I’ve been taking flak this week from several sources about inserting my ‘political’ views into this blog.
Guilty.
I’m also wondering why I didn’t hear similar complaints a few weeks ago when I was pillorying the Democrats [here here and here] for failing to include anything remotely resembling real cost containment in either the House or Senate Finance bills. Which is exactly what the “Town Hall Protesters” should be yelling about.
The problem with the Dems’ health reform efforts to date have nothing to do with death panels, rationing, government control of health care or any other right wing myth. We can’t afford to expand coverage unless we control costs. Covering another 35-45 million folks without controlling cost will devastate the budget, force large tax increases, and take funds away from infrastructure, energy, education, defense, and other critical needs.
That’s where the Dems are vulnerable – another entitlement expansion we can’t afford. Yet for some reason the protesters aren’t screaming at the top of their lungs about cost.
Are they not concerned about cost? Do they think a big new entitlement program is less of a problem than funding abortions or so-called death panels? Is the fate of Trig Palin more of an issue than the potential for vastly increased deficits? Are protesters OK with massive cost increases, as long as there aren’t death panels or comparative effectiveness research?
Of course not.
If they stopped for even a moment and thought about the Democrats’ proposed reform initiatives, the trillion dollar cost would become the front-and-center issue. Why haven’t they?
Perhaps it is because the opponents of health care reform don’t want anyone to start thinking about cost – after all, controlling cost means lower revenues and profits for hospitals, doctors, medical device companies, insurers, pharma, and other stakeholders. Sure, some will come out just fine, but the majority are terrified that meaningful, real cost controls will take big bites out of their top lines. But they can’t say this in public, even if they’re chewing their nails to the elbow in boardrooms.
So instead they are funding these fake ‘grassroots’ movements using made-up and patently false claims to scare the bejesus out of regular folks who will then (hopefully) kill any hope of health reform, thereby preserving the industry stakeholders’ business models.
I don’t have the resources to find out who the funders are behind Americans for Prosperity, Patients United Now (PUN – get it?) and many of the other groups. But there is ample evidence that one of the primary anti-reform groups is headed by Rick Scott, former CEO of hospital company HCA. The founder of Conservatives for Patients’ Rights, Scott has hired the same PR group responsible for the Swift Boat campaign to gin up resistance to reform.
Scott is a sleazeball. While he headed up HCA, the company was fined $1.7 billion for Medicare and Medicaid fraud; the company grew by buying up as many hospitals as possible in a market then shut down selected facilities while jacking up prices at the remaining hospitals. Great for his investors, not great for patients, employers, or taxpayers in HCA-dominated markets.
He’s also an investor in a Florida walk-in clinic operation, Solantic.
I’m sure there are other Rick Scotts out there, using their ill-gotten gains to encourage ignorant folks to rally against health care reform. I just wish I had the time to track them all down.

Former Alaska Gov Sarah Palin (R) has added her own voice to those decrying the current health care reform proposals – and in so doing has added yet more evidence that she is not credible.
According to the unimpeachable Fox News, “Who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course,” the former vice Republican presidential candidate wrote on her Facebook page, which has nearly 700,000 supporters.
“The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care. Such a system is downright evil,” Palin wrote.”
(Fox’ pundits went on to agree with Palin; here‘s one “death panel” quote from one of the ‘experts’ at Fox.) Fortunately, the good folks at ABC did their homework, identifying the source of the ‘death panel’ BS – our old friend Betsy McGaughey.
Just hours after her initial wacko proclamation, Palin appeared to temper her bizarre assertions by asking health reform opponents to calm down and be civil, saying “we must stick to a discussion of the issues and not get sidetracked by tactics that can be accused of leading to intimidation or harassment.”
Unfortunately the former Governor’s call for civility hasn’t had much of an impact – at least not in Memphis. Here’s one rather telling excerpt from the article:
“Roger Fakes, 70, said he sat quitely [sic] during most of the meeting, but Cohen’s insistence that citizens would be able to keep their private health care drove him to his feet.
He argued that changes to private insurance would force citizens into the government plan.
“There are some of us old gray-haired folks that don’t want the government involved in any of our business,” he said.”
Alas, he’s about as well informed as our erstwhile Vice President, Ms. Palin…It appears Mr Fakes isn’t aware that the insurance he so ardently defends is a ‘government program’.
This is one example of the apparent ignorance of at least some of the ‘protesters’ about what is being proposed, what alternatives exist, and the current state of the health care system. You don’t know whether to be furious with these folks for their blind support for right wing causes or pity them for the ease with which they are manipulated.
As I and others have noted, there are significant concerns with the current health reform initiatives, yet none of the real concerns are in evidence at these corporate-funded outrage parties. Lets start with cost – our system just costs too much, and that’s what is making it unaffordable. Why aren’t protesters screaming about cost? Because the people funding their outrage are the very companies that base their business’ success on that system.
Aided by their fellow travelers; here’s anexample of the ‘grass roots’ nature of the anti-reform campaign. The tour bus that has been cruising around North Carolina with an “Americans for Prosperity” logo has been funded by none other than Koch Industries, one of the most notorious polluters in the nation. AFP has also challenged global warming, an intelligent energy policy (one that is backed by oilman T Boone Pickens, no less), and tobacco legislation.
Thank goodness the ACLU will fight to its last nickel to defend these slimeballs’ right to publicize their propaganda.

