Domesticating The Dogs

I don’t think there should be a profit motive in health care. I think all the health care dollars should go to care.”

—Elsa Stone, a North Haven, Connecticut, pediatrician

Well, what do you know.  The universe is starting to make sense. 

From Thursday’s USA Today:

HARTFORD, Conn. – In the past decade, most states have turned Medicaid over to private insurance plans, hoping they could control costs and improve care. Nearly half of the 60 million people in the government program for the poor are in managed-care plans run by insurance giants such as UnitedHealthcare and Aetna. 

Connecticut, the “insurance capital of the world,” is bucking the trend.

Beginning Sunday, Connecticut will jettison its private health plans from Medicaid, the state-federal health insurance program. Instead of paying the companies a set monthly fee to cover the health costs of more than 400,000 children and parents, the state will assume financial responsibility.

Why?

Glad you asked:

State officials say the companies, including Hartford-based Aetna, did not fulfill their promise of lower costs and better care.

Take that all of you private-insurance lovers out there.

Notably, our neighbor to the West, Oklahoma, one of the reddest states in the Milky Way, doesn’t trust the private insurers either, and hasn’t for a while:

Oklahoma moved away from private plans in 2005, and officials there say they have no regrets. “While achieving very encouraging marks in both member satisfaction and quality, the cost per member has grown at a very low average annual rate of 1.2% over the last five years,” says Mike Fogarty, Oklahoma’s Medicaid director.

It appears that in Connecticut (and elsewhere, of course) too much money is being spent on things that have nothing to do with health—like, say, profits. The USA Today story cited,

a 2009 state-commissioned report showing Connecticut was overpaying insurers by nearly $50 million a year–about 6% of total expenses.

Other state reports found the plans were spending too little on health services and published networks of doctors that were misleading because many doctors refused to accept Medicaid patients when “secret shoppers” called for appointments.

And, thus, the story touches, albeit indirectly, on a major problem with the very conservative Affordable Care Act:

Many doctors are happy to see the state’s experiment with managed-care plans end. Many had been frustrated with having to follow different rules for different plans. They also complained about payment delays and problems referring patients to some specialists.

You see, because too much worry is exhausted on who gets paid, the folks in the middle—doctors and patients—tend to suffer. The ACA, while guaranteeing everyone health insurance, still keeps in place that profit-minded system.  In fact, Paul Ryan’s budget plan—fully embraced by the Republican Party—would essentially do for older folks, who would have a hard time getting health care, what the ACA does for younger folks, who can’t afford or aren’t able to get health care. 

Yes, it’s true.

An important but little noticed point made in the recent controversial Politifact article, “Lie of the Year 2011,” explains:

Under the current Medicare system, the government pays the health care bills for Americans over age 65. Under the Ryan plan, future beneficiaries would be given a credit and invited to shop for an approved plan on a Medicare health insurance exchange…Ryan’s plan requires private insurers to accept all applicants and to charge the same rate for people who are the same age…

“Ryan basically proposed the Affordable Care Act for future seniors,” said Jonathan Gruber, an economist at the Massachusetts Institute of Technology, who advised both President Obama and Republican Mitt Romney on health care. “I don’t understand how you can like it for future seniors but not like it for today’s needy uninsured. That doesn’t make any sense.”

Of course, it also doesn’t make sense how most people in the country can like Medicare for seniors and not like Medicare for everyone, but Republicans have done such a darn good job of demonizing everything that comes in contact with government that it  is somewhat understandable why there is such cognitive dissonance out there.

Fortunately, some states, most recently Connecticut, are coming to their senses about how health care is delivered in this country, and it’s not through motivating private insurers with profits. And that, despite all the Republican criticism of it, is what is wrong with the Affordable Care Act.  It is an improvement over the dog-eat-dog insurance system we have now, but the dogs are still out there.

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26 Comments

  1. ansonburlingame

     /  December 29, 2011

    Duane,

    As you said, “it also doesn’t make sense how most people in the country can like Medicare for seniors and not like Medicare for everyone,” I agree that it makes no sense not to like Medicare for all. Great idea and I support it, IF you or anyone else can figure a way to pay for it.

    Real simple. Just come up with enough money and let’s “do it”.

    But FIRST, you must come up with the money, about $2.8 Trillion a year, plus or minus.

    Anson

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  2. ansonburlingame

     /  December 29, 2011

    Duane and other liberals, again,

    As long as we are on the subject of “liking things” I like my SS today.

    Heck why not have SS for all and go to a 25 hour work week to pay the rest of the bills as well.

    Anson

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  3. Funny, the repubs want to govern, but they tell us government is a bad thing. Does this mean they admit they are bad at governing? And do they have to keep proving it so often?

