurance programs. The third factor occurs because HMO premiums are often greater than those for an insurance plan." 9
To bring the privately insured into HMOs, Congress forced employers with 25 or more employees to offer HMOs as an option--a law that remained in effect until 1995. Congress then provided a total of $375 million in federal subsidies to fund planning and start-up expenses, and to lower the cost of HMO premiums. This allowed HMOs to undercut the premium prices of their insurance competitors and gain significant market share.
In addition, the federal law pre-empted state laws, that prohibited physicians from receiving payments for not providing care. In other words, payments to physicians by HMOs for certain behavior (fewer admissions to hospitals, rationing care, prescribing cheaper medicines) were now legal.
The combined strategy of subsidies, federal power, and new legal requirements worked like a charm. Employees searching for the lowest priced comprehensive insurance policy flowed into HMOs, bringing their dollars with them. According to the Health Resources Services Administration (HRSA), the percentage of working Americans with private insurance enrolled in managed care rose from 29 percent in 1988 to over 50 percent in 1997. In 1999, 181.4 million people were enrolled in managed-care plans.
Once HMOs were filled with the privately insured, Congress moved to add the publicly subsidized. Medicaid Section 1115 waivers allowed states to herd Medicaid recipients into HMOs, and Medicare+Choice was offered to the elderly. By June 1998, over 53 percent of Medicaid recipients were enrolled in managed-care plans, according to HRSA. In addition, about 15 percent of the 39 million Medicare recipients were in HMOs in 2000.10
HMOs Serve Public-Health Agenda
Despite the public outcry against HMOs, federal support for managed care has not waned. In August 1998, HRSA announced the creation of a Center for Managed Care to provide "leadership, coordination, and advancement of managed care systems . . . [and to] develop working relationships with the private managed care industry to assure mutual areas of cooperation."11
The move to managed care has been strongly supported by public-health officials who anticipate that public-private partnerships will provide funding for public-health infrastructure and initiatives, along with access to the medical records of private patients.12 The fact that health care is now organized in large groups by companies that hold millions of patient records and control literally hundreds of millions of health-care dollars has allowed unprecedented relationships to form between governments and health plans.
For example, Minnesota's HMOs, MCOs, and nonprofit insurers are required by law to fund public-health initiatives approved by the Minnesota Department of Health, the state regulator for managed care plans. The Blue Cross-Blue Shield tobacco lawsuit, which brought billions of dollars into state and health-plan coffers, is just one example of the you-scratch-my-back-I'll-scratch-yours initiatives. Yet this hidden tax, which further limits funds available for medical care, remains virtually unknown to enrollees.
Federal officials, eager to keep HMOs in business, have even been willing to violate federal law. In August 1998, a federal court chided the U.S. Department of Health and Human Services for renewing HMO contracts that violate their own Medicare regulations.13
The Ruse of Patient Protection
Truth be told, HMOs allowed politicians to promise access to comprehensive health-care services without actually delivering them. Because treatment decisions could not be linked directly to Congress, HMOs provided the perfect cover for its plans to contain costs nationwide through health-care rationing. Now that citizens are angry with managed (rationed) care, the responsible parties in Congress, Senator Kennedy in particular, return with legislation ostensibly to protect patients from the HMOs they instituted.
At worst, such offers are an obfuscation designed to entrench federal control over health care through the HMOs. At best, they are deceptive placation. Congress has no desire to eliminate managed care, and federal regulation of HMOs and other managed-care corporations will not protect patients from rationing. Even the U.S. Supreme Court acknowledged in its June 12, 2000, Pegram v. Herdrich decision that to survive financially as Congress intended, HMOs must give physicians incentives to ration treatment.
Real patient protection flows from patient control. Only when patients hold health-care dollars in their own hands will they experience the protection and power inherent in purchasing their own insurance policies, making cost-conscious health-care decisions, and inciting cost-reducing competition for their cash.
