HEALTHCARE THREAD

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squarefair (Shakey Mo Collier), Wednesday, 11 November 2009 23:34 (fourteen years ago) link

why anyone listens to economists about anything is beyond me

squarefair (Shakey Mo Collier), Wednesday, 11 November 2009 23:34 (fourteen years ago) link

C'mon, that's just a wee bit bit facile.

l'homme moderne: il forniquait et lisait des journaux (Michael White), Wednesday, 11 November 2009 23:47 (fourteen years ago) link

one in four families gets hit by a piano

lots of jerks (gbx), Thursday, 12 November 2009 04:11 (fourteen years ago) link

So on another health-care thread, I asked why some projections show that premiums under the public-option will be higher than premiums for private-plans. A colleague of mine gave me an explanation today. It's all about the size of the public-option and enhanced competition. Under some proposed public-option plans -- e.g., make everyone immediately eligible for Medicare -- the public option would be so large that it would have bargaining power and leverage over, say, hospitals. The gov't would say to hospitals, "These are the rates: Take it or leave it, and if you leave it, you leave all forms of Medicare reimbursement." No hospital would dare do that.

But the public-option in the House bill only insures those who haven't been able to secure private insurance for the previous six months. Thus, the pool of applicants will be (a) sicker and (b) smaller than optimal. That public-option no longer has strong leverage over providers, and it will be small enough where it must compete in the marketplace (and therefore will have the same overhead as private insurers).

I'm hoping this is only horribly oversimplified, rather than horribly wrong. If someone knows, I'd greatly appreciate their input.

Daniel, Esq., Thursday, 12 November 2009 22:30 (fourteen years ago) link

it won't have the same overhead if only for the fact that it won't have to hire an army of people to find ways of denying coverage to people.

presumably it would also not need to spend as much on thousand dollar lunches to woo potential business partners, etc.

i am just speculating though.

Tracer Hand, Thursday, 12 November 2009 22:55 (fourteen years ago) link

yeah the idea that a public option will have the same overhead as a private option is ludicrous

hoth as fuck (Shakey Mo Collier), Thursday, 12 November 2009 22:58 (fourteen years ago) link

i guess everyone expects it to be filled w/ ppl uninsurable in any other way ie pricey patients. if it's not tied to medicare's negotiated rates, then, yeah, premiums will go up. beats not having any care i guess.

goole, Thursday, 12 November 2009 23:00 (fourteen years ago) link

"will go up" should be "will be high to begin with"

i've kinda come around to the idea that the public option is not that important in the scheme of things. it's one way to bring down costs but not the only way. plenty of countries have better HC systems that we do w/o a government run insurance company. if you regulate the bejeezus out of all of them, it starts to make less difference.

goole, Thursday, 12 November 2009 23:02 (fourteen years ago) link

goole i believe most countries without government plans have essentially made it illegal to profit from health insurance, i.e. switzerland

Tracer Hand, Thursday, 12 November 2009 23:06 (fourteen years ago) link

or the netherlands; i don't know if their insurance co's are non-profit by fiat tho

goole, Thursday, 12 November 2009 23:07 (fourteen years ago) link

in the u.s.a. though i believe the constitution guarantees the right to profits for all incorporated organizations

Tracer Hand, Thursday, 12 November 2009 23:13 (fourteen years ago) link

Whores, all of them:

In House, Many Spoke With One Voice: Lobbyists’

“One of the reasons I have long supported the U.S. biotechnology industry is that it is a homegrown success story that has been an engine of job creation in this country.” This written statement by Rep. Joe Wilson of South Carolina on the health care bill was identical to one by Representative Blaine Luetkemeyer and used language suggested by lobbyists.

By ROBERT PEAR
Published: November 14, 2009
WASHINGTON — In the official record of the historic House debate on overhauling health care, the speeches of many lawmakers echo with similarities. Often, that was no accident.

Statements by more than a dozen lawmakers were ghostwritten, in whole or in part, by Washington lobbyists working for Genentech, one of the world’s largest biotechnology companies.

E-mail messages obtained by The New York Times show that the lobbyists drafted one statement for Democrats and another for Republicans.

The lobbyists, employed by Genentech and by two Washington law firms, were remarkably successful in getting the statements printed in the Congressional Record under the names of different members of Congress.

