Obama speaks... does Languish listen?

[Valmy]

It's not easy but there are a lot of good ideas out there, by Dems, Repubs and others. Just not many of those in the bill perhaps, at least not the original bill which was more about govt take over than addressing many of the real health care problems.

I have some confidence that a simple government take over will not be what end up with thanks to the opposition.  Any reform that increases the public cost is simply not feasible or realistic.  The Federal Government already pays way too much for health care.

Bush already played the 'huge unfunded government health program' game and those toys are played out.

[Berkut]

The basic problem is one any basic economist can point out - they is no market force driving down costs or rewarding efficiency. The only market force is to drive billing up forever, and this will continue no matter what "plan" is put in place to cover more and more poor people with insanely expensive "insurance".

Is there a solution to this problem?

Of course there is - quit removing the buying decisions from the person getting the service, and force healthcare providers to compete on cost and quality like every other business in the entire world.

It is not "incredibly horrible" at all in fact, it is just ridiculously expensive

Bad service for high prices with tons of overhead sounds pretty horrible to me but I am not sure what service you are comparing it to.

It isn't bad service at all -the US has some of the very best healthcare available anywhere in the world.

[DisturbedPervert]

Is there a solution to this problem?

Outsource it overseas.

[Razgovory]

The basic problem is one any basic economist can point out - they is no market force driving down costs or rewarding efficiency. The only market force is to drive billing up forever, and this will continue no matter what "plan" is put in place to cover more and more poor people with insanely expensive "insurance".

Is there a solution to this problem?

Of course there is - quit removing the buying decisions from the person getting the service, and force healthcare providers to compete on cost and quality like every other business in the entire world.

It is not "incredibly horrible" at all in fact, it is just ridiculously expensive

Bad service for high prices with tons of overhead sounds pretty horrible to me but I am not sure what service you are comparing it to.

It isn't bad service at all -the US has some of the very best healthcare available anywhere in the world.

Top half at least.

[Brazen]

I've never seen it, but my impression is it's more like American Idol with dancing. What you're describing is similar to the American show Dancing with the Stars, which I do occasionally catch a couple minutes of.

http://www.guardian.co.uk/culture/tvandradioblog/2008/sep/29/strictly.come.dancing.stars

[ulmont]

It isn't bad service at all -the US has some of the very best healthcare available anywhere in the world.

Rescission sucks, shifting doctors every year sucks, having the percentage covered decrease every year sucks, etc.  I'm sure it's still better than Mexico, but from everything I've read I'd rather take my chances with the Canadian, British, or French systems.

[Berkut]

It isn't bad service at all -the US has some of the very best healthcare available anywhere in the world.

Rescission sucks, shifting doctors every year sucks, having the percentage covered decrease every year sucks, etc.  I'm sure it's still better than Mexico, but from everything I've read I'd rather take my chances with the Canadian, British, or French systems.

I've had the same doctor for the last..decade? Something like that. My coverage has not decreased, although the costs have certainly risen dramatically - but that is kind of my point.

[Valmy]

Of course there is - quit removing the buying decisions from the person getting the service, and force healthcare providers to compete on cost and quality like every other business in the entire world.

Except that is not what drives business in the entire world usually is advertising.  Health care works the same way, they advertise some drug and then everybody buys it.  Unless you think McDonalds really provides the best food for the best price in the world. 

It is even worse in health care becuase the product is incredibly complex and contains costs even a genius would have a hard time explaining.

But even if people could somehow be expected to have the extensive medical knowledge necessary to really know who is providing the best care for the best cost how practically and politically could we reform the system to ensure that happens?

It isn't bad service at all -the US has some of the very best healthcare available anywhere in the world.

I am sure it has some of the best, but it also has alot of the worst.

[Berkut]

Of course there is - quit removing the buying decisions from the person getting the service, and force healthcare providers to compete on cost and quality like every other business in the entire world.

Except that is not what drives business in the entire world usually is advertising.  Health care works the same way, they advertise some drug and then everybody buys it.  Unless you think McDonalds really provides the best food for the best price in the world. 

McDonalds provides a desirable product at a competitive price, and the market for fast food is incredibly competitive, which results in very inexpensive food, generally excellent service, and very high "quality" product (albeit terribly unhealthy - I am defining quality by it level of desireability).

It is even worse in health care becuase the product is incredibly complex and contains costs even a genius would have a hard time explaining.

