New version of Toledo Talk


    August 3, 2007

Universal Health Care: What's your beef? - I attended a meeting at Sanger last evening about providing health care for all Americans. Local physician Dr. Johnathan Ross was one of three panelists who spoke on the need for universal health coverage.

I'm interested in the propaganda and disinformation that forum members have heard about universal health care.

Who will begin the list of 'negatives' that you have heard or which think are true about such a program here in America?

posted by Man_with_the_muck_rake to politics at 10:30 A.M. EST     (34 Comments)


Comments ...


I'm interested in the propaganda and disinformation that forum members have heard about universal health care.

So if people dont agree with the point of view that you've been fed it's all lies, correct?

How 'bout this for a quote?

I believe that your 'topic' is narrow-minded and devious at best

posted by billy at 10:50 A.M. EST on Fri Aug 03, 2007     #



I agree with billy. You obvious have a strong opinion and want to set people up so that you can trash them and then expand on your own beliefs. Have some courage and tell us what you think up front.
posted by roygbiv at 11:17 A.M. EST on Fri Aug 03, 2007     #



My, my, a bit edgy.

Contrary to the conspiracy theory suggested above, I am serious about learning what disinformation has already been disseminated by the insurance and pharmaceutical companies and perhaps even the 'news' media.

I believe that there will be an enormous amount of push-back by hospitals, insurance, pharmaceuticals, and other health-care operatives when it is realized that the middle class citizens of this nation are seriously considering supporting a one-payer health system.

If common folks, like those of this forum, have already been fed bits of information and disinformation, I would like to know what it is.

My topic was rather simple and hardly a cunning trap.

posted by Man_with_the_muck_rake at 12:49 P.M. EST on Fri Aug 03, 2007     #



I think our current system is in need of serious repair, but I do not believe that having government take over the industry is the solution. Stand in line at the Post Office for 30 minutes waiting to purchase a book of stamps, then imagine you are in that long line to have a physician look at your serious injury or illness. You'd get a glimpse of socialized medicine.

There are several layers to the problem that have woven together to form a culture of unbelivable revenues for the hospitals, pharma and insurance companies while driving the premiums for medial insurance beyond the point of affordability for many.

Interesting point - There are more MRI facilities on Monroe Street alone than there are in all of Ontario, Canada. That is a strong indication that a lot of money is being made on this service and others like it due largely to the fact that consumers of this service are not asking, or not able to find out how much an MRI costs. If there were transparency in medical billing, and if we could get past the entitlement culture and become true consumers of health care services, only the most efficient and cost effective MRI providers would be in business.

If you've ever been hospitalized or even had an outpatient surgery, you'd know that the bills you receive come at you from every angle and it's nearly impossible to figure out if they are accurate. I believe this is by design. I think that hospitals build in complexity to confuse the insurance companies and the consumers who usually end up paying an inflated price for services rendered. Additionally, many hospitals are non-profit but they are actually making huge profits and reinvesting those profits into their facilities to balance the books. You and I are paying for these huge hospital expansions ($1/2 $billion at Toledo Hospital, $1/4 $billion at St V's) through the premiums in our current system. Do the hospitals care that it's damaging the system? Why should they? If we move to socialized medicine, if we fix our current system or if we stick with the broken system we will all still need hospitals. Their ever-expanding facilities are being constructed on our dimes and we are not taking them to task for it.

Meanwhile the insurance carriers have become some of the largest companies in the country. They consistently provide 10-15% annual increases for company health plans and have a lot of extra points built in that can be reduced in case a competitor presents a lower price to the group. They assume very little of the risk that is typically associated with the insurance business model and they are growing fat on our dime.

Pharmacy is the same story. They've created a consumer market that didn't exist 20 years ago. Who would have dared to tell their doctor what he should prescribe back in 1987? Some individual drugs are spending more in advertising than Pepsi or Coca-Cola. That's your money, paid via insurance premiums.

The solution lies with you and me. We need to be aware of our rights and responsibilities to challenge these providers and insurance companies. Company sponsored health plans are not an entitlement, they are a benefit - often more costly than the monthly payment on a luxury car. If I told you to go buy a 50" flat screen HDTV today, you would go to five different stores, learn all about the brands and the features and make an educated choice before you buy. If you had to go get an MRI, which could cost about the same as that HDTV, you'd go whereever you are told and let the insurance company pay the tab for you. THAT'S YOUR MONEY!! Learn to spend it wisely. If it's hard to understand how much medical services cost, do the extra work and figure it out.

