Obama, Dukakis: Really?

I doubt that the public cooperatives will ever get enough clout to do anything meaningful when it comes to cutting costs or providing health care for those who can't afford it. It's just something to make those who can't put their ideology behind them enough to do what needs to be done feel good.

And your respect is for an Ed that hasn't existed for a while. He went off the deep end a while ago and since moving to Hot Air it's only gotten worse.

Captain Ed's been Midshipman Ed for quite a while now. There's no profit in being a levelheaded conservative.

There's nothing wrong about pointing out (once again) the double standard that we see in Washington and among those who want to re-engineer society so they feel better. What's been routine already is the true depiction of the future on our roadways of being shoehorned into laughably small cars and having to stay out of the way of Obama's (and other elites') monstrous-sized limousines and SUVs.

I guess it actually was a "reverse-Dukakis" moment. But, since the contrast was made, I will give retrospective credit to Dukakis for at least appreciating a leader's duty to walk the walk.

"Four legs good, two legs _better_!" The exposure bothers some. (Why?)

Public cooperatives are a compromise that scuttles any advantage of a public option. For any who have missed the other discussions on health care on this blog, I again make the case for Medicare for all, and challenge anyone to find a single private option that touches it, on ANY of these points:

Medicare pays 19% less than private insurers, yet 97% of doctors (and nearly all hospitals) accept new Medicare patients, virtually the same percent (no statistically significant difference) that accept private PPO patients. Plus, according to the insurance industry itself, Medicare is 12% more efficient in terms of overhead. That's almost 1/3 savings (32%), which we desperately need right now to lower costs and improve coverage.

Further, Medicare has these features, none of which are matched by private insurance:

no eligibility requirements or physical
no exclusion of pre-existing conditions
no cancellation for excess use of services
no penalty for moving or changing jobs
no re-applying for coverage if moving or changing jobs
a stable, mature program known to both physicians and patients
no marketing cost
no sales cost
no commissions
no bloated executive salaries
no palatial executive suites
no corporate jets or limos

DLS,
Why are you obsessed with a push to drive smaller more fuel efficient cars? Do you enjoy dirty air, big parking lots and giving your money to Middle East dictators?

Obama is carted around in a monstrous vehicle because it's built to withstand threats on his life. Some other people have large families, or transport equipment around town. Those people need big cars and trucks. Most of the rest of us don't, and we should be pushed – through taxes or something else – to drive something more responsible.

GD -- if you can source that information, I'd be happy to look at it more closely and generate a unique post around it.

Here is some information regarding Medicare that would seem to refute GreenDreams' assertionis:

Two trends are converging: there is a shortage of internists nationally — the American College of Physicians, the organization for internists, estimates that by 2025 there will be 35,000 to 45,000 fewer than the population needs — and internists are increasingly unwilling to accept new Medicare patients.

In a June 2008 report, the Medicare Payment Advisory Commission, an independent federal panel that advises Congress on Medicare, said that 29 percent of the Medicare beneficiaries it surveyed who were looking for a primary care doctor had a problem finding one to treat them, up from 24 percent the year before. And a 2008 survey by the Texas Medical Association found that while 58 percent of the state’s doctors took new Medicare patients, only 38 percent of primary care doctors did.

from: http://www.nytimes.com/2009/04/02/business/reti...

Green Dreams has provided links to back this up in the past and they appeared to be legitimate, but as I said then it was wildly inconsistent with what I see in the real world and in the NYT article PWT references. I think the 97% referred to physicians taking new Medicare patients under any circumstances, such as if an existing patient turns 65 or they are obligated to while taking hospital call.

It's essentially impossible to reconcile 62% of primary care Texas physicians refusing to take new Medicare patients with 97% of physicians accepting new Medicare nationwide.

The numbers cited in that NYT article are more consistent with experiences of my mother and others in her age bracket of my acquaintance as well.

And consider that the 38% who will take on new Medicare patients are currently able to supplement (or subsidize) that income with patients who are privately insured or the few who self pay, and then consider what will happen when more and more of those patients 'choose' the public health care option or are eventually forced to if their insurer goes out of business or their employer stops providing a private option. Eventually the only possible outcome is that the government will have to start mandating the entire fee structure for the healthcare system, or we'll face serious shortages of physicians and have to resort to rationing of care.

At the very least you have to wonder what young person in their right mind wants to devote a decade of their life to train to become a physician these days. Even for those who are just motivated by a passion for medicine are going to have to be offered some damn good incentives (at least, a drastic lowering of expenses) to go to med school and then complete internships and residencies, and I see little sign that anyone pushing the expansion of public health care has factored in those costs to the taxpayers.

{for the record, I stopped by briefly this afternoon but probably will not have time to engage further in the discussion- so if I don't respond to a comment that refers to mine, it's not because I'm ignoring it.}

You got it, pete. BTW, feel free to slog through the pdf reports. You'll find THIS ppt (a html rendition of the powerpoint. It's much more readable in powerpoint and there's a link at the top of the page) accurately reflects its sources and is much easier to follow. Also, for those who want to see how we compare as a nation with other countries, THIS is a good summary. I know, I know, it's on the Daily Kos site, but it's loaded with interesting graphs. I've followed the links and they too are true to original source.

For a discussion of many of the conservative myths about health care, check HERE.

Specifics of the cost / benefit comparison. The data is from the Medicare Payment Advisory Commission, a Congressional research service set up under GW Bush as a part of Medicare modernization. This data is from their March 2008 report to Congress, available (pdf) from MedPAC

Medicare pays 19% less than private insurers, yet 97% of doctors (and nearly all hospitals, which are paid 25% less) accept new Medicare patients, virtually the same percent (no statistically significant difference) that accept private PPO patients.

