Free Markets, Free People

Some thoughts on a changing health care scene

Don Surber reminded me yesterday in something he wrote that the thing that is being forgotten in all of this is the premise that health care reform is based upon is

cost containment.  Or, as Surber puts it:

Government-run health care is about saving money, not lives.

Think back and think it through. What government is promising is insurance for all (more cost) and lower cost insurance plans (the repeated Obama promise was $2,500 per family on their premium – don’t forget Joe Biden’s promise that this bill “controls” the insurance companies). Those seem to conflict, but in reality, they can be accomplished even though you’re very likely not to like the result.

How? Severe rationing and imposed cost controls. Rationing would be accomplished by increased wait times, outright denials or limited care. Doctor visits would have to be shorter and shorter (reimbursement rates would encourage if not demand that). And of course limiting testing and the use of high-cost, high-tech diagnostic machinery is a given.

But won’t doctors and other health care providers have the choice of whether or not to take patients under such plans? Well, initially yes. However, it stands to reason that at some point, when large numbers of the newly insured can’t find a health care provider because of the constraints on care and reimbursement rates their insurance provides, that government will feel the necessity to step in – again.

If it can order individuals to buy insurance on pain of fine, what is to stop it from ordering doctors and other health care providers to take anyone with insurance, regardless of the reimbursement rates? It certainly doesn’t blink an eye at ordering insurance companies to take anyone with a pre-existing condition.  So at the moment I can’t think of a thing that would stop that sort of a law (that’s not an argument for its constitutionality, it’s simply a recognition of reality). My guess is Congress certainly believes it has that sort of power right now. We can only hope the courts decide otherwise. The whole point, of course, is that having insurance doesn’t guarantee health care or access to a doctor. And low reimbursement rates will guarantee they won’t have access.  The government is going to want to “fix” that.

If government-run health care is about saving money, not lives then one of the targets of any effort to “save money” is going to be high cost treatments. Many of the highest costs in health care come when? In the last months of life, of course. We’ve been told that 500 billion has to come out of the Medicare budget to help us save money on health care overall. And don’t forget, Medicare issues more denials of care than any other insurance provider. I don’t think it should take a particularly intelligent person to do a little dot connecting here.

That brings us back to the providers themselves. What will be their reaction to the primary push for cost control/containment?

Well, don’t forget, almost every practice out there is a small business. And if they make over $250,000 (and the vast majority do) they’re going to first and foremost be taxed at a higher rate. You know, because they’re “rich”. That will probably mean fewer staff, longer waits, less care. Or, by the simple means of taxing the practice, the government will manage to get between you and your doctor by changing how your care is delivered.

And, you have to wonder, how long will the better doctors put up with this before they decide to retire or find something else to do? I’m guessing this will be the first sector in the economy where Atlas will do some shrugging. I think in the next few years you’re going to see medical school enrollments drop, active government recruiting (subsidized education for x years of service) of students to go into the medical field as well as off-shore recruiting as well. Net result – the brightest and best will no longer be a characteristic of our medical community.

Those are a few of my thoughts on the future based on this law. Things may change, but like the CBO, I can only take a look at the static picture and make my assumptions based on that. I don’t see how this all accomplishes what the government has promised unless there are some pretty severe cuts in care and service and a lot of rationing through denial of service or claims. I don’t see how it all works as the government has promised unless all health care providers are forced to take anyone with insurance regardless of the reimbursement rates. That leads me to believe that government will try that in an attempt to accomplish it’s stated goal of bending the cost curve down. And at that point, my guess is health care providers rebel, many doctors quit and massive litigation begins.

For those of you hopping around celebrating this travesty today, is that what you expected or want?

~McQ

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62 Responses to Some thoughts on a changing health care scene

  • In Ontario, Canada as a physician I can opt out of the state system and charge a patient directly. However, I cannot bill more than the fee set by the government plan. So simple, barely a stroke of the legislative pen.
    You are on a long slow slide into mediocrity. Health care will be acceptable but not great.

    • You are incorrect djhancock. YOU have mediocrity, we will not be so lucky. You see, when our government screws up they do it real good.
      Within a few years of the full provisions of this kicking in we will have fewer doctors, higher costs, and longer waiting lines than you Canadians.