Last thought - lasik surgery has come way down in price while quality has increased. During the same time, costs for medical testing and procedures have gone way up. Lasik is not covered by insurance and we've collectively done our due dillignece as consumers and created a competitive marketplace which drove down costs. Meanwhile most of us are not paying attention to how much medical tests and proceedures cost because insurance is paying the bill. We have lost control of the system. It's time to get it back.

posted by RJ at 01:33 P.M. EST on Fri Aug 03, 2007     #



I used to be a strong believer in universal health care, (and still believe the current system is far from satisfactory) But having friends in Europe, Scotland to be exact, and knowing that one had to wait like 6 months just to get an MRI done, and another died while waiting to get in for some heart tests, both of which would have been set up in days here, I'm not such a believer anymore. I have also seen how the government runs its hospitals, anyone here read the stuff on Walter Reed Hospital it was scary, and this is what they did for those defending our country, who knows what they'll do to the average guy.
posted by roygbiv at 02:00 P.M. EST on Fri Aug 03, 2007     #



I'll provide target practice for you.

Hospitals smell.
Drugs are bad.
Placebos are just as effective with less side effects.
Affordable health care and affordable healthy food are more noble pursuits.

Oh and doctors are the 3rd leading cause of death in the US.
http://www.suite101.com/article.cfm/chiropractic_health_care/64085

It's irresponsible to rely on doctors for health.
Modern health care is ineffective and not very efficient at delivering its ineffectiveness.
Insurance sometimes makes people irresponsible.

What percentage of health money is spent in their last year of life? I heard over 50%. not let them grow their own pot so they can die peacefully, painlessly, and happy in the comfort of friends and family in their own home?

All the complicated machinery/computers and experts using them can't get the weather right. How do you expect to get a diagnosis right?

Water rulzz!!!1!!
http://www.watercure.com/
http://www.amazon.com/Water-Health-Healing-Youre-Thirsty/dp/0446690740/ref=sr_1_2/002-6095472-4360065?ie=UTF8&s=books&qid=1186167201&sr=1-2

posted by charlatan at 02:00 P.M. EST on Fri Aug 03, 2007     #



For-profit healthcare is a scam. Luckily for me, I work for a large company so it's not so bad. Plus, I'm one of those types who is never sick (or at least won't admit it). But I have a friend who has started her own business, and I have seen what they charge her. Amazing. I can see now how many cannot afford healthcare. And I'm not just talking about the poor, but about the middle class. Whenever I hear an argument against universal healthcare, it ususally deals with so and so from Canada who had to wait for months. There's just as many stories if not more about people here who can't afford it. What we have with American healthcare is free-market failure. How else would you describe a person with a pre-existing condition not able to buy an insurance policy. I don't blame for-profit healthcare companies. The bottom line is to make profit, that's what they do. But they make more profit by denying benefits. Unfortunately, I don't think universal healthcare will work here either because there are too many politicians who will undermine it, either due to philisophical reasons or they are paid off by lobbyists, or they will just defund it whenever possible. And then when they do kill it, they say "See, we tried it. It just doesn't work."
posted by Chris99 at 02:43 P.M. EST on Fri Aug 03, 2007     #



chris (or to others favoring a universal system), i have a question.

when considering today's structure, do you really consider it to be a free market situation?

posted by wholesaler1972 at 02:57 P.M. EST on Fri Aug 03, 2007     #



Btw, interesing quote from Rudy Giuliani:

"If you listen to Hillary Clinton, Barrack Obama or John Edwards, it's quite clear -- single payer -- give the government more control of health care. If we do we'll have health care like Cuba has, like Canada has, and like Europe has. We want health care like America has."

Well, let's look. According to the World Health Organization rankings, France has the best healthcare, Italy is #2, etc. In fact 6 out of the top 10 healthcare systems are European. The US is #37. Canada is #30.

posted by Chris99 at 03:02 P.M. EST on Fri Aug 03, 2007     #



I find it interesting that many people equate 'insurance' with 'health care' when it comes to costs. Many people find monthly insurance payments to be unaffordable, but could probably afford several doctor visits a year - especially young healthly people like Chris.