Genentech, a subsidiary of the Swiss drug giant Roche, estimates that 42 House members picked up some of its talking points — 22 Republicans and 20 Democrats, an unusual bipartisan coup for lobbyists.

In an interview, Representative Bill Pascrell Jr., Democrat of New Jersey, said: “I regret that the language was the same. I did not know it was.” He said he got his statement from his staff and “did not know where they got the information from.”

Members of Congress submit statements for publication in the Congressional Record all the time, often with a decorous request to “revise and extend my remarks.” It is unusual for so many revisions and extensions to match up word for word. It is even more unusual to find clear evidence that the statements originated with lobbyists.

The e-mail messages and their attached documents indicate that the statements were based on information supplied by Genentech employees to one of its lobbyists, Matthew L. Berzok, a lawyer at Ryan, MacKinnon, Vasapoli & Berzok who is identified as the “author” of the documents. The statements were disseminated by lobbyists at a big law firm, Sonnenschein Nath & Rosenthal.

In an e-mail message to fellow lobbyists on Nov. 5, two days before the House vote, Todd M. Weiss, senior managing director of Sonnenschein, said, “We are trying to secure as many House R’s and D’s to offer this/these statements for the record as humanly possible.”

He told the lobbyists to “conduct aggressive outreach to your contacts on the Hill to see if their bosses would offer the attached statements (or an edited version) for the record.”

In recent years, Genentech’s political action committee and lobbyists for Roche and Genentech have made campaign contributions to many House members, including some who filed statements in the Congressional Record. And company employees have been among the hosts at fund-raisers for some of those lawmakers. But Evan L. Morris, head of Genentech’s Washington office, said, “There was no connection between the contributions and the statements.”

Mr. Morris said Republicans and Democrats, concerned about the unemployment rate, were receptive to the company’s arguments about the need to keep research jobs in the United States.

The statements were not intended to change the bill, which was not open for much amendment during the debate. They were meant to show bipartisan support for certain provisions, even though the vote on passage generally followed party lines.

Democrats emphasized the bill’s potential to create jobs in health care, health information technology and clinical research on new drugs.

Republicans opposed the bill, but praised a provision that would give the Food and Drug Administration the authority to approve generic versions of expensive biotechnology drugs, along the lines favored by brand-name companies like Genentech.

Lawmakers from both parties said it was important to conduct research on such “biosimilar” products in the United States. Several took a swipe at aggressive Indian competitors.

Asked about the Congressional statements, a lobbyist close to Genentech said: “This happens all the time. There was nothing nefarious about it.”

In separate statements using language suggested by the lobbyists, Representatives Blaine Luetkemeyer of Missouri and Joe Wilson of South Carolina, both Republicans, said: “One of the reasons I have long supported the U.S. biotechnology industry is that it is a homegrown success story that has been an engine of job creation in this country. Unfortunately, many of the largest companies that would seek to enter the biosimilar market have made their money by outsourcing their research to foreign countries like India.”

In remarks on the House floor, Representative Phil Hare, Democrat of Illinois, recalled that his family had faced eviction when his father was sick and could not make payments on their home. He said the House bill would save others from such hardship.

In a written addendum in the Congressional Record, Mr. Hare said the bill would also create high-paying jobs. Timothy Schlittner, a spokesman for Mr. Hare, said: “That part of his statement was drafted for us by Roche pharmaceutical company. It is something he agrees with.”

The boilerplate in the Congressional Record included some conversational touches, as if actually delivered on the House floor.

In the standard Democratic statement, Representative Robert A. Brady of Pennsylvania said: “Let me repeat that for some of my friends on the other side of the aisle. This bill will create high-paying, high-quality jobs in health care delivery, technology and research in the United States.”

Mr. Brady’s chief of staff, Stanley V. White, said he had received the draft statement from a lobbyist for Genentech’s parent company, Roche.

“We were approached by the lobbyist, who asked if we would be willing to enter a statement in the Congressional Record,” Mr. White said. “I asked him for a draft. I tweaked a couple of words. There’s not much reason to reinvent the wheel on a Congressional Record entry.”

Some differences were just a matter of style. Representative Yvette D. Clarke, Democrat of New York, said, “I see this bill as an exciting opportunity to create the kind of jobs we so desperately need in this country, while at the same time improving the lives of all Americans.”

Representative Donald M. Payne, Democrat of New Jersey, used the same words, but said the bill would improve the lives of “ALL Americans.”