      • And the really bad news for djhancock is that in the not too distant future a lot of American doctors are going to be facing a pay cut and thinking of perhaps moving to Canada, which will depress pay there. 

  • What do you mean, “saving money?”  Don’t you know that it’s FREE?!?!?

  • Moon Ponies, free lunch, Christmas Presents, Easter Eggs!!!!!   It’s all good, the President said so, and you’re a racist if you disagree, not only that but by asking these questions and pointing out dangers you are WISHING America will fail.
     
    Gosh the grass is GREEN over here in “I Don’t Have to Think Any More Land!!!!”

  • The bill provides for the hire of 16,000+ IRS workers I understand.

    Because nothing says “healthcare” like the IRS….

  • Atlas is already shrugging.  I know of one doctor who has already decided that instead of dealing with all of the government regulations, he has decided to work much less, make much less money, and do other things.
    Right now, every doctor in America is doing a gut-check.

  • Surber’s wrong. Government-run anything is about increasing the wealth and power of people in the government, and their friends and supporters. They are not doing this to control costs. They are doing this to control you.
     
    The inevitable rationing and price controls are incidental. That’s just what happens when the government runs something. If our loving and generous masters in Washington had taken over the auto industry in 1930, we would all be paying $60,000 for identical Model A Fords.
     
    Progressives have a peculiar and crippling cognitive defect: They’re thankful for all that the free market has created, but incapable of understanding where any of it came from, and incapable of imagining that the same cornucopia might ever toss out anything new in the future. For people who yammer so much about “change”, they’re oddly committed to imposing stasis wherever they can.

    • …oops, left out a bit: We’d be paying $60k for a Model A, and the inevitable result would be price controls, rationing, adulteration of the product. A government can’t make a product or service cheaper by producing it more efficiently. All they can do is subsidize it, or adulterate it.

    • You hit the point I’ve been trying to make with my “progressive” friends.  Truly “progressive” reform would involve tearing the current system apart (including regulations and licensing red tape) and letting our best and brightest do their entrepreneurial best.  The response I get:  “That would marginalize human suffering for the sake of profits.”  WTF does that even mean?

      • “WTF does that even mean?”
         
        It’s that crippling cognitive defect at work: They believe that the most profitable enterprise must necessarily be the least efficient. That is to say, they look at the postal service hemorrhaging money, and they think that means it must be providing very good value. They look at Wal-Mart raking in profits, and they think that means Wal-Mart is providing its customers a worse deal than the competition.
         
        They honestly believe that if the survival of health-care providers were absolutely dependent on relieving the most suffering for the least cost, that the ones who came out on top would be the ones who relieve the least suffering at the greatest cost.
         
        They really believe that.

        • True.  One friend started going to bat for Amtrak when I pointed it out as an example of government failure.  His words:

          The perception that Amtrak trains are inefficient, don’t run on time & bleed federal money is largely due to those private corporations which only care about their own bottom lines (their freight trains always get the right of way & they don’t spend the money to maintain their tracks & keep them safe).

          How do you argue with someone who thinks that the problem with Amtrak is all those private corporations crowding the poor bugger out?

          • Yep. He thinks government is more efficient because it doesn’t care about its bottom line.
             
            Functionally, he’s insane.
             
            He wants to make health care more efficient in the following manner:
             
            1. Gasp in amazement at the lack of efficiency.
            2. Track down incentives to be efficient and eliminate them. Incentivize inefficiency.
            3. Restore efficiency by adding a massive and fantastically expensive layer of government bureaucracy and an impenetrable thicket of contradictory regulations to replace the simple and unignorable messages formerly sent by consumer choice with perverse, arbitrary directives and meaningless wheel-spinning.
            4. Man the bureaucracy entirely with unfireable civil servants. Take other steps to incentivize inefficiency and incompetence within the bureaucracy.
            5. Goto 1.
             
            This is not our first trip through Step 3. It’ll keep getting worse.
             

          • There is an enlightening podcast on “The Middleman” at Econtalk – it might be useful to have your friends listen to that podcast.

