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« Respect for the Dead and the Reality of War | Main | Michael Winship - Let's Make a Deal: Beltway Edition »

Assessing President Obama's Health Care Speech and Ideas for Reform

(Photo by Robin Holland)

This week on the JOURNAL, public health expert Dr. Jim Yong Kim, who is also the incoming president of Dartmouth College, spoke with Bill Moyers about his vision of health and educational reforms for a better future. Dr. Kim commented on President Obama’s health care speech and the Republican response, and offered his suggestions for reforms that would benefit America’s dysfunctional medical system.

“As a speech, it was really stunning and masterful... But what was most interesting to me was the Republican response afterwards, and how many things that they seem to agree on... One, everyone should have health insurance. Two, we need to lower costs. Three, we need to maintain quality, [and four,] that the expenditures right now in health care, especially public expenditures, are unsustainable... There's no simple solution to this problem... For many, many years, we've been working under the fantasy that if we come up with new drugs and new treatments, we're done [and] the rest of the system will take care of itself... What we've learned about organizations is that it is very difficult to get a complex organization, a group of people, to work consistently toward a goal... What we need now is a whole new cadre of people who understand the science, who really are committed to patient care, but then also think about how to make those human systems work effectively.”

What do you think?

  • Did President Obama’s speech lay out a practical and substantive vision for health reform in the public interest? Why or why not?

  • Do you agree with Dr. Kim that health reform requires more deep thinking about the delivery of care? Explain.

  • What neglected health reform ideas do you think should be included in health care legislation?


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    Comments

    While surfing Bing I clicked on your link...very interesting! I enjoy reading about this type of stuff. I'll definitely bookmark your site for additional review

    Michael Bergeron,

    Single payer, or Public Option doesn't make a difference. You Americans don't seem to understand the Term " Care for your own people". Please find out from the European Countries who are doing this. At lease find out from the Canadian people what Medical coverage for the people are. They don't spend their money on Film Stars or Hollywood or even Unjust wars. This is your problem. No other country has this kind of problems.

    Nice to have met up with some Canadian friends last night...big hugs...worried faces...conversation tuned to immediate problems to get them out of the way so that "healing" could occur through simple pleasures like dinner and dancing...

    Canadians, "We are shocked at what has happened! How could they take taxpayer money, so much of it!, and give it to Wall Street?!"

    Canadians, "The reason your health care costs are so expensive is because you are asked to pay for the actual health care and for non-health care providing "insurance" companies."

    Yup, the only economies who will be copying USA economy are bound to be fellow idealogical "terrorists" against their own people...

    Live long and prosper...

    Help Care wrote, in part, "It's easy to see that the corporate health insureance system is trying to protect their profit margin."

    It's not that simple...it's about establishing the only river of CASH left that can be updrafted into the pockets of the 1% elite BY LAW...as noted by Grady, the "undergound economy" of vice and slaves for sale is the corporate "competition" for CASH.

    Our HUMAN BODY is being held hostage for ransom.

    This is all depraved. Details to follow in the "health care" bill...thanks to those still working at NO VALUE added "jobs" crunching the numbers.

    Michael Bergeron: Didn't you know: Moyers has been a hostage for 47 years?

    He can't even say "Medicare for all" (or "9/11 Truth" or "I know who killed both Kennedys.") on the air. What do you think would happen if his tongue slipped? (Goodbye foundations and sole corporate sponsor.)

    Taxes are the price we pay for a civilized society.'You get what you pay for'. Quality health care is a necessary service. The profit driven health care system is a complete disaster. There, I'm glad I could help solve the problem. It's easy to see that the corporate health insureance system is trying to protect their profit margin. If we have to fumble along with a public option, until we can implement a single payer plan, because of the funding of extreme right wingnuts, at the publics expense, then that's what we have to do.
    pass along my tune.
    http://www.youtube.com/watch?v=4y08uJ42X48

    Dear Bill,

    I do not understand why you point Obama to Josh Marshall's piece on the public option. You give strong and convincing words towards advancing the human right of healthcare. I was eager to read Marshall, yet he seemed to create the same weak argument that Obama produces. I was expecting to hear the exclaim of Single Payer and Medicare for All and all of got was watered down rhetoric. Do I have it all wrong about you Bill. Are you for public option band-aids or a single payer cure. Please let me know where I have read you wrong.

    Signed,

    A loyal fan

    An alternate way of enforcing the INDIVIDUAL MANDATE to purchase healthcare insurance.

    I counted about 6 or 7 comments about the individual mandate. Nobody likes it! The Democrats are going to pay a huge price if the subsidies to low income healthcare insurance purchasers are not high enough. And the Republicans are going to make hay out of it anyway. Why not do it differently!

    Instead of the politically risky individual mandate where the government fines those who do not purchase healthcare insurance, why don't the Democratic leaders opt to simply legislate that insurance companies cannot discriminate on the basis of pre-existing conditions, et cetera, except when the applicant has had a break in insurance coverage of 180 days or more. In other words no underwriting allowed by private insurance companies as long as one has been continuously insured by a private insurance company, or a private charity, or a government healthcare insurance agency, or other government institution with no breaks longer than the maximum time needed to apply for and obtain replacement healthcare insurance (with a 'safe harbor' guarantee that 180 days or less to replace discontinued insurance is automatically considered qualify as 'continuous coverage'). Then everybody still free to choose what they want to do without government interference, it will be left to chance and the insurance companies to "punish" those who are stupid enough to not purchase affordable healthcare insurance. I think that would work a lot better politically for the Democratic Party.

    PS: I hope everybody read Drew Westen's latest HuffingtonPost blog.

    Dr. Kim’s discussion was a contrast to the image Tracy Kidder’s “Mountains Beyond Mountains” evoked in me. The book did not arouse respect in me for the pharmaceutical industry, with whom much wheeling, dealing and submissiveness is required to convince them to even so much as throw a bone to the poor. It has been a few years since I read it, but some things mentioned hold a worth beyond “rocket science.” Especially meaningful to me was the mention of a slogan in a Cuban airport—“the only real nation is humanity.” I consider ‘our humanity’ to be an equal conscious component of all people. It is an ability to feel a sense of responsibility: to find and express a personal talent; and direct efforts toward the welfare of other people. These are the fuels that drive the human rockets we call celebrities; and where common appreciation lies. The Dr. Paul Farmers can’t be cloned; can’t be reproduced in the classroom; can’t be created through any intellectual formula. The beauty of President Obama’s speech was in his pensiveness on just two words from Senator Ted Kennedy: AMERICAN CHARACTER. What is American character, but an expression of our humanity? How did we regress to the belief our growth and prosperity came ‘down from above’? That it came from any thing other than our respect for personal worth; than the freedom of people to follow their own heart?

    One could wish that Obama would have waited and done nothing for as complicated as this has become, doing nothing is best, for now.

    Thank you.

    Posted by: JJ


    Nice try, JJ.

    If people do not want to do the work, then leave.

    The DATA needed to solve the problem is available - granted like a billion piece puzzle in a box, but that's just how the "perception is reality" illusionist's artistic BIG PICTURE has been presented by corrupt politicians who never had any intention of doing the right thing.

    Amiable and incisive JJ: So correct on a Medicare for all strategy. But Obedient is prohibited from mentioning it by his debate coaches. Who are his debate coaches anyway, JJ?

    Yesterday our man President Obedient told a crowd of college students why they need hospitalization insurance. "You're already deep in debt for education;"he says (paraphrase),"How'd you like another $50 thousand in medical bills piled on top of that? If you're sick or hurt without insurance, that's what will happen!"

    The Democrat Obedient has mastered the right wing technique of half-truth. For not once did he mentioned that if a student had worked one day, that student had already been paying into Medicare, a "socialistic" program the student might not live long enough to get. Naturally, as a person only months from eligibility, I think Medicare is a pretty good deal for me. It has kept millions of retired people healthier and out of poverty for over 40 years. In this last recession a lower percentage of the retired elderly fell into poverty than any other age group, including little children and students. It is so popular it will never go broke as long as the United States continues. But I must tell you the other half of the truth. Medicare is age discrimination pure and simple, because by rights, everyone should have it, not just older Americans like me. Every worker already pays.

    DO NOTHING FOR NOTHING IS GETTING DONE, ANYWAY. WAIT UPON THE LORD.

    It was a sharp, painful moment in American history when Joe Wilson yelled, "You Lie." And that's what folks seem to remember from Obama's talk on Health Care.

    The next scary moment was the law to require all uninsured Americans to pay health insurance -- for wouldn't this be a huge boon to private insurance? not to mention the additional loss of a liberty for those Americans uninsured.

    What a mess.

    At first, it all sounded wonderful, for example, making pre-existing conditions against the law, but after the restrictions put on private insurance companies, and the distractions, the speech fell apart.

    As it was, it was like a trade -- public option in return for restrictions on private insurance companies -- a trade where the American people lose either way.


    It later occurred to this viewer that 1) there was no bill to show because Obama had been waiting for a bi-partisan created bill, and 2) If Single Payer or Universal Health Care were taken seriously, it would at once take care of all of the legal restrictions mentioned in the first part of the speech for private insurers.

    The public option did not sound public (but private) and it did not seem an option (but a requirement) if put into law, benefiting the private insurance companies most.

    Hope this viewer is wrong about that. Is this a start in the right direction? Who knows?

    And what about Medicare and simply lowering the age to receive Medicare from age 65? This would be the simplest thing to do. Obama stuck with original Health Insurance Reform plan. Guess he doesn't read the blogs? or Letters?

    One could wish that Obama would have waited and done nothing for as complicated as this has become, doing nothing is best, for now.

    Thank you.

    "WHAT DO YOU THINK?"

    "Over 1 million students are homeless!"
    Getting into more debt" for "More education," is no guaranty...!
    "Have a million jobs being lost weekly" is no hope, comfort for the heart and soul.
    "How many are in risk of becoming homeless?"
    "45000 die per year because of no HEALTH CARE insurance!"
    Of course, we hear a lot of "human rights violation in other countries!"
    "A harm done by professional do gooders can be considerable when place themselves
    as gods and enforce their will and views on others!"

    Seriously, this is such a stupid, half-wit debate. Here's the problem with that utterly motarded statement by Wilson. If UNDOCUMENTED WORKERS show up at hospitals bleeding to death, they will be treated, not left on the side of the road to die, but it won't be free. Problem is, HOW DO YOU BILL AN UNDOCUMENTED WORKER!?! If the goofy extreme right fringe weren't against anything and everything their brain washers tell them to be, in the name of their corporate sponsors, including immigration reform, we could get these people out of the shadows, paying taxes, accountable, and FREE like we're SUPPOSED TO BELIEVE IN!

    Cripes, how do you people even get your shoes on in the morning without someone telling you to breath in and breath out?

    Jack;Please excuse my misspelling oversight.I know you've seen me spell that word correctly in the past.It's just that cheap trick of calling everyone "racist"or"neo-confederate" all the time is every bit as tiresome and offensive as many of the slurs I will not use when speaking to you.'Just trying to get you to class up a little here.I would rather be called paranoid than victim.I'm just trying to get people to see what is written in the bill.If they choose to not believe their eyes,that's up to them.Thank you both for responding.

    Jack Martin wrote, in part, "Using imagery of the "worthless colored immigrant" to deny our citizens needed health services is exactly what I would expect from selfish- sadist corporate clones. Racism itself is often used as a stalking horse for classism; our primary domestic injustice."