What could be so bad about that? A lot, it seems. Public officials worry privately that patients with power may not choose managed-care plans, eventually destabilizing the HMOs Congress is so dependent on for cost containment and national health-care initiatives. Witness congressional constraints on individually owned, tax-free medical savings accounts and the reluctance to break up employer-sponsored coverage by providing federal tax breaks to individuals. Unless citizens wise up to Congress's unabashed but unadvertised support for managed care, it appears unlikely that real patient power will rise readily to the top of its agenda.
1. John D. Twiname, Administrator, Office of Health, Cost of Living Council, testimony before the House Subcommittee on Public Health and Environment, Hospital Cost Controls, December 19, 1973, p. 3.
2. "OEO Transfer for Policy Research," a document included in the U.S. House of Representatives hearing on Oversight of HEW Health Programs, Subcommittee on Public Health and Environment of the Committee on Interstate and Foreign Commerce, March 1, 1973, p. 20.
3. Senator Edward M. Kennedy (Mass.), "Physicians Training Facilities and Health Maintenance Organizations," hearing, U.S. Senate, Subcommittee on Health of the Committee on Labor and Public Welfare. p. 2.
4. President Richard M. Nixon, "Health Care: Requests for Action on Three Programs," March 2, 1972, message to Congress on health care, Congressional Quarterly Almanac 1972 (Washington, D.C.: Congressional Quarterly Books, 1972), p. 43A.
5. U.S. Representative Harley O. Staggers, Sr. (W.Va.), speech on the floor of the U.S. House of Representatives, Congressional Record, September 12, 1973, p. 29354.
6. "Senate Passes Health Maintenance Organization Bill," Congressional Quarterly Almanac 1972, p. 769.
7. Representative Harley O. Staggers, Sr., speech on floor of the U.S. House of Representatives Congressional Record, December 18, 1973, p. 42229.
8. Senator Edward M. Kennedy, speech on the floor of the U.S. Senate, Congressional Record, December 19, 1973, p. 42505.
9. Representative Claude Pepper (Fla.), speech on floor of the U.S. House of Representatives, Congressional Record, September 12, 1973, p. 29353.
10. Laure McGinley and Ron Winslow, "Major HMOs to Quit Medicare Markets," Wall Street Journal, June 30, 2000.
11. The Federal Register, August 26, 1998.
12. "Public Health and Managed Care: Data Sharing for Common Goals," National Center for Chronic Disease Prevention and Health Promotion, Chronic Disease Notes & Reports, Spring/Summer 1997.
13. "Medicare patients have right to appeal HMO refusals, court says," New York Times, August 14, 1998.
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Twila Brase, R.N., a public health nurse, is president of the Citizens' Council on Health Care in St. Paul, Minnesota.
© Foundation for Economic EducationThe only time success comes before work is in the dictionary -- Vince LombardiComment
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I wouldn't "blame" anybody for HMOs. They are a viable and much cheaper alternative to other forms of health insurance.
For nearly 20 years now, my wife has been in an HMO--and she is a borderline hypochondriac--making generous use of the services. For most of those years, she had family coverage--all the kids and me being covered, although I practically never made use of it. As I have said, the past couple of years when the kids grew up, she got off the family plan.
Anyway, the current rate for coverage is $36 every two weeks for her as an individual. Family coverage would be $97 every two weeks. Yes, this is through her employer, but even the non-affiliated rate through this HMO is only right around twice those rates. So I can tell you first hand, no alternative to the high cost of health coverage is a myth.
What was the supposed negative side of HMOs? I don't recall.
Oh yeah, a word about prescription coverage. I take two blood pressure medications--maybe my only concession to old age. I pay exactly $5 a month for each to HEB, our local grocery chain, through its pharmacy plan. I could go across the street and pay only $4 each at WalMart, but their pharmacy is a little bit busier. That is not copay. That is the cost without insurance. Also, they have no annual fee.
I repeat, the system ain't broke; Don't fix it with any of the idiocy that is being suggested from either side.What could be more GOOD and NORMAL and AMERICAN than Packer Football?Comment
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Bobblehead, I was a little bit disappointed with the brevity of your response to my long post above about how to deal with the concept of failures in the free enterprise system--health care and just in general.
