Giuliani: Cutting costs in health, like plasma TVs

Yeah,
That was the concept behind letting seniors negotiate for lower drug prices from the pharmaceutical companies. Thanks Repubs. Take care of those special interest groups first.

When I want to watch TV on a Plasma TV I simply press the power and tune it to the channel I want to view it works. No questions asked. Sadly Insurance companies may decide that they don't feel that the treatments prescribed are medically necessary and may refuse to pay any benefit. Americans wish Insurance companies worked like Plasma TVs.

Rudy's plan hinges on an crucial factor -- is that tax break going to compell enough people to buy in to drive prices down? Health insurance is not as sexy as a plasma tv. Too many people decide they can do without it, and then when they get sick and break a leg, guess where they go, someplace like Cook County. And we all end up footing the bill for that person anyway. Government needs to take a more active role in making health care available to people, or even at least requiring it, which would create the kind of market that would drive down prices. Rudy even mentions the reality of subsidies for the poor and elderly. Solving this issue is going to take creativity and compromise.

Even a 10 year old would raise an eyebrow at Senore Giuliano's super overly-simplistic reasoning. According to his logic now is the best time to buy a VHS player, cuz they are cheaper than the $700 dollar ones of 20 years ago. Did Julie talk about increasing the number of slots in medical schools so that the health professions graduate more providers, thus helping to reduce the shortages? Did he talk about insurance companies investing much of their earnings in real estate rather than in lower premiums for customers? The thing that amazes me about most of the political candidates is they have perfected the art of sounding as though they are saying something profound. Giuliano is a master of that game. But because he "looks presidential" 25 percent of the Republicans think he's their guy.

HE DOESNT GET IT!
IF PEOPLE HAD $10,000 TO BUY HEALTH INSURANCE THEY WOULDNT BE GOING WITH OUT.
YOU GOTTA HAVE MONEY TO BUY
THE HEALTH CARE POLICY AND THEN WAIT 1 YEAR AND HOPE TO GET IT BACK ON YOUR TAXES.
i DONT SEE ANY DOCTORS,HOSPITALS,OR INSURANCE COMPANYS LOWEERING THEIR PRICES,DO YOU!

It is easy to confuse health care with health insurance. A report by the Tribune on the wide availability of health care to those without insurance would be instructive. It's not only the county hospital but free clinics and emergency rooms in every other hospital. Most hospitals sustain huge losses each year because of the state not reimbursing them fully for free care rendered to those who cannot pay. Maybe the focus should switch to the provision of health care for the uninsured so that the scope of that need is more widely known. The question to be asked: Is anyone denied
necessary health care and treatment and, if so, how is it to be remedied? Making the insurance companies more wealthy with the government paying for insurance is not the answer and certainly a universal government-run health system would risk the creation of health care chaos.

If somebody buys the lower cost plasma TV, they don't end up dead if it stops working, do they? Would anybody with a choice pick the low cost doctor or hospital instead of the best doctor or hospital? Did Giuliani go discount shopping when he had his prostate problem?

I don't know how we ever decided that medical care should be a "for profit" enterprise. The more these guys talk, the better Canada's system looks.

He will never get it. Remmeber Greensburg KS..the town that blew away in May. The median income in 2005 was $29,000. How could anyone in that town afford medical coverage??? The tax break means nothing if you cannot pay for the insurrance in the first place.

Obviously, the answer is to have all our health care delivered in Malaysia and China, and administered by Sony, Samsung, Toshiba, Panasonic, et al. That way we can get our health insurance costs down to the level of a commodity like a TV. Of course, if the store runs out of your procedure, like they do every year when they change the TV models, you're gonna DIE!

Maybe he thinks we should go to China or Korea for our health care?

As usual, a Republican candidate decrying an imaginary straw-man socialized medicine program he pretends was proffered by a Democratic opponent. What's wrong with socialized medicine, anyway, apart from the tired old stereotypes imparted by the label?

What costs more?
Paying thousands into a health care plan only to have to pay out-of-pocket for surgery costing $50k because your claim was denied, or not paying into a health care plan & paying $50k for the same procedure? Duh!

The greatest country on earth is the only industrialized nation without universal healthcare coverage & conservatives have never come-up with a good explanation how Americans benefit.

The healthcare industry is always more concerend about making money over the health of Americans. It's all about money.

Sad how a politically backward country like Cuba can have healthcare coverage for all of its citizens.

Roman, while Cuba may have health care coverage for all its citizens, the quality of care sucks.

There is not one country on this planet that has great care. Quality health care also comes down to the Average Jane and Joe.

Anyway, no one can be turned away if they need medical help in the U.S. One way or another we all are covered.

But nothing is free in life. Whether health care is privatized or "universal," one way or another you are going to pay for it.

If universal health care takes the form of the system in Cuba, count me out. Chronic shortages of drugs and equipment, doctors who are paid so little that the smart ones get out of that business and get into more lucrative ones like waiting on tourists at the resorts. No thanks. Even they're best doctors botched Castro's gastro-intestinal surgery so badly that they had to call in an expert from Spain to save his life. Hey, does Spain have universal health coverage provided by the government?

There is price competition among TV builders and sellers. There is no price competition among hospitals, Insurance companies and doctors. Rudy does not know what he is talking about or he does know and does not care.

What a poor analogy. Producing 100 times as many plasma TVs reduces the price greatly, because the cost of design and tooling are spread over a much wider group of consumers. Health care, on the other hand, is already within the reach of most Americans (with insurance), meaning the market will increase only by something like a factor of 2, not 100. And the cost of staying in the hospital would only be slightly reduced by having twice as many patients.

One question for Giuliani and the other Republicans peddling this nonsensical healthcare "reform" program: "Would you go to the doctor offering the cheapest vaesectomy?" No? Neither would most other Americans. Health care economics do NOT work like traditional economic models, period, and it is a lie to claim otherwise. Televisions my Gd! Most average folk and sick people are not in a position to be consumers on the same, even level with insurers and providers, and therefore will ALWAYS be at a disadvantage without an intermediary advocating on their behalf. Any sick people facing chemo or a bypass in a good position to dicker with a few hospitals over the "best price"? How about buying private healthcare, where insurers get to pick and choose who they want to insure and can later drop you if you become ill? Get real Rudy. We need universal coverage, like Canada, and we need it NOW!