Which is not to say that the old 'major medical' wouldn't be a good idea...it used to be the only insurance you could buy - long before 'preventive' insurance coverage and HMO's...and it would pay 80% of any hospital costs in the event of a 'major' medical issue.

A growing trend is for doctors to take cash instead of insurance...here's an interesting article on the concept:

"Dr. Robert S. Berry, one such maverick, accepts only cash, checks and credit cards for "payment at time of service." Because he does not need a large office staff to deal with insurance claims, he can charge patients less. Dr. Berry charges $35 for an office visit while other doctors in his town charge $55 or more. He also helps patients save money by providing a set of in-house blood tests for $55 while others send patients to an outside lab that charge $100 or more for the same tests."

posted by MaggieThurber at 03:16 P.M. EST on Fri Aug 03, 2007     #



Hrmph. We could've used Dr. Robert S. Berry in NW Ohio not long ago when my uninsured brother, who had $2000 cash-in-hand saved toward it, could not find a doctor to see him, diagnose a strangulated hernia and refer him for surgery for TWO YEARS. No one would take him because he didn't have insurance. Every office he contacted was suddenly "not accepting new patients" when they found out he was uninsured.

Did I say, "Hrmph"?

posted by jmleong at 05:39 P.M. EST on Fri Aug 03, 2007     #



The disinformation I see being distributed is 1) the system is broken and 2) the system is unfair and 3) that because of 1 and 2 there is a crisis in the number of people uninsured. These three arguments are used to remove the system from the private market and grow the government.

I don't believe that the system is broke and, even if it was, there is no way the government can fix it.

I think there are two key components to access to healthcare now that are making this an issue, and neither are the "fault" of the industry. One is the cost of technology and two is the cost of government.

First, technology is accelerating. More and more every day we are inventing mind blowing new things. But it is not cheap to do so. Just because a $15 million XYZ spleen machine can exist doesn't mean that a person that makes $15,000 a year has the expendable income to pay enough to support the capital cost of inventing and manufacturing it much less the operational cost of getting it used on him.

Now for those that don't think of the economic mechanics first, this immediately seems unfair because the benefit received from this machine involves people's health and, literally, their lifespans - so the issue becomes far more emotional than rational. If the machine in question was a $15 million yacht, for example, most of us would accept as reasonable that a fast food employee would not be riding on it. But the XYZ spleen machine - that seems different - emotion takes over and says that the fast food employee should be riding it.

But that's the problem - that difference is only the emotion. The economic mechanics are exactly the same. All the emotion and class hatred in the world will not change the economics. Most importantly - all the government intervention in the world won't change it either.

What's important to note is that the health, nutrition and life expectancy of Americans at the lowest levels of wealth increase year after year and continue to do so. If that's a broken system - I'm in.

What we have is the ability to discover and manufacture things at a rate that outstrips the ability of a portion of the population to fund it. But what's the alternative? Not invent the stuff? If we just take the XYZ machine away, then no one will have it and it will all be fair again, right? That's option one. But I'm sure no one would want that.

So, option two is to require the producer to sell it for less. Option three is to require that some of the customers pay more so that others pay less. Of course, neither option two or three will happen in a free country. So if the government comes in to "fix" this "problem" it will be a combination of two and three. So what is the outcome of this? The less money the producer receives, the less his return. And the less his return, the less attractive he is to investors. So with less investment, he ends up inventing less stuff. The more money the higher paying customers pay, the less they have invested which means less stuff gets invented also. So how is it that options two and three are any different than option one?

The second issue is the cost of government. So why can't some people afford health insurance? Hmmm. Well, direct taxes at all levels of government plus corporate taxes and the cost of tax code compliance embedded in the cost of goods approaches an average 60% of individual income. I wonder if that has anything to do with it?

So first, a particular ideology grows the government to the point that it takes 60% of our working effort, then they turn around and act surprised that some people can't afford health care. So they blame the healthcare industry and propose to do what? Increase the government lol. That's some serious disinformation right there.

posted by babbleman at 09:42 P.M. EST on Fri Aug 03, 2007     #



So first, a particular ideology grows the government to the point that it takes 60% of our working effort, then they turn around and act surprised that some people can't afford health care. So they blame the healthcare industry and propose to do what? Increase the government lol. That's some serious disinformation right there.

