Thursday, July 30, 2009

Government Isn't the Problem

The reason today's healthcare insurance works as well as it does is because of government interference. Reform just cuts out the expensive, profit-sucking middleman.

Tuesday, July 28, 2009

Markets Not Healthcare Solution

Paul Krugman on why markets can't cure healthcare.
There are two strongly distinctive aspects on health care. One is that you don’t know when or whether you’ll need care — but if you do, the care can be extremely expensive. The big bucks are in triple coronary bypass surgery, not routine visits to the doctor’s office; and very, very few people can afford to pay major medical costs out of pocket.

This tells you right away that health care can’t be sold like bread. It must be largely paid for by some kind of insurance. And this in turn means that someone other than the patient ends up making decisions about what to buy. Consumer choice is nonsense when it comes to health care. And you can’t just trust insurance companies either — they’re not in business for their health, or yours.

This problem is made worse by the fact that actually paying for your health care is a loss from an insurers’ point of view — they actually refer to it as “medical costs.” This means both that insurers try to deny as many claims as possible, and that they try to avoid covering people who are actually likely to need care. Both of these strategies use a lot of resources, which is why private insurance has much higher administrative costs than single-payer systems. And since there’s a widespread sense that our fellow citizens should get the care we need — not everyone agrees, but most do — this means that private insurance basically spends a lot of money on socially destructive activities.

The second thing about health care is that it’s complicated, and you can’t rely on experience or comparison shopping. (“I hear they’ve got a real deal on stents over at St. Mary’s!”) That’s why doctors are supposed to follow an ethical code, why we expect more from them than from bakers or grocery store owners.

Wednesday, July 22, 2009

39-days to Mars

A two stage ion engine currently under development could take us to Mars. It would also be useful for moving satellites around and pushing threatening asteroids out of Earth's orbit. To get to Mars it would need a nuclear power plant on board since the sun's power would just not be enough.

Fears about health reform costs are a mirage

Timothy Noah points out that the $600 billion dollar price tag for healthcare reform is not that big of a deal. The Health and Welfare Committe does not have the jurisdiction to propose any taxes to offset the costs. However there is a reasonable amount of taxation that could easily offset the costs.
"The health insurance exclusion is regressive, since people making more money tend to receive the most generous health benefits. On the other hand, eliminating the exclusion entirely would increase the tax liability of people earning less than $50,000, as a percentage of income, much more than it would people earning more than $200,000, assuming both groups received health insurance through their employers. A reasonable compromise, therefore, would be to maintain the exclusion for people earning below a certain amount (say, $50,000) and reduce it for people earning more. In the March 17 New Republic ('Tax My Health Benefits, Please'), Cohn noted that a tax scheme along these lines, proposed by Jonathan Gruber of the Massachusetts Institute of Technology, would raise 'more than $700 billion over ten years.' If included in health reform, such a plan would net the feds a $100 billion surplus during the next decade. As a side benefit, it would exert some pressure on health insurers to lower premiums."

The Impotence of a Republican Congressman

doc Hastings demonstrates the impotence of being a good Republican foot soldier congressman in a congress controlled by the Democratic Party. He has to take hat in hand and curry support from a Democratic congressman in order to secure funding for the Hanford cleanup.

Tuesday, July 21, 2009

American Mullahs

If you are looking for fundamentalist secret organizations with the goal of seizing absolute power in America you need look no further that the Family at the C Street House.

Maddow Demolishes Buchanan's Surreal Facts About America's Racial Past

Oh, what hubris! That people like Pat Buchanan can take their load of horsesh*t on the air with the likes of Rachel Maddow and expect to make points is truly amazing. Rachel deftly shows that Pat's position is basically a racist, self-serving mirage that tells us more about Pat than about the real world.


Deanie Mills has a good article about the continuing trend to underestimate Obama. I think "we ain't seen nuthin' yet"
"He ran to govern.

Governing is tense and messy but good governing gets results. Those who underestimate Barack Obama do so because they are writing a dramatic narrative in their heads that he does not fit, and so they dismiss him.

But Barack Obama has thrown out that old construct and shuffled the entire medium, hurling it into a fresh, new, 21st century story, a story in which all the senses are engaged at all times, the action is fast, the results, unexpected.

In that story, history is respected, but not relived.