Being a swedish citisen i suffering under a socialised health care system of the type Hillary Clinton dream about. I pay more than 50 percent of my income to the goverment to get "free" health care. But i am garanteed nothing except a place at the waiting list. People in Sweden die waiting for treatment. People that can afford it buy private assurances. Profit seeking assunrace companies is propably bad, but beurocrats are worse.
The dynamics of a politically runned systems is destructive. You end up producing health care the same way that they produced cars in former DDR.

The more I hear from Rudy...the more I know he hasn't a clue.

"I pay more than 50 percent of my income to the goverment to get "free" health care."

Finally someone who gets it. You are not going to get universal health care with out raising taxes by a huge margin. 85% of the US has healthcare. SO why should the 85% of us have to pay for the 15% that do not have it. Just like wellfare, those of us that work have to pay for those that sit around all day and do nothing. For every one person taht really can not work there are 50 that abuse the system. The state of Wisconsin did a study that said for every person in Wisconsisn to have Universal Healthcare it would cost each taxpayer an increse of $510 per month. I already pay enough of my money to the gov, and I want them to get out of my life. Those of you that want to help pay for people to get insurance there is no limit to the amount of taxes that you can pay if so desired. We are not a communist country and if you need medical care you can go to the free clinics or County Hospitals. The healthcare problem will be just like the schools. There will never be enough money. Lottery and taxes were suppose to pay for schools, but now it is not enough. Bottom line is the government run programs are always a disaster. Anyone from IL should know this.

Rudy really knows a thing or two about cutting costs, too. After all, he left the City of New York with a FOUR BILLION DOLLAR DEFICIT that Mayor Bloomberg has nearly erased.

Somebody should ask Rudy about the socialized medicine that the Army, Marines, Air Force, Navy, Coast Guard, the President, the Vice President, the Senate and the House of Representatives get - if he's against "socialized" medicine then he should be stumping to remove it from these people.

“As usual, a Republican candidate decrying an imaginary straw-man socialized medicine program he pretends was proffered by a Democratic opponent. What's wrong with socialized medicine, anyway, apart from the tired old stereotypes imparted by the label?”

Posted by: Jim | August 6, 2007 8:33 PM

Jim:

There is nothing “imaginary,” “straw-man” or pretended about the socialized medicine programs proffered by the Democ-rats. Hillary has proposed a socialized health care system, as have Edwards and a number of other, non-contender, Democ-rat candidates. In fact, if one ever bothers to listen to Hillary, she sounds like she wants to socialize everything. She makes me believe that “progressive” is nothing more than a euphemism for “socialist.”

And what’s to dislike about socialized medicine anyway? Plenty, including:

1. The fact it would be unconstitutional if implemented on a federal level. The Constitution simply doesn’t give Congress the power to implement a universal, federal health care system. Sorry.

2. It will be more costly than a regulated, market based system because there would be no competition or market incentives to keep the price of good or services down. Or don’t you remember the $200 toilet seats the Army and Air Force used to buy?

3. It would be inefficient. The rest of the world already testifies to this. Just read the post from the poor Swede, above. People in Canada have the same complaints. Moreover a socialized system would attempt to cover everyone instead of just those too poor or unfortunate to have access to health care. Why do we need to do this? We don’t hand out checks to everyone because we have a welfare system, do we?

4. It would be likely to make the situation worse owing to the inherent ability of large government to corrupt men, waste assets and screw things up, thus making even more government and greater expenditures necessary.

Any more questions or bright ideas?

2. It will be more costly than a regulated, market based system because there would be no competition or market incentives to keep the price of good or services down. Or don’t you remember the $200 toilet seats the Army and Air Force used to buy?
"

The facts prove this one wrong.

The US spends more for Health care Per Capita than any other nation on the planet.

http://www.kff.org/insurance/snapshot/chcm010307oth.cfm

We also spend a higher share of our GDP on health care than any other country.

And for all we spend we do not get the highest quality healthcare.

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678

The market simply isn't working to keep prices down or quality up in health care.

Pardon me, but I forgot one reason to dislike socialized medicine. It is as follows in numerical order:

5. It would result in the loss of civil rights and liberties. Right now, you have the Constitutional right of “privacy” and autonomy in making all of your own medical choices, including the right to refuse any and all medical services if you so choose. That is the reasoning underlying the decision in Roe v. Wade and the more recent “right to die” cases. You also have a Fourth Amendment right to keep the government out of your body unless there is probable cause to search and a substantial governmental need to invade your bodily integrity. You also have rights under the Constitution to freely associate or disassociate with any person or group of people, and to abstain, within reason, from procedures which violate your rights to religion and conscience.

However, once the government medical system gets to monitor your bodily functions and fluids, and keep all of that information in a governmentally accessible database; once the word of a doctor carries the force of law; and once the government thinks all of this is on their dime (when it is really on your dime), they will call the shots and bring bureaucratic pressure to bear to dictate what you can and cannot do in your life. After that, there is little left for an individual to control in his or her life. You can then kiss your privacy, autonomy and individuality goodbye.

To me, it is nothing short of amazing that the Democrats - the so-called party of civil rights and civil liberties - would blink at the privacy and liberty deprivations that would necessarily occur once a universal and socialized medical health care system was put in place. The truth is that civil rights and liberties aren't in your future if you favor politicians like Hillary or the rest of the Borg. Hillary doesn't trust you to tie your shoe or wipe your own butt. She thinks government has to do that for all of you in the unwashed masses. And some of you folks have the audacity to call Republicans sheep! Go look in the mirror.

Anonymous:

The facts do not prove contention No. 2 wrong. Right now, we do not have a regulated market based system with competition and market incentives. We have a bunch of thieving insurance companies and HMO's dressed up as health care providers.

One of the problems with immediately running to a socialized health care system is that no one has first tried to reform the current system to make it better. There are lots of things to be done to drive down the costs of health care and make it more widely available. But no one seems to be very interested in doing so – and certainly not the Democrats. They are too enamored with their socialist idealism to try.