BS. The product is no more complex than air travel. I cannot explain how an airplane flies, or design my own, but I can certainly price shop for the best service and cost for a airplane trip. Can I do that for my health care? Not at all - in fact, I don't even know what a routine test costs.

I don't need to know anyhing to know about how MRIs work to make an informed decision about which one I want to purchase, if in fact I was allowed to make such a decision.

But even if people could somehow be expected to have the extensive medical knowledge necessary to really know who is providing the best care for the best cost how practically and politically could we reform the system to ensure that happens?

I don't know - the healthcare industry is very entrenched, and the hysteria over health care is so insane in this country with the insistence that it is some kind of inalienable right to have a HMO, that it probably isn't going to be fixed.

And it is easy to figure out who provides the best care at the best cost - at least, it isn't impossible. Lots of ways to measure, like previous outcomes, professional evaluations, etc., etc. Health care is not special or magically different from every other service in the world.

Hell, you don't see anyone saying we can't possibly let people shop for lawyers services, because it is just too complicated for people to possibly understand.

[Valmy]

McDonalds provides a desirable product at a competitive price, and the market for fast food is incredibly competitive, which results in very inexpensive food, generally excellent service, and very high "quality" product (albeit terribly unhealthy - I am defining quality by it level of desireability).
BS. The product is no more complex than air travel. I cannot explain how an airplane flies, or design my own, but I can certainly price shop for the best service and cost for a airplane trip. Can I do that for my health care? Not at all - in fact, I don't even know what a routine test costs.

I don't need to know anyhing to know about how MRIs work to make an informed decision about which one I want to purchase, if in fact I was allowed to make such a decision.

Because you understand the goal of air travel pretty clearly: you want to get to point B.  But how would you know an MRI is even the best thing to do here?  How many people exactly know what an MRI is and what exactly it is supposed to do?  You just have to trust the doctor has your best interests at heart when making recomendations...and then there is the issue today where you do not even get told how much whatever service you are using costs much of time.  But that is more related to your main point than this one.

I don't know - the healthcare industry is very entrenched, and the hysteria over health care is so insane in this country with the insistence that it is some kind of inalienable right to have a HMO, that it probably isn't going to be fixed.

And it is easy to figure out who provides the best care at the best cost - at least, it isn't impossible. Lots of ways to measure, like previous outcomes, professional evaluations, etc., etc. Health care is not special or magically different from every other service in the world.

Hell, you don't see anyone saying we can't possibly let people shop for lawyers services, because it is just too complicated for people to possibly understand.

Yes so my point here is that incremental change and reform to take the system in another direction is probably desireable.  At least in the short term I would like to see the system reformed to encourage people to take the plunge into self-employment and so forth and not avoid it because of the ridiculous health care costs...it may not remove the disparaty between them and corporate drones but it may help.

As for the second part I never said it was impossible just very difficult.  You really have to be assertive and not trust what the medical people are telling you and be very well informed on your medical condition to get good service in my experience.  That is alot to ask from the everyday consumer but you clearly feel differently and in fact feel somehow insulted I even bring that up so I think we should just end that conversation.  I never ever said we should not let people shop around btw, I think most people want a system where people can pick their own doctors.

[Neil]

The entire thing is a waste of time though, since none of the health care "reform" actually addresses what is broken about health care in the US. If anything, it is going to make it worse.

What would actually address the problems?  I think we need some sort of force to drive prices down and create some sort of competition, I kind of liked the idea of putting small businesses and individuals to broker collectively.

Also worrying about damaging an already incredibly horrible system doesn't really bring up that much fear for me.  There may be a risk of making shit stinkier but it was already shit.

It is not "incredibly horrible" at all in fact, it is just ridiculously expensive.

The basic problem is one any basic economist can point out - they is no market force driving down costs or rewarding efficiency. The only market force is to drive billing up forever, and this will continue no matter what "plan" is put in place to cover more and more poor people with insanely expensive "insurance".

So legislate the price then.

[Valmy]

So legislate the price then.

Ah the Nixon plan.

[Neil]

So legislate the price then.

Ah the Nixon plan.

It cannot fail.

[jimmy olsen]

The basic problem is one any basic economist can point out - they is no market force driving down costs or rewarding efficiency. The only market force is to drive billing up forever, and this will continue no matter what "plan" is put in place to cover more and more poor people with insanely expensive "insurance".

Is there a solution to this problem?

Of course there is - quit removing the buying decisions from the person getting the service, and force healthcare providers to compete on cost and quality like every other business in the entire world.