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  4. ansonburlingame

     /  December 30, 2011

    Sekan,

    I recall your family’s plight concerning the health of your father and don’t recall being “cutting” in view of your plight. For sure such circumstances have my empathy.

    My reply was strictly, as I recall, along national policy lines of what to do in such situations. Personal empathy for a family should have nothing to do with such policy considerations. It is what is best for ALL Americans that should be considered.

    For sure I wish you and your family all the best and hope to resolve his condition. But somethings, unfortunately are beyond the control of govenment, for sure.

    Anson

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    • I had explained my father’s disability and the long period of time that he has been this way. I believe your comment was “I wonder who’s paying for that?”
      Your intent was clear, if not written. You intended to suggest that everyone else is carrying a financial burden. You still suggest that.
      You must have no clue as to how heartless your comment and this reply actually are. I prefer to think you misunderstand. He has a spinal cord injury. This is not something you “resolve”.

      National policy? Like what? Is it a conservative value to unplug a respirator when it’s an ongoing cost? Policy is to continue to provide life support for him. His disability has not affected his mind, he’s not in a coma.

      Once again, you seem to suggest that there is a valid “policy argument” for ending his life due to cost. Say it ain’t so.
      Let me guess, you’re “pro-life” too.

      I don’t need to go find the comment and explain why it was inappropriate. I did not say anything when you made the original comment because I was offended and angry.

      Enough of this. I shouldn’t even have bothered to reply.

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  5. ansonburlingame

     /  December 30, 2011

    To all,

    Again the issue of censorship comes up. We will see if this comment “makes the cut” as I suspect it will. Duane always in the past has let me say what I choose to say, herein.

    Geoff Caldwell posted a very lengthy comment to this blog, refuting in great detail Duanes’s position on HC. Duane refused, so I am told to post the comment because it was “too long”. OK, I condense the comment,dramatically. Here it is, in essence:

    1. The cost of HC is too high and going higher.
    2. ACA does nothing to reduce such skyrocketing costs
    3. There are “conservative” ways to reduce such costs and the list is extensive. Geoff again, with 20 years experience in the HC field provides such a list.

    Again, such a long comment was “censored” by Duane, or so I am told and I certainly do not see the comment on this blog.

    If you are interested in the substance of such rebutal, go the Geoff’s blog, his public blot with no “DB” links. You can find it on the Globe sponsored public blog pages, if interested in different points of view.

    Anson

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  6. King Beauregard

     /  December 30, 2011

    Geoff keeps insisting that Duane has perpetuated a lie about Mitt and the KKK, despite the fact that Duane did the exact opposite. Here’s what Duane actually said:

    To compare a legitimate GOP candidate for high office to the KKK is obnoxious race baiting in my view. I know of NOTHING in Mitt’s background that aligns him with ANYTHING the KKK might espouse. I would say the same for every GOP candidate for the GOP nomination as well.

    So why should Duane give Geoff the time of day, much less a voice on this blog?

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    • Yes Duane did say that, but when your read the ENTIRE post in context he did no different than MSNBC and the Washington Post, used a misleading blog post as the lead in to tie racism into the Republican party and in addition the EC leaves up “N” word comments that others have had to take down and in his own words states he “has nothing to apologize for”.
      In the definition of hypocrite he doesn’t, in the real world of responsible publishing he does.
      MSNBC and the Washington Post apologized for such irresponsibility and the EC’s own source of survival the Joplin Globe also editorialized against such behavior but as usual with the left wing fringe, there is nothing to apologize for as long as it furthers the agenda no matter how irresponsible it is.

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  7. ansonburlingame

     /  December 30, 2011

    Simple reason, King.

    Because it is a publicl formum for comment and debate, supported by a public newspaper that pays Duane (and me) to write. Is that simple enough an explanation or do you want to argue over that point?

    Duane is not in the position in my view, to “give” Geoff anything, ceriainly not agreement. But “room” to debate, you bet!!!

    Anson

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  8. King Beauregard

     /  December 30, 2011

    So in the Anson universe, lying = debate. Glad to see you hold the truth in such high esteem.

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  9. ansonburlingame

     /  December 30, 2011

    to all,

    KIng, again, is off the mark. Let me try to put it this way.

    THE BEST battleground, locally, for liberal and conservative views is THIS BLOG. No question in my mind over that point.

    Duane writes, polemically and admittedly at times, the liberal view. Fine. He has every right in the world to do so.

    But, as stated many times, it is a public forum, supported and paid for by a public newspaper, just as my conservative leaning blog is written.

    Few liberals come my way, so to speak, to refute my conservative views. That is fine with me if they so choose not to engage. But as well I get all sorts of support for conservative views, not LIES, but views and opinons as well.

    But Duane, with his polemics, self described polemics, has attached me and Geoff to refute his views and those of most of his supporters.