“Somebody should ask Rudy about the socialized medicine that the Army, Marines, Air Force, Navy, Coast Guard, the President, the Vice President, the Senate and the House of Representatives get - if he's against "socialized" medicine then he should be stumping to remove it from these people.”

Posted by: BC | August 7, 2007 2:09 PM

BC:

The armed forces, the President and members of Congress get health care in consideration for their service. As such, there is nothing "socialized" about those government medical plans for Rudy to dislike.

What Rudy doesn’t like is the idea of a collectivized taxation and redistribution scheme like Billary and the rest of the Democ-rat Borg have in mind. Please get your ideas straight – and then engage brain.

John w.-

Please document ONE european country with socialized medicine where your doctor can force you to undergo any medical procedure against your will by force of law. Just one.

"Right now, we do not have a regulated market based system with competition and market incentives."

What type of incentives and competition? Coupons for open heart surgery?

Regulated by whom? The evil government who wants to monitor your precious bodily fluids?

By the way John W., habve you ever seen a commie drink a glass of water?

Anonymous:

You ask, "What type of incentives and competition?" I will answer this with one of many examples; the rest of your snide remarks be damned.

One of the largest costs to the medical profession, if not the largest cost, is malpractice insurance. Hospitals are each faced with multi-million dollar malpractice premiums on a yearly basis – and it’s worse if they maintain an emergency room. Malpractice insurance is so high in some places that doctors simply cannot afford to practice medicine, and many hospitals are closing their emergency rooms because they can’t afford to pay the premiums to keep them open. Mississippi, for instance, has a sever shortage of practicing physicians for this very reason.

The market regulated based fix for this problem would be to put a monetary cap on malpractice awards, and eliminate certain malpractice actions altogether – such as those that do not result in actual physical harm. The limitation on malpractice liability awards would invariably drive down the cost of malpractice insurance. In return for the cap, the government would then get to tell hospitals and doctors that, if they want to stay under the protection of that malpractice cap, they must: 1) maintain ongoing professional, educational and training standards – to maintain and/or raise the quality of care (and make malpractice less likely too); 2) demand competitive bidding and contracts from their equipment and medicine suppliers; and 3) pass their cost savings onto the public in the form of lower rates, especially for the poor and needy.

This is just one idea out of many. It would save a lot of medical costs if it were used more often. And, yes, it does tinker with the market economics. But that, by itself, does not make it a socialist intervention. Hospitals and doctors would still be allowed to operate as private, for-profit businesses.

This particular idea would never be used by the Democrats because they are in bed with the trial lawyers associations, and particularly those who represent plaintiffs in civil actions. It’s a pity, because this kind of limitation would be necessary if one were to put a socialized health care system in place. If it doesn’t get used, you will never have a government run health care system. You’d end up with a government run lottery instead.

BTW, are you ashamed of telling us who you are Anonymous?

BTW, Anonymous, I have seen a commie drink a glass of water. I was in Russia a number of years ago. They still have commies there even though communism is no longer the official form of government.

John W-

I think you need to familiarize yourself with one of the best satires ever put on film-

"Dr. Strangelove, or, How I learned to stop worrying and love the bomb"

However, I do have to tell you that the character of General Jack D. Ripper is not meant as a hero or role model. I think you might get a bit confused on that.

How about all those European countries that force meldical procedures on patient unwillingly. Found those yet?

As for malpractice caps, what is the value of my sight if I lose it due to a doctors gross negligence? What is the value of my childs life if they end up mentally disabled for life do to a doctors incompetence?

Who do you believe should set those values? The Government? Surely not! Tyranny! How about the market? We could trade Disability futures.

Here's a radical thought- how about a jury of free american citizens?

Typical republican response though, protect the corporations and those with money, and leave the victim, who in the case of malpractice has done nothing wrong, holding the bag alone.

Anonymous, who insists on remaining so, spewed forth the following:

“I think you need to familiarize yourself with one of the best satires ever put on film-

‘Dr. Strangelove, or, How I learned to stop worrying and love the bomb’

However, I do have to tell you that the character of General Jack D. Ripper is not meant as a hero or role model. I think you might get a bit confused on that.”

- to which I reply:

I think you need to stop telling people, and me in particular, what to do. And stop being so patronizing with the “I think you might get a bit confused on that” kind of crap, you ninny. I’ve seen the movie many times, and I know what it means. I have an education, and I think with my own brain - unlike someone I know. Nudge Nudge, Wink Wink.

- and then Anonymous asked:

“How about all those European countries that force meldical procedures on patient unwillingly. Found those yet?”

- to which I reply:

The word is “medical,” and not “meldical.” And furthermore, it would be “force medical procedures” on “a patient” or “patients” and not simply “patient.” The first two alternatives are proper because they denote nouns, whereas “patient,” alone, appears to be an adjective and is, thus, awkward and ambiguous. Imagine, two mistakes like that in the space of one sentence?

So, now how does it feel to have someone patronizing you?

And if you are looking for European countries that force “medical” procedures on patients unwillingly, go look at France, Belgium and Portugal. All of them have socialized medicine and mandatory (meaning “like it or not”) vaccination laws. But, hey, we didn’t have to go to a country with socialized medicine to find that, did we? We have that right here in the good ol’ U.S. of A – and not without a great deal of controversy. And you can imagine the situation will only get more heated if we drop that into the middle of a socialized medical system.

- and then Anonymous asked:

“As for malpractice caps, what is the value of my sight if I lose it due to a doctors gross negligence? What is the value of my childs life if they end up mentally disabled for life do to a doctors incompetence?”

- to which I reply:
You mean “child’s,” and not “childs.”

As corrected, the question is absurd. One cannot never place a dollar figure on a lost sense or a child’s life. The best one can hope for is an approximate dollar figure to make up what will be needed to offset the future impact of those losses.

But that’s not the issue, is it?

The question is how one makes a medical system affordable. And the first answer has to be: Lower the costs. Capping malpractice awards takes out the most expensive cost of health care. So, yes, there will be people who may never be fully compensated for their losses as a result of caps on malpractice awards. But, without them, there will be no such thing as medical care, much less affordable health care, for many people.