    Cherry-picking history is only ethical if you are writing a work of "fiction" - literature's definintion of fiction.

    In the past, "immigrants" were checked at the gate (actually they were held in QUARANTINE for up to a month, if needed) to ascertain their true state of health. Screened out were leprosy, tuberculosis, etc. - infectious diseases and plagues. Don't know when someone made the argument, that others bought, that QUARANTINE is a discriminatory practice. I still see it as a necessary aspect of the "medical arts" - how can you argue for some kind of "preventative medicine" without the occasional need for a quarantine until the disease is cured, or banished as an epidemic threat?!

    POLITICS is what has become sadistic and, therefore, stupid from a science standpoint. Science is to be used in service to the human being and everyone should be "free" to use science to MAINTAIN the necessities of food, shelter, defense, infrastructures, etc.

    It's NOT about "classism", "racism" or any other "ism" that social engineers are going to invent with fantastic thinking - it's about SLAVERY. Sadists do NOT want to have any other kind of relationship with "humanity" other than to use them as "slaves". You can call it "volunteerism" - the volunteer class and the needy RULING class - how's that? But it's still slavery. The DELUSION is that the least competant (needy rulers), through magic word PCism, will be SERVED by the most competant. Delusionsal and suicidal in final future outcome...

    They're not going to Switzerland, they're going to Poland. The city guide given to guests of the Polonia Hotel in Warsaw, Poland listed 9 pages of "gentlemen's clubs" in the city - I think the Las Vegas brochure might not even have that many...anyway, a sure giveaway (travel guide) that the pigs are coming....

    And the sign of protest in Stare Miasto was, "Is Poland to become the next Palestine"....? Country is being turned into one big Holocaust Museum...

    Another "proxy" fight against Russia in the works...? Backdoor to Iran...? Really?

    "Practical and substantive vision for health reform in the public interest? "


    The "VISION"of the intent of the proposed "health care plan" is to "REDUCE THE
    RANK of UNINSURED by 29 millions over decade." A convenient method to maintain
    "status quo plan" for DECADES.
    Of the 49 million uninsured the other 20 million are not even considered!
    It all depends whose son, daughter, mother, father etc. is or will be not
    considered as important!
    The "TEA PARTY DEMONSTRATORS... in Washington opposed THE GOVERMENT
    take over of HEALTH CARE." One can only assume, their tummy and bellies are full
    and have insurance!
    It is the only "insiders rules" of "oligarchy" for self interest placed in effect. The rules for
    "interest of common welfare" have been denied as people are "outsiders!"
    The outsiders have been denied to participate in the process, to express
    "THEIR WILL on ALL ISSUESS!" Had the outsiders had inherent right, to participate
    in the process on issues, the health care issue would have been decided by the
    majority of the people, and not by the "oligarchy!"

    Lee, yes you’re right. The Senate requires 60 votes to create a filibuster proof bill. But what about budget reconciliation acts? They only require a majority vote. So, since the neo-confederates had used them to protect and enhance the greedy, shouldn’t the Dems be allowed to use them to serve the needy? This sound fair, doesn’t it?
    http://thinkprogress.org/2009/03/24/budget-reconciliation/
    http://healthcare.change.org/blog/view/whats_the_deal_with_budget_reconciliation

    Just because the Dems gave the neo-confederates a month or two to define (swift-boat) HR 3200, it doesn’t mean this death panel propaganda is true.
    http://factcheck.org/2009/07/false-euthanasia-claims/

    From what I read, the National Medical Device Registry appears to be procedures for keeping track of devices (an inventory for the devices). RFID chip might be Class II devices, but this section pertains to tracking devices, not people. And even if all this RFID paranoia was true, I can’t see why it would bother the neo-confederates. They’re not worried about wiretapping and torturing Americans, are they?
    http://medical-dictionary.thefreedictionary.com/class+II+device

    Lee: You might learn to spell racist (rasist?) before harping on my pointing out of the obvious. Using imagery of the "worthless colored immigrant" to deny our citizens needed health services is exactly what I would expect from selfish- sadist corporate clones. Racism itself is often used as a stalking horse for classism; our primary domestic injustice.

    Concerning various legislative bills:The American public has been completely "educated" by corporate advertising and infotainment. I think it is good that Lee can read HR3200 and other bills, but to selectively quote and then to insert your boogeyman conspiracy theories is unfair to other correspondents. (It shows an easily manipulated personality.) No specific bill has yet been finalized. If we had a better democracy without corporate clout (bribery and revolving door collusion) public need would miraculously write a better version. The problem comes when the bribees do something procedural in the dead of night.

    Actually President Obedient (compliant to the needs of corporate citizens) has the strongest point: Health care costs are overwhelming our economic means: bodily extortion, like being mailed your own ear or finger. Only a diabolical sadist could have designed the medical system that has evolved through greed and corruption. As Andrew Weil said yesterday on the Diane Rehm Show: Medicare for all would be only a first step in reform.

    Lee might agree that our government is not to be trusted in its present form. I sometimes ridicule upper middleclass advocates of campaign finance reform. My analysis shows that the primary flaw in our system lies in the runaway corporate charter and that executives, and large investors too, must be held accountable for business actions and policies. Corporations are a vehicle that limits the risks and responsibilities of those holding great wealth. That is their primary purpose. (Notice how this parallels with the tendencies of "tort reform" (liability) that would sets limits and caps making dimwits and butchers unaccountable? Who would want a "laissez faire" physician not accountable for mistakes?) These oligarchs are the very class of people we should expect to take a greater responsibility for the health of the government that creates the order of law and security, and even currency creation, that makes their "success" possible. Recent actions reveal a state of panic that shows them packing to potentially leave a collapsing nation. (How do they think they'll fair out there in the cold, cruel world of Switzerland and the Lesser Antilles?)

    Thankfully it is the people who do the necessary work (including medical providers)who create all value, and we have done so repeatedly.

    David F,It may not be as simple as you think.I believe the 60 vote level in the senate was established for some very good reasons(to insure anything being passed into law would have a reasonable margin of acceptance,popularity ,and support).If HR3200 is the bill you are talking about and it is passed with 51 votes,we will be fighting over it until it's reversed.I am one of those "uneducated citizens"of which you speak,but here are some things you might consider.If you get your copy of HR3200 and start reading on page429 line6 you will find reference to a document described as "an actionable medical order" which may be signed by someone with as little authority as a "physician's assistant"(line 13).This order may authorize witholding of liquids and or nutrition(page 430 lines 16 and 17)I hope you do not find yourself in that situation someday.(There is no provision to verify that this is actually your wish.)I'm trying to keep this short,so I won't go into all the details about what you will find beginning on page 1000 about electronic medical devices that are implantable (RFID chips are class two medical devices)which may be used for surveillance or other purposes as determined by the Secretary.If this were law it would establish the national registry and a path to citizens being chipped.I'm not ready for that.

    MISCHIEF DAY, Fri, Oct 2nd

    The only way to show politicians we mean business is to FIGHT BACK

    Until Lobbyists can no longer purchase our Senators and Congressmen, we will have no Health Care or Wall Street Reform. How do we do that?

    Don't go to work or spend any money on Friday, Oct 2nd

    If that doesn't get their attention we do it again, and again. And again

    Yes Grady, Medicare for all.

    I’m so tired of these neo-confederate obstructionists (both Congressional and uneducated citizens). I could understand if they had any half valid view points, but this is far beyond ridiculous. The Dems need to ram this bill through and if it gets filibustered, fine, then just pass a Budget Reconciliation Act. It’s that simple (I think). So, what are the Dems waiting for?

    What we need is a list of all the obstructionist Dems. Then we can make them choose: employed representatives of The People or unemployed representatives of The Greedy.

    The 'real plan' may have been to enrich the HMO's and ram the latest scam the 'Individual Mandate' down our throats.

    Lets look at how it went down, after all, it is quite a change from what they promised

    From...Socialized Healthcare for All Americans paid for by the rich.

    To...You (uninsured Americans) MUST buy healthcare insurance or you will be fined a penalty of thousands of dollars. (Up to $3800)

    [url]http://www.washingtonpost.com/wp-dyn/content/article/2009/07/21/AR2009072103410.html[/url]

    Do you agree with Dr. Kim that health reform requires more deep thinking about the delivery of care? Explain.

    Yes, I agree.

    Caught one of those pharma commercials on TV yesterday and it got me thinking, if not “deeply” but certainly technically. I never learned the secret math formula in school that could present the boatload of freaky “side effects” (AKA as “risk”) that accompanied the drug being advertised on TV for the management of “depression”. Might need to take a few brush up courses in the local community college, but now I’m scared to be a student because of what happened to Annie Le (“….who would want to hurt someone as nice as her…?”) at Yale…blind ambition and big pharma bucks certainly could corrupt ethically immature minds.

    But back to the “risk” math….”normal” healthy people in their 20s, 30s, 40s and even 50s and 60s, would never evolve a sudden onset of ANY of those “side effects” that happened when some people took that “depression” drug! And compound the “risk” factoring with the fact that a certain amount of the undigested drug enters municipal water supplies along with so many others theses days so millions of people are ingesting micro doses of “risk” profile drugs we don’t need or want, and it seems to me that the “risk” factor is NOT being calculated properly in drug development.

    Also, since there are so many approved and experimental drugs available as choices for managing “depression” (just when there is a financial “depression” in full swing, go figure the mind body connection there, huh?), shouldn’t any NEW drug being approved have the bar raised for “efficacy” rather than lowered? Meaning that if other therapies are available, why should such a, basically, unnatural boatload of sudden onset side effects profile be approved in the first place?

    Certainly MDs can start putting their money where the “healor” in them directs them. You’ve got the “power”.

    Sticking to my theory that ALL the math that should be included when calculating “costs” is NOT being included as part of the reality of “costs”, President Obama might want to have some math geeks over for beer and poker – thse geeks who are re-attaching the human being back into the economic “profit” equation that EXCLUDES MAINTENANCE (health, infrastructure, housing, etc.) and replaced it with “built in obsolescence” (AKA “jobs ain’t coming back”).

    A PERFECT amount of sunlight to support life was something even loveless “atoms” did without a whole lot of “ethical” grandstanding. Surely we can think deeper than an atom?

    There’s a certain irony in how much personal and profession risk there is in talking about math formulas that calculate “risk”….not a ha ha moment, although I’m sure a dose of sarcastic humor will be had by both the “norms” and the “paths” (socio and psycho). God bless America.

    Jim Yong Kim, in the beginning of the interview, stated:
    You know I work with Paul Farmer.... and he's one of my heroes and my closest friend in the world-

    Well, Paul Farmer is featured in a DVD called ¡Salud!
    which is an amazing documentary on the worldwide effect that Cuban medicine has made.

    I somehow knew that Cuba would not come up in your interview with Dr. Kim.

    Could this be a case of self-sensoring?
    What would happen to Bill Moyers' Journal if you covered ¡Salud! as it applies to medical practice in the third world?

    Do you ever publish your answers to these queries? Or write back to the person who writes to you?

    Posted by: Carole Lieff, "What, besides complaining, are you doing about these things?
    Put Your Money Where Your Mouth is?"