    Many times, Duane has called me on my own comments. sometimes polemic comments. Fine. He should defend himself and his supporters as necessary. But for sure he has never censored me or any of my comments as well, nor would I do with any comment he or “you” would make on my own blog.

    Frankly, I don’t know why Duane choose to “ban” Geoff some months ago. I know the attacks from Geoff seemed personal but in fact they were political in my view. No one has “banned” LImbaugh from public radio broadcasts, have they? Many just ignore him or comment on Limbaugh where he himself will not respond.

    Don’t like what Geoff writes herein in conservative rebutal, legitimate rebutal with real facts in my view, fine. Don’t read and comment on them. But ban them. Nope, I disagree. Same with my comments as well. You can be sure I almost always provide a conservative rebutal to that which Duane writes. Just as his goal is to “repent” for former transgressions in religion and conservative views, my goal is to sustain some of those points of view, right here in River City.

    And thank you, Duane, he has allowed me to do so as he should.

    It is really all about freedom of expression of political views. That is about as “American” as it can get, in my view.

    anson

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    • Couldn’t agree more. To me this isn’t about “me” versus “him”. It is about “public” vs “private”. If the EC wishes to take his blog private he has every right as a publisher to pick and chose whatever content he wishes. But as long as the EC sits on and benefits greatly from being on a public forum page he has a responsibility to allow ALL comment and debate (as fits within the already distributed Globe guidelines of course, of which I’ve NEVER broken.) post through for ALL to see. Just as the Corner has done for years and Anson has done since he started.
      As of this writing he is still hiding behind “too long” to censor the direct rebuttals to his “Medicare for all” mantra.
      The “comment that shall not be heard” along with background can be found here: http://caldwellscorner.com/blog/2011/12/the-kitchens-just-too-hot-for-the-erstwhile-conservative/ and it is complete with links to back up the facts that “Medicare for all” is anything BUT a solution to the nation’s healthcare system.

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  10. ansonburlingame

     /  December 30, 2011

    One more point, King.

    Your “quote” above of what Duane said, regarding the KKK referal was MY quote in response to the blog. I said it, not Duane.

    Jeez!!

    Anson

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    • King Beauregard

       /  December 30, 2011

      You’re right, I grabbed the wrong quote. Here’s Duane’s quote:

      “Which no one seriously believes Romney knew was tied to the KKK.”

      That is still the polar opposite of claiming a connection between Romney and the KKK.

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      • And I agree, but the entire post plays the same game as what MSNBC and the POST apologized for. But then again, since the EC feels it now quite fine to delete my comment links and replace them with his own, pretty much any form of censorship now seems to be approved on this site. (At least for now)
        Goebbels would be quite proud.

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  11. Coming late to the party, I know, because I fell behind over the holidays. But Duane’s original post (waaay back up there behind all the back-biting) was well-written and made its points very effectively. The core of it, IMO, was in this quote (emphasis added):

    Under the current Medicare system, the government pays the health care bills for Americans over age 65. Under the Ryan plan, future beneficiaries would be given a credit and invited to shop for an approved plan on a Medicare health insurance exchange…Ryan’s plan requires private insurers to accept all applicants and to charge the same rate for people who are the same age…
    “Ryan basically proposed the Affordable Care Act for future seniors,” said Jonathan Gruber, an economist at the Massachusetts Institute of Technology, who advised both President Obama and Republican Mitt Romney on health care. “I don’t understand how you can like it for future seniors but not like it for today’s needy uninsured. That doesn’t make any sense.”

    This gets at the heart of the problem because none of the solutions being discussed, not Medicaid, not the ACA, not Medicare, not the Ryan Plan, conforms to the definition of “insurance”. Insurance is a concept where customers can average out their risks with a large group of other people at the cost of paying a middleman for administering the arrangement. And the middleman naturally attempts to increase his profit by manipulating the system statistically. So, when you mandate coverage for all and also price controls, you have eliminated the concept of “insurance” and you are left with bureaucratic inefficiency and a large incentive to trick the system.

    Let me offer one example I noticed in a USA Today article last month. Large hospital chains are beginning to hire large numbers of young, bright, attractive “physician liaisons” to visit with doctors. Why? The article says this (emphasis added):

    While hospitals have always tried to woo doctors to refer patients to them, the institutions are growing more direct in their efforts. The hospitals mine data to see which doctors have the most profitable, well-insured patients, and then they assign those doctors to a sales rep.

    Government systems are not insurance, they are social programs and as Massachusetts has found out, they are more efficient than the for-profit model in providing healthcare coverage for all citizens. The social programs would be even less costly if they had true cost-control, but that is anathema to the cherished meme that our present system is a market place – it is nothing of the kind, and that is why our healthcare costs double what it should.