So, the real question is whether it is an acceptable tradeoff to cap malpractice awards, leaving, on the one hand, some people only partially compensated for their losses, while thereby assuring, on the other hand, that most or all people have access to affordable health care. I would answer that question in the affirmative. I’m not saying this because it is important for big businesses and those with money to stay rich. I’m saying it because it is more valuable for everyone to have health so that fewer people will suffer and die than if they had no health care at all.

And I’m also saying this because it is something needed to make health care affordable regardless of whether one has a socialized system or a regulated market based system. For, even in a system of socialized medicine, failure to cap malpractice awards would encourage frivolous litigation. A lot of malpractice litigation is frivolous now; but undeserving plaintiffs are too often paid off because trying every case would be too expensive to the insurance companies. In a socialized medical system without a malpractice cap, the defendants would always be YOU, the taxpayer. Your tax dollars would get diverted from providing medical services in order to pay those awards. The result would be higher taxes to pay awards and receive the same level of crappy medical services.

Finally, you misrepresent what I suggest as leaving the “the victim . . . holding the bag alone.” I suggested a malpractice award “cap.” An award cap means a limitation on awards, and not doing away with them. That is hardly leaving worthy plaintiffs holding the bag alone. That was rather disingenuous of you to suggest otherwise.

Anonymous,
John W believes in the Republican way of "if you can't afford good health care, to bad, because you should be able afford it and as far the GOP and John W are concerned, you should just go off somewhere and die and quit bothering them."

John E:

You just entirely misrepresented my position. I have been advocating making health care more affordable through market based incentives - so that more people can have health care without going to the extreme of a socialized medical system. I never suggested that everyone who cannot currently afford health care should go off and die, as you suggest.

It is uncharacteristically disingenuous for you to be this way. And you think I'm a party hack?

It is uncharacteristically disingenuous for you to be this way. And you think I'm a party hack?

Posted by: John W. | August 7, 2007 9:36 PM

John W,
It's disingenious of you to keep insuating that Democrats are going to socialize all of the American government if they win the White House in 08.
This is a bald face lie that you continue to repeat and you know better.

John W. bravely comes out against mandatory vaccination laws, thereby proving that we can all further ignore his brilliant theories on health care reform.

How many people have had smallpox lately? Darned vaccination laws, stopping those diseases from killing off huundreds of thousands of people!

He also was a coward in avoiding how the malpractice caps should be set. He obviously wants the government to do it, even though he claims he doesn't believe the government should have a role in health care decisions. Come on Johhny, be honest. You believe in malpractice caps. What should be the monetary cap in damages for a child who ends up mentally disabled at birth due to a doctors negligence?

But keep pointing out those typos Johnny. They sure make your point.

John E:

It's not disingenuous to suggest that Hillary and her Borg entourage will take the United States into the direction of European Democratic Socialism. But don't take my word for it. Go read Hillary's speeches. She has them posted on her own web site. They have socialism dripping from every word. And many of the Democ-rats, John Edwards included, say much of the same thing. The only one who hasn't come out directly in favor of a higher degree of socialism is Barak Obama; and one is only left wondering why.

So I have uttered no lie in characterizing her and other Democrats as socialists. If you don't know what socialism is, that's not my problem. But it is the absolute truth.

Anonymous:

Still cowardly hiding behind that pseudonym of yours? Or don't you know how to fill out the Swamp form yet?

No, I didn't come out against vaccinations; and neither have I supported them. There is a lot of controversy regarding them, and that is all I pointed out. But leave it to you to misinterpret what I wrote.

And, no, I didn't cowardly avoid saying how malpractice caps would be set. Obviously, if the government is going to use a cap as an incentive to get health care providers to lower their prices, then the government has to decide what the cap is going to be. No one else can enforce a cap. So, of course the government should do it. The government has to do it. That's a no-brainer. But I thought you could figure that out from what I wrote. I guess I was wrong.

And, BTW, setting a cap is not government intervention into health care. It is intervention into the tort system, which is an intervention into (and some would claim a reform of) the legal system. L-e-g-a-l s-y-s-t-e-m. Make a note of it, so you don’t confuse the legal system with the health care industry in the future. I’d hate to see you show up to court asking for an enema.

Some States have already set malpractice caps. North Carolina, I believe, has a law that puts the cap at $1 million, but only if there is an agreement to go to binding arbitration. California, I believe, has a cap of somewhere between $250,000 and $300,000 for non-economic damages (e.g. pain and suffering, etc.).

I personally like California’s approach. The economic impact of an injury resulting from malpractice is often not the largest part of the award, although it can be quite large for long term disabilities. Most of a personal injury award is given for pain and suffering, which is just the jury’s way of showing its sympathy (and paying the lawyer’s bills). I think we can afford to do with a little less sympathy if it helps make health care affordable for the rest of the population.

If you want to find out the dollar value for a brain dead child from malpractice go look at the various state laws. They’ll give you an idea. You have just as much chance finding them as I do; and I don’t step and fetch for people like you. So, go to it.

I’m surprised you didn’t pick on the typos I left in my last post. I left them there for you, because I know how patronizing you love to be.

Actually, I was picking on your post because I wanted to tell you how little I respect people with a condescending attitude. If you cop that attitude with me, you’ll get it right back. I guess you didn’t get the message the first time around. Oh, well.

John w-

I'd rather attack your arguements than your typing.

"I think we can afford to do with a little less sympathy if it helps make health care affordable for the rest of the population."

Oh your care for the common man is awe inspiring.

Let see who benefits from this plan:

Insurance companies: Definitely.

Bad Doctors: Definitely

Victims of medical malpractice: Not at all

Users of the medical system: There is no solid evidence that health care costs come down when malpractice award caps are put in place.

http://www.cbo.gov/ftpdoc.cfm?index=4968&type=0

"Several studies have found that various types of restrictions on malpractice liability can indeed reduce total awards and thereby lead to lower premiums for malpractice insurance. By themselves, however, such changes do not affect economic efficiency: they modify the distribution of gains and losses to individuals and groups but do not create benefits or costs for society as a whole. The evidence for indirect effects on efficiency--through changes in defensive medicine, the availability of medical care, or the extent of malpractice--is at best ambiguous."