This guy's absolutely right. What's interesting is the "universal health care" types are doing what doctors are pressured into doing now... they're not trying to fix the problem, they're trying to cure the symptoms.

posted by TheTalentedMrC at 10:19 P.M. EST on Fri Aug 03, 2007     #



This guy's absolutely right.

Thanks, MrC - but I am only echoing this guy who said it first and way better:

Great nations are never impoverished by private, though they sometimes are by public prodigality and misconduct. The whole, or almost the whole public revenue, is in most countries employed in maintaining unproductive hands... Such people, as they them-selves produce nothing, are all maintained by the produce of other men's labour... Those unproductive hands, who should be maintained by a part only of the spare revenue of the people, may consume so great a share of their whole revenue, and thereby oblige so great a number to encroach upon their capitals, upon the funds destined for the maintenance of productive labour, that all the frugality and good conduct of individuals may not be able to compensate the waste and degradation of produce occasioned by this violent and forced encroachment.

Adam Smith
The Wealth of Nations, Book II, Chapter III
.

posted by babbleman at 12:29 A.M. EST on Sat Aug 04, 2007     #



Thank you all for your comments.

It is my prediction that we citizens will soon be in for a barrage of slick TV and radio commercials sponsored by the insurance and pharmaceutical industries. They are very good at scaring Americans and redirecting us back to the tired [profitable] system. Recall those commercials about drugs for Medicare?

What I am hoping is that by laying bare the cheap tactics and bogus claims ahead of time, the citizens will recognize the ruse as a scam when they see it on TV.

Naturally they will use the old bag of bogus debate tactics [red herring, straw man..]

Among the false statements will be these:

• your taxes will go up
• another bureaucratic government agency
• the government can't run anything well
• you won't have choice of your own doctor
• you'll wait months for an operation
• compare our system to Canada and Europe

The answers/counter statements to these are all positive. Take the first, about taxes. YES, there will be a slight increase in SOME people's taxes [but most probably no one who is on this board]. Even with a slight additional tax for those earning over $90,000, millions of Americans will no longer pay health insurance premiums, co-pays, and other related medical charges.

Businesses small and large will at last be free of having to include health insurance for its employees, freeing up large sums of money for product development, distribution, and perhaps even bonuses for its workers.

One more bogus idea: the government can't run anything well. What about Medicare. Here is a single-payer system that humms along very well. We have living proof that a single-payer health care system is operating well and cleanly. And when Congress stops butting in with its perks for the pharmaceutical industries, we will have competition in drug purchasing added to the program.

Ohio's single payer proposal is found here www.spanohio.org>

posted by Man_with_the_muck_rake at 07:13 A.M. EST on Sat Aug 04, 2007     #



What about Medicare. Here is a single-payer system that humms along very well.

NO IT DOESN'T.

I'm not saying that I disagree with the idea of a single payer. However, I hate it when someone uses the argument that "Medicare works great" when trying to validate why we should have a single payer.

(I've went into great detail about some of the problems with Medicare on here before, and don't feel like typing them all over again. Damn the person who bought me a shot of tequila last night and left my brain hurting this morning...lol)

If you want people to take your arguments for a single payer system seriously, you may want to refrain from using Medicare as an example.

posted by mom2 at 07:58 A.M. EST on Sat Aug 04, 2007     #



If we go to some type of government sponsored health-care program will Washington D.C. be running it directly such as the example of Walter Reed? Do we not have many private businesses in this country that rely on the government as their sole customer? You bet we do! These businesses are S-Corps, LLC's, and even Mom and Pop operations. THEY run the shop and THEY take the profits. I foresee a system where capitalism can thrive and the consumer can still shop around for the best practitioner. Good business practices, customer service, and quality health-care don't necessarily have to go bye-bye in a single-payer system. Of course, we would now be opening up a whole new area of opportunity for kickbacks and political back-scratching but it's not like we don't have it under the current system, right?

Also, I have a friend who lives in Sarnia, Ontario who is upset with their system. He is in need of back surgery and recently had to wait THREE WEEKS to get in a surgeon's office. Hell, earlier this year my daughter had to wait 5 weeks to get into an ENT specialist's office and another month to get her tonsils out.

