R. B. MD, Writes on February 25, 2010:
+
I've worked as a doctor for over thirty years now. As well as seeing patients with every insurance to no insurance and paying for health insurance for my family and employees I have come to the conclusion that a Medicare like health coverage for all is the way to go. Ask anyone over 65 if Medicare works for them and the answer is always yes. Yes, one buys supplemental, and that could, and perhaps should continue and/or medical savings account that could also be allowed.
Medicare insures the worse population.......the older folks and most certainly the ones who will pass away while under that coverage and spend a lot of money in the process. Best way to "spread the risk"...insure the young as well as the old.
Use of money for health and illness care really should not be thought of as insurance. Insurance is something you hope you don't use and insures against risk, like getting into a car wreck, or hitting a deer or moose, or having your dog bite the meter man. Everyone uses, or should use some health dollars, for preventive care, immunizations, having babies. We should think of having health coverage (and paying for it), as well as insurance to the catastrophic unanticipated events, like hitting a moose or being the meter man who gets bitten.
So what does health insurance cost now? Well, here in Michigan I have a Blue Cross Policy for my wife and me, a reduced policy from what I had two years ago, because I couldn't afford that one anymore. Now I have $8,000 deductible, which I fund through a medical savings account (allowed in this state), and then pay $1000 a month for "catastrophic" coverage, up from about $700/month just last year.
Now, instead of paying Blue Cross $12,000/year, how would I feel about payroll deduction of about $5,000-$8,000/year for my wife and me that went for Medicare like coverage. Pretty good. I believe Medicare is better run than many private insurance companies, has less administrative costs, does not have to pay expensive executives, does not have to create reserves. I believe all should contribute through payroll deduction, amount of which can be "means" tested and dependent on factors such as age, income, and perhaps life-style (smokers should pay more). The insurance should cover certain valuable preventive care fully, and have some copays or deductibles on other care. Medical savings accounts should be allowed to build up as savings over many years and be used for supplemental care, the deductibles and copays.
Here's another problem many of the public don't understand. Doctors and hospitals bill maximum for everything in order to capture every insurance dollar. But most accept insurance as full payment. Thus there may be a $300 doctor bill but the doctor accepts $150 from insurance. Or the Hospital bill $20,000 but accepts $10,000. It is illegal to bill lower to the self pay or uninsured or underinsured. So if you don't have insurance you have to pay much more. It would be much better for all if the "billing" side was appropriate and fair, and that the full amount was paid by all. Right now if doctors or hospitals or pharmacies lower their fees, insurance is likely to pay them even less.
So who would lose out on this? The insurance companies? No..claims processing would still be needed so I think those jobs would be preserved. The highly paid execs? Probably. Okay by me.
Doctors and hospitals? No matter what, they are needed and must be paid appropriately to stay in business and keep health care the best and available. Reductions in payment on the high end would likely be compensated by receiving payment for all, whereas now there is still lots of free and underinsured care given in ER's, doctor's offices and hospitals.
I don't think a government administered plan would fail. All Americans would have a stake in it.
Lastly, there is medicare, medicaid and other insurance fraud and abuse. Some real teeth have to be put into saving those lost dollars, and such savings would benefit all.
Skog....keep up the good work. What is really needed for most of our problems is education about the problem. Too often emotion, false beliefs, politics obscure and distort reality and the correct path to solutions. If you got this far, accept my thanks for listening. R B , MD
Thursday, February 25, 2010
Monday, February 8, 2010
Paul Krugman
Paul Krugman.
Fred R. Conrad/The New York TimesPaul Krugman joined The New York Times in 1999 as a columnist on the Op-Ed Page and continues as professor of Economics and International Affairs at Princeton University.
Mr. Krugman received his B.A. from Yale University in 1974 and his Ph.D. from MIT in 1977. He has taught at Yale, MIT and Stanford. At MIT he became the Ford International Professor of Economics.
Mr. Krugman is the author or editor of 20 books and more than 200 papers in professional journals and edited volumes. His professional reputation rests largely on work in international trade and finance; he is one of the founders of the "new trade theory," a major rethinking of the theory of international trade. In recognition of that work, in 1991 the American Economic Association awarded him its John Bates Clark medal, a prize given every two years to "that economist under forty who is adjudged to have made a significant contribution to economic knowledge." Mr. Krugman's current academic research is focused on economic and currency crises.
At the same time, Mr. Krugman has written extensively for a broader public audience. Some of his recent articles on economic issues, originally published in Foreign Affairs, Harvard Business Review, Scientific American and other journals, are reprinted in Pop Internationalism and The Accidental Theorist.