"Moreover, using a different set of data, CBO found no statistically significant difference in per capita health care spending between states with and without limits on malpractice torts. Still, the question of whether such limits reduce spending remains open, and CBO continues to explore it using other research methods."

So tell me again John W. (Your full legal name, right?) why malpractice vitims, who live with a lifetime of pain and suffering, should bear the brunt of healthcare reform, while bad doctors and insurance companies see their economic outlook improve?

So I have uttered no lie in characterizing her and other Democrats as socialists. If you don't know what socialism is, that's not my problem. But it is the absolute truth.

Posted by: John W. | August 8, 2007 7:31 AM

John W,
It's a "LIE" and a GOP Lie on top of that.
So much for you being a "real conservative."

Hey John W,
Here's the guy you voted for in 2000:

http://www.flickr.com/photos/26506376@N00/479329569/

Why should I believe that you're a "real conservative" after that?

Anonymous:

That is exactly none of your full legal name, right?

Now you are talking at me and past me, and you are beginning to make less and less sense.

You again claim that insurance companies and bad doctors are the only real beneficiaries of my suggestion, whereas malpractice victims do not benefit at all, and there is no evidence that users of the medical system derive any benefits from a malpractice cap. You base the lack of evidence of benefit on a single source which finds the evidence “ambiguous at best.”

Your arguments demonstrate that you’ve never really read anything I’ve written.

You have attacked a system where the government doesn’t require anything of the health care industry in exchange for a malpractice cap. And that is not what I suggested. If you go back a few posts to where I first suggested a malpractice cap as a means of lowering health care costs (above, August 7, 2007 7:14 PM) you will see where I wrote, and I quote:

“In return for the cap, the government would then get to tell hospitals and doctors that, if they want to stay under the protection of that malpractice cap, they must: 1) maintain ongoing professional, educational and training standards – to maintain and/or raise the quality of care (and make malpractice less likely too); 2) demand competitive bidding and contracts from their equipment and medicine suppliers; and 3) pass their cost savings onto the public in the form of lower rates, especially for the poor and needy.”

In other words, I never suggested handing out a malpractice cap without strings attached. I understand (and understood) that doing so would make lower consumer prices depend entirely on the undependable magic of supply side economics. Instead, lower consumer prices and higher professional standards were the quid pro quo for the cap in the scenario I suggested. Do you see that now? That means consumers would have to be beneficiaries of the cap.

Second, you again falsely claim the system I suggest would leave malpractice victims entirely without any benefit. That is simply not true. I never advocated taking away all compensation from malpractice victims. Capping non-economic harm would not take away the costs of lifetime care needed to accommodate the victim, if necessary; nor would it leave the victim uncompensated for loss of employment, out of pocket costs, or any other tangible economic loss. In fact, it would not entirely deny the victim compensation for pain and suffering. They just wouldn’t get as much, and that is all.

Moreover, my idea also included requiring health care professionals to keep up their professional training and health care standards. The point of that was to promote higher levels of competency, so that the system would produced fewer malpractice victims. In other words, the bad doctors would not get much benefit from the system if they persisted in their incompetence.

Under these circumstances, it is entirely untrue to suggest that the plan I advocated would result in forcing malpractice victims to bear the brunt of the health care reform, or even that only insurance companies and bad doctors would see their economic outlook improve. A little better reading would have saved you the trouble of asking a question with so many false premises.

Liar, Liar, Pants on Fire....John W.

1) maintain ongoing professional, educational and training standards – to maintain and/or raise the quality of care (and make malpractice less likely too)

Already required.

http://www.ama-assn.org/ama/pub/category/2640.html

2) demand competitive bidding and contracts from their equipment and medicine suppliers;

Hmmm, sounds like government intervention into the health care market to me!

3) pass their cost savings onto the public in the form of lower rates, especially for the poor and needy.”

Mandating lower prices. Price controls. That's the sum total of what you are proposing to add to the system that is already in place in some areas. You closet socialist!

John W. (if that is your real name) I note that you attack the evidence I linked to as being from only one source. I can't help but notice that your have sourced exactly zero percent of your assertions on this matter. So your challenge is really quite baseless.

So what we get down to is that your "plan" (much of which is already in place) has no evidence behind it to suggest that it would in fact have the results you claim, and that there is evidence that where these very same strategies (minus the price controls) are in place that they have zero effect on costs or quality of care.

Not very convincing.

"Second, you again falsely claim the system I suggest would leave malpractice victims entirely without any benefit."

I forgot to add to my previous post that you are mistating my position here. The CHANGES you suggest (i.e. your plan) would not be to the benefit of victims. They would have something taken away, the ability to get jury awards higher than the cap, without receiving any compensating benefit in return.

Anonymous:

1. Whatever standards of professionalism may be required, they are not high enough. Have you spoken to a doctor about serious treatment options in the last year? I have. Let me tell you how very disheartening it is when I have to remind doctors that medicine is a science, and that science is based on observation and measurement. I have no doubts in my mind that the medical profession is seriously lacking in professionalism these days.

2. It's not a socialist plan to demand prudent business practices, or to demand a business pass on some cost savings to the consumers, in exchange for a favor from the government. The difference between a socialist system and what I have suggested is twofold. One, anyone in the medical health care system would still be free to reject the cap, risk the consequences and depend on market forces to save them. A socialist system wouldn’t let anyone opt out. Second, the method is not based on the collectivization of all people and assets or having an entire system financed from a single government controlled fund. The absence of collectivization, alone, means that it has no tendency toward socialism. Or don’t you know what socialism is?

I might remind you that the federal government has passed tens, if not hundreds, of thousands of laws which provide benefits to businesses, industries and the States, the availability of which depend on their compliance with federal regulations. It is a common and accepted market based method of enticing people to go along with the will of the federal government. Yet, no one has ever claimed that such methodology, by itself, constitutes socialism or that it has a tendency to promote socialism.

3. John W. is my real first name and my real last initial. That’s more than you or I can say for your use of the moniker “Anonymous.”