The key question is, do you show compassion or just let 'em suffer? The secondary question is if there is government activity at all, which do you hate the worst, regulation or spending? My obvious answer is regulation. I absolutely despise authority of any kind, especially government, telling what I can and can't do. Spending without tax increases at worst only brings inflation, and only that if you don't believe in Keynesian Economics. Yet you guys seem so open to REGULATION forcing good normal Americans to pay for health insurance.What could be more GOOD and NORMAL and AMERICAN than Packer Football?Comment
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Bobble,
I've read that post on the HMOs before ad it illustrates the way government involvement typically is a disaster. It's insidious because people clamor for government involvement even when it is demonstrably against their best interests. Unfortunately, most people base their decisions on false information and propaganda. Like the current health care debate. Most people who are in favor of governmental interference in health care are people who are paying extremely high premiums for health care relative to their salary or wage income, or people without care who think that they can't get care without government take over. The truth is that care is available right now to everyone who wants it. For example, ALL CHILDREN are covered already. If you show up, uninsured, with a child who needs treatment, they will be enrolled. Most adults who show up for treatment also are eligible for some type of plan. Most hospitals (county hospitals who receive most of the uninsured) have an economic 'triage' system. So if you show up uninsured, they will get information from you regarding your status - are you employed, what do you earn, etc. It's extremely rare to find someone who doesn't qualify for Medicare or Medicaid but then doesn't make enough money to pay simple out of pocket expenses for most treatments. as far as the ER goes, many hospitals have triage nurses/administrators that are now checking incoming patients for true emergencies versus typical office visit stuff and rescheduling them to come back later.
So the irony is that of the 45 million uninsured, almost all U.S. citizens either can afford insurance, qualify for some existing program, or can afford to pay out of pocket. The largest (by far) uninsured group in the U.S. happens to be illegal aliens - those that can't pay are not eligible for existing programs. So when Barry talks about expanding government assistance to the uninsured, he's basically talking about coverage for illegals - no questions asked.
It's clear that government interference is a disaster - When you subsidize something, the costs always go up, and the quality always drops. I'm all for the safety net for those who truly cannot pay (even illegals who come in sick or injured), but the system cannot continue to tolerate an approach that promotes the idea that health care should be 'free' for all. I don't know the the exact pathway for a long term solution, but I do know that allowing the government more and more control - through increased regulation and through being a third party payer for more and more people, will only lead to a worsening of the system. The system as it is sucks mostly because of government. What Barry is promoting will lead to health care rationing and it will lead to the government deciding who gets care and who doesn't. If that's what you want, vote for Barry."Never, never ever support a punk like mraynrand. Rather be as I am and feel real sympathy for his sickness." - WoodbuckComment
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Still waiting for your answer regarding eduction.Originally posted by HowardRoark
Are you going to be in favor of bailing out education companies if they fail?
And, are there any huge/critical companies/banks/etc...that repubs won't bail out..and therefore influence the free market?Comment
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I'll try to splain it best I can. I have always said that gov't has a role in regulation, infrastructure and picking up where capitalism has no incentive to create (more or less my stance).Originally posted by texaspackerbacker
My main gripes are that once gov't gets involved they tend to screw up worse than what they are trying to fix and I outlined that by pointing out that their "cures" for the healthcare system general.
you ask if I have compassion....yes, that is why I want to help make the system better, cheaper and even more accessible. As it stands doctors work for HMO's and that isn't healthy. People should be making the calls and paying out of HSA's. There is the little problem of pre-existing conditions as well. Some people are tied to their jobs because they can't get insurance elsewhere. Insurance companies can also drop you when it looks like you are going to cost them too much. These are all problems, but they are problems the market can solve long term.
What I would like to see is health insurance companies that are co-ops much like a credit union. I would like a system that actually punishes someone who could have an HSA and a disastor policy but chooses not to, then runs up huge bills passed on to the public.
Compassion to me has nothing to do with handing out benefits with no accountability on the backs of the working public. You either can require people to get a plan if its available with real consequences or you get no right to complain about people who suffer due to not having coverage.
Do I think you are right...no, but I do think you are consistent in your views and at least back them up.The only time success comes before work is in the dictionary -- Vince LombardiComment
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