  • I understand that the next piece of legislation the ‘Democrats’ are going to pass will force car companies to sell Porsche Boxsters (or the equivalent) to all Americans for $2000 (with an exemption for GM and Chrysler). After this, they will take on the profiteers in the citizen-enslaving food industry by requiring Safeway and all other supermarket chains to charge no more than $10 per bag of groceries (hemp bags only, and all food will be organic).

    Can you imagine how awesome this will be? We’ll stick it to The Man and all drive bitchin’ roadsters, and have cheap, abundant, healthy food!

    After this, they intend to pass a law making it illegal to age past 35. We shall become a nation of young citizens!! We’ll all live forever, driving roadsters full of cheap groceries!!!

    Anything, anything is possible when legislators care for us!!

    http://cartagodelenda.blogspot.com/2010/03/next-move.html

    This sarcastic post demonstrates the fundamental fallacy of government-run health care: you simply cannot mandate a good outcome.  Reality has a nasty habit of intruding, generally with bad results.  Ask the British.

    • “This sarcastic post demonstrates the fundamental fallacy of government-run health care: you simply cannot mandate a good outcome.  Reality has a nasty habit of intruding, generally with bad results.  Ask the British.”
      No, this reform is going to work.  Don’t kid yourself into thinking this is going to fail to improve healthcare, because this will make America “healthier”.  Don’t (whatever you do) ask the British who will tell you that their healthcare is generally good, because in reality you can mandate an outcome after which its just a matter of cleverly defining your outcome as “good”. 

      The USA has higher than OECD average infant mortality and a lower than average life expectancy – these will be made “good”.  And it is easy to do by providing more money to use existing technology to for young mothers, youth healthcare and by lowering family sizes (by for instance offering better access to birth controls).   The problem is that it costs a lot of money which has to be found.  In other places within the health sector money can be “saved”  by restricting care to old people or disincentivising R&D.   In other places in the state money can be found by reducing the military spend and raising taxes. 

  • To this point, I took note of this point in the  Heritage timeline  (PDF) of the  Obamacare rollout:

    2012: Payment penalties for hospitals with the highest readmission rates for selected conditions.

    I have not looked at the details in the bill  to understand the “selected conditions” – but apparently pneumonia and heart failure are among them, with more to be added later. This is supposed to control costs, but how long do you think it will be before the system is gamed? To avoid the penalties, hospitals are incentivized to find ways to either extend initial stays  (increasing costs) or find ways of avoiding readmissions –  to the detriment of patients.  Unintended consequences.

    • Those consequences are totally intended. Because then it will be another problem for Daddy Sam (he’s no longer  our uncle) to fix, and another group of “greedy” enemies to demonize and organize the rubes against.

      It’s war without end.

    • Actually, there is some reasonable evidence out there that suggests our push to minimize the length in hospital stays, in a cost savings measure, has had the exact opposite of the intended.
      I’m not optimistic that this will really be the outcome, especially since it comes from the barrel of a gun pointed at you by some government panel, but if the outcome is to extend the stays, it might actually result in a net reduction of overall spending.

  • What was promised bears no relation at all to what will come of this.

    This bill finalizes a divorce from reality. The federal government already has two huge entitlements heading into bankruptcy and so it adds a third. Some people just assume that means we are headed into European social democracy. But I’d put my money on Cuban socialism as the more likely target.

    There’s considerable wealth left to plunder in America, but just look at the size of that government. It can do anything the master of the plantation sets his mind to. With states like New York and Californian lending a hand, I think that the cannibal pot is big enough to handle the traffic.

  • My first time posting here, but I’m really interested to know if anyone here thinks that we can throw out this bill in part or preferably in its entirety come november? I think the Dems have put quite a few things in there that might prevent the bill from being repealed, and ofcourse CNN is broadcasting about how difficult throwing out the bill will be. I suppose if the Republicans became as ruthless as the Dems there would be a way for sure, but I think we need to see an end to this type of behavior by legislators in general.

    • 2012 for any repeal, and that is iffy as it would need 60 GOP senators.
      Unconstitutional is the best hope.