It is not "incredibly horrible" at all in fact, it is just ridiculously expensive

Bad service for high prices with tons of overhead sounds pretty horrible to me but I am not sure what service you are comparing it to.

It isn't bad service at all -the US has some of the very best healthcare available anywhere in the world.

Top half at least.

I've gotten top notch service with medicaid.

[The Minsky Moment]

Even the usually reliably pro-Obamateur AP couldn't swallow this crap, though they're still being charitable:

No they aren't really.  Let's grade the AP.

OBAMA: "I will not sign a plan that adds one dime to our deficits either now or in the future. Period."

THE FACTS:  . . .

No dispute here - I agree with the AP writers that this is not a credible pledge.

OBAMA: "Nothing in this plan will require you or your employer to change the coverage or the doctor you have."

THE FACTS: That's correct, as far as it goes. But neither can the plan guarantee that people can keep their current coverage. Employers sponsor coverage for most families, and they'd be free to change their health plans in ways that workers may not like, or drop insurance altogether. 

So the short answer is that he is correct.  The long answer also includes the idea that because obama - despite what hans may believe - is not in fact imposing a Marxist dictatorship - he will not be able to prevent individual employers from changing coverage.  Which indeed is the same situation that exists now.  As a practical matter, employers that currently offer plans that are no better than what the proposed "public option" would offer might very well just abandon their plan and pay their employees more money instead.  I don't see the problem.

OBAMA: "The reforms I'm proposing would not apply to those who are here illegally." One congressman, South Carolina Republican Joe Wilson, shouted "You lie!" from his seat in the House chamber when Obama made this assertion. Wilson later apologized.

THE FACTS: The facts back up Obama.

hans did you actually read this stuff before posting.   

OBAMA: "Don't pay attention to those scary stories about how your benefits will be cut. ... That will never happen on my watch. I will protect Medicare."

THE FACTS: Obama and congressional Democrats want to pay for their health care plans in part by reducing Medicare payments to providers by more than $500 billion over 10 years. The cuts would largely hit hospitals and Medicare Advantage, the part of the Medicare program operated through private insurance companies.

Although wasteful spending in Medicare is widely acknowledged, many experts believe some seniors almost certainly would see reduced benefits from the cuts. That's particularly true for the 25 percent of Medicare users covered through Medicare Advantage.

Supporters contend that providers could absorb the cuts by improving how they operate and wouldn't have to reduce benefits or pass along costs. But there's certainly no guarantee they wouldn't.

As AP admits, this is all speculative - it depends on how the new program is implemented and how the cuts are implemented.  Obama is not saying the program itself guarantees no cuts, but that he personally he won't implement it in a way that results in benefit cuts.  You can express whatever skepticism you want but there is no way to know until it happens.

OBAMA: Requiring insurance companies to cover preventive care like mammograms and colonoscopies "makes sense, it saves money, and it saves lives."

THE FACTS: Studies have shown that much preventive care — particularly tests like the ones Obama mentions — actually costs money instead of saving it. That's because detecting acute diseases like breast cancer in their early stages involves testing many people who would never end up developing the disease. The costs of a large number of tests, even if they're relatively cheap, will outweigh the costs of caring for the minority of people who would have ended up getting sick without the testing.

This is misleading - what the studies show is that preventative care doesn't result in decresed medical spending.  In order to conclude it doesn't "save money" overall, you have to further conclude that saving lives (or more accurately life-years or QALYs) has no economic value, which is very obviously wrong according to any known CBA methodology. 

OBAMA: "If you lose your job or change your job, you will be able to get coverage. If you strike out on your own and start a small business, you will be able to get coverage."

THE FACTS: It's not just a matter of being able to get coverage. Most people would have to get coverage under the law, if his plan is adopted.

So Obama is telling the truth but not responding to some different concern the AP writers have. 

OBAMA: "There are now more than 30 million American citizens who cannot get coverage."

THE FACTS: Obama time and again has referred to the number of uninsured as 46 million, a figure based on year-old Census data. The new number is based on an analysis by the Kaiser Commission on Medicaid and the Uninsured, which concluded that about two-thirds of Americans without insurance are poor or near poor. "These individuals are less likely to be offered employer-sponsored coverage or to be able to afford to purchase their own coverage," the report said. By using the new figure, Obama avoids criticism that he is including individuals, particularly healthy young people, who choose not to obtain health insurance.

Again - bottom line is that Obamas speech was accurate and truthful and indeed quite conservative in its calculation.