Plus, according to the insurance industry itself (CAHI report pdf), Medicare is 12% more efficient in terms of overhead (16.7% for private insurers vs 5.2% for Medicare). That's almost 1/3 savings (12%+19% = 31%), which we desperately need right now to lower costs and improve coverage. [update. MedPAC has recommended this year raising the physician payments by 1.1%].

Further, Medicare has these features, none of which are matched by private insurance (I hope you don't need a link to the well known features of Medicare):

no eligibility requirements or physical
no exclusion of pre-existing conditions
no cancellation for excess use of services
no penalty for moving or changing jobs
no re-applying for coverage if moving or changing jobs
a stable, mature program known to both physicians and patients
no marketing cost
no sales cost
no commissions
no bloated executive salaries
no palatial executive suites
no corporate jets or limos

BTW, the MedPAC data specifies NEW Medicare patients, not existing patients who turn 65.

There is a truly weird disconnect here, in which everyone seems to get that we need to lower costs, but continue to argue that no one should make less money, not physicians, hospitals or drug companies. Yet globally, health care performs better without paying more. Further, public option opponents claim that if Medicare (or a public system) negotiates lower drug prices, it will hurt pharmaceutical innovation, conveniently ignoring the fact that ALL insurance companies insist on generic equivalents, thus denying the drugs' innovators the very profit that's claimed to be essential for future drug development. Additionally, European and Asian drug companies now outpace American firms (4 of the top 5), despite having been under government single payer systems for decades.

Doctor shortages? Projected by a physicians' group? How convenient. Meanwhile hundreds of qualified premed students, denied admission to limited slots in American med schools, go abroad and become doctors. Why? Not because they want to drive a BMW and rake in the cash. They want to practice medicine.

Wait a cotton pickin minute PWT. Are you using a derivative source? Look at the MedPAC June 2008 Data book. The numbers of people who had "no problem" finding a NEW primary physician under Medicare was significantly less (70% vs. 82%). That's the first year that's happened, and no telling if it will be repeated for 2008 or 2009. But the number of people who had a "big problem" finding a new primary physician was NOT significantly different between Medicare and private insurance.

The chart PWT refers to is entitled "Access to physicians is similar for Medicare beneficiaries and privately insured people." So if his point was to contend that MedPAC thinks the opposite, that is clearly not true.

Medicare pays 19% less than private insurers, yet 97% of doctors (and nearly all hospitals, which are paid 25% less) accept new Medicare patients, virtually the same percent (no statistically significant difference) that accept private PPO patients.

GD the study says that 80% of physicians accept "all or most" Medicare patients. To me this means that 20% do not accept "all or most". I think your 97% figure really is misleading. I can't find if they break down that 80% further to primary care or not.

What is your solution to insure adequate primary care physicians are available and what is your cost estimate? If we're going to pay for all their medical schools and residencies that's going to be pretty expensive. Even then what is the reason they would choose primary care over better paying specialties?

DaGoat, there is a breakdown of doctors taking new Medicare patients: primary care (97%) and specialists (88% surgeons, 92% proceduralists). The point is that there is no significant difference between Medicare and private in any of these categories except that both private PPO and Medicare are significantly better accepted than HMOs or Medicaid. As for the "all or most" that too was comparable to private. I do not see any further drilling down into the data, but unless someone can point to better data, I just do not buy the idea that doctors OR hospitals would close up shop if Medicare is the payer.

As for "doctor shortage" I don't think the problem is doctors fleeing Medicare at all. I talked to American medical students in the Caribbean. They worked their butts off to get into medical school in the US, but it's SO exclusive, and SO expensive, they couldn't. They were so determined to be doctors that they go to overseas medical schools, then American residencies and take the boards to become American doctors. I suggest that we crank up medical education, or even dish out some scholarships. But it doesn't matter at all whether we're talking private model, Medicare for all, co op or single payer. If we need more docs, that applies across the board, hence is not relevant to the decision today, which is simply "who issues the check?" As for "why would they become primary care physicians?" who knows? Maybe there's another survey out there that explores that question. But the fact is, totally independent of Medicare questions, some choose to be GP, some choose to be pediatricians, some surgeons. You'd think, as is implied in your question, that they'd choose the most lucrative practice. My friend, some people even choose to be teachers.

Another thing you might want to look at is the doctor monopoly on care. In many cases nurse practitioners or physician assistants could take on more, if doctors would let them. And, I know MANY cases in which nurses are making the decisions and doctors just signing off.

"Why are you obsessed with a push to drive smaller more fuel efficient cars?"

I'm not, obviously Objection is not obscession. Try again, Chris.

"Most of the rest of us don't, and we should be pushed – through taxes or something else – to drive something more responsible."

Vehicles? Homes? (Is ten square meters in a concrete block building "responsible")? Etc..

You're incorrect. There is no "should," nor are ideological or political goals or personal preferences inherently "responsible."

Thanks, GD. It's gonna take me awhile to get through all that -- but I do appreciate you taking the time and I will give it a serious, objective review.

"I suggest that we crank up medical education, or even dish out some scholarships."

If we were going to have government get involved, we could address something that is a problem in addition to the variation among general practitioners versus specialists (with so many students who seek specialties, and yes, future income does matter to so many students). A scholarship program could be used to address the relative shortage of doctors in underserved places (obviously there's a shortage there!) such as on the Great Plains and other rural areas, as well as old central cities (war zones). (Doctors are people, too, and have preferences and have places they'd rather not live or practice instead.) Such a scholarship program that addresses this could offer to pay expenses for education in exhange for say a four-period in an underserved area, or (or in addition to) spending one's residency there.