4. I didn’t attack your “evidence” for being only one citation. I thought it irrelevant because the article called the evidence of malpractice caps’ benefits “ambiguous at best,” meaning that it didn’t prove the negative to which you assigned to it. But, more importantly, it did not address the scenario that I proposed. The article never dealt with a situation in which health care providers were given a malpractice award cap only if they passed measurable benefits onto their clients, and onto the poor and needy in particular. The reason being is that malpractice caps are given now without that quid pro quo. So, how could the article give any valuable insight into a situation the author never confronted? It couldn’t. In which case your reliance on the article, like your reasoning, was faulty at its most basic level.

5. You haven’t the whole of what I would propose as a plan. Go back a few posts and you will see where I spoke of the malpractice cap as being merely “one of many examples.” There are many tried and true market based incentives to make businesses tow the line. Manipulating the tax code to give businesses tax breaks for giving cost-effective and affordable health care to the underprivileged would be another non-socialist method of addressing the problem. But, I’m not going into this with you because you simply isolate one idea, attack it, and then drive us away from the central point of the argument.

The central point is, and always has been that a single monolithic government system in which everyone is enrolled, and required to be enrolled (much like social security), and then paid for through tax dollars still suffers from many of the ills I have outlined in this thread. [By the way, THAT is a socialist system because of the required collectivization.] You have addressed nearly none of those concerns in the course of this debate.

Most importantly, you have never begun to address the claim that such a grandiose plan would be entirely unconstitutional, likely to be an extremely expensive drain on tax revenues due to its entire lack of incentives to cut costs, and entirely inefficient in its delivery of health care. Your divide and obfuscate method of argument made it certain that we would never reach those issues here. Bully for you.

"A socialist system wouldn’t let anyone opt out."

Well then, by your definition most countries in Europe do not have a socialist system. There are private medical services available in those countries, and doctors can opt out, and patients can pay for health care outside of the national system.

But I see you have no arguement that your plan doesn't come down to government enforced price caps, my pink friend. So much for your belief market capitalism.

"Most importantly, you have never begun to address the claim that such a grandiose plan would be entirely unconstitutional, likely to be an extremely expensive drain on tax revenues due to its entire lack of incentives to cut costs, and entirely inefficient in its delivery of health care."

Umm Yes, as a matter of fact I did respond to most of that.

Remembered when I showed that the US spends more per capita on health care and a greater portion of it's GDP, but provides lesser quality healthcare than any other industrialized country, all of whom have some sort of "socialized" medicine? Their programs, are more efficient and give better care than the US. Fact. Sorry that it doesn't fit into your world view.

As to the unconstitutionality, I suggest you check out
Helvering vs. Davis 1937. In addition you may want to consider that medicare has been around for over 40 years now, and the courts in that period of time has found that program to pay for healthcare for american citizens unconstitutional.

Go do some research, find out what's really going on in the world, and then we can talk again.

Sorry, that should have been...

"In addition you may want to consider that medicare has been around for over 40 years now, and the courts in that period of time has found that program to pay for healthcare for american citizens constitutional."

But then again, you seem to have realiized that the facts and evidence don't agree with your simplistic notions of how to improve health care and have given up the fight.

Nice to see you coming around to a more realistic view.

Anonymous:

Not so fast. I do not believe the decision in Helvering v. Davis, 301 U.S. 619 (1937), would be decided today, by the current Supreme Court, the same way it was decided under the coercion and threats from F.D.R. I also believe, that the current Supreme Court would strike down a centralized, federal socialized health care system as an excess of Constitutional power in violation of the 10th Amendment.

I'm not going to go into the fine details, because I fear the legal discussion would be entirely lost on you either because you wouldn’t understand it or because you wouldn’t want to believe despite its correctness. The Davis decision, itself, pointed to two other cases to support its conclusion that Article I, Section 8, Clause 1 of the Constitution gave Congress the power to spend money on anything as long as it was for the “General Welfare.” That is a misreading of the clause, and contradicts intention for the clause, the meaning given the clause when the Federalists sold the Constitution to the States, and the meaning given to the clause by those who voted to ratify the Constitution. In addition the cited cases relied on two other arguments, namely an “emergency” doctrine, and the fact the States “consented” to the law as further ground to uphold its constitutionality. None of these arguments hold any water.

Moving in reverse order, in the case of New York v. United States et al., 505 U.S. 144, 182 (1992) the U.S. Supreme Court held that a State’s “consent” cannot confer powers on the federal government that violates the 10th Amendment, i.e. that are not given in the Constitution. Thus, the “consent” basis for the line of cases including Steward Machine Co. v. Davis r, 301 U.S. 548 (1937), and United States v. Butler, 297 U.S. 1, 65 (1936), and Davis, doesn’t exist any more, if it ever did.

Second, the emergency rationale of the Court in Stewart Machine Co., is equally flawed. Putting aside for the moment the absurd idea that a retirement scheme somehow addresses a then existing emergency, the Court had never held up to that time that an emergency creates greater powers than those granted by the Constitution, or that an unconstitutional act becomes constitutional because of an emergency. To the contrary, the court had already decided two years before that emergencies do not create powers to do things that would be unconstitutional without the emergency. (See A.L.A. Schechter Poultry Co. v. United States, 295 U.S. 495, 528-29 (1935) [“Extraordinary conditions do not create or enlarge constitutional power. . . . Those who act under ... [constitutional grants of power] ... are not at liberty to transcend the imposed limits because they believe that more or different power is necessary.”] I might also mention that numerous cases involving constitutional issues, before and after the Stewart Machine Co. – Butler – Davis line of cases, have always said that whenever an emergency justifies an otherwise unreasonable act, the justification for further such action stops when the emergency stops. This has been the rule with regard to the Fourth Amendment as well as the construction of Congress’ power to suspend the Writ of Habeas Corpus. Thus, since we are no longer in a depression (the cited emergency), the emergency rationale fails to explain or justify why we still have a social security system now (except maybe for the fact that nobody in their right mind would challenge the law and expect to live very long).
Having disposed of Justice Cardozo’s two throw-away arguments (consent and emergency), it is left to see how the Court today would rule if it re-visited the longstanding debate between Madison and Hamilton over the scope of federal power and the so-called “general welfare” clause. I don’t believe the Stewart Machine Co. – Butler – Davis line of cases would survive. I believe, instead that the Court would side with Madison and hold that the general welfare clause cannot be used to effectuate an “end run play” around the limitations of Congress’ power imposed by the Constitution.