(Some) Opponents of health reform have abandoned all pretext of honesty, and instead have embarked on a campaign of fear, intimidation, and outright lies in an effort to halt Congressional action.
That’s not to say advocates of reform haven’t stretched the truth from time to time, but to date opponents’ behavior is by far the more egregious. If you sense a tone of anger here, you’re perceptive. These people are scum.
Exhibit One – The Death-ers
Last week, Betsy McCaughey said on Fred Thompson’s show that the House health care bill contained a provision requiring counseling sessions for seniors on how “to do what’s in society’s best interest … and cut your life short.” House Minority Leader John Boehner (R OH) also said the same provision “may start us down a treacherous path toward government-encouraged euthanasia if enacted into law.”
In reality, the provision in question simply requires Medicare pay for voluntary counseling sessions to help seniors plan for end-of-life medical care, including designating a health care proxy, hospice options, and advice on deciding on life-sustaining treatment.
Boehner and McCaughey’s characterization is fear mongering at its worst. And puts them in league with blowhard Rush Limbaugh, who recently claimed Correspondent Helen Thomas would be “soon to be put out to pasture at Statist Farm…first time she gets sick it will be judged not worth it…”
It’s also patently stupid – why would the Democrats seek to kill off a demographic that favors them?
Exhibit Two – The disrupters
God forbid opponents of reform actually let Congressfolk hear their constituents’ opinions on this critical issue. No, they want to shout their Representatives and Senators down, intimidate them, and threaten those who disagree with physical violence.
News flash to the disrupters who are so blindly willing to be manipulated by the health insurance and medical device industries – this is a democracy, and the majority rules. You aren’t the majority, you lost, get over it. Now you know how the other side felt for the last eight years, yet they didn’t find it necessary to engage in brown-shirt tactics to vent their spleen.
Exhibit Three – Congress’ plan to Canadian-ize our health system
False false false. Canada has a single payer system – which is not under serious consideration here in the US. There is no single payer option in any bill under review, and single payer has been specifically rejected by the President, Secretary Sibelius, the Senate Finance Committee, and most of the House. Committed liberals aren’t happy with this, either.
Exhibit Four – The Canadian system almost killed me
Shona Holmes contends that she had to cross the border to get a brain tumor removed because the Canadian system would have forced her to wait over a year, and she would have died.
Highly unlikely. According to FactCheck; “CBC News (the Canadian Broadcasting Centre) aired a story July 31 quoting a top neurosurgeon in Canada saying that the claim that she would have died is “an exaggeration.” Holmes was diagnosed with Rathke’s cleft cyst, a rare, benign cyst that forms near the pituitary gland. It’s not known to be fatal. [emphasis added] Another neurosurgeon told CBC News that he’d never heard of someone dying from the condition.”
Yet the anti-reform forces persist in publicizing this nonsense.
When you confront these liars about the inaccuracy of these statements, they respond with allegations about the Democrats’ secret agenda to move everyone to single payer, ration care with waiting lines, and cover illegal immigrants (again, why would a politician provide services to folks who can’t vote?).
Ohhhh, here’s why…

The good people at the Kaiser Family Foundation have put together a terrific tool that enables side=by=side comparison of all the major health reform plans – or selected plans – across one or multiple areas.
For example, I looked at the Wyden-Bennett plan compared to the latest Senate Finance version and Rep Tom Price’s (R ) offering, specifically on cost containment, mandate, financing, benefit design.
Once again, W-B looks best – and cheapest too.
You’ll undoubtedly have your own set of criteria, and KFF is keeping this updated to reflect the latest variations and changes. Keep it tabbed if you want to stay on top of the real story.