    Millions of people have put their "money where their mouth is,"
    only to learn that their funds were not save in institutions that were
    created by a corrupt "dysfunctional government!" These institutions
    placed themselves as gods - "debtors in possessions!"
    In"Socialism," "Fascism," and "Debtors in possessions," the rights of the
    people, funds - money, property... etc., have been confiscated - suspended!
    A corrupt "justice system," it turned blind eye as the corruption, bankruptcy, lies,
    bonuses were on rampage - Indy Bank, Lahman Brothers... LBHC, Washington Mutual
    Investment, AIG, School districts etc.
    The question should have been directed to the "armchair philosophers"
    - tyrants, liars of the "dysfunctional government," that had violated the constitutional
    articles, plunge the country into "eviction, depression, war on fouls pretense,
    and a system that denied affordable health care plan for ALL!"
    Do not stand too close, as I stand and use a pitch fork to shovel...
    "The people are obedient... , in the face of poverty... starvation...war and
    cruelty.... Howard Zinn."
    "The truth as always it hurts!"

    Other than complaining in a blog, what has any of you armchair philosophers actually done?

    What, besides complaining, are you doing about these things?

    Put Your Money Where Your Mouth is

    Carole Lieff

    Just keep calling everyone RASIST until no one listens anymore.The mouth speaks the abundance of the heart.Jack Martin.Is there ever anything other than race on your mind?

    David F.- So goes the escalation of weaponry in a hard-fought struggle. And what are they fighting over, the contributions generated by big insurance and big pharma and provider lobbies. The suffering People with their nasty diseases and idiotic injuries (generated by exploitive conditions) are an afterthought. Every "condition" is just a buck to be harvested. Why not Medicare for all? (health hurts profits, cuts into the GNP)

    Today on Olbermann, in reference to a Public Option, Senator Reed said if they couldn't get 60 votes in the Senate, then they will use the Budget Reconciliation Program.

    Here's a link showing how the neo-confederates used it: http://thinkprogress.org/2009/03/24/budget-reconciliation/

    So BG would prefer a car that gets 12 miles a gallon to one that gets 40 miles per gallon because the clerk at the gas station is underpayed. If this reasoning seems sane then your head may have sprung a leak. And why in Hell are you worried about profiteerng insurance corporations BG. One might think you were an "insurance man" or an investor in such corporations.

    The bottom "bottom line" is the duplication in billing and the corporate profits derived from sick and hurt people. Don't worry, the doctors will get paid. Maybe we need to subsidize education for general practitioners.

    Some people blame our bad health on diet, and others on environmental pollution. They're correct. But isn't it the same corporate profit model which spoils health care by parasitism that causes us to be unable to improve the American diet and environment. Look for the "BIG SOLUTIONS" but start with Medicare for all. Whatever it costs it costs, but in the long run it will promote better health and be cheaper than the predatory sadism we suffer from today.

    The problem with Medicare Buy-In or Medicare For-All is that it ignores the simple fact that Medicare severely underpays medical providers. My understanding is that the cost of these underpayments is then shifted to insurance companies and uninsured/under-insured patients.

    So, if everyone shifts to Medicare, who is going to pay doctors and hospitals? Obviously, this would drive the quality of service down.

    The real problem is that we are like blind people trying to describe an elephant - every one of us only sees a small part of the problem.

    Unfortunately, even Bill Moyers' program does not provide an unbiased full picture of this issue.

    Step away from the lofty rhetoric and you'll see that Obama's speech, sans the jabs at Republicans, could have been delivered by a Republican. It was really that bad from a policy standpoint.

    The reality is Obama and the Congress Dems have sold us down the river. As mentioned by a previous poster, the folk at PNHP, specifically Kip Sullivan have done a yeoman's job exposing the severe deficiencies in the plan, impediments so great they are beyond repair with the currently conceived public option. The best part is that they rip apart the plan, piece by piece without ever mentioning the words "single payer."

    Read Kip Sullivan's papers as posted by Dr. Coates: http://pnhp.org/blog/author/andrew-coates-md and you'll see there is no possibility for incrementalism. This is a plan that can only be fixed by repeal, which the Republicans will pledge to do as they run for Congress in 2010 and they'll win big on it.

    Additionally, those who argue taking an incrementalist route ignore that the Democratic Party hasn't had majorities this large in both Houses of Congress and the White House in 45 years. This type of opportunity comes around once every 2-3 generations and we're squandering it, all because Democratic politicians are addicted to grabbing defeat from the jaws of greatness.

    And greatness is so easy to obtain. All the president, Pelosi and Reid need to do is go before the cameras and say, "Instead of that whole public option and exchange thingy, we're going to allow everyone the opportunity to buy into Medicare. If you don't want Medicare you can keep your private insurance."

    A Medicare Buy-In program (which is different from single-payer) in lieu of the public option and with the five major provisions Hacker had for the "public option" (open to everybody, auto-enrolling all Medicaid patients, subsidies only for those in the program, etc.) would be something Democrats could run on for a generation.

    It's a plan so popular you could bet on a good number of Republicans voting for it. Just as they did when Medicare was passed in '65 a good number of Republicans will vote for it after they loose their voice bad mouthing it, because they'll want to be associated with the most popular piece of legislation to come out of Congress in more than a generation.

    Paid for through premiums and with subsidies for those who can't afford it, a Medicare Buy-In program makes Medicare more solvent (ending the need for medigap) by creating a risk pool filled with younger and healthier people. It would also be an instant economic stimulus as plans could be offered at a fraction of current insurance rates - rates so low that corporations and business across America would flock to it.

    It is simple to understand and would be something that Democrats could run on for a generation. Yet in Democratic Party fashion they're so near-sighted they can only see the campaign donations going to themselves or their opponent in the next cycle, and the progressive movement proving their total uselessness have done absolutely nothing to try to talk democrats off the ledge. And on the ledge is exactly where the Democratic Party is right now. Because instead of talking about allowing anyone to buy into Medicare, they're talking about proposing a public option that is firewalled and set up to fail (again just read Sullivan), and a mandate to buy private insurance. It's political suicide.

    This is an amazing blog/comment site. I have rarely read such a wide mix of brilliant, modest, and absolutely ignorant comments in one list. It certainly is easy to differentiate the thinkers from the rigid; but it is a frustratingly long read to see the balance in democracy.

    H Delany wrote, in part, "I personally would ask the medical industry to solve its IT and related "systems" problems themselves at their own cost. Every other "business" in the world has had to make these investments to stay in the game."

    Being polite and just stating a fact, but you really do not know what you are talking about.

    The reason "costs" kept going up in health care is because the investment in STUPID, non-useful "technology" - billions of $$$ - was passed on to YOU.

    Neo-abolition policies would correct most of what we are suffering. The place to start is in adopting universal medicare for all Americans as a right. We are holding the world back. Partners in Heath utilizes selfless providers to care for indigent populations. It is these populations that bear the brunt of our inaction, and they who are fighting for our rights by resisting monstrous corporate policy wherever they live. Paul Farmer sees medicine as a primary form of politics and has described the crimes of government dominated by global corporate needs. Jim Kim knows these things to.

    As a Neo-abolitionist I propose the deconstruction of the corporate model to facilitate the disbursement of accumulated holdings and level the human playing field. My main hope is the end of wage slavery on this planet. But first we must prove that is possible by starting with Medicare for all. It is the doorknob that can take us beyond adulterated and manipulated food, a spoiled environment and the sadistic stresses stored in human genes over generations. By not confronting corporate power and turning that knob we embrace the death of this planet. Don't let the hard-hearted wealthy retard needed solutions and technology any longer, or use the corporate form to avoid accountability.

    I know there are immediate fears. I too fear the attitude of compensated throwback racists like Congressman Joe Wilson, and the crooked bought power commanded by President Obedient. It is too late technologically for armed insurrection, so we must move, boycott, strike and speak together.
    Talk amongst yourselves because the time is close.

    Dear Mr. Moyers,

    I thank you for your wonderful programs and inspired commentary.

    Re Dr. Kim's "take" on many issues, I would like you to follow up with some unasked questions:

    1) who is really paying for third world pharmaceuticals? I believe the answer is we the Americans. As an example, I know that the Italian government (and Italy is NOT a 3rd world country) will not allow American pharmaceutical companies to charge Italians what they charge us for, say, Lipitor.

    When we have people dying in this country because they can't afford the doctors and medicines they need, this is wrong.

    Why should we Americans subsidize the health of every other nation, including our allies?

    Shouldn't our government be standing up for us?

    2)I think "IT and Systems Management" are sorely needed in the medical infrastructure to increase efficiencies, ensure accurate data etc. But medicine, and its practice, is not entirely subject to this kind of "rocket science" application of systems and metrics.

    What about the quality of care? All the efficiency gains in the world won't solve the question of quality care at affordable cost for all.Doctors, too, need to be held accountable to ensure patient care. They are the most protected species on earth. Outcome measurements are important, but they are not the only measurement of what will work for any given patient. Medicine when practiced properly is an art, and it is this aspect that needs to be preserved and enhanced if CARE is to be retained in the whole equation.

    I personally would ask the medical industry to solve its IT and related "systems" problems themselves at their own cost. Every other "business" in the world has had to make these investments to stay in the game. Why not hospitals and doctors? This much needed overhaul should not be on the backs of the taxpayers. Nor should the taxpayers who are all potential patients be under delusion that these investments are going to necessarily provide better CARE.

    3) Most importantly, you neglected to ask Dr. Kim if 3rd world countries have insurance companies? I don't believe they do. It is my guess that health care outcomes are much easier to improve with bona fide medicines, caring doctors, and a straight path to the patient without profiteering middlemen.

    I would like to see you include in your airing of the health care debate a panel of real front-line doctors in THIS country, and what they have to say about the role of insurance companies in the care of their patients.

    Thank you for listening.

    When President Obama, during his recent speech before the Joint Session of Congress, ackowledged Republicans' desire for tort reform, the members of that rowdy party gave him a standing ovation. Their low esteem for trial lawyers is no secret, and they've long been advocates for tort reform across the board, including to protect powerful corporations that destroy environments and the health of communities.

    What I've never heard when reform of laws that allow malpractice suits against physicians is discussed is what the responsibility of the American Medical Association is. I and my family have suffered from malpractice by doctors. We didn't sue, and it's highly likely no attorney would have taken the cases. A trial attorney once told me that a malpractice suit must be based on treatment so egregious as to be the equivalent of amputating the wrong leg.

    My mother was misdiagnosed for years. Our family internist told her that her symtoms were due to "stress," i.e. they were psychosomatic. She was eventually diagnosed with breast cancer, from which she eventually died.

    I was also told by an internist that the pains in my side and up my back I reported were due to sympathy for my mother, who was dying from breast cancer. On the third or fourth opinion I sought, an internist finally ordered the right tests and diagnosed gall stones. The surgeon later told me he had never seen a gall bladder so chock-full of gall stones, and that I obviously had a very high threshold for pain. The truth is I had almost died from a gall stone attack, but, because I was capable of going to a doctor and calmly and articulately describe my symptoms, I was taken for a hypochondriac. I had described, the surgeon explained, textbook symptoms, therefore they thought I had gotten my symptoms from a textbook.

    I once visited a gynocologist whose manners were cruel, to say the least. He, too, was a misogynist. I learned that he was also a severe alcoholic and had a couple of DUIs to his credit.