It's kind of like the difference between, say, an old Vaudeville variety show...and Cirque de Soleil."

Sunday, July 19, 2009

Mass 'Kiss-In' Protest At Mormon Temple Leads To Confrontation

Hyper-sensitive positions seem to always lead to unintended consequences. If the original security guards had simply treated the same-sex kissers as they would have treated any other amorous couple there would have been no headlines. Instead they handcuffed them and through one of them to the ground. Now they have mobs of same-sex kissers and unflattering headlines to deal with.

Friday, July 17, 2009

Paul on Goldman Sachs

Op-Ed Columnist - The Joy of Sachs - "The bottom line is that Goldman’s blowout quarter is good news for Goldman and the people who work there. It’s good news for financial superstars in general, whose paychecks are rapidly climbing back to precrisis levels. But it’s bad news for almost everyone else."

Planned Parenthood clinic update

The Pasco Planning Commission kicks the Planned Parenthood clinic decision down the road. Sadly it isn't because they are concerned about the merits of the case. It's because they are looking for some sort of legal cover for the decision they are about to make. Their own biases as well as the preponderance of testimony they have received about the permit leads them to think that protesters will make the site inappropriate due to its proximity to a school. Rick White, the city's community and economic development director, told the commission that a previous court case made the issue of potential protesters insufficient grounds for denying a permit.

It appears that the courts have already ruled against the bullying tactics employed by the planned parenthood opposition. The opposition has made it clear to the commission that if the permit is granted, they will protest. Thankfully the court has made it illegal for the commission to cave to the threats of the protesters. It's no wonder these people want to destroy the courts. They view their religious conviction as a higher standard than our country's legal system. Said legal system seems to always get in the way of their efforts to shove their particular religious views down the throats of the populace.

I, for one, am thankful that the establishment clause continues to be protected.

Tuesday, July 14, 2009

House health plan is out

The House health plan presented today shows a great deal of promise.

Healthcare Expert Stuart Altman speaks in the Tri-Cities

When Richard Nixon made the first national foray into health care he chose an economist who knew little about health care to head the effort. That person was Stuart Altman.

Dr. Altman opened his remarks by describing himself as a radical moderate and noted that his remarks would probably support whatever bias any member of the audience may have had when they came in. At the time that Nixon appointed him to that commission health care spending was 7.5% of GNP. The thinking was that if it got above 8% the nation would be in trouble. The spending is now at 17.5%. Is there a correct answer for what the spending should be? Should our spending be limited? There is no right answer and anyone who tells you they have the answer is stupid. But there is no doubt that this level of spending is causing problems.

Healthcare has been an issue for a long time. Truman ran on a platform plank of public healthcare. He won but he was never able to bring that policy into fruition. Nixon almost got a public healthcare policy in place but was side-tracked by a third-rate burglary and the public embarrassment of Congressman Wilbur Mills. Bill Clinton tried it. Clinton’s original plan was undercut by a person Altman chooses to call Rasputin. Altman’s team proposed a plan that would cover everyone plus prescription drugs but would cost at that time $100 billion. Clinton’s jaw dropped. Rasputin countered that he had a plan that would cost nothing. But Rasputin’s plan would be a radical change to the way healthcare was paid for and delivered. Altman objected that people would not accept such a radical change. Altman’s days in the Clinton administration were terminated.

Now we have a new president who has made healthcare a key priority. Altman was one of Obama’s advisors during the campaign. There should not be 50 million people in this country with no healthcare coverage. But there are some big obstacles to changing that.

There are three major options:
1. An all-government program like the systems in Europe on Medicare here.
2. Restructure the current mixed system and make it work better.
3. Eliminate the tax exemption on employer-provided insurance and provide tax credits for people to buy their own insurance.
Altman thinks that most Americans prefer option 2. This is the sort of thing that has been proposed by both Obama and Hilary Clinton.

There is a precedent for this kind of plan in the state of Massachusetts. There are critics of this kind of plan at both extremes so that is an indicator that it is a decent moderate choice. In Massachusetts, that moderation was arrived at as a compromise between the Republican governor Mitt Romney and a Democratic legislature. In the plan everyone has a share of the responsibility, be they the government, individuals, or employers. It was a shift from a subsidized safety net to universal insurance. The idea was to get everyone covered then decide how much to pay for that coverage. At the state level there is an advantage that isn’t available at the national level. Much of the money the state was able to use came from the federal government. At the national level there isn’t a higher power that can assist in the funding.