      • Additionally, you still, come November, have a Democratic president.  He is unlikely to sign any bill that dismantles his beloved HCR.  A more likely possibility, though still improbable, is that the HCR could be dismantled piece by piece using admendments in several different bills.  The President is likely to veto any such bill and blame Republicans for “putting politics first.”  No, undoing this mess is going to require Republican majorities in Congress and a Republican president.  We’ll make progress in Congress this November, more in 2012.  And hopefully we’ll elect a conservative president in 2012 as well.  But challenging this bill via the courts is the best short-term solution.  We still need to be active in every election, though.

  • Hmmmm.  I note a dearth of optimism in the commnets here.  For a bit of levity, here is my (anxiously awaited) review of Professor Erb’s book “German Foreign Policy”  which I recently bought from Amazon $3.04 (used)).  Of course, I cannot be considered a traditionally qualified reviewer of such a tome. That is probably a good thing.  This book reads like just what one would expect from an obscure Progressive academic.
    Suppose you were to write a history book called:  “American Foreign Policy”.  Take a huge stack of 3”X5” notes from various American history books.  Divide it chronologically into 8 stacks of 25 or 30 cards for each chapter’s footnotes.  Write six chapters reviewing American foreign policy to date by filling in the blanks between footnotes.  Write one more chapter on 09/11.  Then add a final chapter entitled:  “Foreign Policy in an Era of Globalization:  the American Model”.
    Then simply retitle this draft “German Foreign Policy”,  substitute German names for the American names (i.e. Sommer in place of Kissinger) (Berlin for Gettysburg) and you’ve pretty much got it.  I’ll list a few quotes from Professor Erb’s book that sum up the philosophical part:
    Chapter One:
    page 8:  “The thesis of this book is straightforward:  Germany’s multilateral cooperative approach to foreign policy is likely to persist both because it rests on culturally shared values and because it works.”
    Translation:  Multiculturism is good.
    page 13:  “Although [in this book], mass public opinion will be alluded to, the most important debates are those among the educated political elites, focused on academics, political parties and public debates.”
    Translation:  Forget the flyover rubes, it’s what the elites (especially the academics) believe and do that is important.
    Page 16:  “German policy success…could become a model for other states…”
    Translation:  America should be like Germany.
    Chapter Two
    Page 19:  [Professor Erb explains how Nazism happened]  “These beliefs – love for the fatherland, fear of Bolshevism…desire for a German “place in the sun” – could be used to build on traditional beliefs of war as being virtuous, honorable, and at times necessary.”
    Translation:  As opposed to the beliefs “hate America”, love of Socialism and a desire that America disappear into a multicultural international system, the true values one should espouse.  Also, war is always evil, dishonorable and never necessary (just surrender, like France).
     
    So yeah, this book is pretty much what one would expect from Professor Erb.

    • “which I recently bought from Amazon $3.04 (used)).”

      That much, eh? Well, I wasn’t far off when I wrote a few years back that you could buy it by the foot to use as insulation.  

  • What I hope the Republicans do is say “we could not stop this, let’s work with the President and the Democrats to incorporate ideas that they’ve said are good, and tackle things like cost containment.”  While I appreciate that many of you are so ideologically opposed to such a program, it’s very unlikely it will ever be repealed — and the Democrats may benefit more politically from this than the Republicans (my blog today addresses that).  However, practically, it’s here.   President Obama should reach out to the Republicans and say, “if you want to talk on ways to improve them, cut costs, and the like, let’s work together.”  The GOP can still have an impact on the future of health care reform, and they have some good ideas.   But screaming about the destruction of America and “communism” will simply push the American people away and further weaken the GOP.   The CNN poll that said 59% opposed the bill, also said 13% opposed it because it was not liberal enough.  Added with the 39% who supported it that means 52% either supported the bill or wanted one more liberal.  It’s also very unlikely the courts will overturn it, given the vast precedent on the side of the government here.   But there is time to make substantive changes — if the Republicans want to take the effort.

    • Uh, the legislation is garbage, Scott. It’s not something that can be “worked with.” It must go, if for no other reason — and there are many reasons to toss it — than that it will bankrupt the country.

      It is a mirage. Doesn’t have a new baby boom generation coming along to pay for it. Social Security and Medicare are already on the glide path to bankruptcy.

      Passing this bill was an abandonment of reality based on a superficial and stupid appeal to conscience that was unconscionable. It was also an appeal to the false belief that the President and the Congress must certainly know what they are doing. It is, at its very foundation, a lie.

