For April, 2011

Mr Reich, Improved Medicare for All is the Solution

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Paul Ryan is off the wall on Medicare.  Robert Reich is lots better.  But off just enough. 

The following widely followed column describes every problem in our health care system, problems Medicare shares and perpetuates.

What’s great about Medicare:  everyone’s in it and the government runs it.

What’s wrong with Medicare:  Fee-for-service payments, no incentives for quality like more primary care and electronic medical records.  All improvements that are included in the Affordable Care Act.


Medicare for All Is the Solution
By Robert Reich, Robert Reich’s Blog – 13 April 2011
Mr. President: Why Medicare Isn’t the Problem, It’s the Solution hope when he tells America how he aims to tame future budget deficits the President doesn’t accept conventional Washington wisdom that the biggest problem in the federal budget is Medicare (and its poor cousin Medicaid).
Medicare isn’t the problem. It’s the solution.
The real problem is the soaring costs of health care that lie beneath Medicare. They’re costs all of us are bearing in the form of soaring premiums, co-payments, and deductibles.
Americans spend more on health care per person than any other advanced nation and get less for our money. Yearly public and private healthcare spending is $7,538 per person. That’s almost two and a half times the average of other advanced nations.
Yet the typical American lives 77.9 years – less than the average 79.4 years in other advanced nations. And we have the highest rate of infant mortality of all advanced nations.

Medical costs are soaring because our health-care system is totally screwed up.


Doctors and hospitals have every incentive to spend on unnecessary tests, drugs, and procedures.


You have lower back pain? Almost 95% of such cases are best relieved through physical therapy. But doctors and hospitals routinely do expensive MRI’s, and then refer patients to orthopedic surgeons who often do even more costly surgery. Why? There’s not much money in physical therapy.


Your diabetes, asthma, or heart condition is acting up? If you go to the hospital, 20 percent of the time you’re back there within a month. You wouldn’t be nearly as likely to return if a nurse visited you at home to make sure you were taking your medications. This is common practice in other advanced countries. So why don’t nurses do home visits to Americans with acute conditions? Hospitals aren’t paid for it.


America spends $30 billion a year fixing medical errors – the worst rate among advanced countries. Why? Among other reasons because we keep patient records on computers that can’t share the data. Patient records are continuously re-written on pieces of paper, and then re-entered into different computers. That spells error.


Meanwhile, administrative costs eat up 15 to 30 percent of all healthcare spending in the United States. That’s twice the rate of most other advanced nations. Where does this money go? Mainly into collecting money: Doctors collect from hospitals and insurers, hospitals collect from insurers, insurers collect from companies or from policy holders.
A major occupational category at most hospitals is “billing clerk.” A third of nursing hours are devoted to documenting what’s happened so insurers have proof.
Trying to slow the rise in Medicare costs doesn’t deal with any of this. It will just limit the amounts seniors can spend, which means less care. As a practical matter it means more political battles, as seniors – whose clout will grow as boomers are added to the ranks – demand the limits be increased. (If you thought the demagoguery over “death panels” was bad, you ain’t seen nothin’ yet.)
Paul Ryan’s plan – to give seniors vouchers they can cash in with private for-profit insurers — would be even worse. It would funnel money into the hands of for-profit insurers, whose administrative costs are far higher than Medicare.
So what’s the answer? For starters, allow anyone at any age to join Medicare. Medicare’s administrative costs are in the range of 3 percent. That’s well below the 5 to 10 percent costs borne by large companies that self-insure. It’s even further below the administrative costs of companies in the small-group market (amounting to 25 to 27 percent of premiums). And it’s way, way lower than the administrative costs of individual insurance (40 percent). It’s even far below the 11 percent costs of private plans under Medicare Advantage, the current private-insurance option under Medicare.
In addition, allow Medicare – and its poor cousin Medicaid – to use their huge bargaining leverage to negotiate lower rates with hospitals, doctors, and pharmaceutical companies. This would help move health care from a fee-for-the-most-costly-service system into one designed to get the highest-quality outcomes most cheaply.
Estimates of how much would be saved by extending Medicare to cover the entire population range from $58 billion to $400 billion a year. More Americans would get quality health care, and the long-term budget crisis would be sharply reduced. Let me say it again: Medicare isn’t the problem. It’s the solution.


Budget – Obama – Strategy?

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Unfortunately for Obama, the Republicans have him trapped against the wall. First, Republicans have a foolish wing that believes that a government shutdown would be good for the nation and would force immediate savings. Second, the nation has an enormous budget deficit and the debt ceiling that needs to be extended now. As a result, unless Obama was willing to make some painful cuts, the Republicans pull out the trump card and threaten a government shutdown or default on America’s debt. I resent playing this game of chicken on our country. My prediction is that the Republicans like this and will extend the debt ceiling by maybe $500 billion and keep using it as a hammer every year. Obama needs to say some really radical stuff tomorrow when he addresses the nation- like single payer national health insurance or get us out of the wars that we have to stop pretending we can afford. That is where we are now, but I doubt he is willing to say that. So the choice in Nov. 2012 will be between the lesser of two depressing visions of which Obama will probably be preferable. My only hope is that once he is a lame duck, he will be wiling to lead.