Obama has already made some down payments on a mixed plan. SCHIP was funded. Money has been provided for health information technology. Money is proposed for research on effectiveness. (What most people don’t realize that is that governmental regulatory bodies are not tasked to determine what products are cost effective. They only determine whether the product works or not. They don’t determine whether products make economic sense. Effectiveness research takes that next step to determine whether the cost of the product is justified by its effectiveness.) Money is proposed for the unemployed and the disadvantaged on Medicaid.

But when Obama came to Washington the pressures came to bear. Massachusetts was able to get a compromise. Such a compromise just may not be possible in D.C. $2.5 trillion is being spent each year on healthcare. Over the next ten years that number will be over $30 trillion. This is a great deal of money with which to work. Adding the uninsured is not going to break the bank. There are those who advocate single-payer. There are those who advocate an individual mandate. The problem with an individual mandate is how to deal with the individuals who refuse to get insurance. Obama would like to avoid that issue. Because employer-provided insurance is not considered as income for tax purposes there is an incentive to overuse the insurance. Furthermore, a number of unions have negotiated contracts in which they have accepted lower wages in exchange for secure healthcare.

The two most contentious issues are whether to create a public plan to compete with private insurance and how serious should we be about cost containment. Altman considers the public plan in competition to be a distortion and distraction from a more important issue. He thinks that getting universal coverage is much more important. Serious cost containment is going to hurt some powerful lobbies. It will be difficult to achieve.

Cost containment has several issues. Why should the government be stuck with paying for the high administrative costs in the private system? What exactly is government going to pay to providers? Currently the government tends to only pay 70% of what private sources pay. How will that shortfall be made up?

Already the original proposals have morphed. Original the people who qualified was a limited set. Now the proposal has been extended to everybody. There are a number of other versions going around the Hill. The Ways and Means Committee has a plan that requires everyone one to be in it. Ted Kennedy has a plan that defers the payment level decision to the administration. Some are championing a plan based upon Group Health of Puget Sound.

Whatever happens, the fact is that providers now lose money on Medicare and Medicaid patients. Currently that money is made up by private payers. So either the Medicare and Medicaid payments must go up or the quality of care must go down.

In 1983 Medicare was changed from cost-based to diagnosis-based payments. The cost-based system was good for small rural hospitals but the diagnosis-based system hurt them. Many began to close. Altman was interviewed on the TODAY show to defend this. There were cases where the extra travel required resulted in unnecessary deaths. He was asked, “Why are you killing people in America?” He went back to Washington determined to fix the problem. That fix was the Critical Access Hospital program. The diagnosis-based system with Critical Access Hospitals has become a gold mine for consultants because it is so complicated that specialized knowledge is needed to use it smoothly. Today hospitals have a difference of opinions on public plans. Some will do well and others will not.

A real question is, “Why are costs raising so much?” Are we just using too much care? Altman’s basic answer is that we just pay more than other countries pay. Obama’s proposals will not be successful in serious cost containment because they are political plans. All the options may make slight improvements in costs but there is no “silver bullet” out there. All the ideas have some merit but there is no big idea that will solve the problem. The basic way to spend less money is to have the discipline to just spend less money. That is what other countries do. They set the budget for healthcare and the system simply has to live within that budget.

Altman’s Law is this. Most every major healthcare constituent group favors universal coverage and healthcare reform BUT if the plan deviates from their preferred approach they would rather stay with the “status quo”.

He believes that we will eventually do something but it will fall short. Some will not be covered and costs will continue to go up. The big debate will be about expanded and modified Medicare. The status quo on Medicare is not sustainable. We will have to either cut it, make people pay more, cut payments to providers, and/or make rich people pay more. If we significantly improve the delivery system and reduce the demand on Medicare we can maintain the quality of care. We must wean ourselves from fee-for-service and get to a state of integrated and coordinated care. Currently providers get paid more for doing more. Systems are encouraged to aggressively compete against one another instead of collaborate well. We need to pay them more for doing less if doing less gets the job done. We need to be willing to pay more for appropriate care instead of paying more for just any care at all. In the end the healthcare communities need to come up with their own solutions.