    • If somebody were raping your wife, y0u’d offer to help. We’re not like you.
       
      Go help somebody rape your wife, Scott. It’ll make you feel useful.

    • Tell you what there Erb – I will go along with the idea of working with Obama and as you yourself say, President Obama should reach out to the Republicans and say, “if you want to talk on ways to improve them, cut costs, and the like, let’s work together.”

      I’ll make a prediction and be willing to put money on the outcome, against odds, because  He’s not going to do that.  He has already put pen to paper and signed this abomination into law.  For him to now reach out to the Republicans would be to admit they have good points that should be in the bill – points they made at the health care conference that he blew off.  And he will not do that because he would have to admit the bill was flawed to do so.

      But I am willing to work with him and to paraphrase your own words, “But there is time to make substantive changes — if Obama wants to take the effort.”

    • “Let’s work with the President!”
      So, your plan is to take 2700 pages of legislation and add….what?  200 more?  500 more?  1000 more?
       
      You’re a fool, you don’t even know what’s in it. THEY don’t even know what’s in it, and you delude yourself into the view that whatever it is can’t hurt us and must be good.    There aren’t time to makes changes you hopeless sheep, it’s law, NOW.
       
      In the vain of what you’ve just paid for, I’ll ship you a box full of wonderful things, before I do, I’ll need you to send me $350.00, but I promise, promise , promise that the box contains things that will never hurt you, and are good for you.   It’s a bit voluntary at the moment, but maybe I could get a Congresscritter to see the need for my “box full of wonders” and mandate that everyone buy one.  Civilized nations will all want them, we can be first, set the trend, trust me.

    • RE: “IT IS NOT LIKELY TO EVER BE REPEALED”
      I don’t know, a whole lot of unforeseen things might happen when the whole damn government goes bankrupt.
      We are nearly there now, and the only recourse will be massive inflation.  We might get a wholesale repeal of all of the great society when that happens.

      • OK, if the US doesn’t only decline but goes into complete collapse then a whole lot changes.   The only way that will happen is if energy prices sky rocket and we have a long, deep energy crisis.  The debt levels projected aren’t good, but aren’t enough to bankrupt the US.   A peak oil like crisis, on the other hand, would change everything.

        • Welcome Mr. Cap and Trade.

        • A peak oil like crisis, on the other hand, would change everything.

          So let me get this strait, Obamacare is fine as long something like a peak oil-like crisis doesn’t hit.  Well, let’s see what’s going on with oil right now:

          Oil is a limited resource, the more we use, the less we have left,
          Extraction is getting more and more expensive,
          Governments are beginning to impose Cap and Trade,
          Governments, including our own, are limiting drilling, exploration, etc.,
          Global demands continues to increse, and
          The main country which best controls access to the Persian Gulf is becoming more militant and devloping nuclear weapons.

          Nope, no threat of peak oil anytime soon.  I’m so relieved.

    • “and tackle things like cost containment”

      But I thought that is what this bill did. The major reason given for the need for ‘reform’ was to avoid bankrupting the country with health care costs.