On October 13, 2008, it was announced that Mr. Krugman would receive the Nobel Prize in Economics.
Fred R. Conrad/The New York TimesPaul Krugman joined The New York Times in 1999 as a columnist on the Op-Ed Page and continues as professor of Economics and International Affairs at Princeton University.
Mr. Krugman received his B.A. from Yale University in 1974 and his Ph.D. from MIT in 1977. He has taught at Yale, MIT and Stanford. At MIT he became the Ford International Professor of Economics.
Mr. Krugman is the author or editor of 20 books and more than 200 papers in professional journals and edited volumes. His professional reputation rests largely on work in international trade and finance; he is one of the founders of the "new trade theory," a major rethinking of the theory of international trade. In recognition of that work, in 1991 the American Economic Association awarded him its John Bates Clark medal, a prize given every two years to "that economist under forty who is adjudged to have made a significant contribution to economic knowledge." Mr. Krugman's current academic research is focused on economic and currency crises.
At the same time, Mr. Krugman has written extensively for a broader public audience. Some of his recent articles on economic issues, originally published in Foreign Affairs, Harvard Business Review, Scientific American and other journals, are reprinted in Pop Internationalism and The Accidental Theorist.
On October 13, 2008, it was announced that Mr. Krugman would receive the Nobel Prize in Economics.
It’s so bad that I miss Newt Gingrich
America Is Not Yet Lost
By PAUL KRUGMAN
Published: February 7, 2010
We’ve always known that America’s reign as the world’s greatest nation would eventually end. But most of us imagined that our downfall, when it came, would be something grand and tragic.
What we’re getting instead is less a tragedy than a deadly farce. Instead of fraying under the strain of imperial overstretch, we’re paralyzed by procedure. Instead of re-enacting the decline and fall of Rome, we’re re-enacting the dissolution of 18th-century Poland.
A brief history lesson: In the 17th and 18th centuries, the Polish legislature, the Sejm, operated on the unanimity principle: any member could nullify legislation by shouting “I do not allow!” This made the nation largely ungovernable, and neighboring regimes began hacking off pieces of its territory. By 1795 Poland had disappeared, not to re-emerge for more than a century.
Today, the U.S. Senate seems determined to make the Sejm look good by comparison.
Last week, after nine months, the Senate finally approved Martha Johnson to head the General Services Administration, which runs government buildings and purchases supplies. It’s an essentially nonpolitical position, and nobody questioned Ms. Johnson’s qualifications: she was approved by a vote of 94 to 2. But Senator Christopher Bond, Republican of Missouri, had put a “hold” on her appointment to pressure the government into approving a building project in Kansas City.
This dubious achievement may have inspired Senator Richard Shelby, Republican of Alabama. In any case, Mr. Shelby has now placed a hold on all outstanding Obama administration nominations — about 70 high-level government positions — until his state gets a tanker contract and a counterterrorism center.
What gives individual senators this kind of power? Much of the Senate’s business relies on unanimous consent: it’s difficult to get anything done unless everyone agrees on procedure. And a tradition has grown up under which senators, in return for not gumming up everything, get the right to block nominees they don’t like.
In the past, holds were used sparingly. That’s because, as a Congressional Research Service report on the practice says, the Senate used to be ruled by “traditions of comity, courtesy, reciprocity, and accommodation.” But that was then. Rules that used to be workable have become crippling now that one of the nation’s major political parties has descended into nihilism, seeing no harm — in fact, political dividends — in making the nation ungovernable.
How bad is it? It’s so bad that I miss Newt Gingrich.
Readers may recall that in 1995 Mr. Gingrich, then speaker of the House, cut off the federal government’s funding and forced a temporary government shutdown. It was ugly and extreme, but at least Mr. Gingrich had specific demands: he wanted Bill Clinton to agree to sharp cuts in Medicare.
Today, by contrast, the Republican leaders refuse to offer any specific proposals. They inveigh against the deficit — and last month their senators voted in lockstep against any increase in the federal debt limit, a move that would have precipitated another government shutdown if Democrats hadn’t had 60 votes. But they also denounce anything that might actually reduce the deficit, including, ironically, any effort to spend Medicare funds more wisely.
And with the national G.O.P. having abdicated any responsibility for making things work, it’s only natural that individual senators should feel free to take the nation hostage until they get their pet projects funded.
The truth is that given the state of American politics, the way the Senate works is no longer consistent with a functioning government. Senators themselves should recognize this fact and push through changes in those rules, including eliminating or at least limiting the filibuster. This is something they could and should do, by majority vote, on the first day of the next Senate session.
Don’t hold your breath. As it is, Democrats don’t even seem able to score political points by highlighting their opponents’ obstructionism.