The text of the so-called “general welfare” clause, in context, does not grant Congress the power to spend money on the “general welfare” separate and apart from Congress’ other enumerated powers. This is because the wording “general welfare” and “common defense,” properly understood, are purposes and limitations on the power of taxation, rather than powers separate from the taxation power given in the same clause.

Article I, Section 8, Cl. 1 states in relevant part that: “The Congress shall have Power [t]o lay and collect Taxes, [etc.] . . . to pay the Debts and provide for the common Defence and general Welfare of the United States; . . . .” Immediately following this clause, the balance of Article I, Section 8 enumerates no fewer than sixteen other objects of legislation, along with the power to enact all laws “necessary and proper” to carry into execution all of the previous enumerated powers and all other powers vested in the federal government. All of the powers following Clause 1 can be subdivided into those which touch upon either the “common Defence” or “general Welfare” of the nation.

The first rule of construing constitutions and statutes is to implement the intent of the framers in accordance with the plain meaning of the language employed. A necessary corollary is that implementing the intent of a law according to its language requires that none of its language be construed in a manner that renders any of it useless or meaningless - the presumption being that a writing as solemn as a constitution or does not contain words that are meaningless.

But that is precisely what happens when one construes the “general welfare” language as power separate and apart from the power to tax to which it is affixed. In fact, the entire balance of Article I, Section 8 is rendered meaningless surplusage by that construction. If Congress has the independent power to tax (etc.) to provide for the “common Defence” does it not also imply that Congress has the power to defend? If so, then why does Article I, Section 8 also include separate powers to provide for the Army and Navy, and to call forth and regulate the militia? Those separate provisions would be worthless if Congress had a separate power to spend money to accomplish those very goals. The same is true of the power to spend to “provide for the “general Welfare.” If that was a separate power, would it not also include the power to legislate generally for the welfare of the United States? If so, then why does the rest of Article I, Section 8 include specific authorizations for Congress to legislate concerning everything from piracy, to post roads, to coining money, to establishing standards and weights? If Congress could spend money to accomplish all of these things, all admittedly objects for the “general welfare,” then all of these separate enumeration of powers were useless. They could accomplish all of these goals simply by spending money to accomplish them.

This, by the way, was exactly Madison’s objection to the notion that the “general welfare” clause was a separate power. In The Federalist 41, he explicitly explained that the “general welfare” language was a description of the taxation, and not a separate power:

“Some, who have not denied the necessity of the power of taxation, have grounded a very fierce attack against the constitution, on the language in which it is defined. It has been urged and echoed, that the power “to lay and collect taxes, duties, imposts, and excises, to pay the debts, and provide for the common defence and general welfare of the United States,” amounts to an unlimited commission to exercise every power, which may be alleged to be necessary for the common defence or general welfare. No stronger proof could be given of the distress under which these writers labour for objections, than their stooping to such a misconstruction.

“Had no other enumeration or definition of the powers of the congress been found in the constitution, than the general expressions just cited, the authors of the objection might have had some colour for it; though it would have been difficult to find a reason for so awkward a form of describing an authority to legislate in all possible cases. A power to destroy the freedom of the press, the trial by jury, or even to regulate the course of descents, or the forms of conveyances, must be very singularly expressed by the terms “to
raise money for the general welfare.”

“But what colour can the objection have, when a specification of the objects alluded to by these general terms, immediately follows; and is not even separated by a longer pause than a semicolon? If the different parts of the same instrument ought to be so expounded, as to give meaning to every part which will bear it; shall one part of the same sentence be excluded altogether from a share in the meaning; and shall the more doubtful and indefinite terms be retained in their full extent, and the clear and precise expressions be denied any signification whatsoever? For what purpose could the enumeration of particular powers be inserted, if these and all others were meant to be included in the preceding general power? Nothing is more natural or common, than first to use a general phrase, and then to explain and qualify it by a recital of particulars. But the idea of an enumeration of particulars, which neither explain nor qualify the general meaning, and can have no other effect than to confound and mislead, is an absurdity which, as we are reduced to the dilemma of charging either on the authors of the objection, or on the authors of the constitution, we must take the liberty of supposing, had not its origin
with the latter.”

This is exactly the argument that Madison and E. Randolph employed during the Virginia ratification convention to overcome fears that the federal government would be of a self-aggrandizing, self-defining government that could swallow the States. You can find that discussion yourself in a work called “The Debates in the Several State Conventions on the adoption of the Federal Constitution, etc.” by Jonathan Elliot (a.k.a. “Elliot’s Debates”). Madison made the same point scrupulously over and over again when vetoing a number of bills that attempted to expand the power of Congress though the power of the purse.

I propose, as a fallback argument, that the language of Article I, Section 8, Clause 1 is, at worst, ambiguous. But when wording is ambiguous, the Courts then resort to legislative intent to resolve the ambiguity. That is the favorite policy of the ever growing number of “original intent” Justices on the Supreme Court. The Federalist Papers are the first place the Court looks, and then to Elliot’s Debates. Given the ample record in those places of the intent to have Article I, Section 8, Clause 1 constitute a single taxing power, as opposed to separate, taxing and spending powers, the resolution of that ambiguity could hardly be resolved in any manner other than against the construction used by the Supreme Court in 1937.

So, no I do not consider this issue either decided or lost. I think the cases, including Helvering v. Davis, were tragic. The Court was then under immense pressure to comply with F.D.R.’s New Deal legislation or face having the court packed with 9 to 11 more pro-New Deal justices. Justice Roberts later admitted that the Court betrayed the Constitution to save itself in the Stewart Machine Co. – Butler – Davis line of cases, and that they were decided wrongly. The current court would not so soon forget.

Sorry to disappoint your belief that somehow I had come over to your entirely unreasonable viewpoint on the subject.

And, no, my plan never did come down to simple intervention, or the mere malpractice cap.. I told you that this and other ideas – like provisions resulting from manipulation of the tax code – could also provide the needed “carrots” to get the health care industry to alleviate the current health care problems without costing the federal government so much money. But you still apparently cannot read, which is why you didn’t see this the second or third time around. It even begs the question why I ever favored you with an idea regarding how Helvering v. Davis, and social welfare programs might not pass constitutional muster in the future. [P.S. This is a first draft, and not necessarily the most detailed or inclusive series of arguments I could make.]