Mr. Payne and Mr. Brady said the bill would “create new opportunities and markets for our brightest technology minds.” Mr. Pascrell said the bill would “create new opportunities and markets for our brightest minds in technology.”

In nearly identical words, three Republicans — Representatives K. Michael Conaway of Texas, Lynn Jenkins of Kansas and Lee Terry of Nebraska — said they had criticized many provisions of the bill, and “rightfully so.”

But, each said, “I do believe the sections relating to the creation of a market for biosimilar products is one area of the bill that strikes the appropriate balance in providing lower cost options.”

http://www.nytimes.com/2009/11/15/us/politics/15health.html?_r=1&partner=rss&emc=rss

Adam Bruneau, Sunday, 15 November 2009 15:06 (fourteen years ago) link

“One of the reasons I have long supported Mrs.Aminata Ali from Cote D`ivoire (Ivory Coast) is that she is a widow being that she lost her husband some year's ago that had a foreign account here in Cote D'Ivoire(Ivory Coast) up to the tune of $5m which he told the bank was for the importation of cocoa processing machine.However,due to her bad health situation occassioned by cancer, she wish me to do me a favour to receive this fund to a safe account in our country or any safer place as the beneficiary so that I will invest it in a good business venture for the benefit and education of her son,Mustafa, who will be coming to stay under our kind custody after the transfer for his education and future because my health is failing me.” This written statement by Rep. Joe Wilson of South Carolina on the health care bill was identical to one by Representative Blaine Luetkemeyer and used language suggested by lobbyists.

it's a harb knock life for us (Curt1s Stephens), Sunday, 15 November 2009 15:22 (fourteen years ago) link

The Dems have run on an openly 'pro-reform' attitude to health care. They won - both the presidency and the rest. They don't need to monitor polls - they have a straightforward and obvious mandate for change. Elections are elections -the Right failed to convince the people to oppose health care reform. And that's that. Push it through, you have the mandate.

grobravara hollaglob (dowd), Sunday, 15 November 2009 23:12 (fourteen years ago) link

hmmmm i wonder why the lines look like this

http://sas-origin.onstreammedia.com/origin/gallupinc/GallupSpaces/Production/Cms/POLL/hjxlx9mrte-_aurevouwlq.gif

max, Sunday, 15 November 2009 23:35 (fourteen years ago) link

I'm shocked the GOP number is that high -- in 2001 or 2009.

Daniel, Esq., Sunday, 15 November 2009 23:36 (fourteen years ago) link

CBO says Reid bill is under the budget ceiling and will reduce the deficit, debate to start within the next couple days...

Jack Kirby's Orangutan Surfing Civilization (Shakey Mo Collier), Wednesday, 18 November 2009 22:36 (fourteen years ago) link

How is Reid's plan different from the House plan, in terms of (a) the public option, (b) regulation of the insurance industry (e.g., prohibitions of denying coverage for pre-existing conditions)?

Daniel, Esq., Wednesday, 18 November 2009 22:50 (fourteen years ago) link

public plan allows for the states to opt out (a proposition I find totally lolsome), denial of coverage for pre-existing conditions is outlawed

Jack Kirby's Orangutan Surfing Civilization (Shakey Mo Collier), Wednesday, 18 November 2009 23:11 (fourteen years ago) link

"goole i believe most countries without government plans have essentially made it illegal to profit from health insurance, i.e. switzerland"

Very very wrong.

Three Word Username, Wednesday, 18 November 2009 23:32 (fourteen years ago) link

Elitist.

Hell is other people. In an ILE film forum. (Alfred, Lord Sotosyn), Thursday, 19 November 2009 14:32 (fourteen years ago) link

handy comparison between the bills, by topic (listed down the left-hand side). caveats and obvious problems stipulated, but i'm sort of pleasantly surprised by how strong both of them are overall. of course reid has to get his onto the floor, so i hope there's sufficient muscle on his side to bring bayh, lieberman, nelson, etc. to heel.

hellzapoppa (tipsy mothra), Thursday, 19 November 2009 15:30 (fourteen years ago) link

i'm sort of pleasantly surprised by how strong both of them are overall

Never waste a(n) (economic) crisis.