One more thing. I would like to read up a little more on the other systems out there, especially in Europe. Can you folks point me towards some good websites?

posted by Catharsis at 08:56 A.M. EST on Sat Aug 04, 2007     #



The answers/counter statements to these are all positive. Take the first, about taxes. YES, there will be a slight increase in SOME people's taxes [but most probably no one who is on this board]. Even with a slight additional tax for those earning over $90,000, millions of Americans will no longer pay health insurance premiums, co-pays, and other related medical charges.

You must be out of your gourd if you think there will be "a slight increase in SOME people's taxes". Do you not remember $300 hammers? When the government is the only entity that can purchase something, they then have no bargaining power. You think health care is expensive now, just wait until it's free.

posted by TheTalentedMrC at 02:06 P.M. EST on Sat Aug 04, 2007     #



Three comments after my last one:

#1
Here is a single-payer system that humms along very well.

NO IT DOESN'T.


Well? Do you have any proof of what you just wrote or are you parroting something you 'heard'?


#2

If we go to some type of government sponsored health-care program will Washington D.C. be running it directly such as the example of Walter Reed?

Nice diversion. No one is talking about Walter Reed. I am discussing the functioning governmental agency already in place, Medicare. Let's have some honest debating here without some diversionary tactics.

#3

You must be out of your gourd if you think there will be "a slight increase in SOME people's taxes". Do you not remember $300 hammers?

Diversionary. We're not talking Pentagon. Further, the Ohio plan has no additional tax for those making $87,800. From there to $100,000 it rises to $750.

Apparently with the comments given above, one can see how 'confusing' the single-payer system will become to the voters. That is why the clear facts about the program need to be known and discussed ahead of time.

The disinformation bandwagon is already rolling forward.

posted by Man_with_the_muck_rake at 07:24 A.M. EST on Sun Aug 05, 2007     #



The disinformation bandwagon is already rolling forward.

And you're the chief engineer. Toot toot!

You keep saying "This isn't Walter Reed" and "This isn't the Pentagon", but it IS. It's all GOVERNMENT. And government's only purpose is to grow. And there's a ripe place to grown in health care, given it's problems.

So they've sold you a bill of goods. Hey, free health care! And you won't even have your taxes raised! They will. You know, Those that'll never miss it. Oh, well that's fantastic. Until the program gets put into place, doctors flee, prices skyrocket, and suddenly the original plan isn't enough. Now you ARE on the hook. And you'll be wishing you had your health plan back.

I'm not saying the current system is perfect. Not by a long shot. The current system is broken. Broker than broke. But they need to fix the system, not take it over.

posted by TheTalentedMrC at 07:37 P.M. EST on Sun Aug 05, 2007     #



I'm not saying the current system is perfect. Not by a long shot. The current system is broken. Broker than broke.

Well, THAT's refreshing to read.

Just what might be your 'solution' to this outrageously costly and exclusive medical system that ranks us #37 in the world?

posted by Man_with_the_muck_rake at 08:43 P.M. EST on Sun Aug 05, 2007     #



Just what might be your 'solution' to this outrageously costly and exclusive medical system that ranks us #37 in the world?

I'll be happy to offer mine, if you don't mind.

1. Eliminate the current health services regulation that costs the industry $340 billion annually, or the average family $1,500.

2. Enact tort reform that would run John Edwards style ambulance chasers out of business ($3,300 annual cost to a family of four).

3. Increase the opportunity to access healthcare by decreasing the expenses of a family with 2 members over the age of 19 by $7,900 annually ($658 per month) by eliminating the following:

- Department of Health and Human Services ($6,480)

- Department of Agriculture ($926)

- Housing and Urban Development ($694)

- Department of Commerce ($46)

- Department of Labor ($446)

(item 3 uses publicly available federal budget numbers divided by the 216,000,000 people in the US over age 19).


.

posted by babbleman at 12:12 A.M. EST on Mon Aug 06, 2007     #



Just what might be your 'solution' to this outrageously costly and exclusive medical system that ranks us #37 in the world?

First off, Consider the methodology that got us to #37. Because according to the WHO, cripples don't count!