  •  
    Hmmmm.  I note a dearth of optimism in the comments here.  For a bit of levity, here is my (anxiously awaited) review of Professor Erb’s book “German Foreign Policy”  which I recently bought from Amazon ($3.04 (used)).  Of course, I cannot be considered a traditionally qualified reviewer of such a tome. That is probably a good thing.  This book reads like just what one would expect from an obscure Progressive academic.
    Suppose you were to write a history book called:  “American Foreign Policy”.  Take a huge stack of 3”X5” notes from various American history books.  Divide it chronologically into 8 stacks of 25 or 30 cards for each chapter’s footnotes.  Write six chapters reviewing American foreign policy to date by filling in the blanks between footnotes.  Write one more chapter on 09/11.  Then add a final chapter entitled:  “Foreign Policy in an Era of Globalization:  the American Model”.
    Then simply retitle this draft “German Foreign Policy”,  substitute German names for the American names (i.e. Sommer in place of Kissinger) (Berlin for Gettysburg) and you’ve pretty much got it.  I’ll list a few quotes from Professor Erb’s book that sum up the philosophical part:
    Chapter One:
    page 8:  “The thesis of this book is straightforward:  Germany’s multilateral cooperative approach to foreign policy is likely to persist both because it rests on culturally shared values and because it works.”
    Translation:  Multiculturism is good.
    page 13:  “Although [in this book], mass public opinion will be alluded to, the most important debates are those among the educated political elites, focused on academics, political parties and public debates.”
    Translation:  Forget the flyover rubes, it’s what the elites (especially the academics) believe and do that is important.
    Page 16:  “German policy success…could become a model for other states…”
    Translation:  America should be like Germany.
    Chapter Two
    Page 19:  [Professor Erb explains how Nazism happened]  “These beliefs – love for the fatherland, fear of Bolshevism…desire for a German “place in the sun” – could be used to build on traditional beliefs of war as being virtuous, honorable, and at times necessary.”
    Translation:  As opposed to the beliefs “hate America”, love of Socialism and a desire that America disappear into a multicultural international system, the true values one should espouse.  Also, war is always evil, dishonorable and never necessary (just surrender, like France).
     
    So yeah, this book is pretty much what one would expect from Professor Erb.

     

  • I did not mean to repeat the comment; it did not seem to “go” the first time.  My error?

  • Here’s a bonus for people who get laid off:

    “The mandates require that all Americans carry a minimum level of health insurance or pay a separate tax for every month they are without such coverage.”

    It’s an unemployment penalty!  Have insurance through your employer?  Hold on to that job.  Unless I’m missing something and health care “reform” included COBRA reform.
    We are in for some wonderful unintended consequences.

  • I have a prediction. Some enterprising individuals are going to open some first class hospitals in several of the Caribbean islands, then offer Americans health insurance (purchased in an offshore account.)  So when you want medical care that you will no longer be able to get in any reasonable time frame from Obamacare, then you will go out to the hospital and it will be a nice “working” vacation.  Much as they already do in Thailand.
     
     

    • Why travel so far?   The cruise industry could just start offering popular medical services along with their spa treatments.  The ship leaves port with this week’s patients, and once they are far enough out to sea they can open the casino and the doctor’s office.
      They could even offer creative financing:  “Come on Red 12! Granny needs a new liver.”
       

  • Too bad this wasn’t “Legal Insurance Reform” where lawyers would be required to take all comers regardless of the strength of the case and could only charge govt certified rates. How long do you think that would have lasted?

    • We have such programs – Public Defenders, Indigent Legal Services, etc., all with lawyers on fixed government salaries.  Want to guess the quality of legal services you receive there vs. a free market private system?

  • A bit on the image of success — the popularity of the bill has gone up (rawstory says “Sky rockets,” over at “538  Politics Done Right” Nate Silver cautions against reading to much in the early “bounce.”   Rasmussen has Obama at 48% approval, for him a much higher than usual number.  Gallup has also seen Obama’s numbers improve in recent days.  The idea that the country hates this bill is simply wrong.

    • Then I would love to hear your explanation for Massachusetts.

    • Yeah, Scott, there will be a lot of PR smoke blown up everyone’s ass about this bill.

      But the fact is that it creates a metastatic bureaucracy, imposes itself on states and on the people, and is a piece of trash. It is a genetically flawed bill that, at the end of the day, will break the existing medical industry and require more of what? Of itself, and then even more of itself, and then even more. And it will do that in the absence of any money to pay for it. It will begin to happen immediately, even though the real garbage — the rusted out home appliances and disintegrating tractor tires — won’t wash onto the beaches until 2014.

      We could have done better if we just found the diagram of the old Soviet system and used that. At least that would have spared us the pretense.

      This bill must go and it must go at the earliest possible opportunity, regardless of how much smoke your friends blow up America’s ass.

      Here’s a good example of what this perverted thing will turn into.

  • “The idea that the country hates this bill is simply wrong.”

    Wait until the taxes start but the services don’t.  Wait until the first person who walks into a hospital demandingt service can’t get it because the program doesn’t kick in for four years.  Wait until you file your taxes and the IRS comes to visitand fines you because you are not “on the list” but the services don’t kick in for four years.  Wait until  . . .

    Shall I go on?