This concludes Altman’s formal remarks. Additionally in the handout materials there are the following points.

There are 4 options for changing the payment system:
1. Bundled or Case Payments
2. Significant pay-for-performance add-ons or penalties
3. Value-base payments
4. Permit wider use of “gain-sharing” between hospitals and doctors
The following payment reforms are likely to be in the Congressional bill:
1. Bundled payment for acute and post-acute care
2. Penalties for excess re-admissions
3. More extensive pilot or demonstrations for bundle payments including ambulatory care (with special emphasis on chronic conditions)
4. Extra funding to expand primary care workforce
a. Medical Home
b. Additional funding for primary care residencies

Questions and Answers
Q: Will taxing healthcare benefits reduce costs?
A: Economists like this because it makes sense in free markets. But healthcare doesn’t always behave according to free market rules.

Q: Much of the private costs are in administration. Explain how we could recover those costs without a single-payer system.
A: Insurance companies are often bad actors. Generally the government should be able to administer thing cheaper. But there may be problems with a government system as well. With Medicare a person gets Cadillac care for Chevy prices. The real answer is to get tougher on the insurance companies.

Q: If drug makers can’t make money, how will we be able to fund new drug research and development?
A: Drug companies also skew their development toward profit-making drugs instead of needed niche drugs that may not be as profitable. Altman acknowledges this as a tough problem.

Q: There are revolutionary plans than can be quite cost-effective.
A: It’s my contention that any revolutionary plan will not be adopted.

Q: What are the future and political challenges of Medicare managed-care systems? Oregon has an efficient system. Can that be duplicated elsewhere?
A: That apparent efficiency is a political fluke. Politicians from Washington and Oregon noticed that Florida was receiving really high payments because of the large number of procedures being done there. They banded together and got a special political dispensation to get more money from Medicare. In typical bureaucratic behavior, areas with high efficiencies are exposed to being cut more than areas with low efficiencies.

Q: This sounds like we are just arguing about different ways to pay the same sets of bills. When will we get more serious about prevention?
A: We should be paying for things that actually make us healthier instead of for just procedures.

Q: If we were able to match the Massachusetts program on a national scale could we achieve the same kinds of statistics?
A: I don’t know. The experience just may not transfer. And there are some real problems with the Massachusetts system that may not be reflected in the statistics. One of those is a real shortage of primary care physicians.

Q: What do you think of the plusses and minuses of the Maryland system?
A: Maryland is the only state with an all-payer regulatory system. It is a complex system that has some problems. There is much friction between hospitals. It does enable the state to get more federal money. But it does generally work. However, the complexity of it all keeps plenty of consultants in business.

End of presentation.

Sunday, July 12, 2009

Benton County suffers Republican Incompetence

As if the incompetence and irrelevance of the Republican party at the national level isn't enough, a couple of our local Republican county officials cook up a crazy scheme to achieve the consolidation of the local crisis center. Brad Peck seems bent on taking money from the struggling transit system with any convenient excuse. He was shot down in the past when he wanted to take the money for the Franklin County jail. And thankfully he was shot down again this time for wanting to take public transportation money for the Crisis Center. What is with this guy and his new wannabe jerk, Jim Beaver? It's not bad enough that Republicans are always looking for ways to destroy needed government services by starving them of funds but they are willing to take the funds that have been approved by the taxpayers for a given purpose and use them somewhere else.

There seem to be two classes of Republicans: those who live such a life of wealth and privilege that they have no need for public services and those who cluelessly use public services without understanding that taxes are required to provide them. They are like John Boehner who thought the government had deserted him when we he was on welfare and food stamps.

Friday, July 03, 2009

Differences Between Embryonic And Reprogrammed Cells

A recent study has shown that there are molecular differences between embryonic stem cells and skin cells that have been reprogrammed to be pluripotent. But whether the differences matter is yet to be shown.

Holmquist praised by contractors association

State Sen. Janea Holmquist(R-Moses Lake) is a friend of business wallets across the state. A stalwart opponent of collective bargaining for childcare workers, paid family leave, and business and income taxes. And a big friend of business. That's sad for the voters in Moses lake.

Hanford for mercury storage?

DOE to consider Hanford for mercury storage. Public meeting from 5:30 to 9:30 PM at the Clarion Hotel in Richland on July 28.
DOE website at