    Many of us have had similar close encounters with bad physicians that resulted in near-death or even death, bad doctors who deserved to have suffered monetary losses due to their irresponsible misdiagnoses and abuses, if not to have lost their medical license.

    What I never hear considered in these discussion of health insurance reform is the fact that the AMA protects physicians who shouldn't be practicing, and that the AMA's irresponsibility is at least part of the reason that physicians have to pay large malpractice insurance fees.

    Where is the responsibility of physicians and the AMA to prevent malpractice by weeding out bad doctors? Instead, they blame the patients who have suffered at the hands of doctors who made grave errors, saying they had no right to high rates of compensation, and they blame another professional group--trial lawyers--for their plight.

    It seems so...unprofessional. It's but chauvinism at its worst.

    Another professional organization has been reluctant to take responsibility for the actions of its members. The American Psychological Association has been very slow to condemn the complicity of psychologists in the U.S. government's torture program. I've heard little about any action by the AMA against medical doctors who have participated in tortures.

    Where is the responsibility of the AMA to make certain that the U.S. doctors "do no harm," and that their advocates in congress do no harm to patients who have been harmed? Republican congressmen are not only standing in the way of all Americans having the right to health care, they would also like to diminish their right to compensation for harm done to them by harmful physicians.

    President Obama has shown that he's willing to compromise our right to healthcare to the extent that the greedy are unhappy only because it's their condition to want more than everything, to the detriment of others, and we--the others, the patients--are still the last ones to be considered.

    If President Obama's health insurance reform bill is to include tort reforms, the public debate needs to encompass that as well.

    We need to have a Treasury Secretary that understands economics well enough to understand that it is the demand side of economics that supports the supply side of economics. What we need is a positive tax system that supplements workers incomes to provide them with cost of living incomes that provides them enough money to buy health insurance, support their government, protect the environment and invest in the supply side of economics.
    The objective of money is to provide the exchange of goods and services. Without the necessary money to support the society; the society is unable to maintain its obligations and the people suffer.

    Dear Bill,

    I admire your program and your intelligent way of analyzing the news. However I think that there are a lot of things that you are afraid to talk about, even though deep in your heart you might beleive that they are possible. You still talk about Bin Laden as if you are 100% sure that he is alive. As an intellegent journalis, you must know that he is dead, but never mention it on your program. Why is every one so afraid of talking about the truth. Why are you afraid to invite David Griffin to your program and talk to him about his point of view. I like to ask you to go the a website called sign of the times.net and read some of their articles and may be talk about them in your journal.

    Obama speech was excellent and in sufficient detail to leave the house and senate to fix the details accordingly. Its not his job or the White House to write detailed legislation as is often called for.
    If it was weak, it was not defining where he stands on the so called public option or "Federal Coop" ( state coops will be eaten alive by the private market) and still leave some without cover.
    The cost issue is upper most in people minds ( QED increasing the deficit) He should have made clear that raising income tax on those jointly earning more than $500K per annum and the removal of tax breaks on cadillac plans, or plans where the Employer and employee combined exceed $12,500 each, up to that level tax deductible over that not.
    The Mal practice review has to go ahead along with proper control of drug costs to both the private market and Federal coop, why are the same drugs frequently twice the cost in the US versus say Canada and Europe,
    That is not sustainable, and must be dealt with in any reform plan or bill.
    Then National individual comprehensive medical records moving with each individual from "thier chosen physician" is a major cost reducer over 10 years, and you can minimise set up costs or help physicians and clinics with intial set up costs to speed up that process.
    One other idea worth considering is that In Japan
    Companies are obliged to pay for each full time employees annual medical.
    Under 40's quite cheap $60 over 40's more extensive in content and $90 and its tax deductible to the company and effective preventitive care. Retirees get 30 % of the cost from government and 30 % from medicare and Pay 30 % themselves and you decide whether to take or not.
    Hope I answered the questions.
    Regards,
    Hodgson.

    While on the subject of our social ills, why is no one, NO ONE, addressing the more than egregious problem of Internet Pornography? This is a mental health issue that neither mothers, fathers, nor our politicians will touch with a ten-foot pole.

    Internet pornography can be downloaded by any 14 year-old with a celphone or iphone, is surpassing financial issues as the leading cause of divorce, and is available free of charge on 600 million websites. It brings in 15% of the revenue on the internet.

    Are people unaware? Or too embarrassed to address? Why has no politician spoken out? The ACLU has put the "free speech" rights of pornographers ahead of the irreparable damage this internet viper does to our children

    I don't get it. I am forming a national coalition of mothers to address this. Hop onboard before the fabric of our society dinintegrates into nothingness

    Here's an idea: How about implemeting a heavy excise tax on pornographers to pay for health care? Even you, Bill, have never addressed this issue.

    Please feel free to email me with your thoughts.

    Carole Lieff
    clieff1@aol.com

    as the news of the machinations surrounding healthcare insurance unfold, it becomes clearer that the President must become clearer on what is needed.

    http://highhorsegazette.wordpress.com/

    Dear Mr. Moyers, Moyers Journal Staff, and All,

    The health care issue is very fascinating, and I am thankful that it is a focus of national debate. Thank you to everyone at the Moyers Journal for your outstanding work and contribution to the debate. It's especially important in this time of division, and fear and hate mongering, to have your sane and rational voice of reason.

    There are other issues besides health care that are very important right now, like: bailouts, climate change, all sorts of other environmental degradation (including extinction of species), and wars of aggression - among other important issues. But the health care issue is important because it demonstrates the workings of some of the most fundamental aspects of our socio-economic-political system.

    I believe the current situation (with health care in the USA) shows that the concept of care may simple be fundamentally contradictory and anathema to the concept of economic self-interest, economic growth growth, and the self-interested pursuit of enhancement of the financial bottomline. I believe that people (and ecological health) should always come before profit. But it's not working out that way in the USA.

    I also believe that health care ought to be delivered in a way that is egalitarian: recognizing the fact that all human beings are inherently sufficient, wonderful, and unique creatures. All people deserve access to the highest possible quality of care - regardless of socio-economic privilege. I think that health care is a human right.

    In my opinion, society and the economy ought to be built around the notion of serving the common interests of all people. And what could we all have more in common than the desire for HEALTH?

    As everyone discusses and debates the nuts and bolts of how we should approach healthcare,(who pays whom,and who gets what)The neglected healthcare reform idea which I think should be included in legislation is the consideration of the health of our individual spirits after so many of our precious liberties and freedoms have been taken away under the guise of healthcare reform.I'm remembering the "good old days"of just a year ago when none of this was being discussed.The last eight months have been a nightmare for me.I wish the government would just get back and shut up.

    You interviewed the wrong founder of Partners in Health, Bill. Where's Paul Farmer. (Even Tracey Kidder would have been a better guest.) Jim Kim is a Kansas farm boy who rose to be a champion fundraiser: Hence the Dartmouth presidency. As a manager of projects he has been a "merry prankster" manipulating the UN and big donors, volatile governments. I know Jim Kim got tired of the low compensation and needed validation. I wish he'd explained more about the Partners in Health free clinic in Boston, and its implication for our health care system here. Well, at least he doesn't have to pick Pel Farmer up at the airport anymore. I wish I were 18 again and just starting to Dartmouth.

    Why is the country not listening to anything resonable right now

    I think we are out of control and the news is stirring up a pot that's going to boil over in a bad way

    Jerry Hirsch wants to join Samuri-fascist Toyota to LEAN on the laborers. I remember when Jimmuh Peanut was taken in by this "quality circle" repression. Readers must understand that such social pressuring goes on in a non-union atmosphere. Focus on the customer is the biggest falsehood of all, for all auto manufacturers are majority owned by a few wealthy persons. They simply chose to phase out North American union shops by shifting their capital. Mostly they are obedient to the oligarchy in making 95% internal cumbustion vehicles as were possible in the 1930s (minus plastics and electronics. And these "electronics" enable them to disrupt the use of vehicles at will.)Jerry must hold some car stock to think as he does. He also must have fascist fantasies of dominating the lives of workers completely. The "car of the future" is a 1936 model, Jerry, and you're welcome to it. The auto-age and the corporate age and American empire are over. And I'm glad I lived to see it happen. There goes Jerry through the Kyber pass with a load of gas! Don't blow up, Man.

    The doctor was not impressive. He did not address our country's health care, rather used your program as a forum to promote and congratulate himself all the good work he's done overseas. I was surprised you didn't call him on his skirting of the many issues you posed. We are not taking care of our own. Why do we applaud Bill Gates for shipping his billions of dollars overseas? What's wrong with helping the Katrina victims? Or the destitute of Flint, MI who are an army recruiters dream because they have no other options? We brought African Americans over here as slaves, and we have never made restitution. It is positively nauseating to see Gates send money to Africa with such need in our own African American communities. Dr Kim had an insufficient and glib answer as to why he concentrates on foreign nations' health care. Maybe he enjoys international travel that he can write off on his tax return. Gates, the same. And why did Warren Buffet give $100M to a Chinese car company to develop an electric car? Does everyone have something against Americans? What did we do wrong?

    The doctor was not impressive. He did not address our country's health care, rather used your program as a forum to promote and congratulate himself all the good work he's done overseas. I was surprised you didn't call him on his skirting of the many issues you posed. We are not taking care of our own. Why do we applaud Bill Gates for shipping his billions of dollars overseas? What's wrong with helping the Katrina victims? Or the destitute of Flint, MI who are an army recruiter's dream because they have no other options? We brought African Americans over here as slaves, and we have never made restitution. It is positively nauseating to see Gates send money to Africa with such need in our own African American communities. Dr Kim had an insufficient and glib answer as to why he concentrates on foreign nations' health care. Maybe he enjoys international travel that he can write off on his tax return. Gates, the same. And why did Warren Buffet give $100M to a Chinese car company to develop an electric car? Does everyone have something against Americans? What did we do wrong?

    Perhaps naively, I believe there is a silver bullet or two for health care reform. End the connection between health care and employment, namely, the tax exemption for premiums payed by employers.If we do this, most employers would likely stop providing coverage and hand over the corresponding wages to the wage earner.
    Without being able to spend our pre-taxed dollars, employers would no more want the superfluous plans (that have driven health care cost up for decades) than we would if we were spending our own money. Instead, most consumers would get a low premium high deductible plan. Preventative measures would be out of the end users pocket, discouraging unnecessary procedures and deflating supply side excesses, while encouraging self teaching about ones own health.

    Insurers would immediately come up with a plethora of affordable plans that tended to deal with catastrophic illness( I believe we used to call it hospitalization).

    Lets face it, we already have a single payer system(us) employers are spending our money.
    Lets take back our spending power, from employers and lets take responsibility for our own general health.
    Even our own government has agreed to not bargain collectively for lower drug cost, please.

    The Pharmaceutical and Insurance industries have largely co-opted our medical industry to profit from our collective non-well-being.

    Perhaps naively, I believe there is a silver bullet or two for health care reform. End the connection between health care and employment, namely, the tax exemption for premiums payed by employers.If we do this, most employers would likely stop providing coverage and hand over the corresponding wages to the wage earner.
    Without being able to spend our pre-taxed dollars, employers would no more want the superfluous plans (that have driven health care cost up for decades) than we would if we were spending our own money. Instead, most consumers would get a low premium high deductible plan. Preventative measures would be out of the end users pocket, discouraging unnecessary procedures and deflating supply side excesses, while encouraging self teaching about ones own health.