HiI hear you all loud and clear. (Catherine, I did not know about how Obama
was handling the Bradley Manning case, and I’m very disappointed to hear
this. I travel so much in developing countries, and I miss some news
events. I was very disturbed about how many handled that, including Amazon,
Visa, etc.)So, what are we are our alternatives to re-electing Obama? What are we going
to do? This morning NPR said that the big stumbling block for Mitt Romney
to get the republican nomination was that he had created something in Mass
that was considered the equivalent of ObamaCare, so republicans are
skeptical of him. Who/what should we be supporting now: Mitt Romney as a
republican president?I have become very disenchanted with black-white or “winner takes all”
aspect of American politics, where there seems to be no middle ground (which
at least Obama is looking for). The speeches and Op Ed pieces that
criticize what is happening offer no practical solutions in a political
environment where market economics is viewed with a religious fervor by
many, where social solidarity is not an underlying value in this society,
and where no one seems willing to give up anything to repair a declining
economy, which will ultimately undermine everything else. I’ve watched
health care statistics improve tremendously in developing countries that
were really “developing” because the population is better off and can afford
better food, education, sanitation, etc. (e.g. Cambodia, despite entrenched
corruption). And I’ve seen the entire socio-economic structure collapse
along with economic decline (e.g. Jamaica). My Canadian dollars were worth
around $0.70 US a couple of years ago; now they are worth more than an
American dollar. If action is not taken to repair the American economy, all
of the social services (including public education) will continue to
decline, and the worst of the damage will not be evident for a generation.I am on a number of lists that would be described as left-wing, and I don’t
see any strategy emerging from those, anything where we are also making
informed decisions (that are very difficult to make) about what concessions
can be made. Not that I am any better: I clicked the buttons that “Move On”
and others sent to me to lobby for NPR funding, but then I know that I’m
asking other tax payers to fund a service that they may not use and that is
not an essential when I lobby for NPR.Maggie 

Krugman bemoans the absence of President Obama’s willingness to take a stand,
Professor Greenwood ( tells us what
price we pay and where Obama ought to lead.



Though the arrows were aimed at Obama, Paul Krugman’s column was mainly
about Ryan’s budget proposal. Let’s see how President Obama responds to
that proposal Wednesday night.

Paul Johnston
I hate to get into these kinds of discussions, BUT I will on this one.
And this is my personal opinion.It’s a caution about putting our energies into disappointments with
Obama. You might want to think about the basic politics of counting
votes. I was at the White House when Obama kicked off the healthcare
debate. He was right on target and said all the right things. Then
various folks in Congress (many on the D side of the aisle) turned it
into a much less robust piece of progress. But that is where the VOTES
WERE! Anyone remember Max Baucus? What he did? If Obama didn’t have
the votes for single payer or public option, then his championing of it
would have gone where?It’s easy to be disappointed. I don’t see the leadership or risk-taking
either. But that’s an easy way out for all of us. The fact is that we
thought we could take a shortcut to a progressive agenda by electing a
President we thought was progressive. We forgot that there still has to
be an actual base that believes in a progressive vision and is
emotionally enough attached to that vision to fight for it. We forgot
that we needed a Congress that understood they would be voted out if
they defied the progressive desires of their constituents. Until we
build that, the Obama’s of the world will come and go and we will grouse
and complain. It’s a good thing that we have Krugman to point out the
lack of leadership. But it’s a mistake to spin our wheels there. Lets
talk about how to go out and capture the imagination of the American
people with a vision and organization that can confront regressive
forces and rebuild the nation. The good thing about a politician that
has no basic moorings is that when we get the wind blowing our way,
he’ll float that direction too….________________________________From: []
On Behalf Of John Troidl
Sent: Monday, April 11, 2011 6:13 PM
To: Maggie Huff-Rousselle
Cc: Karl Keener;
Subject: Re: [EQUAL] Paul Krugman is looking for President ObamaMaggie,I think it “comes with the territory”. He needs to come up with better
approaches that are wise enough to bring people together or have the
guts to fight for what he believes in. Maybe he’s too young…..JohnOn Mon, Apr 11, 2011 at 2:41 PM, Maggie Huff-Rousselle
<> wrote:It is easy to get up on a soap box and criticize Obama with some punchy
prose in an Op Ed, and not so easy to do his difficult job. I don’t
think by publicly undermining Obama that those of us with shared
concerns about health care (and other social issues) are accomplishing
anything. We should be mobilizing to educate baby boomers who will
gradually retire to lobby against undermining Medicare, etc. etc.MaggieFrom: []
On Behalf Of Karl Keener
Sent: Monday, April 11, 2011 11:27 AM
Subject: [EQUAL] Paul Krugman is looking for President ObamaIn today’s NY Times is an excellent op-ed by Krugman. It truly is a
shame the guy we campaigned for and elected in 2008 is

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