Those vultures have nothing on (some of our) health care lobbyists and their funders.
After returning to ‘civilization’ from a couple weeks in the Tanzanian bush, it is interesting to see how much progress we’ve made in the health reform debate – or, as the Obama administration has taken to calling it, the ‘health insurance reform’ debate. As a measure of just how much progress has been made, some opponents have called out the big guns of misinformation and outright lies, employed at the ‘grass roots’ by people who, whether they know it or not, are working against their own best interests.
There have been many reports of town hall meetings disrupted by what appears to be carefully organized groups, using an approach scripted by a Washington lobbying firm headed by none other than former Texas Republican Rep. Dick Armey.
Armey’s clients include insurers and medical device companies, firms that are terrified of the potential that health reform may actually harm their business models. The disrupt and obstruct model was actually tested here in Connecticut in a town hall meeting held by Fairfield County’s Jim Himes (D). Read the memo at the link to see just how disgusting these people are.
What’s interesting is reform as currently described in the House bill would have the opposite effect – it would create a huge new constituency, a new market of folks previously without insurance who would suddenly have access to coverage – and the care that that coverage buys. Care that would include stents and drugs and MRIs and surgical implants and pain meds and therapy and tests and operations – creating revenue for Armey’s clients.
Now I don’t for a minute believe Armey’s clients are dumb. Therefore they must be concerned – very concerned – that reform will actually hurt them financially.
That’s really good news. The implication is clear – the health care industry fears that Congress will pass and the President will sign legislation that will actually control costs – reducing the overuse of drugs, technology, and treatments and impacting insurer admin expense. That certainly hasn’t been apparent from the House bill, or for that matter the bills that have gotten the most attention in the Senate.
I don’t know if they know something I don’t, or if they’re just running (very) scared, but I’m hoping their concerns are well-founded and we’ll see a serious health reform bill that does attack cost.
I’d suggest anyone who wants a dispassionate, objective, factual review of the debate make it a point to visit Politifact,

Health reform news reaches far and wide, even into the middle of the Serengeti, where I learned today that the NYTimes published a piece by David Leonhardt commenting on a variation of Bob Laszewski’s Affordability Model.
It’s more and more apparent that the train wreck scenario is coming to pass. And increasingly clear that some form of taxation is going to be required for health reform to happen.

Whether health reform will pass comes down to one thing, and one thing only – the CBO score.
The Congressional Budget Office is a non-partisan entity that determines (in this case) what legislation will cost. Their numbers have sent Finance Committee members scrambling back to find new sources of revenue for their ‘test’ bill and forced the House to recommend taxing the wealthy for universal coverage.
The CBO determines the cost, and Congress and the President determines if that cost is do-able. Fortunately, so far none of the ideas/bills circulated around the Hill have passed both screens.
As the debate approaches meltdown temperature over the next two weeks, watch for the CBO’s score.
Prediction – none of the current bills will pass, resulting in a desperate attempt to find an alternative, at the end of which smarter heads will finally be heard saying “Hey, What about Wyden Bennett with Laszewski’s Affordability Model?”.
That’s the only way we’ll get reform that we can afford.

MCM will be dark for the next two weeks, as the Paduda clan will be in Africa on a long-awaited and much-anticipated family vacation – photo safari, Olduvai Gorge, and a Bushmen village.
I expect I’ll be back at it August 5 – and no, there’s no truth to the rumor that a certain very large work comp managed care firm sent me a one-way ticket to deepest Africa…

A third of US health care dollars are spent on treatments (see the Dartmouth Atlas) that are questionable/doubtful/could have been avoided if the chronic condition was addressed.
That’s $7 trillion over ten years, and if we could snap our fingers and only pay for what we should, that would cover all Americans, with the rest paying off the war debts and giving every kid a college education.
Back here in the real world, precious little has been done – locally or systemwide or in Congress – to take on this biggest of all issues. Fortunately, the fine folks up in Massachusetts have seen fit to jump into reimbursement restructuring in a major way.
The Special Commission on the Health Care Payment System has come up with a very solid set of recommendations, including (quoting from their report):
* A global payment system in which providers would receive a payment per person, adjusted for patients’ health status [emphasis added] and other factors to ensure that they are compensated fairly for their patients’ health care needs. Payments would also be based on meeting common core performance measures to ensure high quality care.
* An emphasis on patient-centered medicine, with doctors and other providers providing coordinated, evidence-based, high-quality care for patients. In addition to providing more effective care for patients, this approach will also help to reduce health care costs in the longer term.
* A careful transition to global payment within five years, during which “shared savings” would serve as an interim payment model to help some providers become more familiar with global payment with no or reduced exposure to risk. There would also be infrastructure support for providers to facilitate the transition to global payments, including technical assistance and training and information technology.
Say what you will about Massachusetts; while the rest of us are talking endlessly, they are doing something. Not all of it is right, and some is pretty questionable, but I applaud the Commonwealth’s initiative. We are all learning much from their efforts.