    Insurers would immediately come up with a plethora of affordable plans that tended to deal with catastrophic illness( I believe we used to call it hospitalization).

    Lets face it, we already have a single payer system(us) employers are spending our money.
    Lets take back our spending power, from employers and lets take responsibility for our own general health.
    Even our own government has agreed to not bargain collectively for lower drug cost, please.

    The Pharmaceutical and Insurance industries have largely co-opted our medical industry to profit from our collective non-well-being.

    I thought it was a very good speech. Social Security and Civil Rights weren’t won with a single sweeping legislation. We may have to establish a foot-hold before advancing further. This could be a very good beginning.

    John Jonik wrote, in part, "This may account for why we hear so much about illnesses caused by our behavior ("smoking", drinking, over-eating, etc.), and natural things like germs, viruses, "faulty" genes, bugs, insects, the sun, etc., and so little about dioxins, pesticides, genetically engineered “foods”, and other corporate substances."

    Exactly. And how can anyone claim to know what the REAL "costs" are when the DATA is so cherry-picked to provide the WRONG answer?

    And come on, four years from now...? There must be another Tuskegee-like, or worse, "secret" experiment going on, no?

    Based on REAL data, the budget committee should cut the projected amount of the 50-something's needed SS checks in the near future in half. Whatever is going on IN SECRET is working. They're dying like ants exposed to DDT - ask the CIA for that REAL "death panel" data...oh right, it's not available because of "national security"...

    A "thoughtful" bloviator asked what is wrong with the "economy"...how about the incredibly uneducated a-- kissing, sociopathically political workforce that was hand picked by the psychopaths in "power"? What did you think those kind of people were going to "unify" to produce in the way of secure and sustainable wealth?

    Totally Stalinistic - mass murder of a generation dangerously SMARTER than those clawing their way to "power"...

    I still giggle at the poster who conjured up the image, a while ago, of how Paulsen held a gun to his own head to get trillions of $$$ in ransom - just like in that Mel Brooks movie. PERFECT analogy...

    "someone help him..."

    "What neglected health reform ideas do you think should be included in health care legislation?"

    Proper nutrition is generally glossed over as "personal responsibility"; however, there are much deeper implications that the food industry, the pharmaceutical industry, and the advertising industry does not want "framed" as part of the health care debate - mainly, their "business models" contribution to the health care crisis!

    For example, should we as a society continue to allow the food industry to peddle its poison on the "free markets", reap the profits, and dump the negative side effects on the taxpayer by blaming the consumer for lack of "personal responsibility"?

    Likewise, if we emphasize a strong "nutritional focus" much of the pharmaceutical industry would be rendered obsolete as poor nutrition leads to poor health - not the lack of a pill!

    Finally, the advertisers know how to prey on the weakness of the "human will" and leverage "physiological research" to entice consumers into poor choices known to be harmful! How much of this type of deceit must we as a society tolerate "in the name of personal freedom"?

    The debate must include the cause of the "health crisis" and not remain so tunnel focused on treating the effect.

    In short, just like the cigarette industry, the industries cited above must be made to adopt a socially responsible business model. We can no longer tolerate profit taking at the expense of social responsibility!

    Despite endless talk and news coverage, some integral things are being left out of the health care discussion.

    -- Dealing with private insurers is an unacceptable Adversarial Situation as the insurers have motive and corporate duty to charge as much as possible for the lowest level of service possible.

    -- Private insurers must grow, thus guaranteeing cost rises forever.

    -- For-Profit insurers are saturated with Conflicts-of-Interest by way of their multi-billion dollar investments in some of the worst health-damaging industries on the planet...including cigarette manufacturing, tobacco pesticides, dioxin-producing chlorine industries, military weaponry, and on and on.. This may account for why we hear so much about illnesses caused by our behavior ("smoking", drinking, over-eating, etc.), and natural things like germs, viruses, "faulty" genes, bugs, insects, the sun, etc., and so little about dioxins, pesticides, genetically engineered “foods”, and other corporate substances.

    -- Such insurers also invest in Pharmaceuticals...another conflict that may push the insurer to favor its investment property's drugs over others that may be safer, cheaper, and more effective…if a drug is even needed at all in some cases. Insurer investments in Big Pharma also guarantees continued use of their power to persist in the “war on drugs”…meaning the unpatented ones in the public domain such as marijuana and even tobacco.

    -- To not cover "illegal" immigrants is not just cruel and inhumane, it is to set the stage for uncontrolled disease epidemics. That would be a boon for Big Pharm's vaccine business, but it's an intolerable threat to the public at large.

    -- We hear calls for "Medicare for all", but it is rarely, if ever, noted that Medicare still requires private insurance for the "fill the gap" co-pay area...a cost still unaffordable to many.

    -- Malpractice is an issue, but what is not mentioned is the ubiquitous malpractice where doctors, even oncologists, routinely fail to check patients for exposures to industrial substances, especially carcinogens like pesticides and dioxins. Is this because insurers invest heavily in the complicit industries? This malpractice extends to research that so rarely considers industrial substances as part of various health problems.

    -- It is said that there may be “significant fees” charged to insurers, pharms, and others to help cover the program, but nothing has yet been said, apparently, about whether or not those insurers and pharms, etc., may simply pass those costs along to “customers”.

    -- Constitutional questions about illegal Compulsory Speech are not asked regarding the "individual mandate" matter. Unlike mandatory auto insurance, where they justify that by saying “no one is compelled to drive”, there is no way to Opt Out of the health insurance mandate except by leaving the country or dying…or by depleting ones assets to qualify for government-paid coverage for the poor.

    -- If there is to be a mandate, it will not only require paying for health coverage but for other things that have nothing to do with health...such as advertising, CEO Bonuses, corporate jets, lobbying, headquarters’ lawn care, and campaign gifts to political candidates. No Public Interest can be found in those areas to justify a mandate.

    -- A portion of a "customer's" premium would go to fund those campaign gifts by insurers to candidates a person opposes. This is an insult to, and an assault upon, democratic principles, if not laws, regarding Voting and Elections.

    -- If the government pays private insurers to administer coverage of low-income people, it remains that private insurers will still get money---public money from all taxpayers this time---for those non-health related things...and the investments by for-profits...and those campaign contributions.

    This is to say that too little attention is being given to what might be called "The Corporate Option"...one that would become unacceptable to virtually everyone in the land if it were understood.

    Even the Right Wing would take issue with any insurer investments in businesses hated by the Right...such as birth control pills, porn publishers, stem cell interests, firms that provide rights for gay employees, etc....not to mention the campaign gifts perhaps going to unacceptable candidates.

    Despite endless talk and news coverage, some integral things are being left out of the health care discussion.

    -- Dealing with private insurers is an unacceptable Adversarial Situation as the insurers have motive and corporate duty to charge as much as possible for the lowest level of service possible.

    -- Private insurers must grow, thus guaranteeing cost rises forever.

    -- For-Profit insurers are saturated with Conflicts-of-Interest by way of their multi-billion dollar investments in some of the worst health-damaging industries on the planet...including cigarette manufacturing, tobacco pesticides, dioxin-producing chlorine industries, military weaponry, and on and on.. This may account for why we hear so much about illnesses caused by our behavior ("smoking", drinking, over-eating, etc.), and natural things like germs, viruses, "faulty" genes, bugs, insects, the sun, etc., and so little about dioxins, pesticides, genetically engineered “foods”, and other corporate substances.

    -- Such insurers also invest in Pharmaceuticals...another conflict that may push the insurer to favor its investment property's drugs over others that may be safer, cheaper, and more effective…if a drug is even needed at all in some cases. Insurer investments in Big Pharma also guarantees continued use of their power to persist in the “war on drugs”…meaning the unpatented ones in the public domain such as marijuana and even tobacco.

    -- To not cover "illegal" immigrants is not just cruel and inhumane, it is to set the stage for uncontrolled disease epidemics. That would be a boon for Big Pharm's vaccine business, but it's an intolerable threat to the public at large.

    -- We hear calls for "Medicare for all", but it is rarely, if ever, noted that Medicare still requires private insurance for the "fill the gap" co-pay area...a cost still unaffordable to many.

    -- Malpractice is an issue, but what is not mentioned is the ubiquitous malpractice where doctors, even oncologists, routinely fail to check patients for exposures to industrial substances, especially carcinogens like pesticides and dioxins. Is this because insurers invest heavily in the complicit industries? This malpractice extends to research that so rarely considers industrial substances as part of various health problems.

    -- It is said that there may be “significant fees” charged to insurers, pharms, and others to help cover the program, but nothing has yet been said, apparently, about whether or not those insurers and pharms, etc., may simply pass those costs along to “customers”.

    -- Constitutional questions about illegal Compulsory Speech are not asked regarding the "individual mandate" matter. Unlike mandatory auto insurance, where they justify that by saying “no one is compelled to drive”, there is no way to Opt Out of the health insurance mandate except by leaving the country or dying…or by depleting ones assets to qualify for government-paid coverage for the poor.

    -- If there is to be a mandate, it will not only require paying for health coverage but for other things that have nothing to do with health...such as advertising, CEO Bonuses, corporate jets, lobbying, headquarters’ lawn care, and campaign gifts to political candidates. No Public Interest can be found in those areas to justify a mandate.

    -- A portion of a "customer's" premium would go to fund those campaign gifts by insurers to candidates a person opposes. This is an insult to, and an assault upon, democratic principles, if not laws, regarding Voting and Elections.

    -- If the government pays private insurers to administer coverage of low-income people, it remains that private insurers will still get money---public money from all taxpayers this time---for those non-health related things...and the investments by for-profits...and those campaign contributions.

    This is to say that too little attention is being given to what might be called "The Corporate Option"...one that would become unacceptable to virtually everyone in the land if it were understood.

    Even the Right Wing would take issue with any insurer investments in businesses hated by the Right...such as birth control pills, porn publishers, stem cell interests, firms that provide rights for gay employees, etc....not to mention the campaign gifts perhaps going to unacceptable candidates.

    "What neglected health reform ideas do you think should be included in health care legislation?"

    With all the rancor over the use of public money to pay for "health care", it would be interesting to understand the details of how public money is used to fund research & development leading to the advancement in medical technology, and just how the Capitalist compensate the taxpayers for the cost of such research (grants to Universities, etc.)when finally implemented on a "for profit" basis!

    Listening to Obama, I couldn't help but feel like we've been 'sold-out'. The whole reason he holds the presidency is because the majority of the American people wanted change from the status quo. He told us as much, not only campaigning to end the wars (he hasn't) but on the public option. Now, it's a weak watered down option that in all probability will be full of coops or triggers, leaving millions stuck in the same old system that does not work...except for the Insurance Co's.
    I'm angry too with his insuations that we on the left are the radicals, pushing for a public option. His statement 'there are many ways to achieve these ends' speaks volumes about his plans, as if we (the left) are now a fringe element expecting real competition to the multi-billion dollar insurance companies… making profits off denying people coverage. The very fact that insurance cos stocks went up after his speech is clear indication that they are very happy with his "plan” too. Obama must think we're pretty dumb not to see whats happening.
    Disappointed? You bet I am. But it's more than that. He's betrayed us. We thought we voted for a truthful, forthright, patriot (like us) who'd fight for us, making this country whole again (after 8yr nightmare). Instead he's sold us out to the highest bidder, just like the rest of Washington.