John W.-

Sorry my friend, while you are quite verbose, I don't find your arguements that spending on social programs are unconstitutional at all convincing.

For 70 years now it has been accepted that Social Security and similar programs do pass constitutional muster, and there has been no serious challenge to that conclusion. We're well into the land of "well settled law" on this one.

While I'm sure you have simply awesome legal credentials, you're standing pretty alone on this one. Given a choice between 70 years precedent and court decisions and you as a source of deciding what is and is not constitutional, I'll stick with the courts, thank you very much.

I note you haven't bothered to dispute that your malpractice cap proposal is dependant on federally imposed price controls to work. Or to dispute the fact that socialized medical plans in other countries are in fact more efficient at providing quality health care than our current system. notr have you bothered to show ANY evidence that ANY of your proposals would result in lower costs or higher quality, even when evidence to the contrary has been produced.

I think it's safe to say we're done here. Arguing further against your factually unsupported notions, and your fringe legal theories can't serve any further purpose.

Anonymous:

I didn't think you would find it convincing. But that has more to do with your recalcitrance of mind than the merits of the argument. I even bothered to preface the argument with that observation.

And, no, I am not the only person who believes this to be true. I also suspect you will see a challenge along these lines if and when the Federal government decides to implement a universal socialized health care system.

I also suspect my legal credentials might just be sufficiently good - just as you snidely quipped.

And furthermore, 70 years of precedent mean nothing to the U.S. Supreme Court, especially under these circumstances. To date, there hasn't been a more conservative court. There has certainly been no Court more willing to to hear the aforementioned argument since Helvering v. Davis was decided. Thomas and Scalia, at least, would probably love a chance to stab the New Deal in the back.

I notice further that you have no substantive argument to counter anything I said. As such, I was absolutely correct that what I wrote was simply lost on you. Thus, it does not lie in your mouth to call mine a fringe argument. You wouldn’t know a fringe argument if it bit you on the butt. BTW, the argument I made was, in fact, exactly the way the constitution was understood and interpreted from the founding of the Country until the Supreme Court betrayed the Constitution to save the Court from F.D.R. Go and do what I did: read Elliot's debates from cover to cover a few times.

I do, in fact, dispute that socialized medicine in Europe, or anywhere else, is more efficient at providing health care than our current system. Yes, those countries provide good free emergency care. But for everything else, from a routine check-up to a bilateral orchidectomy, people are put on very long waiting lists and get to suffer (although I suppose in the latter case, a long wait isn't such a bad thing.) And furthermore, many of those countries are running out of money to run their systems. Many of England's health trusts, as they are called, are running in deficit spending to cover costs. The problem with finance have become so problematic that countries with socialized medicine have now opted to allow people with a lot of money to seek private health care. Wow, that's really efficient - Not.

My proposal for a malpractice cap is merely one possible piece of legislation to offer market based incentives. You know what an "example" is, don't you? How many times do I have to tell you this before you finally look at what I wrote?

And even that "example" doesn't depend on price control. Telling the health care industry that they have to pass on even a percentage of cost savings to consumers in exchange for the cap is not a price control. No prices are set or fixed for the consumer. If savings do not result from the cap, or the overall prices increase, then consumers would still have to pay to make up the difference.

The difference is that prices would have to be lower in the case of savings from the cap, because the allocation of savings to the consumer has to occur if the cap is to be given at all. In other words, the cap would be performance driven, and not price driven.

Again, the article you cited simply said that the evidence was "ambiguous at best" that malpractice caps result in any cost savings to the consumer. This was said in the context of a system where there is no requirement that cost savings be passed to consumers as the quid pro quo of the cap. Since there is no required reallocation of cost savings to the consumers, how does it have any bearing on a system (like the one I proposed) where cost savings must be credited to consumers? This, again, for the fourth time, is why the article you cite isn't persuasive.

Finally, I agree we are all talked out on this issue. I might as well try to persuade a a plate glass window that the sun does not rise in the east or set in the west.

"The difference is that prices would have to be lower in the case of savings from the cap, because the allocation of savings to the consumer has to occur if the cap is to be given at all. In other words, the cap would be performance driven, and not price driven."

Nope. Wrong.

The only way "passing on the savings" could be enforced is by the government setting price caps.

Let's say that The malpractice cap is set in year 1. There will be a savings in premiums, presumably, from year zero. In order to enforce the "passing on savings" the government would have to require that the health care providers prices in year 1 are their year 0 prices plus any documented cost increase, minus the savings. That's a price cap.

It gets even worse in year 2. In year 2, there are no real savings in malpractice premiums in year 2 as compared to year 1 because the caps have been in place both years. So now the government must intervene to ensure that price increases are not enacted in year 2 that would have the effect of undoing the "savings" of year one. So now the government must set a standard as to how much prices can increase in year 2 to keep "passing along" the now theoretical savings. The government will now be required to determine what the acceptable profit margin of health care providers can be. Price control.

If they don't do this, your whole plan will become a one year only sham, with no savings in future years, even as the malpractice caps remain in place. Perhaps this was your intention all along.

"I do, in fact, dispute that socialized medicine in Europe, or anywhere else, is more efficient at providing health care than our current system." again you provide zero proof, just your wown conjecture. That's make discussing this with you pointless. I provide an international study that show socilaized medical systems provide higher quality health care cheaper. You simply say "no it doesn't". No studies, no proof, just your own unsupported preconceptions.

"The problem with finance have become so problematic that countries with socialized medicine have now opted to allow people with a lot of money to seek private health care."

Again, wrong. Private health care has ALWAYS been available in Britain's National Health System. But at least ypou now acknowledge that you were either ill-informed or lying when you stated that a socialist system wouldn't let anyone opt out.

http://en.wikipedia.org/wiki/National_Health_Service

John W. you can have your own opinions, but you can't have your own facts.

Again, unless you are willing have this discussion based on verifiable facts, not "facts" that you make up to attempt to support your point, there is no point in continuing.