Daniel, Esq., Thursday, 19 November 2009 16:38 (fourteen years ago) link

Nothing about the progress of the bills so far has made me change my mind about wishing men should by rights recuse themselves from limiting women's reproductive health choices.

viagra falls (suzy), Thursday, 19 November 2009 16:43 (fourteen years ago) link

^^^ i would tend to agree with that

itdn put butt in the display name (gbx), Thursday, 19 November 2009 16:44 (fourteen years ago) link

Three Word Username - elaborate please!! i think most of us here wd like to be edjimicated on these things

Tracer Hand, Thursday, 19 November 2009 16:45 (fourteen years ago) link

i am v uneducated, but i think in countries that still retain private insurance companies (france, eg) those companies are still allowed, legally, to be for-profit

itdn put butt in the display name (gbx), Thursday, 19 November 2009 16:46 (fourteen years ago) link

which would make the quoted statement in 3WUN's post at least factually incorrect

itdn put butt in the display name (gbx), Thursday, 19 November 2009 16:47 (fourteen years ago) link

(but regs may be so tight that those private companies simply do not post profits with margins even approaching those seen in the US)

itdn put butt in the display name (gbx), Thursday, 19 November 2009 16:48 (fourteen years ago) link

i thot that US health insurers don't have margins that amazing? like, not more that 4-5%?

hospital groups, device makers, PHARMA all do quite well, i believe.

goole, Thursday, 19 November 2009 16:50 (fourteen years ago) link

Excluding the menz thing is tempting but unworkable, even if only because then it's like, well, who gets to vote on Alzheimer's research funding -- only people or family members of people with Alzheimer's? Or people with the gene showing that they MIGHT get it -- but when what if they vote unpopularly and then they NEVER get it, how can you justify their votes having counted? I mean it's just a prospective disaster.

WHY DON'T YOU JUST LICK THE BUS DIRECTLY (Laurel), Thursday, 19 November 2009 16:50 (fourteen years ago) link

is that the case, goole? honestly didn't know, i had blithely lumped them in with all the other players in the industry that DO post what are just jaw-dropping profit margins

itdn put butt in the display name (gbx), Thursday, 19 November 2009 16:55 (fourteen years ago) link

i dunno there's probably an ezra klein blog post somewhere laying it all out

goole, Thursday, 19 November 2009 16:56 (fourteen years ago) link

in countries that still retain private insurance companies (france, eg) those companies are still allowed, legally, to be for-profit

yes but france has a govt insurance system as well! in essence the private insurance is to cover your deductible, and the rest is covered by the government.

i was saying that the industrialized countries that DON'T have any govt. insurance scheme have incredibly tight regs on the private companies that in effect make them nonprofits HOWEVER that is just something i READ and could in fact be WRONGGO

Tracer Hand, Thursday, 19 November 2009 17:00 (fourteen years ago) link

u.s. insurance companies have something like 5-9% profit margins but as the "1st bank of change" from SNL says it's all about volume, baby

Tracer Hand, Thursday, 19 November 2009 17:00 (fourteen years ago) link

laurel: yeah, that's why i would ~tend~ to agree with suzy, but ultimately feel that any kind of healthcare plan that involves every person in america as a stakeholder will by necessity run into conflicts of interest in how we deliver care/research/etc. HOWEVER, i really believe that an individual woman's right to make decisions regarding her own body is qualitatively different than those situations you outlined. being a woman is not pathological (~somewhere, a cad makes a joke~), and it might not be useful to think of it in the same terms as, say, multiple sclerosis or something, you know? that is, including reproductive health measures into a public option (birth control, reg ob-gyn visits, abortions, etc) is just flat-out different from the apportionment of resources to investigate conditions that affect waaaay less than 50% of the population

(not that this is anything you really need to be told, obv! i'm just sorta being pedantic)

itdn put butt in the display name (gbx), Thursday, 19 November 2009 17:02 (fourteen years ago) link

ahh, tracer, i see. i didn't realize that the euro countries in question had ONLY private insurance