    As The Who sings:
    "Meet the new boss-Same as the old boss"

    At last! By Dr. Kim, a reference to "Six Sigma/Lean/Toyota" as applied to government functioning. I wish Bill Moyers had followed up with Dr. Kim.

    I've been mystified throughout the campaign and afterward that when the administration speaks of making health care (and government in general) operate more productively, a proven tool is ignored.

    “Lean” is a manufacturing discipline originated by Toyota 25 years ago. It is now in practice at many of the world’s largest, most successful businesses. Lean is applicable to any enterprise that has processes and objectives.
    The cornerstones of Lean are:
    •The continuous improvement of processes by the reduction of waste; that is, tasks that don’t add value.
    •The empowerment of workers at all levels in pursuing this objective
    •The establishment of a customer-focused culture.

    Well-established, proven methods exist for implementing Lean. A wealth of literature and expertise is available. Just Google "lean thinking", "lean manufacturing", etc.

    I want to join with others who seek to inject this topic into the national dialog. I would be grateful to learn of other individuals or organizations with the same objective. If you'll reply to this post with the appropriate link or email I'll get in touch.

    Jerry Hirsch, Los Angeles

    I loved watching the interviews with Nancy Youssef and Dr. Jim Yong Kim last night! This is the sort of television that television was invented to be! Please continue producing interviews like this to EDUCATE the public better than the public school systems do.
    ~

    Dr. Jim Yong Kim is to be rewarded for what he has accomplished in his life but like too many academics that have risen to a level of power and prestige, he is taking the politically safe view that is espoused by the current administration in power.

    The statistical research he is talking about is Comparative Effectiveness Research, one of those long standing academic theories that has finally risen to cult status due to it's introduction into the debate by Dr. Ezekiel Emanuel, one of Obama's Chicago boy advisors and brother of President Obama's closest advisor. I find it interesting that we haven't even got a new healthcare system established yet and the physician bean counters have already come up with a way to ration healthcare to patients. This is the plan that solicited cries from various segments of the population of a Nazi Healthcare System. Many historians have also expressed concerns associated with this claim.

    As far as the Free Market is concerned, Dr. Jim Yong Kim's comments about pandering to big pharma's profit motivation to incentivize the development of new drugs is what got us Part D. Medicare Coverage with no cost controls on prescription drug prices. Once again government is positioning themselves to continue the big taxpayer giveaway to various US corporate entities. When the only players are the usual American based corporate insiders, real competition to achieve cost control from companies outside the country is out of the question. Is there still any doubt that our government is held in a death grip by a few large US business and financial interests? The current healthcare debate is only the most recent glaring example !

    Mr. Moyers –

    This show with Nancy Youssef and Dr. Jim Yong Kim may have been put together by accident or divine providence, because watching the two juxtaposed I see a new way of thinking.

    Near the end of his interview, Dr. Kim spoke about his anthropological training and said something to the effect that, as an anthropologist, he walks into a room and thinks “Who are these people and what do they want?”

    Ms. Youssef, in talking about the U.S. war in Afghanistan, spoke of her reservations of the ‘fit’ of American-style democracy on the land and its people, let alone the elephantine logistical and strategy problems.

    My thought after seeing both was – Is it time to approach Afghanistan not from a power/dominance dynamic but from an anthropological dynamic? Could we be a thousand times more effective in achieving both our goals and the Afghani people’s goals if we added an anthropological component and asked “Who are these people and what do they want – and how can we help them get it?”

    Notice I didn’t ask “what do WE want”. And I think that is where we as a nation, and most every other nation, get hung up.

    Combat and conflict are changing. It’s no longer a matter of whose army has the might to impose its will – that is never going to happen again.

    Dr. Kim also mentioned Margaret Mead’s famous quote “A small group of thoughtful people could change the world. Indeed, it’s the only thing that ever has.”

    Well, a small group of hateful people can also change the world now, and we need an anthropologist’s touch to understand how to combat that new kind of dynamic.

    People aren’t so different – they want to have their needs met, be with family and friends, be safe and happy. If we understand the people we interact with, then we can meet their needs. If we approach them where they are and help them survive better in their land, we can win their respect instead of fear and resentment – and people who seek power on the backs of their own people will be met with more resistance, and those seeking to ‘impose’ their will on communities and nations will be less likely to succeed.

    So if you wouldn’t mind terribly, would you get the Pentagon to add an anthropology department and change the world by shifting our vision of war and conflict. I would appreciate it very much.

    Kind regards,
    Tam Chin

    As a first generation immigrant-American citizen, who came ashore only three decades ago to actualize my American Dream, whatever that might mean now, I am appalled by these so-called “comments” I see here and elsewhere in public arena. No, I am not talking about poor grammar; rather, I am talking about illogical, politically-driven, long-winded gibberish people dump here—as if their sermonizing comments will convert others.

    If you cannot digest and synthesize your thoughts in a single paragraph, you have not understood the issue at hand. When you cannot think clearly, how do you expect to write clearly? Not only do you lack upstairs (reasoning) but you also lack downstairs (writing), as well. Please make your comments short, powerful, and penetrating. And please avoid fiction-writing; I assure you nobody will read it. That you cannot write critically seems to be the worse problem than any healthcare or financial meltdown issues we Americans face. Or is this the symptom of educational meltdown?

    I do not understand why Obama's healthcare bill(HR3200)was not immediately rejected with outrage.Are Americans now willing to accept the creation of a national registry of information from implantable "electronic medical devices" used for survellance (page 1003)as determined by the secretary?Is this a Trojan Horse,or what?Are we all asleep?

    I appreciated yur comments with Dr. Jim Young Kim. My disbelief was that as he talked he failed to emphasize that nutrition plays a major role in TB infection and all the diseases, too. As beef cattle were sold off in Dominican Republic and less meat was available for the population under Dictator Trujillo, the rate of TB infection rose dimetrically opposite to the decrease in food available to the public at the same time.
    Vitamin C at 3-5 grams a day cause many aspects of scurvey to disappear. My suggestion is that, since we cannot synticize Vit C, we humans have to consume added buffered Vit. C or we become very scorbutic and initiate many diseases. Medical profession fail us by not addressing nutrition in their training or analysis when we visit their offices. They also run experiments with treatments of Vit. C at 1/20th of my suggested concentration of the Vit C and then "prove" that vit C does no good for control of the disease. This is sad.

    I appreciated yur comments with Dr. Jim Young Kim. My disbelief was that as he talked he failed to emphasize that nutrition plays a major role in TB infection and all the diseases, too. As beef cattle were sold off in Dominican Republic and less meat was available for the population under Dictator Trujillo, the rate of TB infection rose dimetrically opposite to the decrease in food available to the public at the same time.
    Vitamin C at 3-5 grams a day cause many aspects of scurvey to disappear. My suggestion is that, since we cannot synticize Vit C, we humans have to consume added buffered Vit. C or we become very scorbutic and initiate many diseases. Medical profession fail us by not addressing nutrition in their training or analysis when we visit their offices. They also run experiments with treatments of Vit. C at 1/20th of my suggested concentration of the Vit C and then "prove" that vit C does no good for control of the disease. This is sad.

    Bill: Thank you for introducing Dr. Kim's contribution to public health practice to your viewers. For his and Dr. Farmer's efforts to make low cost HIV drugs available in the developing world I thank them!!! They should receive the Nobel Peace Prize.

    Until such efforts the CDC was saying it couldn't be done and was actually sponsoring research to give pregnant women in sub-sahara Africa an alternative to the standard HIV prevention protocol because in their expert opinion this drug regimen was unaffordable!!!

    But the other discussion ...the stuff about the Navajo Nation, the link between growing food and health, I am surprised that an academic would not give credit to his mentors and teachers.

    In 1965, apparently 20 years before Dr. Kim began his career, H. Jack Geiger of Tufts University and John Hatch, now retired Emeritus Professor, UNC founded the Mound Bayou Community Health Center in Mound Bayou MS. Dr. Hatch at that time was a community organizer, and the link between land tenure, growing sustainable food, and health was recognized.

    Second, The Navajo Nation and tribes throughout Indian Country, especially Alaskan Natives have pioneered the use of community health workers for decades.

    No country in the world has solved the problem of access to care in underserved areas. While I am an advocate of a community and patient-centric medical home model of health care, why didn't Dr. Kim mention strategies such as restricting the number of residencies for sub-specialties, and providing incentives to undergaduates (6 year medical schools) to go into primary care by PAYING THEIR TUITION IN FULL. If you want to be a plastic surgeon it will cost you $2 million, if you want to be a family physcian $0. Maybe then we wouln't be concerned about increasing disparities-- community health workers for the Navajo, and cadillac care at the dartmouth medical school for the elite.

    Respectfully,

    Alan Friedlob, PhD, United States Public Health Service (ret)

    Your interview with Dr. Kim was astounding. I know he will be happy at Dartmouth, but what an intellect! What an understanding of the real issues that face us! I hope the Obama administration is aware of this amazing talent to be tapped!

    he talked a very long time but he did not say anything.

    Thanks Bill for this wonderful interview to Dr, Jim Yong Kim. It was an inspiration for our organization Somos La LLave del Futuro Inc. We are running a project Somos Salud or We are health in the rural areas of Dutchess and Sullivan Counties. Our comunity health workers are volunteers and are truly making a difference among the Latino Immigrant comunities. Our promotores are becoming leaders and with their guidance the process of navegating the health system is easier for the immigrants who faced many barriers. Again Dr. Yong Kim thanks and we wish you luck at Dartmouth.

    Because a Republican disrespectfully called the President “a Liar”. Is he really a liar? Can anyone answer this – if an illegal immigrant comes into a Hospital Emergency room are they turned away!!!? Who pays for their care? What if an illegal delivers a baby in the US, who pays for the delivery, hospital stay, and nursery care?? Can anyone answer my questions? The House explicitly prohibits spending any FEDERAL money to help illegal immigrants get health care coverage. An illegal immigrant can:
    • Buy private health insurance
    • Buy into a new government insurance plan IF congress creates one.( IF?)
    • They (Illegals) do not get federal subsidiaries.
    The House bill’s exact language:
    “Nothing in this subtitle shall allow federal payments for affordability credits on behalf of individuals who are not lawfully in the U.S”
    This doesn’t go far enough – it’s not what’s in the Bill but what’s left OUT.
    There are NO PROVISION FOR:
    1. How is the prohibition going to be enforced? (Hospital Czars?)
    2. No requirements for people to prove they are citizens or legal residents before getting health care benefits.
    Democrats deflated a Republican amendment that would have required people to verify their legal status before getting care.
    If there is NO enforcement, how would/can it be enforced???
    Excerpts from the Washington Post’s Writers Group – if you have a chance to read this in its entirety please do so:

    Where now is the intellectual center of gravity – the thrill of innovation, the ideological momentum – in American politics? Not in the party of Obama.
    This failure of imagination was on full display during Pres Obama’s address to Congress. In a moment that demanded new policy to cut an ideological knot, or at least new arguments to restart the public debate, Obama saw fit to provide neither.
    His health speech turned out to be an environmental speech, devoted mainly to recycling. On every proposal, he chose to double down and stack the motives of opponents. (Obama was the other public official who talked of a ‘lie’ that evening.) Concerns about controlling health costs, the indirect promotion of abortion and the effect of a new entitlement on future deficits were dismissed but NOT ANSWERED)
    Obama has taken the most tired, most predictable agenda in American politics – the agenda of congressional liberalism – and made it his own. A pork-laden stimulus. A highly centralized health reform.
    Obama was a conventional congressional liberal in every way – except in his extraordinary abilities. His great talent was talent itself, not ideological innovation. And given the general Republican collapse of 2006 to 2008, Obama did not need innovation to win. Only ability and the proper tone.