  •  
     
    I see that the Progressive narrative* is starting to take hold:
     
    “WASHINGTON — Americans by 9 percentage points have a favorable view of the health care overhaul that President Obama signed into law Tuesday, a USA TODAY/Gallup Poll finds, a notable turnaround from surveys before the vote that showed a plurality against it.
    By 49%-40% those surveyed say it was “a good thing” rather than a bad one that Congress passed the bill. Half describe their reaction in positive terms, as “enthusiastic” or “pleased,” while about four in 10 describe it in negative ways, as “disappointed” or “angry.””
     
    The drive-by voters tuned in Sunday for the speeches by Democrats following the passage of the bill, then read accounts of the bill in their local liberal newspaper Monday.  They were paying attention to the bill for the first time.  Hey, why read and listen to stuff about some bill if it hasn’t even passed yet?  Of course, if that (the Progressive narrative) is all they know about the bill, it is wonderful.
     
    Wanna’ bet that the USA/Gallup Poll was not limited to probable voters?
     
    *The positive-points-only speeches of Speaker Pelosi and President Obama (as if those were the only provisions contained in the bill) laid out the Progressive narrative.

    • Yeah, Erb has a nasty habit of blowing off the import of polls until he finds one (out of dozens it seems) that just happens to agree with his way of looking at things and then it becomes gospel.

  • If the Democrats want the Republicans to fix the bill, they should ask for help in a polite and respectful manner. “We made mistakes in our bill and need some help to fix it.” Then  the GOP could possibly help. Otherwise, the Dems are just pulling their usual scam of having the GOP do the dirty, unpopular work, while they scream “Vote for the Dems or the GOP will steal your healthcare.”
    The GOP should be very clear that if they cannot repeal it, well, then the voters need to figure out a way to make the Dems be bipartisan and cooperate in repealing it. As Obama says, “if you made the mess, grab a broom and help, but shut up.” Let’s see if the Dems can live by those words…

    • I think you vastly overstate the position the Republicans are in right now.   The Republicans are playing to a small angry cadre of their party that could really hurt them come election time.   The GOP erred in strategy.  They could have early on been part of the process, and had a major impact on the bill.   But by the time they said “start over and do it right,” it was too late.  They chose to obstruct and do everything they could to block any bill that wasn’t the kind of bill they wanted.  They thought they could make that Obama’s Waterloo, as Sen. DeMint said.  They almost succeeded.  In failing they have revived the Obama Presidency, made Obama look like a true leader, and lost a major policy battle.
      As time passes and one sees that the “rage” of the tea partiers — there were rather tiny numbers of folk in DC protesting this — is not wide spread, and other issues start dominating, it’ll become clear that to be relevant the Republicans will have to give up obstructionism.    Right now Obama looks likely to be the left’s Reagan, and shift the political center a bit to the left, just as Reagan moved it to the right.   But when the crazies start yelling that “it’s the end of freedom” or a “war on America,” they’re playing right into the Democrats’ hands.

      • Health care is Obama’s Waterloo, Scott. You’re in the thrall of the 72 hour bubble surrounding its passage. Most Americans didn’t want it before it was passed, and as the reality of it begins to sink in, even more won’t want it. Obama’s bounce in the polls came from Democrats. Nada from Independents and Republicans. Zip. The GOP has a very unusual lead in generic preference for Congress in Rasmussen’s likely voters poll. It’s at around eight points. They usually do well if they go into an election tied in generic preferences.

        What you will eventually understand…No, I take that back. What you should eventually understand is that the health care legislation is garbage. It is compounded technocratic fantasy divorced from reality. It took a situation already bad because of too much government interference and intervention and made that situation easily ten times worse.

        Now, the sense of just that is growing in the country, not by the day, but by the minute. The Tea Party is a one-in-ten movement. For every one person directly involved there are ten who are interested and listening. These are people who can’t pay any more taxes, who don’t want any more government in their lives, who regret the government they already have in their lives, who might have once been Democrats but will never vote for them again, and who think intellectuals and academics are about as useful as tits on a boar.

        • Yah!  McPhillips, who is not only sometimes, but ALWAYS wrong in his predictions, predicted health care reform will hurt Obama.  That assures that this is only the start of a wave of transformational change.   Super!