It should be a simple message (and it should have been the central message in Massachusetts): a vote for a Republican, no matter what you think of him as a person, is a vote for paralysis. But by now, we know how the Obama administration deals with those who would destroy it: it goes straight for the capillaries. Sure enough, Robert Gibbs, the White House press secretary, accused Mr. Shelby of “silliness.” Yep, that will really resonate with voters.
After the dissolution of Poland, a Polish officer serving under Napoleon penned a song that eventually — after the country’s post-World War I resurrection — became the country’s national anthem. It begins, “Poland is not yet lost.”
Well, America is not yet lost. But the Senate is working on it.
By PAUL KRUGMAN
Published: February 7, 2010
We’ve always known that America’s reign as the world’s greatest nation would eventually end. But most of us imagined that our downfall, when it came, would be something grand and tragic.
What we’re getting instead is less a tragedy than a deadly farce. Instead of fraying under the strain of imperial overstretch, we’re paralyzed by procedure. Instead of re-enacting the decline and fall of Rome, we’re re-enacting the dissolution of 18th-century Poland.
A brief history lesson: In the 17th and 18th centuries, the Polish legislature, the Sejm, operated on the unanimity principle: any member could nullify legislation by shouting “I do not allow!” This made the nation largely ungovernable, and neighboring regimes began hacking off pieces of its territory. By 1795 Poland had disappeared, not to re-emerge for more than a century.
Today, the U.S. Senate seems determined to make the Sejm look good by comparison.
Last week, after nine months, the Senate finally approved Martha Johnson to head the General Services Administration, which runs government buildings and purchases supplies. It’s an essentially nonpolitical position, and nobody questioned Ms. Johnson’s qualifications: she was approved by a vote of 94 to 2. But Senator Christopher Bond, Republican of Missouri, had put a “hold” on her appointment to pressure the government into approving a building project in Kansas City.
This dubious achievement may have inspired Senator Richard Shelby, Republican of Alabama. In any case, Mr. Shelby has now placed a hold on all outstanding Obama administration nominations — about 70 high-level government positions — until his state gets a tanker contract and a counterterrorism center.
What gives individual senators this kind of power? Much of the Senate’s business relies on unanimous consent: it’s difficult to get anything done unless everyone agrees on procedure. And a tradition has grown up under which senators, in return for not gumming up everything, get the right to block nominees they don’t like.
In the past, holds were used sparingly. That’s because, as a Congressional Research Service report on the practice says, the Senate used to be ruled by “traditions of comity, courtesy, reciprocity, and accommodation.” But that was then. Rules that used to be workable have become crippling now that one of the nation’s major political parties has descended into nihilism, seeing no harm — in fact, political dividends — in making the nation ungovernable.
How bad is it? It’s so bad that I miss Newt Gingrich.
Readers may recall that in 1995 Mr. Gingrich, then speaker of the House, cut off the federal government’s funding and forced a temporary government shutdown. It was ugly and extreme, but at least Mr. Gingrich had specific demands: he wanted Bill Clinton to agree to sharp cuts in Medicare.
Today, by contrast, the Republican leaders refuse to offer any specific proposals. They inveigh against the deficit — and last month their senators voted in lockstep against any increase in the federal debt limit, a move that would have precipitated another government shutdown if Democrats hadn’t had 60 votes. But they also denounce anything that might actually reduce the deficit, including, ironically, any effort to spend Medicare funds more wisely.
And with the national G.O.P. having abdicated any responsibility for making things work, it’s only natural that individual senators should feel free to take the nation hostage until they get their pet projects funded.
The truth is that given the state of American politics, the way the Senate works is no longer consistent with a functioning government. Senators themselves should recognize this fact and push through changes in those rules, including eliminating or at least limiting the filibuster. This is something they could and should do, by majority vote, on the first day of the next Senate session.
Don’t hold your breath. As it is, Democrats don’t even seem able to score political points by highlighting their opponents’ obstructionism.
It should be a simple message (and it should have been the central message in Massachusetts): a vote for a Republican, no matter what you think of him as a person, is a vote for paralysis. But by now, we know how the Obama administration deals with those who would destroy it: it goes straight for the capillaries. Sure enough, Robert Gibbs, the White House press secretary, accused Mr. Shelby of “silliness.” Yep, that will really resonate with voters.
After the dissolution of Poland, a Polish officer serving under Napoleon penned a song that eventually — after the country’s post-World War I resurrection — became the country’s national anthem. It begins, “Poland is not yet lost.”
Well, America is not yet lost. But the Senate is working on it.
Subscribe to:
Posts (Atom)