    I live 2 miles from Dartmouth Hitchcock hospital and after living in Boston for fifteen years, I am not impressed with the level of care that Dartmouth gives it's patients. Above and beyond this most of the research for the development of drugs takes place in universities that are paid for with our tax dollars and then sold by drug companies. Further more, many of the "new" medications are combinations of old medications that have been on the market for years and then repackaged with new names. Advair is just one example. Also, the amount of money that is used to advertise medications on TV and in magazines costs far more then the money that is used for research. Just a couple of years ago The New England Journal of Medicine wrote "You can't trust the data coming from drug companies." Big Pharma is a profit driven industry and there is no incentive to find cures. Instead drugs are produced with dangerous and even life threatening side effects that can cause other illnesses like diabeates. I was saddened to see this doctor so bought into the drug industry and the lack of support for a public option that is so desperately needed here in the US where mobile hospitals, usually working in 3rd world nations, have been helping people here.

    While agreeing with Dr. Kim that electronic transfer of information would decrease health care costs, I fear that until insurance companies are forced to treat all regardless of pre-existing conditions, this
    would allow insurance companies to continue their practice of refusing care for so called pre-existing conditions. It seems there are numerous catch-22 situations like this that prevent change to health care reform. Not until insurance companies are forced to stop this tom-foolery, can we even begin to tackle reform.

    I would also have liked Dr. Kim as head of Dartmuth, to address that one way to decrease costs would be to accept med students who want to go into medicine to help people, not just become rich on the backs of sick people. Doctors do work hard, but who says they deserve to continue to make high incomes when we are having these problems. I believe we are approaching the bursting point of the "health care bubble". And people don't fool yourselves, that is what is fixing to happen to health care in America. If we don't get serious about reform, we will wake up one morning to find ourselves with the total collaspe of our health care system just as what happened to wall street. Quite frankly, I don't believe we can stand to see another huge chunk of our gross national product disappear again and have another bailout of a failed system. I would rather have preimtive than emergency bailout. It's our choice!

    Thank you, Mr. Moyers, for the interview with Dr. Jim Yong Kim! Within two weeks, you have managed to capture two major topics that I am addressing in lectures this week: Money-Driven-Medicine and Dr. Jim Yong Kim's philosophy of medicine and my following lecture for undergraduate Honors College Biomedical ethics course at FIU in Miami. [Incidentally, we have a new Herbert Wertheim Medical School first year class starting their fourth wee, in a curricular that seems to compliment the ideas Dr.Kim expresses.]

    It's my understanding that the concern with health reform is how we fund health care.Health care delivery is a seperate issue

    I'm concerned that, in terms of 'deeper thinking on delivery of services,' that some criticisms I've been reading from single payer advocates are pretty emphatic that the public option--this idea so radioactive to the insurance companies and their representatives in the Senate--simply won't work in the form it's taking in the hands of 'pragmatic' legislators.

    People like Drs Andrew Coates and Len Rodberg of the PNHP (Physicians for a Public Health Plan,)seem in particular both well versed in the particulars and deeply unimpressed. Here are a few examples:

    “'Public option' advocates circle their wagons around two useless sentences in HR 3200"
    http://pnhp.org/blog/2009/09/09/option-advocates-circle/


    "The 'chicken and egg' problem: Can the “public option” succeed where Prudential failed?"
    http://pnhp.org/blog/2009/09/05/the-chicken-and-egg-problem-can-the-public-option-succeed-where-prudential-failed/

    Nick Skala interview
    http://www.youtube.com/watch?v=dWBZz070m-k
    [go to 4:40 for the crux of Skala's argument]

    choice snippet:
    Pub Op "It preserves all the systemic deficiencies that we see in the current system...it's not a sustainable system; it won't cover everybody, and will fall apart quickly due to rising costs, like we've seen in MA, VT, OR, TN, MN..."

    These folks say the public option as originally conceived of by Jacob Hacker has morphed into something not at all up to the challenge of it's own hype.

    According to Coates, Hacker had five essential elements in mind for a viable "option" plan:
    "(1) It had to be pre-populated with tens of millions of people;
    (2) Only “option” enrollees could get subsidies (people who chose to buy insurance from insurance companies could not get subsidies);
    (3) The “option” and its subsidies had to be available to all non-elderly Americans (not just the uninsured and employees of small employers);
    (4) The “option” had to be given authority to use Medicare’s provider reimbursement rates (which are typically 20 percent below the rates paid by insurance companies); and
    (5) The insurance industry had to offer the same minimum level of benefits the “option” had to offer."

    The argument, then, is that Democrats "abandoned the first four of Hacker’s criteria and kept only the last one (the one requiring insurance companies and the 'option' to cover the same benefits)." As a result, the efficiencies of scale so key to the public plan, won't deliver. It won't work.

    If this is a valid argument, what an epic disaster both political and in human terms it'll be if
    (a) progressives both in and outside of government expend alot of political capital in holding the line on this individual-mandate-included thing;
    (b) the public option gets signed into law, and
    (c) a few years down the line, a lame failure of a program results.

    As a unabashed 'slippery sloper' - albeit one who sees in concept the value of a public-private competitive friction keeping everybody on their service-providing toes - the above scenario doesn't sound like any fast track to single payer to me.

    This is tough stuff for a layman to follow with any great confidence, and anyone hates risking letting the perfect be the enemy of the good on a reform so desperately important as this one (like so many others, this stuff very much 'hits me where I live').

    That said, I for one find it hard to know quite how to square these PNHP-style criticisms with the outspoken public option advocates who I tend to agree with and trust throwing their support behind the public plan.

    They may have liked his academic credentials, but Dartmouth football, I understand, could use a shot in the arm. I'm afraid tho that the health care question involves a lot more than learning better management techniques. Since you've asked, here is what I wrote a few days ago about the speech in the Rose blog:

    "As usual the Congress made a spectacle of itself, while the president pandered to public opinion with a veracity scarcely higher than a TV commercial. I thought it was ruder than the representative from South Carolina. Presidential leadership does not equate to hectoring Congress. South Carolina, btw, was a leader second only to Massachusetts in the Revolution. I thought also that the mention of Kennedy, which clearly flopped as a peroration, was really too much. The man seems to have written to everyone trading on his imminent passing. Good riddance to him, his stupid ideas and pretentious family. My father died of a brain tumor and I don't recall him writing the president or the pope, and he was smarter, too.

    The plain fact is that this country is headed down the same ruinous path as the Soviet Union. If the president is looking for someone who has disputed the assertion that health care is the cause of our deficit, I have, and given not only a reasonable, but true account of the reason for it. The admin can lower health care prices thru insurance reform, but it will be probably at the expense of the quality of care overall, and still likely do nothing to correct the maldistribution of it. It would be as tho the building of McMansions was to be stopped by reducing home financing to a uniform amount. Now, there is nothing wrong with suggesting that ppl stop building McMansions if the country cannot afford them, but it comes at the problem from the wrong end. Besides being averse to equality of opportunity, it is likely to mean that the wealthy seek care in private clinics or overseas, and that those in govt supported plans will see the greatest decline in care. As I've said from the beginning, the health care problem is a symptom of our malaise, not the cause of it. The correct tack is not to insure the poor, but see to it that some do not enjoy unmerited wealth - gain without working for it - which our supposedly democratic financial policies perversely promote, and which drives up prices. Reducing the amount we pay for medical care can, of course, mean a reduction in research and development, but that is only being supported by a shrinking base, so that in the end greater income equality will be better able to sustain the system, which is at present on the same trajectory as the country, itself. We need to be concerned about the welfare of those who actually do the work in society, but Harringtonian quotas are not the means.

    And universal coverage of this sort, without a real incentive to save money and live healthier, has all the flaws of no-fault auto insurance, which is bound to further drive up costs as that idiocy did. Too, you can regulate the life out of the industry, but you cannot prevent health care professionals from leaving it either, which they will surely do, tho perhaps we can import more Indians or Chinese to take their places, for a time. That has always been the Democratic way, hasn't it?

    The president compared his plan to the founding of public higher education, a fair analogy, but we clearly see a multi-tiered system there, and similarly rising prices. Small private colleges are an endangered species, while the Ivy League and a few others dominate every aspect of the system, from recruitment to placement, siphoning off the best students and faculty, without providing any better education. The state-supported institutions, while growing in size and proportion, have had to hike tuition steadily as the states have become increasingly unable to support them, all of which will certainly happen in the same way if public health care institutions are inserted into this failing economy.

    As in Moyer's recent programs there was much finger-pointing at insurance cos and health care professionals in this discussion also. Insurance is in fact a public good if there ever was one. You either accept that, or you don't accept the idea of public goods. The issue is black and white. There is no point in talking about markets for insurance. Insurance is the antithesis of competition. In any case, while I'm sure they are engaged in all sorts of things we'd rather they weren't, like financial manipulations, cherry-picking, and bureaucratic red-tape, the real rise in price has very little to do with the insurance cos, and the fact that they aren't very profitable is proof of it.

    Some would therefore argue that the hospitals and doctors must be the real culprits and point to the fact that patients either have no clout or alternative to force down prices, or don't understand what is going on so must accept what they are being sold. But due to professional regulation doctors rarely sell snake oil nowadays and ultimately must accept what patients can pay anyway or leave the profession, and, if allowed to operate, that dynamic will set the necessary price for their services. In addition, the idea of rewarding only successful treatment and not the attempt neglects the fact that someone must pay for the learning curve, just as in a military contract someone has to pay for the cost of development, and so we usually find cost-plus contracts, like them or not. You would not expect your mechanic to quote you a flat price to fix the noise in your engine when he doesn't know what is causing it. Further, eliminating competition, as is often the situation in defense purchases, surely increases the probability of abuse rather than lowering it, and would likely stifle innovation at the same time, if it did not also result in shoddy work. In other words, if lack of knowledge leads to lack of competition, bureaucracy must be a much more direct route. Wal-Mart is only cost-effective, because competition in low-end retailing and groceries is voracious, and the margins, of necessity, wafer-thin. Without question care provided in an environment of many individual providers will result in the greatest efficiency, in an area as uncertain as health care.

    The insurance cos and the physicians point their fingers at the lawyers, but don't expect anyone in this administration to talk about that. Nevertheless, suits are not exactly productive, and most medical mistakes and rationing decisions are clearly not the result of indifference or the desire to bilk ppl, but because draconian efficiency measures have been forced on the system by its increasing poverty.

    That leaves the drug cos, where clearly, if we can get patents and the FDA under control, there ought to be competition. But, like everyone else, the drug cos charge what the mkt will bear, hence what costs x in the US will certainly be less in Bangladesh, and if prices are higher here someone must be paying them, and that is ultimately the Fed, because through monetary policy the central bank has the unquestioned ability to make certain that debt is not run up so that prices must come down to what ppl can afford."