  • The Canadian system seems to work very well.  The idea in the current Health Care Reform Idea was to have a parallel system in which public insurance and private insurance systems would exist.  If things work out as they should, that will still be the case.  There has never been any plan to move toward socialized medicine.  While I certainly have no problems with people earning more than $250k per year, I am not the least bit interested in hearing them whine about a tax.  And I also do not believe that such disparity of income is necessary to the provisioning of competent medical practitioners.  The problem I see with most of the coments on this blog is that you are all obviously Libertarians or Republicans that believe money to be the only motivator for competency.  It isn’t. Some people actually _WANT_ to be physicians. And some of us seek fame as opposed to riches.  The real “stars” don’t do it for the money.

    • I came from the Canadian System.  It blew and I knew it.
       
      My first visit to a specialist on this side of the border confirmed everything I suspected.   The part about only waiting 2 weeks for my first appointment was a surprise but could have been a fluke opening from a cancellation.  I wasn’t sure.   But I needed to make a followup appointment in 4 months and I went to schedule before I left they told me to call back in 3 months because they didn’t keep appointments that far out.  I laughed out loud.  Any specialist that’s still allowed to practice medicine would have at least a 4 month backlog at the time in Ontario easily.

    • The problem I see with most of the coments on this blog is that you are all obviously Libertarians or Republicans that believe money to be the only motivator for competency.  It isn’t. Some people actually _WANT_ to be physicians.

      That’s a hell of an assumption.  The question isn’t if ‘some people’ want to be physicians, it’s if smart, capable people want to do it.  All other things being equal, most of these people will choose careers that are challenging, stimulating, and rewarding. Financial and non-financial rewards both matter, but if it takes 8+ years of education to become a doctor and you’ll end up being paid the same as any career that only takes 4 years (or less) of school, a lot of these people won’t become doctors.  Why do you think there is a growing shortage of primary care specialists?  It isn’t lack of desire or altruistic motivation.

  • “Government-run health care is about saving money, not lives.”
     
    I’m with the sentiment that Government run health care is about controlling money, not saving it.
     
    Bruce, I think you’re just Jonesing for that philosophical debate which makes it tempting to take things at the face value in order to have that a sounding board for that debate.
     
    I believe the motivation is much less misguidedly noble and more disguised self-interest for the enrichment of themselves and their present and future cronies.

    • Not really – the entire thrust of the government narrative is “cost is out of control” and unless we “fix” health care we’re going to go “bankrupt”. People may want to believe that this is all about saving lives (insuring the uninsured). But that’s not been what they constantly talk about (although they do use it when convenient). If this was about insurance and the uninsured, we could have done that for a fraction of the cost of this bill. And it wouldn’t require the establishment of over 100 boards, panels, commissions, etc. The big claim is government – the entity that has put us in a 52 trillion dollar unfunded Medicare benefits hole – can do this better, save money (through their promised “efficiency” such as the elimination of waste, fraud and abuse) and reduce the deficit. There are ways to do it, but not with their promised outcome (less care, longer waits, less reimbursement, fewer diagnostic tests, etc.).

  • Let’s not forget the whole distortion of liberty that has happened with this bill.  What if I don’t want to buy health care?  I am now forced at the point of a gun to do something which I did not want to do.  Using finances and emotional anecdotes is slim justification for stomping on my rights.

    Do we have the right to health care?  No, we have the right to access health care.  Just like I having the right to purchase food from a grocery store does not give me the right to the food itself.  I must agree with the store owner on a price and pay for what I take.  No one would argue that we should institute a national system so that everyone could walk into a grocery store and take whatever they want without mutual consent.  Yet, that is essentially what we’ve done with health care.

    So, we’ve passed a law that gives everyone a right that does not exist by curtailing rights that do exist.  Such twisted logic.

    And don’t even bother arguing anything even remotely to the effect of the end justifies the means (e.g. “but this law will help people by…”).  That is the arguement of every dictator in history.  I don’t want to hear it.

  • The harsh fact of the matter is when you’re going to pass legislation that will cover 300 [million] American people in different ways it takes a long time to do the necessary administrative steps that have to be taken to put the legislation together to control the people.