The fierce battle over the public plan option is much ado about very little, an epic battle over a useless piece of political ground. It is the health care debate’s version of the Battle of the Hurtgen Forest – a huge waste of time, resources, and talent on a pretty much pointless contest.
The political treasure spent by pro- and o-ponents to date has been huge, and the spending looks likely to increase in the coming days.
For what? How does the public option help, or hurt, health care and the health care system?
The short answer is – it doesn’t.
Democrats see the public option as critical; it adds competition to a mostly non-competitive business, puts pressure on private insurers, and ensures individuals and businesses can get access to good coverage at a reasonable cost.
How? Premium rates are driven by medical costs. Plans with low costs get more members, and take share from plans with higher costs. That’s why the big indemnity carriers of the late eighties (Travelers, Home Life, Great West, Time, Phoenix et al) are mostly out of business and the world is dominated by HMO-based plans – the HMOs’ cost of goods sold was lower.
Costs are the price per service times the volume of services provided to members who get those services times the number of members getting those services – more simply, price x utilization x frequency. Price is the primary reason health care costs here are so much higher than in other countries.
How would a public plan control price per service? It can’t. The Republican bemoaning the ability of a public plan to use Medicare rates (or a similarly low fee schedule) miss the fact that docs and other providers would not have to sign up for this plan – as with Medicare, there’s nothing forcing them to agree to participate. Sure, most providers do accept Medicare, but that’s because it is a huge payer. Which brings us to the second point.
A public plan would begin with zero members. And zero bargaining power. The big health plans have lots of members, which is how they convince providers to agree to discount their services. Without volume, no discount.
Without discount, no price advantage. Without price advantage, higher premiums. With higher premiums, few members. With few members, no volume.
See where we’re going here? A public plan could not compete effectively because it could not get a lower ‘cost of goods sold’.
The opponents of a public plan are equally confused, claiming it would damage the free market, adding unfair competition. The reality is that in most areas, there is no free market in health insurance; markets are already monopsonies.
Almost every market is already dominated by a very few health plans, so much so that in most markets, there really is very little market competition amongst health plans.
Here are a few factoids using 2005 data; if anything there has been more market consolidation, so these percentages are even higher today…
– 96% of HMO/PPO markets are deemed highly concentrated
– 99% of HMO markets are highly concentrated
– in 96% of markets, at least one insurer has share higher than 30%
– in almost two-thirds of the markets, at one insurer has share greater than 50%
– in a quarter of the markets, one insurer has share at or above 70%.
As I said back in January, would a new governmental plan have an advantage over, say, Blue Cross of Alabama, which has market share ranging from 67 percent in Tuscaloosa to 95 percent in Gadsden? Or Blue Cross of Arkansas, with share from 63 percent in Hot Springs to 97 percent in Texarkana? Or the two dominant health plans in Ohio, with combined share ranging from 46 percent to 80 percent?
It wouldn’t; in fact it would be an uphill climb on a very icy slope for a governmental plan to reach market parity, much less market dominance in most of the country’s MSAs. Health plans execs spend every waking hour, and some while asleep, thinking about how they can steal share from their competition. They beat each others’ brains out on a daily basis, fighting over each employer, each member, each new contract. And most are very, very good at it.
Yes, a governmental plan could try to force docs to accept lower fees, and physicians could and would tell the Feds to pound sand. There is precedence for this – try and find a doc who will accept Medicaid in New York. Recall the revolt of physicians last summer when they were facing a dramatic cut in Medicare reimbursement. Physicians do not have to work with any health plan – governmental or private.
There just isn’t any logical basis for the argument that a governmental option would somehow be unfair for competition, or drive out private plans, or lead to a government monopoly. Just as there is no basis for contending that a public plan would add reasonable competition, thereby forcing the ‘market’ to hold down costs.
If the Democrats succeed in passing health reform with a public plan option, it will have very little impact on system cost. And if the GOP and moderate Democrats are able to stop a public plan yet reform still passes, their ‘victory’ will have no impact on system costs.
The health reform war is about cost. The battle over the public plan is a fight over a useless piece of ground.
A huge new governmental program without meaningful, and effective, cost control is a recipe for disaster. We don’t need another Part D with its eight trillion dollar unfunded liability (passed by a Republican Congress and signed by a Republican President.

What we need is health reform that injects competition into a non-competitive business.