    Some seem to think advocating government-run healthcare is abandonment of capitalism. It’s not, it is recognition that not all systems are amenable to that concept. But for selling commodities and items that people have time and inclination to shop for, it is the proven best system in the world. Healthcare doesn’t fit that mold, and “freedom” is an illusion in the system we have now.

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    • Jim you state:
      Government systems are not insurance, they are social programs and as Massachusetts has found out, they are more efficient than the for-profit model in providing healthcare coverage for all citizens.
      Yet:
      Massachusetts has the HIGHEST healthcare costs in the nation AND sorry to burst your bubble but government systems ARE insurance. They’re just insurance paid for by the taxpayer. Graham still won’t post my point by point addressing to this post but it can be found at: http://caldwellscorner.com/blog/2011/12/the-kitchens-just-too-hot-for-the-erstwhile-conservative/
      One of the dirtiest little secrets about the whole “medicare for all” is that :
      1. medicare requires thousands of dollars a year paid into it in private dollars via premiums from subscribers (sounds a lot like “insurance now doesn’t it) and
      2. the only part of Medicare coming in UNDER cost estimates is the prescription drug benefit that has private insurers competing once a year for customers.
      You can write “public option” over and over, recite it in your sleep every night, and cross your fingers and toes till unicorns fly but it will still not fix the problems we have today within our nation’s healthcare system. (No I will not lay out the point by points again here in this comment)
      Surprisingly on one aspect I do agree with the EC on Connecticut and Oklahoma going their own way. The 10th amendment is working as it was intended. Obamacare is the direct opposite and if such bad legislation is allowed to be fully implemented will have very dire consequences for all.

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  12. ansonburlingame

     /  January 2, 2012

    Jim,

    Just very briefly, to counter your assertion that Medicare is NOT “insurance”. Go the the Medicare government site and see, right there the DEFINITION of Medicare as an INSURANCE program. You pay in “premiums” over time and take out “benefits” when the need arises, legally. THAT is insurance, poorly run and driving us bankrupt, but still insurance, as defined by our own government.

    Anson

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    • Anson and Geoff,

      Nope, I don’t buy it. Insurance is a business, one intended to yield a profit. “Government insurance” is an oxymoron. The government chooses to define it this way that to make it politically palatable – if they defined it correctly, as a social program, or even worse, as a socialistic program, there would be political hell to pay. This game has been afoot for a long time:

      ‘When I use a word,’ Humpty Dumpty said in rather a scornful tone, ‘it means just what I choose it to mean – neither more nor less.’ – –
      Lewis Carroll

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      • Well of course you “don’t buy it”. You want what you want and facts don’t matter. That “profit” you’re so concerned about runs about 3.5 to 4 percent AND unlike government employees that COST the taxpayer, those insurers employ thousands upon thousands of taxpaying citizens. Taxpayers who by the way pay your retirement.
        Why someone so dependent upon the taxpayer would insist on adding more burden to an already broken system is beyond me, but then again the left is the left. OH wait……..yep there it goes…….did you see it……..a full fledged flying unicorn!!!!

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  13. ansonburlingame

     /  January 2, 2012

    Jim,

    You refute a government provided definition and Duane recently challenges PolitiFact to support your HC argument views. Fine as long as we see it as such.

    I also agree with you that the FACT that Medicare is a social program NOT designed to pay out only that taken in is a valid point. In essence that is what Medicare has always been and SS has now become. Both are social programs, only designed to help old people, NOT JUST POOR old people, or any poor people not old.

    If you lend any credence at all the Herb’s link and $65 Trillion, which I assume you do after reading your latest blog, that both SS and Medicare programs are undoubtedly on the leading edge of driving us over that huge cliff. And THAT is happening while our only attempt so far is to help ALL OLD people, without regard to POOR people, primarily.

    Well all old people LOVE the programs and younger ones want theirs as well when they get old. WANT, WANT, WANT, all from government with no way to make money in equalling money out over time.

    Call Medicare a SOCIAL BENEFIT PROGRAM all you like. That is what it really is Now using such a definition, show me how to sustain it financially over any lenght of time.

    Anson

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    • Anson,
      I guarantee you that if the government actually raised the premiums on beneficiaries to reflect the cost of what Medicare is actually paying out (as a private insurer HAS to do) all those screaming for a public option or the “medicare for all” would be singing a different tune.
      Medicare subscribers already have to pay in thousands of dollars a year in “premiums” (how that doesn’t make it an insurance program is beyond me) and those thousands of dollars a year are still not enough to keep the system as currently operating financially stable.
      And let’s not even get into that dirty little secret of AARP supporting the ACA while raking in BILLIONS from “licensing” fees with United Healthcare. (Of which it is exerting more and more control over)

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