Secondly, get the taxes out of health care. The Health Spending accounts are a good start, but an individual still suffers a tax penalty if they forgo their employers health care and purchase their own. Level the playing field by letting individuals make the call on who their provider is. When there is choice, prices drop.

Of course, that's not the end-all be-all, but it's a start.

posted by TheTalentedMrC at 06:36 A.M. EST on Mon Aug 06, 2007     #



Muck - since you asked for other perspectives, let me offer this alternative by Chuck Muth:

"Muth's Truths


Health Insurance Blues: Give Choice a Chance
By Chuck Muth

The nation's largest health insurer, UnitedHealth Group, wants to buy up Sierra Health Services in Nevada. The merger would give the new company a virtual monopoly over health insurance in the Silver State, reducing competition, which usually means increasing costs. Supporters, however, say the merger will actually reduce costs and improve service due to the efficiencies of scale the giant conglomerate will enjoy.

Hmm. That doesn't exactly seem to be the case when it comes to the publik skools now, does it?

Nevertheless, being a free-market kinda guy I haven't yet heard any compelling reason for the government to block this merger of two private companies. And the fact that the self-serving Culinary Union is now in open opposition to the takeover tends to weather-vane me in the opposite direction.

No, the answer to legitimate concerns about giving UnitedHealth a virtual monopoly over the health insurance market in Nevada isn't to block the takeover of Sierra Health Services, but to open Nevada's market to interstate competition. In this age of Amazon and eBay, it makes no sense whatsoever that Nevadans are prohibited from buying health insurance from a company located in another state.

And yet, thanks to an anachronistic law passed in 1945, the McCarran-Ferguson Act, combined with the lobbying power of Big Insurance, there is no competitive interstate insurance market similar to the highly competitive interstate banking market. For example, Nevadans can deal with a relatively small local bank or choose to deal with a big interstate bank such as Bank of America or Wells Fargo. Both entities thrive in Nevada and consumers, armed with market choice, benefit greatly.

Not so when it comes to health insurance companies. Why not?

Because state legislators want to retain the ability to force insurance companies to foot the bill and cover expensive benefits which they don't have the guts to sock directly to taxpayers. These are called "mandates" - as in, the legislature makes it mandatory that the insurance company cover them or the insurance company doesn't get to operate in Nevada. Yes, legal extortion.

Around the country, many states force insurance companies to cover benefits ranging from acupuncture to marriage counseling; from contraceptives to hearing aids to hairpieces; from podiatry to osteopathy; from chiropractors to even massage therapy. All in all, there are over 1,800 such mandates found across the country. And these mandates jack up the cost of insurance, creating a huge difference in premium costs between some states.

For example, a recent e-HealthInsurance.com study showed that a healthy 25-year-old male could pick up a basic health insurance policy in Kentucky for $960 a year. That same policy in New Jersey, however, would set the lad back a staggering $5,880 a year.

And the Wall Street Journal noted that the same study "found that a typical insurance policy - $2,000 deductible, 20% co-insurance - for a family of four could be had for as little as $172 per month in a reasonably regulated locality like Kansas City, Missouri. But in New York that family's only option - managed care - would run $840 per month, and in New Jersey family policies run a whopping $1,200-plus."

Why shouldn't a family in New York be able to purchase that far less expensive policy from the Missouri company?

If you want to shrink the ranks of the uninsured, perhaps it's time to open the market and reduce the cost so that average people can afford basic coverage without all the government mandated frills. Instead of blocking the mergers of health insurance companies in one state, perhaps it's time to open up the competition among all 50 states?

Rep. John Shadegg, Arizona Republican, has proposed just such legislation in Congress; however, Congress is in the hands of pro-union/anti-free market Democrats and is unlikely to act favorably on such a common-sense, cost-free solution to the health care insurance problem. Which is why state legislatures should take the lead and open up their own markets without waiting for the feds.

Let's give choice a chance."


Some believe that the solution to health insurance costs isn't more government action, but more open market action...

HeyHey often weighs in with really insightful comments as he's actively involved in the industry...

posted by MaggieThurber at 07:51 A.M. EST on Mon Aug 06, 2007     #



If we go to some type of government sponsored health-care program will Washington D.C. be running it directly such as the example of Walter Reed?

Actually, one of the main problems with the Walter Reed situation was privatization.