(i rarely have time to actually ~read~ this thread, which is a bummer since that's why i started it in the first place. figured ilx would know a lot more about all this than i did)

itdn put butt in the display name (gbx), Thursday, 19 November 2009 17:03 (fourteen years ago) link

shock at the SHAMBLES that is socialized medicine - many women in the UK have to wait UP TO THREE WEEKS for a FREE ABORTION:

http://www.nhs.uk/LiveWell/sexualhealth/Pages/Abortionyouroptions.aspx

Tracer Hand, Thursday, 19 November 2009 17:07 (fourteen years ago) link

gotta say that seeing a ".gov" address that ended in "Abortionyouroptions" would cause some major cognitive dissonance over here

itdn put butt in the display name (gbx), Thursday, 19 November 2009 17:11 (fourteen years ago) link

xposts although having said that, I'm sure there are plenty of anti-abortion women who'd be only too happy to limit others' reproductive options because they're just sisterly like that. It's like feminism taking a hit because there are women who think pole dancing lessons are cool. Laurel, abortion itself is like no other medical issue because wrt Alzheimer's we all have brains but just over half of us have a uterus - what would be nice here is for men to accord the same respect to women as we accord to them - nobody is trying to limit men's reproductive choices with any coverage or legislation - and that can mean anything from vasectomy to Help! My Sperms Are Hiding to Viagra.

Having lived outside the US most of my adult life, I now find it culturally weird for my health history to be something my employer has to know about before hiring me, or a point of negotiation, at any rate - I would prefer that my health be a confidential matter between me and my doctor. I think it would be better for business if employers did not have to shell out for healthcare for their employees but instead paid a flat rate of social security whatever the number of employees, but that would mean insurers would starve OH NOES. In countries with single payer or socialized medicine, the public care provisions take care of the seriously ill that insurers in the US would baulk at and private care is a top-up offered by employers that might help with, say, not waiting ages to see a dermatologist, being a worried well person who'd like an MRI, or getting your eyes lasered.

viagra falls (suzy), Thursday, 19 November 2009 17:14 (fourteen years ago) link

I agree about the 50% thing, gbx, and also the non-pathologism of being female etc. But what conclusion you come to about that kind of depends on how you draw the lines between different "kinds" of people, ie what associations you privilege.

WHY DON'T YOU JUST LICK THE BUS DIRECTLY (Laurel), Thursday, 19 November 2009 17:15 (fourteen years ago) link

xposts although having said that, I'm sure there are plenty of anti-abortion women who'd be only too happy to limit others' reproductive options because they're just sisterly like that.

glad you raised this cuz I was gonna say... male lawmakers may be the face of anti-choice legislation but let's not kid ourselves that a solid majority of women are pro-choice

Jack Kirby's Orangutan Surfing Civilization (Shakey Mo Collier), Thursday, 19 November 2009 17:16 (fourteen years ago) link

Sorry, the (deliberate?) misreading of the Swiss system by Democrats with ties to big insurance has lead to a great deal of misinformation floating about. Swiss insurance companies are not known for their charity, and are intended to be profit-making. Everybody knows by now that all Swiss residents are required by law to have health insurance. Companies which issue health insurance are required to have basic coverage policies available, from which they may not profit. These policies kinda suck, although they are not terrible, and folks who can afford to get more coverage (which is most folks in Switzerland) will pay more for better coverage. There's profit in those insurance policies.

The most important that gets left out when people talk about the Swiss system: the Swiss minimum wage, which most moderate US Democrats would find shockingly high.

Three Word Username, Thursday, 19 November 2009 17:36 (fourteen years ago) link

My mom (for example) has moved from being totally pro-choice/fuck those guys with their signs into middle age to 'only in cases of rape or threat to woman's life' so I know women are hardly united and some like punishing other women for their life choices or accidents of circumstance. Maybe I'm just looking for even one male politician (who isn't Al Franken) to show some humility about something 35 per cent of women - including those who 'don't approve' - have to deal with at some point in their lives. And like I said, women don't generally act/have the power to limit things to do with men's reproductive health.

viagra falls (suzy), Thursday, 19 November 2009 17:37 (fourteen years ago) link

xp Is it? Wikiped thinks the gross annual wage in Switz is 15,551 International dollars, whatever those are when they're at home. (Note: apparently there is no statutory minimum wage but greater collective bargaining power to raise wages in general?)

WHY DON'T YOU JUST LICK THE BUS DIRECTLY (Laurel), Thursday, 19 November 2009 17:40 (fourteen years ago) link

TWU thanks - that makes sense. So there's a non-profit basic plan that these private insurers must offer, and then you can top that up with more enhancements later? I think France is not actually too different - only in that the basic plan is a government plan.

What I'd be interested in knowing is how expensive an average "top up" plan in Switzerland costs. I think in France it's something on the order of 80 euro a month.

Tracer Hand, Thursday, 19 November 2009 17:42 (fourteen years ago) link


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