    Is Health care a right? Education isn't (San antonio Independent School district vs. Rodriguez, 1973). If it is, then do we as humans, have a moral duty to take care of ourselves? Obama's speech was a speech, nothing more. If this is Obama's health care bill, how come others are writing it? Obama threw out a bone, but he threw the bone to the cat, instead to the dog.
    Yes, there should be some sort of health care bill voted on for ALL AMERICANS, not just for those who are uninsured.
    Though politics always come into play, the current bill is 1200 or more pages long. What is in it? Are the things that the President laid out in his speech, in the Bill? Obama wants us to support a bill that doesnt exists and is being rewritten and restructured everyday. I wonder what the FINAL product will look like? Because, Obama is not writing this bill, if those things that the president laid out in his speech are not in the bill, then I guess Steve Wilson was right all along. YOU LIE!, well, we shall see.....

    The American people are pouring their hard earned tax dollars into 2 endless wars, 800+ bases and the biggest prison system on the planet. Instead of taking 50 cents on every stock transaction as they do in the UK to raise billions for health care and college, our tax dollars are being used for endless military expenditures at our expense. Afghanistan is just one of many war zones in the world. It is our elvangelical generals who are intent on waging a religious crusade in this region and using our tax dollars to build mega churches while handing out bibles as we kill innocent people. But it us, the people, that must ulimately rise up and demand a society that does not leave us in the gutter while holding a gun to our heads to pay our taxes to them!!!!

    Legalize reality
    Life, liberty…in the pursuit of happiness.


    Prelude

    This is what it’s about, and the story goes on.
    Back in the day’ of the founding fathers of this country.
    Brilliant minds gathered and formed a concept and guidelines to follow so we could achieve Life, liberty…in the pursuit of happiness.

    Well, we have blown that right out of the water.
    • Life is your health.
    • Liberty, you’ll know that if you’re educated.
    • Pursuit of happiness.
    Starting our first in reverse order.
    The pursuit of happiness’ is the life you live. How much happiness you experience will depend on your education which gives you liberty.
    Throw it all out if you’re not healthy.

    So working this out into our reality-we need to be healthy, money should not be a problem.
    Nowadays lots of talk about health care…coverage...who is and who is not.
    I’m looking at big picture. We need to have everyone covered period.
    But wait…think…. We pay all this money for premiums for everyone and then wait for people to get sick...to justify the money we already have spent. This is too expensive it would cost too much.
    So instead of paying premiums. We pay for services when needed.

    Healthcare costs are going up and to cover everyone will break all of our backs, so to speak.

    We eliminate healthcare insurance. No Medicare or medical.
    No more plans period.

    This is how it will work.
    A person has to go to the doctor and goes, the doctor bills the fed.
    End of story.

    Some areas the emergency bills are so outrageous. This could have been avoided if people had seen a doctor sooner.
    We have created extra costs into our system of healthcare. That needs to change. I don’t want the government to control healthcare; I just want them to pay for it.
    I get to get specifics later. I will speak about the liberties, which are achieved through education.

    Education should be free period. Which would mean that you would not have to fill out a lot of financial paperwork.
    All the people, whose job is to give out grant money, they will need to find new jobs and so on. The whole business of education funding will be eliminated. The attendants pay nothing…the schools bill the FED. Just like the doctors and hospitals.
    Everyone goes to school if they want to. Our people will become more healthy, more productive and smarter. We will become much stronger, in so many ways.

    Now hold on…. This sounds like some kind of socialism. Whatever.

    We need to talk.
    We have seen what happens economically to our beautiful country, when the wrong principles are guiding us.
    We do not have to reinvent the wheel, it’s not broken. It’s just gone.
    We need to build another ‘so to speak.

    INTRODUCTION
    • Going to get more specific in the following areas; Life and your health, Liberty, and the Pursuit of happiness.


    Health
    SO MANY TOPICS AND ISSUES HERE, I’LL POINT OUT FIRST WE ARE SPENDING A FORTUNE TALKING ABOUT HEALTHCARE ISSUES…SUP W/THAT. I SHOULD WRITE A BOOK ON THAT AND MAKE A LOT OF MONEY.

    My first reaction is that, hang on here, I’m already covered…and this sounds like I’ll going to pay more money for something I already have just so people who don’t have anything have something. I don’t want to change its going to cost me.

    Starting with our health, we get sick, go to the doctor; we do the paperwork with the insurance company and so on.
    Some people have no insurance, they get sick…. They lose work…sometimes their job. They fall behind financially at a time when they need money…not a good story. Eventually they get so sick that they end in an emergency room.

    And the taxpayer end up having to pay…these costs are figured into the hospital, doctor services. We all have to pay…currently has it is.

    -My idea is that when you feel bad you go to the doctor. The doctor bills the fed, period.

    Fewer people will end up in the emergency room.
    More people will show up at work healthy.

    To make that happen, well change is going come.

    A lot of people will lose their jobs. Simply by eliminating health insurance...a whole industry of jobs will disappear. Currently many states currently have training programs that are already paid for. For people who become unemployed, who get pay while they get trained/going to school etc. So there is an answer to that issue.

    The complete business of health insurance involves many aspects. First making profit. Which is done by limiting paying for services. If not they would be out of business.
    It involves a process of billing, with patient and doctors etc. This process costs doctors, who hire staff who handle and process the insurance claims. This raises the total cost of all services delivered factored in as the cost of doing business.

    Now in my life every time I speak with a person of importance and I speak them saying ‘we should get rid off the health insurance companies’….
    They will jump in and say ’Well …they are too big…you’ll never get rid of them. They are powerful and have lots of money etc.”

    Well I beg to differ.
    I have contacted a big insurance carrier…spoke with people who were in management. It kinda went like this…I knew that to be in insurance of their type etc….there is a pool of money that is untouchable so to speak. Premiums going into this fund. And from this fund, money is distributed to the doctors’ etc. The fund is kinda like a bond to do business. Well if all the companies could take that fund and walk away…they would make a fortune. I mentioned ‘hey if you guys could walk with all the money would you?’ They basically said …we would run!
    Eliminating health insurance…. So there is an answer to that issue.


    Currently I’m covered by health insurance, and it does not cover cost of healing me. I pay in each month and I have to pay more…’co-payments’. I have been paying in my own life and when I need it the most….it does not pay.
    So I ask myself…why? I’m I wasting my money each month. I should have opened up my own bank account just for medical help and put in monthly deposits. Had I done that, well I would have easily paid for my healthcare, because I would have had the money. I would be healthy and would be out spending money on things I want and need. Having fun working.

    I have noticed the advances of medicine. It’s almost miraculous…new science and machines. We are advancing in research finding causes, discovering solutions to help conditions etc. this cost huge amounts of capital. We all have to pay.
    I be thinkin again…all the fancy new machines designed to find out how to save the worst case scenarios…the money spent here is huge. We all are paying, in the cost of services…factored in. I have experience these machines…tested in many. I have cancer.
    After they finished all the tests. It boiled down to…sorry good luck. Wish we could have seen you when it was first diagnosed.
    My first thought...well why was I not seen earlier? They would have stopped the cancer. I would not have got into those fancy machines…that tell me exactly how I’m going to die.
    It is this equipment that has cost us, sure it is good to some degree. A lot cheaper to prevent.
    The total unnecessary costs associated with health care…take up most of the money. Healthcare prices are going up….everything else is not keeping pace. This is hurting us.
    I was not seen earlier…because of the referral system relating to services that are rendered by insurance companies.
    The process takes time, as you go from to doctor to doctor – at this point, it is not a matter of whets wrong, or figuring how are we going to fix it. They know exactly what to do. It is a problem…finding the proper wording to put on the insurance forms so they can get paid. Lots of things are not covered. For example I had surgery, insurance does not paid for pain relief during the surgery. I had to pay that. They could have at least given me a bone to chew.

    Points to make here.
    • If you’re covered-you’re really not covered. You’ll pay also.
    • You’re not covered but you will get emergency help. So we all pay for this one, which is the biggest expense.
    • Emergency visits-could be avoided.
    • The government’s only involvement is to pay the bills.
    • Healthcare insurance gone.
    • Medicare gone.

    In conclusion we need to really change the system.
    Before we go there…. I look at the ideal big picture. _Anyone can, at any time can go to see a doctor, there is no insurance, and government foots the bill_
    Now if we find out that by helping everyone we are going broke. We need to rethink life, as we know it. It will work this way, doctors bill the fed. The fed deducts from our paychecks. (Currently they deduct for Medicare and so on). Keep this in mind.
    Could it boil down to we are really on our own. So I say let’s go for it.
    Liberty
    A beautiful word.
    I feel liberty comes through education. If you were not educated, you would not know what the word means. I think and believe the founding fathers were trying to guarantee our health and provide for our education. So we could live our lives. Too many people walking around unhealthy, others need education. This is a huge $ burden in the big picture that is factored in.
    Simple solution - for the liberty issue. Free education period, for anyone.
    Now, if that was the case (the what if’s are popping into my head like popcorn going off). Most of the kids all start to go to school (this will cause a teacher shortage) and since anyone now can go, many regular citizens start going also. A side effect of this will be in the market place. Now employers are finding it harder to find workers, they will have to raise wages to attract potential employees. Very good things! Supply and demand. Lets us use the principles of human nature, and the effects such as supply and demand.

    In conclusion we need to change…..our collective activities….are bring us all down….as you can see. For example our economic condition.
    46 million no coverage.
    Contact me scott.wells@state.or.us
    Phone 541-776-6060 ext 236

    I personally think it was a good speech, Obama showed that he has backbone, however I am not to happy with his public health plan option, it appears that he may be whim-ping out or watering it down to appease the republicans, I believe that he should make the public plan equal to or better than existing medicare, and as far as paying for it, it should be done through premium payments, higher tax on tobacco and alcohol, also I think the majority of payments should come from the lobbyists, e.g.:( Washington should issue a federal license to all lobbyists that work the capital hill and DC, and the cost of license should be for example about $200,000. per year, this would cover just about any deficit that we get in public plan and then some.) p.s.: no in four years, right now - I may be dead in four years, I need coverage now!

    As I expected, it was an excellent speech. Once again it was important to focus on his language and not read too much into the speech. He made a good case for and description of the public option and immediately warned not to get attached to it.

    He was eloquent when he spoke about Ted Kennedy's letter and the sentiments. If only that eloquence could have led the nation into the health care debate instead of only being mentioned after Kennedy's letter. Many of us thought the most valuable thing about this president would be his rhetorical abilities that might used to remind the citizenry of the moral necessity for health. care. Better late than never, except now there are few who are still persuadable.

    I was surprised when Barack Obama said this health care bill, once signed will go into effect in four years! Isn't that too long to wait for a cost-controlling, coverage-for-all, etc. reform of health care. What happens in the mean time? Don't we need this to go into effect immediately?

    President Obama's speech was excellent. His tying health care access for all to our American character was brilliant. Are we a society that would deny access to health to millions of Americans? And why would we do that? We, as a society, have to answer this question.

    He clarified his goals for health care reform, albeit in general terms, minus the details. I would have liked to see a little more substance in his address to congress, for their sake... to make their job more focused. I realize that he was also speaking to the American public, who also need clarification. In that regards, I think he did a great job.

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