Some things to consider:

According to the Center for Medicare and Medicaid Services per beneficiary costs have risen in nominal dollars by 519.5 percent since 1980. By contrast, the cost per enrollee of private insurance has risen by 676.6 percent over this same period.

Also, private insurers spend about 8% on administrative costs, or around 4 times the amount Medicare spends for the same purpose.

On the other hand, Medicare isn't perfect. They should deal more with prevention. But if Medicare was so bad, why is it that 99% of private insurances tell you "we follow Medicare guidelines"? Btw, for disclosure purposes I am a manager at a healthcare facility and my girlfriend is a physician. Not that that makes us experts by any means

posted by Chris99 at 10:01 A.M. EST on Mon Aug 06, 2007     #



Chris - do they follow medicare guidelines because it's easier to just have one set of guidelines? I know they have to follow such guidelines for reimbursement purposes when asking for medicare payment...
posted by MaggieThurber at 12:21 P.M. EST on Mon Aug 06, 2007     #



Actually, one of the main problems with the Walter Reed situation was privatization.

Chris, the government owns and is responsible for Walter Reed. If they hired poorly performing private contractors or did not manage their private contractors well, it is not and indictment of the private sector. If the private sector owned Walter Reed and was responsible for it and if whatever group owned it was in competition with someone else, they would not be able to afford to mismanage it the way the government did.

posted by babbleman at 12:52 P.M. EST on Mon Aug 06, 2007     #



I believe that's the case Maggie, which makes doubly disappointing when Medicare gets cut. Reimbursments shink, and that gives private insurers reason to cut reimburement as well.

Babbleman, I may not have all the facts from the Walter Reed scandal but this article is very interesing. In it, it details some of the problems that occured due to privatizing services:

Committee Chairman Henry Waxman and subcommittee Chairman John Tierney asked Weightman to testify about an internal memo that showed privatization of services at Walter Reed could put “patient care services at risk of mission failure.”

The memorandum “describes how the Army’s decision to privatize support services at Walter Reed Army Medical Center was causing an exodus of ‘highly skilled and experienced personnel,’” the committee’s letter states. “According to multiple sources, the decision to privatize support services at Walter Reed led to a precipitous drop in support personnel at Walter Reed.”

The letter said Walter Reed also awarded a five-year, $120-million contract to IAP Worldwide Services, which is run by Al Neffgen, a former senior Halliburton official.

They also found that more than 300 federal employees providing facilities management services at Walter Reed had drooped to fewer than 60 by Feb. 3, 2007, the day before IAP took over facilities management. IAP replaced the remaining 60 employees with only 50 private workers.

“The conditions that have been described at Walter Reed are disgraceful,” the letter states. “Part of our mission on the Oversight Committee is to investigate what led to the breakdown in services. It would be reprehensible if the deplorable conditions were caused or aggravated by an ideological commitment to privatize government services regardless of the costs to taxpayers and the consequences for wounded soldiers.”

The letter said the Defense Department “systemically” tried to replace federal workers at Walter Reed with private companies for facilities management, patient care and guard duty – a process that began in 2000.

“But the push to privatize support services there accelerated under President Bush’s ‘competitive sourcing’ initiative, which was launched in 2002,” the letter states.

During the year between awarding the contract to IAP and when the company started, “skilled government workers apparently began leaving Walter Reed in droves,” the letter states. “The memorandum also indicates that officials at the highest levels of Walter Reed and the U.S. Army Medical Command were informed about the dangers of privatization, but appeared to do little to prevent them.”

The memo signed by Garibaldi requests more federal employees because the hospital mission had grown “significantly” during the wars in Iraq and Afghanistan. It states that medical command did not concur with their request for more people.

“Without favorable consideration of these requests,” Garibaldi wrote, “[Walter Reed Army Medical Center] Base Operations and patient care services are at risk of mission failure.”

posted by Chris99 at 03:03 P.M. EST on Mon Aug 06, 2007     #



...I may not have all the facts from the Walter Reed scandal but this article...details some of the problems that occured due to privatizing services

Chris, whether they are facts or not - let's assume everything quoted from the article is correct. My point is that the success or failure of a government run system that outsourced work to the private sector cannot be used as an argument for or against a decision to run a system by the government or let it exist on the free market.

The government controlled this system (Walter Reed) - so any success or failure of this system is a point for or against running things by the government. If anything, Walter Reed is not something one would want to bring up when arguing for the superiority of government run systems over those run in the free market.

The free market never got to run Walter Reed, so we don't know how they would have done. Private companies working as contractors does mean that the system was run in the free market. That's a totally different thing.

posted by babbleman at 04:24 P.M. EST on Mon Aug 06, 2007     #



EDIT: Private companies working as contractors doesn't mean...
posted by babbleman at 04:26 P.M. EST on Mon Aug 06, 2007     #



If anything, Walter Reed is not something one would want to bring up when arguing for the superiority of government run systems over those run in the free market

I didn't intend to use Walter Reed as an example of gov't superiority. Merely pointing out that their problems occurred when they decided to privatize services. The system itself may not operate in the free market, by the private contractor does. They (IAP in this case) were chosen over other private contractors due to free market forces--lower costs, better product, more efficient, whatever. Once they secured the gov't contract, they operated as they saw fit (within their scope of services). And that included their decision to replace 300 federal employees down to 60, and then to 50. It's easy to see why they did this--it saves them money. Unfortunately, patient care suffered. It may not be a direct failure of the free market. But I think you can make the case that free market forces had an indirect effect (in my opinion).

The government controlled this system (Walter Reed) - so any success or failure of this system is a point for or against running things by the government.

These gov't systems can (and have) work properly under the right leadership. For instance, under another administration you could make the argument they they would have never tried to privatize some of the services, and they wouldn't have had this problem.

However, I think when you get an administration with a certain ideology, they tend to undermine gov't programs that they think shouldn't exist in the first place. An example would be to appoint the guy who ran the Arabian Horse Association to head FEMA. Or to appoint a lobbyist for NAM (a trade group opposing product safety regulation) to head the Consumer Product Safety Commission (see--Michael Baroody).

Walter Reed wasn't a gov't failure. It was an administration failure, due to ideology.

posted by Chris99 at 09:10 A.M. EST on Tue Aug 07, 2007     #



...Once they secured the gov't contract, they operated as they saw fit...

Well, I guess we could go around about this all day - but here in the real world, when you have a project, you carefully divide the services you need and write contract scopes to get what you want. You then negotiate the best deal, cut the contract and then monitor progress daily. If a given contractor is not meeting scope benchmarks, you warn them once, then twice (if you're generous), then give them a 24 hour notice and find someone else.

I don't mean any offense, Chris, but you make it sound like the process involves very vague direction in which the contractor can then run off and do whatever they want.

The project was managed poorly - plain and simple. And it can only be the project manager's fault (the government). There is no way to blame the subcontractor - they weren't monitored and managed. Now, if you want to allege that a bad project manager was put in place by the administration to torpedo the program, that's fine. Although I would expect something like to be more likely in a non-defense department.

No matter how you slice it, if someone managed their business like that in the real world, it wouldn't be in business anymore. But, if you notice, they are still in business. Their only incentive to perform is to stay out of the news. But I think we'll have to agree to disagree - I think when each of us looks at the world we see completely different structures.

posted by babbleman at 04:08 P.M. EST on Tue Aug 07, 2007     #



but here in the real world, when you have a project, you carefully divide the services you need and write contract scopes to get what you want. You then negotiate the best deal, cut the contract and then monitor progress daily. If a given contractor is not meeting scope benchmarks, you warn them once, then twice (if you're generous), then give them a 24 hour notice and find someone else.

Agreed. But we are not dealing with the real world in this situation, we're dealing with the Bush administration. We cannot assume that oversite is done after doling out gov't contracts. The opposite is probably closer to the truth.

No matter how you slice it, if someone managed their business like that in the real world, it wouldn't be in business anymore.

True again. However I have to go back to my premise in that poor gov't performance can usually be traced back to the people in charge, not the institution itself. It's no different than a failed business.

posted by Chris99 at 08:27 P.M. EST on Tue Aug 07, 2007     #



Did you see the retired iron worker from Chicago on the AFL/CIO debate last evening? I'm betting that all by himself he has raised the bar to a new level on the issue of universal health care.
posted by Man_with_the_muck_rake at 07:59 P.M. EST on Wed Aug 08, 2007     #



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